Aim-To refine and psychometrically test the Am I ON TRAC for Adult Care questionnaire. Background. Inadequate transition to adult care for adolescents with special health care needs has been associated with greater risk of treatment non-adherence, lack of medical follow-up, increased morbidity and mortality. Presently there are no well-validated measures assessing adolescents' readiness to transition from paediatric to adult medical care. Design-Descriptive cross-sectional study.Methods-The Am I ON TRAC for Adult Care questionnaire was refined to improve the instrument's methodological soundness. A literature review informed the revisions. A convenience sample of 200 adolescents, 12-19 years, was recruited from four outpatient clinics at a paediatric hospital in Western Canada between April -June 2012. Construct validity was evaluated by Exploratory Factory Analysis; concurrent validity was assessed using the Psychosocial Maturity Index. Internal consistency was evaluated by computing Cronbach's alpha estimates.Results-Factor analysis of the knowledge items identified a 14-item unidimensional scale. Knowledge and behaviour sub-scale scores increased with age, with a stronger relationship between knowledge and age. Psychosocial maturity correlated with both sub-scale scores, but had CIHR Author ManuscriptCIHR Author Manuscript CIHR Author Manuscript a stronger association with behaviour. Psychosocial maturity and age had a weak but significant correlation suggesting age is a loose proxy for maturity. Only 27% of 17-year-olds, but 62% 18-year-olds, scored above the behaviour cut-off for transition readiness. Conclusion-TheAm I ON TRAC for Adult Care questionnaire is a psychometrically sound measure that has potential to be used as a readiness assessment tool in both clinical practice and research.
Sexual exploitation of children and adolescents is a pressing, yet largely under-recognized form of child abuse. The goals of this review were to identify interventions that have been implemented with sexually exploited children and adolescents and to better understand their effectiveness for fostering healing with this population. Our systematic search generated 4,358 publications of which 21 met our inclusion criteria. Based on their objectives and delivery, we organized the interventions into five categories: (a) focused health and/or social services, (b) intensive case management models, (c) psychoeducational therapy groups, (d) residential programs, and (e) other. Most programs were gender-specific, targeting girls and young women with just one being for boys and young men only. Studies reported on a range of outcomes including psychosocial outcomes, risky behaviors, trauma responses, mental health, protective factors, and public health outcomes. Despite differences in delivery, most of the interventions did, to some degree, appear to foster healing among sexually exploited children and adolescents. Findings from this review have implications for researchers, policy and program developers, and frontline practitioners who, through partnerships with one another, can advocate for the creation of evidence-informed, purpose-built, and thoughtfully delivered interventions.
This systematic review assessed the current state of the literature on sexually exploited boys internationally. We aimed to describe what is known about sexual exploitation of boys, identify gaps in the literature, provide implications for practice, and make recommendations for future research. Multiple database searches were conducted using a combination of controlled vocabulary and keywords to capture child and adolescent sexual exploitation. Our search identified 11,099 unique references and excluded studies that did not include male participants less than 18 years old or disaggregate results by relevant age groups and/or by sex. This review identified 42 studies from 23 countries, providing evidence that sexual exploitation of boys is an issue in both high- and low-income countries. Seventeen articles had sexual exploitation as their primary variable of interest, the majority of which sampled boys who accessed services (i.e., shelters, health care, social, and justice services). Boys' experiences of sexual exploitation varied in terms of venue, exploiters, and compensation. Compared to their non-sexually exploited peers, sexually exploited boys more commonly reported experiences of child abuse, substance use, conduct problems, and mental health problems such as anxiety, depression, and self-harm. Despite increasing evidence that boys are sexually exploited around the world, the current literature provides limited data about the antecedents, sequelae, and the specific features of sexual exploitation experiences among boys. Further research is needed to inform, policy, social services and health care delivery specific to the needs of sexually exploited boys.
Research and policies on child and adolescent sexual exploitation frequently focus on the sexual exploitation of girls and fail to recognize the experiences of sexually exploited boys, including their potentially unique health care and social support needs. This oversight limits the ability of health care and social service providers to offer both targeted and evidence informed care to sexually exploited boys. As a first step in a larger grant to understand the experiences of sexually exploited boys and to develop interventions for this specific population, we conducted a systematic review to address the question, "What is the state of the research on sexually exploited boys internationally?" As we undertook this review, we faced a number of significant challenges that made the process more difficult than anticipated. In this paper we discuss four key methodological challenges we encountered: lack of a consistent definition of child and adolescent sexual exploitation, difficulties in differentiating sexual exploitation as a specific concept within child sexual abuse, failure to disaggregate data usefully across multiple variables, and limited epidemiological studies to inform prevalence. We reflect on how these challenges limited our ability to systematically analyze, synthesize, and interpret the available research. We conclude by making recommendations to improve the state of the research regarding sexually exploited boys with the aim of better informing future policy and practice.
BackgroundMaternal and paternal depression has been associated with infants’ behavioral sleep problems. Behavioral sleep interventions, which alter parental cognitions about infant sleep, have improved infant sleep problems. This study reports relationships between parental depression, fatigue, sleep quality, and cognitions about infant sleep pre and post-intervention for a behavioral sleep problem.MethodsThis secondary analysis of data from Canadian parents (n = 455), with healthy infants aged 6-to-8-months exposed to a behavioral sleep intervention, examined baseline data and follow-up data from 18 or 24 weeks post intervention (group teaching or printed material) exposure. Parents reported on sleep quality, fatigue, depression, and cognitions about infant sleep. Data were analyzed using Pearson’s r and stepwise regression analysis.ResultsParents’ fatigue, sleep quality, sleep cognitions, and depression scores were correlated at baseline and follow-up. At baseline, sleep quality (b = .52, 95% CI .19–.85), fatigue (b = .48, 95% CI .33–.63), doubt about managing infant sleep (b = .44, 95% CI .19–.69), and anger about infant sleep (b = .69, 95% CI .44–.94) were associated with mothers’ depression. At baseline, fathers’ depression related to sleep quality (b = .42, 95% CI .01–.83), fatigue (b = .47, 95% CI .32–.63), and doubt about managing infant sleep (b = .50, 95% CI .24–.76). At follow-up, mothers’ depression was associated with sleep quality (b = .76, 95% CI .41–1.12), fatigue (b = .25, 95% CI .14–.37), doubt about managing infant sleep (b = .44, 95% CI .16–.73), sleep anger (b = .31, 95% CI .02–.59), and setting sleep limits (b = −.22, 95% CI -.41-[−.03]). At follow-up, fathers’ depression related to sleep quality (b = .84, 95% CI .46–1.22), fatigue (b = .31, 95% CI .17–.45), sleep doubt (b = .34, 95% CI .05–.62), and setting sleep limits (b = .25, 95% CI .01–.49).ConclusionsMothers’ and fathers’ cognitions about infant sleep demonstrate complex relationships with their depression scores. While mothers’ setting sleep limit scores are associated with decreased depression scores, fathers’ setting limits scores are associated with increased depression scores. Parental doubts about managing infant sleep and difficulties with setting sleep limits require attention in interventions.
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