Does parental involvement make a difference in school-based nutrition and physical activity interventions? A systematic review of randomized controlled trials

Objectives

Parental involvement is often advocated as important for school-based interventions, however, to date, only inconsistent evidence is available. Therefore, this study aimed at determining the impact of parental involvement in school-based obesity prevention interventions in children and adolescents.

Methods

A systematic review of obesity prevention studies published from 1990 to 2010 including a comparison between school-based interventions with and without parental component was conducted. Only studies reporting effects on health behaviour-related outcomes were included.

Results

Some positive effects of parental involvement were found on children’s behaviours and behavioural determinants. Parental modules including different strategies and addressing several home-related determinants and parenting practices concerning eating and physical activity behaviours were more likely to be effective. However, no conclusive evidence could be provided concerning the added value of parent involvement, because of the paucity of studies to test this hypothesis. The few studies that are available provide inconsistent evidence.

Conclusions

There is a need for more studies comparing school-based interventions with and without a parental component, and dose, strategies and content of parental components of school-based interventions should be better reported in articles.     

School Reintegration Following Psychiatric Hospitalization: An Ecological Perspective

Background

School reintegration following psychiatric hospitalization can be challenging for children, their families, and school personnel. While school reintegration of children with physical illness has received considerable professional attention, our knowledge about the needs of children returning to school after psychiatric hospitalization is still limited.

Objective

This paper delineates an ecological perspective on school reintegration of children after hospitalization for mental health reasons. This perspective takes into account the multiple social systems in which children are embedded and focuses on both individual and environmental factors that may contribute to a child’s well-being or, conversely, trigger emotional and behavioral difficulties.

Methods

This is a theoretical paper based on the systematic review of empirical literature related to psychiatric hospitalization of children, post discharge adjustment, school reintegration following hospitalization, mental health stigma in children, and cross-agency collaboration.

Results

Several ecological factors that may affect school reintegration after psychiatric hospitalization were identified, including: (1) child/youth experiences with and perceptions of having a mental health condition, being hospitalized, and subsequent school reentry; (2) parental experiences and perceptions of child/youth psychiatric condition and hospitalization; (3) attitudes and reactions from members of the child/youth school ecology including teachers and peers; and (4) inter-disciplinary collaboration. The paper proposes ecologically informed guidelines to facilitate successful school reintegration and discusses the roles of the school-based mental health professionals in this process.

Conclusions

While complex and challenging, a successful reintegration may be the key step in reducing inpatient recidivism rates and improving a child’s future academic and behavioral success.     

It can't hurt to ask; a patient-centered quality of service assessment of health canada's medical cannabis policy and program

Background

Integrated treatment programs (those that include on-site pregnancy-, parenting-, or child-related services with addiction services) were developed to break the intergenerational cycle of addiction, dysfunctional parenting, and poor outcomes for mothers and children, yet there has been no systematic review of studies of parenting outcomes.

Objectives

As part of larger systematic review to examine the effectiveness of integrated programs for mothers with substance abuse issues, we performed a systematic review of studies published from 1990 to 2011 with data on parenting outcomes.

Methods

Literature search strategies included online bibliographic database searches, checking printed sources, and requests to researchers. Studies were included if all participants were mothers with substance abuse problems at baseline, the treatment program included at least one specific substance use treatment and at least one parenting or child service, and there were quantitative data on parenting outcomes. We summarized data on parenting skills and capacity outcomes.

Results

There were 24 cohort studies, 3 quasi-experimental studies, and 4 randomized trials. In the three randomized trials comparing integrated programs to addiction treatment-as-usual (N = 419), most improvements in parenting skills favored integrated programs and most effect sizes indicated that this advantage was small, ds = -0.02 to 0.94. Results for child protection services involvement did not differ by group. In the three studies that examined factors associated with treatment effects, parenting improvements were associated with attachment-based parenting interventions, children residing in the treatment facility, and improvements in maternal mental health.

