Impacts of the Attachment and Child Health (ATTACHTM) Parenting Program on Mothers and Their Children at Risk of Maltreatment: Phase 2 Results.

Early adversity (e.g., family violence, parental depression, low income) places children at risk for maltreatment and negatively impacts developmental outcomes. Optimal parental reflective function (RF), defined as the parent's ability to think about and identify thoughts, feelings, and mental states in themselves and in their children, is linked to secure attachment and may protect against suboptimal outcomes. We present the results of Phase 2 randomized control trials (RCTs) and quasi-experimental studies (QES) of the Attachment and Child Health (ATTACHTM) parental RF intervention for families with children at risk for maltreatment. Phase 2 parents experiencing adversity, along with their children aged 0-5 years (n = 45), received the 10-12-week ATTACHTM intervention. Building on completed Phase 1 pilot data, Phase 2 examined outcomes of long-standing interest, including parental RF and child development, as well as new outcomes, including parental perceived social support and executive function, and children's behavior, sleep, and executive function. RCTs and QES revealed significant improvements in parents' RF, perception of social support, and executive function, children's development (i.e., communication, problem-solving, personal-social, and fine motor skills), and a decrease in children's sleep and behavioral problems (i.e., anxiety/depression, attention problems, aggressive behavior, and externalizing problems), post-intervention. ATTACH™ positively impacts parental RF to prevent negative impacts on children at risk of maltreatment.

Attachment & Child Health (ATTACH) pilot trials: Effect of parental reflective function intervention for families affected by toxic stress.

Toxic stressors (e.g., parental violence, depression, low income) place children at risk for insecure attachment. Parental reflective function-parents' capacity to understand their own and their child's mental states and thus regulate their own feelings and behavior toward their child-may buffer the negative effects of toxic stress on attachment. Our objective was to test the effectiveness of the Attachment and Child Health (ATTACH) intervention, focusing on improving reflective function and children's attachment security, for at-risk mothers and children <36 months of age. Three pilot studies were conducted with women and children from an inner city agency serving vulnerable, low-income families and a family violence shelter. Randomized control trial (n = 20, n = 10 at enrollment) and quasi-experimental (n = 10 at enrollment) methods tested the effect of the ATTACH intervention on the primary outcome of reflective function scores, from transcribed Parent Development Interviews. Our secondary outcome was children's attachment patterns from Ainsworth's Strange Situation Procedure. Despite some attrition, mixed methods analysis of covariance and t tests revealed significant differences in maternal, child, and overall reflective function, with moderate effect sizes. While more children whose mothers received the ATTACH program were securely attached posttreatment, as compared with controls, significant differences were not observed, which may be due to missing observations (n = 5 cases). Understanding the effectiveness of programs like the ATTACH intervention contributes to improved programs and services to promote healthy development of children affected by toxic stress.

Los factores tóxicos de estrés (v.g. violencia de los padres, depresión, bajos recursos económicos) colocan a los niños bajo riesgo de una insegura afectividad. La función de reflexión de los padres, o sea, lacapacidad de los padres de comprender su propio estado mental y el de sus niños y por tanto regular sus propios sentimientos y conductas hacia su niño, pudiera amortiguar los efectos negativos del estrés tóxico sobre la afectividad. Nuestro objetivo fue probar la eficacia de la intervención Afectividad y Salud del Niño (ATTACH), enfocándonos en mejorar la función de reflexión y la seguridad de la afectividad de los niños, para madres y niños de <36 meses de edad bajo riesgos. Se llevaron a cabo tres estudios pilotos con mujeres y niños de una agencia del centro de la ciudad que les sirve a familias vulnerables de bajos recursos económicos y un albergue para casos de violencia familiar. Un ensayo controlado al azar (n = 20, n = 10 al momento de inscribirse) y métodos cuasi-experimentales (n = 10 al momento de inscribirse) pusieron a prueba el efecto de ATTACH sobre el resultado primario de los puntajes de la función de reflexión, a partir de las transcritas Entrevistas del Desarrollo del Progenitor. Nuestro secundario resultado fueron los patrones de afectividad de los niños con base en el Procedimiento de la Situación Extraña de Ainsworth. A pesar de algunas bajas (n = 2 casos), los análisis de co-variantes con métodos combinados y las pruebas-t revelaron significativas diferencias en la función de reflexión materna, del niño, y en términos generales, con niveles de efectos moderados. Aunque más niños cuyas madres recibieron el programa ATTACH presentaron seguridad en su afectividad después del tratamiento, comparados con el grupo de control, no se observaron diferencias significativas, lo cual pudiera ser consecuencia de observaciones ausentes (n = 5 casos). Comprender la eficacia de programas como ATTACH contribuye a programas y servicios mejorados con el fin de promover un saludable desarrollo de los niños afectados por el estrés tóxico.

