Week 12: Prevention of youth psychopathology Flashcards
Prevention
Can we stop children’s mental health problems before they start?
Identify risk factors and target those
Child maltreatment
Identify high risk populations and intervene before problems begin
Youth whose parents have experienced depression (more prone to depression)
Preventing Child Maltreatment
Risk factor for many types of disorders
Conduct problems
Depression
Eating disorders
Can we reduce incidence of child abuse?
Nurse-Family Partnership Program
NFP; David Olds
Support for mothers “at risk” Low income Single Young (under age 19) Treatment model Structured home visits Education and social support (like do not smoke) High intensity during pregnancy High intensity immediately post-pregnancy (6 weeks) Lower intensity through age 2 ½
NFP Target Outcomes
Pregnancy Smoking and substance use Premature births Caregiving Abuse Neglect (e.g., accidents) Maternal “life course” Education and employment Number and spacing of additional births Long-term youth behavio
NFP Elmira Study
Participants
400 pregnant women
62% not married
47% younger than 19 years
61% lower income
89% non-Hispanic White (reflects upstate NY)
Design
Random assignment
“Usual services” (e.g., development screening)
NFP
Two groups
One received home visits during pregnancy only and the second
received visits both during and after pregnancy
NFP Elmira Outcomes
◼ Pregnancy outcomes – 25% less smoking – Fewer infections – Fewer pre-term deliveries ◼ Dysfunctional caregiving – 27% fewer ER visits – 56% fewer accidents – 80% less abuse (verified) – Effects strongest for women with least resources
Less times:
Running away, stopped by police, convictions and probation violations
NFP Outcomes
Significant effects on pregnancy outcomes, parental behavior
In general, saw effects for the group that was visited only during pregnancy that were between the control group and the group that
was also visited during infancy
Also saw effects on children’s behavior 15 years later
Saw benefits for both treatment groups
Intervening to Stop Child
Maltreatment
In Olds’ program, women are visited during pregnancy
Can a similar program when children are older stop child abuse?
MacMillan et al. 2005 designed a nurse-home visitation program targeting stopping recurrence of child abuse
This means it was given to families which were already known to be maltreating kids
MacMillan et al. 2005
Families randomly assigned to the treatment group or the control group
Control group:
Standard services provided by child protection agency
E.g., Follow up by social workers, education
Treatment group
Standard services
Home visits (1.5 hours) by a public-health nurse every week for six months,
then every two weeks for six months, and then monthly for twelve months
Nurse visits focused on family support, parent education, and helping
families get services needed (e.g., special education, employment services)
Goal was to reduce stressors and increase support
Primary outcome was reports of child abuse/neglect made to CPA
Research assistants went through CPA records and identified cases
of abuse or neglect
MacMillan et al. 2005
Results
Found that the intervention had no effect
No differences between intervention and control group
Were not seeing lower rates of recurrence in the intervention group
Incidences in the intervention group were as severe as incidences in the
control group
Findings suggest that once a family is involved with Child Protective
Services it may be hard to help
Importance of intervening before the problem starts
Prevention
Can we stop children’s mental health problems before they start?
Identify risk factors and target those
Child maltreatment
Identify high risk populations and intervene before problems begin
Youth whose parents have experienced depression
Parental Psychopathology
Parental psychopathology associated with a number of problematic outcomes in childhood Disorders often “run in families” Genetics Environment
Parental Depression
Primary prevention (i.e., targeting children in general) has not been
very effective - like just going to an elementary school does nto work
Programs targeting high-risk samples
Children of parents with depression are at higher risk for developing
a depressive disorder
SO FOCUS ON THESE KIDS
Group CBT
Coping with Stress course
15, 45 minute group sessions
Taught cognitive techniques - just like 1-1 CBT
E.g., identifying and challenging negative thoughts
Reduce negative thoughts before sub-clinical symptoms become
more significant
Can we:
Reduce symptoms?
Prevent depressive episodes?
Clark et al. 2001
Initial recruitment letters sent
by physicians to parents
with depression and
teenage children (N = 3374)
Youth categorized as subsyndromal and agreed to randomization (N = 94) (i,e, not yet had MDD episode, we are trying to stop it) Group CBT (N = 45) Usual Care (N = 49)
RESULTS
Youth in experimental group less likely to experience a depressive episode than youth in control group
At 16 months, 90% of youth in experimental group remained nondepressed, compared with 70% in control group
