The effectiveness, acceptability and cost-effectiveness of psychosocial interventions for maltreated children and adolescents: An evidence synthesis

DESIGN We will address our research objectives by searching the published and unpublished literature and conducting an evidence synthesis of i) studies of the effectiveness of psychosocial interventions provided for children and adolescents who have suffered maltreatment, ii) economic evaluations of these interventions and iii) studies of their acceptability to children, adolescents and their carers. SEARCH STRATEGY: Evidence will be identified via electronic databases for health and allied health literature, social sciences and social welfare, education and other evidence based depositories, and economic databases. We will identify material generated by user-led,voluntary sector enquiry by searching the internet and browsing the websites of relevant UK government departments and charities. Additionally, studies will be identified via the bibliographies of retrieved articles/reviews; targeted author searches; forward citation searching. We will also use our extensive professional networks, and our planned consultations with key stakeholders and our study steering committee. Databases will be searched from inception to time of search. REVIEW STRATEGY Inclusion criteria: 1) Infants, children or adolescents who have experienced maltreatment between the ages of 0 17 years. 2) All psychosocial interventions available for maltreated children and adolescents, by any provider and in any setting, aiming to address the sequelae of any form of maltreatment, including fabricated illness. 3) For synthesis of evidence of effectiveness: all controlled studies in which psychosocial interventions are compared with no-treatment, treatment as usual, waitlist or other-treated controls. For a synthesis of evidence of acceptability we will include any design that asks participants for their views or provides data on non-participation. For decision-analytic modelling we may include uncontrolled studies. Primary and secondary outcomes will be confirmed in consultation with stakeholders. Provisional primary outcomes are psychological distress/mental health (particularly PTSD, depression and anxiety, self-harm); ii) behaviour; iii) social functioning; iv) cognitive / academic attainment, v) quality of life, and vi) costs. After studies that meet the inclusion criteria have been identified (independently by two reviewers), data will be extracted and risk of bias (RoB) assessed (independently by two reviewers) using the Cochrane Collaboration RoB Tool (effectiveness), quality hierarchies of data sources for economic analyses (cost-effectiveness) and the CASP tool for qualitative research (acceptability). Where interventions are similar and appropriate data are available (or can be obtained) evidence synthesis will be performed to pool the results. Where possible, we will explore the extent to which age, maltreatment history (including whether intra- or extra-familial), time since maltreatment, care setting (family / out-of-home care including foster care/residential), care history, and characteristics of intervention (type, setting, provider, duration) moderate the effects of psychosocial interventions. A synthesis of acceptability data will be undertaken, using a narrative approach to synthesis. A decision-analytic model will be constructed to compare the expected cost-effectiveness of the different types of intervention identified in the systematic review. We will also conduct a Value of information analysis if the data permit. EXPECTED OUTPUTS: A synthesis of the effectiveness and cost effectiveness of psychosocial interventions for maltreated children (taking into account age, maltreatment profile and setting) and their acceptability to key stakeholders.

Obesity markers and blood pressure in a sample of Portuguese children and adolescents.

Little information exists regarding the effect of several obesity markers on blood pressure (BP) levels in youth. Transverse study including 2494 boys and 2589 girls. Height, weight and waist were measured according to the international criteria and body fat (BF) by bioimpedance. BP was measured by an automated device. Hypertension was defined using sex-specific, age-specific and height-specific observation-points. Body mass index (BMI) and waist were positively related with systolic blood pressure (SBP) and diastolic blood pressure (DBP) and heart rate in both sexes, whereas the relationships with BF were less consistent. Stepwise linear regression analysis showed that BMI was positively related with SBP and DBP in both sexes, whereas BF was negatively related with SBP in both sexes and with heart rate in boys only; finally, waist was positively related with SBP in boys and heart rate in girls. Age and heart rate-adjusted values of SBP and DBP increased with BMI: for SBP, 117+/-1, 123+/-1 and 124+/-1 mmHg in normal, overweight and obese boys, respectively; corresponding values for girls were 111+/-1, 114+/-1 and 116+/-2 mmHg (mean+/-SE, P<0.001). Overweight and obese boys had an odds ratio for being hypertensive of 2.26 (95% confidence interval: 1.79-2.86) and 3.36 (2.32-4.87), respectively; corresponding values for girls were 1.58 (confidence interval 1.25-1.99) and 2.31 (1.53-3.50). BMI, not BF or waist, is consistently and independently related to BP levels in children; overweight and obesity considerably increase the risk of hypertension.

