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The four response options measure frequency of symptomatology with the following options: almost never, sometimes, a lot of the time, and all the time. A 30th item uses a rebus response format with five faces depicting a range of happy to sad faces. An Assessment Strategy for Depression As we have in previous chapters, we recommend a five-stage assessment process for the assessment of depression: screening, classification, co-morbidities, alternative causes, and treatment considerations (see Table 18. In light of the prevalence of depression, its common comorbidity with other problems, its adverse effects on development in a variety of domains, and its less-than-flagrant symptomatology, we recommend that every child who is seen by a clinician should be screened for depression. Research findings support the need for screening all referrals that are seen not only by psychologists, but also by other professionals. Classification Comorbidities Alternative Causes Treatment Considerations the child and a parent would take only a few minutes. Screening efforts may allow the clinician to implement intervention in order to avert considerable suffering (see Box 18. The psychologist has to be sure that malingering, response sets, or other threats to validity have not had an effect on the report of symptoms. An adolescent, for example, may be asked if he/she has experienced decreased appetite, fatigue, sleeplessness, agitation, and suicidal ideation. He/she may discern that it is wise to deny all of these difficulties if he/she thinks that he may be a candidate for inpatient or partial hospitalization treatment. Clinicians who treat adolescents have seen cases in which the youth denies suicidal ideation, although he/she may have been transferred from a hospital emergency room because of a suicide attempt. An array of valid assessment methods is necessary in order to ensure adequate documentation of symptoms: l l Structured and semi-structured interviews. Indeed, semi-structured interviews, because of their flexibility and comprehensive have been described as "best practice" by Klein et al. Self-report inventories and parent and teacher rating scales can provide further documentation of symptoms, screen for comorbid problems, and assess for 424 Box 18. He was reportedly enrolled in speech therapy throughout his elementary school years. He is performing adequately in math, but he complains that he has trouble taking notes in class and comprehending them after he takes them. He reportedly failed in his English class during the first semester of the current academic year. He is very distraught about these failures because of his desire to go to college following graduation and his concerns about disappointing his parents. He recently broke off a 1-year relationship with a girlfriend, and he is receiving rehabilitation for a severe back injury that he incurred in a bicycle accident six months ago. He even asked the examiner questions about his interests and offered his full cooperation with the assessment process. Matt described many successes in his life, including being chosen as captain of the baseball team at his school. Aside from athletics, he is reportedly involved in a variety of other extracurricular activities. He acknowledged guilt about past failures, uncontrollable sadness, insomnia, hopelessness, decreased appetite, increased fatigue, low self-esteem, concerns about his appearance, lack of interest in social activities, and occasional thoughts of hurting himself, among other symptoms. The incongruence between the symptoms endorsed on rating scales and his presentation was striking. During the feedback session, Matt and his parents were apprised of these findings and asked to verify their validity, which they did. He was then referred for follow-up assessment and intervention for his depression. This case illustrates how time-efficient screening for depression can be of potential importance. In this scenario, depression was not suspected by the referral sources, the examining psychologist, or the client. Anxiety symptomatology should be assessed concurrently with all of the data collection necessary for classification. Omnibus rating scales that include a well-validated anxiety scale and interview schedules that also assess for anxiety are helpful in this regard. Somatization problems, phobias, milder fears, obsessive-compulsive disorder, and separation anxiety disorder should be distinguished.
