Family-focused weight management program for five- to nine-year-olds incorporating parenting skills training with healthy lifestyle information to support behaviour modification

his case study aims to describe how general parenting principles can be used as part of parent-led, family-focused child weight management that is in line with current Australian Clinical Practice Guidelines. A parent-led, family-focused child weight management program was designed for use by dietitians with parents of young children (five- to nine-year-olds). The program utilises the cornerstones of overweight treatment: diet, activity, behaviour modification and family support delivered in an age-appropriate, family-focused manner. Parents participate in 16 sessions (4 parenting-focused, 8 lifestyle-focused and 4 individual telephone support calls) conducted weekly, fortnightly then monthly over six months. This case study illustrates how a family used the program, resulting in reduced degree of overweight and stabilised waist circumference in the child over 12 months. In conclusion, linking parenting skills to healthy family lifestyle education provides an innovative approach to family-focused child weight management. It addresses key Australian Clinical Practice Guidelines, works at the family level, and provides a means for dietitians to easily adopt age-appropriate behaviour modification as part of their practice.

The effectiveness of a short-term group music therapy intervention for parents who have a child with a disability

The relationship between the quality of parent-child interactions and positive child developmental trajectories is well established (Guralnick, 2006; Shonkoff & Meissels, 2000; Zubrick et al., 2008). However, a range of parental, family, and socio-economic factors can pose risks to parents’ capacity to participate in quality interactions with their children. In particular, families with a child with a disability have been found to have higher levels of parenting stress, and are more likely to experience economic disadvantage, as well as social isolation. The importance of early interventions to promote positive parenting and child development for these families is widely recognised (Shonkoff & Meissels, 2000). However, to date, there is a lack of evidence about the effectiveness of early parenting programs for families who have a young child with a disability. This thesis investigates the impact of a music therapy parenting program, Sing & Grow, on 201 parent-child dyads who attended programs specifically targeted to parents who had a young child with a disability. Sing & Grow is an Australian national early parenting intervention funded by the Australian Government Department of Families, Housing, Community Services and Indigenous Affairs and delivered by Playgroup Queensland. It is designed and delivered by Registered Music Therapists for families with children aged from birth to three years. It aims to improve parenting skills and confidence, improve family functioning (positive parent-child interactions), enhance child development, and provide social networking opportunities to socially isolated families. The intervention targets a range of families in circumstances that have the potential to impact negatively on family functioning. This thesis uses data from the National Evaluation Study of Sing & Grow from programs which were targeted at families who had a young child with a disability. Three studies were conducted to address the objectives of this thesis. Study 1 examines the effects of the Sing & Grow intervention on parent reported pre and post parent mental health, parenting confidence, parenting skills, and child development, and other parent reported outcomes including social support, use of intervention resources, satisfaction with the intervention and perceived benefits of and barriers to participation. Significant improvements from pre to post were found for parent mental health and parent reported child communication and social skills, along with evidence that parents were very satisfied with the program and that it brought social benefits to families. Study 2 explored the pre to post effects of the intervention on children’s developmental skills and parent-child interactions using observational ratings made by clinicians. Significant pre to post improvements were found for parenting sensitivity, parental engagement with child and acceptance of child as well as for child responsiveness to parent, interest, and participation in the intervention, and social skills. Study 3 examined the nature of child and family characteristics that predicted better outcomes for families while taking account of the level of participation in the program. An overall outcome index was calculated and served as the dependent variable in a logistic regression analysis. Families who attended six or more sessions and mothers who had not completed high school were more likely to have higher outcome scores at post intervention than those who attended fewer sessions and those with more educated mothers respectively. The findings of this research indicate that the intervention had a positive impact on participants’ mental health, parenting behaviours and child development and that level of attendance was associated with better outcomes. There was also evidence that the program reached its target of high risk families (i.e., families in which mothers had lower educational levels) and that for these families better outcomes were achieved. There were also indications that the program was accessible and highly regarded by families and that it promoted social connections for participants. A theoretical model of how the intervention is currently working for families is proposed to explain the connections between early parenting, child development and maternal wellbeing. However, more research is required to further elucidate the mechanisms by which the intervention creates change for families. This research presents promising evidence that a short term group music therapy program can elicit important therapeutic benefits for families who have a child with a disability.

