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Fleming GE, Kohlhoff J, Morgan S, Turnell A, Maiuolo M, Kimonis ER. An Effectiveness Open Trial of Internet-Delivered Parent Training for Young Children With Conduct Problems Living in Regional and Rural Australia. Behav Ther 2021; 52:110-123. [PMID: 33483109 DOI: 10.1016/j.beth.2020.03.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 01/13/2020] [Accepted: 03/08/2020] [Indexed: 01/13/2023]
Abstract
There is accumulating evidence for the efficacy of online parent management training (PMT) programs to improve conduct problems in young children, and findings have been used to support the potential of online programs to close the research-to-practice gap in underserved rural settings. However, to date, no study has evaluated the effectiveness of online PMT under real-world conditions; that is, delivered by community practitioners as part of services-as-usual to families residing in rural communities. This has resulted in a critical lack of evidence supporting the capacity of online PMT to ameliorate actual geographical disparities in service accessibility. Accordingly, the current study evaluated effectiveness and engagement outcomes of Internet-delivered Parent-Child Interaction Therapy (I-PCIT) delivered from a community-based early childhood clinic to rural consumers. Participants were 27 mothers and their 1.5- to 4-year-old child with conduct problems (M age = 3.02, SD = 0.73) living in regional and rural New South Wales, Australia. Parent-rated and observed child conduct problems and observed parenting behaviors were assessed pre and post I-PCIT, and treatment attrition, parental satisfaction with treatment, and homework compliance provided indicators of treatment engagement. Results of linear mixed and marginal models indicated that I-PCIT produced significant improvements in parent-reported and observed child conduct problems and observed parenting behaviors, with "small" to "very large" effect sizes (ds = 0.3-1.4). Treatment retention was adequate (63%), and treatment-completing parents reported high treatment satisfaction and good homework compliance. Findings provide preliminary evidence for the real world effectiveness of I-PCIT, supporting its capacity to narrow the research-to-practice gap. Findings suggest a role for I-PCIT in a stepped care model of remote treatment for childhood conduct problems in Australia.
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Barbaro J, Masi A, Gilbert M, Nair R, Abdullahi I, Descallar J, Dissanayake C, Eastwood J, Hasan I, Jalaludin B, Karlov L, Khan F, Kohlhoff J, Liaw ST, Lingam R, Mendoza Diaz A, Ong N, Tam CWM, Unwin K, Woolfenden S, Eapen V. A Multistate Trial of an Early Surveillance Program for Autism Within General Practices in Australia. Front Pediatr 2021; 9:640359. [PMID: 33968847 PMCID: PMC8102783 DOI: 10.3389/fped.2021.640359] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 03/12/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The early detection of developmental conditions such as autism is vital to ensure children can access appropriate and timely evidence-based supports, services, and interventions. Children who have undetected developmental conditions early in life are more likely to develop later health, developmental, learning, and behavioral issues, which in turn can have a cumulative effect over the life course. Methods: The current protocol describes a multi-site, cluster randomized control trial comparing a developmental surveillance pathway for autism to usual care, using opportunistic visits to general practitioners (GPs). Units of randomization are GP clinics across two Australian states (New South Wales and Victoria), with thirty clinics within each state, each of which will aim to recruit approximately forty children aged between ~18- and 24-months, for a total of ~2,400 participants. Children will be randomized to two clusters; namely, an autism surveillance pathway (ASP) or surveillance as usual (SaU). The screening process for the ASP arm involves primary and secondary screenings for developmental concerns for autism, using both parent and GP reports and observations. Children in both arms who show signs of developmental concerns for autism will be offered a full developmental assessment by the research team at 24 months of age to determine the efficacy of developmental surveillance in successfully identifying children with autism. Trial Registration: The trial is registered with ANZCTR (ACTRN12619001200178) and reporting of the trial results will be according to recommendations in the CONSORT Statement.
