A Qualitative Study of Parent to Parent Support for Parents of Children With Special Needs

Objective: To examine qualitatively the experiences of parentsparticipating In Parent to Parent programs. Method: Twenty-fourparents of children with special needs, a subset of subjectsin a larger quantitative study, participated in a semi-structuredtelephone interview to explore the Impact and meaning of beingmatched with a trained supporting parent. Results: Qualitative analysis reveals a successful match iscontingent upon creation of a "reliable ally" in the supportingparent, comprised of four main components: (1) perceived sameness,(2) situational comparisons that enable arning and growth, (3)round-the-clock availability of support, and (4) mutuality ofsupport. Conclusions: Parent to Parent support creates a community ofsimilar others trained to listen and be supportive and providesan opportunity for matched parents to experience equality andmutuality in their relationship. Findings also identify theneed for quality control In Parent to Parent programs and theimportance of such programs as an adjunct to traditional professionalservices.     

Future Directions of Evidence-Based Practice in Athletic Training: Perceived Strategies to Enhance the Use of Evidence-Based Practice

Context:

The shift to a culture of evidence-based practice (EBP) in athletic training is a necessary step in both the optimization of patient care and the advancement of athletic trainers (ATs) as health care professionals. Whereas individuals have gained knowledge in this area, most ATs still are not practicing in an evidence-based manner. Exploring perceived strategies to enhance the use of EBP will help to determine the best approaches to assist ATs in applying EBP concepts to practice to improve patient care.

Objective:

To explore beneficial strategies and techniques ATs perceived would promote successful implementation of EBP within athletic training education and clinical practice.

Design:

Qualitative study.

Setting:

Individual telephone interviews.

Patients or Other Participants:

Twenty-five ATs (12 educators, 13 clinicians; athletic training experience = 16.00 ± 9.41 years) were interviewed.

Data Collection and Analysis:

One phone interview was conducted with each participant. After the interview was transcribed, the data were analyzed and coded into common themes and categories. Triangulation of the data occurred via the use of multiple researchers and member checking to confirm the accuracy of the data.

Results:

Participants identified several components they perceived as essential for enhancing the use of EBP within the athletic training profession. These components included the need for more EBP resources, more processed information, focused workshops, peer discussion and mentorship, and continual repetition and exposure. Participants also indicated that ATs need to accept their professional responsibilities to foster EBP in their daily practices.

Conclusions:

The proper shift to a culture of EBP in athletic training will take both time and a persistent commitment by ATs to create strategies that will enhance the implementation of EBP across the profession. Researchers should focus on continuing to identify effective educational interventions for ATs and to determine successful strategies to implement EBP into didactic curricula and clinical practice. Additional focus should be given to which strategies most effectively produce changes in clinical practice.Key Words: professional responsibility, mentorship, evidence-based medicine, qualitative research

Key Points

• Participants perceived that certain strategies might enhance the inclusion of evidence-based practice concepts throughout athletic training.
• Researchers should continue to identify effective educational interventions for athletic trainers and determine successful strategies to implement evidence-based practice into didactic curricula and clinical practice.
• Focus also needs to be placed on strategies that most effectively achieve knowledge translation to effect change in clinical practice.

