Community capacity coach: Embedded support to implement evidenced-based prevention

Given the pervasive nature of child abuse and neglect, multilevel public health approaches are necessary. Implementation science can help in understanding the most effective ways to build infrastructure and support delivery of such approaches. In this theoretical paper, we describe the implementation of the Positive Parenting Program (Triple P), an evidence-based population-level parenting program in South Carolina. While implementation science has informed how to move population-level efforts to scale, we discuss challenges that persist in practice, such as when there is a need for multiple stakeholders to understand, support, and apply implementation best practices in a systematic and consistent way. To address this challenge, we introduce the role of a Community Capacity Coach, who lives in the local community and works towards the implementation of Triple P. The Coach is responsible for bridging gaps between the local community and statewide support systems. We detail the ways in which the Coach's role aligns with key intermediary functions, and how the Coach is embedded within the larger Triple P statewide support system. We then discuss the assessment of the Coach's impact; and conclude with future directions and next steps for this role within Triple P South Carolina.     

What works? Lessons from a pretrial qualitative study to inform a multi-component intervention for refugees and asylum seekers: Learning Through Play and EMDR Group Traumatic Episode Protocol

Almost half of the trials failed to recruit their targeted sample size of which 89% could be preventable. Successful implementation of mental health trials in a context of forcibly displaced individuals can be even more challenging. Mental health difficulties have the potential to impact parenting skills, which are linked to poor development in children, while parenting interventions can improve parents' mental health and parenting behaviors. However, the evidence on parenting interventions for refugees is limited. A parenting intervention, Learning Through Play Plus Eye Movement Desensitization and Reprocessing Group Treatment Protocol, has been designed to address parental mental health. This pretrial qualitative study, conducted with refugees, asylum seekers and professionals, aimed to explore their perceptions of the intervention and to identify barriers and recommendations for better engagement, recruitment, and delivery. Three themes were generated from thematic analysis: the content of the intervention, suggestions for improvement and implementation, and understanding the role of the facilitator. These themes provided insights into the issues that might predict the barriers for delivery of the intervention and offered several changes, including destigmatization strategies to improve engagement.     

Ethical issues in public health informatics: implications for system design when sharing geographic information

Public health programs today constitute a multi-professional inter-organizational environment, where both health service and other organizations are involved. Developing information systems, including the IT security measures needed to suit this complex context, is a challenge. To ensure that all involved organizations work together towards a common goal, i.e., promotion of health, an intuitive strategy would be to share information freely in these programs. However, in practice it is seldom possible to realize this ideal scenario. One reason may be that ethical issues are often ignored in the system development process. This investigation uses case study methods to explore ethical obstacles originating in the shared use of geographic health information in public health programs and how this affects the design of information systems. Concerns involving confidentiality caused by geographically referenced health information and influences of professional and organizational codes are discussed. The experience presented shows that disregard of ethical issues can result in a prolonged development process for public health information systems. Finally, a theoretical model of design issues based on the case study results is presented.     

Urban bioethics: adapting bioethics to the urban context.

Urban bioethics is an area of inquiry within the discipline of bioethics that focuses on ethical issues, problems, and conflicts relating to medicine, science, health care, and the environment that typically arise in urban settings. Urban bioethics challenges traditional bioethics (1) to examine value concerns in a multicultural context, including issues related to equity and disparity, and public health concerns that may highlight conflict between individual rights and the public good, and (2) to broaden its primary focus on individual self-determination and respect for autonomy to include examination of the interests of family, community, and society. Three features associated with urban life-density, diversity, and disparity-affect the health of urban populations and provide the substrate for identifying ethical concerns and value conflicts and creating interventions to affect population health outcomes. The field of urban bioethics can be helpful in creating ethical foundations and principles for public health practice, developing strategies to respect diversity in health policy in a pluralistic society, and fostering collaborative work among educators, social scientists, and others to eliminate bias among health professionals and health care institutions to enhance patients' satisfaction with their care and ultimately affect health outcomes. Educational programs at all levels and encompassing all health professions are needed as a first step to address the perplexing and important problem of eliminating health disparities. Urban bioethics is both contributing to the social science literature in this area and helping educators to craft interventions to affect professional attitudes and behaviors.     

