A modified video-feedback intervention for carers of foster children aged 6 years and under with reactive attachment disorder: a feasibility study and pilot RCT.

BACKGROUND: Looked-after children are at risk of suboptimal attachment patterns and reactive attachment disorder. However, access to interventions varies widely and there are no evidence-based interventions for this disorder. OBJECTIVES: (1) To adapt an existing video-feedback intervention to meet the specific needs of foster children in the UK with reactive attachment symptoms, (2) to conduct a case series to road-test the treatment manual and study procedures, (3) to conduct a scoping study of the key hurdles in a pilot trial and (4) to conduct a pilot randomised controlled trial of the adapted intervention to determine the feasibility of a future full-scale trial. DESIGN: This was a mixed-methods study. The adapted treatment manual was developed with expert input and tested on a small case series. Qualitative interviews with key stakeholders were used in the scoping study in preparation for the trial and later with foster carers who received the new intervention. The final stage was a feasibility and pilot randomised controlled trial of the new intervention, compared with usual care. Researchers assessing the outcomes were blinded to group assignment. SETTING: The study was set in outpatient child and adolescent mental health services and partner social services departments. Sites included urban and rural/semirural areas. PARTICIPANTS: Participants were foster carers with children aged ≤ 6 years presenting with difficulties in the domain of reactive attachment disorder. Key stakeholders included children's services managers and mental health service practitioners in the scoping study. Foster carers who received the modified intervention participated in qualitative interviews. INTERVENTION: The video-feedback intervention to promote positive parenting and sensitive discipline is an extensively evaluated and effective treatment approach. This intervention was modified (based on the adapted version for foster care in the Netherlands) to suit the needs of young children with reactive attachment symptoms in foster care in the UK and was delivered to improve the sensitive responding of foster carers, foster carer-child relationships and child outcomes. The modified intervention was delivered in-home by trained mental health professionals over a period of 4-6 months. MAIN OUTCOME MEASURE: The main outcome was reactive attachment symptom scores on the Disturbances of Attachment Interview. RESULTS: A series of minor changes to the intervention programme were introduced, which focused on improving its suitability for the UK foster care context. Challenges in recruitment meant that, despite numerous modifications to the protocol and the inclusion of additional sites, only 30 families (target, n = 40) were recruited to the randomised controlled trial (15 allocated to each group). However, most other trial parameters were deemed feasible and acceptable, particularly the high levels of data and treatment completeness. All randomised families were available for baseline analyses, but two in the treatment arm were not available for post-treatment analyses. The revised intervention was positively received by practitioners and foster carers. LIMITATIONS: Only three-quarters of the target sample size was recruited. Furthermore, the sites' own exclusion of potential participants and the low return rates of screening questionnaires raise the possibility of non-randomness of non-responses. CONCLUSION: A larger-scale trial may be feasible, but only if recruitment barriers can be overcome. Dedicated resources to support recruitment within local authorities and wider inclusion criteria are recommended. Central resourcing of intervention capacity to supplement NHS staff is also recommended. TRIAL REGISTRATION: This trial is registered as ISRCTN18374094. FUNDING: This project was funded by the National Institute for Health and Care Research ( NIHR ) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 35. See the NIHR Journals Library website for further project information.

Children in foster care typically have had a very difficult start in life, often as a result of abuse or neglect within their family of origin, and separation from caregivers. These children can find it difficult to trust new adults, and in some cases difficulties in attachment may justify a diagnosis of reactive attachment disorder. This disorder is a pattern of behaviour among young children who have received extremely insufficient early care, whereby they fail to seek or respond to comfort from carers when hurt or distressed, and they can be very withdrawn. There are currently no evidence-based treatments for reactive attachment disorder. The Video-feedback Intervention to promote Positive Parenting and Sensitive Discipline is a treatment programme that was developed to promote secure attachments in young children and to help parents deal with difficult behaviour. A practitioner films the child and parent interacting at home and provides feedback in the following session. This treatment was previously adapted for use in foster care in the Netherlands. In this study, we modified the treatment further to ensure that it appropriately addressed the needs of young children in foster care in the UK who present with reactive attachment disorder symptoms. We then worked with local authorities and linked mental health services to develop a system for identifying young children in foster care in need of this treatment. Finally, we conducted a small (pilot) study to gather information about the best way to provide the modified treatment in this context. The revised treatment was positively received by practitioners and foster carers. The majority of the processes involved in running a trial also worked well (e.g. good levels of attendance at assessments and at the treatment sessions). However, we encountered significant difficulties in recruiting foster carers to the study. We concluded that a full-scale trial would be very valuable, and could potentially be undertaken if difficulties with recruitment are overcome. We recommend that greater resources be provided to local authorities to help them engage and recruit foster carers.

Children in foster care with symptoms of reactive attachment disorder: feasibility randomised controlled trial of a modified video-feedback parenting intervention.

BACKGROUND: Looked-after children are at risk of suboptimal attachment patterns and reactive attachment disorder (RAD). However, access to interventions varies widely, and there are no evidence-based interventions for RAD. AIMS: To modify an existing parenting intervention for children with RAD in the UK foster care setting, and test the feasibility of conducting a randomised controlled trial (RCT) of the modified intervention. METHOD: The intervention was modified with expert input and tested on a case series. A feasibility and pilot RCT compared the new intervention with usual care. Foster carers and children in their care aged ≤6 years were recruited across nine local authorities, with 1:1 allocation and blind post-treatment assessments. The modified intervention was delivered in-home by trained mental health professionals over 4-6 months. Children were assessed for RAD symptoms, attachment quality and emotional/behavioural difficulties, and foster carers were assessed for sensitivity and stress. RESULTS: Minimal changes to the intervention programme were necessary, and focused on improving its suitability for the UK foster care context. Recruitment was challenging, and remained below target despite modifications to the protocol and the inclusion of additional sites. Thirty families were recruited to the RCT; 15 were allocated to each group. Most other feasibility outcomes were favourable, particularly high numbers of data and treatment completeness. The revised intervention was positively received by practitioners and foster carers. CONCLUSIONS: A large-scale trial may be feasible, but only if recruitment barriers can be overcome. Dedicated resources to support recruitment within local authorities and wider inclusion criteria are recommended.

