Early Intervention Work Research Articles

Utilizing Family Theories to Maximize Early Intervention Work: An Examination and Application of Family Systems Theory and Bioecological Theory

The field of early intervention is rapidly expanding. Individuals trained in Human Development and Family Science programs are uniquely situated for work in this setting, due to their diverse understanding of human development, from birth through death, and the role of the family system in influencing development. More specifically, individuals from this academic discipline can employ a family systems theory and bioecological theory perspectives to inform their intervention work. The unique insight these theories provide to enhance early intervention work will be discussed and then applied using an actual case study. Though family systems theory and bioecological theory do have limitations in this field, namely their inability to explain a behavioral change and non-linear orientation, the authors feel the benefits of both these theoretical perspectives for explaining family contexts outweigh the limitations.

Empowering and educating the next generation of pharmacists through children’s books: A quality assurance initiative

ObjectiveThe objective of this quality assurance initiative was to internally measure children’s perceptions of the book, “All Aboard the Rx-Express!” and knowledge gained from its content. MethodsThis pharmacy-focused children’s book was read to elementary-age youth at a rural, Pennsylvania elementary school in the Spring of 2022. A brief, optional, anonymous prepost survey was administered to the youth before and after the reading to measure the book’s impact on third through fifth graders’ perceptions and knowledge of the pharmacy profession. Descriptive statistics, chi squared analysis, independent samples t-tests, and one sample proportions tests were used to analyze survey responses. ResultsOne hundred ninety-one students participated in the presurvey to assess baseline knowledge about the pharmacy profession before the book was read. One hundred eighty-five students answered the postsurvey. Prepost respondent demographics were collected in aggregate and were not significantly different between the pre- and postcohorts. Survey results demonstrated an increase in all questions that asked about students’ perceptions of pharmacists and the profession, and students reported favorable perceptions of the book itself. ConclusionEarly interventions such as this can increase elementary-age youth’s perceptions and knowledge of the roles of pharmacists. Future work in early intervention will be needed to increase interest in the profession and admissions to pharmacy schools.

Developing the "single-session mindset" in eating disorder research: Commentary on Schleider et al., 2023 "Realizing the untapped promise of single-session interventions for eating disorders".

Schleider and colleagues' paper on the application of single-session interventions (SSIs) to eating disorders is timely given the broader focus in mental health on flexible approaches to delivering support at the time the person needs it most. The eating disorder field needs to embrace these innovations including developing a "single-session mindset" with greater attention paid to testing the relevance of SSI for eating disorders. The use of well-powered trials of brief, focused and rapidly scalable interventions is an ideal vehicle for generation and evaluation of new and longer interventions. Our future research agenda needs to carefully consider our target audience, the primary outcome variable of most relevance, and the SSI topic that would be most likely to effect change. Research in prevention might focus on weight concern and evaluation of SSIs that focus on self-compassion or cognitive dissonance related to appearance ideals in the media. Work in early intervention could target denial and disordered eating using SSIs on growth mindset, behavioral activation, and imagery rescripting. Treatment waitlists provide another suitable opportunity, evaluating SSIs that aim to increase hope for change, treatment retention, and kick start early change in therapy, a robust predictor of better treatment outcome.

A Tailored Occupational Therapist-Led Vocational Intervention for People With Stroke: Protocol for a Pilot Randomized Controlled Trial.