The acceptability and feasibility of the Baby Triple P Positive Parenting Programme on a mother and baby unit: Q-methodology with mothers with severe mental illness

New mothers with severe mental illness (SMI) frequently experience significant difficulties in caring for their babies. There are no structured, evidence-based interventions that guide health professionals to help these women improve early parenting. The extensively researched and effective Triple P Positive Parenting Programme has recently been expanded to families with children less than 1 year old, which provides an opportunity to develop the intervention for women with severe postnatal mental illness. This study explored the views of mothers with SMI about the acceptability and feasibility of Baby Triple P (Baby TP) in the setting of a psychiatric Mother and Baby Unit (MBU). An 88-item Q-sort was conducted with a purposive sample of 15 mothers using Q-methodology. Three main factors were identified: ‘what we need’, ‘what we want’ and ‘we can do it’. A consensus was noted with general agreement about the benefits of Baby TP, and suitability of the MBU environment to accommodate Baby TP. Baby TP was viewed as an acceptable and feasible parenting intervention and deemed positive and non-stigmatising. Mothers requested more staff awareness and knowledge about the programme so that they were supported in learning and generalising skills.     

Behavioral family intervention for children with developmental disabilities and behavioral problems.

The outcomes of a randomized clinical trial of a new behavioral family intervention, Stepping Stones Triple P, for preschoolers with developmental and behavior problems are presented. Forty-eight children with developmental disabilities participated, 27 randomly allocated to an intervention group and 20 to a wait-list control group. Parents completed measures of parenting style and stress, and independent observers assessed parent-child interactions. The intervention was associated with fewer child behavior problems reported by mothers and independent observers, improved maternal and paternal parenting style, and decreased maternal stress. All effects were maintained at 6-month follow-up.     

Adherence and Flexibility: They Can (and Do) Coexist!

[Clin Psychol Sci Prac 17: 258–264, 2010] Using their experiences disseminating the Triple P parenting program, Mazzucchelli and Sanders (2010) make a strong case for how flexibility enhances provider satisfaction, critical thinking about intervention delivery, and most importantly, adherence and fidelity. Their article makes an outstanding and innovative contribution to the literature on implementation research, advancing the field to a view of flexibility as a feature that may facilitate adherence. In this commentary, we place Mazzucchelli and Sanders’s work within the context of ongoing implementation research. We also call for embedding questions about implementation science into effectiveness trials to better inform dissemination efforts aimed at facilitating provider adoption and adherence to empirically supported treatments.     

Patient education in Finland

No mandated policies, practices, and procedures of patient education or patient health education exist in Finland but the efforts have been local in nature. Traditionally, primary and secondary health education as a part of maternal health care and during dental appointments have been known to exist. Hospital patient education efforts which may have resulted from past public health problems or legislative endeavors do exist in many hospital units but official hospital policies or strategies still do not. Patient education is often seen as health education. Voluntary agencies tend to emphasize practical issues rather than strategic planning in patient education. Finland complies with the WHO health strategies of 2015, and as a part of the Finnish strategies, it is considered important that large groups of people participate. A recent movement in health care to plan and implement shared decision-making activities (Seamless Macro Project, Path-project) is still short-term in nature. Practical actions are guided by professional skills, ethical practices, professional norms, and habits of the land, and of the three laws (public health law, occupational health law, patient status and rights law) guiding health education activities, the third one is specifically directed to patient education with an intent that when a treatment is not acceptable, another acceptable one must be found. Empowerment is a term seen in many contexts.     

The role of ethics in information technology decisions: a case-based approach to biomedical informatics education

The purpose of this paper is to propose a case-based approach to instruction regarding ethical issues raised by the use of information technology (IT) in healthcare. These issues are rarely addressed in graduate degree and continuing professional education programs in health informatics. There are important reasons why ethical issues need to be addressed in informatics training. Ethical issues raised by the introduction of information technology affect practice and are ubiquitous. These issues are frequently among the most challenging to young practitioners who are ill prepared to deal with them in practice. First, the paper provides an overview of methods of moral reasoning that can be used to identify and analyze ethical problems in health informatics. Second, we provide a framework for defining cases that involve ethical issues and outline major issues raised by the use of information technology. Specific cases are used as examples of new dilemmas that are posed by the introduction of information technology in healthcare. These cases are used to illustrate how ethics can be integrated with the other elements of informatics training. The cases discussed here reflect day-to-day situations that arise in health settings that require decisions. Third, an approach that can be used to teach ethics in health informatics programs is outlined and illustrated.     