The athletic training profession has begun to place greater emphasis on evidence-based practice (EBP) to align with the 2003 recommendations from the Institute of Medicine.¹ These recommendations focus on the inclusion of 5 core competencies: (1) delivering patient-centered care, (2) working as part of interprofessional teams, (3) practicing evidence-based medicine, (4) focusing on quality improvement, and (5) using information technology. While focusing on the EBP competency, researchers have reported that athletic training students, educators, and clinicians believe that EBP is an important shift for the profession,^2–6 but barriers, including time, accessibility to resources, and knowledge of EBP concepts, are preventing athletic trainers (ATs) from applying this paradigm to clinical practice.^6–9 The release of the fifth edition of the Athletic Training Education Competencies,¹⁰ which includes an EBP focus, has provided a preliminary mechanism for helping future generations of ATs overcome some of these barriers at the professional education level. The hope is that the inclusion of EBP concepts within curricula will promote a new generation of clinicians who will translate the concepts of EBP into their daily clinical practices. The incorporation of EBP will require ATs to understand and teach the principles of EBP didactically and to be familiar with and willing to implement these concepts into clinical practice.As athletic training education moves toward EBP, practicing clinicians also must embrace and adopt this paradigm shift. The approach to creating a culture of EBP needs to be multifaceted^7,11 and must be targeted at all ATs, including those who have been reared in a culture of tradition. Overall, one of the main goals of athletic training is to improve the outcomes of the care provided to patients.¹² However, until all members of the profession are willing to accept this paradigm shift, athletic training may never fully embrace an EBP culture.Leaders in the profession recognize the need for change and are attempting to move in this direction.¹³ In addition to updating the educational competencies, more continuing education in the area of EBP has become available to ATs.¹⁴ The board of directors of the National Athletic Trainers'' Association (NATA) provided funding for the development and dissemination of educational EBP modules that were made available to the entire NATA membership free of cost.¹⁵ A randomized controlled trial on the ability of these modules to increase knowledge of EBP concepts revealed that they were an effective mechanism to teach these concepts to ATs.¹⁵ Only an immediate knowledge increase was assessed, and no authors of the current literature have explored long-term knowledge retention and translation among ATs or implementation practices resulting from the Web-based modules.Whereas education of current ATs is a vital step in shifting the culture of the profession, merely increasing knowledge cannot be assumed to correlate with an actual change in clinical practice. Researchers have conducted multiple systematic reviews in which they assessed the effectiveness of educational interventions on clinical practice changes. Forsetlund et al¹⁶ concluded that educational meetings elicit small improvements in professional practice and health care outcomes. Freemantle et al¹⁷ reported that printed educational materials, audit and feedback, and meetings or workshops had little to no effect on clinical practice. Most investigators^16–20 have determined that multifaceted educational interventions (eg, didactic lecture combined with interactive discussion) and active rather than passive interventions are most effective in changing professional behavior. Oxman et al²¹ and Foy et al²² found that interventions can only be effective in changing behaviors under ideal conditions, so multiple factors, including the condition and patient and clinician attributes, should be considered when developing an educational intervention. Overall, authors^19,23 of the majority of studies conducted to assess clinical practice changes after an intervention have indicated that most interventions are effective under some circumstances but that no single intervention is effective for all circumstances.The true shift to EBP in athletic training requires not only enhanced knowledge of EBP concepts but also a translation of this knowledge into practices that will improve patient care outcomes. Therefore, it is important not only to assess if a knowledge gain has occurred but also to determine if and how this knowledge has translated to clinical practice. Recently, researchers²⁴ have revealed that whereas ATs perceive they have retained knowledge gained from the Web-based modules, they have not shifted that knowledge to their daily practices in patient care. For this reason, it is necessary to seek strategies that will be most effective in bridging the gap between knowledge and practice. Qualitatively exploring the perceptions and experiences of ATs will lead to a rich perspective of which mechanisms they perceive will be most effective in shifting ideas and behaviors toward clinical practice and didactic education. A qualitative exploration allows participants to provide ideas that are not limited by the researchers'' opinions and biases and ideas that they believe will ultimately influence their behaviors. Therefore, the purpose of this qualitative study was to explore the experiences and theories ATs have toward identifying beneficial strategies and techniques to promote successful implementation of EBP within athletic training education and clinical practice.     

Knowledge May Not Be the Best Target for Strategies to Influence Evidence-Based Practice: Using Psychological Models to Understand RCT Effects

Background  

Interventions to enhance the implementation of evidence-based practice have a varied success rate. This may be due to a lack of understanding of the mechanism by which interventions achieve results.     

Leveraging Text Messaging and Mobile Technology to Support Pediatric Obesity-Related Behavior Change: A Qualitative Study Using Parent Focus Groups and Interviews

Background

Text messaging (short message service, SMS) is a widely accessible and potentially cost-effective medium for encouraging behavior change. Few studies have examined text messaging interventions to influence child health behaviors or explored parental perceptions of mobile technologies to support behavior change among children.

Objective

Our aim was to examine parental acceptability and preferences for text messaging to support pediatric obesity-related behavior change.

Methods

We conducted focus groups and follow-up interviews with parents of overweight and obese children, aged 6-12 years, seen for “well-child” care in eastern Massachusetts. A professional moderator used a semistructured discussion guide and sample text messages to catalyze group discussions. Seven participants then received 3 weeks of text messages before a follow-up one-on-one telephone interview. All focus groups and interviews were recorded and transcribed verbatim. Using a framework analysis approach, we systematically coded and analyzed group and interview data to identify salient and convergent themes.