Resuming work after stroke is a common goal of working-age adults, yet there are few vocational rehabilitation programs designed to address the unique challenges faced following stroke. The Work intervention was developed to address these gaps. This paper presents a protocol that outlines the steps that will be undertaken to pilot both the intervention and trial processes for the Work trial. The Work trial is a 2-arm, prospective, randomized, blinded-assessor study with intention-to-treat analysis. A total of 54 adults of working age who have experienced a stroke <4 months prior will be randomized 1:1 to either (1) an experimental group who will receive a 12-week early vocational intervention (Work intervention) plus usual clinical rehabilitation or (2) a control group who will receive only their usual clinical rehabilitation. Outcomes include study and intervention feasibility and intervention benefit. In addition to evaluating the feasibility of delivering vocational intervention early after stroke, benefit will be assessed by measuring rates of vocational participation and quality-of-life improvements at the 3- and 6-month follow-ups. Process evaluation using data collected during the study, as well as postintervention individual interviews with participants and surveys with trial therapists, will complement quantitative data. The results of the trial will provide details on the feasibility of delivering the Work intervention embedded within the clinical rehabilitation context and inform future trial processes. Pilot data will enable a future definitive trial to determine the clinical effectiveness of vocational rehabilitation when delivered in the early subacute phase of stroke recovery. Australian New Zealand Clinical Trials Registry ACTRN12619001164189; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378112&isReview=true. DERR1-10.2196/40548.

A pilot study of a brief inpatient social-skills training for young adults with psychosis.

Objective: Psychotic disorders are serious illnesses that are most amenable to early intervention. Though inpatient units are typically the first care setting for young people with psychosis, almost all early intervention work has been limited to outpatient settings. Social difficulties are a core feature of psychotic illnesses, and despite need for empirically supported social-skills treatments there are few interventions intended specifically for the developmental phase during which psychosis manifests (i.e., late teenage to early adult years). Method: Our group implemented an adapted social-skills training intervention (SST) designed for young adults on a psychiatric inpatient unit. Nineteen young adult inpatients (aged 18-35) with psychosis participated. Psychiatric symptoms and aspects of social functioning, including reported social self-efficacy and performance on social skills role-plays, were assessed before and after SST participation. Results: Preliminary data demonstrate improvements in both self-report and performance-based measures of social functioning after SST participation. Conclusions and Implications for Practice: These findings, though preliminary, support additional, larger-scale investigations of this SST among young adults with psychosis. Further, multidisciplinary collaborations are valuable in providing specialized care for young adults with psychosis who are receiving inpatient psychiatric care. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Practical observations - the COVID-19 influence on latvian early intervention work with first episode psychosis (FEP) patients

IntroductionCOVID-19 is a very stressful experience for people with FEP and changed the work routine of the mental health services they have used.ObjectivesIn this work, we aim to explore how the restrictions influenced the out-patient visits and rehospitalization rates.MethodsThe Latvian Early intervention programme (Berze et al.,2019) for patients with FEP had started on 1st January, 2019. The 1st group of patients (n=28) finished the programme on 31st December, 2019. The 2nd group of patients were enrolled in programme on 1st January, 2020 (n=12). When on 12th of March in Latvia health care restriction started due the COVID-19 situation, we were forced to change our structure of LAT-EIP.ResultsThe average patient age of patients was 29.9 (SD±7.1) years in the 1st group, in 2nd group average age is 26.2 (SD±5.9) accordingly in years. In the 1st group 60.7% of patients visited the psychiatrist 6-10 times vs 8.33% in 2nd group, in the 1st group 32.1 % of patients had 2-5 visits with psychiatrist vs 75% in 2nd group. There were 72 family sessions in 1st group, whereas in 2nd group the family sessions were excluded. During the programme 7% (n=2) of patients in the 1st group were rehospitalized vs 25% (n=3).ConclusionsThe structure of LAT-EIP had change at the time of COVID-19 restrictions, unfortunately our work lack the statistical power. From the descriptive statistics, we can speculate that the rehospitalization rate is higher because of the lack of regular contact with psychiatrist and the lack of psychoeducation with families.

