Immigrant Mothers' Perspectives of Barriers and Facilitators in Accessing Mental Health Care for Their Children.

Introduction: Data on immigrant and refugees' access to services in Canada typically focus on adult populations generally but not children specifically. To fill this gap, this study explored immigrant and refugee mothers' perceptions of barriers and facilitators for mental health care for their children in Edmonton, Alberta, Canada. Method: In this qualitative descriptive study, researchers conducted 18 semistructured interviews with immigrant and refugee mothers who live in Edmonton, self-identify as women, and have children living in Canada. Results: Barriers included financial strain, lack of information, racism/discrimination, language barriers, stigma, feeling isolated, and feeling unheard by service providers. Facilitators included schools offering services, personal levels of higher education, and free services. Discussion: Nurses can improve access to mental health services by addressing issues related to racism within the health system, by creating awareness related to mental health, and by providing trained interpreters to help bridge barriers in communications.

Quantitative Evaluation of Content and Age Concordance Across Developmental Milestone Checklists.

OBJECTIVE: Clinicians and caregivers rely on milestone checklists as tools for tracking a child's development. In addition, medical students and residents use milestone checklists to learn about normal child development. However, there are multiple published milestone checklists that vary qualitatively in structure and content, hindering their effective use in developmental surveillance and medical education. This project systematically evaluated the consistency and variability between commonly used milestone checklists. METHODS: A team of child psychologists and developmental pediatricians reviewed a total of 1094 milestones derived from 4 published checklists (2 developed for providers, 2 developed for caregivers) to create a comprehensive set of 728 discrete developmental observations, with each observation mapped to corresponding milestones. This observation-milestone relational database was then used to determine the degree of content overlap and milestone age range concordance across milestone checklists. RESULTS: Of the 728 discrete developmental observations, 40 (5.5%) were mapped to milestones in all 4 milestone checklists, and an additional 90 (12.4%) were mapped to 3 checklists. Among these 40 "universal" observations, most (42.5%) were in the motor domain. Of those 130 observations mapped to milestones in at least 3 of the 4 checklists, 26.9% (35/130) were mapped to milestones that were discordant in their associated age range. CONCLUSION: Four commonly used developmental milestone checklists were found to have limited overlap in content, and those that overlapped were inconsistent in their associated age ranges. The resulting observation-milestone relational database could be used to further validate age estimates of milestones and facilitate milestone surveillance through the electronic health record.

[Voluntariness in Outpatient Psychotherapy with Children and Adolescents]. / Über die Freiwilligkeit in der ambulanten Kinder- und Jugendlichenpsychotherapie.

Voluntariness in Outpatient Psychotherapy with Children and Adolescents Voluntariness is no selective construct in psychotherapy with children and adolescents. Generally psychotherapy is utilized under external pressure, at least partially. At any rate it is crucial to painstakingly analyze the motivation for change and possible obstacles to motivation. On that basis different strategies to foster motivation for change can be applied. Problems regarding the efficiency of voluntary or involuntary utilization of outpatient psychotherapy for children and adolescents should be subjects to further research.

Annual Research Review: The state of implementation science in child psychology and psychiatry: a review and suggestions to advance the field.