Psychologists in Long-Term Care: Overview of Practice and Public Policy: Introduction to the Special Series

With the overall aging of the population and the concomitant need for the provision of mental health care for older adults, professional psychology in long-term care has come of age. Psychologists are now increasingly practicing in such traditional long-term care settings as nursing homes and in less traditional ones such as rehabilitation units, day centers, partial hospitaliza-tion programs, and hospices. The practice of psychology in long-term care is strongly influenced by public policy issues relating to Medicare, such as conditions of reimbursement, the rise of managed Medicare, and the continued disparity between payment for mental health and medical diagnoses. Ceropsychologists must be flexible in the form of their healthcare delivery to continue to provide quality services. The following articles in this special section on long-term care summarize the research on assessment and interventions for long-term care patients, outline the training opportunities available, and provide a decision-making framework for the common professional ethical/legal issues encountered in long-term care settings.     

生物医学领域人工智能应用的伦理问题

人工智能在生物医学领域的应用正在加速发展,在公共卫生、临床诊疗、健康管理方面展露出广阔的发展前景,同时也引起了许多潜在和现存的伦理困境。目前,讨论比较集中的伦理议题有:1)人工智能的道德地位;2)人工智能应用引起的各种公平性问题;3)个人权利与公共利益之间的张力问题。本文试图对上述议题进行初步的探讨,从平衡的观点出发,提出若干原则供学术界共同讨论和批评。     

Prevention of type 1 diabetes from laboratory to public health.

Despite recent progress in immunology and genetics, the causes of type 1 diabetes remain unknown. Prevention of autoimmune diseases through immunomodulation or gene therapy has not yet been successful in humans. In contrast, some autoimmune diseases such as celiac disease, rheumatic fever, and congenital rubella induced diabetes can be avoided through modification of environmental factors. Candidate environmental causes of type 1 diabetes are now being characterized in cohort studies and clinical trials. An alternative approach to prevention of type 1 diabetes may include a "vaccination" in early childhood to induce tolerance to critical autoantigen(s). This paper reviews the status of current diabetes prevention trials in humans and selected new interventions that are being tested in animal models. We estimate the cost of public health implementation of selected screening and intervention scenarios. The ethical, logistic, and funding issues underlying these scenarios are discussed.     

Supporting ethical practice in primary care research: strategies for action.

Researchers in primary care share the general ethical obligations of all researchers. However, these obligations may raise different issues in the unique context of primary care. Current professional ethical guidance for primary care research is complex and fragmentary. The newly introduced research governance framework does not specifically address primary care research, and recent changes in legal requirements have significant implications for research. In this paper, ethical issues arising from research in primary care are considered, current standards and resources are described, and strategies for supporting ethical practice are discussed. Four ethical issues are discussed: consent and competence; confidentiality; power relations; and procedural issues. In the final part of the paper, broad strategies to support ethical practice in primary care research are recommended. These include education and resources, greater clarity of relevant standards, financial support, a greater role for primary care networks, and greater public debate.     

Is informed consent related to success in exercise and diet intervention as evaluated at 12 months? DR's EXTRA study

Background  

There is a permanent need to evaluate and develop the ethical quality of scientific research and to widen knowledge about the effects of ethical issues. Therefore we evaluated whether informed consent is related to implementation and success in a lifestyle intervention study with older research participants. There is little empirical research into this topic.     

Suicide Prevention in Older Adults: An Interdisciplinary Challenge

Suicide among older adults represents one of the most salient and intractable problems in geriatric mental health. As indicated by Heisel and Duberstein (this issue), despite advances in conceptual models of late-life suicide, risk-factor assessment, and intervention strategies targeting at-risk elderly, prevalence rates of elder suicide remain high. Although partly explained by conceptual, methodological, and systemic barriers that hinder research, these persisting high rates may also be attributable to practice models that, until recently, did not adequately recognize elder suicide as a public health problem calling for an interdisciplinary solution. Greater attention to targeted assessment and intervention for select subgroups, to public health and policy issues, and to implementation of interdisciplinary practice models may assist suicide prevention efforts.     