Measuring subjective stress among young people in Hong Kong: validation and predictive utility of the single-item subjective level of stress (SLS-1) in epidemiological and longitudinal community samples

Abstract Aims Brief measurements of the subjective experience of stress with good predictive capability are important in a range of community mental health and research settings. The potential for large-scale implementation of such a measure for screening may facilitate early risk detection and intervention opportunities. Few such measures however have been developed and validated in epidemiological and longitudinal community samples. We designed a new single-item measure of the subjective level of stress (SLS-1) and tested its validity and ability to predict long-term mental health outcomes of up to 12 months through two separate studies. Methods We first examined the content and face validity of the SLS-1 with a panel consisting of mental health experts and laypersons. Two studies were conducted to examine its validity and predictive utility. In study 1, we tested the convergent and divergent validity as well as incremental validity of the SLS-1 in a large epidemiological sample of young people in Hong Kong (n = 1445). In study 2, in a consecutively recruited longitudinal community sample of young people (n = 258), we first performed the same procedures as in study 1 to ensure replicability of the findings. We then examined in this longitudinal sample the utility of the SLS-1 in predicting long-term depressive, anxiety and stress outcomes assessed at 3 months and 6 months (n = 182) and at 12 months (n = 84). Results The SLS-1 demonstrated good content and face validity. Findings from the two studies showed that SLS-1 was moderately to strongly correlated with a range of mental health outcomes, including depressive, anxiety, stress and distress symptoms. We also demonstrated its ability to explain the variance explained in symptoms beyond other known personal and psychological factors. Using the longitudinal sample in study 2, we further showed the significant predictive capability of the SLS-1 for long-term symptom outcomes for up to 12 months even when accounting for demographic characteristics. Conclusions The findings altogether support the validity and predictive utility of the SLS-1 as a brief measure of stress with strong indications of both concurrent and long-term mental health outcomes. Given the value of brief measures of mental health risks at a population level, the SLS-1 may have potential for use as an early screening tool to inform early preventative intervention work.

The moral economy of early intervention

In November 2015, protests erupted in Oxford in response to the decision of the Oxfordshire County Council to cut, among other things, forty-four Children’s Centres and seven Early Intervention Hubs. The debate about whether these centres could be considered as disposable or not did not get to an agreement. I argue that the main cause of this outcome is that the opposing arguments were based on moral positions that were not only incompatible but fundamentally incommensurable. Those in favour of reducing deficit spending argue that cuts to social services (including family and children services) are unavoidable. Parents, however, refuse to accept austerity measures that will undermine the rights of their children to access services that will improve their chances in life. Neither position is based on incontrovertible evidence. On the one hand, the decision to cut a given service always involves the arbitrary evaluation of that service against other services that will not be cut. On the other, the demand to fund those services is based on the hope that early intervention initiatives will benefit children, even if the evidence that early intervention works is unconclusive or thin. On the basis of a thematic analysis of twenty-seven stories written by Oxfordshire parents, I interpret this conflict using the notion of moral economy, and argue that such an approach allows an appreciation of the link between health economics, perinatal mental health, the morality of parenting, and the early intervention discourse.

Optimizing favorable outcomes when counseling the gifted: A best practices approach

This article provides an integration of the empirical research literature on child psychotherapy and what the author has gleaned, first hand, in counseling work with gifted children and youth, and their families, over his 40-year career as a clinical psychologist. The article focuses on best practices in counseling gifted students in a way that optimizes favorable outcomes. The article has application for preventive and early intervention work, as well as for individual and group counseling efforts. Four principles of evidence-based counseling are emphasized, including the pre-eminence of a common factors’ perspective in work with gifted clients. The article highlights the value of progress monitoring and incorporating a strength-based focus, and provides a clinical case to illustrate counseling work with a troubled gifted adolescent guided by evidence-based practice.

Common genetic architecture and environmental risk factors underpin the anxiety-disordered eating relationship: Findings from an adolescent twin cohort.

