Public health approaches to family maltreatment prevention: Resetting family psychology's sights from the home to the community.

The authors review recent trends within the family maltreatment research field toward a public health approach, discuss the rationale for community-level interventions for family maltreatment, and sketch the history and development of community-level prevention approaches. Next, to illustrate the both the logistic and the scientific challenges of such work, the authors discuss the development and testing of an empirically guided, research-community partnership for the prevention of family maltreatment, the United States Air Force's NORTH STAR initiative (New Orientation to Reduce Threats to Health From Secretive Problems That Affect Readiness). Finally, recommendations are made for effective and disseminable family maltreatment prevention interventions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Provoking evolution in child and youth mental health in Canada.

Approximately 14–25% of Canadian children and youth have a diagnosable mental disorder. Fewer than 25% of those with such disorders receive specialised services. Even for those receiving services, there is no guarantee that the interventions provided are effective or based on any credible evidence. It is time that child and youth mental health be recognised as the health priority that it truly is. The barriers to meaningful change in child and youth mental health are many and include historical, attitudinal, cultural, financial, and systemic considerations. True change will require creativity, innovation, collaboration, and leadership. Mindsets need to be shifted and the status quo needs to be challenged. Canadian psychologists have skillsets that should be critical in accelerating change in child and youth mental health. We should not shy away from taking on leadership roles to provoke such change. Examples of where this is occurring and opportunities for further action are profiled. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dating violence prevention with at-risk youth: A controlled outcome evaluation.

This study evaluated a community-based intervention to help at-risk teens develop healthy, nonabusive relationships with dating partners. Participants were 158 14-16-year-olds with histories of child maltreatment who were randomly assigned to a preventive intervention group or a no-treatment control group. They completed measures of abuse and victimization with dating partners, emotional distress, and healthy relationship skills at bimonthly intervals when dating someone. Intervention consisted of education about healthy and abusive relationships, conflict resolution and communication skills, and social action activities. Growth curve analyses showed that intervention was effective in reducing incidents of physical and emotional abuse and symptoms of emotional distress over time. Findings support involvement of youths in reducing the cycle of violence as they initiate dating in midadolescence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Framing public policy and prevention of chronic violence in American youths.

Metaphors can both inspire and mislead the public. Current metaphors for youth violence are inconsistent with scientific evidence about how chronic violence develops and evoke inaccurate or harmful reactions. Popular, problematic metaphors include superpredator, quarantining the contagious, corrective surgery, man as computer, vaccine, and chronic disease. Four new metaphors that more accurately reflect the science of child development are proposed to shape the field. Preventive dentistry offers a lifelong system of universal, selected, and indicated intervention policies. Cardiovascular disease offers concepts of distal risk factors, proximal processes, equifinality and multifinality, and long-term prevention. The Centers for Disease Control and Prevention's public health model focuses on injury and the victim to elicit popular support. Public education for illiteracy offers concepts of long-term universal education coupled with specialized help for high-risk youths and goes beyond metaphor to represent a truly applicable framework. Research is proposed to test the scientific merit for and public receptivity to these metaphors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Behavioral and social sciences at the Centers for Disease Control and Prevention: Critical disciplines for public health.

The mission of the Centers for Disease Control and Prevention (CDC) is to promote health and quality of life by preventing and controlling disease, injury, and disability. Fifty years ago, CDC's efforts were focused on epidemiologic and laboratory studies of malaria, typhus, and plague. Today, CDC's activities cover a broad range of diseases and conditions, and a broader range of disciplines are required to address these diverse public health problems. The behavioral and social sciences have a critical role to play in helping the public understand risk group characteristics and the frequency, context, and determinants of risky behaviors and in developing, implementing, and assessing prevention programs. CDC is taking steps to foster an environment in which behavioral and social sciences can flourish and to integrate these sciences into all of CDC's prevention activities. Other articles in this section describe the breadth and nature of the contributions of behavioral and social sciences at CDC. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Tennessee Lives Count: Statewide gatekeeper training for youth suicide prevention.

Youth suicide remains a significant public health problem in the United States. In 2004, the Garrett Lee Smith Memorial Act provided states and tribes with funding to implement and evaluate youth suicide prevention programs. The Tennessee Lives Count project was developed through a collaborative model at the state level and delivers an enhanced version of the Question, Persuade, Refer gatekeeper training program to individuals working with youth across the state. This article describes the development of the project and preliminary outcomes of 416 participants in child welfare, juvenile justice, health, and education systems at pretest, posttest, and 6-month follow-up. The findings suggest the training has an immediate and long-term impact on perceived knowledge of suicide prevention, self-efficacy, and attitudes about the inevitability of suicide. Policy and practice implications are presented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Military youth and the deployment cycle: Emotional health consequences and recommendations for intervention.

