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Laupacis M, Acai A, MacMillan HL, Vanstone M, Stewart D, Dimitropoulos G, Kimber M. A Qualitative Description of Resident Physicians' Understanding of Child Maltreatment: Impacts, Recognition, and Response. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063319. [PMID: 35329006 PMCID: PMC8949331 DOI: 10.3390/ijerph19063319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/08/2022] [Accepted: 03/09/2022] [Indexed: 11/22/2022]
Abstract
Child maltreatment (CM) is a public health problem with devastating effects on individuals, families, and communities. Resident physicians have varied formal education in CM, and report feeling inadequately trained in identifying and responding to CM. The purpose of this study is to explore residents’ understanding of the impacts of CM, and their perceptions of their role in recognizing and responding to CM to better understand their educational needs. This study analyzed qualitative data obtained from a larger project on family violence education. Twenty-nine resident physicians enrolled in pediatric, family medicine, emergency medicine, obstetrics and gynecology, and psychiatry training programs in Alberta, Ontario, and Québec participated in semi-structured interviews to elicit their ideas, experiences, and educational needs relating to CM. Conventional (inductive) content analysis guided the development of codes and categories. Residents had thorough knowledge about the impacts of CM and their duty to recognize CM, but there was less consistency in how residents understood their role in responding to CM. Residents identified the need for more education about recognizing and responding to CM, and the need for educational content to be responsive to training, patient and family factors, and systemic issues. Despite knowledge about the impacts of CM and laws pertaining to mandated reporting, residents reported challenges with responding to concerns of CM. Findings of this study emphasize the need for better training in response to CM. Future educational interventions should consider a multidisciplinary, experiential approach.
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Affiliation(s)
- Megan Laupacis
- Department of Pediatrics, McMaster University, Hamilton, ON L8S 4K1, Canada; (M.L.); (H.L.M.)
- McMaster Children’s Hospital, Hamilton, ON L8N 3Z5, Canada
| | - Anita Acai
- Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, ON L8S 4K1, Canada;
| | - Harriet L. MacMillan
- Department of Pediatrics, McMaster University, Hamilton, ON L8S 4K1, Canada; (M.L.); (H.L.M.)
- Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, ON L8S 4K1, Canada;
- Offord Centre for Child Studies, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - Meredith Vanstone
- Department of Family Medicine, McMaster University, Hamilton, ON L8S 4K1, Canada;
| | - Donna Stewart
- Centre for Mental Health, University Health Network, University of Toronto, Toronto, ON M5G 2C4, Canada;
| | - Gina Dimitropoulos
- Faculty of Social Work, University of Calgary, Calgary, AB T2N 1N4, Canada;
| | - Melissa Kimber
- Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, ON L8S 4K1, Canada;
- Offord Centre for Child Studies, McMaster University, Hamilton, ON L8S 4K1, Canada
- Correspondence:
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Brewerton TD, Gavidia I, Suro G, Perlman MM, Genet J, Bunnell DW. Provisional posttraumatic stress disorder is associated with greater severity of eating disorder and comorbid symptoms in adolescents treated in residential care. EUROPEAN EATING DISORDERS REVIEW 2021; 29:910-923. [PMID: 34523192 DOI: 10.1002/erv.2864] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 08/21/2021] [Accepted: 09/02/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Past traumatic events, subsequent posttraumatic stress disorder (PTSD) and related psychiatric comorbidities are commonly associated with eating disorders (EDs) in adults but remain understudied in adolescents. METHODS Adolescent participants (mean [SD] age = 15.1 ± 1.5 years, 96.5% female) with EDs entering residential treatment (n = 647) at six sites in the United States completed validated self-report assessments of ED, PTSD, major depression, anxiety disorders and quality of life. Provisional DSM-5 PTSD diagnoses (PTSD+) were made via the Childhood Trauma Questionnaire, admission interviews and the PTSD Symptom Checklist for DSM-5. RESULTS PTSD+ occurred in 35.4% of participants, and those with ED-PTSD+ had significantly higher scores on all assessments (p ≤ 0.001), including measures of ED psychopathology, major depression, anxiety disorders and quality of life, as well as significantly higher rates of all forms of childhood trauma. Those with PTSD+ also exhibited a significantly higher percent median body mass index for age and sex and a lower propensity toward anorexia nervosa, restricting type. CONCLUSIONS Results confirm that adolescent patients in residential treatment with ED-PTSD+ are more symptomatic and have worse quality of life than their ED counterparts without PTSD. Integrated treatment approaches that effectively address ED-PTSD+ are greatly needed in ED programs that treat adolescents.
