Clinically elevated parent depressive symptoms and stress at child type 1 diabetes diagnosis: Associations with parent diabetes self-efficacy at 18-months post-diagnosis.

OBJECTIVE: Eighteen percent of new diagnoses of type 1 diabetes (T1D) occur in children ages 9 and younger, and the burden of diabetes management in young children predominantly falls on parents. Despite the significant amount of information parents must learn and implement quickly after diagnosis, little research has examined diabetes self-efficacy in parents of young children soon after diagnosis in a longitudinal manner. The current study examined changes in parent diabetes self-efficacy over time, and parent depressive symptoms and stress soon after child T1D diagnosis as predictors of parent diabetes self-efficacy at 12- and 18-months post-diagnosis. RESEARCH DESIGN AND METHODS: One hundred fifty-seven primary caregivers (91.7% female, 62.2% White, Non-Hispanic) of young children (Mage  = 4.47 ± 1.65 years, 54.8% female, 60% White, Non-Hispanic) were recruited within 2 months of their child's T1D diagnosis from two pediatric hospitals in the United States as part of a randomized clinical trial. Parents self-reported on their diabetes self-efficacy, depressive symptoms, and stress and at baseline (Mdays since diagnosis = 29) and on parent diabetes self-efficacy again 12- and 18-months post-diagnosis. RESULTS: Parent diabetes self-efficacy significantly improved from baseline to 12-months and 18-months post-diagnosis (p < 0.05). Parents exhibiting clinically elevated levels of depressive symptoms and stress at baseline had significantly lower parent diabetes self-efficacy 12- and 18-months post-diagnosis compared to parents with normal levels of depressive symptoms and stress. CONCLUSIONS: Brief interventions for parents with clinically elevated depressive symptoms and stress soon after their child's diagnosis may improve parents' diabetes self-efficacy and ultimately support the management of their child's diabetes.

The global therapist competence scale for youth psychosocial treatment: Development and initial validation.

OBJECTIVE: We describe the development and initial psychometric properties of the observer-rated Global Therapist Competence Scale for Youth Psychosocial Treatment (G-COMP) in the context of cognitive-behavioral treatment (CBT) for youth anxiety disorders. METHOD: Independent coders rated 744 sessions from a sample of 68 youth (mean age = 10.56 years) using the G-COMP and the instruments of alliance, involvement, CBT adherence, CBT competence. RESULTS: Inter-rater reliability coefficients, ICC(2,2), were greater than .60 for the 5 G-COMP domain scores. G-COMP scores yielded small to medium correlations with instruments of alliance (rs = .17-.44) and youth involvement in treatment (rs = .08-.53), and medium to large correlations with instruments of CBT competence and adherence (rs = .26-.63). Therapists in the research setting were rated higher compared to newly trained therapists in community clinics. CONCLUSION: Preliminary reliability and validity of the G-COMP are promising, but future research is needed with non-CBT samples.

Parent Traumatic Stress After Minor Pediatric Burn Injury.

Parents are at increased risk for psychological sequelae following their child's burn injury which has demonstrated negative impacts on the child. The current study sought to address gaps in the literature on risk factors for parental distress by examining the relationships among demographic variables, burn characteristics, and child functioning after burn injury, with parent post-traumatic stress symptoms (PTSS). Participants included parents of 660 pediatric burn patients from a regional burn clinic. Parents completed measures during their initial visit to the burn clinic. Additional demographic and burn data were retrospectively collected by medical chart review. Fifteen percent of parents reported at-risk levels of parent PTSS. Parent PTSS was independently associated with child burn characteristics of total body surface area (TBSA) affected by the burn, required hospitalization, number of nights hospitalized, and number of ambulatory burn appointments attended. Minority race was associated with higher parent PTSS than non-minority race status, with Asian parents endorsing the highest scores. Furthermore, when considered simultaneously, impaired child quality of life (QOL), a higher number of ambulatory burn appointments attended, and racial minority status were associated with higher parent PTSS. These findings highlight the need for routine parent trauma screening in pediatric burn clinics, while additionally identifying a feasible screening measure.

