Early Family Intervention Research Articles

Children's voices: ‘Home is where their heart is’

This paper discusses the negative effects on children who are placed in out-of-home care and the need for early intervention and support for families to enable children to remain at home.

The relation between abuse and socio-demographic factors, intelligence and brain function in sheltered runaway adolescents

This study was intended to investigate socio-demographic characteristics, intelligence, brain function and abuse experience in sheltered runaway adolescents and also to exam the relation between them. And the ultimate purpose is to offer basic data which are needed in establishing comprehensive protection policy in sheltered runaway adolescents. 128 adolescents who stayed in the runaway shelters were investigated. Basic questionnarre about socio-demographic characteristic, developmental history, family environment, and abuse experience were asked to complete by themselves and Korean Wechsler Adult Intelligence SCaleIK-WAIS), Bender-Geslalt Test(BGT) were carried by a psychologist. The most common age of the subjects was 15 years old. The first runaway episode was most common in the middle school period. and mostly their runaway was repeated sexual abuse history was more frequent in female，and emotional abuse was more frequent in male. Physical abuse was more frequent in 12-15 years old group and sexual abuse was more frequent in 16-21years old group. Emotional abuse was most frequent in whom the first runaway episode occurred in elementary school period. Physical abuse was most frequent in whom repeated runaway. ln intelligence test, 22% of subjects was mentally retarded. Emotional abuse was significantly related with decrease of verbal intelligence scores, and sexual abuse was significantly related with decrease of performance intelligence scores. ln BGT, 39.4% of subjects manifested brain dysfunction signs and mean error score significantly higher in adolescents with history of emotional abuse, sexual abuse and neglect. Abuse experience were significantly more frequent in runaway adolescents than in general adolescents. And this result caused various harmful effect in cognitive brain function. To prevent this and to provide prolection policy for runaway adolescents, more active investigation about the abuse history and early family intervention are needed.

Application Research on Early Family Intervention in Prevention and Treatment of Cerebral Palsy

Objective To explore the effect of family early intervention on development of infants with prematurity and hypoxic ischemic encephalopathy(HIE).Methods 136 cases of premature infants,moderate and severe HIE infants were randomly divided into a treatment group and a control group.Every region of intelligence development was detected by Gesell Developmental Schedules at 16 weeks,28 weeks and 12 months respectively.Results Motor behavior,adaptive behavior,language behavior and personal social behavior increased obviously in the treatment group,while the incidence rate of cerebral palsy markedly decreased,showing a significant difference compared with the control group.Conclusion Early family intervention can efficiently improve the development of premature infants or infants with HIE,and prevent cerebral palsy from occurrence. Key words: Family intervention; Cerebral palsy; Premature; Hypoxic ischemic encephalopathy

Engagement and Effectiveness of Parent Management Training (Incredible Years) for Solo High-Risk Mothers: A Multiple Baseline Evaluation

AbstractThe effectiveness ofThe Incredible Yearsparent-training program with a small sample of four high risk solo mothers in a public clinic setting was assessed. All families had a number of risk factors for early drop-out and poor outcomes. Mindful of resource limitations in the public setting, economical strategies were used to enhance attendance rates and engagement. For the outcome evaluation, a multiple baseline across participants design was used. Participants attended a 2-hour group treatment session weekly for twenty weeks, with booster sessions at 2 months and 4 months following treatment. Participants had sons aged between 6 years and 9 years diagnosed with ADHD. Family functioning was assessed from a pretreatment interview schedule, measures of child behaviour and parent and family functioning. Participants also completed program satisfaction and program evaluation measures. Results showed: (a) all mothers engaged with and finished the program, (b) improvement in family functioning, (c) improvements in some teacher and parent reports of child behaviour, (d) increased parenting confidence, (e) reduced stress and depression levels for most parent participants, and (f) reports of better parent–child relationships. Additionally, participants all reported being highly satisfied with the program. Findings overall support the use of easy to do engagement strategies and the use of theIncredibleYears parent-training program as an effective, low cost and early step intervention for families at higher risk in a day-to-day practice setting. The use of this intervention in an overall stepped care approach is considered and discussed.

