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The study of moderation and mediation of youth treatment outcomes has been recognized as enormously beneficial in recent years. However, these benefits have never been fully documented or understood by researchers, clinicians, and students in training. After nearly 50 years of youth treatment outcome research, identifying moderators and mediators is the natural next step-shifting focus to mechanisms responsible for improved outcomes, identifying youth who will benefit from certain treatments or who are in need of alternative treatments, and recognizing the challenges associated with the study of moderators and mediators and their routine use in clinical practice. Moderators and Mediators of Youth Treatment Outcomes examines conceptual and methodological challenges related to the study of moderation and mediation and illustrates potential treatment moderators and mediators for specific disorders. The volume also considers empirical evidence for treatment moderators and mediators of specific disorders and illustrates how theoretical and empirical knowledge regarding moderators and mediators can be harnessed and disseminated to clinical practice. This book will be invaluable to researchers conducting treatment outcome studies (both efficacy and effectiveness), clinicians interested in evidence-based work and in understanding for whom and why certain treatments work, and students of clinical child and adolescent psychology and psychiatry.
Social isolation and loneliness are serious yet underappreciated public health risks that affect a significant portion of the older adult population. Approximately one-quarter of community-dwelling Americans aged 65 and older are considered to be socially isolated, and a significant proportion of adults in the United States report feeling lonely. People who are 50 years of age or older are more likely to experience many of the risk factors that can cause or exacerbate social isolation or loneliness, such as living alone, the loss of family or friends, chronic illness, and sensory impairments. Over a life course, social isolation and loneliness may be episodic or chronic, depending upon an individual's circumstances and perceptions. A substantial body of evidence demonstrates that social isolation presents a major risk for premature mortality, comparable to other risk factors such as high blood pressure, smoking, or obesity. As older adults are particularly high-volume and high-frequency users of the health care system, there is an opportunity for health care professionals to identify, prevent, and mitigate the adverse health impacts of social isolation and loneliness in older adults. Social Isolation and Loneliness in Older Adults summarizes the evidence base and explores how social isolation and loneliness affect health and quality of life in adults aged 50 and older, particularly among low income, underserved, and vulnerable populations. This report makes recommendations specifically for clinical settings of health care to identify those who suffer the resultant negative health impacts of social isolation and loneliness and target interventions to improve their social conditions. Social Isolation and Loneliness in Older Adults considers clinical tools and methodologies, better education and training for the health care workforce, and dissemination and implementation that will be important for translating research into practice, especially as the evidence base for effective interventions continues to flourish.
Objective: Test changes in (a) perceived coping efficacy, (b) negative self-statements, and (c) interpretive biases to threat as potential mediators of the relationship between treatment condition and long-term follow-up (average of 6.5 years after intervention). Test moderating effect of age at time of randomization on mediational effect for the 3 putative mediators. Method: Participants included 301 youth who had participated in the Child/Adolescent Multimodal Study (CAMS) and agreed to participate in a naturalistic follow-up study beginning an average of 6.5 years after the end of the acute treatment phase. In the intervention phase, participants (ages 7 to 17) were randomized to cognitive behavioral therapy (CBT), pharmacotherapy (sertraline), combined CBT and sertraline, or pill placebo. Putative mediators were measured at 4 time-points over the course of the intervention phase. The follow-up study consisted of five annual assessment visits that included ratings of current anxiety based on an interview by an independent evaluator who was blind to the randomization of participants. Results: Reductions on a measure of interpretive biases to threat over the course of the combined intervention condition mediated anxiety outcomes at the first follow-up visit. No other significant mediated effects were found for any of the putative mediators. Age did not significantly moderate any mediated effects. Conclusions: The findings suggest that interpretive biases to threat, an often elevated characteristic of anxious youth, may be important to address as part of the treatment of anxiety in order to maintain reductions in anxiety in the years following treatment. The specificity of this finding to the combined CBT and sertraline condition offers support for the synergistic effect of CBT and sertraline when implemented in tandem to reduce anxiety-related cognitive factors with long-term implications.
