Adapting an attention-deficit hyperactivity disorder parent training intervention to different cultural contexts: The experience of implementing the New Forest Parenting Programme in China, Denmark, Hong Kong, Japan, and the United Kingdom.
The New Forest Parenting Programme (NFPP) is a parenting program developed for parents who have a child with attention-deficit hyperactivity disorder (ADHD). It is a manualized program that is delivered in a parent's home over 8 weeks, or in a group format, or through a self-help manual. Three randomized controlled trials have been carried out in the United Kingdom. The NFPP group has adapted the program according to feedback from parents and therapists, and for use with different populations, both within the United Kingdom and internationally. The first international trial took place in New York, United States. Trials in Denmark, Hong Kong, and Japan followed. More recently, a trial of the self-help manual has been carried out in mainland China. This paper will outline the adaptions that were needed in order to be able to deliver the program in different countries with their own expectations of parenting, culture, and language. Training had to be differently focused; manuals and handouts had to be revised, translated and back-translated; and supervision had to be delivered at a distance to maintain the fidelity of the program. The international group will outline their experience of running trials in their own countries with the NFPP in a face-to-face format (Denmark), a group format (Hong Kong and Japan), and a self-help format (mainland China).
The under-representation in medical education of students from lower socio-economic backgrounds is an important social issue. There is currently little evidence about whether changes in admission strategies might increase the diversity of the medical student population. Denmark introduced an 'attribute-based' admission track to make it easier for students who may not be eligible for admission on the 'grade-based' track to be admitted on the basis of attributes other than academic performance. The aim of this research was to examine whether there were significant differences in the social composition of student cohorts admitted via each of the two tracks during the years 2002-2007.
This prospective cohort study included 1074 medical students admitted during 2002-2007 to the University of Southern Denmark medical school. Of these, 454 were admitted by grade-based selection and 620 were selected on attributes other than grades. To explore the social mix of candidates admitted on each of the two tracks, respectively, we obtained information on social indices associated with educational attainment in Denmark (ethnic origin, father's education, mother's education, parenthood, parents living together, parent in receipt of social benefits).
Selection strategy (grade-based or attribute-based) had no statistically significant effect on the social diversity of the medical student population.
The choice of admission criteria may not be very important to widening access and increasing social diversity in medical schools. Attracting a sufficiently diverse applicant pool may represent a better strategy for increasing diversity in the student population.
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Comment In: Med Educ. 2013 Jun;47(6):542-423662869
OBJECTIVES: To examine the association between health behavior indicators, school contentment, and academic achievement. METHODS: Structural equation modeling with 5810 adolescents. RESULTS: Our model explained 36% of the variance in academic achievement and 24% in school contentment. BMI and sedentary lifestyle were negatively related to school contentment and academic achievement, but physical activity was positively related to school contentment and academic achievement (P
To determine whether seeking advice prior to an unscheduled visit to a pediatric emergency department (PED) influences appropriate use of this setting for minor illnesses.
Cross-sectional questionnaire survey.
The medical emergency department of the Montreal (Quebec) Children's Hospital, a major referral and urban teaching hospital.
Four hundred eighty-nine of 562 consecutive parents visiting the PED over two periods, one in February and the other in July 1989.
None.
Parents of children between 0 and 18 years of age visiting the PED were asked whether they had previously sought advice from family, friends, or a physician. Other factors possibly related to the decision to seek care were also measured. Appropriateness was rated, blind to discharge diagnosis, by two pediatricians using a structured series of questions incorporating the child's age, time of the visit, clinical state, and problem at presentation. Thirty-four percent of visits among respondents were judged appropriate. In bivariate analysis, appropriate visits occurred significantly more often when a parent spoke to both a physician and a nonphysician (47%) prior to visiting the PED than when no advice was sought (29%; P
The purpose of this study was to evaluate the outcomes following participation in the ESPACE parents' workshop. A group of 55 parents who participated in the program, implemented in elementary schools in the Quebec city region, was compared to a group of 217 parents who did not attend the prevention workshop. The results revealed that attending parents suggested more adequate interventions to the vignette depicting a hypothetical situation of sexual abuse compared to nonattending parents. Attending parents are found to be more likely to suggest interventions sustaining the child in her own problem-solving process, seek help from specialized agencies, and attempt to offer emotional support to the victim. Data also reveal that the parents workshop has a positive outcome on knowledge. While the workshop is associated with beneficial outcomes, attendance rates are low. The findings are discussed in the context of identifying means to foster parent involvement in the prevention of child abuse.
Several parent training programmes and behavioural teacher training programmes built on learning theory have been developed for problem prevention and treatment of attention-deficit/hyperactivity disorder (ADHD) and/or oppositional defiant disorder (ODD) during the last few decades. Group format has often been used for parent training but single-subject designs are more common in teacher training. More studies have focussed on pre-school children than on older children, and a minority have been conducted in public mental health settings.
This study aimed to evaluate a combined parent and teacher manual-based group training programme for children with ADHD conducted by the staff at a child and adolescent psychiatric clinic in Sweden.
The intervention was a modified version of Barkley's programme. Children were randomized to an Intervention or a Control group. Sixty-one parents and 68 teachers answered questions about ADHD and ODD symptoms, and about behavioural problems when the study started and at a 3-month follow-up.
RESULTS showed that the intervention resulted in a reduction of the number of children who met DSM-IV criteria for ADHD and/or ODD. Effects were more pronounced in the home setting than in the school setting, and were further accentuated when both parents and teachers of the same child took part in the intervention. Teachers with more problematic classroom situations benefited most from the intervention.
The programme, "Strategies in Everyday Life", has, in a regular clinical setting, demonstrated promising effects on children's disruptive behaviour, and a clinical implication was to recommend involving both parents and teachers in the programme.
Acquiring proficiency in motivational interviewing (MI) may be more difficult than generally believed, and training research suggests that the standard one-time workshop format may be insufficient. Although nurses represent one of the professions that have received most training in MI, training in this group has rarely been systematically evaluated using objective behavioral measures.
To evaluate an enhanced MI training program, comprising a 3.5-day workshop, systematic feedback on MI performance, and four sessions of supervision on practice samples.
Nurses (n = 36) in Swedish child health services were trained in MI. Skillfulness in MI was assessed using the Motivational Interviewing Treatment Integrity (MITI) Code. Effects of training were compared to beginning proficiency thresholds.
Participants did not reach beginning proficiency thresholds on any of the indicators of proficiency and effect sizes were small.
The present study adds to a growing body of literature suggesting that the current standard MI training format may not provide practitioners with enough skillfulness. Moreover, the results indicate that even enhanced training, including systematic feedback and supervision, may not be sufficient. Suggestions for improved MI training are made.