The United States military force includes over 2.2 million volunteer service members. Three out of five service members who are deployed or are preparing for deployment have spouses and/or children. Stressors associated with the deployment cycle can lead to depression, anxiety, and behavior problems in children, as well as psychological distress in the military spouse. Further, the emotional and behavioral health of family members can affect the psychological functioning of the military service member during the deployment and reintegration periods. Despite widespread acknowledgment of the need for emotional and behavioral health services for youth from military families, many professionals in a position to serve them struggle with how to best respond and select appropriate interventions. The purpose of this paper is to provide an empirically based and theoretically informed review to guide service provision and the development of evidence based treatments for military youth in particular. This review includes an overview of stressors associated with the deployment cycle, emotional and behavioral health consequences of deployment on youth and their caretaking parent, and existing preventative and treatment services for youth from military families. It concludes with treatment recommendations for older children and adolescents experiencing emotional and behavioral health symptoms associated with the deployment cycle. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Triple P-Positive Parenting Program as a public health approach to strengthening parenting.

Parenting programs have considerable potential to improve the mental health and well-being of children, improve family relationships, and benefit the community at large. However, traditional clinical models of service delivery reach relatively few parents. A public health approach is needed to ensure that more parents benefit and that a societal-level impact is achieved. The Triple P-Positive Parenting Program is a comprehensive, multilevel system of parenting intervention that combines within a single intervention universal and more targeted interventions for high-risk children and their parents. With Triple P, the overarching goal is to enhance the knowledge, skills, and confidence of parents at a whole-of-population level and, in turn, to reduce the prevalence rates of behavioral and emotional problems in children and adolescents. The distinguishing features of the intervention and variables that influence its effective implementation are discussed. Self-regulation is a unifying concept that is applied throughout the entire system (e.g., to interactions between children, parents, service providers, and agencies involved in delivering the intervention). Challenges and future directions for the development of public health approaches to parenting are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Fifty years of applied population-based prevention research at the Centers for Disease Control and Prevention

Infantile regurgitation is a frequently occurring problem. Throughout the world, anxious parents are imploring physicians to eliminate their infant's regurgitation. General practitioners, pediatricians and pediatric gastroenterologists strive to alleviate infantile regurgitation and its related parental stress. In this paper we define the scope of the problem and analyze the optimal, cost-efficient management approach to simple regurgitation in infants. The intent of this paper is to disseminate this information to practicing physicians and other health care professionals in an attempt to minimize the impact of this annoying problem of infancy and to eliminate confusion and expensive diagnostic tests and use of sub-optimal treatment modalities. Parental reassurance and dietary management by feeding thickened formula are important components in managing regurgitation in infants while maintaining optimal nutritional intake for adequate growth and development.     

Consequences of client-initiated workplace violence: The role of fear and perceived prevention.

The authors suggested and tested a model of the consequences of client-initiated workplace violence, introducing perceived prevention of violence and perceived coping ability as factors that reduce fear of future violence and mitigate negative personal and organizational consequences. Survey data from 330 frontline staff from job centers and social security offices were analyzed using structural equation modeling. The data supported the model and confirmed the central role of the fear of violence with regard to outcomes such as psychological and physical well-being or irritability. Results point further to perceived prevention of violence as an important factor that influences fear levels in different ways, predicts turnover intentions, and should therefore be considered when managers aim to address the consequences of client-initiated violence and threats. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Adopting a public health approach to the delivery of evidence-based parenting interventions.

A public health perspective to the delivery of parenting programs has the potential to greatly increase the impact of evidence-based psychological interventions targeting parents and families. However, a population-level benefit is unlikely to be achieved unless sustained programmatic efforts are undertaken to further increase the reach of efficacious interventions. In addition, such programs need to be adapted to local circumstances, be delivered in a culturally relevant manner, and be used in a sustained way by adoptee organisations if the potential benefits of these interventions are to be realised. The multilevel Triple P system of parenting interventions is used as an example to illustrate the benefits and challenges involved in delivering a comprehensive system of parenting interventions, services, and programs. Practical implications for large-scale implementation and possible future directions for research are identified. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

When youth mental health care stops: Therapeutic relationship problems and other reasons for ending youth outpatient treatment.

