Scot W. McNary

Delaying second births among adolescent mothers: a randomized, controlled trial of a home-based mentoring program.

CONTEXT. Rates of rapid second births among low-income black adolescent mothers range from 20% to 50%. Most efforts to prevent rapid second births have been unsuccessful. OBJECTIVES. There were 4 objectives: (1) to examine whether a home-based mentoring intervention was effective in preventing second births within 2 years of the adolescent mothers first delivery; (2) to examine whether greater intervention participation increased the likelihood of preventing a second birth; (3) to examine whether second births were better predicted from a risk practice perspective or a family formation perspective, based on information collected at delivery; and (4) to examine how risk practices or family formation over the first 2 years of parenthood were related to a second birth. DESIGN. We conducted a randomized, controlled trial of a home-based intervention curriculum, based on social cognitive theory, and focused on interpersonal negotiation skills, adolescent development, and parenting. The curriculum was delivered biweekly until the infants first birthday by college-educated, black, single mothers who served as mentors, presenting themselves as “big sisters.” The control group received usual care. Follow-up evaluations were conducted in the homes 6, 13, and 24 months after recruitment. METHODS. Participants were recruited from urban hospitals at delivery and were 181 first time, black adolescent mothers (<18 years of age); 82% (149 of 181) completed the 24-month evaluation. RESULTS. Intent-to-treat analyses revealed that control mothers were more likely than intervention mothers to have a second infant. The complier average causal effect was used to account for variability in intervention participation. Having ≥2 intervention visits increased the odds of not having a second infant more than threefold. Only 1 mother who completed ≥6 visits had a second infant. At delivery of their first infant, mothers who had a second infant were slightly older (16.7 vs 16.2 years) and were more likely to have been arrested (30% vs 14%). There were no differences in baseline contraceptive use or other measures of risk or family formation. At 24 months, mothers who had a second infant reported high self-esteem, positive life events, and romantic involvement and residence with the first infants father. At 24 months, there were no differences in marital rates (2%), risk practices, or contraceptive use between mothers who did and did not have a second infant. Mothers who did not have a second infant were marginally more likely to report no plans for contraception in their next sexual contact compared with mothers who had a second infant (22% vs 8%, respectively). CONCLUSIONS. A home-based intervention founded on a mentorship model and targeted toward adolescent development, including negotiation skills, was effective in preventing rapid repeat births among low-income, black adolescent mothers. The effectiveness of the intervention could be seen after only 2 visits and increased over time. There were no second births among mothers who attended ≥8 sessions. There was no evidence that risk behavior or contraceptive use was related to rapid second births. There was some evidence that rapid second births among adolescent mothers were regarded as desirable and as part of a move toward increasing autonomy and family formation, thereby undermining intervention programs that focus on risk avoidance. Findings suggest the merits of a mentoring program for low-income, black adolescent mothers, based on a relatively brief (6–8 sessions) curriculum targeted toward adolescent development and interpersonal negotiation skills.

A Social Support Intervention to Ease the College Transition: Exploring Main Effects and Moderators

This study examined effects of a peer-led social support group intervention on college adjustment. Ninety first-year students, randomly assigned to participate in the intervention, reported higher levels of perceived social support and reduced loneliness when compared to controls (n = 94), after accounting for preintervention levels on these variables. Effects were not moderated by precollege adjustment concerns or gender. Results of this study suggest that a cost-effective peer-led intervention program can positively affect students’ social adjustment to university at a large, 4-year institution.

A review of dissociative disorders treatment studies.

This review examines empirical reports of treatment for Dissociative Disorders (DD), including 16 DD treatment outcome studies and 4 case studies that used standardized measures. Collectively, these reports suggest that treatment for DD is associated with decreased symptoms of dissociation, depression, posttraumatic stress disorder, distress, and suicidality. Effect sizes, based on pre/post measures, are in the medium to large range across studies. Patients with dissociative disorder who integrated their dissociated self states were found to have reduced symptomatology compared with those who did not integrate. The magnitude of pre/post effect sizes for these DD studies are comparable to pre/post effect sizes in treatment studies of complex PTSD. There are significant methodological limitations in the current DD treatment outcome literature that reduce internal and external validity including regression towards the mean, limited sample sizes, and nonrandomized research designs. Implications for future research and treatment planning for patients suffering from DD are discussed.