A comparison of injuries among children and adult football (soccer) players

Football is a universal and an affordable game but we need to minimize the incidence of accidents among the increasing number of young football players. Our 11 year retrospective epidemiological study (1990-2000) of football injuries in children (N= 1000) was compared with those of adult players in the 2006 European Championship. This comparative study confirmed that the anatomical, biomechanical and biological conditions differ between adults and children and that they warrant particular attention to protect the latter vulnerable group against bone avulsions, overuse pathologies and fatigue-fractures. Injuries were shown to increase significantly with age up to 16 years (P=0.005). Children suffer mainly from contusions, fractures and sprain injuries. Head injuries were more common in boys (P=0.070), while girls were more prone to sprains. The types of injuries differ between adults and children (sprain versus fractures), the anatomical location of injuries is different (lower limbs in adults, lower and upper limbs in children), the circumstances of the injuries are different (contact in adults versus non-contact in children), and teenage girls have different types of injuries than teenage boys. An increased incidence of injuries is due to changes in the position of the center of gravity and in the morphotype during rapid growth. For these reasons it is mandatory to adapt the training to the age and sex of the players. It is unsafe to train children the same way as adults. The height, the weight and the speed of growth must be taken into account by the multidisciplinary team when organising the training programmes. -- Le football fait partie des sports les plus pratiqués au monde en raison de sa popularité et de son accessibilité économ ique. L'incidence des blessures liées à cette pratique doit être diminuée surtout chez les jeunes joueurs en raison de la croissance exponentielle du nombre de joueurs féminins et masculins. Une étude épidémiologique rétrospective sur 11 ans (1990-2000) a été réalisée chez les enfants victimes de blessures liées au football (N==1000), puis a été comparée aux données recueillies de l'UEFA lors d'un Championnat Européen en 2006 sur les lésions des joueurs adultes. Cette étude comparative confirme que les structures anatomiques, biologiques et les tensions biomécaniques chez l'enfant diffèrent de celles de l'adulte. Les enfants ont un risque plus élevé de souffrir d'avulsion osseuse et de fractures de fatigue que les adultes. Les blessures augmentent significativement avec l'âge jusqu'à 16 ans (P==0,005). Les traumatismes crâniens sont plus fréquents chez les garçons tandis que les entorses sont plus à risque chez les filles. Les adultes font plus souvent des entorses tandis que les enfants font plus de fractures. La localisation anatomique diffère également entre ces deux groupes (les membres inférieurs chez l'adulte et les membres inférieurs et supérieurs chez l'enfant). La circonstance des blessures diffère également (choc avec un autre joueur chez l'adulte et des blessures sans contact chez l'enfant). Chez les adolescents, les blessures des filles diffèrent de celles des garçons. L'augmentation chez les enfants de cette incidence est liée au déplacement lors de la croissance du centre de gravité, avec une maladresse accrue lors des phases de croissance. Pour toutes ces raisons, il est justifié d'adapter les entraînements de football en fonction de l'âge, du sexe et du morphotype. L'entrainement des enfants doit être différent de celui des adultes. Le poids, la taille et la vitesse de croissance doit être prise en compte dans des structures multidisciplinaires afin de permettre une meilleure longévité sportive des jeunes joueurs de football.

