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Hormone therapy decision-making processes: Transgender youth and parents. J Adolesc 2020; 79:136-147. [DOI: 10.1016/j.adolescence.2019.12.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 11/22/2019] [Accepted: 12/30/2019] [Indexed: 01/18/2023]
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Stjerneklar S, Hougaard E, McLellan LF, Thastum M. A randomized controlled trial examining the efficacy of an internet-based cognitive behavioral therapy program for adolescents with anxiety disorders. PLoS One 2019; 14:e0222485. [PMID: 31532802 PMCID: PMC6750608 DOI: 10.1371/journal.pone.0222485] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 08/30/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Anxiety disorders are highly prevalent in adolescence, but access to health care services is limited and only few receive professional help. Internet-based cognitive behavioral therapy (ICBT) has been proposed to increase accessibility and reduce costs of treatment. OBJECTIVE The study evaluated the efficacy of a Danish version of the guided ICBT program ChilledOut Online, developed at the Centre for Emotional Health, Macquarie University, Australia. METHOD At the Centre for Psychological Treatment of Children and Adolescents, Aarhus University, Denmark, a randomized controlled trial was conducted with 70 adolescents (13-17 years) with anxiety disorders according to DSM-IV. Participants were randomly assigned to a 14-weeks therapist-guided ICBT or to a waitlist condition. Outcomes were evaluated post-treatment and at 3- and 12-month follow-up. RESULTS At post-treatment, the ICBT group significantly outperformed the waitlist condition with moderate to large between-group effect sizes on diagnostic severity and anxiety symptoms rated by clinicians, and by adolescents and their parents. Forty percent of adolescents in ICBT were free of their primary diagnosis compared to 16% in the waitlist condition. Treatment gains were maintained at 3- and 12-month follow-up. CONCLUSION Results of the study provide support for the efficacy of guided ICBT for adolescents with anxiety disorders. TRIAL REGISTRATION ClinicalTrials.gov: NCT02535403.
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Affiliation(s)
- Silke Stjerneklar
- Department of Psychology and Behavioral Sciences, School of Business and Social Sciences, Aarhus University, Aarhus, Denmark
| | - Esben Hougaard
- Department of Psychology and Behavioral Sciences, School of Business and Social Sciences, Aarhus University, Aarhus, Denmark
| | - Lauren F. McLellan
- Centre for Emotional Health, Department of Psychology, Macquarie University, New South Wales, North Ryde, Australia
| | - Mikael Thastum
- Department of Psychology and Behavioral Sciences, School of Business and Social Sciences, Aarhus University, Aarhus, Denmark
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Stjerneklar S, Hougaard E, Nielsen AD, Gaardsvig MM, Thastum M. Internet-based cognitive behavioral therapy for adolescents with anxiety disorders: A feasibility study. Internet Interv 2018; 11:30-40. [PMID: 30135757 PMCID: PMC6084871 DOI: 10.1016/j.invent.2018.01.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 12/21/2017] [Accepted: 01/04/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Cognitive behavioral therapy (CBT) is a well-documented effective method for the treatment of anxiety disorders in children and adolescents. While internet based CBT (ICBT) programs for adults have been widely investigated, research on ICBT programs for anxiety disorders in youth is still in an early phase: To date, no such program has been developed or evaluated in Denmark. AIM As preparation for a randomized controlled efficacy trial, this study aimed at evaluating the feasibility of a translated and adapted version of the ICBT program 'Chilled Out' for adolescents with anxiety disorders, developed at Macquarie University, Australia. METHODS At the University Clinic in Aarhus, Denmark, we conducted a feasibility study with six adolescents with a primary anxiety disorder. The 12-week ICBT intervention consisted of eight online modules. Participants received weekly phone calls from a clinical psychologist. Semi-structured interviews on participant's experiences of the program were administered post-treatment and at three-month follow-up. Outcome was evaluated post-treatment and at follow-up using diagnostic interview and questionnaires. RESULTS Five of the six participants completed the program. Participants were generally satisfied with the program and the majority would recommend it to others. Preliminary clinical outcome results indicated moderate to large improvements (e.g., a standardized mean difference from pre- to post-treatment of d = 1.54 on the clinical severity rating of their primary anxiety disorder). CONCLUSION Results from this study indicate that a translated and revised version of the Chilled Out program could be a feasible psychological intervention for Danish adolescents with anxiety disorders.