Results

We reached thematic saturation after five focus groups and seven follow-up interviews with a total of 31 parents of diverse race/ethnicity and education levels. Parents were generally enthusiastic about receiving text messages to support healthy behaviors for their children and preferred them to paper or email communication because they are brief and difficult to ignore. Participants anticipated high responsiveness to messaging endorsed by their child’s doctor and indicated they would appreciate messages 2-3 times/week or more as long as content remains relevant. Suggestions for maintaining message relevance included providing specific strategies for implementation and personalizing information. Most felt the negative features of text messaging (eg, limited message size) could be overcome by providing links within messages to other media including email or websites.

Conclusions

Text messaging is a promising medium for supporting pediatric obesity-related behavior change. Parent perspectives could assist in the design of text-based interventions.

Trial Registration

Clinicaltrials.gov {"type":"clinical-trial","attrs":{"text":"NCT01565161","term_id":"NCT01565161"}}NCT01565161; http://clinicaltrials.gov/show/{"type":"clinical-trial","attrs":{"text":"NCT01565161","term_id":"NCT01565161"}}NCT01565161 (Archived by WebCite at http://www.webcitation.org/6LSaqFyPP).     

Evaluation Methods for the Assessment of Acute Care Nurse Practitioner Inserted Central Lines: Evidence-Based Strategies for Practice

BackgroundAssessing acute care nurse practitioners' (ACNPs) procedural competence for central line insertions encourages best patient outcomes and meets requirements of national credentialing bodies. Implementation of processes to effectively evaluate procedural competence is complicated by the lack of validated, evidenced-based metrics to evaluate ACNP practices.PurposeThis article identifies validated, evidenced-based metrics to effectively evaluate ACNP procedural competencies.Methodology: A two-part literature review was performed to 1) determine competency evaluation methods for ACNP skills and to 2) evaluate the use of templates/checklists as a means to encourage compliance with national, evidence-based guidelines. Due to the lack of literature on the use of evaluation tools to assess ACNP procedural competency, literature related to medical training programs and practices was reviewed.Review of Literature: Fifteen articles were identified that met review criteria related to procedural competency evaluation. Eleven methods for competency evaluation were commonly identified in the literature; however, conclusive evidence indentifying the most effective means of procedural competency evaluation was not found. Seven studies and one expert consensus were identified related to use of standardized forms and templates/checklists to improve national guideline compliance. All studies indicated the use of standardized documentation significantly increased compliance with national guidelines.     

An Integrative Psychotherapy Approach to Foster Community Engagement and Rehabilitation in Schizophrenia: A Case Study Illustration

This case study illustrates the use of a long‐term integrative psychotherapy approach with a middle‐ aged man with chronic schizophrenia and a mood disorder. The case of “Holst” describes a man with a history of insecure attachment and trauma who later went on to contract a serious chronic illness, precipitating the onset of psychotic symptoms, depression, and chronic suicidal ideation, resulting in multiple hospitalizations. Combining metacognition‐oriented therapy with elements of cognitive behavioral therapy and psychiatric rehabilitation, this approach fostered significantly improved community functioning and attainment of personal goals over time. Through the journey of therapy, the patient also developed a more coherent narrative about his life, established a stable sense of self, and became an active agent in the world. This case illustration demonstrates that these three different approaches can be used in a sequential and complementary fashion to foster recovery in the midst of serious physical and mental illness.     

Parent Engagement With a Telehealth-Based Parent-Mediated Intervention Program for Children With Autism Spectrum Disorders: Predictors of Program Use and Parent Outcomes