Universal online interventions might engage psychologically distressed university students who are unlikely to seek formal help

University students are a high risk population for mental health problems, yet few seek professional help when experiencing problems. This study explored the potential role of an online intervention for promoting wellbeing in university students, by investigating students' help-seeking behaviour, intention to use online interventions and student content preference for such interventions; 254 university students responded to an online survey designed for this study. As predicted, students were less likely to seek help as levels of psychological distress increased. Conversely, intention to use an online intervention increased at higher levels of distress, with 39.1%, 49.4% and 57.7% of low, moderate and severely distressed students respectively indicating they would use an online program supporting student well-being. Results suggest that online interventions may be a useful way to provide help to students in need who otherwise may not seek formal help.

Correlates of sitting time in working age Australian women : who should be targeted with interventions to decrease sitting time?

Background: While there is emerging evidence that sedentary behavior is negatively associated with health risk, research on the correlates of sitting time in adults is scarce. Methods: Self-report data from 7,724 women born between 1973-1978 and 8,198 women born between 1946-1951 were collected as part of the Australian Longitudinal Study on Women’s Health. Linear regression models were computed to examine whether demographic, family and caring duties, time use, health and health behavior variables were associated with weekday sitting time. Results: Mean sitting time (SD) was 6.60 (3.32) hours/day for the 1973-1978 cohort and 5.70 (3.04) hours/day for the 1946-1951 cohort. Indicators of socio-economic advantage, such as full11 time work and skilled occupations in both cohorts and university education in the mid-age cohort, were associated with high sitting time. A cluster of ‘healthy behaviours’ was associated with lower sitting time in the mid-aged women (moderate/high physical activity levels, non-smoking, non-drinking). For both cohorts, sitting time was highest in women in full-time work, in skilled occupations and in those who spent the most time in passive leisure. Conclusions: The results suggest that, in young and mid-aged women, interventions for reducing sitting time should focus on both occupational and leisure-time sitting.

Identifying parents' perceptions about physical activity : a qualitative exploration of salient behavioural, normative and control beliefs among mothers and fathers of young children

Drawing on the belief-based framework of the Theory of Planned Behaviour, this study employs qualitative methodology involving individual and group interviews to examine the beliefs associated with regular physical activity performance among parents of young children (N = 40). The data were analysed using thematic content analysis. A range of advantages (e.g. improves parenting practices), disadvantages (e.g. interferes with commitments), barriers (e.g. time), and facilitators (e.g. social support) to performing physical activity are identified. Normative pressures are also identified as affecting parents’ activity behaviour. These identified beliefs can be used to inform interventions to challenge inactivity among this at-risk group.

Identifying key belief-based targets for promoting regular physical activity among mothers and fathers with young children

We investigated the key beliefs to target in interventions aimed at increasing physical activity (PA) among mothers and fathers of young children. Parents (288 mothers and 292 fathers) completed a Theory of Planned Behaviour belief-based questionnaire and a 1-week follow-up of PA behaviour. We found that a range of behavioural, normative, and control beliefs were significantly correlated with parents’ PA intentions and behaviour, with only a few differences observed in correlations between PA beliefs and intention and behaviour by gender. A range of key beliefs was identified as making independent contributions to parents’ PA intentions; however, the behavioural beliefs about improving parenting practices (β = 0.13), interfering with other commitments (β = −0.29); normative beliefs about people I exercise with (β = 0.20); and control beliefs about lack of time (β = −0.24), inconvenience (β = −0.14), lack of motivation (β = −0.34), were revealed as significant independent predictors of actual PA behaviour. Furthermore, we found that a limited amount of parents already hold these beliefs, suggesting that these key beliefs warrant changing and, therefore, are appropriate targets for subsequent intervention. The current study fills an empirical gap in the PA literature by investigating an at-risk group and using a well established theoretical framework to identify key beliefs that guide parents’ PA decision-making. Overall, we found support for parents being a unique group who hold distinctive behavioural, normative, and control beliefs toward PA. Attention to these key underlying beliefs will assist intervention work aimed at combating inactivity among this at-risk population.