BACKGROUND: Scientists have developed evidence-based interventions that improve the symptoms and functioning of youth with psychiatric disorders; however, these interventions are rarely used in community settings. Eliminating this research-to-practice gap is the purview of implementation science, the discipline devoted to the study of methods to promote the use of evidence-based practices in routine care. METHODS: We review studies that have tested factors associated with implementation in child psychology and psychiatry, explore applications of social science theories to implementation, and conclude with recommendations to advance implementation science through the development and testing of novel, multilevel, causal theories. RESULTS: During its brief history, implementation science in child psychology and psychiatry has documented the implementation gap in routine care, tested training approaches and found them to be insufficient for behavior change, explored the relationships between variables and implementation outcomes, and initiated randomized controlled trials to test implementation strategies. This research has identified targets related to implementation (e.g., clinician motivation, organizational culture) and demonstrated the feasibility of activating these targets through implementation strategies. However, the dominant methodological approach has been atheoretical and predictive, relying heavily on a set of variables from heuristic frameworks. CONCLUSIONS: Optimizing the implementation of effective treatments in community care for youth with psychiatric disorders is a defining challenge of our time. This review proposes a new direction focused on developing and testing integrated causal theories. We recommend implementation scientists: (a) move from observational studies of implementation barriers and facilitators to trials that include causal theory; (b) identify a core set of implementation determinants; (c) conduct trials of implementation strategies with clear targets, mechanisms, and outcomes; (d) ensure that behaviors that are core to EBPs are clearly defined; and (e) agree upon standard measures. This agenda will help fulfill the promise of evidence-based practice for improving youth behavioral health.

[Relevance and experience of surveillance and brief contact intervention systems in preventing reattempts of suicide among children and adolescents]. / Pertinence et expérience des dispositifs de veille et de recontact dans la prévention suicidaire auprès des enfants et des adolescents.

In France, one adolescent out of ten has already attempted suicide. In this population, suicide reattempts are frequent and significantly impact the vital, morbid and functional long-term prognosis. For about fifteen years, surveillance and brief contact intervention systems (SBCIS) have been used to complete the French suicide reattempt prevention arsenal for youth. The relevance of such strategy appears once the mental health service gap observed at this period of life is considered. In addition to prompting better coordination between the different professional stakeholders, the SBCIS help to alleviate the adolescent's help-seeking barriers, especially the ambivalence between conquest of autonomy and need for help. The first results from the French SBCIS dedicated to children and adolescents are encouraging. Although they have to deal with specific challenges, we argue that they relevantly complement and potentiate the already available prevention resources, thus optimizing the whole prevention system for suffering youth.

Validation of the child ptsd symptom scale (cpss) in spanish adolescents / Validación española de la Child PTSD Symptom Scale (CPSS) en adolescentes

Background: One of the most frequently used instruments to assess posttraumatic stress in children and adolescents is the Child PTSD Symptom Scale. However, there has been limited evaluation of its construct validity in the Spanish language despite Spanish being one of the most widely spoken languages in the world. Objective: To provide data on the psychometric properties of the CPSS in a sample of Spanish adolescents, to establish the internal consistency of the measure, and to examine its criterion validity. Method: The participants were 339 adolescents (172 boys and 167 girls, mean age 13.95) exposed to peer violence during the previous year. Results: Confirmatory factor analysis demonstrated a good fit to the four-factor dysphoria model. The alpha reliabilities for the overall measure and its subscales were suitable. Discussion: The Spanish version of the scale has sound psychometric properties with good reliability and validity. Moreover, it integrates the four-factor structure corresponding to the dimensions of PTSD described in the DSM-V (AU)

Antecedentes: la Child PTSD Symptom Scale es uno de los cuestionarios más utilizados para evaluar el estrés postraumático en niños y adolescentes. Sin embargo, es escasa la investigación acerca de la validez de constructo de la versión en español de este instrumento, a pesar de tratarse de uno de los idiomas más hablados en el mundo. Objetivo: validar la versión española de esta escala en una muestra de adolescentes. Método: los participantes fueron 339 adolescentes (172 varones y 167 mujeres, con una media de edad de 13,95 años) que cumplían los criterios de haber sufrido violencia por parte de sus iguales durante el año previo al estudio. Resultados: el análisis confirmatorio mostró un buen ajuste del modelo de cuatro factores de disforia. Los coeficientes de fiabilidad para la medida global y sus subescalas fueron adecuados. Discusión: la versión española la escala presenta buenas propiedades psicométricas y una estructura factorial que se corresponde a los criterios para el trastorno de estrés postraumático del DSM-V (AU)