For 25 years, Lewis's Child and Adolescent Psychiatry has been the cornerstone of every child and adolescent psychiatrist’s library. Now, three colleagues of Dr. Lewis at the world-renowned Yale Child Study Center, have substantially updated and revised this foundational textbook for its long-awaited fifth edition, the first in ten years. Encyclopedic in scope, it continues to serve as a broad reference, deftly encompassing and integrating scientific principles, research methodologies, and everyday clinical care.
The current studies examine moderators and mediators of outcomes in Multisystemic Therapy (MST), an intensive, home- and family-based treatment for serious juvenile offenders that has received considerable empirical support. Two large samples of youth (N = 176 in Study 1 which included random assignment to treatment condition; N = 447 in Study 2) adjudicated for serious criminal offenses were examined. Child and family demographic characteristics, child verbal ability, and family adversity variables were examined as potential moderators of numerous instrumental (i.e., theory-driven, such as improved family relations) and ultimate (i.e., pertinent to all treatments for antisocial behavior, such as lower posttreatment arrest rates) MST outcomes. Over a posttreatment follow-up period of over 10 years, MST participants evidenced 50% fewer arrests, 33% fewer days on probation as adults, and 60% fewer days confined as adults than a comparison group of youth receiving individual therapy (in Study 1) or usual juvenile office services (in Study 2). Few variables were found to moderate the effectiveness of MST. Relative to youths from two-parent families, MST participants from single-parent families showed less improvement on instrumental, but not ultimate, outcomes. Improvements in peer relations and school performance did not mediate the relation between improvements in family functioning and ultimate outcomes, but improved family functioning directly predicted less criminal recidivism for the MST group. Family engagement in MST was found to mediate the relation between high family adversity and drop-out from MST. Implications of these results for the continued refinement and dissemination of MST are discussed.
Guest edited by Drs. Marjorie Eskay-Auerbach and Robert Rondinelli, this issue of Physical Medicine and Rehabilitation Clinics will discuss Medical Impairment and Disability Evaluation and Associated Medicolegal Issues. This issue is one of four selected each year by our series Consulting Editor, Dr. Santos Martinez of the Campbell Clinic. Topics in this issue include, but are not limited to: The Physician’s Approach to Impairment Rating and Disability Benefits Determinations; Claimant-related Issues; Evaluating Return-to-work ability using Functional Capacity Evaluation; Evaluating Human Functioning Using CAT Methodology for Disability Determination within the SSA; Burden of treatment compliance; Measuring Quality of Life Loss in Litigation; Medical-Legal Causation Analysis; Actuarial Analysis and Life Expectancy Determination after Catastrophic Illness or Injury; Validity Assessment in Acquired Brain Injury Disability Evaluation; Medicolegal Expert Core Competencies & Professionalism; The Physician as Expert Witness; Rehabilitating the Injured Worker to Maximum Medical Improvement (MMI); The Independent Medical Examination (IME); and Life Care Planning, among other topics.
Innovations in Family Therapy for Eating Disorders brings together the voices of the most-esteemed, international experts to present conceptual advances, preliminary data, and patient perspectives on family-based treatments for eating disorders. This innovative volume is based partly on a special issue of Eating Disorders: The Journal of Treatment and Prevention and includes a section on the needs of carers and couples, "Tales from the Trenches," and qualitative studies of patient, parent, and carer experiences. Cutting edge and practical, this compendium will appeal to clinicians and researchers involved in the treatment of eating disorders.