Les stresseurs toxiques (par exemple la violence parentale, la dépression, la pauvreté) placement les enfants à risque d'attachement insécure. La fonction parentale de réflexion, c'est-à-dire la capacité des parents à comprendre leurs propres états mentaux et celui de leur enfant et donc de réguler leurs propres sentiments et comportement envers leur enfant, peut servir de tampon aux effets négatifs du stress toxique sur l'attachement. Notre objectif était de tester l'efficacité de l'intervention Attachement et Santé de l'Enfant (en anglais, Attachment and Child Health, soit, ATTACH), en s'attachant à améliorer la fonction de réflexion et la sécurité de l'attachement des enfants, pour des mères à risques et leurs enfants <36 mois d'âge. Trois études pilotes ont été faites avec des femmes et des enfants d'une agence de quartiers défavorisés servant des familles vulnérables, de milieu défavorisé, ainsi qu'un refuge familial pour les victimes de violence. Un essai contrôlé randomisé (n = 20, n = 10 à l'inscription) et des méthodes quasi-expérimentales (n = 10 à l'inscription) ont testé l'effet de ATTACH sur le résultat principal de scores de fonction de réflexion, à partir d'Entretiens du Développement du Parent transcrits. Notre deuxième résultat était les patterns d'attachement des enfants à partir de la Procédure de Situation Etrange d'Ainsworth. En dépit d'une attrition (n = 2 cas), une analyse mixte de la covariance et les tests-t ont révélé des différences importantes dans la fonction de réflexion générale, maternelle, et de l'enfant, avec une ampleur modérée. Alors que plus d'enfants dont les mères ont reçu le programme ATTACH étaient attachés de manière sécure après le traitement, comparés aux contrôles, aucune différence importante n'a été observée, ce qui pourrait s'expliquer par des observations manquantes (n = 5 cas). La compréhension de l'efficacité de programmes comme ATTACH contribue à améliorer des programmes et des services promouvant un développement sain des enfants affectés par le stress toxique.

A feasibility study comparing a web-based intervention to a workshop intervention for caregivers of adults with eating disorders.

OBJECTIVE: To assess for the validity of a future trial, the current feasibility study aimed to compare the feasibility and efficacy of a web- and workshop-based education intervention for caregivers of adults with eating disorders. METHODS: Psychoeducation was provided to caregivers, who were randomly assigned to a web or workshop condition. Independent samples t tests were conducted to analyse the between-group effect sizes for intervention condition with regard to change over time. A random selection of participants from each intervention provided qualitative feedback about their experiences. RESULTS: Overall, participants reported positive experiences in both education interventions. From baseline to the end of intervention, small between-group effect sizes were observed for changes in caregiver accommodation, problem-solving abilities, the quality of psychological health, and the quality of social relationships, favouring the web-based intervention, and changes in expressed emotion in the family context, caregiver burden, perceived stress, and the quality of the environment, supporting the workshop intervention. CONCLUSIONS: There was a difference in initial feasibility of the web intervention. A future large-scale trial of these interventions is supported by the results of this feasibility study.

Family-based treatment for transition age youth: the role of expressed emotion and general family functioning.

The aim of this study was to investigate changes in family functioning and parental expressed emotion (EE) in parents and transition age youth (18 to 25 years old) with Anorexia Nervosa participating in Family-Based Treatment for Transition Age Youth (FBT-TAY). Further, we examined whether perceived family functioning and EE were associated with changes in eating disorder behaviour and weight in participants at end-of-treatment and three months post-treatment. Generalized estimating equations revealed that changes in family functioning significantly improved from baseline to end-of-treatment (p = .0001), and baseline to three months post-treatment (p = .0001) in parents; and from baseline to end-of-treatment (p = .011), and baseline to three months post-treatment (p = .0001) in transition age youth. The level of parental EE did not differ significantly from baseline to end-of-treatment (p = .379), or baseline to three months post-treatment (p = .185). A series of Ordinary Least Square regression models demonstrated that changes in perceived family functioning and EE were not significantly associated with changes in eating disorder behaviour and weight restoration of transition age youth at end-of-treatment and three months post-treatment. Overall, perceptions of family functioning improved during the course of FBT-TAY, but EE did not.