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Thombs BD, Levis B, Lyubenova A, Neupane D, Negeri Z, Wu Y, Sun Y, He C, Krishnan A, Vigod SN, Bhandari PM, Imran M, Rice DB, Azar M, Chiovitti MJ, Saadat N, Riehm KE, Boruff JT, Cuijpers P, Gilbody S, Ioannidis JPA, Kloda LA, Patten SB, Shrier I, Ziegelstein RC, Comeau L, Mitchell ND, Tonelli M, Barnes J, Beck CT, Bindt C, Figueiredo B, Helle N, Howard LM, Kohlhoff J, Kozinszky Z, Leonardou AA, Radoš SN, Quispel C, Rochat TJ, Stein A, Stewart RC, Tadinac M, Tandon SD, Tendais I, Töreki A, Tran TD, Trevillion K, Turner K, Vega-Dienstmaier JM, Benedetti A. Overestimation of Postpartum Depression Prevalence Based on a 5-item Version of the EPDS: Systematic Review and Individual Participant Data Meta-analysis. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2020; 65:835-844. [PMID: 33104415 PMCID: PMC7658422 DOI: 10.1177/0706743720934959] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE The Maternal Mental Health in Canada, 2018/2019, survey reported that 18% of 7,085 mothers who recently gave birth reported "feelings consistent with postpartum depression" based on scores ≥7 on a 5-item version of the Edinburgh Postpartum Depression Scale (EPDS-5). The EPDS-5 was designed as a screening questionnaire, not to classify disorders or estimate prevalence; the extent to which EPDS-5 results reflect depression prevalence is unknown. We investigated EPDS-5 ≥7 performance relative to major depression prevalence based on a validated diagnostic interview, the Structured Clinical Interview for DSM (SCID). METHODS We searched Medline, Medline In-Process & Other Non-Indexed Citations, PsycINFO, and the Web of Science Core Collection through June 2016 for studies with data sets with item response data to calculate EPDS-5 scores and that used the SCID to ascertain depression status. We conducted an individual participant data meta-analysis to estimate pooled percentage of EPDS-5 ≥7, pooled SCID major depression prevalence, and the pooled difference in prevalence. RESULTS A total of 3,958 participants from 19 primary studies were included. Pooled prevalence of SCID major depression was 9.2% (95% confidence interval [CI] 6.0% to 13.7%), pooled percentage of participants with EPDS-5 ≥7 was 16.2% (95% CI 10.7% to 23.8%), and pooled difference was 8.0% (95% CI 2.9% to 13.2%). In the 19 included studies, mean and median ratios of EPDS-5 to SCID prevalence were 2.1 and 1.4 times. CONCLUSIONS Prevalence estimated based on EPDS-5 ≥7 appears to be substantially higher than the prevalence of major depression. Validated diagnostic interviews should be used to establish prevalence.
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Kohlhoff J, Cibralic S, Lennie L, Rabbetts L, Morgan S. Qualitative evaluation of Australian Caregiver's experiences of parent–child interaction therapy delivered in a community‐based clinic setting. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kohlhoff J, Wallace N, Morgan S, Maiuolo M, Turnell A. Internet‐delivered parent–child interaction therapy: Two clinical case reports. CLIN PSYCHOL-UK 2020. [DOI: 10.1111/cp.12184] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Cibralic S, Kohlhoff J, Wallace N, McMahon C, Eapen V. Treating Externalizing Behaviors in Toddlers with ASD Traits Using Parent-Child Interaction Therapy for Toddlers: A Case Study. Clin Case Stud 2020. [DOI: 10.1177/1534650120969854] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Up to 27% of children with autism spectrum disorder (ASD) experience clinically significant externalizing behavior. Child emotional dysregulation is thought to be one of the main reasons for the manifestation of externalizing behaviors during toddlerhood and has also been associated with insecure and disorganized parent-child attachment relationships. Parent-Child Interaction Therapy for Toddlers (PCIT-T) is an attachment and behavioral based parent training program targeted at children aged 12 to 24 months with externalizing behavior. This study assessed the effectiveness of PCIT-T in reducing child externalizing behavior as well as improving child emotional regulation and the parent-child attachment relationship in a child with moderate-to-severe ASD traits, low intellectual and adaptive functioning, externalizing behaviors within the clinical range, and a disorganized/insecure mother-child attachment relationship. The intervention occurred over a 12-week period and focused on improving positive parenting skills, parent emotional regulation, and child emotional regulation. Treatment progress was tracked using the Child Behavior Checklist Externalizing Behavior subscale, the Deverux Early Childhood Assessment for Toddlers Attachment/Relationship and Self-Regulation subscales, the Dyadic Parent-Child Interaction Coding System, version 4, and the Strange Situation Procedure. Study results provide preliminary support for the use of PCIT-T in reducing externalizing behavior, improving the parent-child attachment relationship and child emotional regulation. These results indicate that PCIT-T can be beneficial for children with ASD traits, however, further research with a larger sample size is needed to strength these findings.