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Also, each group of girls was supervised by two co-leaders, and these co-leaders varied from group to group. This study did not make any statistical adjustments to account for group leader effects on variability in program outcomes. Although the random assignment and pre/post-test methods used are elements of a strong research design, this program has been designated as a promising program due to the above-listed factors. Blythe, Moving into Adolescence: the Impact of Pubertal Change and School Context, New York: Aldine De Gruyter, 1987. Richard Catalano developed the program based on the social development model, which holds that strong bonding to positive influences reduces problem behaviors, such as delinquency and substance abuse. This is combined with research that has identified both risk and protective factors in the development of behavior problems. Protective factors include regular communication or parental warmth and affection, presentation of clear and pro-social expectations, monitoring of children, and consistent and moderate discipline. The program is offered in a series of sessions, each designed to focus on one of five areas. It then focuses on teaching parents the skills that help mitigate these risk factors, such as how to clearly communicate expectations for behavior, how to reduce family conflict, and how to encourage the expression of positive feelings and love. One of the sessions teaches both parents and children various ways to resist peer and social pressures to engage in inappropriate behavior. Among the participating students, 52 percent were minorities, 48 percent were from low-income families, and 39 percent were from singleparent homes. The evaluation studies looked at 209 families in the central Midwest, where the families were predominantly white. The first evaluation (Kosterman and Hawkins, 1997) recruited families of all sixth and seventh graders from six schools districts in the central Midwest. The families were then randomly assigned to either the program or to a waitlisted control group. Before each videotaping, family members independently filled out a survey identifying the primary causes of family disagreements, such as chores, curfews, or finances. Then in Task 1, the family was asked to answer some questions concerning general family life, such as how chores were handled. In Task 2, the family was asked to discuss and resolve an issue they had identified in the earlier survey. Using the videotapes, the families were then scored on a five-point scale across 60 different individual dimensions. For analysis, these dimensions were grouped into three main areas: proactive communication, negative interaction, and relationship quality. The analysis only included parents participating in both the pretest and posttest (174 mothers and 157 fathers), regardless of how many individual sessions the parents had attended. Information was collected up to two months prior to the intervention with family questionnaires and a videotaped family task, although the videotapes were not used in the evaluation. A similar posttest assessment was completed approximately nine months later, with follow-up assessments at about 1, 2, and 3. The evaluation team created four constructs based on items from the parent and child surveys. The third assessed family conflict - the amount and the ways in which the family dealt with conflict. In the scales that were developed, a higher score represents a higher level of the construct - i. The evaluation study by Kosterman and Hawkins (1997) found the following: · the program was effective in promoting proactive communication from parent to child. After the program, mothers in Task 1 and both parents in Task 2 showed much more proactive communication. In Task 1, mothers were significantly less likely to engage in negative interaction, specifically antagonistic behavior.
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Schochet, Jeanne Brooks-Gunn, Diane Paulsell, Kimberly Boller, Jill Constantine, Cheri Vogel, Allison Sidle Fuligni, and Christy Brady-Smith, Making a Difference in the Lives of Infants and Toddlers and Their Families: the Impacts of Early Head Start, Vol. Moiduddin, Ellen Eliason Kisker, and Barbara Lepidus Carlson, Early Head Start Children in Grade 5: Long-Term Follow-Up of the Early Head Start Research and Evaluation Study Sample, Washington, D. Regular classroom teachers carry out the program, usually with the help of instructional aides or older students. Kindergarten is a whole class literature-based emergent literacy/oral language program with small group follow-up for children who need extra help. In grades 3 and 4, students continue to apply their phonics knowledge and word recognition strategies to the reading of connected text and work on fluency, vocabulary, and comprehension. Based on scores on the Metropolitan Achievement Test, teachers identified 31 students who they thought would benefit from the reading intervention program. An average of 43 percent of the students at the schools received subsidized lunches. A total of 35 students from seven schools participated as control subjects, with teachers identifying up to seven students per classroom who they felt would benefit from an early reading intervention program. Of the seven control schools, two were from the same two districts as the treatment schools, and five were from neighboring districts. Outcomes that were assessed