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Affiliation(s)
- Silke Stjerneklar
- Department of Psychology and Behavioral Sciences, Aarhus BSS, Aarhus University, Bartholins Allé 9, 8000 Aarhus C, Denmark
| | - Esben Hougaard
- Department of Psychology and Behavioral Sciences, Aarhus BSS, Aarhus University, Bartholins Allé 9, 8000 Aarhus C, Denmark
| | | | - Majken M. Gaardsvig
- Department of Psychology and Behavioral Sciences, Aarhus BSS, Aarhus University, Bartholins Allé 9, 8000 Aarhus C, Denmark
| | - Mikael Thastum
- Department of Psychology and Behavioral Sciences, Aarhus BSS, Aarhus University, Bartholins Allé 9, 8000 Aarhus C, Denmark
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Barlevy D, Wangmo T, Elger BS, Ravitsky V. Attitudes, Beliefs, and Trends Regarding Adolescent Oncofertility Discussions: A Systematic Literature Review. J Adolesc Young Adult Oncol 2016; 5:119-34. [DOI: 10.1089/jayao.2015.0055] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Affiliation(s)
- Dorit Barlevy
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Tenzin Wangmo
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Bernice S. Elger
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Vardit Ravitsky
- Bioethics Program, School of Public Health, University of Montreal, Montreal, Canada
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Abstract
Adolescent pregnancy is not a new phenomenon in the United States. The 31.3% adolescent birth rate in the US remains one of the highest among industrialized nations. Healthy People 2020 targeted a specific goal of a 10% reduction in pregnancy rates among adolescent females. This objective is important to healthcare providers working in the maternal-child arena, as the consequences of pregnancy and birth can be relatively detrimental to the adolescent, the offspring, and society as a whole. Programs purposely designed for the adolescent population are essential to promoting and achieving optimal results. The intent of this article was to highlight 3 successful prenatal programs that use a collaborative and interprofessional approach to caring for pregnant adolescents: group prenatal care, school-based programs, and age-specific clinics.
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Ross LF, Ross LF, Saal HM, David KL, Anderson RR. Technical report: Ethical and policy issues in genetic testing and screening of children. Genet Med 2013; 15:234-45. [PMID: 23429433 DOI: 10.1038/gim.2012.176] [Citation(s) in RCA: 307] [Impact Index Per Article: 27.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
The genetic testing and genetic screening of children are commonplace. Decisions about whether to offer genetic testing and screening should be driven by the best interest of the child. The growing literature on the psychosocial and clinical effects of such testing and screening can help inform best practices. This technical report provides ethical justification and empirical data in support of the proposed policy recommendations regarding such practices in a myriad of settings.
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Hoek W, Schuurmans J, Koot HM, Cuijpers P. Effects of Internet-based guided self-help problem-solving therapy for adolescents with depression and anxiety: a randomized controlled trial. PLoS One 2012; 7:e43485. [PMID: 22952691 PMCID: PMC3432036 DOI: 10.1371/journal.pone.0043485] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Accepted: 07/20/2012] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Symptoms of depression and anxiety are highly prevalent in adolescence and they are the cause of considerable suffering. Even so, adolescents are not inclined to seek professional help for emotional problems. Internet-based preventive interventions have been suggested as a feasible method of providing appropriate care to adolescents with internalizing symptoms. The objective of this study was to evaluate the effects of preventive Internet-based (guided) self-help problem-solving therapy (PST) for adolescents reporting mild to moderate symptoms of depression and/or anxiety as compared to a waiting list control group (WL). METHODOLOGY/PRINCIPAL FINDINGS A total of 45 participants were randomized to the 2 conditions. PST consisted of 5 weekly lessons. Participants were supported by e-mail. Self-report measures of depression and anxiety were filled in at baseline and after 3 weeks, 5 weeks, and 4 months. Of the 45 participants, 28 (62.2%) completed questionnaires after 3 weeks, 28 (62.2%) after 5 weeks, and 27 (60%) after 4 months. Hierarchical linear modeling analyses revealed overall improvement over time for both groups on depressive and anxiety symptoms. However, no significant group x time interactions were found. No differences were found between completers and non-completers. CONCLUSIONS/SIGNIFICANCE Results show that depressive and anxiety symptoms declined in both groups. No support was found, however, for the assumption that Internet-based PST was efficacious in reducing depression and anxiety in comparison to the waiting list control group. This finding could represent lack of power. TRIAL REGISTRATION Netherlands Trial Register NTR1322.
