The assessment of representational risk (ARR): Development and psychometric properties of a new coding system for assessing risk in the parent-infant relationship.

There are few clinically valid tools that can be used to assess potential parent-infant relational risk. This study describes the development and initial validation of the assessment of representational risk (ARR) coding system to be applied to the parent development interview (Slade, A., Aber, J. L., Bresgi, I., Berger, B., & Kaplan, M. (2004). The Parent Development Interview - Revised. Unpublished protocol. New York, NY: The City University of New York.) for assessing potential risk in caregivers' representations of their infant, themselves as parents, and their relationship. The ARR was developed and validated in three samples in England. A review of the literature informed the selection of 10 items. It had a three-factor structure that was used to inform subscales: hostile, helpless, and narcissistic caregiving representations. The subscales and total risk scores showed good criterion validity for discriminating between high and low risk samples and good concurrent validity with measures of parental psychopathology and parent-infant interaction. The ARR is a potentially valuable coding system for identifying risk in early attachment relationships.

Hay pocas herramientas clínicamente válidas que pueden usarse para evaluar los posibles riesgos en la relación progenitor-infante. Este estudio describe el desarrollo y la convalidación inicial de la Evaluación del Riesgo Representacional (ARR), un sistema de codificación para aplicarse a la Entrevista del Desarrollo del Progenitor (PDI; Slade et al., 2004) para evaluar el posible riesgo en las representaciones que los cuidadores tienen de sus infantes, de ellos mismos como padres y de sus relaciones. La ARR se desarrolló y se convalidó en tres grupos muestras en Inglaterra. Una revisión de la información disponible sirvió de base para la selección de 10 puntos. La misma tenía una estructura de tres factores que se usó como base en las subescalas: representaciones para prestar cuidado de tipo Hostil, Desesperanzado y Narcisista. Los puntajes de las subescalas y los totales mostraron buen criterio de validez para diferenciar entre los grupos muestras de alto y bajo riesgo, así como una buena validez concurrente con las medidas de sicopatología de progenitores y la interacción progenitor-infante. La ARR es un sistema de codificación de valor potencial para identificar el riesgo en las tempranas relaciones de afectividad.

Il existe peu d'outils cliniquement valables qui peuvent être utilisés pour évaluer le risque relationnel potentiel parent-nourrisson. Cette étude décrit le développement et la validation initiale du système de codage Evaluation du Risque Représentationnel (abrégé ici ERR en français) destiné à être appliqué à l'Entretien du Développement du Parent (PDI; Slade et al., 2004) pour évaluer le risque potentiel dans les représentations que les parents se font de leur nourrisson, d'elles-mêmes ou d'eux-mêmes en tant que parents, et de leur relation. L'ERR a été développé et validé dans trois échantillons en Angleterre. Une revue des recherches a éclairé la sélection de 10 éléments. Celle-ci a suivi une structure de 3 facteurs qui ont été utilisés pour éclairer les sous-échelles: représentations des parents de l'enfant Hostiles, Impuissantes, Narcissiques. Les Sous-échelles et les scores de risque total ont fait preuve d'une bonne validité du critère pour séparer les échantillons à risque élevé et à faible risque, et d'une bonne validité concurrente avec des mesures de psychopathologie parentale et d'interaction parent-nourrisson. L'ERR s'avère pouvoir être un système de codage utile pour l'identification du risque dans les relations d'attachement précoce.

Reflective Functioning on the Parent Development Interview: validity and reliability in relation to socio-demographic factors.

The Reflective Functioning coding of the Parent Development Interview (PDI-RF) is a widely used method for assessing a caregivers' capacity for mentalization. However, little is known about its psychometric properties.The aim of this study was to examine the distributions and discriminant and criterion validity of the PDI-RF scale in relation to a number of demographic and socioeconomic factors.Mothers of infants and toddlers (N = 323) from low, medium, and high-risk samples were interviewed with the PDI and transcripts were coded for RF. Demographic and socio-economic data were recorded.The PDI-RF scale showed high inter-rater reliability, internal consistency, and criterion validity. Modest associations with some sociodemographic variables and PDI-RF were found, but together these only accounted for a small amount of variance in the measure, suggesting adequate discriminant validity. Overall, the scale had good psychometric properties, although some caveats for its use were identified.

Effectiveness and costs of acute day hospital treatment compared with conventional in-patient care: randomised controlled trial.

BACKGROUND: Data on effectiveness of acute day hospital treatment for psychiatric illness are inconsistent. AIMS: To establish the effectiveness and costs of care in a day hospital providing acute treatment exclusively. METHOD: In a randomised controlled trial, 206 voluntarily admitted patients were allocated to either day hospital treatment or conventional wards. Psychopathology, treatment satisfaction and subjective quality of life at discharge, 3 months and 12 months after discharge, readmissions to acute psychiatric treatment within 3 and 12 months, and costs in the index treatment period were taken as outcome criteria. RESULTS: Day hospital patients showed significantly more favourable changes in psychopathology at discharge but not at follow-up. They also reported higher treatment satisfaction at discharge and after 3 months, but not after 12 months. There were no significant differences in subjective quality of life or in readmissions during follow-up. Mean total support costs were higher for the day hospital group. CONCLUSIONS: Day hospital treatment for voluntary psychiatric patients in an inner-city area appears more effective in terms of reducing psychopathology in the shortterm and generates greater patient satisfaction than conventional in-patient care, but may be more costly.

The costs and effectiveness of two psychosocial treatment programmes for personality disorder: a controlled study.

This paper examines the costs and cost-effectiveness of psychosocial treatment for personality disorder in a controlled study. Using well-validated cost and outcome measures three groups are compared: the One-Stage group (n=32) received 12 months of inpatient treatment; the Step-Down group (n=29) received 6 months of inpatient treatment followed by 12 months of outpatient therapy; and the control group of 47 people used routinely available services. Both specialist programmes were more effective than routine psychiatric services but more costly. Using an extended dominance approach the incremental cost-effectiveness ratio showed that achieving one extra person with clinically relevant outcomes required an investment in the Step-Down programme of around 3400 pound sterling over 18 months. Small sample sizes and non-random allocation to programmes are limitations of this study but the costs and effectiveness findings consistently point to advantages for the shorter residential programme followed by community-based psychotherapeutic support.

The economic impact of chronic pain in adolescence: methodological considerations and a preliminary costs-of-illness study.

Chronic pain in adulthood is one of the most costly conditions in modern western society. However, very little is known about the costs of chronic pain in adolescence. This preliminary study explored methods for collecting economic-related data for this population and estimated the cost-of-illness of adolescent chronic pain in the United Kingdom. The client service receipt inventory was specifically adapted for use with parents of adolescent chronic pain patients to collect economic-related data (CSRI-Pain). This method was compared and discussed in relation to other widely used methods. The CSRI-Pain was sent to 52 families of adolescents with chronic pain to complete as a self-report retrospective questionnaire. These data were linked with unit costs to estimate the total care cost package for each family. The economic impact of adolescent chronic pain was found to be high. The mean cost per adolescent experiencing chronic pain was approximately 8,000 pounds per year, including direct and indirect costs. The adolescents attending a specialised pain management unit, who had predominantly non-inflammatory pain, accrued significantly higher costs, than those attending rheumatology outpatient clinics, who had mostly inflammatory diagnoses. Extrapolating the mean total cost to estimated UK prevalence data of adolescent chronic pain demonstrates a cost-of-illness to UK society of approximately 3,840 million pounds in one year. The implications of the study are discussed.