Parent resilience after young child minor burn injury.

OBJECTIVE: Pediatric burn injuries are common injuries that are traumatic for the child and their families. Although many families report high amounts of distress soon after injury, most are resilient and do not continue to experience prolonged psychosocial problems. The aim was to identify factors associated with parent resilience after pediatric burn injury. METHOD: Fifty-seven parents of young children (< 5 years old) enrolled in a longitudinal assessment study. Baseline evaluations were conducted within 1 week of injury and included a medical chart review and parent self-report measures of resilience, social support, family functioning, and coping. Follow-up measurement of parent traumatic stress was measured 3 months after injury. We examined baseline resilience, positive emotionality, social support, family functioning, and problem-solving coping behaviors for relationships to traumatic stress. RESULTS: Parent resilience at baseline was associated with lower rates of parent traumatic stress symptoms at follow-up. Lower rates of traumatic stress were more common in parents of older children with more trait-level resilience, more social support, and more planning problem-solving behaviors at baseline. CONCLUSIONS: Baseline resilience characteristics are associated with less traumatic stress for parents several months after the injury. Findings can be used to develop screening strategies and interventions that address planning and problem-solving and emphasize social support. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Acceptability and Feasibility of Examining Physical Activity in Young Children with Type 1 Diabetes.

Physical activity is important but may be difficult to evaluate in young children (YC) with Type 1 diabetes (T1D) because of parents' fears of hypoglycemia, difficulties engaging YC in physical activity, and use of assessment devices. This study aimed to explore the acceptability and feasibility of an in-lab exercise session for YC with T1D. Ten YC ages 3 through7 years with T1D participated in a 20-minute exercise session while wearing blinded continuous glucose monitors and accelerometers. High acceptability was found for participation in the exercise session; high feasibility and acceptability were reported for the assessments. Although most children completed the session, it did not produce moderate to vigorous physical activity. YC were found to spend most of their day sedentary, and they had frequent blood glucose excursions. Findings support the feasibility of conducting a more extensive examination of the relationship among blood glucose levels and physical activity in YC with T1D.

Information needs among adolescent bariatric surgery patients and their caregivers.

BACKGROUND: Bariatric surgery is an invasive medical treatment for morbid obesity that requires behavioral maintenance for physical success. Patient knowledge, motivation, and adherence are important factors in optimizing results. OBJECTIVES: The purpose of the present study was to identify perceived informational gaps of adolescent and young adult bariatric surgery patients with morbid obesity (body mass index≥40 kg/m(2)). SETTING: This study took place in a pediatric tertiary care academic medical center. METHODS: Thirty-one adolescents/young adults who had undergone Roux-en-Y gastric bypass surgery at the authors' institution were recruited to complete questionnaires at their postsurgical visits (≥3 months postsurgery). Seventeen caregivers also participated in this study. The questionnaire used in the present study prompted patients and caregivers to reflect on information they wish they had known before surgery; questionnaire items included multiple choice and open-ended questions. RESULTS: Participants indicated that their informational needs were generally well met before surgery, although there were more needs noted by patients than by caregivers. Adolescent/young adult participants expressed a desire to have had more information about the necessity of taking vitamins daily and about having more gas. An association between informational needs and satisfaction was also found. Qualitative data revealed the importance of conveying cognitive-behavioral aspects of surgery to families (e.g., adherence, motivation). CONCLUSION: Despite most patients and caregivers being satisfied with the adolescent bariatric surgery program at the authors' institution, informational gaps exist. Teen-friendly ways to disseminate information would be helpful in influencing patients' satisfaction.

The role of setting versus treatment type in alliance within youth therapy.