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Kohlhoff J, Lee S, Cibralic S, Jones P, Khajehei M. Development and validation of the Karitane Family Outcomes Tool. J SPEC PEDIATR NURS 2020; 25:e12295. [PMID: 32445615 DOI: 10.1111/jspn.12295] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 03/26/2020] [Accepted: 05/04/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE The purpose of this study was to develop the Karitane Family Outcomes Tool (KFOT), a brief parent-report questionnaire to measure outcomes of Australian Early Parenting Centres (EPCs) and similar programmes worldwide. DESIGN AND METHODS The study was conducted in two stages. In Stage One, an initial item pool (80 items) was developed via focus group discussions with clinical experts and parents. In Stage Two, three samples of parents were recruited (online community sample: n = 849, clinical sample 1: n = 141, clinical sample 2: n = 109). The online community sample completed the 80-items and then non-normally distributed items were culled, leaving a total item pool of 57 items. The online community sample was then split into two subsamples (subsample 1: n = 650, subsample 2: n = 199). Exploratory factor analysis (EFA) was then conducted on online community subsample 1 and confirmatory factor analysis (CFA) on online community subsample 2 and clinical sample 1. Using clinical sample 2, concurrent validity was assessed by examining correlations between KFOT factor scores with scores on the Parenting Stress Index. Finally, discriminant validity was assessed by examining the KFOTs sensitivity to change following EPC intervention and by comparing KFOT scores of clinical and community samples. RESULTS EFA revealed 13 items loading onto three factors: "Parental feelings," "Reading cues & meeting the child's needs" and "Perceptions of child behaviour." The factor structure was confirmed using CFA in both the community and clinical samples. Significant differences on all three KFOT factors and on the total score were found between the clinical and community samples, suggesting that the scale is able to discriminate between clinical and nonclinical groups. Significant differences were also found between pre- and postintervention scores, and between pre- and follow-up scores, on all three KFOT factors, providing further indication of discriminant validity. The KFOT factors correlated in the expected direction with scores on the Parenting Stress Index, showing concurrent validity. PRACTICAL IMPLICATIONS Results indicate that the KFOT is a brief, valid and reliable parent-report scale that can be used by nurses to evaluate outcomes of EPC and similar parenting programmes.
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Kohlhoff J, Cibralic S, Wallace N, Morgan S, McMahon C, Hawkins E, Eapen V, Briggs N, Huber A, McNeil C. A randomized controlled trial comparing parent child interaction therapy - toddler, circle of security- parenting™ and waitlist controls in the treatment of disruptive behaviors for children aged 14-24 months: study protocol. BMC Psychol 2020; 8:93. [PMID: 32867832 PMCID: PMC7457749 DOI: 10.1186/s40359-020-00457-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 08/05/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND It is common for toddlers to display disruptive behaviors (e.g., tantrums, aggression, irritability) but when these become severe and persistent they can be the start of a trajectory towards poor outcomes in childhood and adolescence. Parent Child Interaction Therapy - Toddler is an intervention model designed to meet the specific developmental needs of toddlers aged 12-24 months presenting with disruptive behaviors. METHODS This study will use a randomized controlled design to evaluate the efficacy of the Parent Child Interaction Therapy - Toddler intervention for children aged 14-24 months with disruptive behaviors. Ninety toddlers with parent-reported disruptive behavior will be randomly allocated to either Parent Child Interaction Therapy - Toddler, Circle of Security- Parenting™ or a waitlist control group. Key parenting capacity outcome variables will include positive and negative parenting, parenting sensitivity, parental sense of competence in managing negative toddler emotions, parent sense of caregiving helplessness, parent mentalizing about the child, parent emotion regulation, child abuse potential and parental stress. Key outcome variables for children will include child social-emotional functioning (initiative, relationship functioning, self-regulation), child emotion regulation, child attachment security, and child behavior. DISCUSSION Delivered in the early intervention period of toddlerhood, Parent Child Interaction Therapy - Toddler has the potential to bring about significant and lasting changes for children presenting with early onset behavioral issues. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ANZCTR), 12618001554257 . Registered 24 September 2018 - retrospectively registered.
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Lam-Cassettari C, Kohlhoff J. Effect of maternal depression on infant-directed speech to prelinguistic infants: Implications for language development. PLoS One 2020; 15:e0236787. [PMID: 32730322 PMCID: PMC7392317 DOI: 10.1371/journal.pone.0236787] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 07/14/2020] [Indexed: 01/24/2023] Open
Abstract
The nature and timing of caregivers' speech provides an important foundation for infant attention and language development in the first year of life. Infant-directed speech is a key component of responsive parent-infant communication that is typically characterised by exaggerated intonation and positive affect. This study examines the effect of postnatal depression on the expression of positive vocal affect and pitch, the quantity of mothers' infant-directed speech input and the timing of vocal responses between mother and infant. Postnatal mothers currently experiencing symptoms of depression (n = 13) were matched to postnatal mothers who were not experiencing symptoms of depression (n = 13), and audio-recorded while playing with their 6-month-old infants. Compared with depressed mothers, non-depressed mothers used a higher mean pitch and pitch range, spoke more, gave faster verbal responses and were rated as expressing more positive valence in their voice. These preliminary findings indicate that mothers experiencing low mood use less infant-directed speech and less exaggerated pitch with prelinguistic infants. Postnatal depression is a major health issue that adversely impacts the parent and child. Early interventions for PND may benefit from identifying ways to support the timing of conversations and mothers' use of appropriate vocal pitch and infant-directed speech modifications. Further research is needed to confirm whether these strategies support early conversations.
