Perceptions by Families of Emergency Medical Service Interventions During Imminent Pediatric Out-of-Hospital Death.

OBJECTIVE: To understand how family members view the ways Emergency Medical Services (EMS) and other first responders interact with distressed family members during an intervention involving a recent or impending pediatric death. METHODS: In depth interviews with 11 grieving parents of young children and survey results from 4 additional grieving parents of adult children were conducted as part of a larger study on effective ways for EMS providers to interact with distressed family members during a pediatric death in the field. The responses were analyzed using qualitative content analyses. RESULTS: Family reactions to the crisis and the professional response by first responders were critical to family coping and getting necessary support. There were several critical competencies identified to help the family cope including: (1) that first responders provide excellent and expeditious care with seamless coordination, (2) allowing family to witness the resuscitation including the attempts to save the child's life, and (3) providing ongoing communication. Whether the child is removed from the scene or not, keeping the family apprised of what is happening and why is critical. Giving tangible forms of support by calling friends, family, and clergy, along with allowing the family time with the child after death, giving emotional support, and follow-up gestures all help families cope. CONCLUSION: The study generated hypothetical ways for first responders to interact with distressed family members during an OOH pediatric death.

Compassionate Options for Pediatric EMS (COPE): Addressing Communication Skills.

INTRODUCTION: Each year, 16,000 children suffer cardiopulmonary arrest, and in one urban study, 2% of pediatric EMS calls were attributed to pediatric arrests. This indicates a need for enhanced educational options for prehospital providers that address how to communicate to families in these difficult situations. In response, our team developed a cellular phone digital application (app) designed to assist EMS providers in self-debriefing these events, thereby improving their communication skills. The goal of this study was to pilot the app using a simulation-based investigative methodology. METHODS: Video and didactic app content was generated using themes developed from a series of EMS focus groups and evaluated using volunteer EMS providers assessed during two identical nonaccidental trauma simulations. Intervention groups interacted with the app as a team between assessments, and control groups debriefed during that period as they normally would. Communication performance and gap analyses were measured using the Gap-Kalamazoo Consensus Statement Assessment Form. RESULTS: A total of 148 subjects divided into 38 subject groups (18 intervention groups and 20 control groups) were assessed. Comparison of initial intervention group and control group scores showed no statistically significant difference in performance (2.9/5 vs. 3.0/5; p = 0.33). Comparisons made during the second assessment revealed a statistically significant improvement in the intervention group scores, with a moderate to large effect size (3.1/5 control vs. 4.0/5 intervention; p < 0.001, r = 0.69, absolute value). Gap analysis data showed a similar pattern, with gaps of -0.6 and -0.5 (values suggesting team self-over-appraisal of communication abilities) present in both control and intervention groups (p = 0.515) at the initial assessment. This gap persisted in the control group at the time of the second assessment (-0.8), but was significantly reduced (0.04) in the intervention group (p = 0.013, r = 0.41, absolute value). CONCLUSION: These results suggest that an EMS-centric app containing guiding information regarding compassionate communication skills can be effectively used by EMS providers to self-debrief after difficult events in the absence of a live facilitator, significantly altering their near-term communication patterns. Gap analysis data further imply that engaging with the app in a group context positively impacts the accuracy of each team's self-perception.

Impact of Two Adolescent Pregnancy Prevention Interventions on Risky Sexual Behavior: A Three-Arm Cluster Randomized Control Trial.

OBJECTIVES: To test the efficacy of Reducing the Risk (RTR) and Love Notes (LN) on reducing risky sexual behavior among youths yet to experience or cause a pregnancy. METHODS: The four dependent variables were ever had sex, condom use, birth control use, and number of sexual partners at 3- and 6-month follow-up in a 3-arm cluster randomized controlled trial of 1448 impoverished youths, aged 14 to 19 years, in 23 community-based organizations in Louisville, Kentucky, from September 2011 through March 2014. RESULTS: At 3 and 6 months, compared with the control condition, youths in RTR reported fewer sexual partners and greater use of birth control. At 6 months, LN participants reported greater use of birth control and condoms, fewer sexual partners, and were less likely to have ever had sex compared with the control condition. CONCLUSIONS: We provided additional evidence for the continued efficacy of RTR and the first rigorous study of LN, which embeds sex education into a larger curriculum on healthy relationships and violence prevention.

Family Centered Practice During Pediatric Death in an Out of Hospital Setting.

