Chaundrissa Oyeshiku Smith

Family‐based interventions for child and adolescent disorders.

Emotional and behavioral symptoms and disorders are prevalent in children and adolescents. There has been a burgeoning literature supporting evidence-based treatments for these disorders. Increasingly, family-based interventions have been gaining prominence and demonstrating effectiveness for myriad childhood and adolescent disorders. This article presents the current evidence in support of family-based interventions for mood, anxiety, attention-deficit hyperactivity, disruptive behavior, pervasive developmental particularly autism spectrum, and eating disorders. This review details recent data from randomized controlled trials (RCTs) and promising interventions not yet examined using a randomized controlled methodology. It highlights the evidence base supporting various specific family-based interventions, some of which are disorder dependent. A practitioner perspective is then offered with regard to recommendations for future practice and training. The article closes with a summary and directions for future research.

Treatment adherence among low-income, African American children with persistent asthma.

Objective. The study aims to assess medication adherence and asthma management behaviors and their modifiable predictors in low-income children with persistent asthma. Methods. The authors conducted a cohort study of 143 children ages 6 to 11 prescribed a daily inhaled controller medicine that could be electronically monitored. Children were recruited from clinics or the emergency department of an urban childrens hospital. Data were collected at baseline (T1) and 1 year later (T2). Outcome measures were adherence to controller medications as measured by electronic monitoring devices, observed metered-dose inhaler and spacer technique, exposure to environmental tobacco smoke, and attendance at appointments with primary health care provider. Results. Medication adherence rates varied across medications, with higher rates for montelukast than for fluticasone. Eleven percent to 15% of children demonstrated metered dose inhaler and spacer technique suggesting no drug delivery, and few (5% to 6%) evidenced significant exposure to environmental tobacco smoke. Less than half of recommended health care visits were attended over the study interval. Few psychosocial variables were associated with adherence at T1 or in the longitudinal analyses. Fluticasone adherence at T2 was predicted by caregiver asthma knowledge. Conclusions. A substantial number of low-income children with persistent asthma receive less than half of their prescribed inhaled controller agent. Patients without Medicaid, with low levels of caregiver asthma knowledge, or with caregivers who began childrearing at a young age may be at highest risk for poor medication adherence.

A developmental perspective of the relationship of racial-ethnic identity to self-construct, achievement, and behavior in African American children.

This longitudinal study examines the development of racial-ethnic identity among African American children. Racial preferences were assessed in early elementary school with the Racial Attitudes, Beliefs, and Stereotypes Measure-II, a projective technique using paired comparisons of pictures of African American, Asian, Latino, and Caucasian children. Racial-ethnic identity in 3rd grade was assessed using the Multi-Ethnic Identity Measure Ethnic Belonging subscale. Multilevel models indicated that own-group racial preferences increased with age. Second-grade own-group preferences were positively related to 3rd-grade racial-ethnic identity scores. Third-grade racial-ethnic identity was associated positively with self-esteem variables (scholastic, social, physical appearance, and behavioral) and with academic performance. Identity correlated negatively with parent-rated aggression and externalizing and internalizing behaviors. The findings suggest that childrens racial-ethnic identity develops differentially by gender, with girls showing faster growth but lower initial ethnic identity. Racial-ethnic identity was shown to be modestly but statistically significantly associated with various important child outcomes.

Competencies for Psychologists in Academic Health Centers (AHCs)

This paper begins by providing the landscape that undergirds the competency-based movement within professional psychology education, training, credentialing, and performance appraisal. Attention is then paid to the relevance of this culture shift for psychologists working as practitioners, educators, researchers, and administrators in AHCs. In this regard, there is an articulation of the essential subcomponents of each of the core foundational and functional competency domains that are salient for AHC psychologists. Implications of the competency-based movement for professional psychologists in AHCs are offered.

A competency-based approach to couple and family therapy supervision.

The competency-based movement continues to guide professional psychology. This has been highlighted through the establishment of essential foundational and functional competencies. The current paper focuses on the intervention competency domain and delineates its relevance within the field of couple and family therapy (CFT). We begin by providing an overview of 8 essential components of CFT: developing a systemic formulation, forging a systemic therapeutic alliance, understanding family-of-origin issues, reframing, managing negative interactions, building cohesion/intimacy/communication, restructuring/parenting, and understanding and applying evidence-based CFT models. We then provide a brief illustration of foundational and functional competencies essential to CFT. We conclude by addressing the CFT competency within an integrative approach to supervision and provide a case illustration that depicts this process. The relevance of establishing unique, evidence-based, theory-specific competency components is highlighted.