An educator's perspective of Dr. Feingold's K-P (Kaiser- Permanents) elimination diet for hyperkinetic children and others

Do evaluation of the literature and a regional observational report support Dr. Feingold's claim that the K-P (Kaiser-Permanente) elimination diet improves the behaviours of hyperkinetic children, and others? Dr. Feingold suggests that some hyperkinetic children, and other children as well, are genetically predisposed to intolerance of food additives, particularly food colours and flavours. He claims that the K-P diet, that eliminates salicylates and artificial food colours and flavours, improves the hyperkinetic child's behaviour, muscle co-ordination, and scholastic performance. Public acceptance of the K-P diet has outstripped acceptance in the medical and scientific communities. Evaluation of available data and additional studies are needed to arrive at a conclusion of acceptance or rejection of the K-P diet for hyperkinetic children and others. My interest in the K-P elimination diet for hyperkinetic children is educational. My experience as an elementary school teacher in special education and in the classroom from K-8 has taught me that attentiveness is crucial to learning. Hyperkinesis appears to impair a child's ability to attend. Learning problems appear, followed by behavioural and social problems. l If we accept the possibility of a relationship between diet and attentiveness, and attentiveness and school behaviours, then the diet-behaviour link could be of lay importance. For instance, if a diet such as the K-P diet could do what is claimed, substantial benefits could accrue to the child. One could, for example, improve a child's behaviours. One could identify attending disturbances early in the child's education, possibly minimizing, or eliminating future difficulties in school. Finally, the greatest benefit may be the fulfillment of the basic goal of our Ontario schools, that the eh~ld-,lIla1p.evelop happily and competently within our educational framework. 2 This thesis reports evidence from the literature and from a regional observational investigation to determine the possibility of a link between the behaviours of children and Dr. Feingold's K-P elimination diet. The literature research examines (1) Dr. Feingold's concept of H-LD, (2) his K-P elimination diet, and (3) the response from three sectors, medicine, science, and the public. The regional investigation examines the observed behaviours of nine children in Regional Niagara during a nine-month period on the K-P diet.

A sequential analysis of therapist scaffolding and child concept formation in narrative therapy

Narrative therapy is a postmodern therapy that takes the position that people create self-narratives to make sense of their experiences. To date, narrative therapy has compiled virtually no quantitative and very little qualitative research, leaving gaps in almost all areas of process and outcome. White (2006a), one of the therapy's founders, has recently utilized Vygotsky's (1934/1987) theories of the zone of proximal development (ZPD) and concept formation to describe the process of change in narrative therapy with children. In collaboration with the child client, the narrative therapist formalizes therapeutic concepts and submits them to increasing levels of generalization to create a ZPD. This study sought to determine whether the child's development proceeds through the stages of concept formation over the course of a session, and whether therapists' utterances scaffold this movement. A sequential analysis was used due to its unique ability to measure dynamic processes in social interactions. Stages of concept formation and scaffolding were coded over time. A hierarchical log-linear analysis was performed on the sequential data to develop a model of therapist scaffolding and child concept development. This was intended to determine what patterns occur and whether the stated intent of narrative therapy matches its actual process. In accordance with narrative therapy theory, the log-linear analysis produced a final model with interactions between therapist and child utterances, and between both therapist and child utterances and time. Specifically, the child and youth participants in therapy tended to respond to therapist scaffolding at the corresponding level of concept formation. Both children and youth and therapists also tended to move away from earlier and toward later stages of White's scaffolding conversations map as the therapy session advanced. These findings provide support for White's contention that narrative therapists promote child development by scaffolding child concept formation in therapy.

Developing Physical Activity Habit in Schools for Active Lifestyle Among Children and Adolescents

This study sought to identify and suggest ways to develop physical activity habits in school-aged children and adolescents that could help them continue healthy active practices throughout their lifespan. A systematic review of the literature identified 4 key factors that may influence school-based physical activity habit formation—motivation, enjoyment, commitment, and sustainment—and how each may be achieved in schools. The research paper begins by exploring the definitions and meaning of a habit, how it is developed, and its effect on a healthy active lifestyle. The study proposes a framework comprising 3 major components (i.e., programs, teachers, students) and offers practical strategies that support and nurture the development of students’ physical activity habits in schools. The study concludes by making recommendations for further study.

