BackgroundParent–child interaction therapy (PCIT) is a short‐term, evidence‐based parent training program for parents of children aged 2–7-years with disruptive behaviour disorders (DBDs). The evidence‐base for the effectiveness of PCIT is extensive but to date most studies have been quantitative in nature and conducted in university research clinics within the United States. Thus, understanding of the effectiveness and acceptability of PCIT in community‐based settings in other countries, including Australia, is limited.ObjectiveThis study used a qualitative methodology to explore Australian caregiver's perceptions of a standard PCIT program delivered at a community‐based PCIT clinic.MethodParticipants were nine mothers and one father who completed the PCIT program at the clinic for treatment of child DBD.ResultsThematic analysis yielded four major themes, namely “Parenting challenges before PCIT”; “Positive treatment outcomes” (sub‐themes: improved child behaviour, increased parental confidence, increased insight into the child needs, and improved relationships with partner); “Program strengths” (sub‐themes: child‐directed interaction, parent‐directed interaction, home practice, therapeutic relationship); and “Challenges experienced.”ConclusionsThese findings highlight the benefits of the PCIT program for families who are struggling with DBD in early childhood, and point to the potential positive impacts of disseminating PCIT within clinical settings more widely across Australia.
Abstract Background Evidence suggests that enhanced midwifery care may lead to reduction of antenatal distress among pregnant women. Nevertheless, the access/uptake and outcomes for expectant mothers from culturally and linguistically diverse (CALD) backgrounds may be limited. Therefore, this study investigated the effects of enhanced midwifery care in reducing antenatal distress among pregnant women presenting with elevated but sub-clinical symptoms of depression in an ethnically diverse, socio-economically, and geographically disadvantaged area in the South Western Sydney Local Health District (SWSLHD). Methods A multisite, single-blinded, randomised controlled trial was conducted with a follow-up period of 6 months. Participants included pregnant women attending the Fairfield and/or Liverpool Antenatal clinic with an Edinburgh Depression Scale (EPDS) score of 10–12 and a psychosocial assessment during the first antenatal visit. Participants were randomly allocated to either the intervention group or usual care group. The enhanced midwifery care was led by a dedicated Research Midwife (RM) that provided care coordination/navigation and social care support from pregnancy to the early postnatal period whereas the usual care group received routine antenatal care. Primary outcomes included reduction in mental ill-health symptoms assessed via EPDS and Kessler’s Psychological distress (K10) assessments whereas secondary outcomes included improvement in parenting confidence (Karitane Parenting Confidence Scale (KPCS)). Linear mixed-effects model was used to examine the effects of treatment on outcomes. Fixed-effects such as time, treatment, and time-by-group interactions were also assessed separately for each outcome variable whilst adjusting for confounders. Results 37 mothers were recruited into the study, 18 were randomised to the intervention group and 19 to the usual care group. Findings of the mixed-effects model showed significant within group differences in EPDS scores as indicated by the significant effect of time but no significant effect of treatment. Further, there were no significant effects of time, treatment, or significant interactions between time and treatment group for K10 and KPCS. Conclusion Findings showed non-significant improvements in antenatal distress and parenting confidence among expectant mothers in the enhanced midwifery care model group compared to usual care. Larger and appropriately powered trials are needed to determine whether small differences in care can reach statistical and clinical significance. Trial registration: Australian New Zealand Clinical Trials Registry (ACTRN12623000698673).
BackgroundParent–child interaction therapy with toddlers (PCIT‐T) is an adaptation of standard PCIT, developed to treat young children (12–24-months) with disruptive behaviours. The aim of this study was to gather preliminary qualitative data to gauge parental perceptions about the program.MethodsSemi‐structured interviews were conducted with five parents who received the first phase of the program, 'child directed interaction‐Toddler' (CDI‐T) at a community based child behaviour treatment clinic. Interview transcripts were analysed thematically.ResultsParticipants were initially motivated to seek treatment because of concerns about and difficulties managing child behaviour. All participants reported a range of positive gains as a result of CDI‐T including new parenting strategies, improved parental confidence and improved parent–child relationship quality. Live coaching from behind the one‐way mirror, the relationship with the therapist and the home‐based practice of skills between sessions were identified as important treatment components. Many participants spoke, however, about the difficulties they experienced with continuing to implement the home practice after program completion.ConclusionsResults suggest that CDI‐T is perceived positively by consumers, and highlight a number of key program components.
The purpose of this perspective article is to emphasise the importance of the 'First 2000 Days' policy of life from conception to age five, and to propose new directions in which the policy's implementation could be extended for the benefit of children and families. The proposed approach highlights principles of responsiveness, integration, sustainability and equity, specifying initiatives that embody the kind of innovation each principle aspires to. The article also proposes innovations in data collection and linkages that would strengthen the implementation of first 2000 days policies and frameworks. This perspective proposes a framework that could improve health systems implementation of services in the first 5 years of life, by proposing a well-coordinated continuum of services with integrated physical and digital solutions. This has the potential to transform how the health system monitors and responds to children and families' needs in the critical early years of life during and beyond the current pandemic.