Conclusions

This is the first systematic review of studies evaluating the effectiveness of integrated programs on parenting. The limited available evidence supports integrated programs, as findings suggest that they are associated with improvements in parenting skills. However, more research is required comparing integrated programs to addiction treatment-as-usual. This review highlights the need for improved methodology, study quality, and reporting to improve our understanding of how best to meet the parenting needs of women with substance abuse issues.     

A review of multidomain interventions to support healthy cognitive ageing

Objective

The risk for cognitive decline and for developing Alzheimer’s disease increases with age. The aetiology is assumed to be of multi-factorial origin, and treatment opportunities are lacking. Despite the multi-factorial origin, many intervention studies focused on single factors to influence cognitive health with inconsistent findings. In this view, more and more intervention studies aim to intervene on multiple factors simultaneously to affect or slow down cognitive decline. The purpose of this paper is to give an overview of these multidomain intervention trials.

Methods

We conducted a non-systematic literature search in Medline, Scopus, Cochrane Library, and clinical trials databases up to October 2011 to review multidomain interventions that investigated effects of combined lifestyle-related factors on cognitive decline and the progression of dementia.

Results

Interest in multidomain interventions increased over the past years. We identified six completed and published trials and eight ongoing or not yet published studies that investigated effects on cognitive outcomes. First completed trials yielded promising results for the combination of exercise and mental training and diet and behavioural weight management. Results of ongoing multidomain trials are awaited.

Conclusions

Some evidence suggests that strategies which target multiple factors simultaneously may prove more effective than those focusing on a single mechanism or domain. Larger high-quality randomized controlled trials are required to systematically investigate the cognitive effect of programs comprising physical and mental activity as well as nutritional aspects.     

Predictors of Initial Engagement in Child Anxiety Mental Health Specialty Services

Background

Child and family mental health services remain largely underutilized despite the relatively high rate of youth suffering from mental, emotional, and behavioral disorders. As such, it is important to address challenges and examine factors related to child mental health service use and engagement, especially when it comes to children in need of services for anxiety.

Objective

Informed by the behavioral model of health services use, the present study sought to examine predictors of service use and engagement for families seeking assistance for their anxious children. Initial levels of engagement in culturally tailored services were predicted from predisposing characteristics (e.g., child age, ethnicity), enabling resources (e.g., Spanish services, transportation), and need characteristics (e.g., child clinical severity).

Methods

Participants included Latino (n = 126) and Caucasian (n = 116) families who presented to a specialty clinic due to child emotional and behavior problems related to anxiety. Initial service utilization and engagement was assessed along the following levels toward services care: (1) initiated contact and completed a clinical intake, (2) completed a home screen, and (3) completed an on-site diagnostic assessment. All procedures were culturally tailored to the presenting needs of families.

Results

Predisposing characteristics, enabling resources and need characteristics emerged as significant predictors of child mental health service use, with some variations. Child age, ethnicity, referral source, and enabling resources predicted completion of a home screen. Proximity to services predicted completion of the on-site diagnostic assessment.

Conclusion

Knowledge of factors that predict engagement in child mental health services can help identify avenues to promote service utilization, especially among ethnic minority children and families. Our culturally tailored approach to serving families appears to be promising in bridging the cross-ethnic services gap and therefore has implications for practice.     

Health-related quality of life in fathers of children with or without developmental disability: the mediating effect of parental stress

Purpose

The aims of this study were to compare parental stress and health-related quality of life (HRQOL) between Taiwanese fathers of children with and without developmental disabilities (DDs) and to examine the mediating effect of parental stress on the association between having a child with DD and paternal HRQOL within Chinese culture.

Method

This cross-sectional, prospective, unmatched case–control study included 206 fathers of children with DDs and 207 fathers of healthy children. HRQOL was assessed by the SF-36 short-form questionnaire, and parental stress was assessed by the Chinese version Parental Stress Scale.