Despite established comorbidity between anxiety and disordered eating (DE), and a plethora of research using various methodologies to examine this overlap, use of twin modeling to expose whether a shared genetic liability underpins these conditions remains rare. Data from a longitudinal sample of female twins were selected: measures of risk for DE from Wave 1 (N = 699, 351 pairs, aged 12-15 years), and the Eating Disorder Examination (EDE) and Children's Anxiety Sensitivity Index (CASI) from Wave 2 (N = 669, 338 pairs, aged 16-19 years). At this time, they also completed Children's Anxiety Sensitivity Index (CASI). Bivariate Cholesky decomposition models adjusting for age and body mass index centile investigated the covariance structure between the CASI and EDE. Modeling both genetic and nonshared environmental influences parsimoniously fit these data. All paths were significant. Additive genetic influences were notable for CASI and EDE phenotypes; 14% of the heritable variance was contributed by CASI to the expression of EDE. There was also a smaller but significant contribution of nonshared environmental influences. A multinomial logistic regression indicated body dissatisfaction (RRR = 1.53; 95% CI = 1.07-2.18) differentiated groups with highest EDE scores from the highest CASI scores. Shared genetic and environmental influences appear to underpin the relationship, and potentially the observed comorbidity, between anxiety sensitivity and DE. The age of onset is typically earlier for anxiety than DE, suggesting a significant opportunity for early intervention work to reduce the likelihood of subsequent development of DE.

Maternal inflammation during pregnancy and offspring psychiatric symptoms in childhood: Timing and sex matter

ObjectiveMaternal infection during pregnancy has been associated with increased risk of offspring psychopathology, including depression. As most infections do not cross the placenta, maternal immune responses to infection have been considered as potentially contributing to this relationship. This study examined whether gestational timing of maternal inflammation during pregnancy is associated with offspring internalizing and/or externalizing symptoms during childhood and, further, whether fetal sex moderated this relationship. MethodParticipants were 737 pregnant women and their offspring who were continuously followed through late childhood. Archived first and second trimester sera were analyzed for markers of inflammation [interleukin 8 (IL-8), IL-6, IL-1 receptor antagonist (IL-1ra), and soluble tumor necrosis factor receptor-II (sTNF-RII)]. When offspring were aged 9–11, mothers completed a questionnaire assessing psychological symptoms. ResultsMultivariate regression analyses indicated that elevated IL-8 in the first trimester was associated with significantly higher levels of externalizing symptoms in offspring. Higher IL-1ra in the second trimester was associated with higher offspring internalizing symptoms. Further, second trimester IL-1ra was associated with increased internalizing symptoms in females only. ConclusionThese findings demonstrate that elevated maternal inflammation during pregnancy is associated with the emergence of separate psychological phenotypes and that timing of exposure and fetal sex matter for offspring outcomes. Given that internalizing and externalizing symptoms in childhood increase risk for a variety of mental disorders later in development, these findings potentially have major implications for early intervention and prevention work.

Postdisaster Counselling: Personal, Professional, and Ethical Issues

ABSTRACTVolunteer counsellors face particular challenges in postdisaster interventions. This research investigates personal, professional, and ethical issues faced by mental health volunteer counsellors recruited to a counselling service that emerged following the 2011 earthquakes in the Canterbury region of New Zealand. Earthquakes create major community disruption that can overwhelm existing service systems and require new agency arrangements and increased use of volunteers to manage and provide services. The disaster exposed counsellors to personal challenges in their own lives as well as those of their clients and significantly affected their professional practice. The findings indicate that emergency organisations and professional registration bodies should give further consideration to the management of volunteers and their early intervention work in postdisaster counselling.IMPLICATIONSDelivery of postdisaster services must encompass service management, targeted interventions, and supervision.When counsellors and clients experience the same disaster personal, professional, and ethical aspects are intertwined. Counsellors need self-care and support to manage these events.Further arrangements could be made to ensure professional insurance is available for volunteer counsellors postdisaster.