included reading speed and number of words read correctly in a story passage, accuracy in the retelling of a story passage, the percentage of correct answers to reading comprehension questions related to the passage, and the percentage of children who could read at a primer level or higher with at least 93 percent accuracy. Children become familiar with the schedule of lessons on each particular day of the program, and this knowledge may help them to become more efficient in the learning of reading skills. For three days a week, the group engages in repeated reading of and guided writing about a short illustrated book. Students are trained in phonemic awareness and word-recognition strategies to foster independent reading and to become better able to answer high-level reading-comprehension questions. The third-grade program uses both narrative and informational books, while the fourth-grade program uses only informational materials that the children use to practice the reciprocal teaching model (reading to students in lower grade levels) as a reading reading-development technique. These factors limit our ability to know for certain that the program alone caused the observed positive outcomes. It should be noted that the program developer participated in all three program evaluations cited in this program description. Watts, "Helping Struggling Readers: Linking Small-Group Intervention with Cross-Age Tutoring," the Reading Teacher, Vol. Frye, "First Grade Teachers Provide Reading Intervention in the Classroom," in Richard L. Funding the evaluation report did not disclose sources of funding for this program. In addition, the program was usually aided by one or two student teachers during the spring semester. The professional development included printed materials, lectures, workshops, and examples from outside experts once every three months. The research, which was conducted over two years, was implemented according to rigorous standards and included an intervention group of 38 students, a control group of 36 students, and a comparison group of 50 students. There is a large body of empirical literature that has established a positive relationship between small class size and better student outcomes (Finn, 1990 and 1999; Mosteller, 1995). The current study included a relatively small sample size of approximately 100 students attending one school in one location. Therefore any generalization from this single case and unique set of circumstances should be made cautiously. It should also be noted that the program evaluation was conducted by the program developers rather than an independent evaluator. Bibliography Almon, Joan, "Educating for Creative Thinking: the Waldorf Approach," Re-Vision, Vol. Mosteller, Fredrick, "The Tennessee Study of Class Size in the Early School Grades," the Future of Children, Vol. Strickland, "A Locus of Control Scale for Children," Journal of Consulting and Clinical Psychology, Vol. Duke, "Individual Differences in the Nonverbal Communication for Affect: the Diagnostic Analysis of Nonverbal Accuracy Scale," Journal of Nonverbal Behavior, Vol.
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The study assessed self-reported condom use (consistent use, frequency, at last sexual encounter) and frequency of intercourse. Key Evaluation Findings Jemmott, Jemmott, and Fong (1992) found the following at the three-month follow-up (adjusting for differences in the groups at baseline): · Total days of sexual intercourse in past three months was significantly lower in the treatment group than the control group (2. Total number of sexual partners in the past three months was significantly lower in the treatment group than the control group (0. Frequency of condom use was higher in the treatment group than the control group (4. There was no significant difference across groups on subjective norms regarding condoms. There were no significant differences on any of the risky sexual behaviors measured. Treatment participants reported a lower frequency of unprotected sexual intercourse than those in the control group (47 versus 70 percent of sexual acts unprotected). There were no significant differences between treatment and control groups in prevention beliefs. At the four-month follow-up: o o o o o o · Knowledge of proper condom use was significantly higher in the treatment group than in the control group (4. At the 12-month follow-up: o o o o · Knowledge of proper condom use was significantly higher in the treatment group (4. Sexual behaviors (sexual initiation, frequency of intercourse, and condom use) were not significantly different between treatment and control groups at any of the follow-ups. Condom use at last sexual encounter was significantly higher in the treatment group than in the control group (70. There were no significant differences in frequency of sexual intercourse or self-rated frequency of condom use on a five-point scale. Implementation Detail Program Design · · Program materials are culturally and ethnically specific. Multiple methods of instruction are used to keep participants engaged in the program. Evaluations indicate that the program produced some positive results; however, the results are somewhat inconsistent. The 2010 evaluation did show sustained effects at 12-month follow-up; however, the effects were not large enough to receive a "proven" rating. The mission of Big Brothers Big Sisters is to provide supportive relationships for young people to assist them in realizing