Interventions for preventing and managing aggressive patients admitted to an acute hospital setting: A systematic review

Background: Violence in health care has been widely reported and health care workers, particularly nurses in acute care settings, are ill-equipped to manage patients who exhibit aggressive traits. Aim: The aim of this systematic review was to establish best practice in the prevention and management of aggressive behaviours in patients admitted to acute hospital settings. Data Sources: An extensive search of the major databases was conducted from 1990 to 2007. The search included published and unpublished studies and papers in English. Review Methods: This review considered any quantitative research study design that evaluated the effectiveness of interventions in the prevention and management of patients who exhibit aggressive behaviours in an acute hospital setting. Each included study was quality assessed by two independent reviewers and data were extracted using the relevant tools developed by the Joanna Briggs Institute. Results: Ten studies met the inclusion criteria and were included in the review. The evidence identified from the studies includes: the benefit of education and training of acute care nurses in aggression management techniques; use of “as required” medications is effective in minimising harm to patients and staff; and that specific interventions such as physical restraint may play a role in managing aggressive behaviours from patients in the acute care setting. Conclusions: This review makes several recommendations for the prevention and management of aggressive behaviours in acute hospital patients. However, due to the lack of high-quality studies conducted in the acute care setting there is huge scope for future research in this area.

The Early Prevention of Obesity in CHildren (EPOCH) collaboration : an individual patient data prospective meta-analysis

Background: Efforts to prevent the development of overweight and obesity have increasingly focused early in the life course as we recognise that both metabolic and behavioural patterns are often established within the first few years of life. Randomised controlled trials (RCTs) of interventions are even more powerful when, with forethought, they are synthesised into an individual patient data (IPD) prospective meta-analysis (PMA). An IPD PMA is a unique research design where several trials are identified for inclusion in an analysis before any of the individual trial results become known and the data are provided for each randomised patient. This methodology minimises the publication and selection bias often associated with a retrospective meta-analysis by allowing hypotheses, analysis methods and selection criteria to be specified a priori. Methods/Design: The Early Prevention of Obesity in CHildren (EPOCH) Collaboration was formed in 2009. The main objective of the EPOCH Collaboration is to determine if early intervention for childhood obesity impacts on body mass index (BMI) z scores at age 18-24 months. Additional research questions will focus on whether early intervention has an impact on children’s dietary quality, TV viewing time, duration of breastfeeding and parenting styles. This protocol includes the hypotheses, inclusion criteria and outcome measures to be used in the IPD PMA. The sample size of the combined dataset at final outcome assessment (approximately 1800 infants) will allow greater precision when exploring differences in the effect of early intervention with respect to pre-specified participant- and intervention-level characteristics. Discussion: Finalisation of the data collection procedures and analysis plans will be complete by the end of 2010. Data collection and analysis will occur during 2011-2012 and results should be available by 2013. Trial registration number: ACTRN12610000789066

Nurse-led telephone interventions for people with cardiac disease : A review of the research literature

