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| 2. |
- Andersson, Peter, et al.
(författare)
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Implementation and evaluation of Illness Management and Recovery (IMR) in mandated forensic psychiatric care-Study protocol for a multicenter cluster randomized trial
- 2022
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Ingår i: Contemporary Clinical Trials Communications. - : Elsevier. - 2451-8654. ; 27
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Forensic mental health care is hampered by lack of evidence-based treatments. The Swedish forensic mental health population consists of patients suffering from severe illnesses such as schizophrenia and bipolar disorders, similar to populations in international studies. Illness Management and Recovery (IMR) is an intervention for patients with serious mental illness, based on psychoeducational, cognitive-behavioral and motivational components. The purpose is to strengthen participants' illness management skills and recovery.Objective: To test effectiveness of IMR within forensic mental health by comparing it to treatment as usual.Method: This is a cluster-randomized controlled trial. Patients in forensic mental health inpatient units are randomized to an active (IMR) or a control condition (treatment as usual). Clustering of patients is based on ward-units where inpatients are admitted. Patients in the active condition receive two group and one individual IMR sessions per week. The treatment phase is estimated to last nine months. Outcomes include illness related disability, illness management skills, sense of recovery, hope, mental health and security related problems. Outcomes are measured at baseline, four months into treatment, at treatment completion and at three months follow-up. Staff experiences of implementing IMR will be explored by a self-report measure and semi-structured interview based on Normalization Process Theory.Ethics and dissemination: The study is approved by the Swedish Ethical Review Authority (Registration No. 2020-02046). Participation will be voluntary based on written informed consent. Results will be disseminated through peer-reviewed articles and conferences. The study is registered in the US registry of clinical trials (NCT04695132).
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| 3. |
- Björnsdotter, Annika, 1970-
(författare)
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Evaluation of Family Check-Up and iComet : Effectiveness as well as Psychometrics and Norms for Parent Rating Scales
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis compromise four studies, three regarding psychometrics and norms of parent rating scales, and one study regarding effectiveness of two different interventions. A normative sample consisting of 1443 parents with children aged 10 to 13 years old, was used in the Study I, II and III. In Study IV, 231 self-referred parents with children aged 10-13 years old with externalizing behavior problem (EBP) were randomized to either Family Check-Up (FCU) or iComet.The Strengths and Difficulties Questionnaire (SDQ) used in Study I proved to be a reliable and valid instrument with high internal consistency, clear factor structure and high correlation with other similar instruments. In addition, the results support the online use of SDQ as well as using norms obtained through traditional administration even when the SDQ has been administrated online. The Emotion Regulation Questionnaire (ERQ) investigated in Study II was shown to have adequate reliability and construct validity. The specific use of expressive suppression or cognitive reappraisal as a parental emotion regulation strategy was correlated as expected to the couple’s satisfaction, family warmth, and the employment of adequate discipline strategies. Swedish norms for self-rated ERQs are also presented. Study III investigated the Parental Knowledge and Monitoring Scale (PKMS), which was shown to be a useful instrument for assessing parental knowledge and its sources. Family climate appears to moderate important relationships between parental knowledge and conduct problems with implications for such things as family interventions. Finally, a person-oriented analysis was used in Study IV to subtype the children according to combinations of prosocial behavior and EBP, such as different levels of attention deficit hyperactivity disorder (ADHD) symptoms and/or oppositional defiant disorder (ODD) behaviors. Despite being a heterogeneous group of children with EBP, they were meaningfully grouped into significantly different profiles. Both FCU and iComet resulted in post-treatment measurement within non-clinical range for three of the five profiles. The two profiles that included high levels of ADHD behaviors at baseline assessment continued to have residual symptoms post intervention.
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| 5. |
- Björnsdotter, Annika, 1970-, et al.
(författare)
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Psychometric properties of online administered parental Strengths and Difficulties Questionnarie (SDQ), and normative data based on combined online and paper-and-pencil administration
- 2013
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Ingår i: Child and Adolescent Psychiatry and Mental Health. - : Springer Science and Business Media LLC. - 1753-2000. ; 7
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Tidskriftsartikel (refereegranskat)abstract
- ObjectiveTo examine the psychometric properties of the online administered parental version of the Strength and Difficulties Questionnaire (SDQ), and to provide parental norms from a nationwide Swedish sample.MethodsA total of 1443 parents from of a national probability sample of 2800 children aged 10-13 years completed the SDQ online or as usual (i.e., using paper-and-pencil).ResultsThe SDQ subscales obtained from the online administration showed high internal consistency (polychoric ordinal alpha), and confirmatory factor analysis of the SDQ five factor model resulted in excellent fit. The Total Difficulties score of the SDQ and its other subscales were significantly related to the Disruptive Behavior Disorders (DBD) rating scale. Norms for the parent version of SDQ obtained from the Internet were identical to those collected using paper-and-pencil. They were thus combined and are presented sorted by child gender and age.ConclusionsThe SDQ seems to be a reliable and valid instrument given its high internal consistency, clear factor structure and high correlation with other instruments capturing the intended constructs. Findings in the present study support its use for online data collection, as well as using norms obtained through paper-and-pencil-administration even when SDQ has been administrated online.