Abstract Background Autism Spectrum Disorder (ASD) has varying prevalence rates worldwide, often higher in culturally diverse populations. Cultural differences can affect autism symptom recognition. Language barriers and differing healthcare attitudes may delay diagnosis and intervention. Most autism screening tools were developed in Western, predominantly Caucasian populations, and their appropriateness in culturally and linguistically diverse (CALD) contexts remains uncertain. There is a lack of comprehensive data on the accuracy of these tools in identifying autism in culturally and linguistically diverse groups. Consequently, it is unclear whether current screening tools are culturally sensitive and appropriate. Methods A research protocol was registered in PROSPERO (CRD42022367308). A comprehensive search of literature published from inception to October 2022 was conducted using the following databases: PubMed, Medline Complete, Scopus, PsychInfo and CINAHL Complete. The articles were screened using pre-determined inclusion and exclusion criteria. Data extracted included participant demographics, screening tool psychometric properties (validity, reliability, accuracy) and acceptability. A thematic narrative approach was used to synthesise results. Results From the initial retrieval of 2310 citations, 56 articles were included for analysis. The studies were conducted in 33 different countries with screening tools in the following languages: Chinese, Spanish, Korean, Turkish, Arabic, Kurdish, Persian, Serbian, Italian, French, Sinhala, Taiwanese, Finnish, Northern Soho, Albanian, German, Japanese, Vietnamese, Farsi, Greek and English. There was no data on acceptability of the screening tools in CALD populations. Validity, reliability, and accuracy ranged from poor to excellent with consistently high performance by screening tools devised within the populations they are intended for. Conclusions The review evaluated autism screening tools in culturally diverse populations, with a focus on validity, reliability, and acceptability. It highlighted variations in the effectiveness of these tools across different cultures, with high performance by tools devised specifically for the intended population, emphasizing the need for culturally sensitive screening tools. Further research is needed to improve culturally specific, reliable autism screening tools for equitable assessment and intervention in diverse communities.
Abstract Objective To establish any health outcomes for infants to age one, associated with their mother having a diagnosis of an active eating disorder during pregnancy or the 12‐month postnatal period. Method A qualitative systematic literature review of numerous databases (Medline, PsycINFO, CINAHL, Scopus, Cochrane Library, MedNar, PsycExtra, National Institute for Health and Care Excellence and Open Grey) was performed examining any infant health outcomes. Results This resulted in 22 included studies (17 cohort, 3 cross‐sectional, 1 case controlled and 1 mixed methods study). A range of adverse infant outcomes including poor birth, growth and interactional feeding outcomes were identified. Discussion Antenatal identification and treatment for women with an eating disorder during the perinatal period and their infants are vital. Optimizing pregnancy nutrition, maternal eating disorder symptoms and feeding interactions appear particularly important.
Parent–Child Interaction Therapy—Toddler (PCIT-T) is an attachment-informed intervention model designed to meet the specific developmental needs of toddlers aged 12–24 months presenting with challenging behaviors. This study used a randomized controlled design to evaluate outcomes of PCIT-T for children aged 14–24 months with disruptive behaviors. Ninety toddlers with parent-reported disruptive behavior were randomly allocated to PCIT-T (intervention), an active control condition (Circle of Security– Parenting™; COS-P), or a non-treatment control condition (wait-list; WL). Outcomes were assessed at baseline (Time 1), post treatment/post waitlist (Time 2) and 4-month follow-up (Time 3). At follow-up, the PCIT-T group displayed the highest levels of parenting sensitivity and positive parental verbalizations, and the lowest levels of negative child-directed verbalizations and non-attuned mind-minded statements. Of the three groups, the PCIT-T group showed the greatest degree of change on these variables, followed by the COS-P group and then the non-treated controls. The PCIT-T group were also the only group to show significant within-group improvements in sensitivity, self-reported parental reflectiveness, empathy and emotional understanding, parent-reported child social competence, child internalizing problems, and general behavior issues. Significant reductions in parental stress, child externalizing behaviors and parenting behaviors were seen for both the PCIT-T and COS-P groups. Delivered in the early intervention period of toddlerhood, Parent–Child Interaction Therapy—Toddler has the potential to bring about significant changes for children presenting with early onset behavioral issues. Australian New Zealand Clinical Trials Registry (ANZCTR), 12,618,001,554,257. Registered 24 September 2018 – retrospectively registered, https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12618001554257 .
Perinatal mental ill-health is a global health priority. Mental health screening during pregnancy is a routine part of clinical practice in many public hospital obstetric services across Australia, but implementation in the private hospital system has lagged.This study explored health professionals' perspectives on the Pre-admission Midwife Appointment Program (PMAP), an antenatal mental health screening program at the Mater Hospital, Sydney.Nine midwives and three medical specialists participated in focus groups or individual interviews; key themes were determined using thematic qualitative analysis.Five major themes and three sub-themes were identified: immediate benefits to women (identifying women at risk; referrals to support services; supporting and educating women); enhanced overall quality of care at the hospital; the dilemma of partners attending; factors that make the program successful; and recommendations for improvement.Results will inform the implementation of antenatal mental health screening programs at other private hospitals across Australia.
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