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Bennett E, Simpson W, Fowler C, Munns A, Kohlhoff J. Enhancing access to parenting services using digital technology supported practices. ACTA ACUST UNITED AC 2020. [DOI: 10.33235/ajcfhn.17.1.4-11] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Kohlhoff J, Morgan S, Briggs N, Egan R, Niec L. Parent-Child Interaction Therapy with Toddlers in a community-based setting: Improvements in parenting behavior, emotional availability, child behavior, and attachment. Infant Ment Health J 2020; 41:543-562. [PMID: 32589327 DOI: 10.1002/imhj.21864] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Parent-Child Interaction Therapy with Toddlers (PCIT-T) is a new attachment-based parenting intervention designed to meet the needs of children aged 12-24 months presenting with challenging behaviors. This study examined outcomes of the first phase of PCIT-T, Child Directed Interaction-Toddler (CDI-T), 4-months post treatment. Participants were 56 toddlers (Child Mage = 19.13 months) referred to receive CDI-T over an 8-week period at an Australian community-based child behavior treatment clinic for treatment of difficult toddler behaviors. Participants completed questionnaires and observational measures at baseline (Time 1), post-treatment (Time 2), and 4-month follow-up (Time 3). At both Time 2 and Time 3, there were statistically significant increases in observed positive parenting skills and emotional availability and decreases in negative parenting behaviors and child noncompliance. There were also significant improvements in parent-reported child externalizing and internalizing behaviors, parental stress, and maternal depression. There was a pattern of a shift away from attachment insecurity and attachment disorganization. Results suggest that the CDI-T phase of PCIT-T is a promising intervention for toddlers presenting with behavioral issues. Future studies should be conducted to assess efficacy in other settings, using larger samples and utilizing randomized controlled designs.
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Kohlhoff J, Mahmood D, Kimonis E, Hawes DJ, Morgan S, Egan R, Niec LN, Eapen V. Callous-Unemotional Traits and Disorganized Attachment: Links with Disruptive Behaviors in Toddlers. Child Psychiatry Hum Dev 2020; 51:399-406. [PMID: 31894435 DOI: 10.1007/s10578-019-00951-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 12/13/2019] [Accepted: 12/16/2019] [Indexed: 10/25/2022]
Abstract
Children with callous-unemotional (CU) traits and children with disorganized attachment patterns are at heightened risk of poor psychological outcomes but little is known about the overlap between these constructs and their unique contributions to conduct problems in early childhood. This study examined associations between CU traits, disorganized attachment, and conduct problem (CP) severity in a sample of clinic-referred toddlers with behavioral problems. Mother-child dyads (n = 56; mean child age 19.50 months) completed parent-report questionnaires, a dyadic play session, and the Strange Situation Procedure to assess child attachment pattern. Significant positive associations were found between CU traits and disorganized attachment, independent of CP severity. CU traits but not disorganized attachment predicted CP severity. Results indicate that among toddlers with clinic-referred disruptive behavior problems, there are clear links between CU traits and attachment disorganization. Of the two constructs, however, CU traits appear to be most salient in the expression of CPs.
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Baker J, Kohlhoff J, Onobrakpor SI, Woolfenden S, Smith R, Knebel C, Eapen V. The Acceptability and Effectiveness of Web-Based Developmental Surveillance Programs: Rapid Review. JMIR Mhealth Uhealth 2020; 8:e16085. [PMID: 32324149 PMCID: PMC7206511 DOI: 10.2196/16085] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 01/05/2020] [Accepted: 02/10/2020] [Indexed: 12/05/2022] Open
Abstract
Background Web-based developmental surveillance programs may be an innovative solution to improving the early detection of childhood developmental difficulties, especially within disadvantaged populations. Objective This review aimed to identify the acceptability and effectiveness of web-based developmental surveillance programs for children aged 0 to 6 years. Methods A total of 6 databases and gray literature were searched using a Preferred Reporting Items for Systematic Reviews and Meta-Analyses–informed protocol. Data extraction included variables related to health equity. Results In total, 20 studies were identified. Most papers implemented web-based versions of the Modified Checklist for Autism in Toddlers, Revised with Follow-Up screener for autism spectrum disorder or Parent Evaluation of Developmental Status screeners for broad developmental delay. Caregivers and practitioners indicated a preference for web-based screeners, primarily for user-friendliness, improved follow-up accuracy, time, and training efficiencies. Conclusions Although evidence is limited as to the necessity of web- versus face-to-face–based developmental screening, there are clear efficiencies in its use. Trial Registration PROSPERO CRD42019127894; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=127894