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| 6. |
- Björnsdotter, Annika, 1970-, et al.
(författare)
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The Importance of Parental Knowledge
- 2013
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Poor parenting is an important risk factor for development of conduct problems in children and adolescents. Inadequate parental monitoring is an example of a negative parenting behavior that has been shown to predict child conduct problems Findings from previous research on parental monitoring has been mixed due to the use of inconsistent and vague definitions. However, later research suggests that it is "parental knowledge" rather than "parental monitoring" that is associated with child and adolescent conduct problems. In the present study, we used an existing questionnaire that measures three possible sources of parental knowledge: child disclosure, parental solicitation and parental control. Our aims were to 1) examine the factor structure of a parenting monitoring/knowledge scale, 2) analyze if a high level of child disclosure and parental control as well as a low level of parental solicitation were associated to low conduct problems, 3) examine if a measure of family warmth correlates with child disclosure, and 4) whether parental knowledge mediates the relation between parental warmth and conduct problems. Parents of a national probability sample of 2800 children aged 10-13 years old were asked to complete a survey including these different scales. A total of 1446 parents completed the questionnaires. Brief description Analysis of the importance of parental knowledge regarding child disruptive behavior using an existing questionnaire that measures parental knowledge through three possible sources: child disclosure, parental solicitation and parental control.
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| 7. |
- Björnsdotter, Annika, 1970-, et al.
(författare)
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The Parental Knowledge and Monitoring Scale : Psychometrics and relations to conduct problems
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- This study investigated psychometrics (internal consistency, factor structure) of the Parental Knowledge and Monitoring Scale (PKMS) when used for parents of children aged 10-13 years. We also evaluated PKMS associations to child conduct problems and potential moderators (family warmth, and conflict). Totally 1442 parents participated. The internal consistencies ranged from alpha .70 to .90. A confirmatory factor analysis of the sources of parental knowledge resulted in a fairly acceptable fit for a 4-factor model (Parental Solicitation, Parental Control, Child Disclosure, and Secrecy: RMSEA=.076, CFI=.99, GFI=.94). The subscales correlated positively (Secrecy negatively) with Parental Knowledge. Secrecy was associated with conduct problems in a hierarchical regression analysis. Family warmth and conflict significantly moderated the association of parental knowledge to conduct problems.
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| 8. |
- Blom, Lisa, et al.
(författare)
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Little All Children in Focus (Little ACF), evaluation of a parental support program for parents of children aged 1–2 years : study protocol for a randomized controlled trial
- 2023
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Ingår i: Trials. - : BioMed Central (BMC). - 1745-6215. ; 24:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Child health and development can be promoted by strengthening and supporting parents. Research on parental support programs based on positive psychology and a health-promoting approach aimed at all parents, and in particular parents of infants is limited. All Children in Focus (ACF) is a parental support program that has been evaluated in a randomized trial in parents of children 3–12 years. The ACF is based on health promotion aiming to increase parents’ confidence and child’s well-being. In the current study, we will study the effects of a revised version of the ACF called Little ACF adapted to parents with children aged 1–2 years.Methods: The study includes a randomized controlled trial (RCT) taking place at several Child Health Centers (CHCs) in Sweden. The RCT will evaluate the efficacy of Little ACF (intervention) in comparison with four digital lectures about child development and parenting (active control). Parents are recruited at the 10-, 12-, or 18-month visits to CHC by CHC-nurses. Data to assess changes in parental competencies and child socio-emotional development are collected through online questionnaires completed by parents at five time points: baseline, post-intervention, after 6 and 12 months, and when the child is 3 years old.Discussion: The paper describes a study protocol of a randomized controlled trial evaluating the effects of a parental support program during infancy. Several issues related to the methodology and implementation are discussed.Trial registration: ClinicalTrials.gov NCT05445141. Registered on 6 July 2022.
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| 9. |
- Bråthén Wijana, Moa, et al.