Power, Contextual Intelligence and Leadership: Research Approaches for Understanding Participatory Community Climate Change Adaptation

Analysis of power in natural resources management is important as multiple stakeholders interact within complex, social-ecological systems. As a sub-set of these interactions, community climate change adaptation is increasingly using participatory processes to address issues of local concern. While some attention has been paid to power relations in this respect, e.g. evaluating international climate regimes or assessing vulnerability as part of integrated impact assessments, little attention has been paid to how a structured assessment of power could facilitate real adaptation and increase the potential for successful participatory processes. This paper surveys how the concept of power is currently being applied in natural resources management and links these ideas to agency and leadership for climate change adaptation. By exploring behavioural research on destructive leadership, a model is developed for informing participatory climate change adaptation. The working paper then concludes with a discussion of developing research questions in two specific areas - examining barriers to adaptation and mapping the evolution of specific participatory processes for climate change adaptation.

Postcolonial entanglements of Power, Race, Class and Privilege in Child and Youth Care Work Within a Brazilian Favela

This research assesses the various aspects of Child and Youth Care (CYC) work and how relationships between child or youth and care provider are limited and constricted within greater political, social and historical contexts. Specifically, this research takes place internationally in Rio de Janeiro, Brazil within a favela (slum) and unveils the entangled and complex relationship that I, not only as an ethnographer, but also as a CYC worker had with the many young people that I encountered. It will address a variety of theories that demonstrate the potentials of reproducing oppressive relationships, and argue that it is imperative for CYC workers to critically reflect on the greater contexts in which their work is situated in order to gain forces with those young people whom they are attempting to serve.

The Spirit of Hope: Research Centre Named in Honour of Father Sean O'Sullivan

An article in "Community Contact" (a publication by St. Joseph's Hospital, St. Joseph's Community Health Centre, and St. Joseph's Health Care Foundation) discussing the naming of the Father Sean O'Sullivan Research Centre. The article describes the time Father Sean spent at the hospital and his battle with leukemia.

Investigating active transportation to and from school : identification of predictors and health benefits

Funding support for this doctoral thesis has been provided by the Canadian Institutes of Health Research-Public Health Agency of Canada, QICSS matching grant, and la Faculté des études supérieures et postdoctorales-Université de Montréal.

Le lien intervenant-jeune en unité de réadaptation : de la relation d’aide à l’alliance thérapeutique dans un contexte d’autorité

L’intervention psychosociale auprès des jeunes vivant en Centre jeunesse est régie par la Loi sur la protection de la jeunesse (LPJ). La posture professionnelle des intervenants s’inscrit à la fois dans une relation d’autorité, renforcée par le cadre institutionnel et les obligations légales, et dans une relation d’aide. Ce mémoire s’est attardé à ce double mandat (réadaptation sociale et relation d'aide) et à son impact sur le lien jeune-éducateur. Le terrain de cette recherche s’est déroulé pendant trois mois dans une unité de réadaptation de Montréal (CJM-IU). L’analyse s’est faite à partir de la rencontre des corpus de données; les récits des jeunes et des éducateurs (entretiens semi-directifs) et l'observation de ce milieu de vie. L’approche utilisée, puisant à la fois dans la tradition ethnographique et dans la phénoménologie, nous a permis de faire émerger l’interprétation et les perceptions qu’ont les jeunes et leurs intervenants sur la question de la relation d’aide et de la relation d’autorité. Les résultats de recherche portent sur les conditions qui favorisent la conciliation ou la polarisation de ces mandats qui peuvent parfois sembler antagonistes. Il a ainsi été possible d’identifier les éléments qui fragilisent l’établissement de liens significatifs et de confiance entre les jeunes et leurs éducateurs ou au contraire les éléments qui les renforcent. Ultimement, les résultats ont permis d’illustrer les embûches à la création d’une alliance thérapeutique en centre de réadaptation pour mineurs et l’impossibilité de sa réalisation dans le contexte actuel.

Participation in leisure and physical activity among children and adolescents with juvenile idiopathic arthritis