Inteligencia emocional y prácticas relacionales con la familia en atención temprana

La intervencion en Atencion Temprana esta necesariamente dirigida al nino y a su familia. Conseguir mejorar la intervencion y colaboracion con la familia, a partir de unas adecuadas practicas relacionales, es una preocupacion actual en la disciplina. Nuestro objetivo fue comprobar si determinadas habilidades de inteligencia emocional, en los profesionales, pueden estar vinculadas con un mayor o menor ejercicio de practicas relacionales con la familia. Participaron 420 profesionales, 25 hombres y 387 mujeres, de 13 comunidades autonomas de Espana. Cumplimentaron dos instrumentos: Trait Meta-MoodScale (TMMS-24), del grupo de investigacion de Salovey y Mayer, traducida por Fernandez-Berrocal y Extremera (2006); Inventario sobre Practica Profesional en Atencion Temprana (IPPAT), creado al efecto. Los resultados demuestran que los profesionales de Atencion Temprana realizan practicas relacionales en sus intervenciones y poseen altos niveles de habilidades emocionales. Con todo, encontramos diferencias significativas en estas practicas relacionales en funcion de sus puntuaciones en las habilidades de inteligencia emocional. Los resultados se discuten tambien en terminos de sus implicaciones de cara a la formacion de futuros profesionales en Atencion Temprana.

Addressing the STEM Problem in Ways That Work

Let's look at two solutions that should be effective in addressing the gender issue in STEM. First, early intervention works. Scientific and mathematical learning can, and should, be integrated into early childhood learning and development. Miner et al. (2018) mention the potential of nurturing a child's interest in STEM through early education. The challenge is that it is segregated by gender biases (“early schooling differences, parental choices in encouraging child interests and hobbies, and other early reinforcement differences that are societally based”; Miner et al., 2018, p. 270). According to Gunderson, Ramirez, Levine, and Beilock (2012) parents tend to expect that their boys are more gifted in STEM than their girls, even when their achievement levels do not differ objectively. The focus needs to shift from moving along with this gender bias to constructively using the gender difference.

Promoting Best Practice in Assessment and Intervention: The Challenges of Working in Times of Cutbacks and Change

Promoting Best Practice in Assessment and Intervention: The Challenges of Working in Times of Cutbacks and Change

Verbal Working Memory as a Longitudinal Mechanism of Vocabulary Problems in Preschoolers with ADHD.

Elucidation of early potential risk factors of Attention-Deficit/Hyperactivity Disorder (ADHD) is important to allow for early identification of ADHD and targeted early intervention for children with ADHD. Delayed language skills, particularly poor vocabulary, is an early-developing potential risk factor that is thought to be involved in developmental pathways to ADHD; however, mechanisms explaining the relationship between poor vocabulary skills and ADHD symptoms are unclear and warrant investigation. The present study examines the relationship between poor vocabulary skills and ADHD symptoms by testing cognitive mechanisms, namely verbal working memory (WM), that might account for this link. Participants were 109 young children between the ages of three and six and their primary caregivers. Diagnostic information on ADHD symptoms was available from parents and teachers/daycare providers via standardized rating forms. Vocabulary skills and WM were measured through child performance on laboratory tasks. Mediation analyses found poor verbal working memory significantly partially explained the vocabulary-ADHD association for both parent and teacher-rated ADHD symptoms. Further, effects of verbal WM on the association between poor vocabulary and increased ADHD symptoms largely held at one-year follow-up. Development of early interventions targeting verbal WM may be a promising new direction for early ADHD intervention work.

Negative Expectations: Medical Narrative Rewriting in Early Intervention and Disabilities Work

Negative Expectations: Medical Narrative Rewriting in Early Intervention and Disabilities Work

The Team of Life: A narrative approach to building resilience in UK school children