Offspring of suicide attempters at greater risk of suicide events

Comments on: Melhem NM, Brent DA, Ziegler M, et al. Familial pathways to early-onset suicidal behavior: familial and individual antecedents of suicidal behavior. Am J Psychiatry 2007;164:1364–70. The article by...

Parenting Style Impacts on Quality of Life in Children with Cerebral Palsy

To assess the impact of parenting style and disease severity on quality of life (QOL) in children with cerebral palsy (CP). Thirty-nine children with CP, their siblings, and their parents participated in the study. Probands and siblings, ages 6 to 18 years, completed questionnaires on parenting style (accepting, rejecting, controlling, and autonomy allowing) using the Children's Report of Parental Behavior Inventory. Parents completed generic (Child Health Questionnaire [CHQ]) and disease-specific (Pediatric Outcomes Data Collecting Instrument [PODCI]) QOL questionnaires for both children. A physician determined disease severity with the Gross Motor Function Classification System. In children with CP, parenting style positively correlated with the CHQ scores: physical summary and psychosocial summary (r = 0.40, P = .01) and family activities scale (r = 0.34, P = .03). Autonomy allowing parenting style impacted on psychosocial aspects of QOL, as reflected by CHQ scores, more than the degree of disability. In other domains of QOL, the effect of parenting style was greater than IQ, anxiety, and socioeconomic status. Parenting style is a significant factor in QOL in CP and the only known factor to impact on the psychosocial domains of the CHQ, exceeding the effect of disease severity. Because QOL is an important treatment goal in children with CP, early family interventions, particularly those focusing on parenting style, should be considered.

Key Challenges and Prospects in Peer-Based Delinquency Prevention Programs: Comment on van Lier, Vitaro, and Eisner

This article provides a brief commentary on Pol van Lier, Frank Vitaro, and Manuel Eisner’s excellent article in this issue. In Saving Children from a Life of Crime: Early Risk Factors and Effective Interventions (Farrington and Welsh 2007), we found that there is convincing evidence of the effectiveness of a number of early individual, family, and school interventions to tackle risk factors to prevent delinquency and later offending, but little is known about peer-based programs. Future experiments are needed to test the effectiveness of these programs, as well as to investigate the causal effects of peer influence.

小児一側性難聴の検討

A series of 60 children was studied (aged 0 to 10 years, 32 boys, 28 girls) with severe unilateral sensorineural hearing loss of unknown etiology.There were two peaks, at 0 and 6 years. In 19 children, hearing loss was identified during a conservative general health checkup for school or preschool children. In 21 children aged 0 years, 16 were suspected of hearing loss by newborn hearing screening.Temporal bone computed tomography scans were examined in 51 patients. Sixteen ears (31.4%) with hearing loss had inner ear and/or internal auditory canal abnormalities. In one patient, the anomaly was the presence of a bony wall dividing the internal auditory canal into two separate compartments associated with severe inner ear hypoplasia. Two patients had a common cavity. In one of these patients, the anomaly was revealed because of severe bacterial meningitis, and another was detected by newborn hearing screening. Six patients had a narrow internal auditory canal, 4 had a narrow internal auditory canal and hypoplastic cochlea, and 1 had a narrow internal auditory canal and cystic vestibule, and lateral semicircular canal dysplasia. Two patients had a cystic vestibule and lateral semicircular canal dysplasia.One case showed fluctuation of the hearing level in the contralateral ear with normal hearing during the observation period at an average of 20 months.The number of children whose unilateral hearing loss is detected early by newborn hearing screening has enormously increased. Strategies for follow-up, early intervention, and support for families are necessary for young children with unilateral hearing impairment.