Contexte: L’arthrite juvénile idiopathique (AJI) est l’une des maladies chroniques auto-immune les plus répandues chez les enfants et est caractérisée par des enflures articulaires (maladie active), de la douleur, de la fatigue et des raideurs matinales pouvant restreindre leur niveau de participation aux activités quotidiennes (par exemple: les loisirs, l’activité physique, la mobilité et les soins personnels) à la maison comme à l’école. Participer aux activités de loisirs et à l’activité physique a des bienfaits au niveau de la santé et du développement de tous les enfants et démontrent aussi des effets positifs qui réduisent les symptômes des maladies chroniques telle l’AJI. Malgré ces bienfaits la participation aux loisirs chez les jeunes avec l’AJI demeure largement sous-étudiée. Objectifs: Cette étude vise à évaluer le niveau de participation aux loisirs et à l’activité physique chez les enfants et les adolescents atteints d’AJI, ainsi qu’à identifier les facteurs liés à la maladie, la personne et l’environnement. Méthodes : L’évaluation du niveau de participation et l’exploration des facteurs associés aux loisirs et à l’activité physique ont été complétés par l’entremise d’une revue systématique de la littérature, l’analyse de données d’un échantillon national représentatif d’enfants canadiens atteints d’arthrite âgés entre 5 et 14 ans (npondéré = 4350), ainsi que l’analyse standardisée du niveau de participation aux loisirs à l’aide du Children’s Assessment of Participation and Enjoyment (n=107) et la mesure objective de l’activité physique par accéléromètre (n=76) auprès d’un échantillon d’enfants (âgés entre 8 et 11 ans ) et d’adolescents (âgés entre 12 et 17 ans) suivis en clinique de rhumatologie à l’hôpital de Montréal pour enfants, Centre Universitaire de Santé McGill. Les résultats cliniques ont été comparés à des données normatives, ainsi qu’à un groupe contrôle sans AJI. Nous avons exploré les facteurs associés avec le niveau de participation aux loisirs et à l’activité physique en utilisant les modèles de régression linéaire multiple et l’analyse hiérarchique. Résultats : Les enfants et les adolescents atteints d’AJI participent à une multitude d’activités de loisirs; cependant ils sont moins souvent impliqués dans des activités physiques et de raffinement en comparaison aux autres types d’activités de loisirs. Ceux avec l’AJI étaient en général moins actifs que leurs pairs sans arthrite et la plupart n’atteignaient pas les recommandations nationales d’activité physique. Les garçons avec l’AJI participent plus souvent à des activités physiques et moins aux activités sociales, de raffinement et de développement de soi en comparaison avec les filles ayant l’AJI. En général, être un garçon, être plus âgé, avoir une meilleure motivation pour participer aux activités de motricité globale, avoir un statut socio-économique plus élevé et être d’origine culturelle canadienne sont associés à un niveau de participation plus élevé aux activités physiques. La préférence pour les activités de raffinement, un niveau d’éducation maternelle plus élevé et être une fille étaient associés à un niveau de participation plus élevé aux activités de raffinement. Conclusion: La participation aux loisirs et à l’activité physique en AJI est un concept complexe et semble surtout être expliqué par des facteurs personnels et environnementaux. L’identification des facteurs associés aux loisirs et à l’activité physique est très importante en AJI puisqu’elle peut permettre aux professionnels de la santé de développer des interventions significatives basées sur les activités préférées des enfants, améliorer l’observance au traitement et promouvoir des habitudes de vie saine.

Verbal proficiency as fitness indicator: Experimental and comparative research on the evolutionary psychology of language and verbal displays

