Ashley M. Butler

Treatment Outcome for Low Socioeconomic Status African American Families in Parent-Child Interaction Therapy: A Pilot Study

The course and efficacy of parent-child interaction therapy (PCIT) were examined in 18 socioeconomically disadvantaged African American families of preschoolers with disruptive behavior disorders. Mothers reported significant improvements in child disruptive behavior but not in maternal depressive symptoms or parenting stress. Attrition was 56%, most often occurring after pre-treatment assessment but before treatment began. Results suggest that PCIT may lead to positive behavior changes for disadvantaged young African American children when families complete treatment. Recruitment, engagement, and retention remain significant problems requiring further study. Reduction of parenting stress also requires study in this population.

Predictors of a Health-Promoting Lifestyle and Behaviors Among Low-Income African American Mothers and White Mothers of Chronically Ill Children

This study used Health Self-Empowerment (HSE) Theory as a framework for examining the predictors of engagement in both a health-promoting lifestyle and individual health-promoting behaviors among low-income African American mothers and non-Hispanic white mothers (N = 96), each of whom is the primary caregiver for a chronically ill adolescent. The individual health-promoting behaviors investigated are eating a healthy diet, exercising consistently, stress management practices, and health responsibility behaviors. The examined HSE Theory-based predictor variables were health self-efficacy, active coping, health motivation, and health self-praise. Multiple regression analyses revealed that these predictor variables together accounted for a significant amount of variance (67%) in level of engagement in a health-promoting lifestyle. Additionally, active coping, health self-praise, health self-efficacy, and health motivation were significant individual predictors of 1 or more individual health-promoting behaviors. Findings from this study suggest that further research should be conducted to assess the usefulness of HSE Theory in predicting level of engagement in health-promoting behaviors and to examine the effectiveness of HSE Theory-based interventions for increasing health-promoting behaviors among women similar to those in this study. The findings also suggest that health care providers should promote active coping, health self-praise, health self-efficacy, and health motivation to increase health-promoting behaviors among patients who are similar to those in this study.

Parent–child interaction therapy and ethnic minority children

Abstract Disruptive behaviours constitute the most frequent reason for referral of young children to mental health services. Parent–child interaction therapy (PCIT) is a theoretically grounded, assessment-driven, empirically supported treatment for children with disruptive behaviour disorders. PCIT is based on Baumrinds research demonstrating positive outcomes for children of parents with an authoritative parenting style. The child-directed interaction phase of PCIT focuses on strengthening the parent–child bond and increasing positive parenting. The parent-directed interaction phase focuses on increasing parental consistency, predictability and fairness in discipline. This article presents an overview of PCIT and highlights PCIT research with ethnic minority children.

The relationship of reported neighborhood conditions with child mental health.

OBJECTIVE Although in many studies authors have documented the relationship between neighborhood socioeconomic status and child mental health, few have examined the association between neighborhood conditions and mental health disorders. The objective of this study was to determine whether parent-reported neighborhood conditions are associated with common child mental health disorders. METHODS We analyzed data on children ages 6 to 17 (N = 64,076) collected through the 2007 National Survey of Childrens Health. Primary outcome variables were a child being reported to have a diagnosis of (1) anxiety and/or depression and (2) attention-deficit-hyperactivity disorder (ADHD) and/or disruptive behavior. Main independent variables were parent-reported neighborhood amenities (eg, recreation center), poor physical characteristics (eg, dilapidated housing), social support/trust, neighborhood safety, and school safety. Multivariate logistic regression analyses were conducted to examine associations between neighborhood conditions and (1) anxiety/depression and (2) ADHD/disruptive behavior. RESULTS Children living in a neighborhood with 3 poor physical characteristics had greater odds of anxiety/depression (adjusted odds ratio [AOR] 1.58, 95% confidence interval [95% CI] 1.01-2.46) and ADHD/disruptive behavior (AOR 1.44, 95% CI 1.04-1.99) compared with children living in a neighborhood with no poor physical characteristics. Children of parents who reported living in a neighborhood with low social support/trust had greater odds of depression/anxiety (AOR 1.71, 95% CI 1.28-2.30) and ADHD/disruptive behavior (AOR 1.47, 95% CI 1.19-1.81) than children living in a neighborhood with greater social support/trust. CONCLUSIONS Parent perception of neighborhood social support/trust and physical characteristics may be important to assess in clinical settings and should be examined in future study of child mental health burden.

Stress and A1c Among People with Diabetes Across the Lifespan.

Stress is known to negatively affect health and is a potentially serious barrier to diabetes-related health outcomes. This paper synthesizes what is known about stress and glycemic control among people with type 1 and type 2 diabetes across the lifespan. Chronic stress—especially in relation to living with diabetes—was most strongly associated with A1c, particularly among subgroups that face disproportionate stress, such as minority groups or adolescents/young adults. Mechanisms of the stress-A1c association include physiological, psychological, behavioral, and environmental links. Understanding the dimensions of stress as they relate to health in diabetes can be of significant clinical importance, and interventions targeting mechanisms that either exacerbate or buffer stress have reported modest improvements in A1c.