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Kohlhoff J, Morgan S, Briggs N, Egan R, Niec L. Parent–Child Interaction Therapy with Toddlers: A Community-based Randomized Controlled Trial with Children Aged 14-24 Months. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2020; 50:411-426. [DOI: 10.1080/15374416.2020.1723599] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Kohlhoff J, Cibralic S, Horswood D, Turnell A, Maiuolo M, Morgan S. Feasibility and acceptability of internet-delivered parent-child interaction therapy for rural Australian families: a qualitative investigation. Rural Remote Health 2020; 20:5306. [PMID: 31917594 DOI: 10.22605/rrh5306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Parent-child interaction therapy (PCIT) is an evidence-based parent management training program for the treatment of childhood disruptive behaviour disorders (DBDs). In Australia, however, due to a lack of services in regional, rural and remote areas, the program is not accessible to all families who might benefit. Preliminary evidence demonstrates that telehealth technologies can be leveraged to deliver PCIT via internet (I-PCIT) to urban families. It is not known, however, to what extent I-PCIT is acceptable and effective for regional and remote families, who are traditionally underserved and face a range of stressors unique to living outside major cities. The present study represents the first qualitative investigation into the experience of I-PCIT for rural or regional Australian families. METHODS Qualitative interviews were conducted with 10 parents who were living in regional, rural and remote areas of New South Wales (NSW), Australia, and who were referred to an I-PCIT program for treatment of DBD in a child aged 2-4 years. RESULTS Thematic analysis yielded two pre-treatment themes: motivation for seeking treatment and barriers to previous service access. Three overarching themes were identified in post-treatment interviews: positive outcomes, valuable program components and challenges and acceptability of internet delivery. Results demonstrate that consumers from regional, rural and remote NSW view I-PCIT as an acceptable and effective treatment of childhood DBD, bolstering preliminary evidence about the utility of internet technologies to deliver the high-quality results of PCIT. While internet connection issues were a hindrance to treatment for some participants, all parents reported meaningful positive outcomes for both child and parents. CONCLUSION The study highlights that I-PCIT effectively expands the reach of mental health services to Australian communities that previously could not access clinic-based parenting services.
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Levis B, McMillan D, Sun Y, He C, Rice DB, Krishnan A, Wu Y, Azar M, Sanchez TA, Chiovitti MJ, Bhandari PM, Neupane D, Saadat N, Riehm KE, Imran M, Boruff JT, Cuijpers P, Gilbody S, Ioannidis JPA, Kloda LA, Patten SB, Shrier I, Ziegelstein RC, Comeau L, Mitchell ND, Tonelli M, Vigod SN, Aceti F, Alvarado R, Alvarado-Esquivel C, Bakare MO, Barnes J, Beck CT, Bindt C, Boyce PM, Bunevicius A, Couto TCE, Chaudron LH, Correa H, de Figueiredo FP, Eapen V, Fernandes M, Figueiredo B, Fisher JRW, Garcia-Esteve L, Giardinelli L, Helle N, Howard LM, Khalifa DS, Kohlhoff J, Kusminskas L, Kozinszky Z, Lelli L, Leonardou AA, Lewis BA, Maes M, Meuti V, Nakić Radoš S, Navarro García P, Nishi D, Okitundu Luwa E-Andjafono D, Robertson-Blackmore E, Rochat TJ, Rowe HJ, Siu BWM, Skalkidou A, Stein A, Stewart RC, Su KP, Sundström-Poromaa I, Tadinac M, Tandon SD, Tendais I, Thiagayson P, Töreki A, Torres-Giménez A, Tran TD, Trevillion K, Turner K, Vega-Dienstmaier JM, Wynter K, Yonkers KA, Benedetti A, Thombs BD. Comparison of major depression diagnostic classification probability using the SCID, CIDI, and MINI diagnostic interviews among women in pregnancy or postpartum: An individual participant data meta-analysis. Int J Methods Psychiatr Res 2019; 28:e1803. [PMID: 31568624 PMCID: PMC7027670 DOI: 10.1002/mpr.1803] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 08/05/2019] [Accepted: 08/16/2019] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVES A previous individual participant data meta-analysis (IPDMA) identified differences in major depression classification rates between different diagnostic interviews, controlling for depressive symptoms on the basis of the Patient Health Questionnaire-9. We aimed to determine whether similar results would be seen in a different population, using studies that administered the Edinburgh Postnatal Depression Scale (EPDS) in pregnancy or postpartum. METHODS Data accrued for an EPDS diagnostic accuracy IPDMA were analysed. Binomial generalised linear mixed models were fit to compare depression classification odds for the Mini International Neuropsychiatric Interview (MINI), Composite International Diagnostic Interview (CIDI), and Structured Clinical Interview for DSM (SCID), controlling for EPDS scores and participant characteristics. RESULTS Among fully structured interviews, the MINI (15 studies, 2,532 participants, 342 major depression cases) classified depression more often than the CIDI (3 studies, 2,948 participants, 194 major depression cases; adjusted odds ratio [aOR] = 3.72, 95% confidence interval [CI] [1.21, 11.43]). Compared with the semistructured SCID (28 studies, 7,403 participants, 1,027 major depression cases), odds with the CIDI (interaction aOR = 0.88, 95% CI [0.85, 0.92]) and MINI (interaction aOR = 0.95, 95% CI [0.92, 0.99]) increased less as EPDS scores increased. CONCLUSION Different interviews may not classify major depression equivalently.
