Preventing behaviour problems through a universal intervention in Jamaican basic schools: a pilot study / Prevención de los problemas de comportamiento a través de una intervención universal en las escuelas preescolares de Jamaica: un estudio piloto

OBJECTIVE: To evaluate the effect of a preventative intervention in Jamaican basic schools on child behaviour and parent-teacher contacts. DESIGN AND METHODS: Five basic schools in Kingston, Jamaica, were randomly assigned to an intervention (n = 3) or control (n = 2) condition. Intervention involved seven whole-day teacher workshops using the Incredible Years Teacher Training Programme supplemented by fourteen lessons on social and emotional skills in each class. Within each classroom (n = 27), children were screened for behaviour difficulties through teacher report and children with the greatest difficulties were selected for evaluation of outcomes (135 children). Teachers' reports of child behaviour using the Strengths and Difficulties Questionnaire and of the quality of teacher-parent contacts were collected at the beginning and end of the school year. Multilevel regression analyses controlling for school and classroom were used to evaluate the effects of intervention on child behaviour. RESULTS: Significant benefits of intervention were found for children's conduct problems (regression coefficient (b) = -0.62, 95% confidence interval (CI): -0.01, -1.23), hyperactivity (b = -0.84, 95% CI: -1.57, -0.11) and peer problems (b = -1.24, 95% CI: -1.89, -0.59). The effect sizes were 0.26 for conduct problems, 0.36 for hyperactivity and 0.71 for peer problems. No significant benefits were found for the prosocial and emotional problems subscales. The intervention also resulted in increases in the number of positive teacher-parent contacts (p < 0.0001). No benefits were found for the number of negative teacher-parent contacts. CONCLUSION: This is a promising approach for reducing children's externalizing behaviour and peer problems and for improving the quality of teachers' contacts with parents of children with behaviour problems.

OBJETIVO: Evaluar el efecto de una intervención preventiva en el comportamiento de los niños y los contactos entre padres y maestros en las escuelas preescolares de Jamaica. DISEÑO Y MÉTODOS: Cinco escuelas preescolares en Kingston, Jamaica, fueron asignadas de manera aleatoria a una intervención (n = 3) o condición de control (n = 2). La intervención comprendió siete talleres de maestro el día entero, usando el Programa de Entrenamiento de Maestros "Años Increíbles", complementado por catorce lecciones sobre habilidades sociales y emocionales en cada clase. Dentro de cada aula (n = 27), se realizó un pesquisaje de niños en busca de dificultades en la conducta a través del informe del maestro, y los niños con las mayores dificultades fueron seleccionados para la evaluación de resultados (135 niños). Informes de los maestros sobre la conducta de los niños - realizados mediante el Cuestionario de fortalezas y dificultades, y sobre la calidad de los contactos entre maestros y padres - fueron recogidos al inicio y al final del año escolar. Análisis de regresión multinivel para el control de la escuela y el aula, fueron usados para evaluar los efectos de la intervención sobre el comportamiento de los niños. RESULTADOS: Se hallaron beneficios significativos para los problemas de la conducta de los niños (coeficiente de regresión (b) = -0.62, 95% intervalo de confianza (IC): -0.01, -1.23), hiperactividad (b = -0.84, 95% IC: -1.57, -0.11) y problemas con los iguales (b = -1.24, 95% IC: -1.89, -0.59). Los tamaños de efecto fueron 0.26 para los problemas de conducta, 0.36 para la hiperactividad y 0.71 para los problemas de iguales. No se hallaron beneficios significativos para las subescalas de problemas prosociales y emocionales. La intervención también trajo como resultado aumentos en el número de contactos positivos entre maestros y padres (p < .0001). No se hallaron beneficios para el número de contactos negativos maestros-padres. CONSLUSIÓN: Este trabajo representa un abordaje prometedor a la hora de reducir la conducta externalizadora de los niños y los problemas de iguales, así como para mejorar la calidad de los contactos entre los maestros y los padres de los niños con problemas de conducta.

A pilot study of the Incredible Years Teacher Training programme and a curriculum unit on social and emotional skills in community pre-schools in Jamaica.