Results

Fathers of children with DDs experienced poorer mental and physical HRQOL and higher parental stress than fathers of healthy children. Parental stress acted as a complete mediator for paternal physical HRQOL, while parental stress had a partial mediating effect on the relationship between having a child with DD and paternal mental HRQOL. Having a child with DD also directly affected paternal mental HRQOL.

Conclusions

Fathers of children with DDs should be monitored for parental stress and HRQOL, and interventions should be provided to empower them with the knowledge and skills to reduce their stress and to enhance their HRQOL.     

‘It helps me make sense of the world’: the role of an art intervention for promoting health and wellbeing in primary care—perspectives of patients, health professionals and artists

Background

Art interventions are increasingly used in public health for the enhancement of patients’ health and wellbeing. The present study investigated perceived outcomes and role of an art intervention from the collective perspectives of participants (patients who took part), deliverers (artists) and referrers (general practitioners and practice nurses).

Methods

A qualitative methodology, using interviews and focus groups, allowed investigation of participants (n?=?18) perceived outcomes and role of the intervention. Participants included patients (n?=?10), artists (n?=?5), and referring health professionals (n?=?3).

Results

Themes that emerged from the analysis included perceived benefits, role and value of the intervention, and setting and referral process. Central to these themes were psychological and mental health benefits, an appreciated holistic treatment option and the merits of the intervention being situated in the surgery setting.

Conclusions

The study showed that art interventions within primary care are valuable in the promotion of public health, and in particular, patients’ mental health. Interactions between other participants and the artist were central to achieving patients’ perceived health improvement. Locating the intervention in primary care facilitated patient participation and provided health professionals with a holistic treatment alternative. There is also some evidence that participation in the intervention encourages less dependence on the health professional.     

Mental health literacy and attitudes in a Swedish community sample – Investigating the role of personal experience of mental health care

Background

The role of social and family environments in the development of mental health problems among children and youth has been widely investigated. However, the degree to which parental working conditions may impact on developmental psychopathology has not been thoroughly studied.

Methods

We conducted a case-control study of several mental health outcomes of 19,833 children of sawmill workers and their association with parental work stress, parental socio-demographic characteristics, and paternal mental health.

Results

Multivariate analysis conducted with four distinct age groups (children, adolescents, young adults, and adults) revealed that anxiety based and depressive disorders were associated with paternal work stress in all age groups and that work stress was more strongly associated with alcohol and drug related disorders in adulthood than it was in adolescence and young adulthood.

Conclusion

This study provides support to the tenet that being exposed to paternal work stress during childhood can have long lasting effects on the mental health of individuals.     

Observations of Group Care Worker-Child Interaction in Residential Youth Care: Pedagogical Interventions and Child Behavior

Background

The work of group care workers in residential youth care is often described as professional parenting. Pedagogical interventions of group care workers influence the quality of care for looked-after children.

Objective

The aim of the current study was to observe the pedagogical interventions of group care workers within residential youth care and their associations with child behaviors.

Methods

Group care worker interventions and child behaviors were videotaped during structured observations. Participants included 95 children (64 % boys, M _age = 9.19) and 53 group care workers (74 % female, M _age = 33.79 years). A coding system was developed to code pedagogical interventions and child behaviors.

Results

It showed that group care workers mainly used positive pedagogical interventions (warmth/support and positive control) and seldom used negative pedagogical interventions (permissiveness and negative control). Frustration and anger of children was associated with positive controlling interventions and permissiveness of group care workers. The hypothesis that child anxiety and nervousness is associated with warm and supportive interventions could not be confirmed.

Conclusions

Pedagogical interventions should be part of education, training, and supervision of group care workers.     

Socioeconomic inequalities in mental health and health-related quality of life (HRQOL) in children and adolescents from 11 European countries

Objectives

To assess the presence and magnitude of social inequalities in mental health and health-related quality of life (HRQOL) in the population aged 8–18 years in 11 European countries.