Shared decision-making, stigma, and child mental health functioning among families referred for primary care-located mental health services.

There is growing emphasis on shared decision making (SDM) to promote family participation in care and improve the quality of child mental health care. Yet, little is known about the relationship of SDM with parental perceptions of child mental health treatment or child mental health functioning. The objectives of this preliminary study were to examine (a) the frequency of perceived SDM with providers among minority parents of children referred to colocated mental health care in a primary care clinic, (b) associations between parent-reported SDM and mental health treatment stigma and child mental health impairment, and (c) differences in SDM among parents of children with various levels of mental health problem severity. Participants were 36 Latino and African American parents of children (ages 2-7 years) who were referred to colocated mental health care for externalizing mental health problems (disruptive, hyperactive, and aggressive behaviors). Parents completed questions assessing their perceptions of SDM with providers, child mental health treatment stigma, child mental health severity, and level of child mental health impairment. Descriptive statistics demonstrated the majority of the sample reported frequent SDM with providers. Correlation coefficients indicated higher SDM was associated with lower stigma regarding mental health treatment and lower parent-perceived child mental health impairment. Analysis of variance showed no significant difference in SDM among parents of children with different parent-reported levels of child mental health severity. Future research should examine the potential of SDM for addressing child mental health treatment stigma and impairment among minority families.

Parental information, motivation, and adherence behaviors among children with sickle cell disease†

Identification of psychosocial correlates of health care utilization has become an important strategy in improving clinical care. The objective of the study was to examine the fit of the Information‐Motivation‐Behavioral Skills (IMB) model, applied to health care utilization among children with sickle cell disease (SCD).

Systematic Review of Engagement in Culturally Adapted Parent Training for Disruptive Behavior.

This article reviews the literature reporting engagement (enrollment, attendance, and attrition) in culturally adapted parent training for disruptive behavior among racial/ethnic minority parents of children ages 2 to 7 years. The review describes the reported rates of engagement in adapted interventions and how engagement is analyzed in studies, methods to develop adaptations, and adaptations that have been implemented. Seven studies are identified. Parental engagement varied across and within studies. Only one study examined whether adaptations improved engagement compared with non-adapted intervention. Frequent methods to develop adaptations were building partnerships or conducting interviews/focus groups with minority parents or community members. Adaptations included addressing cultural beliefs (perceptions of parenting skills), values (interdependence), or experiences (immigration) that affect parenting or receptivity to interventions; ensuring racial/ethnic diversity of interventionists; and addressing cultural relevancy and literacy level of materials. Future research should examine engagement in adapted interventions compared with non-adapted interventions and examine factors (e.g., immigration status) that may moderate impact on engagement.

Cross-Racial Measurement Equivalence of the Eyberg Child Behavior Inventory Factors Among Low-Income Young African American and Non-Latino White Children

This study examined the cross-racial measurement equivalence of the three Eyberg Child Behavior Inventory Intensity Scale factors, found by Stern and Johnson: Oppositional Defiant Behavior, Attention Difficulties, and Conduct Problems. Cross-racial measurement equivalence was examined between 278 low-income African American and 119 non-Latino White children aged 3 to 6 years. Results did not support configural equivalence of the three subscales between groups. Exploratory factor analyses conducted separately for each racial group showed support for a single factor structure in both groups. Convergent validity of the Intensity Scale was found separately for both groups. Findings suggest the three Intensity Scale factors should not be used to screen or compare treatment outcomes of specific externalizing behavior problems among community samples that include low-income non-Latino White and African American preschoolers.

Impact of a Culturally Sensitive Health Self-Empowerment Workshop Series on Health Behaviors/Lifestyles, Body Mass Index, and Blood Pressure of Culturally Diverse Overweight/Obese Adults

Objective. To examine the impact of the health self-empowerment theory–based, culturally sensitive Health Self-Empowerment (HSE) Workshop Series to Modify and Prevent Obesity on levels of health promoting (health-smart) behaviors, motivators of and barriers to these behaviors, health promoting lifestyle variables, and health status indicators (body mass index [BMI] and blood pressure) among a culturally diverse sample of overweight/obese adults from mostly low-income households. Design. A total of 153 overweight/obese adults participated in an immediate treatment (IT) group (n = 100) or a waitlist control (WC) group (n = 53). Results. Post-intervention, the IT group compared with the WC group reported (a) significantly higher engagement in physical activity and healthy eating; (b) significantly less intake of calories, total fat, trans fat, saturated fat, sugar, and added sugar; (c) significantly higher motivators for engaging in 2 of 4 specific health-smart behaviors; (d) significantly lower barriers to engaging in 3 of 4 specific health-smart behaviors; and (e) significantly lower BMI and systolic blood pressure. Conclusion. The HSE Workshop Series may be an effective intervention for treating and preventing obesity among diverse low-income adults—individuals who often perceive/experience limited power over their health. Health care providers, particularly physicians, have important health empowerment roles in this intervention.