Efficacy of an Internet-based depression intervention to improve rates of treatment in adolescent mothers.

Approximately 400,000 adolescents give birth in the USA annually. Although one-half experience depressive symptoms, less than 25% comply with referrals for depression evaluation and treatment. The current study tested the effectiveness of an Internet-based depression intervention on seeking depression treatment. Based upon the theory of planned behavior (TPB), the intervention included vignettes, questions and answers, and resources. Before the intervention, immediately after the intervention, and 2 weeks later the adolescent mothers (n = 151) answered questions related to TPB variables and depression treatment. Data were compared to adolescent mothers (n = 138) in the control group. Data were collected in community organizations or home visits for the control group. Adolescent mothers in the intervention group answered questions and completed the intervention from a computer of their choice. The adolescents were primarily African American (89.2%), less than high school educated (51.7%), had given birth in last year (97.1%), with a mean age 18.2 years. The intervention led to significant changes in attitude, perceived control, intention to seek mental health treatment, and actually seeking depression treatment. Untreated postpartum depression dramatically impacts a mother's relationship with her child, her functioning at work and school, health care-seeking behaviors, mothering skills, and her development as well as the development of her child. An Internet-based depression intervention is an inexpensive method to increase rates of depression treatment.

From Family Therapy to Family Intervention.

For many, family therapy refers to sessions in which all family members are present. Yet in contemporary psychiatry there are many ways to work with families in addition to this classic concept. This article proposes family intervention as an encompassing term for a new family paradigm in child and adolescent psychiatry. Developmental psychopathology is a guiding principle of this paradigm. A full range of ways to work with families clinically is described with clinical examples.

Family intervention as a developmental psychodynamic therapy.

Families are the context for development. One key way families influence developing children is through family experience, which becomes part of the child's inner world. It is through this cognitive template that the child interprets the world and negotiates developmental challenges. This article reviews a continuum of family interventions targeting interactions that shape the child's mind, and offers guidance to the clinician about when to use individual and family approaches.

Adapting and testing telephone-based depression care management intervention for adolescent mothers.

This phase 1 clinical trial combined qualitative and quantitative methods to modify a collaborative care, telephone-based, depression care management intervention for adolescent mothers and to determine the acceptability, feasibility, and initial efficacy of the intervention in a sample of adolescent mothers (n = 97) who were recruited from a Teen Parent Program. Outcomes included measures of depressive symptoms, functioning, and use of mental health services. Acceptability of the intervention was demonstrated, but feasibility issues related to the complex life challenges confronting the adolescent mother. Although only four adolescent mothers received mental health treatment, there was a trend for improved depressive symptoms over time. Results of the study provide data for the need of further refinement of the intervention before a large clinical trial is conducted for adolescent mothers with symptoms of depression.

Reinventing family therapy: teaching family intervention as a new treatment modality.

OBJECTIVE: This article discusses the pedagogy of teaching family therapy in the new millennium. It draws on the strengths of "family systems therapy" but goes beyond it-suggesting a new paradigm, new terminology, and a new teaching perspective. It discusses the historical background of family therapy training, a scientific foundation for what residents should be taught, and an integrative clinical model for how it could be taught. METHODS: The article is the synthesis of the perspectives and experience of a child and adolescent psychiatrist educator who began his career at the end of the systemic era in psychiatry and continues it through the developments of the neurobiologic era. It draws on selected literature from the fields of family therapy, child and adolescent psychiatry, developmental psychopathology, and general psychiatry. RESULTS: This article submits that the term "family therapy" should be replaced by the term "family intervention"; the evidence base indicates that family interventions are effective; family risk and protective factors influence the onset and course of disorders; families help shape and maintain cognitive schema; intervention must start with thorough case formulation; and family interventions should be coordinated with other interventions, include parent management training, and build on family strengths. CONCLUSION: Family intervention is an important clinical process in child and adolescent psychiatry, and contemporary education must address the multiple ways clinicians can assist families. Future models will be successful to the degree they build on the past contributions of systems thinking and include the perspectives of developmental psychopathology. Contemporary education should teach that family interventions are not optional but ideally can be integrated with other interventions in a sequential manner, emphasizing the interrelationship between self and system.

Neutrality, autonomy and mental health: a closer look.

Clinicians have traditionally viewed neutrality as the primary means of promoting patient autonomy, and by extension mental health. But patients also require expert direction, want other values incorporated into their treatment, and benefit from collaborating with clinicians toward shared therapeutic objectives. A historical perspective on the physician-patient relationship reveals an evolving richness in the concepts of autonomy and neutrality. Formal, or authentic, autonomy is more descriptive of mental health than individual autonomy, and nurture is a more effective strategy for promoting it than neutrality, although technical neutrality remains an indispensable tactic. This model of mental health treatment is comprehensive, relational, and developmental.

Talking with patients about spirituality and worldview: practical interviewing techniques and strategies.