Behaviour and emotional problems in toddlers with pervasive developmental disorders and developmental delay: associations with parental mental health and family functioning

Behavioural and emotional problems occur at a high rate in children and adolescents with intellectual disability, often from a young age. Some studies have indicated that children and adolescents with autism present with even higher rates. Less is known about the presentation, development and family impact of these difficulties in young children with autism. This study aimed to explore these issues in toddlers with pervasive developmental disorders (PDDs), those with delay without a PDD, and their families. Participants were 123 children aged 20-51 months, referred to a developmental assessment clinic. Parents completed a checklist on child behavioural and emotional problems, and individual questionnaires on family functioning, their own mental health, and stress in relation to parenting their child. The child's language and cognitive skills, adaptive functioning and behaviour were assessed by standardized measures. Measures were repeated 1 year postdiagnosis. Behavioural and emotional problems in young children with a PDD were compared with those in children with developmental delay without a PDD, and their impact on parental outcomes explored over time. Initial and follow-up measures of child behaviour and emotional problems, parent mental health problems, parent stress and family functioning were significantly correlated, providing some evidence of stability over time. Child emotional and behavioural problems contributed significantly more to mother stress, parent mental health problems, and perceived family dysfunction than child diagnosis (PDD/non-PDD), delay or gender. Compared with mothers, all fathers reported significantly less stress in relation to parenting their child. Results highlighted the importance of addressing emotional and behavioural problems in very young children with autism and/or developmental delay. The need for early support and intervention for mothers, fathers and families in this context was also evidenced. As research has shown that behavioural and emotional problems persist into adolescence and young adulthood, understanding of these issues in very young children and their parents has important implications for intervention and long-term outcomes.

Domestic violence, maternal parenting, maternal mental health, and infant externalizing behavior.

This study examined whether maternal functioning mediated the relationship between domestic violence (DV) and infant externalizing behavior. Participants were 203 mother-infant dyads. Support was found for a partially mediated model in which maternal functioning mediated the relationship between current DV and infant externalizing behaviors. Past DV was directly associated with infants' externalizing behavior. Results suggest the need for early intervention and prevention efforts for families living with DV.

The Impact of the Family Communication Coordinator (FCC) Protocol on the Role Stress of Hospital Chaplains

The Family Communication Coordinator (FCC) Protocol was implemented to provide early family intervention and to facilitate effective communications during potential organ donation cases. Previous studies found the Protocol associated with improved donor outcome measures and with reduced role stress for ICU nurses caring for potential donors. The present study examines the impact of the Protocol on the perceived role stress of hospital chaplains serving as FCCs. All hospital chaplains serving as FCCs at an academic teaching hospital were surveyed. Their perceptions of job dimensions, role stress, job satisfaction, and commitment were measured; interviews and secondary data supplemented the surveys. The findings demonstrate that the FCC Protocol is associated with improved role stress, specifically role ambiguity and role conflict, among hospital chaplains serving as FCCs. Additionally, the findings suggest that satisfaction with the Protocol may be associated with experience with the Protocol.

CE Test: Early Intervention for Children and Families With Special Needs

MCN, The American Journal of Maternal/Child Nursing: July 2005 - Volume 30 - Issue 4 - p 268-269

Early Intervention for Children and Families

The purpose of this article is to provide a general overview of early intervention and how nurses can interface with this important program for children. "Early intervention" in this context refers to services for young children (birth to age 3) who have developmental delays or are at risk for delays, as well as for their families. These programs are administered by each state but are federally funded under Part C of the Individuals with Disabilities Act. The primary objective of early intervention is to maintain or maximize a child's development; a wide range of services may be provided including nursing, physical therapy, occupational therapy, and family counseling. Overall, early intervention programs have been shown to improve developmental outcomes, strengthen parent-child interactions, and provide a supportive family environment. There is a continued need for research, however, in many areas, including assessing the long-term effects of services for specific groups, determining the most effective means of providing services, and evaluating outcomes of family functioning.