The future of tundra carbon storage in Greenland - Sensitivity to climate and plant trait changes.

The continuous change in observed key indicators such as increasing nitrogen deposition, temperatures and precipitation will have marked but uncertain consequences for the ecosystem carbon (C) sink-source functioning of the Arctic. Here, we use multiple in-situ data streams measured by the Greenland Ecosystem Monitoring programme in tight connection with the Soil-Plant-Atmosphere model and climate projections from the high-resolution HIRHAM5 regional model. We apply this modelling framework with focus on two climatically different tundra sites in Greenland (Zackenberg and Kobbefjord) to assess how sensitive the net C uptake will expectedly be under warmer and wetter conditions across the 21st century and pin down the relative contribution to the overall C sink strength from climate versus plant trait variability. Our results suggest that temperatures (5-7.7 °C), total precipitation (19-110 %) and vapour pressure deficit will increase (32-36 %), while shortwave radiation will decline (6-9 %) at both sites by 2100 under the RCP8.5 scenario. Such a combined effect will, on average, intensify the net C uptake by 9-10 g C m-2 year-1 at both sites towards the end of 2100, but Zackenberg is expected to have more than twice the C sink strength capacity of Kobbefjord. Our sensitivity analysis not only reveals that plant traits are the most sensitive parameters controlling the net C exchange in both sites at the beginning and end of the century, but also that the projected increase in the net C uptake will likely be similarly influenced by future changes in climate and existing local nutrient conditions. A series of experiments forcing realistic changes in plant nitrogen status at both sites corroborates this hypothesis. This work proves the unique synergy between monitoring data and numerical models to assist robust model calibration/validation and narrow uncertainty ranges and ultimately produce more reliable C cycle projections in understudied regions such as Greenland.

Greenland-wide inventory of ice marginal lakes using a multi-method approach.

Ice marginal lakes are a dynamic component of terrestrial meltwater storage at the margin of the Greenland Ice Sheet. Despite their significance to the sea level budget, local flood hazards and bigeochemical fluxes, there is a lack of Greenland-wide research into ice marginal lakes. Here, a detailed multi-sensor inventory of Greenland's ice marginal lakes is presented based on three well-established detection methods to form a unified remote sensing approach. The inventory consists of 3347 ([Formula: see text]%) ice marginal lakes ([Formula: see text]) detected for the year 2017. The greatest proportion of lakes lie around Greenland's ice caps and mountain glaciers, and the southwest margin of the ice sheet. Through comparison to previous studies, a [Formula: see text]% increase in lake frequency is evident over the west margin of the ice sheet since 1985. This suggests it is becoming increasingly important to include ice marginal lakes in future sea level projections, where these lakes will form a dynamic storage of meltwater that can influence outlet glacier dynamics. Comparison to existing global glacial lake inventories demonstrate that up to 56% of ice marginal lakes could be unaccounted for in global estimates of ice marginal lake change, likely due to the reliance on a single lake detection method.

Imagery retrieval may explain why recall of negative scenes contains more accurate detail.

We investigated whether the presence of imagery at retrieval was associated with the finding that negative pictures and scenes are recalled with greater perceptual detail. Participants were presented with 30 scenes taken from the International Affective Picture System that were rated either high or low on valence, but similarly on arousal. Recall was prompted with matched visual or verbal cues. During recall, participants reported any images that came to mind and rated them for vividness, whereas accuracy was rated independently. Imagery was described at test in response to over 60% of the stimuli. Whereas vividness was predicted by negative valence, images occurred more often in response to visual cues. The association of negative valence and visual cueing with better recall was observed only in the presence of reported imagery. These findings have important implications for models and experiments focusing on the recall and recognition of visual stimuli.

Delta progradation in Greenland driven by increasing glacial mass loss.

Climate changes are pronounced in Arctic regions and increase the vulnerability of the Arctic coastal zone. For example, increases in melting of the Greenland Ice Sheet and reductions in sea ice and permafrost distribution are likely to alter coastal morphodynamics. The deltas of Greenland are largely unaffected by human activity, but increased freshwater runoff and sediment fluxes may increase the size of the deltas, whereas increased wave activity in ice-free periods could reduce their size, with the net impact being unclear until now. Here we show that southwestern Greenland deltas were largely stable from the 1940s to 1980s, but prograded (that is, sediment deposition extended the delta into the sea) in a warming Arctic from the 1980s to 2010s. Our results are based on the areal changes of 121 deltas since the 1940s, assessed using newly discovered aerial photographs and remotely sensed imagery. We find that delta progradation was driven by high freshwater runoff from the Greenland Ice Sheet coinciding with periods of open water. Progradation was controlled by the local initial environmental conditions (that is, accumulated air temperatures above 0 °C per year, freshwater runoff and sea ice in the 1980s) rather than by local changes in these conditions from the 1980s to 2010s at each delta. This is in contrast to a dominantly eroding trend of Arctic sedimentary coasts along the coastal plains of Alaska, Siberia and western Canada, and to the spatially variable patterns of erosion and accretion along the large deltas of the main rivers in the Arctic. Our results improve the understanding of Arctic coastal evolution in a changing climate, and reveal the impacts on coastal areas of increasing ice mass loss and the associated freshwater runoff and lengthening of open-water periods.