Julia Muennich Cowell

The equivalence of the Child Behavior Checklist/11/2-5 across parent race/ethnicity, income level, and language

This study examined the equivalence of the Child Behavior Checklist/1 1/2-5 (CBCL/1 1/2-5) in 682 parents of 2- to 4-year-old children stratified by parent race/ethnicity (African American, Latino, and non-Latino White), family income (low vs. middle-upper), and language version (Spanish vs. English). Externalizing Scale means differed by income and child gender. Internalizing Scale means differed by income and parent race/ethnicity. Differential item analyses showed that few items functioned differently by racial/ethnic, language, and income group. A confirmatory factor analysis demonstrated that the Externalizing Scale provided a good fit with the data across racial/ethnic and income groups. However, model fit was improved for the Internalizing Scale when factor weights were allowed to vary. Findings support the equivalence of the CBCL/1 1/2-5 when used with parents of low-income preschool children from African American and Latino backgrounds, although further study of the factor structure for the Internalizing Scale is recommended.

Depression and Suicidal Ideation Among Mexican American School-Aged Children.

The purpose of this study was to describe depression and suicidal ideation rates in a community sample of 182 urban fourth and fifth grade Mexican American children using the Children’s Depression Inventory (CDI). We used a descriptive secondary data analysis design. The mean CDI score was 9.55 (SD = 5.8). Thirty-one percent fell in the depressed range using a clinical cut point of 12 and 7% fell into the depressed range using the non-clinical cut point of 19. Thirty-eight percent (n = 69) reported suicidal ideation. The depression rate was consistent with national rates. A non-clinical cut point of 19 showed that 87% of children reporting suicidal ideation were not identified as depressed. Many of these children do not report the most typical symptoms of depression. The results of this study provide school nurses with vital information to support efforts addressing the mental health needs of Mexican American children.

Regional Variations in Cancer Screening Rates Found in Women With Diabetes

Background: A review of the literature gives conflicting findings regarding gender-specific cancer screening rates found in women with chronic illness. Objectives: The purpose of this study was to determine if women with diabetes have different patterns of cancer screening than women of the general population, and if so, to identify the determinants of these screening patterns guided by the Predisposing, Reinforcing, and Enabling Constructs in Educational Diagnosis and Evaluation (PRECEDE) model. Methods: The 12 states using the optional womens health module for the 2003 Behavioral Risk Factor Surveillance System were downloaded into the STATA software. Contingency tables were used to identify the prevalence of cancer screening in women who self-report that they have diabetes in comparison with women who report being nondiabetic. Logistic regression was used to examine the association between the PRECEDE model determinants and the screening behaviors. Results: No significant association was found between having a diagnosis of diabetes and having mammography screening rates (F = 1.5, p =.22). However, cervical cancer screening rates were statistically significantly different between the two groups of women (F = 39.01, p <.01). A gap in cervical cancer screening rates was identified among women with diabetes as compared with women without diabetes (78% versus 86%, respectively). Regional exceptions were noted between the 12 states. Ten of the 11 PRECEDE variables demonstrated a significant association with Papanicolaou test screening rates. The states demonstrating inadequate screening rates were the states with the most negative PRECEDE factors. Discussion: Research has shown that the primary reason women seek cancer screening is when they are encouraged by a healthcare provider. If other care providers are focused on disease management, nurses who provide holistic care can build on the advocacy role inherent in nursing and encourage screening in underserved areas of the country.

Clinical Trail Outcomes of the Mexican American Problem Solving Program (MAPS)

Depression among Mexican immigrant women and children exceeds national prevalence rates. Given the influence of maternal depression on children, a clinical trial testing the effects of the Mexican American Problem Solving (MAPS) program was designed to address depression symptoms of Mexican immigrant women and their fourth and fifth grade children (302 dyads) through a linked home visiting and after school program compared to peers in a control group. Schools were randomized to intervention and control groups. There were statistically significant improvements in the childrens health conceptions and family problem solving communication, factors predictive of mental health. Improvements in childrens depression symptoms in the intervention group approached statistical significance. These promising results suggest that refined school based nursing interventions be included in community strategies to address the serious mental health problems that Mexican immigrants face.

Childhood Obesity Research Directions for School Health Researchers and School Nurses

Is there a school nurse in the world that is not aware of the childhood obesity epidemic in the United States and the growing concern globally? A review of The Journal of School Nursing since the February 2009 reveals eight articles concerning childhood obesity reporting perceptions about obesity, factors related to obesity or interventions addressing obesity in the United States or other countries. In this issue, there are four articles addressing obesity. Several articles published during the past 2 years, addressing diabetes or cardiovascular risk (CVR) are not included, because the focus was on diabetes or CVR, even though the obesity relationship was identified in the study.

Attention to fidelity: why is it important.