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Baker JR, Raman S, Kohlhoff J, George A, Kaplun C, Dadich A, Best CT, Arora A, Zwi K, Schmied V, Eapen V. Optimising refugee children's health/wellbeing in preparation for primary and secondary school: a qualitative inquiry. BMC Public Health 2019; 19:812. [PMID: 31242897 PMCID: PMC6595577 DOI: 10.1186/s12889-019-7183-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 06/16/2019] [Indexed: 01/27/2023] Open
Abstract
Background Children from refugee backgrounds are less likely to access appropriate health and social care than non-refugee children. Our aim was to identify refugee children’s health/wellbeing strengths and needs, and the barriers and enablers to accessing services while preparing for primary and secondary school, in a low socio-economic multicultural community in Australia. Method Ten focus groups were facilitated with Arabic-speaking refugee parents of children aged 2–5 years (n = 11) or in first year secondary school (n = 22); refugee adolescents starting high school (n = 16); and key service providers to refugee families (n = 27). Vignettes about a healthy child and a child with difficulties guided the discussions. Data was thematically analysed and feedback sought from the community via the World Café method. Results Personal resilience and strong family systems were identified as strengths. Mental health was identified as a complex primary need; and whilst refugees were aware of available services, there were issues in knowing how to access them. Opportunities for play/socialisation were recognised as unmet adolescent needs. Adults spoke of a need to support integration of “old” and “new” cultural values. Parents identified community as facilitating health knowledge transfer for new arrivals; whilst stakeholders saw this as a barrier when systems change. Most parents had not heard of early childhood services, and reported difficulty accessing child healthcare. Preschooler parents identified the family “GP” as the main source of health support; whilst parents of adolescents valued their child’s school. Health communication in written (not spoken) English was a significant roadblock. Differences in refugee family and service provider perceptions were also evident. Conclusions Refugee families face challenges to accessing services, but also have strengths that enable them to optimise their children’s wellbeing. Culturally-tailored models of care embedded within GP services and school systems may assist improved healthcare for refugee families. Electronic supplementary material The online version of this article (10.1186/s12889-019-7183-5) contains supplementary material, which is available to authorized users.
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Brunton R, Dryer R, Saliba A, Kohlhoff J. Re-examining pregnancy-related anxiety: A replication study. Women Birth 2019; 32:e131-e137. [DOI: 10.1016/j.wombi.2018.04.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 04/05/2018] [Accepted: 04/16/2018] [Indexed: 10/17/2022]
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Brunton RJ, Dryer R, Krägeloh C, Saliba A, Kohlhoff J, Medvedev O. The pregnancy-related anxiety scale: A validity examination using Rasch analysis. J Affect Disord 2018; 236:127-135. [PMID: 29730512 DOI: 10.1016/j.jad.2018.04.116] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 03/21/2018] [Accepted: 04/08/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Pregnancy-related anxiety is increasingly recognised as a common condition that is associated with many deleterious outcomes for both the mother and infant (e.g., preterm birth, postnatal depression). Limitations in the psychometric properties and/or breadth of existing scales for pregnancy-related anxiety highlight the need for a psychometrically sound measure to facilitate effective screening and possible early interventions. The recently developed Pregnancy-related Anxiety Scale (PrAS) was evaluated using Rasch analysis to explore how the scale's psychometric properties could be fine-tuned. METHOD A sample of 497 pregnant women completed the PrAS. Data were subjected to Rasch analysis, and the resulting scale structure examined using Confirmatory Factor Analysis. RESULTS After minor modifications, the Rasch model with 33-items and 8-factors demonstrated good fit, unidimensionality and excellent targeting and internal consistency. Confirmatory Factor Analysis confirmed the final structure, and Cronbach's alpha demonstrated excellent reliability. LIMITATIONS The use of the same sample for all analyses was a potential limitation due to the possibility of sample-specific influences. CONCLUSIONS The Rasch analysis further supports the internal construct validity of the PrAS. Ordinal to interval score conversions provide added precision to the analysis of the PrAS scores. The Rasch results, together with previous validation evidence, point to the PrAS as a comprehensive and psychometrically sound screening scale for pregnancy-related anxiety. The PrAS offers clinicians the ability to screen for pregnancy-related anxiety. The subscales provide additional insights into a woman's pregnancy-related anxiety and her specific areas of concern, enabling more targeted interventions.
