Patricia A. Brandt

The prq, a social support measure

The Personal Resource Questionnaire (PRQ) is a two-part measure of the multidimensional characteristics of social support. Part one provides descriptive information about the persons resources, the satisfaction with these resources, and whether or not there is a confidant. Part two contains a 25-item Likert scale developed according to Weisss relational dimensions and a five-item Self-Help Ideology scale. The PRQ was administered as the measure of one of the independent variables in a study of 149 male or female spouses of individuals with multiple sclerosis. Content and face validity procedures were completed previous to the study. An internal consistency reliability coefficient of α = .89 was obtained for the PRQ Part 2. Moderate intercorrelations for the dimensional subscales—intimacy, social integration, worth, and assistance—indicate that there is some overlap of these dimensions. Low intercorrelations between nurturance and the other four subscales suggest that nurturance is an independent scale. Modest predictive validity coefficients were obtained. At the present time the intended use of the PRQ is for research. Plans for tool development include obtaining further construct validity information and test-retest reliability.

Making the most of the moment: when a child's mother has breast cancer.

The demands and uncertainties associated with adjustments to chronic illness present challenges to maintaining a stable family life. Little has been reported about mother–child relationships within the cancer experience and even less about interventions that may be useful to help these dyads maintain stability. The focus of this article is a pilot study of an intervention addressing the mother–child relationship of women with breast cancer and their school-aged children. A part of the data collection comprised interviews of mothers and fathers to assess their perceptions of the influence of the intervention on the quality of the mother–child relationships after the program. Using inductive content analysis, the fathers’ and mothers’ data were organized into categories, domains, and an explanatory construct, called making the most of the moment. The processes by which the intervention affected the mother–child relationships and implications for professionals who work with families are reported.

Stress-buffering effects of social support on maternal discipline

The purpose of this study was to investigate whether social support and stress influence maternal discipline of the six-month to three-year-old child with a developmental delay. Ninety-one mothers completed self-administered measures of support, stress, and discipline. Results of multiple regression analyses revealed that the stress and support interaction variable showed a strong trend (p less than .09) in predicting restrictive discipline. The failure of the independent variables, social support and stress, to have significant main effects appeared to be due, in part, to the multicollinearity (r = -.51, p less than .001) of these variables. For subsequent analyses, stress was used as a categorization variable. The total number of subjects was categorized first into two subgroups using a median split--high or low maternal stress--and into two other subgroups based on number of developmental delays. Pearson correlations indicated that social support was inversely related to restrictive discipline for high-stress mothers, but not for low-stress mothers. The positive influence of social support was also found for mothers of children with three to five delays but not for mothers of children with one to two delays. A negative response style of maternal discipline was reduced when the mother felt supported.

Telephone Interviewing: A Method to Reach Fathers in Family Research:

Collecting data from fathers has been an ongoing problem for researchers interested in developing a comprehensive view of the mother-child relationship from data-producing samples of families. The sampling design for a recent pilot of an intervention addressing the mother-child relationship included multiple data sources. One component required obtaining data from fathers of school-age children whose mothers were in the treatment phase for early-stage breast cancer. It was anticipated that information provided by fathers would be a valuable addition for describing the quality of the mother-child relationship and providing an important adjunct to understanding how the mother’s cancer experiences influenced her relationship with her child. Telephone interviewing was selected as the method for collecting data from the fathers. Limitations and strengths of this method are discussed along with utilization of the method. Telephone interviewing of the fathers was subsequently incorporated into a full clinical trial of the intervention.

The Enhancing Connections Program: a six-state randomized clinical trial of a cancer parenting program.

OBJECTIVE The purpose of this study was to test the efficacy of a cancer parenting program for child rearing mothers with breast cancer, the Enhancing Connections Program. Primary goals were to decrease maternal depressed mood and anxiety, improve parenting quality, parenting skills and confidence, and enhance the childs behavioral-emotional adjustment to maternal breast cancer. METHOD A total of 176 mothers diagnosed within 6 months with Stage 0 to Stage III breast cancer and their 8- to 12-year-old child were recruited from medical providers in 6 states: Washington, California, Pennsylvania, Minnesota, Arizona, and Indiana. After consenting and obtaining baseline measures, study participants were randomized into experimental or control groups. Experimental mothers received 5, 1-hr educational counseling sessions at 2-week intervals; controls received a booklet and phone call on communicating and supporting their child about the mothers cancer. Outcomes were assessed at 2 and 12 months. RESULTS Compared to controls, at 2 months experimental mothers significantly improved on depressed mood and parenting skills; experimental children improved on behavioral-emotional adjustment: total behavior problems, externalizing problems, and anxiety/depressed mood significantly declined. At 1 year, experimental children remained significantly less depressed than controls on both mother- and child-reported measures. The intervention failed to significantly affect parenting self-efficacy or maternal anxiety. CONCLUSIONS The Enhancing Connections Program benefitted mothers and children in specific areas and warrants refinement and further testing.