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Affiliation(s)
- Timothy D Brewerton
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA.,LLC, Mt. Pleasant, South Carolina, USA.,Monte Nido and Affiliates, Miami, Florida, USA
| | | | - Giulia Suro
- Monte Nido and Affiliates, Miami, Florida, USA
| | - Molly M Perlman
- Monte Nido and Affiliates, Miami, Florida, USA.,Department of Psychiatry and Behavioral Health, Florida International University Herbert Wertheim College of Medicine, Miami, Florida, USA
| | | | - Douglas W Bunnell
- Monte Nido and Affiliates, Miami, Florida, USA.,Private Practice, Westport, Connecticut, USA
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Kimber M, McTavish JR, Vanstone M, Stewart DE, MacMillan HL. Child maltreatment online education for healthcare and social service providers: Implications for the COVID-19 context and beyond. CHILD ABUSE & NEGLECT 2021; 116:104743. [PMID: 32980151 PMCID: PMC7513691 DOI: 10.1016/j.chiabu.2020.104743] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 09/10/2020] [Accepted: 09/13/2020] [Indexed: 05/12/2023]
Abstract
Evidence indicates that healthcare and social service providers (HSSPs) receive inadequate education related to recognizing and responding to child maltreatment. This is despite the fact HSSPs are identified as an important factor in the primary, secondary, and tertiary prevention of this childhood exposure. The need for online education for HSSPs' is highlighted during the COVID-19 pandemic restrictions and will continue to be relevant afterward. The objective of this commentary is to provide an overview of: (a) educational interventions for HSSPs' related to recognizing and responding to child maltreatment; (b) the development of VEGA (Violence, Evidence, Guidance, Action), which is an online platform of educational resources to support HSSPs to recognize and respond to child maltreatment; and (c) the RISE (Researching the Impact of Service provider Education) project, which is an ongoing multi-province evaluation of VEGA in Canada. It is important to consider ongoing ways that HSSPs can receive education related to recognizing and responding to child maltreatment. The virtual implementation of VEGA and the RISE Project provide a necessary opportunity to continue to increase the capacity of Canada's HSSPs to adequately and safely recognize and respond to child maltreatment, while simultaneously advancing education scholarship for the field of child maltreatment and which will have relevance for the COVID-19 context and beyond.
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Affiliation(s)
- Melissa Kimber
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1280 Main Street West, MIP Suite 201A, Hamilton, ON, L8S 4K1, Canada.
| | - Jill R McTavish
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1280 Main Street West, MIP Suite 201A, Hamilton, ON, L8S 4K1, Canada
| | - Meredith Vanstone
- Department of Family Medicine, Faculty of Health Sciences, McMaster University, 1280 Main Street West, DBHSC 5003E, Hamilton, ON, L8S 4K1, Canada
| | - Donna E Stewart
- Centre for Mental Health, University of Toronto and University Health Network, 200 Elizabeth Street, EN-7-229, Toronto, ON, M5G 2C4, Canada
| | - Harriet L MacMillan
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, and Department of Pediatrics, McMaster University, 1280 Main Street West, MIP 201A, Hamilton, ON, L8S 4K1, Canada
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Kimber M, Gonzalez A, MacMillan HL. Recognizing and Responding to Child Maltreatment: Strategies to Apply When Delivering Family-Based Treatment for Eating Disorders. Front Psychiatry 2020; 11:678. [PMID: 32754071 PMCID: PMC7366365 DOI: 10.3389/fpsyt.2020.00678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 06/29/2020] [Indexed: 11/29/2022] Open
Abstract
Child maltreatment encompasses a constellation of adverse parental behaviors that include physical, sexual, or emotional abuse, physical or emotional neglect, as well as exposure to violence between parents. A growing body of literature indicates that exposure to child maltreatment is a significant risk factor for the development and maintenance of eating disorders (EDs) and that practitioners experience challenges related to recognizing and responding to various forms of child maltreatment in their practice. Parent-child interactions signifying possible child maltreatment can be subtle; furthermore, the emotional and behavioral symptoms associated with an ED can overlap with those linked with child maltreatment, making it difficult for practitioners to distinguish whether children's symptoms are attributable to underlying psychopathology versus exposure to child maltreatment. This challenge can be further complicated in the context of delivering family-based treatment (FBT); FBT reaffirms that there is no single cause of EDs and asserts the leadership role of parents in their child's recovery process-both of which may lead practitioners to inadvertently miss indicators of child maltreatment. In this article, we provide an overview of the evidence linking child maltreatment to EDs among children and adolescents, as well as evidence-informed strategies for practitioners to safely recognize and respond to suspected child maltreatment when delivering FBT to children and adolescents in their practice.