BACKGROUND: School-based interventions involving teacher and/or child training have been shown to benefit teacher practices and to prevent conduct problems and improve children's social and emotional competence in developed countries; however, we are aware of no reports from a developing country. We conducted a pilot study of the Incredible Years Teacher Training programme and a curriculum unit on social and emotional skills based on concepts and activities drawn from the Incredible Years Dina Dinosaur Classroom Curriculum to determine if this approach is appropriate for use with Jamaican pre-school teachers and children. METHODS: Five pre-schools in Kingston, Jamaica were randomly assigned to an intervention (3 pre-schools with 15 classrooms) or control (2 pre-schools with 12 classrooms) condition. Intervention involved seven whole-day teacher workshops using the Incredible Years Teacher Training programme supplemented by 14 child lessons in each class. The project was evaluated through structured observations of four categories of teacher behaviour and four observer ratings: two rating scales of child behaviour and two rating scales of classroom atmosphere. RESULTS: Significant intervention benefits were found to teachers' behaviour with increased positive behaviour [b = 7.9; 95% confidence interval (CI): 3.5, 12.3], reduced negative behaviour (b =-3.5; 95% CI: -6.6, -0.2) and increases in the extent to which teachers promoted children's social and emotional skills (b = 46.4; 95% CI: 11.0, 81.7). The number of teacher commands was not significantly reduced (b =-2.71; 95% CI: -6.01, 0.59). Significant intervention benefits were found to ratings of child behaviour with an increase in children's appropriate behaviour (b = 5.7, 95% CI: 1.0, 10.8) and in children's interest and enthusiasm (b = 7.2, 95% CI: 0.9, 13.5). Intervention also benefited classroom atmosphere with increases in opportunities provided for children to share and help each other (b = 1.3, 95% CI: 0.5, 2.1) and in teacher warmth (b = 1.3, 95% CI: 0.9, 1.8). CONCLUSION: This is a promising approach for improving the emotional climate of Jamaican pre-school classrooms and for improving child behaviour and participation.

Preventing behaviour problems through a universal intervention in Jamaican basic schools: a pilot study.

OBJECTIVE: To evaluate the effect of a preventative intervention in Jamaican basic schools on child behaviour and parent-teacher contacts. DESIGN AND METHODS: Five basic schools in Kingston, Jamaica, were randomly assigned to an intervention (n = 3) or control (n = 2) condition. Intervention involved seven whole-day teacher workshops using the Incredible Years Teacher Training Programme supplemented by fourteen lessons on social and emotional skills in each class. Within each classroom (n = 27), children were screened for behaviour difficulties through teacher report and children with the greatest difficulties were selected for evaluation of outcomes (135 children). Teachers'reports of child behaviour using the Strengths and Difficulties Questionnaire and of the quality of teacher-parent contacts were collected at the beginning and end of the school year Multilevel regression analyses controlling for school and classroom were used to evaluate the effects of intervention on child behaviour. RESULTS: Significant benefits of intervention were found for children's conduct problems (regression coefficient (b) = -0.62, 95% confidence interval (CI): -0.01, -1.23), hyperactivity (b = -0.84, 95% CI: -1.57, -0.11) and peer problems (b = -1.24, 95% CI: -1.89, -0.59). The effect sizes were 0.26 for conduct problems, 0.36 for hyperactivity and 0.71 for peer problems. No significant benefits were found for the prosocial and emotional problems subscales. The intervention also resulted in increases in the number of positive teacher-parent contacts (p < 0.0001). No benefits were found for the number of negative teacher-parent contacts. CONCLUSION: This is a promising approach for reducing children's externalizing behaviour and peer problems and for improving the quality of teachers' contacts with parents of children with behaviour problems.

Breastfeeding patterns among six-week-old term infants at the University Hospital of the West Indies.

Eighty-nine mothers attending post-natal clinics at the University Hospital of the West Indies were interviewed at six weeks postpartum regarding their breast-feeding patterns and problems. Breastfeeding was practised by 97.8% of the mothers, with 29.9% practising exclusive breastfeeding and 70.1% partial breastfeeding. Only two women were solely bottle feeding. The pattern of breastfeeding was not significantly affected by maternal parity, age, education, employment or socioeconomic status. An intention to wean later (at six months) or when the mother felt the baby was 'ready,' was associated with increasing parity, age and further education. Babies who were exclusively breastfed achieved greater weight gain compared with those who partially breastfed but this difference did not achieve statistical significance. Breastfeeding trends appear to have remained stable over the last several years.