Methods

Cross-sectional surveys were carried out in representative samples of children/adolescents (8–18 years) from the participating countries of the KIDSCREEN project. Mental health was assessed using the Strengths and Difficulties Questionnaire (SDQ), and HRQOL by means of the KIDSCREEN-10. Socioeconomic status (SES) was assessed using the Family Affluence Scale and parental level of education. The association between health outcomes and SES was analyzed with the regression-based relative index of inequalities (RII) and population attributable risk.

Results

A total of 16,210 parent–child pairs were included. The SDQ showed inequalities in mental health according to family level of education in all countries (RII = 1.45; 1.37–1.53). The RII for HRQOL was 2.15 (1.79–2.59) in the whole sample, with less consistent results by age and country.

Conclusions

Socioeconomic inequalities in mental health were consistently found across Europe. Future research should clarify the causes of these inequalities and define initiatives which prevent them continuing into adulthood.     

Validating physician-certified verbal autopsy and probabilistic modeling (InterVA) approaches to verbal autopsy interpretation using hospital causes of adult deaths

Background

Effective implementation of child survival interventions depends on improved understanding of cultural, social, and health system factors affecting utilization of health care. Never the less, no standardized instrument exists for collecting and interpreting information on how to avert death and improve the implementation of child survival interventions.

Objective

To describe the methodology, development, and first results of a standard social autopsy tool for the collection of information to understand common barriers to health care, risky behaviors, and missed opportunities for health intervention in deceased children under 5 years old.

Methods

Under the INDEPTH Network, a social autopsy working group was formed to reach consensus around a standard social autopsy tool for neonatal and child death. The details around 434 child deaths in Iganga/Mayuge Health and Demographic Surveillance Site (HDSS) in Uganda and 40 child deaths in Dodowa HDSS in Ghana were investigated over 12 to 18 months. Interviews with the caretakers of these children elicited information on what happened before death, including signs and symptoms, contact with health services, details on treatments, and details of doctors. These social autopsies were used to assess the contributions of delays in care seeking and case management to the childhood deaths.

Results

At least one severe symptom had been recognized prior to death in 96% of the children in Iganga/Mayuge HDSS and in 70% in Dodowa HDSS, yet 32% and 80% of children were first treated at home, respectively. Twenty percent of children in Iganga/Mayuge HDSS and 13% of children in Dodowa HDSS were never taken for care outside the home. In both countries most went to private providers. In Iganga/Mayuge HDSS the main delays were caused by inadequate case management by the health provider, while in Dodowa HDSS the main delays were in the home.

Conclusion

While delay at home was a main obstacle to prompt and appropriate treatment in Dodowa HDSS, there were severe challenges to prompt and adequate case management in the health system in both study sites in Ghana and Uganda. Meanwhile, caretaker awareness of danger signs needs to improve in both countries to promote early care seeking and to reduce the number of children needing referral. Social autopsy methods can improve this understanding, which can assist health planners to prioritize scarce resources appropriately.     

The effectiveness of psychosocial interventions designed to improve health-related quality of life (HRQOL) amongst asthmatic children and their families: a systematic review

Purpose

Asthmatic children are at risk of compromised health-related quality of life (HRQOL) compared with their healthy peers. This systematic review reports the range and effectiveness of psychosocial interventions designed to improve HRQOL amongst asthmatic children, adolescents, and their families.

Method

Data sources included The Cochrane Airways Group Trials Register of trials, PubMed database, and reference lists from review articles.

Results

Eighteen studies of psychosocial interventions were identified. Interventions were designed to improve HRQOL amongst a range of psychosocial, health care, school-related and clinical outcomes, and were delivered in numerous settings and formats. Four studies reported that interventions were effective for significant improvements in child overall HRQOL scores. These include asthma education (n?=?2), asthma education plus problem solving (n?=?1), and art therapy (n?=?1).