Integrating spirituality and psychotherapy: ethical issues and principles to consider

Professional and scientific psychology appears to have rediscovered spirituality and religion during recent years, with a large number of conferences, seminars, workshops, books, and special issues in major professional journals on spirituality and psychology integration. The purpose of this commentary is to highlight some of the more compelling ethical principles and issues to consider in spirituality and psychology integration with a focus on psychotherapy. This commentary will use the American Psychological Association's (2002) Ethics Code and more specifically, the RRICC model of ethics that readily applies to various mental health ethics codes across the world. The RRICC model highlights the ethical values of respect, responsibility, integrity, competence, and concern. Being thoughtful about ethical principles and possible dilemmas as well as getting appropriate training and ongoing consultation can greatly help the professional better navigate these challenging waters.     

Extending transformational leadership theory to parenting and adolescent health behaviours: an integrative and theoretical review

Abstract

Parenting is a critical social determinant of the health-related behaviours of adolescents. In this article, we argue that extending transformational leadership theory to parenting presents an opportunity for developing a useful conceptual model for (a) understanding the relationships between parenting and adolescents’ health behaviours and (b) supporting the development of parenting interventions. First, we provide a brief review of the extant literature on parenting styles and practices as it relates to adolescent health. Second, after drawing parallels between parents and leaders, we provide a synopsis of transformational leadership theory, and explain the conceptual utility of this framework for understanding and evaluating parenting behaviours. Third, we draw from the leadership and behavioural medicine literatures to outline potential psychological mechanisms through which transformational parenting might predict adolescent health-related behaviours. We conclude by discussing opportunities for the implementation of evidence-based transformational parenting intervention research designed to support parenting behaviours.     

Adopting a population-level approach to parenting and family support interventions

Evidence-based treatments and preventive interventions in the child and family area have not met with widespread adoption by practitioners. Despite the high prevalence of child behavioral and emotional problems, many parents and families in need are not receiving or participating in services, and when they do, the most efficacious interventions are not what is usually provided. Simultaneously addressing the issues of low penetration and insufficient dissemination of evidence-based programming requires a population approach to parenting and family support and intervention. Process issues are important, particularly in relation to engagement of stakeholders, recruitment of practitioners, consideration of organizational factors, and use of media and communication strategies. This article discusses why there is a need for a population-based approach, provides a framework of how to conceptualize such an approach, and describes an example from our own work of a recently initiated prevention trial that illustrates a population-based approach in action. The rationale, structure, and goals of the Triple P System Population Trial are described in the context of the aforementioned population framework.     

Survey of professional education in ethics in clinical psychology intership programs

Attempted to assess the extent to which clinical psychology internship programs offer professional education in ethical standards. While almost 80% of the programs offer such training, less than half of these provide a formal, systematic, and comprehensive learning experience. Many of the programs only provide a limited exposure to ethical standards that occurs on an informal basis as issues emerge in supervision. All but two of the programs that do not offer training in ethical standards reported that this was the primary responsibility of the clinical psychology graduate school program. The immediate implementation of formal training in ethical standards is needed urgently.     

Incorporating genomics into breast and prostate cancer screening: assessing the implications

Individual risk prediction and stratification based on polygenic profiling may be useful in disease prevention. Risk-stratified population screening based on multiple factors including a polygenic risk profile has the potential to be more efficient than age-stratified screening. In this article, we summarize the implications of personalized screening for breast and prostate cancers. We report the opinions of multidisciplinary international experts who have explored the scientific, ethical, and logistical aspects of stratified screening. We have identified (i) the need to recognize the benefits and harms of personalized screening as compared with existing screening methods, (ii) that the use of genetic data highlights complex ethical issues including discrimination against high-risk individuals by insurers and employers and patient autonomy in relation to genetic testing of minors, (iii) the need for transparency and clear communication about risk scores, about harms and benefits, and about reasons for inclusion and exclusion from the risk-based screening process, and (iv) the need to develop new professional competences and to assess cost-effectiveness and acceptability of stratified screening programs before implementation. We conclude that health professionals and stakeholders need to consider the implications of incorporating genetic information in intervention strategies for health-care planning in the future.Genet Med 2013:15(6):423–432