Christine A. Ateah

Can interprofessional collaboration provide health human resources solutions? A knowledge synthesis

Many studies examine the impact of interprofessional (IP) interventions on various health practice and education outcomes. One significant gap is the lack of research on the effects of IP interventions on health human resource (HHR) outcomes. This project synthesized the literature on the impact of IP interventions at the pre- and post-licensure levels on quality workplace, staff satisfaction, recruitment, retention, turnover, choice of employment and cost effectiveness. Forty-one peer-reviewed articles and five IECPCP project reports were included in the review. We found that IP interventions at the post-licensure level improved provider satisfaction and workplace quality. Including IP learning opportunities into practice education in rural communities or in less popular healthcare specialties attracted a higher number of students and therefore may increase employment rates. This area requires more high quality studies to firmly establish the effectiveness of IP interventions in recruiting and retaining future healthcare professionals. There is strong evidence that IP interventions at the post-licensure level reduced patient care costs. The knowledge synthesis has enhanced our understanding of the relationships between IP interventions, IP collaboration and HHR outcomes. Gaps remain in the knowledge of staff retention and determination of staffing costs associated with IP interventions vis-à-vis patient care costs. None of the studies reported long-term data on graduate employment choice, which is essential to fully establish the effectiveness of IP interventions as a HHR recruitment strategy.

PERCEIVED AND PERFORMED INFANT CARE COMPETENCE OF YOUNGER AND OLDER ADOLESCENT MOTHERS

The investigators examined differences in perceived and performed infant care competence for younger (less than 17 years of age) and older (17 to 19 years of age) adolescent mothers. Associations were tested between perceived infant care competence measured at several time points and performed mothering at 12 to 18 months infant age. A convenience sample of 78 adolescent mothers was recruited from two major teaching hospitals in Winnipeg, Canada. The Infant Care Questionnaire (ICQ), a self-report measure of infant care ability, was completed during the 3rd trimester and the 1st and 4th postnatal weeks. Performed mothering was assessed with Caldwells HOME scale administered in the adolescent mothers home when the infant was 12 to 18 months old. Significant increases in competence perceptions over time were demonstrated for both ICQ subscales, the Mom&Baby, F (2, 47) = 22.73, p = 0.000, and Emotionality, F (2, 47) = 43.16, p = 0.000. This increase in infant care competence mirrors the maternal role competence trajectory reported in studies with older mothers. While no significant age group differences were found for Mom&Baby or Emotionality, older adolescent mothers were rated significantly higher on one of the HOME subscales, Variety in Daily Stimulation, t (n = 45), = 2.12, p = .04, and a second approached significance, Responsiveness, t (n = 45) = 1.86, p = .07. Pearson correlations between the Mom&Baby and Emotionality and the HOME subscales, Responsiveness and Environment, ranged between -0.30 and -0.37. Future research is required to further explain the negative correlations between perceived and performed infant care competence, establish clinical validity of self-report methods with adolescent mothers, and assess the influence of social, cultural, and economic factors not considered in this study.

Parents' Views of the Relevance of a Violence Prevention Program in High, Medium, and Low Human Development Contexts.

Every day, almost one billion children around the world experience violent punishment. Eliminating all violence against children is a key target of the United Nations’ 2030 Agenda for Sustainable Development. This is a monumental challenge due to the diversity of cultural, economic and social contexts in which children live. Violence-prevention programs developed in wealthy countries cannot be assumed to be transferable to low- and middle-income countries. We assessed the relevance of Positive Discipline in Everyday Parenting (PDEP) to 525 parents living in countries with high (n = 201), medium (n = 166), or low (n = 158) Inequality-Adjusted Human Development Indices. The outcome measures were parents’ satisfaction with the program and their perceptions of its impact on their parenting. Across IHDI categories, almost all parents were “mostly” or “very satisfied” with the overall program (98.4%), the PDEP parent book (97.9%), and the program activities (97.8%). Parent satisfaction scores were higher in the Low IHDI category than in the High IHDI category. Across IHDI categories, large majorities of parents perceived PDEP as having positive impacts on their parenting. While parents in the Medium IHDI category had the strongest perceptions of PDEP’s positive impact, more than 90% of parents in the Low IHDI category believed that the program will help them to understand their children’s development and feelings, communicate better with their children, control their anger, and build stronger relationships with their children. PDEP is a promising tool for preventing punitive violence against children across human development contexts.