Family-based treatment for transition age youth: parental self-efficacy and caregiver accommodation.

BACKGROUND: Family-Based Treatment (FBT) is the first line of care in paediatric treatment while adult programs focus on individualized models of care. Transition age youth (TAY) with Anorexia Nervosa (AN) are in a unique life stage and between systems of care. As such, they and their caregivers may benefit from specialized, developmentally tailored models of treatment. METHODS: The primary purpose of this study was to assess if parental self-efficacy and caregiver accommodation changed in caregivers during the course of FBT-TAY for AN. The secondary aim was to determine if changes in parental self-efficacy and caregiver accommodation contributed to improvements in eating disorder behaviour and weight restoration in the transition age youth with AN. Twenty-six participants (ages 16-22) and 39 caregivers were recruited. Caregivers completed the Parents versus Anorexia Scale and Accommodation and Enabling Scale for Eating Disorders at baseline, end-of-treatment (EOT), and 3 months follow-up. RESULTS: Unbalanced repeated measures designs for parental self-efficacy and caregiver accommodation towards illness behaviours were conducted using generalized estimation equations. Parental self-efficacy increased from baseline to EOT, although not significantly (p = .398). Parental self-efficacy significantly increased from baseline to 3 months post-treatment (p = .002). Caregiver accommodation towards the illness significantly decreased from baseline to EOT (p = 0.0001), but not from baseline to 3 months post-treatment (p = 1.000). Stepwise ordinary least squares regression estimates of eating disorder behaviour and weight restoration did not show that changes in parental-self efficacy and caregiver accommodation predict eating disorder behaviour or weight restoration at EOT or 3 months post-treatment. CONCLUSIONS: Our findings demonstrate, albeit preliminary at this stage, that FBT-TAY promotes positive increases in parental self-efficacy and assists caregivers in decreasing their accommodation to illness behaviours for transition age youth with AN. However, changes in the parental factors did not influence changes in eating and weight in the transition age youth.

Nursing Child Assessment Satellite Training Parent-Child Interaction Scales: Comparing American and Canadian Normative and High-Risk Samples.

PURPOSE: Many nurses rely on the American Nursing Child Assessment Satellite Training (NCAST) Parent-Child Interaction (PCI) Teaching and Feeding Scales to identify and target interventions for families affected by severe/chronic stressors (e.g. postpartum depression (PPD), intimate partner violence (IPV), low-income). However, the NCAST Database that provides normative data for comparisons may not apply to Canadian families. The purpose of this study was to compare NCAST PCI scores in Canadian and American samples and to assess the reliability of the NCAST PCI Scales in Canadian samples. METHODS: This secondary analysis employed independent samples t-tests (p < 0.005) to compare PCI between the American NCAST Database and Canadian high-risk (families with PPD, exposure to IPV or low-income) and community samples. Cronbach's alphas were calculated for the Canadian and American samples. RESULTS: In both American and Canadian samples, belonging to a high-risk population reduced parents' abilities to engage in sensitive and responsive caregiving (i.e. healthy serve and return relationships) as measured by the PCI Scales. NCAST Database mothers were more effective at executing caregiving responsibilities during PCI compared to the Canadian community sample, while infants belonging to the Canadian community sample provided clearer cues to caregivers during PCI compared to those of the NCAST Database. Internal consistency coefficients for the Canadian samples were generally acceptable. CONCLUSIONS: The NCAST Database can be reliably used for assessing PCI in normative and high-risk Canadian families. PRACTICAL IMPLICATIONS: Canadian nurses can be assured that the PCI Scales adequately identify risks and can help target interventions to promote optimal parent-child relationships and ultimately child development.

Open Trial of Family-Based Treatment of Anorexia Nervosa for Transition Age Youth.