Clinical trials are epitomized by control of extraneous contextual and demographic variables. Participants in intervention and control or comparison groups are assessed for similarities and differences. The content, dose, and duration of interventions are prescribed explicitly. Interventionists are trained, supervised, evaluated, and in some cases retrained during the intervention to ensure adherence to the protocol. Outcome variables are assessed before and after the intervention, and those variables that could influence the results are controlled statistically. Implementing interventions found to be effective in research provides an empirical base for practice, yet control in practice is elusive. Fidelity is paramount in translating research to practice. Fidelity (sometimes called integrity; or delivery, treatment, intervention, or implementation fidelity) is defined as the degree to which an intervention or procedure is delivered as intended. One of the most important factors when implementing empirically supported interventions is that they are delivered with fidelity. In fact, lack of fidelity to an intervention model may underlie why interventions that work well in highly controlled research trials fail to produce the same outcomes in real-world settings. Therefore, monitoring and assuring fidelity is critical in replicating the beneficial results of an intervention in a variety of settings and populations. Therefore, developing a comprehensive fidelity plan is critical for dissemination and translation into practice. Fidelity is an important component of implementation science (Eccles & Mittman, 2006). Implementation science is ‘‘the scientific study of methods to promote the systematic uptake of research findings (and other EBPs) into routine practice, and, hence, to improve the quality and effectiveness of health services and care’’ (Eccles & Mittman, 2006, {2). In other words, implementation science is the study of how research and evidence-based practices (EBPs) are adopted and used in day-to-day practice with fidelity being key to achieving the positive effects in the adoption and implementation process.

Development and Evaluation of a Mexican Immigrant Family Support Program

A report to Congress in the fall of 1998 warned that immigrant children are in a state of emergency regarding access to health care. This article presents the three phases involved in developing, implementing, and evaluating a Mexican American Problem Solving (MAPS) program designed to promote the mental health of families. Methods were Phase 1 focus groups to identify concerns and desired approaches for intervention; Phase 2 instrument assessment and prevalence assessment of mental health; and Phase 3 intervention testing. In Phases 1 and 2, 67% of mothers and 59% of children had mental health scores that required referral for evaluation. Participating mothers and children reported positive views of the intervention and showed significant improvements in mental health scores.

Community/public health nursing practice leaders' views of the doctorate of nursing practice.

OBJECTIVES This paper presents thoughts of practice leaders in the community/public health nursing (C/PHN) specialty on advanced nursing practice (ANP) and the necessary educational preparation for such practice. DESIGN AND SAMPLE Practice leaders were engaged in conversations specifically focused on the Doctor of Nursing Practice (DNP) as preparation for ANP in their specialties, and asked to consider the benefits of, and challenges to, this educational program. MEASURES AND RESULTS The resulting remarks were then assessed for themes by the interviewers and these are presented along with thoughts on the future of education for ANP. CONCLUSION Overall, there was much agreement among the practice leaders interviewed about the importance of a broad skill set for ANP in the specialty. However, the practice leaders interviewed here also identified the practical challenges involved in educating nurses at the DNP level in the C/PHN specialty, as well as some concerns about the definitions of ANP for the future.

Interprofessional practice and school nursing.

As we approach the implementation of the Affordable Care Act (ACA) in 2014, the focus is turning to interprofessional practice. Interprofessional practice happens when health workers across the professions work together to deliver high-quality care (World Health Organization, 2010). The collaboration includes patients or clients, families, and communities. School nurses have experience in interprofessional practice by virtue of their work on the special education staffing teams, case management, and health education programs. But looking at the ACA’s movement for increased practice across professions, we should sharpen our collaboration skills for the future. In today’s world, it is important to identify the competencies associated with interprofessional practice. An interprofessional education and collaborative practice Expert Panel was convened with representatives from the American Association of Colleges of Nursing (AACN), American Association of Colleges of Osteopathic Medicine (AACOM), American Association of Colleges of Pharmacy (AACP), American Dental Education Association (ADEA), the Association of American Medical Colleges (AAMC), and the Association of Schools of Public Health (ASPH). The Expert Panel identified and described four specific competency domains (Interprofessional Education Collaborative Expert panel, 2011):

Analysis of two measures of child behavior problems by African American, Latino, and non-Hispanic Caucasian parents of young children: a focus group study.

This study examined how parents from different racial/ethnic, income, and language groups viewed two widely used parent-report measures of child behavior problems, the Child Behavior Checklist and the Eyberg Child Behavior Inventory. Seventy African American, Latino, and non-Latino Caucasian parents of preschoolers stratified by income met in 1 of 15 focus groups to discuss their perceptions of the instruments. Participants agreed that items on these instruments were relevant indicators of child behavior problems. Overall, parents found the items on both instruments useful, comprehensible, and acceptable. The findings support the use of these instruments in pediatric practice with ethnically diverse parents of young children.