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Affiliation(s)
- Willemijn Hoek
- Department of Clinical Psychology, VU University, Amsterdam, The Netherlands.
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Hoek W, Aarts F, Schuurmans J, Cuijpers P. Who are we missing? Non-participation in an Internet intervention trial for depression and anxiety in adolescents. Eur Child Adolesc Psychiatry 2012; 21:593-5. [PMID: 22736194 PMCID: PMC3470688 DOI: 10.1007/s00787-012-0295-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2011] [Accepted: 06/02/2012] [Indexed: 11/24/2022]
Affiliation(s)
- Willemijn Hoek
- Department of Clinical Psychology, Faculty of Psychology and Education, EMGO+ Institute, VU University, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands
| | - Floor Aarts
- Department of Clinical Psychology, Faculty of Psychology and Education, EMGO+ Institute, VU University, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands
| | - Josien Schuurmans
- Department of Clinical Psychology, Faculty of Psychology and Education, EMGO+ Institute, VU University, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands
| | - Pim Cuijpers
- Department of Clinical Psychology, Faculty of Psychology and Education, EMGO+ Institute, VU University, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands
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Mack R, Giarelli E, Bernhardt BA. The adolescent research participant: strategies for productive and ethical interviewing. J Pediatr Nurs 2009; 24:448-57. [PMID: 19931142 DOI: 10.1016/j.pedn.2008.07.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2007] [Revised: 07/07/2008] [Accepted: 07/20/2008] [Indexed: 10/20/2022]
Abstract
Nurse researchers who seek to study the experiences of adolescents have limited resources to assist them with the process. Although some elements of interviewing are standard practice, special approaches are needed for the adolescent participating in research. Interviews are especially challenging. The purpose of this article is to present strategies to assist researchers as they engage this cohort in research. These strategies include evaluating the adolescent's developmental level, designing developmentally appropriate questions, and refining interviewing techniques to optimize the experience for the participants. Strategies presented are useful to clinicians who wish to establish a therapeutic rapport with young patients.
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Affiliation(s)
- Rita Mack
- University of Pennsylvania, School of Nursing, Philadelphia, PA, USA.
