Care When It Counts: Establishing Trauma-Sensitive Care as a Preventative Approach for 0-3-Year-Old Children Suffering from Trauma and Chronic Stress.

Adverse childhood experiences are an important societal concern. Children aged 0-3 are particularly vulnerable to unpredictable chronic stress due to the critical period for brain development and attachment. Trauma-sensitive care is a preventative approach to reduce the burden of stressful experiences by committing to positive relationships. Professional caregivers are ideally placed to offer trauma-sensitive care; however, earlier research reveals that the tools they need to consciously apply trauma-sensitive care principles are missing. The current study organized living labs (co-creative research method) to present trauma-sensitive care as a preventative approach aimed at children aged 0-3. Two living labs were organized in Belgium and Hungary, where professional caregivers collaborated to create a protocol that offers guidelines on how to implement trauma-sensitive care. The resulting protocol included a theoretical foundation on trauma as well as a translation of these guidelines into practical recommendations. The protocol was evaluated by incorporating it into a training intervention delivered to 100 professional caregivers from childcare organizations across four European countries. The protocol received positive feedback from participants, with results indicating a self-reported increase in knowledge, attitude and practice of trauma-sensitive care principles. We conclude that this trauma-sensitive care protocol is a promising answer to the needs of professional caregivers working with children aged 0-3.

A training intervention to enhance self-management support competencies among nurses: A non-randomized trial with mixed-methods evaluation.

AIM: To evaluate the process and outcomes of INTENSS, a training intervention grounded in Self-Determination Theory to enhance nurses' competencies for self-management support. DESIGN: Non-randomized intervention study with mixed-methods evaluation approach (2019-2020). METHODS: The multifaceted training was implemented in six groups. Cluster-assignment to study arm 1 or arm 2. Arm 1 received a basic training module and arm 2 the basic module with additional video-interaction guidance. Focus groups were held to detect what was helpful in competency enhancement. Intervention effectiveness was determined on trainees' attitude, motivation, self-efficacy and skills for self-management support (multiple time-points by self-reports and observations). RESULTS: Trainees (N = 50) indicated the video-interaction guidance, the connectivity within the training group, the constructive feedback from trainers as well as from peers, as helpful for the acquisition of self-management support skills. At 2-month post-training, participants slightly improved in their competencies for the assess (p = .03), agree (p = .02), arrange (p < .01) phase and partnership skills (p < .01). Between the study arms, video-trained participants significantly reduced their use of controlling approaches (p = .03). Observations indicated that trainees mostly used an autonomy-supportive approach, seldom we observed the use of competence supportive, controlling or chaotic approaches. The interviews gave indications that obligatory training in this field needs to be questioned. CONCLUSION: The outcome evaluation of the INTENNS training indicated most improvement in nurses' skills for collaborative goal setting and partnership with patients. The mixed-methods evaluation emerges transferable principles to implement the training amongst nurses and, by extension, other healthcare professions. A training intervention involving patient experts can add value to further pave the way towards a true partnership between patients and healthcare professionals. IMPACT: A training intervention taking into account the complexity of supporting patients towards self-management is available. Important elements for growth are: connectivity within training group, a safe learning climate where 'failure' is allowed and video-interaction guidance. Obligatory training participation can be questioned.

Self-Determination Theory to observe healthcare professionals' counselling in chronic care encounters: Development of the COUNSEL-CCE tool.

OBJECTIVE: To develop and psychometrically evaluate an observation tool to rate healthcare professionals' engagement in need-supportive and need-thwarting counselling in chronic care encounters. METHODS: The observation tool was developed through three stages (January 2018 - June 2019). First, a set of items was developed according to essential components of need-supportive and need-thwarting counselling as identified in Self-Determination Theory. Second, content validation by five experts. Third, ecological validation using video-recorded real-life consultations. For the psychometric evaluation (June - October 2019), the tool was used by three observers to code 55 units of real-life encounters. RESULTS: The Coding and Observing Need-Supportive Counselling in Chronic Care Encounters (COUNSEL-CCE) consists of 44 items clustered into nine theoretically underpinned behavioural approaches. Psychometric testing indicated acceptable to good consistency in scoring between observers and strong consistency within observers. CONCLUSION: The COUNSEL-CCE captures person-oriented alongside process-oriented aspects during chronic care encounters. A person-oriented approach expresses counselling that is responsive to individual preferences and needs, whereas a process-oriented approach indicates the necessity to support competency building within patients, and is more instrumental of nature. PRACTICE IMPLICATIONS: COUNSEL-CCE is a valuable observation tool to assess (graduate) healthcare professionals' counselling style and address if, and how, counselling evolves as a result of professional training.

The role of observed autonomy support, reciprocity, and need satisfaction in adolescent disclosure about friends.

Although research increasingly addresses the role of parenting in fostering adolescent disclosure, most research relied on self-report measures of parenting and did not address the role of autonomy support. In the present observational study (conducted in Belgium), with 62 mother-adolescent dyads (mean age mothers = 44 years; mean age adolescents = 14 years; 77% of adolescents female), we rated mothers' provision of autonomy support during a 10-minute conversation about friendships. We found that observed maternal autonomy support was related positively to adolescents' degree of and volitional reasons for disclosure about friends. These associations were mediated by observed non-verbal reciprocity during the conversation and by adolescent satisfaction of their needs for autonomy and relatedness. Mothers' autonomy-support and mother-adolescent reciprocity also predicted mothers' own psychological need satisfaction and conversation pleasure. The relevance of the findings for adolescent autonomy and disclosure are discussed.

Raising trophy kids: The role of mothers' contingent self-esteem in maternal promotion of extrinsic goals.

This study examined the role of mothers' child-invested contingent self-esteem, that is, their tendency to hinge their self-worth on their child's achievements, in maternal promotion of extrinsic goals, as perceived by adolescents. It was also examined whether maternal promotion of extrinsic goals would, in turn, relate to adolescents' Social Dominance Orientation (SDO). Participants were 184 mothers and their adolescent children (66% female). Maternal child-invested contingent self-esteem predicted adolescent-perceived maternal promotion of extrinsic goals, even when taking into account the variance shared between the promotion of extrinsic goals and mothers' use of a controlling parenting style. Maternal child-invested contingent self-esteem also moderated associations between mothers' personal pursuit of extrinsic goals and their promotion of those goals, such that the association between mothers' own extrinsic goals and their promotion of those goals was significant only among mothers high on child-invested contingent self-esteem. Maternal promotion of extrinsic goals was, in turn, related to adolescent SDO, suggesting that the dynamics examined in this study ultimately relate to adolescents' social and ideological development.