Validation of a scale for a nonword repetition task to assess lexical development / Baremación de una tarea de repetición de pseudopalabras para la evaluación del desarrollo léxico

It has been demonstrated that the ability to repeat non-words is a good marker of lexical development in a number of languages, including Spanish. In addition, the ability to repeat nonwords has been used as a good discriminator between typically developing children and children with language delays or other language difficulties. However, despite its potential usefulness for clinical and research purposes, there is no validated scale in Spanish. To address this situation, we present a scale based on a sample of 342 monolingual Spanish-speaking children aged from four to seven years. After data analysis, a scale was elaborated to provide populational references for colleagues working in educational, clinical and research fields. The results show a ceiling effect for six years olds, as well as for monomorphemic and bisyllabic items. Implications of these scores are discussed in the corresponding section (AU)

La habilidad para repetir pseudopalabras se ha mostrado como un buen marcador de desarrollo léxico en multitud de lenguas incluyendo el español. Además, permite discriminar en buena medida entre niños con desarrollo típico y niños con trastornos y retrasos del lenguaje. Sin embargo, pese a su potencial importancia para su uso clínico e investigador, en español no contamos con baremos para una lista de estímulos determinada. Con el objetivo salvar esta notable carencia, se realiza una tarea de repetición de pseudopalabras a una muestra total de 342 niños y niñas monolingües españoles de entre cuatro y siete años. Tras el análisis de los resultados se elaboró un baremo con el objeto de aportar referencias poblacionales a colegas que trabajan en las citadas áreas clínico-educativas y de investigación. Los resultados muestran un efecto techo de esta tarea a los 6 años, así como para los estímulos monomorfémicos y bisílabos. Las implicaciones de estos resultados y baremo obtenido son discutidas en el apartado correspondiente (AU)

Editorial: Making clinical trials smarter (and more interesting).

At its heart, the field of child psychology and psychiatry is geared towards using science to develop interventions that promote children's healthy development and treat behavioural and emotional difficulties when they arise. While there have been some successes (e.g. stimulant medication for ADHD, parent training for child conduct problems, Fonagy et al., ) serious challenges lie ahead if we are to achieve reliable and lasting improvements for a larger number of children, and for a broader spectrum of problems.

[Adaptation and validation of the neurological soft sign's scale of Krebs et al. to children]. / Adaptation et validation d'une échelle des signes neurologiques mineurs chez l'enfant.

BACKGROUND: Neurological soft signs (NSS) include anomalies in motor integration, coordination, sensory integration and lateralization and could be endophenotypic markers in autism spectrum disorders (ASD). Their characterization provides a more precise phenotype of ASD and more homogeneous subtypes to facilitate clinical and genetic research. Few scales for NSS have been adapted and validated in children including children with ASD. Our objective was to perform an adaptation to the child of a scale assessing neurological soft signs and a validation study in both general and clinical populations. METHODS: We have selected the NSS scale of Krebs et al. (2000) already validated in adults. It encompasses 5 dimensions: motor coordination, motor integration, sensory integration, involuntary movement, laterality. After a preliminary study that examined 42 children, several changes have been made to the original version to adapt it to the child and to increase its feasibility, particularly in children with ASD. Then we conducted a validation study by assessing the psychometric properties of this scale in a population of 86 children including 26 children with ASD (DSM 5 Criteria) and 60 typically developing children. Children's ages ranged between 6 and 12 years, and patients and controls were matched for gender, age and intelligence. Patients were assessed using the Autism diagnostic Interview-revised and the Childhood Autism Rating Scale to confirm diagnosis. Typically developing children were assessed using the semi-structured Mini International Neuropsychiatric Interview for Children and Adolescents to eliminate any psychiatric disorder. All children with neurological pathologies (history of cerebral palsy, congenital anomaly of the central nervous system, epilepsy, tuberous sclerosis, neurofibromatosis, antecedent of severe head trauma) and obvious physical deformities or sensory deficits that could interfere with neurological assessment were excluded from the study. Both patients and controls were assessed using the Raven Progressive Matrices to exclude intellectual disability, and the adapted Krebs' scale for the assessment of NSS. RESULTS: Adaptation of the scale consisted of a modification in the order of items, in the use of concrete supports for the assessment of laterality and in the elimination of item constructive praxis. The internal consistency was good with a Cronbach alpha of 0.87. Inter-rater reliability was good, kappa coefficient was greater than 0.75 for 16 items, 3 items had a kappa value between 0.74 and 0.60, only 1 item had a kappa coefficient between 0.4 and 0.59. Good inter-rater reliability was also checked for the total score with a value of intra-class correlation coefficient (ICC) of 0.91. Principal component analysis found five factors accounting for 62.96 % of the total variance. About the comparison between patients and controls, significant differences were found for NSS total score (P=0.000) and all subscores. CONCLUSION: The adaptation for children of the Krebs et al.' NSS scale proved to be valid, especially in children with ASD.

