The implementation of a multi-level reflective consultation model in a statewide infant & early childcare education professional development system: Evaluation of a pilot.

The growth in professional development for the infant-early childhood workforce has necessitated the implementation of novel, sustainable approaches to meet infant early childhood mental health (IECMH) training and reflective supervision consultation (RSC) needs. The 12-month pilot of a US statewide reflective consultation (RC) group model included IECMH consultants, grant specialists, supervisors, and program managers (n = 38) and their group reflective consultants (n = 6). The pilot evaluation provided an opportunity to design a study that assessed the impact of RC on infant-early childhood professionals. The mixed-methods study included an assessment of consultees' reflective practice skills and experience of their work. Findings included consultees' self-reported increased reflective practice self-efficacy and increased use of reflective practice skills. While there were no changes in the Maslach Burnout Inventory (MBI) personal accomplishment, emotional exhaustion, or depersonalization results, qualitative findings indicated a decrease in burnout and an increase in relationship-based practice across professional roles. This unique pilot provides an example of an organizational approach to instituting RC with a broad spectrum of infant-early childhood professionals and yields valuable information about the impacts of RC models on such professionals' work experience and professional practice.

El crecimiento en cuanto al desarrollo profesional para los trabajadores del área de infancia y temprana niñez ha necesitado de la implementación de acercamientos novedosos y sostenibles para cumplir con las necesidades de entrenamiento y consulta de supervisión con reflexión (RSC) del campo de la salud mental en la infancia y temprana niñez (IECMH). El plan piloto de 12 meses de un modelo de grupo de consulta con reflexión (RC) a lo largo y ancho de los estados de Estados Unidos incluyó consultores de IECMH, especialistas en fondos de financiación, supervisores y directores de programas (n = 38) y los consultores d reflexión de sus grupos (n = 6). L evaluación del plan piloto proveyó una oportunidad para diseñar un estudio que evaluara los impactos que RC tiene en los profesionales de infancia y temprana niñez. El estudio de métodos combinados incluyó una evaluación de las habilidades prácticas y experiencias reflexivas de trabajo de los consultantes. Los resultados incluyen los auto reportes de los consultantes sobre el aumento de la práctica reflexiva de auto eficacia y el aumento del uso de las habilidades de la práctica con reflexión. Aunque no se dieron cambios en cuanto a los logros personales, el agotamiento emocional o los resultados de despersonalización en el Inventario de Agotamiento de Maslach (MBI), los resultados cualitativos indicaron una baja en el agotamiento y un aumento en la práctica basada en la relación a lo largo de los roles profesionales. Este plan piloto único ofrece un ejemplo de un acercamiento organizacional para instituir RC con un enfoque amplio de los profesionales de la infancia y temprana niñez y aporta información de valor acerca de los impactos que los modelos RC tienen sobre las experiencias de trabajo y la práctica profesional de esos profesionales.

La croissance de la formation professionnelle pour les professionnels de la santé des nourrissons et de la petite enfance a nécessité la mise en place d'approches innovatrices et durables afin de remplir les besoins de formation et de consultation de supervision réflective (RSC) de la santé mentale du nourrisson et de la petite enfance (IECMH). Une étude pilote de 12 mois d'un modèle de groupe de consultation réflective (abrégé RC en anglaise) dans un état des Etats-Unis a inclus des consultants IECMH, des spécialistes des subventions, des superviseurs et des gestionnaires de programme (n = 38) et leurs consultants de groupe de réflexion (n = 6). Cette évaluation pilote a présenté l'opportunité de concevoir une étude évaluant les impacts de la RC sur les professionnels de la santé des nourrissons et de la petite enfance. Cette méthode d'étude mixte a inclus une évaluation des compétences en pratique réflective des personnes consultées et de leurs expériences de leur travail. Les résultats ont inclus une pratique d'auto-efficacité réflective plus élevée (auto-rapportée par les consultés) et une utilisation de compétences de pratique de réflexion plus élevée. Bien qu'il n'y ait pas eu de changements dans la réalisation personnelle, l'épuisement émotionnel ou les résultats de dépersonnalisation de l'Inventaire de Burnout de Maslach (MBI) les résultats qualitatifs ont indiqué une baisse du burnout et une augmentation de la pratique basée sur la relation au travers des rôles professionnels. Cette étude pilote unique offre un exemple d'une approche organisationnelle de l'institution de la RC avec un grand éventail de professionnels de la santé des nourrissons et de la petite enfance et offre des renseignements très utiles sur les impacts des modèles de RC sur l'expérience du travail de tels professionnels et leur pratique professionnelle.