Concern about children and young people’s mental health is high on the UK national agenda. Access to specialist Child and Adolescent Mental Health Services (CAMHS) is perceived as problematic due to high thresholds, clinic-based service delivery and associated stigma. Schools and youth work contexts present alternative and more accessible settings for early intervention and preventative work aimed at promoting positive mental health. The Team of Life is a narrative group methodology with sporting metaphors, which encourages young people to recognise the strength and resilience in their life teams. The approach has been used within diverse contexts internationally, for example with former child soldiers in Uganda, young men from refugee backgrounds and young people in Australian schools. Innovative partnership work between health and education has led to the implementation of the Team of Life in a UK school and the development of a manualised Team of Life Programme. We now report findings from pilot work evaluating feasibility and outcomes for the programme within a UK secondary school setting. Quantitative findings include significant positive change in Goal Based Outcomes as well as significant reductions in emotional and behaviour difficulties measured by the Child Behaviour Checklist. Qualitative thematic analysis of participant feedback indicates benefits relating to the experience of ‘shared understanding’, ‘confidence’, ‘peer support’ and the ‘positive impact of sport’. Further research is planned to evaluate the effectiveness on a larger scale. This pilot study was undertaken as part of CAMHS Extended Schools work. Potential for collaboration between clinical and education psychology colleagues in relation to the promotion of positive mental health in schools is discussed.

The Karamay community alcohol abuse and self-rated health status survey

Objective To investigate the health status and incidence of alcohol abuse of Xinjiang community residents. Methods Through multi-stage random sampling, 1992 community residents (15-65years old) were assessed using socio-demographic information questionnaire, alcohol use disorders identification test (AUDIT) and self-rated health measurement scale-prior test(SHRMS). Single factor analysis and rank sum test were used to identify the incidence of alcohol abuse, the distribution of different populations, and the self-rated health status of abusers. Results Totally 298 cases of alcohol abuse were identified, and accordingly, the prevalence rate of alcohol abuse for general population was 15.1% (male 26.4%, female 4.8%). Key factors for alcohol abuse included male, middle-aged, well-educated, at work, administrative work, high income levels and large number of household. The differences among groups were statistical significant.Presumably the workplace population was at high risk of alcohol abuse.Alcohol abusers were significantly worse than general population in self-rated health status(P<0.01), especially in mental health and social health. Conclusion The incidence of alcohol abuse is relatively high in Xinjiang region, and the problem need more attention.Further survey and early intervention work for high-risk group are advised to achieve the purpose of prevention and control. Key words: Alcohol abuse; Alcohol use disorders identification test(AUDIT); Self-rated health status; High-risk population

Presidential Address, 2015--Making a Difference Through Research, Practice, and Policy.

It is with great pleasure that I address my fellow members of the American Association on Intellectual and Developmental Disabilities (AAIDD). This audience contains mentors, colleagues, existing and emerging leaders at your agencies and universities, self-advocates, and the future leaders of AAIDD. As is often the case when one is asked to give remarks, the immediate thought is: What can I say that is meaningful and helpful to others? So, I’ll begin at the beginning and give some insight into my leadership path. One question students often ask me at the University of Kansas is: How did your career in disability research begin? My career within this field began in general education. I earned a degree in elementary education at the Pennsylvania State University and received teacher certification right around the time that landmark legislation was signed in 1975 providing support for instruction and inclusion of individuals with disabilities in public schools. As special education in the public schools began and evolved into the system of services we have today, I raised a family of three children while taking disability-related classes in reading disorders and cognitive disabilities at universities in New York and Texas. As current special education began with the Education for All Handicapped Children Act, enacted in 1975, and most recently evolved through the Individuals With Disabilities Education Act (IDEA, 2004), so did my perspectives on disability-related services. I also met Michael Wehmeyer, a fellow doctoral student at the University of Texas at Dallas, who is a beacon in the field of disability and self-determination and a mentor to many, including me and our colleague, Karrie Shogren, regarding research and effective practice. Mike also introduced me to AAIDD as a professional home. Following my work in early intervention—birth to age 3 services in family homes and a few years as a researcher at The Arc of the United States—I settled into the role of research professor at the University of Kansas in Lawrence, working primarily to address the gaps in research for individuals with disabilities. Another milestone in policy legislation that spans many of our careers is this year’s 25th anniversary of the Americans With Disability Act (ADA), signed in 1990 by President George H. W. Bush. This momentous anniversary of the original legislation will also help me center my remarks on what has happened in the years since 1990, both within our organization and in the field of disability research, policy, and practice.