The efficacy of cognitive—behavioural therapy (CBT) for the treatment of childhood anxiety has mainly been demonstrated in university-clinic settings. This study aimed to evaluate the effectiveness of CBT for the treatment of childhood anxiety in a community mental health service, compared with standard treatments (‘Treatment as Usual’ [TAU]) 'child psychotherapy, family therapy and eclectic treatments. Fifty-four children with anxiety disorders, aged from 7 to 14 years, were randomly assigned to either a CBT or TAU group. CBT and the standard treatments were provided by 18 experienced therapists, and the mean number of treatment sessions was 12. Baseline and follow-up measures at 3, 6 and 12 months included an interview based on criteria in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) that was conducted by a clinical psychologist who was blind to the treatment conditions, and standardised anxiety measures (parent, child and teacher reports). Significant improvements were found on all anxiety measures over time, but no significant differences were found between CBT and TAU. The challenge of conducting such research in community settings is discussed.
In this paper, we present the process of developing and evaluating an instrument designed to measure the extent to which a complex community system has changed as a result of a community initiative, and for purposes of this research, doing this within the content area of developing local trauma-informed child welfare systems in specific communities in Michigan. The instrument was designed for the Southwest Michigan Children's Trauma Assessment Center's (CTAC) Substance Abuse and Mental Health Services Administration (SAMHSA)-funded initiative to bring a trauma-informed perspective to professionals working with children in child welfare. The Trauma Informed System Change Instrument was developed with the input of experts in trauma-informed system change. Two parts of the instrument were analyzed separately using confirmatory factor analysis. A two factor model was fit for Community Characteristics and a three factor model for Individual Characteristics. Although adequate factorial validity was obtained for the instrument, specific items on the instrument that were problematic in fitting the model were identified, and suggestions for revising the instrument for improved functionality are offered, as are other potential uses of the instrument.
Asthma exacerbations continue to be a major cause of visits to emergency departments (ED). Comprehensive care in the outpatient setting, with planning for early intervention for exacerbations, can reduce emergency visits. Thus, a major goal of ED intervention is to establish a link between the patient and the provider of ongoing asthma care, where complete education can be achieved and reinforced over time. When designing the Asthma 1-2-3 Plan discharge teaching tool for the ED, consideration was given to educational format, readability, patient population, and setting in which education was to be delivered. To evaluate use of the plan, ED records of patients enrolled in a separate asthma study, the Neighborhood Asthma Coalition (NAC), were audited for two 8-month intervals, May-December 1993 (before initiation of the plan) and May December 1994 (starting 1 month after completion of pilot testing on the plan in the ED). To evaluate effectiveness of the plan, records of physicians who cared for children in the NAC were evaluated. The database was reviewed for the date of the first visit for planned review of asthma that occurred after the acute asthma ED visit. After introduction of the plan, the proportion of children told to return to the physician for follow-up increased from 54% to 81%. The proportion of children given advice to return to their physician within the recommended 3 days or less increased from 11% to 54%. Chi2 Analyses showed that these changes were both statistically significant (p<0.0001). The plan was not effective in achieving increased follow-up visits for regular asthma care, in that 7% returned for follow-up within 7 days after an ED visit before the plan and only 6% returned for such a visit after the Plan. Successful initiation of a focused discharge teaching tool into the routine of the ED increased appropriate advice given at time of discharge from the ED. Although unsuccessful in increasing appropriate follow-up, the present intervention uses the ED not as a base for asthma education, but as a point for contacting patients in need of regular care and education, and for promoting access to that regular care.
Many youth entering juvenile court systems show manifestations of psychological trauma. Focusing on rural juvenile courts, systems with greatly underserved and under-researched populations, we assessed practices, barriers, and recommendations around trauma-informed practice, an evidence-based approach for addressing trauma and reducing delinquent behavior and recidivism. As part of a pilot trauma-informed practice initiative at four rural Michigan juvenile courts, semi-structured qualitative interviews were conducted with 15 court staff, including probation officers, referees, judges, and on-site clinical therapists. Respondents expressed an ideological affinity for trauma-informed practice, describing growing inclinations to rely on referralmaking around mental health treatment in lieu of traditional (punitive) sentencing. Key implementation barriers included limited access to local mental health resources, insufficient buy-in from K-12 schools, government, and police, and concerns over professional abilities/boundaries. Respondents recommended additional technical trainings on trauma-informed practice and cross-disciplinary education for clients' families and external stakeholders.
Children entering the child welfare system have experienced some form of maltreatment, with the impact on behavior and development not always recognized. Complicating the impact is the number of maltreatment types and how many of each a child may have experienced. This study analyzes the relationship between the number of maltreatment events with behavior problems and developmental delays in a clinical sample of children involved with the child welfare system. Results indicate that challenging behaviors are the norm for these children, but do not vary with increased types of maltreatment events. The majority of these children have moderate to major developmental delays, with delays increasing with the number of events experienced. Implications are explored and applied to professional practice. Keywords child maltreatment, child welfare, trauma, neurodevelopment, child behavior During the last two decades, researchers have attempted to understand the impact of childhood adversity on children's behavior and development. Childhood adversity includes adversity within the community setting (natural disasters, war, neighborhood violence), victimization from nonfamilial perpetrators (peer and adult violence toward a child), and maltreatment within the familial system. Within the category of familial maltreatment, there are several factors that potentially influence behavior and development. These include the duration and severity of the maltreatment, the age of onset, and the different types of maltreatment events. A complex interactional effect between these factors either mitigates or exacerbates the impact on children's behaviors and development. The current study looks at one of the factors of maltreatment-the number of types of maltreatment that children experience-and the subsequent behavioral and neurodevelopmental impacts. When familial maltreatment reaches a level of "substantial risk of harm," children are often removed from the maltreating caregivers and harmful environment and placed with foster parents or relatives. Removal from an adverse environment and provision of safe placement is accompanied by the expectation of positive emotional, behavioral, and academic response from the child. When aberrant child responses continue in spite of best efforts, adult
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