Presence of anorexia nervosa and bulimia nervosa in Jamaica.

We could find no previous data describing the extent to which eating disorders are a public health problem in Jamaica, and so we carried out two exercises to assess this. We investigated the number of cases of anorexia nervosa (AN) and bulimia nervosa (BN) presenting at the University Hospital of the West Indies (UHWI) between 1985 and 1998, using case records, and carried out a survey among health professionals (psychiatrists, clinical psychologists, paediatricians and nutritionists/dietitians) to determine the number of patients with eating disorders seen by them between 1996 and 1998. We also examined the diagnostic criteria used and correlates of eating disorders. Only two cases of AN were treated at UHWI. Eleven cases each of AN and BN (two males) had presented to the health professionals surveyed, chiefly the psychiatrists. The AN patients ranged in age from 14 to 28 years (mean 20.9 years), and the BN patients from 11 to 35 years (mean 22.2 years). Eating disorders were reported primarily among urban dwellers (76%), and half of the cases were among students. Limiting food intake, excessive exercise and vomiting were the most frequently used methods of weight control. Nine eating disorder patients (41%) were also diagnosed with depression, and five (23%) patients reported previous emotional trauma. The occurrence of eating disorders in Jamaica appears to be very low.

Presence of anorexia nervosa and bulimia nervosa in Jamaica

We could find no previous data describing the extent to which eating disorders are a public health problem in Jamaica, and so we carried out two exercises to assess this. We investigated the number of cases of anorexia nervosa (AN) and bulimia nervosa (BN) presenting at the University Hospital of the West Indies (UHWI) between 1985 and 1998, using case records, and carried out a survey among health professionals (psychiatrists, clinical psychologists, paediatricians and nutritionists/dietitians) to determine the number of patients with eating disorders seen by them between 1996 and 1998. We also examined the diagnostic criteria used and correlates of eating disorders. Only two cases of AN were treated at UHWI. Eleven cases each of AN and BN (two males) had presented to the health professionals surveyed, chiefly the psychiatrists. The AN patients ranged in age from 14 to 28 years (mean 20.9 years), and the BN patients from 11 to 35 years (mean 22.2 years). Eating disorders were reported primarily among urban dwellers (76), and half of the cases were among students. Limiting food intake, excessive exercise and vomiting were the most frequently used methods of weight control. Nine eating disorder patients (41) were also diagnosed with depression, and five (23) patients reported previous emotional trauma. The occurrence of eating disorders in Jamaica appears to be very low.

The use of herbal teas and remedies in Jamaica

We investigated the prevalence of the use of herbs among adults and children in Jamaica in 1996. Two concurrent surveys were conducted in randomly selected urban and rural areas: among adults and among caretakers of young children. From over 90 of the selected households, all caretakers of children under 6 years and one randomly selected adult (18 years or older) were interviewed using structured questionnaires. The 457 adults reportedly used 156 types of herbs: a mean of 6 +/- 3 (mean +/- standard deviation) by the urban adults, and 10 +/- 6 by the rural adults (t-test, p < 0.001). Almost 100 of respondents had at some time used herbs for teas or for treating illnesses. The most common method of preparation was by infusion or boiling in water, then adding sugar. Urban respondents, women and those who were employed were more likely to buy medicines than to use herbal remedies. One hundred and sixty-seven caretakers of 203 children under 6 years were interviewed. The mean number of herbs given to each child was between 2 and 3. The most common herbs were introduced within the first 6 months of life. Many caretaker factors were associated with herbal use. Public health implications include the potential toxicity of some herbs, the possibility that herbal teas given to young children may displace more nutritious foods and delay presentation to health care facilities. The findings will allow policy makers to target those most likely to use herbal preparations or to give them to young children, and target herbs to be analyzed for toxic or beneficial properties.