Psychiatrists now recognize that religion and spirituality are important to much of the populace and that attending to them probably will improve clinical psychiatric practice. This article presents a practical guide for addressing some of the key interviewing skills needed to explore a patient's framework for meaning-the patient's religion, spirituality, and worldview. It offers guidelines on the process of the interview, including ways to initiate conversation in this area, with suggestions and specific questions for a more thorough exploration of the patient's religious and spiritual life.

Practice parameter for the assessment of the family.

The family assessment is one component of the comprehensive psychiatric assessment of the child or adolescent with a psychiatric disorder. This guideline reviews the basic principles in conducting a family interview that gathers history relevant to the child's disorder and observes family interaction associated with the child's disorder. It reviews basic information that must be covered in all evaluations and the information required in complex and specialized situations. The parameter emphasizes that all assessments should include a review of family strengths and resources.

Family-based treatment research: a 10-year update.

OBJECTIVE: To provide an update on the state of the art of family-based treatment research. METHOD: Randomized clinical trials conducted in the past 10 years that included parents as a primary participant in treatment of child and adolescent psychiatric problems were reviewed. Studies were identified from major literature search engines (e.g., PsycINFO, Medline). Current significant pilot work was identified in the National Institute of Mental Health Computer Retrieval of Information on Scientific Projects (CRISP) Web page or from the authors themselves. RESULTS: Family treatments have proven effective with externalizing disorders, particularly conduct and substance abuse disorders, and in reducing the comorbid family and school behavior problems associated with attention-deficit/hyperactivity disorder. Several new studies suggest that family treatments or treatment augmented by family treatments are effective for depression and anxiety. CONCLUSIONS: For many disorders, family treatments can be an effective stand-alone intervention or an augmentation to other treatments. Engaging parents in the treatment process and reducing the toxicity of a negative family environment can contribute to better treatment engagement, retention, compliance, effectiveness, and maintenance of gains. Recommendations for the next decade of research and some implications of family-based treatment for child and adolescent psychiatry are explored.

Religion and spirituality in child and adolescent psychiatry: a new frontier.

This article introduces the interface between child and adolescent psychiatry and religion and spirituality. Developmental psychopathology has become increasingly diverse in its study of risk and protective factors for child and adolescent psychopathology. The effect of religion and spirituality on clinical conditions is among those factors. This review addresses (1) historical aspects of the relationship between psychiatry and religion/spirituality, (2) definitional issues, and (3) unique factors in child and adolescent work. Considering these factors and some general principles of intervention, it prepares the reader for other articles in this issue. The article concludes with some observations on the "secular family".

Religious and spiritual aspects of family assessment.

Childhood emotional and behavioral problems have increased over the past several decades, and the consequences of these behaviors have an impact on the entire family. The role of the family in these problems is clearly an important consideration for the child psychiatrist. A specific understanding of how the family's spiritual worldview or religious convictions impact clinical problems has been underappreciated. The religious orientation or spirituality of parents influences various aspects of family life, from ideals about marriage and family to specifics regarding child rearing. This article reviews the goals of assessment of family religious or spiritual worldview, which include empathically engaging the family of a child in treatment, developing a formulation of how these spiritual factors impact general family functioning, and determining whether the family's religion and spirituality are a resource for treatment or a contributor to disorder. The spiritual and religious assessment of the family facilitates the development of a treatment plan.

Formulation and treatment: integrating religion and spirituality in clinical practice.

Developing scientifically sound and clinically meaningful case formulations is so challenging that it may verge on becoming a "lost art." Pressures (scientific, economic, and cultural) remain that prevent child and adolescent psychiatrists from getting a complete understanding of the patient and family. Including a strong consideration of data related to religion, spirituality, and worldview may seem only to complicate an already arduous task. The clinician who includes these factors in treatment is faced with decisions of when to discuss these issues, how to discuss them and in what depth, and finally, when to refer to a religious/spiritual professional. Nonetheless, the importance of these factors in the lives of many children and families leaves no option but to address them as directly as possible. It is well worth the effort and, in many cases, will open new areas for clinical improvement in patients.

Child and adolescent psychopathology: spiritual and religious perspectives.

This article addresses the relationship between children's religious beliefs and spiritual practices and the presence of psychopathology. Study of this subject represents a formidable task due to the complexity and diversity of the constructs involved, heterogeneity in religious beliefs and practices, and the difficulty in discriminating between the independent effects of religion and culture. Nevertheless, broad links between child psychopathology and spiritual/religious beliefs and practices are proposed. On the whole, the available empiric data suggest that religion is primarily health promoting in direct, positive benefits for children and in indirect, positive effects through parent and family functioning, although there are isolated exceptions. When spirituality and religious beliefs/practices are associated with negative mental health outcomes in children or their families, evidence points to "poorness-of-fit," based on an interaction between the child's psychopathology and aspects and religious beliefs/practice. Clinical implications of the findings and proposels are outlined.