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McMahon C, Huber A, Kohlhoff J, Camberis AL. DOES TRAINING IN THE CIRCLE OF SECURITY FRAMEWORK INCREASE RELATIONAL UNDERSTANDING IN INFANT/CHILD AND FAMILY WORKERS? Infant Ment Health J 2017; 38:658-668. [PMID: 28834602 DOI: 10.1002/imhj.21661] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This article evaluated whether attendance at Circle of Security training workshops resulted in attendees showing greater empathy and attachment-related knowledge and understanding, and fewer judgmental responses to viewing a stressful parent-child interaction. Participants were 202 practitioners who attended and completed a 2-day (n = 70), 4-day (n = 105), or 10-day (n = 27) COS training workshop in Australia or New Zealand in 2015. In a pre/post design, participant reactions to a video clip of a challenging parent-child interaction were coded for empathic, judgmental, or attachment-focused language. Attachment understanding was coded in response to questions about the greatest challenge that the dyad faced. In all training conditions, participants provided significantly more attachment-focused descriptors and showed significantly greater attachment understanding after training, but significantly fewer empathic descriptors. While participants at the longer workshops provided significantly fewer judgmental/critical descriptors, there was no change for those attending the 2-day workshop. Irrespective of workshop duration or professional background, participants took a more relational perspective on the vignette after the training workshops. More detailed research is required to establish the extent to which this increased knowledge and understanding is retained and integrated into infant mental health practice with parents and young children.
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Ogbo FA, Eastwood J, Page A, Arora A, McKenzie A, Jalaludin B, Tennant E, Miller E, Kohlhoff J, Noble J, Chaves K, Jones JM, Smoleniec J, Chay P, Smith B, Oei JL, Short K, Collie L, Kemp L, Raman S, Woolfenden S, Clark T, Blight V, Eapen V. Prevalence and determinants of cessation of exclusive breastfeeding in the early postnatal period in Sydney, Australia. Int Breastfeed J 2017; 12:16. [PMID: 28405212 PMCID: PMC5385049 DOI: 10.1186/s13006-017-0110-4] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 03/27/2017] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Optimal breastfeeding has benefits for the mother-infant dyads. This study investigated the prevalence and determinants of cessation of exclusive breastfeeding (EBF) in the early postnatal period in a culturally and linguistically diverse population in Sydney, New South Wales, Australia. METHODS The study used routinely collected perinatal data on all live births in 2014 (N = 17,564) in public health facilities in two Local Health Districts in Sydney, Australia. The prevalence of mother's breastfeeding intention, skin-to-skin contact, EBF at birth, discharge and early postnatal period (1-4 weeks postnatal) were estimated. Multivariate logistic regression models that adjusted for confounders were conducted to determine association between cessation of EBF in the early postnatal period and socio-demographic, psychosocial and health service factors. RESULTS Most mothers intended to breastfeed (92%), practiced skin-to-skin contact (81%), exclusively breastfed at delivery (90%) and discharge (89%). However, the prevalence of EBF declined (by 27%) at the early postnatal period (62%). Younger mothers (<20 years) and mothers who smoked cigarettes in pregnancy were more likely to cease EBF in the early postnatal period compared to older mothers (20-39 years) and those who reported not smoking cigarettes, respectively [Adjusted Odds Ratio (AOR) =2.7, 95%CI 1.9-3.8, P <0.001 and AOR = 2.5, 95%CI 2.1-3.0, P <0.001, respectively]. Intimate partner violence, assisted delivery, low socio-economic status, pre-existing maternal health problems and a lack of partner support were also associated with early cessation of EBF in the postnatal period. CONCLUSIONS Our findings suggest that while most mothers intend to breastfeed, and commence EBF at delivery and at discharge, the maintenance of EBF in the early postnatal period is sub-optimal. This highlights the need for efforts to promote breastfeeding in the wider community along with targeted actions for disadvantaged groups and those identified to be at risk of early cessation of EBF to maximise impact.
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Rollans M, Kohlhoff J, Meade T, Kemp L, Schmied V. PARTNER INVOLVEMENT: NEGOTIATING THE PRESENCE OF PARTNERS IN PSYCHOSOCIAL ASSESSMENT AS CONDUCTED BY MIDWIVES AND CHILD AND FAMILY HEALTH NURSES. Infant Ment Health J 2016; 37:302-12. [PMID: 27111339 DOI: 10.1002/imhj.21562] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 12/22/2015] [Accepted: 01/30/2016] [Indexed: 11/10/2022]
Abstract
Universal screening for maternal depression and assessment of psychosocial risks has been integrated into the routine perinatal care provided in many Australian hospitals, but to date, partners/fathers have been largely excluded from the process. This study explored the ways in which clinicians in health service settings include partners who attend antenatal and postnatal visits with women. Qualitative data were collected using observations (n = 54), interviews (n = 60), and discussion groups (n = 7) with midwives and child and family health nurses who conducted the appointments. Transcripts from observations, interviews, and discussion groups underwent qualitative analysis, and key themes were identified. Results showed partners to have little or no involvement in psychosocial assessment and depression screening. Thematic analysis revealed four key themes: negotiating partner exclusion, partial inclusion, women's business or a couple concern? and they know anyway. Partner involvement appeared to be challenged particularly by mandatory interpersonal violence screening, which, according to health service policy, is to be conducted confidentially. Overall, results highlighted partner involvement in perinatal depression screening and psychosocial assessment processes and identified some of the benefits such as partner disclosure, but also the challenges and complexities of inclusion of partners. Clinical implications and directions for further education and research are discussed.