Infant mental health home visiting therapists' reflective supervision self-efficacy in community practice settings.

In recent years, there has been an increase in the research on reflective supervision, including the development of tools designed to measure reflective practice in the context of reflective supervision. The Reflective Supervision Self-Efficacy Scale for Supervisees (RSSESS) is a self-report measure that has been used in previous evaluations and is designed to assess perceived reflective practice self-efficacy for Infant Mental Health-Home Visiting (IMH-HV) therapists. Properties of the RSSESS including factor structure and reliability are explored in a first study that lays the foundation for the use of the RSSESS in an IMH-HV evaluation in the State of Michigan. IMH-HV therapists completed the RSSESS at 4 time points over a 12-month period and also completed a Clinician Profile Form that included questions about their IMH background and their work experience, including job satisfaction and burnout. Results indicated that the RSSESS is a reliable tool to measure change in reflective practice skills. IMH-HV therapists demonstrated growth in their use of reflective practice skills with families and their observational skills over the 12-month period. In addition, results indicated correlations between reflective supervision self-efficacy and job satisfaction as well as burnout.

A COMMUNITY MENTAL HEALTH PROFESSIONAL DEVELOPMENT MODEL FOR THE EXPANSION OF REFLECTIVE PRACTICE AND SUPERVISION: EVALUATION OF A PILOT TRAINING SERIES FOR INFANT MENTAL HEALTH PROFESSIONALS.

The Michigan Association for Infant Mental Health identified a need for reflective supervision training for infant mental health (IMH) specialists providing home-based services to highly vulnerable infants and their families. Findings indicate that this pilot of an IMH community mental health professional development model was successful, as measured by the participants' increased capacity to apply reflective practice and supervisory knowledge and skills. Furthermore, IMH clinicians demonstrated an increase in the frequency of their use of reflective practice skills, and their supervisors demonstrated an increase in their sense of self-efficacy regarding reflective supervisory tasks. Finally, the evaluation included a successful pilot of new measures designed to measure reflective practice, contributing to the growing body of research in the area of reflective supervision.

What's in a name? Attitudes surrounding the use of the term 'mental retardation'.

Over the past 200 years, there have been periodic shifts in the terminology used to describe what is still most commonly referred to in the medical world as 'mental retardation'. There are differing opinions about the acceptability of the term, but very little existing evidence on which clinicians can base their decisions regarding what terminology to use with patients and families, and with one another. The present survey of parents and professionals used questions based on paper-based clinical scenarios to survey each group's attitudes about terminology usage. The results of both the parent and professional surveys support a move away from the use of the term mental retardation. The majority of parents indicated that they would be upset if a physician used the term mental retardation. Some professionals reported being criticized for using the term. Teaching about terminology has been variable.

Depuis 200 ans, on observe des changements périodiques dans la terminologie utilisée pour décrire ce qui est encore surtout désigné dans le monde médical par retard mental. Les opinions divergent quant à l'acceptabilité du terme, mais il existe très peu de données probantes sur lesquelles les cliniciens peuvent justifier leur décision quant au choix de terminologie à utiliser auprès des patients et des familles et les uns avec les autres. Ce sondage auprès des parents et des professionnels faisait appel à des questions fondées sur des scénarios cliniques écrits afin de connaître les attitudes de chaque groupe au sujet de l'utilisation de la terminologie. Les résultats du sondage auprès des parents et des professionnels appuient le rejet du terme retard mental. La majorité des parents seraient vexés si un médecin utilisait ce terme. Certains professionnels ont déclaré avoir été critiqués pour l'avoir employé. L'enseignement au sujet de la terminologie est variable.

Parenting with a Life-Limiting Illness.