BackgroundThere has been growing interest in using telehealth to increase access to parent-mediated interventions for children with ASD. However, little is known about how parents engage with such programs.ObjectiveThis paper presents program engagement data from a pilot study comparing self-directed and therapist-assisted versions of a novel telehealth-based parent-mediated intervention for young children with autism spectrum disorders (ASD).MethodsParents of young children with ASD were randomly assigned to receive a self-directed or therapist-assisted version of ImPACT Online. Parent engagement and satisfaction with the different components of the program website were examined using the program’s automated data collection and a post-treatment evaluation survey. We examined the relationship between program engagement and changes in parent knowledge and implementation and participant characteristics associated with program engagement.ResultsOf the 27 parent participants, the majority were female (26/27, 96%), married (22/27, 81%), with a college degree or higher (15/27, 56%), and less than half were not employed outside of the home (10/27, 37%). The mean chronological age of the child participants was 43.26 months, and the majority were male (19/27, 70%) and white (21/27, 78%). Most of the families (19/27, 70%) resided in a rural or medically underserved area. Parents logged into the website an average of 46.85 times, spent an average of 964.70 minutes on the site, and completed an average of 90.17% of the lesson learning activities. Participants in the therapist-assisted group were more likely to engage with the website than those in the self-directed group: F _2,24=17.65, P<.001. In total, 85% of participants completed the program, with a significantly greater completion rate in the therapist-assisted group (N=27): χ² ₁=5.06, P=.03. Lesson learning activities were visited significantly more often than the supplemental activities (all Ps<.05). Multiple regression controlling for pretreatment performance indicated that program completion (beta=.51, P=.02) predicted post-treatment intervention knowledge, and program completion (beta=.43, P=.03) and group assignment (beta=-.37, P=.045) predicted post-treatment intervention fidelity. Partial correlations indicated that parent depressive symptoms at pretreatment were negatively associated with program completion (r=-.40, P=.04), but other key parent and child demographic factors were not. Post-treatment measures of website usability (r=.65, P<.001), treatment acceptability (r=.58, P=.002), and overall satisfaction (r=.58, P=.002) were all related to program completion.ConclusionsParent engagement and satisfaction with ImPACT Online was high for both self-directed and therapist-assisted versions of the program, although therapist assistance increased engagement. Program completion was associated with parent outcomes, providing support for the role of the website in parent learning. This program has the potential to increase access to parent-mediated intervention for families of children with ASD.     

Mindfulness-Based Parent Training: Strategies to Lessen the Grip of Automaticity in Families With Disruptive Children

Disagreements and conflicts in families with disruptive children often reflect rigid patterns of behavior that have become overlearned and automatized with repeated practice. These patterns are mindless: They are performed with little or no awareness and are highly resistant to change. This article introduces a new, mindfulness-based model of parent training and contrasts the model's assumptions with those of behavioral (operant) parent training. The new model informs 3 strategies to lessen the grip of automaticity in families with disruptive children: facilitative listening, distancing, and motivated action plans. The article does not oppose mindfulness to mindlessness or suggest that the former is always better than the latter but instead proposes that each is most useful at different times in the parenting process. I conclude by calling for empirical investigations of mindfulness-based parent training and, if those are successful, for the development of an integrated model that blends behavioral and mindfulness-based principles to inform all facets of intervention.     

Making the Case for Selective and Directed Cultural Adaptations of Evidence-Based Treatments: Examples From Parent Training

With prevailing concerns about the generalizability of evidence-based treatments (EBTs) in real-world practice settings, there has been increased attention to the potential of cultural adaptations of treatments to ensure fit with diverse consumer populations. However, it could also be argued that there has been insufficient dissemination and evaluation of our existing EBTs with minority populations to warrant and guide adaptation efforts. This article discusses a framework (a) for identifying instances where cultural adaptation of EBTs may be most indicated, and (b) for using research to direct the development of treatment adaptations to ensure community engagement and the contextual relevance of treatment content. Ongoing work in the area of parent training is highlighted to illustrate key issues and recommendations.     

The Parent as Teacher: A Guide for Parents of Children With Learning Disabilities (Book)

The purpose of this project was to construct an instrument for the assessment of parental locus of control. In Study 1, the scale was constructed and administered to I47parents. Data analyses yielded a five-factor solution with acceptable indices of reliability. The purpose of Study 2 was to establish the construct and discriminant validity of the Parental Locus of Control (PLOC) Scale. The PLOC and seven additional scales assessing related personality constructs were administered to two groups of parents. Group A consisted of 60parents who reported no difficulties in the parenting role; Group B consisted of 45parents who had requested professional services for parenting problems or whose children had been identified as having behavioral/emotional difficulties. Data analyses revealed significant correlations for the majority of the predicted relationships, thereby demonstrating the construct validity of the PLOC. Group B parents scored significantly more external in locus of control than Group A parents, and three of the PLOC subscales were found to significantly differ beetween groups, thereby offering support for the discriminant validity of the PLOC.     