Conclusions

Most interventions focussed on the delivery of asthma education to children, with the purpose of improving knowledge about asthma and disease management. There is limited evidence to suggest that interventions currently available are effective for significantly improving HRQOL amongst asthmatic children, adolescents, and their families. Most interventions lacked a theoretical basis and did not focus on family functioning variables. Multi-component interventions that incorporate asthma education along with strategies to assist families with implementing behaviour change towards improved asthma management are required. Future interventions should also attempt to address the wider context of family functioning likely to contribute to the family??s ability to engage in successful asthma management in order to improve HRQOL.     

The Reliability and Validity of the Dominic Interactive: A Computerized Child Report Instrument for Mental Health Problems

Background

Children and youths’ self-report of mental health problems is considered essential but complicated.

Objective

This study examines the psychometric properties of the Dominic Interactive, a computerized DSM-IV based self-report questionnaire and explores informant correspondence.

Methods

The Dominic Interactive was administered to 214 Dutch children, 6–11 year old, 122 attended special education schools and 92 children attended public schools. Within 2 weeks 155 children were reassessed. Parents of 211 children completed a paper version of the Dominic Interactive.

Results

The findings showed moderate to good internal consistency and test-retest reliability, although stability increased with age. Factor structure concerning generalized anxiety disorder and major depressive disorder displayed ambiguous results. Comparing special education with public school children revealed that both parents and children in special education reported significantly more problems on almost all scales. The results on informant correspondence revealed that discrepancies in reports were not consistent across individual pairs; they were due to a few extreme cases. Eliminating these cases increased the agreement in reports.

Conclusions

Although more research is needed to determine the value of the Dominic Interactive, the Dominic Interactive has the potential to contribute with its unique features to the existing self-report instruments for screening and assessing child mental health.     

The influence of parental education on child mental health in Spain

Purpose

To analyze the association between parental education and offspring’s mental health in a nationally representative Spanish sample, and assess the contribution of other socioeconomic factors to the association.

Methods

We conducted a secondary analysis of data on 4- to 15-year-olds participating in the 2006 Spanish National Health Survey. Mental health was assessed using the parent-reported Strengths & Difficulties Questionnaire. Parents’ respective educational levels were summarized in a single variable. Univariate and multivariate analyses, controlling for family-, child- and parent-related characteristics, were used to study the association.

Results

The final sample comprised 5,635 children. A strong association between parental education and parent-reported child mental health was observed among 4- to 11-year-olds, with odds ratios (ORs) increasing as parental educational level decreased. Where both parents had a sub-university level, maternal education showed a stronger association than did paternal education. Following adjustment for covariates, parental education continued to be the strongest risk factor for parent-reported child mental health problems, OR = 3.7 (95% CI 2.4–5.8) for the lowest educational level, but no association was found among 12- to 15-year-olds. Male sex, immigrant status, activity limitation, parent’s poor mental health, low social support, poor family function, single-parent families, low family income and social class were associated with parent-reported child mental health problems in both age groups.

Conclusions

Our results show that there is a strong association between parental education and parent-reported child mental health, and that this is indeed stronger than that for income and social class. Among adolescents, however, the effect of parental education would appear to be outweighed by other factors.     

Adverse Childhood Experiences and Child Health Outcomes: Comparing Cumulative Risk and Latent Class Approaches

Objectives This study seeks to further the work exploring adverse childhood experiences (ACEs) by proposing a novel approach to understanding the impact of ACEs through applying advanced analytical methods to examine whether combinations of ACEs differentially impact child health outcomes. Methods Using National Survey of Children’s Health data, we use latent class analysis to estimate associations between classes of ACEs and child health outcomes. Results Class membership predicts child poor health, with differences found for specific ACE combinations. A subgroup of children exposed to poverty and parental mental illness are at higher risk for special healthcare needs than all other groups, including children exposed to 3 or more ACEs. Conclusions Different combinations of ACEs carry different risk for child health. Interventions tailored to specific ACEs and ACE combinations are likely to have a greater effect on improving child health. Our findings suggest children who experience specific ACE combinations (e.g., poverty and parental mental illness) are at particularly high risk for poor health outcomes. Therefore, clinicians should routinely assess for ACEs to identify children exposed to the most problematic ACE combinations; once identified, these children should be given priority for supportive interventions tailored to their specific ACE exposure and needs.     

