Sherri MacKay

Closing the Research-Practice Gap: Factors Affecting Adoption and Implementation of a Children's Mental Health Program

Despite the availability of effective interventions, they are not widely used in community mental health centers. This study examined the adoption and implementation of The Arson Prevention Program for Children (TAPP-C), a program for juvenile firesetters developed at a teaching hospital and disseminated to community settings. Questionnaire data from mental health professionals were used to evaluate the roles of adopter, innovation, and dissemination characteristics in TAPP-C adoption and implementation. Results indicate that different factors are important at different diffusion stages. Moreover, they suggest that innovation characteristics may be particularly important to adoption, whereas adopter and dissemination characteristics may be more influential in implementation.

The link between maltreatment and juvenile firesetting: Correlates and underlying mechanisms☆

OBJECTIVE Despite the widely held belief that abuse is a risk factor for childhood firesetting, the role of maltreatment in firesetting is largely unexplored. This study reports on a sample of children and adolescents referred to a brief assessment and intervention program for juvenile firesetters. Firesetting histories of maltreated youth were compared to a group of firesetting youth with no maltreatment history. METHODS Participants included 205 children and youth aged 4-17 years and their caregivers. Assessments were completed with a standardized protocol. Forty-eight percent of the sample had a history of maltreatment as reported by caregivers; 26% of the sample had experienced more than one type of maltreatment. RESULTS When compared to the non-maltreated group, children with histories of maltreatment demonstrated more frequent fire involvement, more versatility regarding ignition sources and targets, and a greater likelihood of an immediate family stressor as a motive for firesetting (all p<.05). Maltreated children were more likely to become involved with fire out of anger (p=.001), and there was also a trend towards higher rates of recidivism (p=.07). Childrens externalizing behavior partially mediated the influence of maltreatment on specific fire-related outcomes of children (OR=1.10; 95% CI=1.04-1.17; p=.001). CONCLUSIONS Within a juvenile firesetting population, the presence of maltreatment is a risk factor for a more severe course of firesetting. The findings also suggest that the link between maltreatment and firesetting is operating partially through heightened emotional and behavioral difficulties. PRACTICE IMPLICATIONS This study demonstrates that maltreatment is a risk factor that contributes to a more severe course of juvenile fire involvement, and that the link between maltreatment and firesetting operates largely through heightened behavioral and emotional difficulties. These findings highlight the need for mental health clinicians to (a) be aware that these two serious clinical issues frequently co-occur, (b) screen for fire-related behaviors and maltreatment during general assessments, and (c) consider maltreatment status when thinking about the risk of firesetting.

Epidemiology of firesetting in adolescents: mental health and substance use correlates

OBJECTIVE Despite high rates of firesetting among community adolescents, little is known about its correlates. This study identifies the mental health and substance use correlates of four firesetting levels in an epidemiological sample of adolescents. METHODS Three thousand, nine hundred and sixty-five (3,965) students in grades 7 to 12 were surveyed. Multinomial analyses were used to compare non-firesetters; desisters (lifetime, but no past-year firesetting); low frequency firesetters (once or twice in the past 12 months); and high frequency firesetters (3 + times) on measures of mental health and substance use. RESULTS Twenty-seven percent of youth reported firesetting during the past year. Of these, 13.7% reported one or two episodes, and 13.5% reported 3 or more episodes. Firesetting was more prevalent among males and among those in high school. Youth who began firesetting before age 10 were more likely to report frequent firesetting during the past year. Compared to non-firesetters, the firesetting groups had elevated risk profiles. Desisters and low frequency firesetters were more likely to report psychological distress, binge drinking, frequent cannabis use, and sensation seeking. Low frequency firesetters also reported higher rates of delinquent behavior, suicidal intent, and low parental monitoring than non-firesetters. High frequency firesetters reported elevated risk ratios for all of these risk indicators plus other illicit drug use. The cumulative number of risk indicators was positively associated with firesetting severity. CONCLUSIONS Firesetting is associated with psychopathology and substance use during adolescence. Findings highlight the need for programs to address the mental health and substance use problems that co-occur with firesetting.