Adolescent Adjustment Before and After HIV-Related Parental Death.

The impact of HIV-related parental death on 414 adolescents was examined over a period of 6 years. The adjustment of bereaved adolescents was compared over 4 time periods relative to parental death and was also compared with the adjustment of nonbereaved adolescents. Bereaved adolescents had significantly more emotional distress, negative life events, and contact with the criminal justice system than nonbereaved youths; these behaviors did not remain significantly higher after parental death. Depressive symptoms and passive problem solving increased soon after parental death, as compared with nonbereaved adolescents. One year subsequent to parental death, depression and passive problem solving were similar to the levels of nonbereaved peers. Only sexual risk behaviors increased following parental death. These results suggest the importance of early family intervention soon after parental HIV diagnosis, prior to parental death, and sustained over time.

Linking Infant/Family Mental Health Services

This article traces Ohio's progress since 1994 toward integrating an Infant Mental Health (IMH) perspective into its early intervention and mental health service programs for families with very young children. An Infant/Family Mental Health Subcommittee was formed to accomplish this mission and to promote collaborative relationship-based services, teaching, and research across disciplines serving families with young children. This article traces the path our subcommittee has taken across these 8 years; discusses the means by which we have continued to foster advocacy, research, service, and training in IMH; and describes our ultimate transformation into an independent not-for-profit organization, the Ohio Association for Infant Mental Health (OAIMH). The advantages and disadvantages of working with those in state and local government, whose policies and programs directly impact families with young children, are considered.

Parental satisfaction with an early family intervention program.

The objective of this study was to evaluate parental satisfaction with a family intervention program. The program provides help and support for parents with newborns who have specific health problems (e.g., cleft palate and/or lip; Down syndrome). Four family subscales, personal (emotional and cognitive), marital, parental, and extended family and others, were examined. The majority of parents were satisfied with the intervention. Most felt that the intervention had helped them to adapt to the unexpected situation. They received guidance in discerning and discussing their own emotions and those of their partner or spouse, and the help they received gave them confidence about the care their child would receive. Results revealed significant differences in satisfaction levels (depending on the sex of the parent), the child's diagnosis, and annual income. Mothers of newborns with Down syndrome were more satisfied than fathers with the personal-emotional support they received. Low-income families were more satisfied than those with higher incomes for all subscales. On the parental subscale, those whose child had a cleft lip/palate were more satisfied than those whose child had Down syndrome. The results raised several important questions about this type of early intervention program, which will require further in-depth investigation.

Containment, reciprocity and behaviour management: Preliminary evaluation of a brief early intervention (the solihull approach) for families with infants and young children

The present study's objective was to conduct a small-scale study to begin to examine the effectiveness of the Solihull Approach. The Solihull Approach employs a theoretical model that integrates psychotherapeutic, child development and behavioural concepts, supported with resource materials and an open learning course. It is related to the Tavistock Under 5′s model and is designed to be used as a brief (five sessions or less) intervention for those working with infants and young children and their families. The sample consisted of thirteen families recruited over a six week period by health visitors. A within-subject (repeated measures) ANOVA design was used, utilising three measures at baseline, end of support and follow-up. Parents and health visitors rated seventy of presenting difficulty and the parents ‘anxiety about the problem at all three points. In addition the parents completed the Beck Anxiety Inventory at all three points. Results showed significant decreases in presenting difficulty and the parental anxiety about the problem over an average of three sessions. In addition, there was also a significant decrease in parents’ general anxiety as measured by the BAI: an overall decrease of 66.3%. It was suggested that further evaluation would be useful on general effectiveness, the characteristics of families with whom this brief intervention is effective and on teasing out the mechanisms through which this method has an impact. It was also suggested that more ‘user friendly’ psychometric measures for use with very young children need to be developed.

Parents with psychosis.