OBJECTIVE: To understand effective ways for EMS providers to interact with distressed family members during a field intervention involving a recent or impending out-of-hospital (OOH) pediatric death. METHODS: Eight focus groups with 98 EMS providers were conducted in urban and rural settings between November 2013 and March 2014. Sixty-eight providers also completed a short questionnaire about a specific event including demographics. Seventy-eight percent of providers were males, 13% were either African American or Hispanic, and the average number of years in EMS was 16 years. They were asked how team members managed the family during the response to a dying child, what was most helpful for families whose child suddenly and unexpectedly was dead in the OOH setting, and what follow up efforts with the family were effective. RESULTS: The professional response by the EMS team was critical to family coping and getting necessary support. There were several critical competencies identified to help the family cope including: (1) that EMS provide excellent and expeditious care with seamless coordination, (2) allowing family to witness the resuscitation including the attempts to save the child's life, and (3) providing ongoing communication. Whether the child is removed from the scene or not, keeping the family appraised of what is happening and why is critical. Exclusion of families from the process in cases of suspected child abuse is not warranted. Giving tangible forms of support by calling friends, family, and clergy, along with allowing the family time with the child after death, giving emotional support, and follow-up gestures all help families cope. CONCLUSION: The study revealed effective ways for EMS providers to interact with distressed family members during an OOH pediatric death.

Prevalence of Secondary Traumatic Stress Among Direct Support Professionals in Intellectual and Developmental Disabilities Field.

Direct support professionals (DSPs) are deemed by existing literature as vital support to persons with intellectual or developmental disabilities (IDD). They may be exposed to the traumatic experiences of people with IDD with potential psychological implications. Secondary traumatic stress (STS) has been studied among related professionals across human services, but little is known among DSPs. The current study examines the prevalence of STS in a sample of DSPs. The results suggested that DSPs are exposed to traumatic experiences, and exposure to a greater number of traumatized clients is significantly correlated with symptoms of STS. At least 12.4% of DSPs in this sample met the diagnostic criteria for experiencing post-traumatic stress disorder (PTSD) symptoms. Also, results suggest STS differences in DSPs based on demographics.

The Psychology of Coronavirus Behavioral Health Mindset, Vaccination Receptivity, Customer Orientation and Community Public Service.

Three studies were conducted to explore the psychological determinants of COVID-deterrent behaviors. In Study 1, using data collected and analyzed both before and after the release of COVID-19 vaccines, mask-wearing, other preventative behaviors like social distancing, and vaccination intentions were positively related to assessments of the Coronavirus Behavioral Health Mindset (CVBHM); belief in the credibility of science; progressive political orientation; less use of repressive and more use of sensitization coping; and the attribution of COVID-19 safety to effort rather than ability, powerful forces, fate, or luck. In Study 2, favorable COVID-19 vaccination intentions were related to greater willingness to work, lower emotional distress, and greater customer experience mindset. Study 3 examined the personality and motives of individuals who volunteered to help deliver COVID-19 inoculations to the local community. The vaccine-giving volunteers, especially those with prosocial motives, had high CVBHM scores, belief in the credibility of science, low use of repressive coping, greater attribution of COVID-19 protection to effort, low likelihood of voting conservative, were older, and had more education than others. The majority of public health volunteers expressed prosocial motives to help people or join a cause (60.7%), but many (39.3%) expressed the personal motives of getting the COVID-19 vaccination for themselves, conveying a public image of compassion, or structuring time. Based on the three research studies, a COVID-19 Mindset Hierarchy model is proposed to integrate the results.

Sobriety Treatment and Recovery Teams for families with co-occurring substance use and child maltreatment: A randomized controlled trial.