(författare)
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Preliminary evaluation of an intensive integrated individual and family therapy model for self-harming adolescents
- 2018
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Ingår i: BMC Psychiatry. - : Springer Science and Business Media LLC. - 1471-244X. ; 18:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: To investigate the outcome of an integrated individual and family therapy (Intensive Contextual Treatment: ICT) in terms of reducing suffering and increasing functional adjustment among self-harming and/or suicidal adolescents with high symptom loads and their families. METHODS: Forty-nine self-harming and/or suicidal adolescents, Mage = 14.6, of predominantly Swedish origin and female gender (85.7%) participated with their parents. The study had a within group design with repeated measures at pre- and post-treatment, as well as six- and twelve-months follow-ups. Self-reports were used for the main outcomes; self-harm rates, suicide attempts, parent-reported days of inpatient/institutional care, internalized and externalized symptoms, perceived stress, emotion regulation, school hours and adjustment. Secondary outcomes were levels of reported expressed emotions within family dyads, as well as parental anxiety, depression and stress. RESULTS: From pre- to post-assessment, the adolescents reported significant reductions of self-harm (p = .001, d = 0.54) and suicide attempts (p < .0001, d = 1.38). Parent-reported days of inpatient/institutional care were reduced, as well as parent- and adolescent-reported internalizing and externalizing symptoms. Furthermore, school attendance and adjustment were improved, and the adolescents reported experiencing less criticism while parents reported less emotional over-involvement. The results were maintained at follow-ups. CONCLUSIONS: The adolescents and the parents reported improvements for the main outcomes. This treatment appears promising in keeping the families in treatment and out of hospital, suggesting that an integrative approach may be beneficial and feasible for this group. TRIAL REGISTRATION: This study has been approved 19/12 2011, by the regional review board in Stockholm (Dnr 2011/1593-31/5).
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| 10. |
- Enebrink, Pia
(författare)
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Antisocial behaviour in clinically referred boys : early identification and assessment procedures in child psychiatry
- 2005
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Oppositional and aggressive behaviour in children below twelve years of age is a frequent cause of concern for parents and teachers, and a common reason for referral to child and adolescent psychiatry. Whereas most children outgrow these behaviours, a small subgroup is at risk for developing a persistent antisocial lifestyle. Successfully identifying children at risk could prevent potential human and economic suffering of the child, his/her family, potential victim(s) and society. However, predicting which children are at higher risk for future antisocial behaviours is intricate and associated with the perils of mislabelling. Recently, promising approaches for early identification of boys at risk for future antisocial behaviour have been formulated. These include assessments of risk factors (risk assessments) and evaluation of certain personality traits callous-unemotional (CU) traits. CU-traits are defined as patterns of emotional dysregulation, such as a pronounced lack of empathy, remorselessness and shallow affects. The main aim of this thesis was to investigate whether these structured approaches might improve early identification of clinic-referred boys at risk for future antisocial behaviour and to explore clinical child psychiatric work with these children and their families. Method: A combination of quantitative and qualitative methodologies was used. A prospective longitudinal multicentre project was initiated in mid-Sweden during 2001. Parents of clinic-referred boys (n = 76) completed questionnaires and participated in a semi-structured researcher-led interview at baseline, yielding information to evaluate the risk for future antisocial behaviour. Parents were then interviewed again after six and thirty months. At the thirty-month follow-up we also included teachers as informants. Child clinicians at each clinic were asked to fill in separate evaluations of the boys risk. Furthermore, a qualitative study was conducted in which narrative interviews with 16 clinicians from seven child psychiatric teams enabled exploration of clinical work with conduct-disordered boys. Results: Assessments of risk for future antisocial behaviour, based on the risk assessment tool Early Assessment Risk List for Boys (EARL-20B), demonstrated acceptable interrater reliability (Paper I). EARL-20B-based assessments were associated with concurrent and prospective estimates of antisocial behaviour (Paper I-II). Combinations of EARL-20B risk factors were tentatively identified through cluster analysis, distinguishing between boys with high and low levels of antisocial behaviour (Paper I). Comparing the EARL-20B-based baseline evaluations with unstructured clinical baseline evaluations of risk and baseline DSM-IV Conduct Disorder (CD) indicated incremental predictive validity of the EARL-20B. The AUC estimate of CD-diagnosis at the thirty-month follow-up was of good accuracy (.87) for the EARL-20B. Further, conduct problem boys (n = 41) high on CU-traits had significantly more pervasive, varied and aggressive disruptive behavioural problems than boys low on these traits. This finding was not explained by the presence of DSM-IV AD/HD and Oppositional Defiant Disorder (ODD)/CD symptoms. Boys with CU-traits experienced poorer household circumstances, lived in families under high stress and received less help in school from special teachers than boys low in CU-traits (Paper III). The qualitative study suggested that child psychiatry clinicians consider a multitude of case characteristics when working with antisocial boys (Paper IV). The behaviour of the boys sometimes evoked feelings of fear among caregivers, signalling the need for instant interventions. The teams described a lack of consent and collaboration with other agencies, with unclear responsibilities across organisations. Conclusions: The results suggest that structured assessments of risk and the evaluation of CU-traits can be valuable for identifying severe antisocial behaviour in boys. Early identification procedures touch upon the delicate balance between discerning children at risk to prevent them from repeated violent and norm-breaking behaviours, and the dangers of labelling. When addressing either risk for violence or CU-traits in boys, the purpose, due to ethical considerations, should therefore be to prevent serious antisocial behaviours from occurring through the provision of treatment and other interventions. Over the years, researchers and clinicians have pointed to a need for improved management of antisocial behaviour in child psychiatric services. Improved collaboration and clearer responsibilities among agencies still seem necessary to enable good care and management.
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