Parents with life-threatening illness face unique challenges in their dual roles as patients and parents. They are at risk for depression, parenting stress, and impaired family functioning, and their children are at risk for adjustment difficulties. In addition to treatment of depression and other mental health issues, patients may also benefit from evidence-informed guidance addressing the challenges of parenting while ill. Consultations should be tailored to each family, with consideration of children's developmental stage and temperament. Clinical recommendations for communication about a parent's anticipated death, helping children spend meaningful time with an ill parent, and legacy leaving are provided.

Mental retardation in children ages 6 to 16.

Mental retardation (MR) is a life long condition that affects 6 million American and 560,000 Canadian children under the age of 14. This review discusses the definition of MR, an approach to investigation, common comorbidities, and a general approach to management.

New Alström syndrome phenotypes based on the evaluation of 182 cases.

BACKGROUND: Alström syndrome is a recessively inherited genetic disorder characterized by congenital retinal dystrophy that leads to blindness, hearing impairment, childhood obesity, insulin resistance, and type 2 diabetes mellitus. We provide new details on cardiologic, hepatic, gastrointestinal, urologic, pulmonary, and neurobehavioral phenotypes in Alström syndrome and describe the histopathologic findings in 5 individuals. METHODS: We obtained data on 182 patients from clinical examinations, medical record reviews, standardized questionnaires, and personal interviews with physicians and parents. RESULTS: Dilated cardiomyopathy occurred in 60% of patients. Age at onset was either during infancy, often before vision disturbances were noted, or in adolescence or adulthood. There is a risk of recurrence of infantile cardiomyopathy. Hyperinsulinemia (92%) developed in early childhood and progressed to type 2 diabetes mellitus in 82% of those older than 16 years. Hypertriglyceridemia (54%) precipitated pancreatitis in 8 patients. Urologic dysfunction and gastrointestinal disturbances occurred in 48% and 35% of patients, respectively. Fifty-three percent of patients had persistent pulmonary symptoms. Neurologic symptoms in 20% of patients included clonic tic and absence seizures. Developmental motor or language delays were observed in 46% of patients. Fibrotic infiltrations of multiple organs, that is, kidney, heart, liver, lung, urinary bladder, gonads, and pancreas, were observed. CONCLUSIONS: The wide-ranging and complex spectrum of phenotypes reported herein broadens those previously described for Alström syndrome. These findings will aid physicians in making an early and accurate diagnosis and will help effect appropriate monitoring and treatment.

Early repair of congenital heart disease associated with increased rate of attention deficit hyperactivity disorder symptoms.

BACKGROUND: As more children survive with congenital heart disease, their neurodevelopmental outcomes (including attention deficit hyperactivity disorder [ADHD]) are becoming increasingly important. The objective of our study was to determine if school-aged children who underwent early cardiac surgery for congenital heart disease are more likely than healthy control subjects to have screening scores on the Swanson, Nolan, and Pelham IV (SNAP-IV) questionnaire suggestive of ADHD. METHODS: Children aged 7-15 years who underwent open-heart surgery before 1 year of age were identified from the Izaak Walton Killam (IWK) Children's Heart Centre Database. Control subjects were recruited from healthy volunteers. The SNAP-IV questionnaire was administered to all participants and a chart review was performed on all eligible children in the cardiac surgery group. Case and control subjects were compared using Fisher's exact test, linear, and logistic regression analyses. Potential predictors of a positive screening score were sought. RESULTS: A positive screening score was found in 29% (16/56) of the surgical group compared with 3% (2/60) of the control group (P < 0.001). Surgical and control subjects differed in average overall scores (0.93 vs 0.30; P < 0.001) and in scores for hyperactivity (0.83 vs 0.24; P < 0.001) and inattention (1.04 vs 0.37; P < 0.001). No other significant predictors of a positive screening score were identified. The early open-heart surgery participants who responded to the questionnaire did not differ in baseline characteristics compared with nonresponders. CONCLUSIONS: Children who have open-heart surgery at younger than 1 year of age are more likely than healthy control subjects to have a SNAP-IV score suggestive of ADHD when they reach school age.