Audra St. John Walsh

Evidence-based interventions for children with challenging behavior

Chapter 1: Common Early Childhood Behavior Problems.- Chapter 2: Early Childhood Development Theories.- Chapter 3: The Prevention Model and Problem Solving.- Chapter 4: Screening Techniques.- Chapter 5: Evidence-Based Practices with Children and their Caregivers.- Chapter 6: Behavioral Terms and Principles.- Chapter 7: Applying Principles of Behavior.- Chapter 8: Progress Monitoring.- Chapter 9: Evaluating Outcomes.- Chapter 10: Summary & Conclusions of Best Practices in Providing Services for YCCB.- Appendix A: Developmental Milestones References.- Appendix B: ABC Chart for Determining a Behaviors Function.- Appendix C: HOT DOCS Behavior Chart.- Appendix D: Graphing by Hand.- Glossary of Terms.- References.

Decisional capacity and medication adherence among youth with HIV

This exploratory study examined the degree to which decisional capacity (DC) is associated with measures of self-reported medication adherence. We hypothesized that youth with higher levels of DC would report greater levels of antiretroviral medication adherence. Seventy-two (72) youth with HIV aged 13–24 participated in this study. Data collection included administration of the MacArthur Competence Tool for Treatment and measures of adherence (i.e., seven-day self-report interview, visual analog scale, and biological indicators). Data were analyzed using descriptive statistics, intercorrelations, and multiple and Poisson regression analyses. Youth with HIV who exhibited greater understanding of their disease were more likely to report fewer missed doses in the last seven days. Findings build upon literature in the areas of DC and health literacy and highlight the potential utility of enhancing HIV disease understanding among youth with HIV.

Addressing HIV in the school setting: Application of a school change model

This paper describes best practices for responding to youth with human immunodeficiency virus (HIV) in the school setting through the application of a school change model designed by the World Health Organization. This model applies a whole school approach and includes four levels that span the continuum from universal prevention to direct intervention. These levels are described and recommendations made, within the context of addressing mental health and educational issues related to HIV prevention and treatment at school. The challenges associated with implementing this model and strategies to overcome these barriers are discussed.

Screening for depression among youth with HIV in an integrated care setting

ABSTRACT Youth living with HIV (YLWH) are at risk for depression. Depressive symptoms can impact treatment engagement, health outcomes, and quality of life. Early identification of symptoms can guide treatment planning. This study aimed to identify trends in depressive symptoms for YLWH in a specialty-care clinic and follow-up clinical treatment procedures. An archival review of a clinical database provided depression screening information for a sample of 130 YLWH between 11 and 25 years old in the southeastern United States. Findings indicated that approximately 24% of the sample screened positive for depression-risk. Most commonly endorsed symptoms included fatigue (54.3%) and sleep difficulties (48.5%). Depressive symptoms did not differ significantly by age, gender, race, ethnicity, or sexual orientation. Youth who acquired HIV behaviorally were more likely to endorse the critical item (i.e., self-harm and/or suicidal ideation) than youth who acquired HIV perinatally. Forty-percent of the sample (i.e., 51 youth) had a follow-up treatment plan. YLWH who endorsed the critical item were more likely to receive follow-up action when compared to those who did not endorse the item. Despite limitations of the study, findings have important implications for clinical care and future research.

A "Mindful Rational Living" Approach for Addressing HIV in the School Setting.

This paper describes a “mindful rational living” approach, which incorporates mindfulness techniques with rational emotive behavioral therapy strategies for addressing HIV in the school setting. The utility of this approach for attending to the physical, mental, and psychosocial aspects of school-based HIV prevention and treatment will be provided within existing multitier models of intervention.

Medication Adherence in 13- to 24-Year-Old Youth Living With HIV

&NA; Despite advances in HIV medicine, adherence presents as a barrier to effective treatment for youth. We designed this study to assess medication knowledge, adherence, and factors affecting adherence in youth with HIV. Participants were 72 youth ages 13 to 24 years with perinatally or behaviorally acquired HIV. Demographic data were collected and a self‐report adherence interview was administered. Interviews were audio‐recorded to allow for qualitative data analysis. Self‐reported adherence varied depending on the framing of questions, with participants reporting greater adherence when asked how many doses they had missed within the past 7 days compared to results from a 7‐day recall interview. At least 74% of the sample said they sometimes forgot to take their medication. A taxonomic approach to the qualitative analysis revealed internal and external facilitators and barriers to adherence. Findings suggest a need for education and provider support to include strategies to improve adherence.

HIV Prevention and Intervention in the School Setting

The purpose of this chapter is to discuss HIV prevention and intervention in the school setting. We focus not only on the impact of HIV on students infected with or affected by the disease but also on the importance of developmentally appropriate and comprehensive school-based HIV education. Using a three-tiered model, we describe school-related HIV issues within the following contexts: primary prevention, secondary prevention, and tertiary prevention.

The Prevention Model and Problem Solving

With growing numbers of developmental needs expressed in communities, the way services are delivered to families must change to assist children. A prevention model which provides multiple levels of support from prevention efforts to extensive, individualized interventions can assist practitioners in meeting the needs of children efficiently and effectively. In addition, prevention and intervention efforts are more effective when problems are clearly identified and tied to specific interventions which are evidence-based. The use of a problem-solving process gives practitioners a specific way to think about child concerns and develop and track progress of interventions matched to the child or children’s needs.

Evidence-Based Practices with Children and Their Caregivers

When delivering services to children and their caregivers, it is important for early intervention professionals to integrate their clinical expertise, the family’s values, and the best research evidence into selecting strategies to improve developmental outcomes. Referred to as evidence-based practice, this process enhances both optimal outcomes and quality of life by utilizing interventions that have been documented through systematic research efforts.

Summary and Conclusions of Best Practices in Providing Services for YCCB

This final chapter utilizes case studies within the prevention framework in an effort to integrate theories of development, evidence-based practice, behavioral principles, progress monitoring data, and evaluation of outcomes. When possible, the outcomes from each case study are graphically presented so that progress can be observed.