The Use of Adventure Therapy in Community-Based Mental Health: Decreases in Problem Severity Among Youth Clients

Background

There is an increasing need to identify effective mental health treatment practices for children and adolescents in community-based settings, due to current mixed findings of existing interventions. This study looked at adventure therapy (AT) as a viable option to meet this need.

Objective

Using a sample of 1,135 youth from a community-based mental health center, this study addressed the following questions: (1) Is AT an effective treatment modality for youth compared to traditional counseling? (2) How do changes in problem severity associated with participation in AT-based interventions compare with those associated with traditional counseling across gender, age, primary diagnosis, and race? (3) What are the predictors of changes in problem severity in clients?

Methods

In this exploratory non-equivalent groups quasi-experimental design study, pre- and post- mean scores of problem severity as reported by youth’s primary clinician were compared by type of treatment and client characteristics. Treatment and client characteristics were used as predictors of changes in problem severity.

Findings

Participants in AT had significant reported mean decreases in problem severity larger than those of clients not involved in counseling with an adventure component with larger decreases in female and African American clients. AT and psychological counseling were found to be significant predictors of decreases in problem severity; however, length of counseling, not length of AT, was a significant predictor.

Discussion

These findings suggest that community-based AT may be a viable treatment for youth in community settings; yet these findings should be interpreted with caution due to several study limitations.     

Household crowding and psychosocial health among Inuit in Greenland

Objectives

Poor housing conditions experienced by many Indigenous peoples threaten their health and well-being. This study examines whether household crowding is associated with poorer psychosocial health among Greenlanders, and the mediating role of social support. It also assesses whether Inuit men and women are differently influenced by their housing conditions.

Methods

Data on more than 3,000 Inuit aged 18 years and older are from the Inuit health in transition Greenland survey. Associations between household crowding and composition, and mental well-being and binge drinking were examined using logistic regression models, adjusting for individuals’ characteristics.

Results

Household crowding was associated with poorer mental well-being. Binge drinking was more common among people living in households without children. These effects were more important for women than for men. The association between household crowding and mental well-being was significantly mediated by social support. This suggests that having a strong social network may buffer the deleterious impacts of household crowding.

Conclusions

Targeting housing conditions and fostering social support as part of population health interventions might contribute to improving psychosocial health and well-being in Greenland.     

Deliberate Self-harm Among Children in Tertiary Care Residential Treatment: Prevalence and Correlates

Background

Few studies have examined deliberate self-harm (DSH) among children in residential treatment in Canada. Most of the existing studies examined adolescent students or children from pediatric emergency departments.

Objectives

The objectives of this study were to examine the prevalence of DSH among children in tertiary care residential treatment and the factors associated with DSH.

Methods

Data on 284 children aged 5–17 years (M = 11.54 years, SD = 2.56) with mental health problems in tertiary care residential treatment were analyzed. Binary logistic regression was performed to examine the likelihood of engaging in DSH.

Results

About 35 % of children engaged in DSH. Suicidal talk emerged as the strongest factor to be associated with DSH. Children who used alcohol or drugs were also more likely to engage in DSH than those who did not use alcohol or drugs. Furthermore, symptoms of conduct problems were associated with the likelihood of engaging in DSH.

Conclusions

Identifying children at risk for engaging in DSH and suicidal behavior is of critical importance to mental health care providers. These factors could assist in identifying children who might require more specialized treatment related to self-harm during their stay in residential treatment.