Research has shown that a range of adult psychiatric disorders and mental health problems originate at an early age, yet the psychiatric symptoms of an increasing number of children and adolescents are going unrecognized and untreated—there are simply not enough child psychiatric providers to meet this steadily rising demand. It is vital that advanced practice registered nurses (APRNs) and primary care practitioners take active roles in assessing behavioral health presentations and work collaboratively with families and other healthcare professionals to ensure that all children and adolescents receive appropriate treatment. Child and Adolescent Behavioral Health helps APRNs address the mental health needs of this vulnerable population, providing practical guidance on assessment guidelines, intervention and treatment strategies, indications for consultation, collaboration, referral, and more. Now in its second edition, this comprehensive and timely resource has been fully updated to include DSM-5 criteria and the latest guidance on assessing, diagnosing, and treating the most common behavioral health issues facing young people. New and expanded chapters cover topics including eating disorders, bullying and victimization, LGBTQ identity issues, and conducting research with high-risk children and adolescents. Edited and written by a team of accomplished child psychiatric and primary care practitioners, this authoritative volume: Provides state-of-the-art knowledge about specific psychiatric and behavioral health issues in multiple care settings Reviews the clinical manifestation and etiology of behavioral disorders, risk and management issues, and implications for practice, research, and education Offers approaches for interviewing children and adolescents, and strategies for integrating physical and psychiatric screening Discusses special topics such as legal and ethical issues, cultural influences, the needs of immigrant children, and child and adolescent mental health policy Features a new companion website containing clinical case studies to apply concepts from the chapters Designed to specifically address the issues faced by APRNs, Child and Adolescent Behavioral Health is essential reading for nurse practitioners and clinical nurse specialists, particularly those working in family, pediatric, community health, psychiatric, and mental health settings. *Second Place in the Child Health Category, 2021 American Journal of Nursing Book of the Year Awards*
This is the first book to provide a multidisciplinary, critical, and global overview of evidence-based parenting education (PEd) programs. Readers are introduced to the best practices for designing, implementing, and evaluating effective PEd programs in order to teach clients how to be effective parents. Noted contributors from various disciplines examine evidence –based programs from the U.S., Canada, Europe, Asia, Australia, as well as web-based alternatives. The best practices used in a number of venues are explored, often by the developers themselves. Examples and discussion questions encourage application of the material. Critical guidance for those who wish to design, implement, and evaluate PEd programs in various settings is provided. All chapters feature learning goals, an introduction, conclusion, key points, discussion questions, and additional resources. In addition to these elements, chapters in Part III follow a consistent structure so readers can easily compare programs—theoretical foundations and history, needs assessment and target audience, program goals & objectives, curriculum issues, cultural Implications, evidence-based research and evaluation, and professional preparation and training issues. The editor has taught parenting and family life education courses for years. This book reviews the key information that his students needed to become competent professionals. Highlights of the book’s coverage include: Comprehensive summary of evidence-based PEd training programs in one volume. Prepares readers for professional practice as a Certified Family Life Educator (CFLE) by highlighting the fundamentals of developing and evaluating PEd programs. Exposes readers to models of parenting education from around the world. The book opens with a historical overview of PEd development. It is followed by 20 chapters divided in four parts. The initial six chapters focus on fundamentals of parenting education --program design, implementation, evaluation, the role of mediators and moderators, as well as the U.S. Cooperative Extension Parent Framework. The three chapters in Part II review the latest status of parenting education in Europe, Asia, and web-based alternatives. Part III presents ten stellar, evidence-based parenting programs offered around the world. In addition to the learning goals, introduction, conclusion, key points, discussion questions, and additional resources that are found in all chapters, those in Part III also consider theoretical foundations and history, needs assessment and target audience, program goals & objectives, curriculum issues, cultural Implications, evidence based research and evaluation, and professional preparation and training issues. Part IV reviews future directions. Ideal for advanced undergraduate or graduate courses in parent education, parent-child relations, parenting, early childhood or family life education, family therapy, and home, school, and community services taught in human development and family studies, psychology, social work, sociology, education, nursing, and more, the book also serves as a resource for practitioners, counselors, clergy members, and policy makers interested in evidence based PEd programs or those seeking to become CFLEs or Parent Educators.