OBJECTIVE: This pilot study conducted an open trial of a manualized adaptation to Family-Based Treatment for Transition Age Youth (FBT-TAY) for Anorexia Nervosa (AN). The aims were: (1) determine the acceptability of FBT for TAY; and, (2) establish preliminary effect sizes for the impact of FBT-TAY on eating disorder behaviour and weight restoration. METHOD: Twenty-six participants across two paediatric and one adult hospital site were recruited to participate. Participants completed the Eating Disorder Examination Questionnaire (EDE-Q) at the start of treatment, the end-of-treatment, and three-month follow-up. RESULTS: FBT-TAY is an acceptable and feasible treatment to all study therapists as evidenced by their fidelity to the model. FBT-TAY is a feasible and acceptable intervention to transition age youth, given only 27.27% chose treatment as usual over FBT-TAY. Participants presented significant improvement at end-of-treatment and three-months post-treatment (p < .001; ES = 0.34) from baseline on the EDE-Q Global Score. Participants also achieved and maintained weight restoration at the end-of-treatment and three-months post-treatment when compared to baseline (p < .0001, ES = 0.54). CONCLUSIONS: FBT-TAY, the first manualized AN treatment for TAY, demonstrated feasibility and acceptability with therapists and participants as well as improvement for participants in EDE-Q global score and weight. Given the current dearth of effective treatments for TAY with AN, FBT-TAY is a promising adaptation of FBT. A larger clinical trial with a 12-month follow-up is recommended.

OBJECTIF: Cette étude pilote a mené un essai ouvert de l'adaptation dans un manuel du traitement familial pour jeunes en âge de transition (TF-JAT) pour l'anorexie mentale (AM). Les objectifs étaient: (1) déterminer l'acceptabilité du TF pour les JAT; et (2) établir des tailles de l'effet (TE) préliminaires pour l'effet du TF-JAT sur le comportement du trouble alimentaire et la reprise de poids. MÉTHODE: Vingt-six participants dans deux centres pédiatriques et un hôpital pour adultes ont été recrutés pour participer. Les participants ont répondu au questionnaire d'examen sur les troubles alimentaires (EDE-Q) au début du traitement, à la fin du traitement, et au suivi de 3 mois. RÉSULTATS: Le TF-JAT est un traitement acceptable et faisable pour tous les thérapeutes de l'étude comme en atteste leur fidélité au modèle. Le TF-JAT est une intervention faisable et acceptable pour les jeunes en âge de transition, étant donné que seulement 27,27% ont choisi le traitement habituel plutôt que le TF-JAT. Les participants ont présenté une amélioration significative au score global du EDE-Q à la fin du traitement et au suivi de trois mois (p < 0,001; TE = 0,34) comparé au début. Les participants ont également réussi à reprendre du poids et à le maintenir à la fin du traitement et au suivi de 3 mois comparé au début (p < 0,0001, TE = 0,54). CONCLUSIONS: Le TF-JAT, le premier traitement de l'AM dans un manuel pour les JAT, a démontré faisabilité et acceptabilité chez les thérapeutes et les participants ainsi qu'une amélioration pour les participants au score global de l'EDE-Q et de leur poids. Étant donné la rareté actuelle de traitements efficaces pour les JAT souffrant d'AM, le TF-JAT est une adaptation prometteuse du TF. Un essai clinique plus vaste avec suivi de 12 mois est recommandé.

The Relationship Between Psychological Distress and Perception of Emotional Support in Medical Students and Residents and Implications for Educational Institutions.

OBJECTIVE: Psychological distress is pervasive among medical students and residents (MSR) and is associated with academic under-performance, decreased empathy, burnout, and suicidal ideation. To date, there has been little examination of how demographic and socioeconomic factors influence trainee's psychological distress levels, despite suggestion that financial concerns are a common source of stress. Recent Canadian studies examining the prevalence of distress, burnout, and resilience in MSR are limited. METHODS: Undergraduate and postgraduate medical trainees attending a Canadian university were surveyed. The questionnaire included standardized instruments to evaluate psychological distress, burnout, and resilience. Additional items explored MSR living and domestic circumstances, and anticipated debt upon training completion. Ordinary least squares regression models determined predictors of psychological distress, risk for burnout, and resiliency. Logistic regression of psychological distress predicted risk of MSR contemplating dropping out of their training program. RESULTS: Feeling emotionally/psychologically unsupported while attending university was a key predictor of psychological distress and burnout, while feeling supported reduces this risk. Risk for burnout increased with each year of medical training. Psychologically distressed MSR were at significantly greater odds of contemplating dropping out of their medical training program. CONCLUSIONS: Our results point to the important opportunity universities and medical schools have promoting MSR well-being by reducing institutional stressors, as well as teaching and promoting self-care and burnout avoidance techniques, instituting wellness interventions, and developing programs to identify and support at risk and distressed students.