Background: Nurse-led telephone follow-up offers a relatively inexpensive method of delivering education and support for assisting recovery in the early discharge period; however, its efficacy is yet to be determined. Aim: To perform a critical integrative review of the research literature addressing the effectiveness of nurse-led telephone interventions for people with coronary heart disease (CHD). Methods: A literature search of five health care databases; Sciencedirect, Cumulative Index to Nursing and Allied Health Literature, Pubmed, Proquest and Medline to identify journal articles between 1980 and 2009. People with cardiac disease were considered for inclusion in this review. The search yielded 128 papers, of which 24 met the inclusion criteria. Results: A total of 8330 participants from 24 studies were included in the final review. Seven studies demonstrated statistically significant differences in all outcomes measured, used two group experimental research design and valid and reliable instruments. Some positive effects were detected in eight studies in regards to nurse-led telephone interventions for people with cardiac disease and no differences were detected in nine studies. Discussion: Studies with some positive effects generally had stronger research designs, large samples, used valid and reliable instruments and extensive nurse-led educative interventions. Conclusion: The results suggest that people with cardiac disease showed some benefits from nurse-led/delivered telephone interventions. More rigorous research into this area is needed.

The effectiveness of a short-term group music therapy intervention for parents who have a child with a disability

Background The relationship between positive parent-child interactions and optimal child development is well established. Families with a child with a disability may face additional challenges to establishing positive parent-child relationships. There are limited studies addressing the effectiveness of interventions which seek to address these issues with parents and young children with a disability. In particular, prior studies of music therapy with this group have been limited by small sample sizes and the use of measures of limited reliability and validity. Objective This study investigates the effectiveness of a short-term group music therapy intervention for parents who have a child with a disability and explores the factors associated with higher outcomes for participating families. Methods The participants were 201 mother-child dyads, where the child had a disability. Pre and post intervention parental questionnaires and clinician observation measures were taken on a range of parental wellbeing, parenting behaviours and child developmental factors. Descriptive data, t-tests for repeated measures and a predictive model tested via logistic regression are presented. Results Significant improvements pre to post were found for parent mental health, child communication and social skills, parenting sensitivity, parental engagement with child and acceptance of child, child responsiveness to parent, and child interest and participation in program activities. There was also evidence that parents were very satisfied with the program and that it brought social benefits to families. Reliable change on six or more indicators of parent or child functioning was predicted by attendance and parent education. Conclusions This study provides positive evidence for the effectiveness of group music therapy in promoting improved parental mental health, positive parenting and key child developmental areas. Whilst several limitations are discussed, the study does address some of the gaps in the music therapy evidence base in this area.

Online alcohol interventions : a systematic review

Background: There has been a significant increase in the availability of online programs for alcohol problems. A systematic review of the research evidence underpinning these programs is timely. Objectives: Our objective was to review the efficacy of online interventions for alcohol misuse. Systematic searches of Medline, PsycINFO, Web of Science, and Scopus were conducted for English abstracts (excluding dissertations) published from 1998 onward. Search terms were: (1) Internet, Web*; (2) online, computer*; (3) alcohol*; and (4) E\effect*, trial*, random* (where * denotes a wildcard). Forward and backward searches from identified papers were also conducted. Articles were included if (1) the primary intervention was delivered and accessed via the Internet, (2) the intervention focused on moderating or stopping alcohol consumption, and (3) the study was a randomized controlled trial of an alcohol-related screen, assessment, or intervention. Results: The literature search initially yielded 31 randomized controlled trials (RCTs), 17 of which met inclusion criteria. Of these 17 studies, 12 (70.6%) were conducted with university students, and 11 (64.7%) specifically focused on at-risk, heavy, or binge drinkers. Sample sizes ranged from 40 to 3216 (median 261), with 12 (70.6%) studies predominantly involving brief personalized feedback interventions. Using published data, effect sizes could be extracted from 8 of the 17 studies. In relation to alcohol units per week or month and based on 5 RCTs where a measure of alcohol units per week or month could be extracted, differential effect sizes to post treatment ranged from 0.02 to 0.81 (mean 0.42, median 0.54). Pre-post effect sizes for brief personalized feedback interventions ranged from 0.02 to 0.81, and in 2 multi-session modularized interventions, a pre-post effect size of 0.56 was obtained in both. Pre-post differential effect sizes for peak blood alcohol concentrations (BAC) ranged from 0.22 to 0.88, with a mean effect size of 0.66. Conclusions: The available evidence suggests that users can benefit from online alcohol interventions and that this approach could be particularly useful for groups less likely to access traditional alcohol-related services, such as women, young people, and at-risk users. However, caution should be exercised given the limited number of studies allowing extraction of effect sizes, the heterogeneity of outcome measures and follow-up periods, and the large proportion of student-based studies. More extensive RCTs in community samples are required to better understand the efficacy of specific online alcohol approaches, program dosage, the additive effect of telephone or face-to-face interventions, and effective strategies for their dissemination and marketing.