This study examined the prevalence of parenthood in a community-based sample of first-admission patients with DSM-IV diagnoses of Schizophrenia/Schizoaffective Disorder, Bipolar Disorder with psychotic features and Major Depressive Disorder with psychosis. A total of 130 (28.7%) of 453 patients were parents at the time of first admission. Women were twice as likely as men to be parents in all diagnostic groups. Patients with mood disorder with psychosis were twice as likely to be parents as those with Schizophrenia/Schizoaffective Disorder. Substance Use Disorder was a common comorbidity among fathers and to a somewhat lesser extent among mothers as well. At the time of admission, over three-quarters of mothers were living with their children, as were half or more of the fathers with mood disorder. Most continued to live with their children after discharge. Almost 40% of mothers with mood disorders were living as single parents both before and after admission. Almost three-quarters of the children were under 16 years of age. Over 40% of mothers in all diagnostic categories had at least one child under 5 years of age. About 20% of mothers in all 3 diagnoses experienced the onset of psychosis within 6 months of childbirth. Over half of these experienced psychotic symptoms related to the child or had neglected the child prior to admission. Our findings contrast with earlier studies from more chronic patient samples in documenting that first-admission patients with psychosis are generally intimately involved in their children's lives both before and after admission. Despite the fact that over three-quarters of these parents were still in treatment at 6-month follow-up, there was virtually no evidence that any form of educational or family-oriented treatment was offered to these parents. These results, coupled with earlier reports of highly disrupted family lives and serious adverse outcomes among the children of chronically ill parents, underscore the need for early family intervention programs. In addition, there is a need for systematic research to identify effective treatment interventions for this population.

Expressed emotion and the outcome of child and adolescent psychiatric disorders

The review discusses empirical research on the association of "Expressed Emotion" (EE) and the outcome of child and adolescent psychiatric disorders. A comprehensive search in the databases Medline, PsycINFO and PSYNDEX was performed. Moreover, publications cited in the reference sections were taken into consideration. Empirical data suggest that EE is a predictor of the outcome of depressive and eating disorders in childhood and adolescence, but not of behavioural disorders and ADHD. There are no studies on EE and its influence on anxiety disorders and - surprisingly - only two case studies on EE and schizophrenia in childhood and adolescence. Across psychiatric groups there is an association between behavioural disturbances of the child and parental criticism and an association of child anxiety and parental emotional over involvement. Data suggest that EE is not a stable variable. There is some evidence that a high-EE-status of parents transforms from a state into a trait variable. Further studies on the predictive validity of EE for the outcome of child adolescent psychiatric disorders are warranted, as well as studies on variables of the parents and their offspring, which are associated with EE and with the entrenchment of EE with the progress of the disorder. Child and adolescent psychiatrists may contribute to a large research area with studies on the early development of high-EE. The mutual goal is the development of effective early family interventions.

Rural underpinnings for resiliency and linkages (rural): A safe schools/healthy students project

AbstractRural Underpinnings for Resiliency and Linkages (RURAL) is an example of a Safe Schools/Healthy Students (SS/HS) project. RURAL provides services to children and families in a rural Kansas county. The county's rates of juvenile alcohol and illicit drug use are higher than state averages. The RURAL project was designed to enhance existing partnerships among three school districts, the local community mental health center, law enforcement, the regional prevention center, and Fort Hays State University. A significant number of evidence‐based strategies were implemented in the schools and community in a short period of time. Using a public health approach to increase school safety and promote healthy behaviors, RURAL introduced strategies designed to provide universal prevention for the school population, early intervention for at‐risk children and families, and intensive services for those with the greatest needs. Services were provided to students (preschool–young adults) and their families. School psychologists held key roles in the development, implementation, and management of the project. Preliminary evaluation findings are presented, and the importance of local process and outcome evaluation is discussed. © 2003 Wiley Periodicals, Inc. Psychol Schs 40: 531–547, 2003.