Adolescent Standardized Patients: Method of Selection and Assessment of Benefits and Risks

Background: Our psychiatric Objective Structured Clinical Examination (OSCE) group wishes to develop adolescent psychiatry OSCE stations. The literature regarding adolescent standardized patient (SP) selection methods and simulation effects, however, offered limited assurance that such adolescents would not experience adverse simulation effects. Purpose: Evaluation of adolescent SP selection methods and simulation effects for low- and high-stress roles. Method: A two-component (employment-psychological) SP selection method was used. Carefully selected SPs were assigned across three conditions: low-stress medical role, high-stress psychosocial role, and wait list control. Qualitative and quantitative measures were used to assess simulation effects. Results: Our selection method excluded 21% (7% employment and 14% psychological) of SP applicants. For SP participants, beneficial effects included acquisition of job skills and satisfaction in making an important contribution to society. SP reactions of discomfort to roles were reported. Long-term adverse effects were not identified. Conclusions: A two-component adolescent SP selection method is recommended. Adolescent SP benefits outweigh risks.

Firesetting during the preschool period: assessment and intervention issues

Objective To describe a methodology of assessing preschoolers involved in firesetting incidents, and outline the psychiatric implications of firesetting incidents in young children. Method To outline The Arson Prevention Program for Children and present case vignettes. Results The heightened risk of burn injury or fatality in fires caused by young children is highlighted and practical suggestions for facilitating the immediate safety of the child and family are presented. Conclusion Despite the popular notion that fire interest and play is relatively benign in young children, the cases show that, as with older children, firesetting in preschoolers can be associated with serious child and/or family psychopathology.

Interdisciplinary Knowledge Translation: Lessons Learned from a Mental Health: Fire Service Collaboration

Collaborative approaches are being increasingly advocated for addressing a variety of health, mental health and social needs for children, youth and families. Factors important for effective knowledge translation of collaborative approaches of service delivery across disciplines, however, have not been rigorously examined. TAPP-C: The Arson Prevention Program for Children is an intervention program for child and adolescent firesetters provided collaboratively by fire service and mental health professionals. The present study examined the adopter, innovation, and dissemination characteristics associated with TAPP-C implementation, protocol adherence and extent of collaboration by 241 community-based fire service professionals from communities across Ontario. Results revealed that dissemination factors are particularly important for understanding program implementation, adherence and cross-discipline collaboration. Moreover, the findings of this study show significant benefits to both within discipline (intra-disciplinary) and across discipline (interdisciplinary) knowledge translation strategies.

Implications of suicide contagion for the selection of adolescent standardized patients

Standardized patients (SPs) are recognized as an important educational resource in the health care professions. As the use of SPs expands, both age groups and types of simulations represented also expand. Adolescent SPs are now utilized with greater frequency. A literature regarding the many benefits and limited risks associated with adolescent SP work supports this increased activity. While the use of adolescents enhances the range of possible scenarios, certain case simulations may present greater risk for adolescents than others, necessitating research into the specific risks and benefits associated with these simulations. Suicidality case simulations represent one such category of simulation. Although adolescent SPs have been employed in simulations of suicidality, assessment of risks and benefits has not been undertaken. Our psychiatric OSCE group has recommended caution regarding the use of adolescent SPs in psychiatric case simulations until research evaluates such risks. One hypothetical risk associated with adolescent SPs performing suicidality simulations is suicide contagion. Suicide contagion refers to the link between adolescents’ exposure to a ‘‘suicide’’ stimulus and subsequent rise in suicide attempts or suicide rate. Contagion is considered most likely to occur in already suicidal adolescents and to be a time-limited risk, lasting two weeks. Suicide stimuli include media coverage of a real suicide or fictional depictions of suicide in movies or television programming. Although the risk of suicide contagion has not been raised in the SP literature, it has been raised in the child psychiatric literature pertaining to school-based adolescent suicide prevention programs. School professionals have been cautioned regarding the delivery of these programs to unscreened adolescents because of the phenomenon of suicide contagion and the negative reaction of adolescents with suicidal histories to such programs. School-based adolescent suicide prevention programs commonly employ videos, interviews with suicide attempters, plus information regarding adolescent suicide, psychopathology, and development. These programs’ curricular resemblance to SP training methods further emphasizes the need for investigation of the possibility that suicide contagion may be a risk associated with suicidality simulations. The implications of suicide contagion for SP programs that use adolescent suicidality simulations warrants investigation. This study investigated suicidality backgrounds among SP applicants who were considered at hypothetical risk of suicide contagion.

Exposure to Fire Setting Behavior on YouTube

PURPOSE This study is a preliminary examination of fire setting behaviors on YouTube. METHODS Data are based on a 1 day search of YouTube. RESULTS Results indicate YouTube is replete with inappropriate models of fire setting. CONCLUSION The findings have potential implications for intervention with fire setting youth.