Adapting low intensity CBT interventions for clients with severe mental illness

Many people with severe mental illness (SMI) such as schizophrenia, whose psychotic symptoms are effectively managed, continue to experience significant functional problems. This chapter argues that low intensity (LI) cognitive behaviour therapy (CBT; e.g. for depression, anxiety, or other issues) is applicable to these clients, and that LI CBT can be consistent with long-term case management. However, adjustments to LI CBT strategies are often necessary and boundaries between LI CBT and high intensity (HI) CBT (with more extensive practitioner contact and complexity) may become blurred. Our focus is on LI CBT's self-management emphasis, its restricted content and segment length, and potential use after limited training. In addition to exploring these issues, it draws on the authors' Collaborative Recovery (CR; Oades et al. 2005) and 'Start Over and Survive' programs (Kavanagh et al. 2004) as examples. ----- ----- Evidence for the effectiveness of LI CBT with severe mental illness is often embedded within multicomponent programs. For example, goal setting and therapeutic homework are common components of such programs, but they can also be used as discrete LI CBT interventions. A review of 40 randomised controlled trials involving recipients with schizophrenia or other sever mental illnesses has identified key components of illness management programs (Mueser et al. 2002). However, it is relatively rare for specific components of these complex interventions to be assessed in isolation. Given these constraints, the evidence for specific LI CBT interventions with severe mental ilnness is relatively limited.

Non-pharmacological interventions in secondary schizophrenia

Schizophrenia may not be a single disease, but the result of a diverse set of related conditions. Modern neuroscience is beginning to reveal some of the genetic and environmental underpinnings of schizophrenia; however, an approach less well travelled is to examine the medical disorders that produce symptoms resembling schizophrenia. This book is the first major attempt to bring together the diseases that produce what has been termed 'secondary schizophrenia'. International experts from diverse backgrounds ask the questions: does this medical disorder, or drug, or condition cause psychosis? If yes, does it resemble schizophrenia? What mechanisms form the basis of this relationship? What implications does this understanding have for aetiology and treatment? The answers are a feast for clinicians and researchers of psychosis and schizophrenia. They mark the next step in trying to meet the most important challenge to modern neuroscience – understanding and conquering this most mysterious of human diseases.

Review of refugee mental health interventions following resettlement : best practices and recommendations

There are increasing numbers of refugees worldwide, with approximately 16 million refugees in 2007 and over 2.5 million refugees resettled in the United States since the start of its humanitarian program. Psychologists and other health professionals who deliver mental health services for individuals from refugee backgrounds need to have confidence that the therapeutic interventions they employ are appropriate and effective for the clients with whom they work. The current review briefly surveys refugee research, examines empirical evaluations of therapeutic interventions in resettlement contexts, and provides recommendations for best practices and future directions in resettlement countries. The resettlement interventions found to be most effective typically target culturally homogeneous client samples and demonstrate moderate to large outcome effects on aspects of traumatic stress and anxiety reduction. Further evaluations of the array of psychotherapeutic, psychosocial, pharmacological, and other therapeutic approaches, including psychoeducational and community-based interventions that facilitate personal and community growth and change, are encouraged. There is a need for increased awareness, training and funding to implement longitudinal interventions that work collaboratively with clients from refugee backgrounds through the stages of resettlement.