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Stretch R, McCann R, Roberts SA, Elton P, Baxter D, Brabin L. A qualitative study to assess school nurses' views on vaccinating 12-13 year old school girls against human papillomavirus without parental consent. BMC Public Health 2009; 9:254. [PMID: 19622145 PMCID: PMC2718887 DOI: 10.1186/1471-2458-9-254] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2009] [Accepted: 07/21/2009] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND In the UK, parental consent for the routine vaccination of 12-13 year olds schoolgirls against human papillomavirus (HPV) is recommended, although legally girls may be able to consent themselves. As part of a vaccine study conducted ahead of the National HPV Vaccine Programme we sought the views of school nurses on vaccinating girls who did not have parental consent. METHODS HPV vaccination was offered to all 12 year old girls attending schools in two Primary Care Trusts in Greater Manchester. At the end of the study semi-structured, tape-recorded interviews were conducted with school nurses who had delivered the vaccine (Cervarix). The interview template was based on concepts derived from the Theory of Planned Behaviour. Transcripts were analysed thematically in order to understand school nurses' intentions to implement vaccination based on an assessment of Gillick competency. RESULTS School nurses knew how to assess the competency of under-16s but were still unwilling to vaccinate if parents had refused permission. If parents had not returned the consent form, school nurses were willing to contact parents, and also to negotiate with parents who had refused consent. They seemed unaware that parental involvement required the child's consent to avoid breaking confidentiality. Nurses' attitudes were influenced by the young appearance and age of the school year group rather than an individual's level of maturity. They were also confused about the legal guidelines governing consent. School nurses acknowledged the child's right to vaccination and strongly supported prevention of HPV infection but ultimately believed that it was the parents' right to give consent. Most were themselves parents and shared other parents' concerns about the vaccine's novelty and unknown long-term side effects. Rather than vaccinate without parental consent, school nurses would defer vaccination. CONCLUSION Health providers have a duty of care to girls for whom no parental consent for HPV vaccination has been given, and in the UK, this includes conducting, and acting upon, an assessment of the maturity and competence of an adolescent minor. To facilitate this, policies, training and support structures for health providers should be implemented.
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Affiliation(s)
- Rebecca Stretch
- Academic Unit of Obstetrics and Gynaecology, University of Manchester, St. Mary's Hospital Research Floor (5th), Oxford Road, Manchester M13 9WL, UK
| | - Rosemary McCann
- Greater Manchester Health Protection Unit, Eccles, M30 0NJ, UK
| | - Stephen A Roberts
- Health Methodology Research Group, University of Manchester, Manchester M13 9PT, UK
| | - Peter Elton
- Public Health Department, Stockport Primary Care Trust, Stockport SK4 1BS, UK
| | - David Baxter
- Public Health Department, Bury Primary Care Trust, Bury M45 7TA, UK
| | - Loretta Brabin
- Academic Unit of Obstetrics and Gynaecology, University of Manchester, St. Mary's Hospital Research Floor (5th), Oxford Road, Manchester M13 9WL, UK
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Best practices in perinatal nursing: partnering with patients to enhance informed decision making. J Perinat Neonatal Nurs 2009; 23:213-6. [PMID: 19704287 DOI: 10.1097/jpn.0b013e3181af3a73] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Legal Issues in Sexual and Reproductive Health Care for Adolescents. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2009. [DOI: 10.1016/j.cpem.2009.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Abstract
The 1994 International Conference on Population and Development held in Cairo recognized the centrality of reproductive health to human rights and development. Progress on the Cairo agenda has slowed for numerous reasons, however. The United States, once an enthusiastic promoter of this agenda and still the world's leading reproductive health donor, has revised its reproductive health policies radically since the 2000 presidential election of George W. Bush. This study examines how policies have been reconfigured in five key reproductive health areas, sparking controversy both in the United States and internationally. These categories are the content of sex education, access to emergency contraception and to abortion services, condom effectiveness, and HIV/AIDS prevention. The analysis presented here elucidates how ideological considerations have superseded public health and ethical concerns and reflects on health and ethical consequences.
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Affiliation(s)
- Andrzej Kulczycki
- Department of Maternal and Child Health, University of Alabama at Birmingham, 320 Ryals School of Public Health, 1665 University Boulevard, Birmingham, AL 35294-0022, USA.
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Abstract
In the past, minors were not considered legally capable of making medical decisions and were viewed as incompetent because of their age. The authority to consent or refuse treatment for a minor remained with a parent or guardian. This parental authority was derived from the constitutional right to privacy regarding family matters, common law rule, and a general presumption that parents or guardians will act in the best interest of their incompetent child. However, over the years, the courts have gradually recognized that children younger than 18 years who show maturity and competence deserve a voice in determining their course of medical treatment. This article will explore the rights and interests of minors, parents, and the state in medical decision making and will address implications for nursing administrators and leaders.
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Affiliation(s)
- Kathryn Hickey
- Shriners Hospitals for Children-Chicago, 2211 N. Oak Park Avenue, Chicago, IL 60707, USA.
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