Specialization in Psychology and Health Care Reform

This article begins by contextualizing specialization and board certification of psychologists, with attention paid to relevant definitions and expectations of other health care professionals. A brief history of specialization and board certification in professional psychology is offered. The benefits of board certification through the American Board of Professional Psychology are highlighted. Consideration is then given to the primary reasons for psychologists working in academic health sciences centers to specialize in the current health care climate and to obtain board certification as a mark of such specialization.

Service Utilization Patterns of Maltreated and Nonmaltreated Children From Low-Income, African-American Families

OBJECTIVES This study examined health care utilization patterns by maltreatment status among youths from low-income households across multiple service domains. METHODS Face-to-face interviews were conducted with 153 African-American maltreated and nonmaltreated children (ages eight to 12). The youths were children of women recruited at a large inner-city public hospital for a study examining intimate partner violence and child maltreatment. Use of psychiatric, medical, child care, social support, and crisis health care services was assessed. RESULTS Psychiatric and child care service utilization was significantly different between maltreated and nonmaltreated children across three categories of child maltreatment (emotional, physical, and sexual abuse). Maltreated youths were six to 13 times more likely than their nonmaltreated counterparts to use psychiatric and child care services. Medical service utilization was higher for emotionally abused youths. CONCLUSIONS Results of this study may serve to facilitate improved screening, identify points of access for intervention, and enhance treatment for maltreated youths.

Individual and Family Contributions to Depressive Symptoms in African American Children with Sickle Cell Disease

Depressive disorders in children with chronic illnesses have received little attention despite some evidence suggesting that these children experience increased psychological difficulties as a result of their medical condition. Most of the research on depressive disorders among children has been conducted primarily with Caucasian youth, limiting generalizability to ethnically diverse populations. Further, even less research exists on depressive disorders among African American children with Sickle Cell Disease (SCD) and for African American youth from lower socioeconomic status who are at greater risk for depressive disorders. This paper is an extensive review of the major studies conducted on depression and psychosocial aspects of SCD in African American children. The Transactional Stress and Coping model is provided as a conceptual framework. Following the review, clinical and research implications are provided, as well as an illustration of a psychoeducational family intervention with an African American child who has SCD and internalizing behaviors.

Clinically Significant Depressive Symptoms in African American Adolescent Females in an Urban Reproductive Health Clinic

Adolescent depression is a major public health concern. Depression and depressive symptoms are more prevalent in adolescent females and are associated with high-risk sexual behavior. Only one third of adolescents receive professional help for their depression, although about 90% visit their primary care providers on average 2–3 times per year. It is imperative that health professionals seek additional methods in the identification and treatment of depressive symptoms. This paper presents findings of the presence of clinically significant depressive symptoms in African American female adolescents receiving routine health care services within an adolescent primary care reproductive health clinic. Results revealed higher rates of depressive symptoms in this subsample of African American adolescent females when compared to the national sample, suggesting that primary care reproductive health clinics are a viable setting for the identification of depressive symptoms among low income, African American female adolescents. Psychosocial interventions and recommendations for the integration of primary care reproductive health, and behavioral health consultation services are presented.

Using an Evidence-Based Parenting Intervention with African American Parents:

There has been a rise over the past several years in behavior problems among preschoolers. Young children who exhibit disruptive behavior are at increased risk of problematic outcomes later in life. Children from racial or ethnic minority groups and/or disadvantaged backgrounds may be at greater risk for behavioral problems. Therefore, interventions are needed before these behaviors become more entrenched. Parents of children with disruptive behaviors have reported higher parenting stress levels, which has a negative effect on parenting behaviors. Three models of parenting styles and behaviors are discussed, with a focus on the literature on African American parenting styles. To contribute to the literature addressing parenting training programs with African American populations, a case is presented as an example of the usefulness of an evidence-based behavioral family intervention with a low-income African American single parent family. Treatment recommendations are presented when applying evidence-based parenting programs with African American and other racial or ethnic minority groups.