Child mental-health policy development in sub-Saharan Africa: broadening the perspectives using Bronfenbrenner's ecological model.

Despite socio-economic, demographic and epidemiological facts and realities that point to a potential risk for explosion in the prevalence of childhood mental health problems in sub-Saharan Africa, there is still a severe dearth of child and adolescent mental health (CAMH) policy or strategy to respond to the situation in the region. Unfortunately, current attempts at suggesting courses of action in this regard appear to be focused on narrow reactionary approaches. There is a need for theoretical frameworks to capture the full ramification of childhood in sub-Saharan Africa, from which multi-level, context-appropriate and holistic CAMH policy directions can be understood. In this commentary, we propose an amended version of the Bronfenbrenner's ecological model of childhood as such framework that captures proximal, intermediate and distal factors that influence the care environment of children. We then used the insights provided by the model to identify and prioritize intervention points and appropriate intervention strategies in charting a tentative course for CAMH policy development in the region. Though the ecological model provides a distinct perspective to the structure and dynamics of the care environment of children, the proposed framework using the model is still largely theoretical and need to be further integrated into future studies on CAMH policy development in the region.

Topical Review: Building Competency: Professional Skills for Pediatric Psychologists in Integrated Primary Care Settings.

OBJECTIVES : In the midst of large-scale changes across our nation's health care system, including the Affordable Care Act and Patient-Centered Medical Home initiatives, integrated primary care models afford important opportunities for those in the field of pediatric psychology. Despite the extensive and growing attention, this subspecialty has received in recent years, a comprehensive set of core professional competencies has not been established. METHODS : A subset of an Integrated Primary Care Special Interest Group used two well-established sets of core competencies in integrated primary care and pediatric psychology as a basis to develop a set of integrated pediatric primary care-specific behavioral anchors. CONCLUSIONS : The current manuscript describes these behavioral anchors and their development in the context of professional training as well as with regard to Triple Aim goals and securing psychology's role in integrated pediatric primary care settings.

Editorial Perspective: How should child psychologists and psychiatrists interpret FDA device approval? Caveat emptor.

Recently several new tests have received US Federal Drug Administration (FDA) marketing approval as aids in the diagnostic process for attention deficit hyperactivity disorder (ADHD), including the Neuropsychiatric electroencephalogram (EEG)-Based ADHD Assessment Aid (NEBA) Health test. The NEBA test relies upon an EEG-based measure, called the theta to beta ratio (TBR). Although this measure has yielded large differences between ADHD and non-ADHD groups in studies prior to 2009, recent studies and a meta-analysis could not replicate these findings. In this article, we have used the NEBA device as an exemplar for a discussion that distinguishes between FDA de novo marketing approval for a device and any claims that that device is empirically supported, scientifically validated with replicated findings. It is understood that the aims of each differ; however, for many, including the lay public as well as some mental health professionals, these terms may be confused and treated as though they are synonymous. With regard to the TBR measure, there is no reliable association or replication for its clinical usage in the ADHD diagnostic process. The recommendation for potential consumers of the NEBA Health test (as well as perhaps for other existing FDA-approved diagnostic tests) is caveat emptor (let the buyer beware!).