OBJECTIVE: Does the strength of the youth-therapist alliance differ across treatment settings or treatment type? We examined these questions in the context of youth therapy. METHOD: Eighty-nine youths (M age = 10.56, SD = 1.99; 63.70% Caucasian; 52.80% male) diagnosed with an anxiety disorder received (a) manual-based individual cognitive-behavioral therapy (ICBT) in a research setting, (b) manual-based ICBT in practice settings, or (c) nonmanualized usual care (UC) in practice settings. Coders, using the Therapy Process Observational Coding System-Alliance scale, rated 865 sessions. Youth completed the Therapeutic Alliance Scale for Children at posttreatment. RESULTS: Youth who received ICBT in a research setting had significantly higher observer-rated alliance than youth who received either therapy delivered in practice settings. In practice settings, youth who received ICBT had significantly stronger observer-rated alliance early in treatment than youth in UC, but this difference was not observed at the end of treatment. Similarly, youth-report alliance at posttreatment was significantly higher in ICBT in the research setting, and there was no difference between ICBT and UC delivered in practice settings. Alliance differences largely held when controlling for youth characteristics; however, differences early in treatment between the ICBT groups were no longer statistically significant when controlling for anxiety severity or primary anxiety diagnosis. CONCLUSIONS: Our findings suggest that (a) the alliance may be stronger in research settings, and (b) treatment manuals do not undermine alliance. Future research is required to help pinpoint whether other youth, therapist, or setting factors contribute to the lower alliance seen in practice settings.

Motivational interviewing with parents of overweight children: study design and methods for the NOURISH + MI study.

There is an urgent need for innovative approaches to pediatric obesity treatment. There is also a demand for targeted strategies that reduce attrition and improve treatment adherence. Intervening exclusively with parents of overweight children is a novel approach with demonstrated efficacy in reducing child body mass index (BMI) percentile. Motivational interviewing (MI), a brief communication style for exploring and resolving ambivalence about behavior change, might enhance treatment engagement when implemented as part of obesity interventions. The aim of this report is to provide the rationale and methods for a novel study of MI with parents in the treatment of their children's overweight. We designed and are currently implementing NOURISH+MI, a randomized controlled trial examining the feasibility and efficacy of an adjunct values-based MI intervention, implemented within a culturally-tailored parent intervention for overweight children ages 5-11 years, NOURISH(+) (Nourishing Our Understanding of Role modeling to Improve Support and Health). Specifically, we are randomly assigning 60 parents to this adjunctive treatment, and investigating if adding two MI sessions prior to the NOURISH(+) group intervention will enhance treatment effects. We will be able to compare NOURISH+MI participants with those from the two NOURISH(+) treatment conditions (NOURISH(+) and control). We hypothesize that children whose parents participate in NOURISH+MI will demonstrate lower attrition and greater adherence with NOURISH(+), ultimately leading to greater treatment effects, compared with children whose parents are randomized to NOURISH(+) or a control group. Findings will contribute to the emerging literature examining the efficacy of MI within pediatric obesity interventions.

White public regard: associations among eating disorder symptomatology, guilt, and White guilt in young adult women.

OBJECTIVE: As a novel investigation of the role of White racial identity, the current study explored the link between White guilt and disordered eating. PARTICIPANTS: Young adult women (N=375), 200 of whom self-identified as White. METHODS: Measures assessed disordered eating, trait guilt, White guilt, and affect. RESULTS: White guilt is interrelated with disordered eating, particularly bulimic symptomatology. Distress tolerance and tendency to experience negative affect moderated the relation between White guilt and several disordered eating variables. CONCLUSIONS: Exploration of White guilt in clinical and research settings can inform understanding and treatment of disordered eating.

Making a Case for Treatment Integrity as a Psychosocial Treatment Quality Indicator for Youth Mental Health Care.

Measures of treatment integrity are needed to advance clinical research in general and are viewed as particularly relevant for dissemination and implementation research. Although some efforts to develop such measures are underway, a conceptual and methodological framework will help guide these efforts. The purpose of this article is to demonstrate how frameworks adapted from the psychosocial treatment, therapy process, healthcare, and business literatures can be used to address this gap. We propose that components of treatment integrity (i.e., adherence, differentiation, competence, alliance, client involvement) pulled from the treatment technology and process literatures can be used as quality indicators of treatment implementation and thereby guide quality improvement efforts in practice settings. Further, we discuss how treatment integrity indices can be used in feedback systems that utilize benchmarking to expedite the process of translating evidence-based practices to service settings.