Child and adolescent treatment ends for a variety of reasons, but little is known about the underlying factors or about whether any such factors are linked to premature dropout. To address these gaps, the authors administered our Reasons for Ending Treatment Questionnaire to the parents of 344 referred youth (aged 7-18 yrs), from 10 clinics, who had ended outpatient treatment. A factor-analysis identified 6 factors, all showing good test-retest reliability and internal consistency. One of these, Therapeutic Relationship Problems, accounted for the most variance (16%) and was the only factor, other than Money Issues, that distinguished therapy dropouts from completers. The findings highlight major themes underlying decisions to end child therapy, and they highlight the importance of the therapeutic relationship. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Behavioral scientists at the Centers for Disease Control and Prevention. Evolving and integrated roles

BACKGROUND: We assessed the diagnostic usefulness of endoscopic ultrasonography (EUS) for choledocholithiasis. METHODS: A prospective series of 155 patients with suspected choledocholithiasis all underwent EUS, conventional ultrasonography, CT, and ERCP. In 142 patients with a clear cholangiogram on ERCP, we analyzed the capability of EUS to image the extrahepatic bile duct and to identify choledocholithiasis, compared with ultrasonography and CT. RESULTS: No complications were encountered in performing EUS. In 51 patients, ERCP demonstrated bile duct stones, which were confirmed at endoscopic sphincterotomy or surgery. The extrahepatic bile duct was wholly displayed in 96% by EUS, in 60% by ultrasonography, and in 80% by CT. EUS (96%) was more sensitive than ultrasonography (63%) and CT (71%) for detecting choledocholithiasis (p < 0.001). Although ultrasonography and CT were poorly diagnostic for choledocholithiasis in patients with small stones or those with a nondilated common bile duct, EUS was able to accurately detect choledocholithiasis regardless of the size of stones or the diameter of the bile duct. The specificity of EUS (100%) was higher than those of ultrasonography (95%) and CT (97%). CONCLUSIONS: EUS, a safe imaging procedure, is more accurate than ultrasonography and CT and may be as accurate as ERCP for diagnosing choledocholithiasis.     

Multisystemic therapy for child abuse and neglect: A randomized effectiveness trial.

The primary purpose of this study was to conduct a randomized effectiveness trial of Multisystemic Therapy for Child Abuse and Neglect (MST-CAN) for physically abused youth (mean age = 13.88 years, 55.8% female, 68.6% Black) and their families. Eighty-six families being followed by Child Protective Services due to physical abuse were randomly assigned to MST-CAN or Enhanced Outpatient Treatment (EOT), with both interventions delivered by therapists employed at a community mental health center. Across five assessments extending 16 months post baseline, intent-to-treat analyses showed that MST-CAN was significantly more effective than EOT in reducing youth mental health symptoms, parent psychiatric distress, parenting behaviors associated with maltreatment, youth out-of-home placements, and changes in youth placement. Also, MST-CAN was significantly more effective at improving natural social support for parents. Effect sizes were in the medium to large range for most outcomes examined. Although fewer children in the MST-CAN condition experienced an incident of reabuse than did counterparts in the EOT condition, base rates were low and this difference was not statistically significant. The findings of this study demonstrate the potential for broad-based treatments of child physical abuse to be effectively transported and implemented in community treatment settings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The mediating role of parenting stress in the relation between intimate partner violence and child adjustment.

This study examined the role of maternal parenting stress in the relation between intimate partner violence (IPV) and children's emotional and behavioral problems among 139 African American children between the ages of 8 and 12 years. Structural equation modeling was used to investigate a mediational model examining maternal reports of IPV and parenting stress and both mother and child reports of child adjustment. Results suggest that parenting stress helps explain the link between IPV and child emotional and behavioral problems. Findings from this study highlight the importance of parenting stress in outcomes of children from low-income African American families who experience IPV. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Medical care delivery at the 1996 Olympic Games. Centers for Disease Control and Prevention Olympics Surveillance Unit