A DECISION TREE AND CLINICAL PATHS FOR THE ASSESSMENT AND MANAGEMENT OF CHILDREN WITH ADHD

Attention Deficit/Hyperactivity Disorder (ADHD) is a common neurobehavioral disorder. Children with ADHD are disproportionately represented in pediatric populations characterized by school failure, criminal behavior, and substance abuse. Many children who present with ADHD symptomatology do not receive systematic assessments nor comprehensive treatment that is well coordinated across home and school environments. And yet, evidence suggests that early detection and appropriate treatment can alter the probability of a negative developmental trajectory. The Decision Tree and Clinical Paths for Assessment and Management of ADHD identify the critical components of care through a stepwise decision-making process involving the assessment, diagnosis, treatment, and outcome evaluation of children who present with ADHD symptomatology. Preliminary field testing supports the clinical utility and validity of the ADHD Decision Tree/Paths. In addition, cross-validation comparisons indicate consistency between the ADHD Decision Tree/Paths and recently released ADHD clinical guidelines issued by several national professional organizations.

Helping parents with preterm infants: Field test of a protocol

1 Supported by Maternal and Child Health Training, Grant No. MCH‐009035, Bureau of Health Care and Delivery Assistance, Health Resources and Service Administration, Public Health Service, Department of Health and Human Services.

Strengthening PNP Curricula in Mental/Behavioral Health and Evidence-based Practice

INTRODUCTION The incidence of mental health/behavioral and developmental problems in children and teens is escalating. However, many primary care providers report inadequate skills to accurately screen, identify, and manage these problems using an evidence-based approach to care. Additionally, educational programs that prepare pediatric nurse practitioners (PNPs) have been slow to incorporate this content into their curriculums. METHODS The purpose of this project was to implement and evaluate a strengthened curriculum in 20 PNP programs from across the United States that focused on: (a) health promotion strategies for optimal mental/behavioral health and developmental outcomes in children, and (b) screening and evidence-based interventions for these problems. An outcomes evaluation was conducted with faculty and graduating students from the participating programs along with faculty and students from 13 PNP programs who did not participate in the project. RESULTS Participating schools varied in the speed at which components of the strengthened curriculum were incorporated into their programs. Over the course of the project, faculty from participating programs increased their own knowledge in the targeted areas and reported that their students were better prepared to assess and manage these problems using an evidence-based approach. Although reports of screening for certain problems were higher in the graduating students from the participating schools than the non-participating schools, the overall use of screening tools by students in clinical practice was low. DISCUSSION There is a need for educational programs to strengthen their curricula and clinical experiences to prepare students to screen for, accurately identify, prevent, and provide early evidence-based interventions for children and teens with mental health/behavioral and developmental problems. This project can serve as a national model for curriculum change.

Assessing the strength and integrity of an intervention.

PURPOSE/OBJECTIVES To evaluate the strength and integrity of a pilot behavioral intervention designed to assist mothers with breast cancer and their children. RESEARCH APPROACH A single-group analysis of the strength and integrity characteristics of an intervention developed for a pilot research study. SETTING Homes of study participants in an urban area. PARTICIPANTS Seven households with a mother and father and one household with a single mother. METHODOLOGIC APPROACH Observer-reported checklists, audiorecorded intervention session data, and structured interview data obtained from study participants. MAIN RESEARCH VARIABLES Strength of the intervention included dimensions such as the theoretical foundation, competence of the interventionist, and specificity to the breast cancer experience in the family. Intervention integrity consisted of adherence by the interventionist and participants to the intervention plan. FINDINGS The strength of the intervention was determined to be an asset. Careful planning had included a framework, a defined set of scripted sessions, a competent interventionist, and content specific to the breast cancer experience. In regard to integrity, the protocol content was delivered as scripted. Improvements in the dosage and purity dimensions were found to be needed. Homework assignments and in-session skill-building approaches with the mothers were refined. CONCLUSIONS An intervention can be examined carefully for strength and integrity with established criteria to determine improvements needed. INTERPRETATION A clinical research protocol can be improved through an assessment of an interventions strength and integrity.

Preparing psychosocial nurse practitioners for health care delivery

A central task for faculty in programs preparing health care practitioners is to remain timely in educating for the prevailing and future social and health services context. Current considerations in preparing advanced practice psychiatric nurses include the need for greater recognition of comorbidity, concerns about health care access and utilization for vulnerable populations, and changing patterns of practice. In addition, there is a great need to expand the cultural competence and diversity of the population of advanced practice nurses who deliver care to recipients in an increasingly multicultural society. This article describes the educational program developed at the University of Washington to prepare expanded role Psychosocial Nurse Practitioners and sets forth the rationale for major decisions and current directions.