Biologic Therapies in the Treatment of Psoriasis: A Comprehensive Evidence-Based Basic Science and Clinical Review and a Practical Guide to Tuberculosis Monitoring

The treatment of psoriasis has undergone a revolution with the advent of biologic therapies including infliximab, etanercept, adalimumab, efalizumab, golimumab, certolizumab, alefacept, secukinumab, abatacept, and ustekinumab. These medications are designed to target specific components of the immune system and are a major technological advancement over traditional immunosuppressive medications. Herein, we present a comprehensive, unbiased comparison of these medications focusing on their differences. For example, TNF antagonists can differ in the way they are dissolved and administered, the effector molecules they can bind, serum peak and trough levels, the types of intracellular signals they can induce, the in vivo complexes that they can form, their protein structure, and their incidence and timing of rare adverse events, among other things. A critical review of the clinical studies that have tested the efficacy of these molecules is also presented including head-to-head comparison trials. The safety of biologics in terms of their long-term adverse events is discussed, as is their use in different types of psoriasis and in different patient populations. Finally, all anti-TNF agents have been associated with a variety of serious and “routine” opportunistic infections, particularly tuberculosis. For this reason, anti-tuberculosis testing both prior to the initiation of a biologic therapy and annually during treatment is pertinent. The uses and limitations of both the tuberculin skin test (TST) and QuantiFeron®-TB Gold (QFT) are discussed, as is the care of patients who present with latent tuberculosis infection prior to the initiation of biologic therapy. Recommendations for tuberculosis monitoring are provided.     

Maintaining the Treatment Effects of Parent Training: The Role of Booster Sessions and Other Maintenance Strategies

In light of the persistent nature of conduct problem behavior in children, and its enormous cost to families and society, the importance of developing effective interventions that foster lasting changes is discussed. Parent-management training (PMT) and studies of its associated long-term gains are reviewed. Although studies have demonstrated short-term gains for PMT, evidence for the long-term maintenance of treatment gains is limited. Strategies designed to promote the maintenance of treatment gains are drawn from both the adult and child treatment literature and applied to parent training. The need to reduce dropout and to examine the content and timing of booster sessions using randomized control group designs is emphasized. Future research must address the course of children's conduct problem behaviors, as well as the behaviors of parents and others (e.g., peers, teachers) who influence the child following treatment.     

Tailoring reach-to-grasp to intended action: the role of motor practice

Motor learning results from repeated exposure to the same movement and allows a mover to increase movement optimality. Typically, this has only been considered in single-step movements. In sequential movements, an initial reach movement is tailored to the demands of the onward movement. However, the exact role of motor practice in the tailoring to onward task demands is unknown. Eighteen adults performed blocks of 15 movements; each movement consisted of a reach phase and an onward phase (the object was placed in a tight-fitting hole, placed in a loose-fitting hole or thrown). Simple practice effects were seen; for the reach phase, the amount of time spent decelerating decreased over trials, and for the onward phase, the accuracy of the place/throw movements increased over trials. Furthermore, approximately 30 % of variance in the practice effect of the onward phase could be explained by the practice effect in the reach phase. Therefore, we suggest that the changes in the reach phase are directly linked to the changes in the efficiency of action and that this is necessary but not sufficient for explaining the calibration of the onward action.     

Five-Year Clinical Outcomes of a Randomized Trial of Anterior Cruciate Ligament Treatment Strategies: An Evidence-Based Practice Paper

Reference/Citation:Frobell RB, Roos HP, Roos EM, Roemer FW, Ranstam J, Lohmander LS. Treatment for acute anterior cruciate ligament tear: five year outcome of randomised trial. BMJ. 2013;346:F232.Conclusions:Early ACL reconstruction plus rehabilitation did not provide better results at 5 years compared with optional-delayed ACL reconstruction plus rehabilitation. Furthermore, the authors found no radiographic differences among patients with early ACL reconstruction, delayed ACL reconstruction, or no ACL reconstruction (rehabilitation alone).Key Words: knee, anterior cruciate ligament reconstruction, osteoarthritis