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Longman T, Hawes DJ, Kohlhoff J. Callous-Unemotional Traits as Markers for Conduct Problem Severity in Early Childhood: A Meta-analysis. Child Psychiatry Hum Dev 2016; 47:326-34. [PMID: 26123709 DOI: 10.1007/s10578-015-0564-9] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Extensive research has shown that callous-unemotional (CU) traits in middle-childhood and adolescence are markers for a particularly severe and chronic pattern of antisocial behavior (Frick et al. in Psychol Bull 140:1-57, 2014). Comparatively little, however, is known about the relationship between CU traits and antisocial behavior in early childhood. A meta-analysis of k = 10 studies comprising n = 5731 participants was conducted to examine the relationship between CU traits and conduct problem severity prior to 5 years of age. Overall, a significant positive relationship was found between CU traits and conduct problem severity, in the order of large effect size (r = .39, p < .001). Moderator analyses revealed that this relationship differed based on use of same versus different informant across measures, but was consistent across sex and sample type (at-risk/clinic referred or community). This supports the view that CU traits represent a potentially informative focus for clinical assessment in early childhood.
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Dahlen HG, Barnett B, Kohlhoff J, Drum ME, Munoz AM, Thornton C. Obstetric and psychosocial risk factors for Australian-born and non-Australian born women and associated pregnancy and birth outcomes: a population based cohort study. BMC Pregnancy Childbirth 2015; 15:292. [PMID: 26552427 PMCID: PMC4640409 DOI: 10.1186/s12884-015-0681-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 10/04/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND One in four Australians is born overseas and 47% are either born overseas or have a parent who was. Obstetric and psychosocial risk factors for these women may differ. METHOD Data from one Sydney hospital (2012-2013) of all births recorded in the ObstetriX database were analysed (n = 3,092). Demographics, obstetric and psychosocial risk profile, obstetric interventions and complications and selected maternal and neonatal outcomes were examined for women born in Australia and overseas. RESULTS Women born in Australia were younger, more likely to be primiparous (28.6 v 27.5%), be obese (32.0% v 21.4%), smoke (19.7 % v 3.0%), have an epidural (26.2% v 20.2%) and were less likely to have gestational diabetes mellitus (GDM) (6.8% v 13.7% when compared to non-Australian born women. The highest rates of GDM, Gestational Hypertension (GH) and maternal anaemia were seen in women born in China, the Philippines and Pakistan respectively. Differences were also seen in psychosocial screening between Australian and non-Australian women with Australian-born women more likely to smoke and report a mental health disorder. There was an association between having an Edinburgh Postnatal Depression Scale (EPDS) ≥ 13 and other psychosocial issues, such as thoughts of self-harm, domestic violence, childhood abuse etc. These women were also less likely to breastfeed. Women with an EPDS ≥ 13 at booking compared to women with EPDS ≤12 had a higher chance of being diagnosed with GDM (AOR 1.85 95% CI 1.14-3.0). CONCLUSIONS There are significant differences in obstetric and psychosocial risk profiles and maternal and neonatal outcomes between Australian-born and non-Australian born women. In particular there appears to be an association between an EPDS of ≥13 and developing GDM, which warrants further investigation.
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Kohlhoff J, Hickinbotham R, Knox C, Roach V, Barnett Am B. Antenatal psychosocial assessment and depression screening in a private hospital. Aust N Z J Obstet Gynaecol 2015; 56:173-8. [PMID: 26515785 DOI: 10.1111/ajo.12418] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 09/21/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND It has been recommended that psychosocial assessment (including depression screening) be integrated into routine antenatal care across Australia, but implementation in the private sector has lagged. AIMS This study aimed to report preliminary outcomes associated with an antenatal psychosocial assessment and depression screening program implemented at an Australian private obstetric hospital setting and to report characteristics and correlates of elevated depression symptoms in this sample. MATERIALS AND METHODS A total of 993 pregnant women (mean ± SD gestational age 27.9 ± 6.7 weeks) participated in a structured psychosocial assessment interview and completed the Edinburgh Postnatal Depression Scale (EPDS). RESULTS Six per cent of participants scored ≥13 on the EPDS. Psychosocial correlates of antenatal depressive symptoms included low income, history of pregnancy termination, poor practical support, lack of confidence and history of depression. Almost 1 in 10 of the total sample was referred for further assessment and clinical support. CONCLUSIONS The prevalence of clinically significant antenatal depressive symptoms in this sample highlights the importance of antenatal depression screening for all women, including those who choose to access private obstetric care.
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