Stability of maternal depressive symptoms among urban, low-income, African American adolescent mothers

BACKGROUND Maternal depressive symptomatology is an important public health issue with negative consequences for both mothers and infants. METHODS This study examined prevalence and patterns of depressive symptoms among 181 urban, low-income, first-time, African American adolescent mothers recruited from urban hospitals following delivery. Follow-up evaluations were conducted at 6 (N=148; 82%) and 24 (N=147; 81%) month home visits. Depressive symptoms were measured with Beck Depression Inventory (BDI). RESULTS Half of mothers (49%) had BDI scores >9 at baseline, with significant correlations between BDI scores across all visits (r=0.28-0.50). Depressive symptom trajectories analyzed using group-based trajectory modeling revealed three trajectories of depressive symptoms: Low (41%), Medium (45%), and High (14%). The high depressive symptom group reported lower self-esteem, more negative life events, and lower parenting satisfaction than the low and moderate depressive symptoms groups. LIMITATIONS Depressive symptoms were self-reported and not verified with a clinical interview. Findings are limited to urban, low-income, African American adolescent mothers and may not be generalizable to other populations. CONCLUSIONS The high prevalence and relative stability of depressive symptoms through 2years of parenting suggest the need for early identification and treatment of maternal depressive symptoms. Brief screening for maternal depressive symptoms conducted during pediatric well-child visits is a feasible and effective method for identifying mothers with depressive symptoms, however, screening measures can not differentiate between high and low levels of depressive symptoms. Brief intervention may be an effective treatment for mothers with mild symptoms of depression; mothers with moderate to severe symptoms may require more intensive intervention.

An Exploration of Young Adults' Progress in Treatment for Dissociative Disorder

Although treatment outcome research on dissociative disorders (DD) is increasing, an examination of treatment progress in young adults with these disorders remains noticeably absent from the literature. Many studies of DD patients report mean ages over 35. The present study examined the response to treatment of a subsample of young adults ages 18–30 with dissociative identity disorder and dissociative disorder not otherwise specified who participated in a naturalistic, longitudinal study of DD treatment outcome. Over 30 months, these patients demonstrated decreases in destructive behaviors and symptomatology as well as improved adaptive capacities. Compared to the older adult participants in the study, the young adults were more impaired initially. However, these younger patients improved at a rapid pace, such that their clinical presentations were similar to or more improved than those of the older adults at the 30-month follow-up. This brief report suggests not only that young adult DD patients can benefit from a trauma-focused, phasic treatment approach but that their treatment may progress at a faster pace than that of older adults with DD.

Developing as Teacher Educator-Researchers

This self-study explores the role of collaboration in the development of three new faculty members as teacher educator-researchers. The research finds that protocol-structured dialogue about artifacts of classroom practice promotes understanding of the complex relationships among teachers, student, content, and context. We also report on the manner in which examination of instructional practices led us to important epistemological shifts in our beliefs about the nature of teaching and learning. The article concludes by presenting a five-step dialogical model for self-study that supports the development of sustainable collaboration.

An Exploration of Professional Knowledge Needed for Reading and Responding to Student Writing

This study explored the knowledge elementary teachers need for one core practice: reading and responding to students’ writing. Forty-five preservice teachers read and responded to an elementary student’s narrative writing sample. Using teacher noticing as a framework, we first decomposed the practice into five components indicative of differences in teachers’ attention to writing features, reasoning about those features, and suggested responses. We used multiple correspondence analyses to investigate potential underlying relationships among components and developed cases to highlight one underlying relationship that was found. The findings indicate reading and responding draws upon teachers’ pedagogical content knowledge. More specifically, it draws on both knowledge of content and students and knowledge of content and teaching.