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Affiliation(s)
- Melissa Kimber
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Andrea Gonzalez
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Harriet L. MacMillan
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
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Treasure J, Willmott D, Ambwani S, Cardi V, Clark Bryan D, Rowlands K, Schmidt U. Cognitive Interpersonal Model for Anorexia Nervosa Revisited: The Perpetuating Factors that Contribute to the Development of the Severe and Enduring Illness. J Clin Med 2020; 9:E630. [PMID: 32120847 PMCID: PMC7141127 DOI: 10.3390/jcm9030630] [Citation(s) in RCA: 100] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 02/21/2020] [Accepted: 02/25/2020] [Indexed: 02/07/2023] Open
Abstract
The cognitive interpersonal model was outlined initially in 2006 in a paper describing the valued and visible aspects of anorexia nervosa (Schmidt and Treasure, 2006). In 2013, we summarised many of the cognitive and emotional traits underpinning the model (Treasure and Schmidt, 2013). In this paper, we describe in more detail the perpetuating aspects of the model, which include the inter- and intrapersonal related consequences of isolation, depression, and chronic stress that accumulate in the severe and enduring stage of the illness. Since we developed the model, we have been using it to frame research and development at the Maudsley. We have developed and tested interventions for both patients and close others, refining the model through iterative cycles of model/intervention development in line with the Medical Research Council (MRC) framework for complex interventions. For example, we have defined the consequences of living with the illness on close others (including medical professionals) and characterised the intense emotional reactions and behaviours that follow. For the individual with an eating disorder, these counter-reactions can allow the eating disorder to become entrenched. In addition, the consequent chronic stress from starvation and social pain set in motion processes such as depression, neuroprogression, and neuroadaptation. Thus, anorexia nervosa develops a life of its own that is resistant to treatment. In this paper, we describe the underpinnings of the model and how this can be targeted into treatment.
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Affiliation(s)
- Janet Treasure
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, SE5 8AF London, UK; (J.T.); (V.C.); (D.C.B.); (K.R.); (U.S.)
| | - Daniel Willmott
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, SE5 8AF London, UK; (J.T.); (V.C.); (D.C.B.); (K.R.); (U.S.)
| | - Suman Ambwani
- Department of Psychology, Dickinson College, Carlisle, PA17013, USA;
| | - Valentina Cardi
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, SE5 8AF London, UK; (J.T.); (V.C.); (D.C.B.); (K.R.); (U.S.)
| | - Danielle Clark Bryan
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, SE5 8AF London, UK; (J.T.); (V.C.); (D.C.B.); (K.R.); (U.S.)
| | - Katie Rowlands
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, SE5 8AF London, UK; (J.T.); (V.C.); (D.C.B.); (K.R.); (U.S.)
| | - Ulrike Schmidt
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, SE5 8AF London, UK; (J.T.); (V.C.); (D.C.B.); (K.R.); (U.S.)
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Aradas J, Sales D, Rhodes P, Conti J. "As long as they eat"? Therapist experiences, dilemmas and identity negotiations of Maudsley and family-based therapy for anorexia nervosa. J Eat Disord 2019; 7:26. [PMID: 31388424 PMCID: PMC6670233 DOI: 10.1186/s40337-019-0255-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 06/25/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Maudsley Family Therapy and its manualised version Family-Based Therapy for Anorexia Nervosa (FBT-AN) have accrued the most significant research evidence-base for the treatment of adolescent Anorexia Nervosa (AN). A tradition of seeking augmentations for this treatment has also been established to enhance efficacy. There exists, however, a gap in the uptake of this form of manualised treatment into the "real world" of clinicians who work with adolescent AN. AIMS This research study investigated the key experiences and identity negotiations of a group of nine Australian clinicians who were interested in contributing to research into ways that Maudsley and FBT-AN might be improved. METHODS Nine clinicians, who at the time of the interview practised or had previously practised, FBT-AN participated in a semi-structured interview. A critical discursive analysis of interview transcripts generated a thematic map of these therapists' experiences and identity negotiations in their practice of FBT-AN. RESULTS These therapists experienced the structure of FBT-AN as both a secure map for therapy, yet also constraining at times, in their work with adolescents and their families. Additionally, their professional identities were both invested and troubled by the identity position of themselves as evidence-based practitioners, particularly where evidence-based practice (EBP) meant strict fidelity to the manual and restrained them from tailoring a broader range of therapeutic interventions to an individual adolescent and their family. Within their narratives, these therapists refashioned alternative identity positions around what it meant to be an evidence-based practitioner through listening to and drawing on their clinical expertise of what works in therapeutic practice with an individual adolescent and their family. CONCLUSIONS These therapists narratives highlight the power of the dominant discourse of EBP that works to privilege the research evidence over other forms of evidence that include clinician expertise and client preferences. The dilemmas faced by these therapists questioned not only the strict application of FBT-AN for adolescent AN across diverse therapeutic contexts, but also the effects of supervisory practices that paralleled this strict fidelity to the model. Further research is needed into therapeutic interventions and supervisory practices that give greater scope for clinicians to draw on their expertise in the flexible tailoring of treatments to the unique needs and preferences of the individual adolescent and their family.
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Affiliation(s)
- Jessica Aradas
- University of Western Sydney, Locked Bag 1797, Penrith, 2751 Australia
| | - Diana Sales
- University of Western Sydney, Locked Bag 1797, Penrith, 2751 Australia
| | | | - Janet Conti
- University of Western Sydney, Locked Bag 1797, Penrith, 2751 Australia
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