BACKGROUND: Co-occurring parental substance use and child maltreatment has increased in recent years and is associated with poor child welfare outcomes. The Sobriety Treatment and Recovery Teams (START) program was developed to meet the needs of these families. OBJECTIVE: A randomized controlled trial was implemented to compare START to usual child welfare services on three outcomes: out-of-home care (OOHC) placements; reunification; and subsequent child maltreatment. PARTICIPANTS AND SETTING: Families reported to child welfare services in Jefferson County, Kentucky, were eligible if they had a current finding of child maltreatment or services needed, substance use as a primary risk factor, a child under six years of age, and no other open child welfare cases. METHODS: Biased coin randomization was used for a control: treatment randomization ratio of 1:2. Analyses were conducted using intent-to-treat (ITT), though a subsample of families receiving services was also analyzed. Differences were assessed using t-tests, chi-square, and risk ratios. RESULTS: A total of 348 families including 526 children were randomized to START (n = 346) and usual services (n = 180). There were no significant differences between groups on the three outcomes in the ITT sample or the subsample that received services, though the START OOHC rate was 7 percentage points lower (relative difference: 21.6 %) and the reunification rate was 13 percentage points higher (relative difference: 27.6 %) in the subsample. CONCLUSIONS: Although differences between groups were not significantly different, the relative differences were meaningful and this is the third study showing lower rates of OOHC among START relative to usual services. Additionally, the START reunification rate is higher than the overall U.S. average in spite of notable risk factors.

The effects of training reinforcement on training transfer in child welfare.

The purpose of this research was to compare the impact of different training methods on training transfer. Child welfare workers were assigned to one of three groups: classroom training only, classroom training plus reinforcement, and no training. The effect of these different training approaches on the transfer of assessment and case planning skills from the training was examined through a review of 120 child welfare case records. Results indicated that providing both training and reinforcement yielded a higher level of transfer than training alone or no training.

Recruiting and retaining child welfare workers: is preparing social work students enough for sustained commitment to the field?

Graduates of specialized BSW child welfare education programs are more likely to be retained after two years of service in the agency, but many leave at the four year mark. Two studies explored possible reasons for departure at this time. The first study found that graduates of specialized child welfare programs were significantly more likely to engage in best practices in nine areas than workers from other fields. Thus, frustration with practice skill was ruled out as a cause. The second qualitative study found that poor supervision, lack of coworker support, and organizational stress among other variables prompted these high-functioning workers to leave the agency. Suggestions for innovative interventions to enhance retention at this critical juncture are included.

Expedited permanency planning: evaluation of the Kentucky Adoptions Opportunities Project.

This article presents the evaluation findings of a Kentucky Adoptions Opportunities Project (KAOP), a three-year project funded by the U.S. Department of Health and Human Services, Administration on Children, Youth and Families, Children's Bureau. The primary goal of the KAOP was implementation of three permanency planning activities: (1) risk assessment/concurrent planning, (2) one child/one legal voice, and (3) early placement in kinship or foster/adoptive homes. These activities were designed to expedite a permanency placement decision within 12 months for high-risk children. The evaluation of 124 high-risk children in the KAOP revealed that the majority of children had one or both parents coping with multiple risk factors, including mental illness, substance abuse, mental retardation, or family violence. The major barriers to permanency are discussed, as well as the policy and practice implications in the context of Adoption and Safe Families Act of 1997.

The impact of the Solution Based Casework (SBC) practice model on federal outcomes in public child welfare.

OBJECTIVE: To test the effects of the Solution-Based Casework practice model on federal outcomes of safety, permanency and well-being. The Solution-Based Casework model combines family development theory, solution-focused skills and relapse prevention for the casework process in child protection. METHOD: 4,559 public child welfare cases were reviewed through a CQI case review process. RESULTS: This study found that cases with high levels of fidelity to the model demonstrated significantly better outcomes in the areas of child safety, permanency and well-being and exceeded federal standards, while cases with low fidelity to the model failed to meet federal standards. CONCLUSION: Components of the Solution-Based Casework were significant predictors of these federal outcomes and accounted for variance in these outcomes better than any other casework process factors.

Close relationships and social support in coping with HIV: a test of sensitive interaction systems theory.

This study tested sensitive interaction systems theory, and examined how persons with HIV seek and receive social support in relationships with peers versus parents and the association between different kinds of support-receiving behaviors and depressive symptoms. The participants were men and women with HIV in southeastern Virginia who completed a self-administered questionnaire about their relations with parents, an intimate partner, and a close friend. Participants reported using more Ask behaviors (a direct form of support seeking) with a friend and an intimate partner than with parents. They also reported receiving more Approach (Solve/Solace) forms of support from a friend and an intimate partner than from parents and less Avoidance (Escape/Dismiss) from a close friend than from parents. As a support-seeking behavior Ask was most likely to be associated with Approach forms of support providing from all types of relationship partners. Avoidance from parents, an intimate partner, or a friend was positively associated with depressive symptoms. Counselors should discuss with clients the social support process and how different forms of support seeking and support providing may be more or less useful in coping with HIV.