Adults' Insensitivity to Developmental Changes in Children's Ability to Report When and How Many Times Abuse Occurred.

In legal settings, children are frequently asked to provide temporal information about alleged abuse, such as when it occurred and how often. Although there is a sizeable body of work in the literature regarding children's ability to provide such information, virtually nothing is known about how adults evaluate the veracity of that information. This omission is especially noteworthy given that adults' evaluations are critical to the progression and outcome of legal cases. We examined adults' perceptions of children's reports of temporal details regarding alleged sexual abuse. We varied both children's age (6 vs. 11 years) and how certain children were when providing such details to assess whether adults were sensitive to changes in how children of different ages typically talk about temporal information. With regard to credibility, adults were insensitive to children's age, perceiving younger and older children who reported temporal details with confidence as more credible than those who reported information tentatively. Normative developmental trends, however, would suggest that, with age, children are often tentative when reporting true temporal details. With regard to perceptions of children's accuracy in reporting temporal information, adults found younger children who were confident to be the most accurate. Regarding guilt judgments, adults rated defendants as having a higher degree of guilt when children were confident in reporting temporal details. The findings have implications for juror decision-making in cases of alleged sexual abuse in which children report when or how often abuse occurred. Copyright © 2016 John Wiley & Sons, Ltd.

Junior MARSIPAN (Management of Really Sick Patients with Anorexia Nervosa).

We present a review of the Junior MARSIPAN (Management of Really Sick Patients with Anorexia Nervosa) guideline, which provides paediatricians with a framework for managing Anorexia Nervosa in the inpatient setting.

Annual Research Review: Threats to the validity of child psychiatry and psychology.

BACKGROUND: Suggestions have been made that many claims concern false-positive findings in the field of child psychology and psychiatry. FINDINGS: The literature was searched for concepts and findings on the validity of child psychiatry and psychology. Substantial progress has been made in some, but not all, areas and considerable challenges remain in all. CONCLUSIONS: The two major threats to validity concern the inability to examine brain tissues in life and the evidence that there is a high overlap among disorders. We emphasize the need to follow published guidelines on preplanned analyses and we note the dangers associated with unregulated flexibility in data analysis. We note the very important clinical and developmental findings that have been ignored, perhaps partly because of an excessive focus on technologies. Nevertheless, we are positive about both the accomplishments and the ways in which challenges are being met.

Estadios tempranos del conflicto edípico / Early stages of teh oedipus conflict

A largo de este artículo, la autora trata de mostrar algunas de las conclusiones obtenidas en el análisis con niños de entre tres y seis años. Entre ellas se encuentran la constatación de la existencia del sentimiento de culpa asociado a las fijaciones pregenitales, que ella considera efecto directo del conflicto edípico y producto de la formación del superyó, y la existencia para ambos sexos de una fase femenina de vital importancia, consistente en una identificación con la madre muy precoz. Partiendo de los postulados freudianos, la autora considera que el punto esencial de sus consideraciones adicionales está en la ubicación de todos estos procesos en épocas más tempranas y en que las diferentes fases del desarrollo se fusionan más libremente entre sí de lo que hasta entonces se suponía. Desde su perspectiva, los estadios tempranos del conflicto edipídico e encuentran fuertemente dominados por las fases pregenitales del desarrollo, ocultando el inicio de la actividad de la fase genital, que comienza a hacerse más reconocible a la edad de entre tres y cinco años, momento en que el complejo de Edipo y la formación del superyó alcanzan su punto culminante (AU)