CONTEXT: Mass gatherings like the 1996 Olympic Games require medical services for large populations assembled under unusual circumstances. OBJECTIVE: To examine delivery of medical services and to provide data for planning future events. DESIGN: Observational cohort study, with review of medical records at Olympics medical facilities. SETTING: One large multipurpose clinic and 128 medical aid stations operating at Olympics-sponsored sites in the vicinity of Atlanta, Ga. PARTICIPANTS: A total of 10715 patients, including 1804 athletes, 890 officials, 480 Olympic dignitaries, 3280 volunteers, 3482 spectators, and 779 others who received medical care from a physician at an Olympic medical station. MAIN OUTCOME MEASURES: Number of injuries and cases of heat-related illness among participant categories, medical use rates among participants with official Games credentials, and use rates per 10000 persons attending athletic competitions. RESULTS: Injuries, accounting for 35% of all medical visits, were more common among athletes (51.9% of their visits, P < .001) than among other groups. Injuries accounted for 31.4% of all other groups combined. Spectators and volunteers accounted for most (88.9%, P < .001) of the 1059 visits for heat-related illness. The rates for number of medical encounters treated by a physician were highest for athletes (16.2 per 100 persons, P < .001) and lowest for volunteers (2.0 per 100). Overall physician treatment rate was 4.2 per 10000 in attendance (range, 1.6-30.1 per 10000). A total of 432 patients were transferred to hospitals. CONCLUSIONS: Organizers used these data during the Games to monitor the health of participants and to redirect medical and other resources to areas of increased need. These data should be useful for planning medical services for future mass gatherings.     

Alerting the general population to genetic risks: The value of health messages communicating the existence of genetic risk factors for public health promotion.

Background: Health messages alerting the public to previously unknown genetic risk factors for multifactorial diseases are a potentially useful strategy to create public awareness, and may be an important first step in promoting public health. However, there is a lack of evidence-based insight into its impact on individuals who were unaware of the existence of genetic risk factors at the moment of information exposure. Method: The authors conducted 3 experimental studies with health messages communicating information about genetic risk factors for salt sensitivity (Studies 1A and 1B) and heightened cholesterol (Study 2) compared with general information without reference to genetic risk factors as a between-subjects variable and risk perception and intention to engage in preventive behavior as dependent variables. Results: All 3 studies revealed lower perceived susceptibility among participants who received information on genetic risk factors, which was associated with lowered intentions to engage in preventive behavior. In Studies 1A and 1B, these effects were observed only for previously unaware individuals, whereas in Study 2, they were observed for the entire sample. Conclusion: Alerting the public to the existence of genetic risk factors may not necessarily be beneficial to public health. Public health promoters should be aware of the possible adverse effects of alerting the general population to genetic risk factors, and should simultaneously educate the public about the meaning and consequences of such factors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Behavioral science activities at the Centers for Disease Control and Prevention: A selected overview of exemplary programs.

Behavioral research and surveillance activities are conducted across the Centers for Disease Control and Prevention (CDC). This article highlights activities in 4 program areas: violence against women, tuberculosis elimination, HIV prevention, and occupational health. The unique constraints and opportunities of each organization and program focus have shaped the way research has developed in each of these areas. Behavioral scientists also face many common challenges at CDC. Despite the difficulties of integrating behavioral research into an institution that historically has focused on biomedical and epidemiological research, behavioral scientists have made important contributions to public health. Many opportunities remain for psychologists to translate theory and operationalize constructs for use in solving important public health problems. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The ecological effects of universal and selective violence prevention programs for middle school students: A randomized trial.

This study reports the findings of a multisite randomized trial evaluating the separate and combined effects of 2 school-based approaches to reduce violence among early adolescents. A total of 37 schools at 4 sites were randomized to 4 conditions: (1) a universal intervention that involved implementing a student curriculum and teacher training with 6th-grade students and teachers, (2) a selective intervention in which a family intervention was implemented with a subset of 6th-grade students exhibiting high levels of aggression and social influence, (3) a combined intervention condition, and (4) a no-intervention control condition. Analyses of multiple waves of data from 2 cohorts of students at each school (N = 5,581) within the grade targeted by the interventions revealed a complex pattern. There was some evidence to suggest that the universal intervention was associated with increases in aggression and reductions in victimization; however, these effects were moderated by preintervention risk. In contrast, the selective intervention was associated with decreases in aggression but no changes in victimization. These findings have important implications for efforts to develop effective violence prevention programs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Challenges and opportunities in public health perspectives on family interventions: Introduction to the special section.

This introduction to the special section frames the idea of a public health approach to couple and family interventions as focusing upon the impact of interventions on outcomes at the population level. It notes the importance of looking at how evidence-based interventions can be used more effectively at the population level. It also stresses that the goals for population-level studies are different from randomized clinical trials. Public health interventions need evidence that the interventions can be used in widespread practice, that the interventions are cost effective when used as designed, and that monitoring and evaluation tools are available for adopting agencies. Finally, this introduction introduces the three articles of the series. (PsycINFO Database Record (c) 2010 APA, all rights reserved)