Summary: Recent research on the evolution of language and verbal displays (e.g., Miller, 1999, 2000a, 2000b, 2002) indicated that language is not only the result of natural selection but serves as a sexually-selected fitness indicator that is an adaptation showing an individual’s suitability as a reproductive mate. Thus, language could be placed within the framework of concepts such as the handicap principle (Zahavi, 1975). There are several reasons for this position: Many linguistic traits are highly heritable (Stromswold, 2001, 2005), while naturally-selected traits are only marginally heritable (Miller, 2000a); men are more prone to verbal displays than women, who in turn judge the displays (Dunbar, 1996; Locke & Bogin, 2006; Lange, in press; Miller, 2000a; Rosenberg & Tunney, 2008); verbal proficiency universally raises especially male status (Brown, 1991); many linguistic features are handicaps (Miller, 2000a) in the Zahavian sense; most literature is produced by men at reproduction-relevant age (Miller, 1999). However, neither an experimental study investigating the causal relation between verbal proficiency and attractiveness, nor a study showing a correlation between markers of literary and mating success existed. In the current studies, it was aimed to fill these gaps. In the first one, I conducted a laboratory experiment. Videos in which an actor and an actress performed verbal self-presentations were the stimuli for counter-sex participants. Content was always alike, but the videos differed on three levels of verbal proficiency. Predictions were, among others, that (1) verbal proficiency increases mate value, but that (2) this applies more to male than to female mate value due to assumed past sex-different selection pressures causing women to be very demanding in mate choice (Trivers, 1972). After running a two-factorial analysis of variance with the variables sex and verbal proficiency as factors, the first hypothesis was supported with high effect size. For the second hypothesis, there was only a trend going in the predicted direction. Furthermore, it became evident that verbal proficiency affects long-term more than short-term mate value. In the second study, verbal proficiency as a menstrual cycle-dependent mate choice criterion was investigated. Basically the same materials as in the former study were used with only marginal changes in the used questionnaire. The hypothesis was that fertile women rate high verbal proficiency in men higher than non-fertile women because of verbal proficiency being a potential indicator of “good genes”. However, no significant result could be obtained in support of the hypothesis in the current study. In the third study, the hypotheses were: (1) most literature is produced by men at reproduction-relevant age. (2) The more works of high literary quality a male writer produces, the more mates and children he has. (3) Lyricists have higher mating success than non-lyric writers because of poetic language being a larger handicap than other forms of language. (4) Writing literature increases a man’s status insofar that his offspring shows a significantly higher male-to-female sex ratio than in the general population, as the Trivers-Willard hypothesis (Trivers & Willard, 1973) applied to literature predicts. In order to test these hypotheses, two famous literary canons were chosen. Extensive biographical research was conducted on the writers’ mating successes. The first hypothesis was confirmed; the second one, controlling for life age, only for number of mates but not entirely regarding number of children. The latter finding was discussed with respect to, among others, the availability of effective contraception especially in the 20th century. The third hypothesis was not satisfactorily supported. The fourth hypothesis was partially supported. For the 20th century part of the German list, the secondary sex ratio differed with high statistical significance from the ratio assumed to be valid for a general population.

Acogimiento en familia extensa: un estudio desde la perspectiva de los acogedores, de los niños y niñas acogidos y de los profesionales que intervienen. = Kinship foster care: a study from the perspective of the caregivers, the children and the child welfare workers

Desde hace aproximadamente dos décadas, en la mayoría de los países occidentales, los acogimientos en familia extensa han entrado a formar parte de los sistemas de protección infantil, siguiendo una evolución creciente en cuanto a número y peso especifico como recurso de acogimiento. Las investigaciones sobre este fenómeno son aún recientes y escasas como también lo son los programas dirigidos a esta población. En el presente artículo presentamos los resultados de un estudio descriptivo sobre los acogimientos en familia extensa en la ciudad de Barcelona, donde se recogen datos de los principales agentes implicados en este fenómeno. Desde la perspectiva de los estudios de la calidad de vida se analizan las percepciones, evaluaciones, y satisfacción expresada, por parte de los acogedores, los niños/as acogidos y los profesionales de los Equipos de Atención a la Infancia y Adolescencia (EAIA) que se encargan del estudio y seguimiento de estos acogimientos. La investigación presenta unos resultados acordes con los estudios que actualmente se realizan en este ámbito y sienta las bases para el despliegue futuro de programas dirigidos a los acogimientos en familia extensa

Kinship foster care: a study from the perspective of the of the caregivers, the children and the child welfare workers

In the last twenty years, in most Western countries, kinship foster care has become an integral part of childcare systems, growing progressively with regard to the numbers of children involved and relative weight as a care resource within the system; indeed, in some countries it is even more common than other placement options, such as non-kinship foster care and residential care. Research on this phenomenon is still recent and scarce, and there are few programmes targeting this population. In this article we present the results of a descriptive study on kinship foster care in the city of Barcelona, including information and data from the different stakeholders involved. From a quality of life research perspective we analyze the perceptions, evaluation and expressed satisfaction of caregivers, children and practitioners from the specialist Child and Adolescent Teams (EAIAs) responsible for the study and follow-up of kinship foster care cases. The research presented results are in line with those of current research in this field, and lays the basis for the future development of kinship foster care programmes