Throughout this article the author aims to present a number of conclusions obtained in analysis with children between the ages of three and six. These include the discovery of the existence of the sense of guilt associated with pregenital fixation, which she considers to be the direct effect of the Oedipus conflict and a product of the formation of the super-ego, and the existence for both sexes of a vitally important feminine phase consisting of a very early identification with the mother. Starting from Freudian premises, the author considers that the essential point in the additional considerations she advances is that she places all of these processes at earlier points in time and that the different phases of development merge more freely in one other than was hitherto supposed. In her view, the early phases of the Oedipus conflict are largely dominated by pregenital phases of development, concealing the beginning of activity of the genital phase which starts to become more recognizable in the third to the fifth year, an age at which the Oedipus complex and the formation of the super-ego reach their climax (AU)

Implantación piloto de dos programas basados en la evidencia (SafeCare e Incredible Years) en los Servicios de Protección Infantil de Gipuzkoa (España) / Pilot Implementation of two evidence based programs (SafeCare and Incredible Years) in Child Protection Services in Gipuzkoa (Spain)

El presente artículo describe el proceso de implantación de dos la primera letra de las tres palabras minúscula en el Sistema de Protección Infantil de Gipuzkoa (España): SafeCare e incredible years. El primero es un programa de intervención en el domicilio para familias negligentes o en riesgo de negligencia con niños menores de 5 años. El segundo es un programa terapéutico grupal para familias con niños entre 4 y 8 años con problemas de comportamiento cuyos padres tienen dificultades significativas para su manejo. Se describe el proceso por el que las instituciones responsables de la protección infantil en Gipuzkoa iniciaron un cambio desde los modelos actuales de intervención hacia programas más estructurados, focalizados y breves que han mostrado resultados positivos en aplicaciones previas en otros países. Se tratan cuestiones relacionadas con la adaptación de los programas, la selección y formación de profesionales y se presentan los resultados pre- y post- obtenidos en la aplicación preliminar de ambos programas a un número limitado de familias. Se presenta el diseño de la siguiente fase del proceso (implantación piloto con diseño experimental para evaluación de resultados). Se discuten cuestiones relevantes de este proceso, que pueden ser de utilidad para aquellas administraciones e instituciones que pretendan llevar a cabo un proceso similar

This paper describes the implementation process of two evidence-based programs in Gipuzkoa’s Child Protection System (Spain): SafeCare and Incredible Years. SafeCare is a home visiting program for high-risk and neglectful families with children under 5 years. Incredible Years is a parenting skills training program for families with children between 4 to 8 years with behavior problems whose parents have significant difficulties to manage. The paper describes the process by which public institutions responsible for child protection in Gipuzkoa decided to shift from current intervention programs towards more structured, focused, and short-term programs that have shown positive results in previous applications in other countries. Issues related to programs adaptation, selection, and training of professionals and pre- and post- results obtained in the preliminary application of SafeCare and Incredible Years to a limited set of families are presented. Finally, the next step of the implementation process (pilot implementation with a randomized control trial design) is described. The paper discusses a significant number of issues that have been important throughout this process and that may be useful for administrations and institutions that wish to undertake a similar process

¿Por qué a mí?: deesvalimiento y derrumbe psíquico en un niño abusado / Why me?: psychic helplessness and collapse in an abuse child

Con este trabajo se pretende hacer una reflexión sobre el abuso sexual infantil, a través de la presentación de un caso clínico que, siguiendo un recorrido teórico sobre distintos autores que han trabajado sobre este tema y, fundamentalmente, teniendo muy presente la obra de Sándor Ferenczi, nos ayude en la comprensión de la teoría del trauma y la importancia que tiene en la clínica de estos casos (AU)

This paper aims to reflect on child sexual abuse, through the presentation of a clinical case. A theoretical review on different authors who have worked on this issue has been done, and it has been beard in mind the work of Sandor Ferenczi, in order to help in the understanding of the theory of trauma and its importance in these cases (AU)