Review: self help, media-based therapy is effective for behaviour problems in children

Main results 9 studies (1 unpublished; 7 randomised, 2 quasirandomised) met the selection criteria. Follow up ranged from 6 weeks to 2.5 years. Sample sizes ranged from 32 to 160 participants. Sleep problems: 2 studies showed that conventional and booklet treatments were each effective for sleep problems in children. Enuresis: 1 study compared 3 groups: filmed training of behavioural instructions, live training, and a waiting list control. The face to face group had better outcomes than the film group. Another study compared 3 treatments: a urine alarm, a urine alarm plus instructions for parents to immediately reinforce the child awakening and using the toilet upon hearing the alarm, and a urine alarm plus instructions for parents to reinforce the child in the morning for a dry night. At 2.5 years, the treatment success rate was higher for immediate reinforcement than for a urine alarm alone. Pooled results for these 2 studies showed no difference in relapse or treatment failure rates. Attention deficit hyperactivity disorder: 1 small study (n=32) compared a booklet of behavioural management advice plus methylphenidate with methylphenidate alone, but 10 participants dropped out. Conduct disorder: 1 study compared 4 groups: individually administered videotape modelling, group discussion videotape modelling (1 video weekly), group discussion only, and a waiting list control for {10–12 wks}*. All 3 treatment groups showed fewer behaviour problems, more prosocial behaviours, and less spanking than the control group. Another study by the same authors showed that adding 2 hours of therapist time to an individually administered videotape parenting programme enhanced its effectiveness.

Mothering, Guiding, and Responding to Children: A Comparison of Women Abused and Not Abused by Intimate Partners

Intimate partner violence (IPV) has many negative outcomes for women, children, and families. However, researchers have opposing perspectives and findings with respect to the effects on mothering for abused women. The assumption by some service providers that abused mothers are compromised in their parenting generally ignores the larger issue of male violence and women’s and children’s safety. The question examined in this study was whether there were differences in reported positive parenting responses with children between women who have experienced IPV and those who have not experienced IPV. The sample consisted of 1,211 mothers and came from two studies: The National Longitudinal Survey of Children and Youth, and The Healing Journey: A Longitudinal Study of Mothers Affected by Intimate Partner Violence. The Positive Interaction and Rational Parenting scales, adapted from Strayhorn and Weidman’s Parenting Practices Scale, were used to measure parenting interactions. Bivariate correlations between the outcome variables and maternal age, maternal education, child age, and child sex were calculated to determine whether any of these variables were significantly related to the Positive Interaction Scale or Rational Parenting Scale. This was followed by ANCOVA to determine whether mothers who had experienced IPV differed in their scores on the two parenting scales from mothers who had not experienced IPV. Findings did not support the notion that abused women are compromised in their parenting responses with their children in regard to positive interactions and behavior management. Recommendations include a greater focus on the prevention of IPV, addressing the source of violence and providing appropriate support for mothers who experience IPV.

Protective Strategies of Mothers Abused by Intimate Partners Rethinking the Deficit Model

Exposure to intimate partner violence is detrimental to children, but can abused mothers protect them, and, if so, what can they do? This study of 350 Canadian abused women represents the first quantitative examination of such protective strategies. The actions that mothers most commonly used and perceived as effective include showing affection and being nurturing to their children. The strategies often suggested by professionals, such as contacting police and obtaining protection orders, were used less and considered less effective than informal strategies. Professionals are urged to ask mothers what strategies they use, especially those who do not involve formal systems.

The Complexities of Intimate Partner Violence: Mental Health, Disabilities, and Child Abuse History for White, Indigenous, and Other Visible Minority Canadian Women

This research examines how mental health issues associated with intimate partner violence (IPV) relate to womens intersecting identities of race/ethnicity, disability status, and child abuse history. Data ( N = 595) from a Canadian triprovincial study included women who were White ( n = 263, 44.8%), Indigenous ( n = 292, 49.7%), or visible minority ( n = 32, 5.5%). Few demographic differences were found. None of the mental health measures (Symptom Checklist-Short Form [SCL-10], Centre for Epidemiological Studies-Depression [CES-D-10], Posttraumatic Stress Disorder [PTSD] Checklist) were in the clinical ranges. In a MANCOVA on the mental health scales, with IPV severity, racial group, disability status, and child abuse history as variables, only disability was significantly associated with more mental health symptoms.