their potential. The program has been shown to impact a variety of behavioral outcomes without providing a behavior-specific intervention or targeting a specific behavior (such as academic improvement, drug use, or violence). In the traditional Big Brothers Big Sisters mentoring model, the volunteer mentor commits to spending approximately three to five hours per week with the child for at least one year. Big Brothers Big Sisters in School, a mentoring program that takes place in a school environment and allows weekly breaks from regular - 68 - programming for the child to take part in one-to-one activities with the mentor, now serves as many children as the traditional community program. The Big Brothers Big Sisters program received a "proven" rating for the indicators Youths not using alcohol, tobacco, or illegal drugs, Children and youth not engaging in violent behavior or displaying serious conduct problems and Students performing at grade level or meeting state curriculum standards. Program Participants Targeted youth are typically between the ages of 6 and 18 and have associated risk factors, such as residence in a single-parent home or a history of abuse or neglect. Prior to acceptance into the program, youths undergo a screening process involving a written application, interviews with both parent(s) and child, and a home assessment. This process is intended to ensure that both child and parent are prepared and equipped to honor the high level of commitment required by the program. Youths participating in the school-based model undergo screening as well; however, because school personnel determine acceptance into the program, children whose parents lack the initiative or time to make contact with program staff are not excluded from eligibility. Mentor participants undergo an extremely rigorous screening process designed to protect youths by identifying and screening out applicants who are unlikely to honor their time commitment or form positive relationships with youths or who pose a safety risk. The specific training requirements vary from site to site but typically involve discussions on program rules, match expectations, relationship building, match activities, and communication skills. The sample youths were between 10 and 16 years old; 60 percent were male and more than 50 percent were an ethnic minority. Nearly all lived with one parent, many were from low-income households, and a significant number had a prior history of family violence or substance abuse.
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However, McLean and colleagues (2013) also note a number of limitations in the existing literature, including inconsistent terminology; lack of precision in descriptions of the interventions; short-term and small sample sizes in many of the studies examined in the original systematic reviews; and "poor representation of particular groups, such as those with multiple comorbidities, cognitive impairment, disabilities or social problems" (pp. A team of autism subspecialists in Columbia, Missouri, including pediatric developmental and behavioral subspecialists, psychologists, nutritionists, and social workers, organizes biweekly televised conferences during which providers present anonymized case studies to encourage discussion with others on best strategies for care management. These services fall into three primary domains: habilitative and rehabilitative services, mental and behavioral health care services, and health promotion services. Habilitative and Rehabilitative Services Habilitative and rehabilitative services are provided to children and youth who have developmental disorders. Habilitative services help individuals "keep, learn, or improve skills and functioning for daily living," while rehabilitative services help individuals "keep, get back, or improve skills and functioning for daily living that have been lost or impaired" (HealthCare. Habilitative and rehabilitative services may include physical therapy, occupational therapy, and speechlanguage therapy. This section focuses primarily on physical and occupational therapy services; because speech and language therapy services are most commonly delivered in school-based settings, and to avoid duplication, they are discussed in Chapter 5. Occupational therapy helps individuals participate in the daily activities they want and need to do (occupations). Once therapeutic services have been requested, a therapist evaluates the child to determine the appropriate type, frequency, and intensity of services. Services can be delivered in a variety of settings, including hospitals, clinics, outpatient practices, and schools. In contrast, task-oriented interventions that emphasize improving the performance of daily life skills rather than altering the underlying impairments are supported by a growing body of evidence (Graham, 2014; Law et al. Taskoriented therapy encourages and supports participation in daily activities, which generally results in more frequent practice of emerging skills and better carryover into real-world situations (Gannotti et al. However, access to these services for children with disabilities varies considerably, and substantial unmet needs exist across the country (Benedict, 2006). Additionally, a growing body of research documents the extent to which the environment affects the participation of children with diverse disabilities in home, school, and community (Anaby et al. A holistic5 child- and family-centered approach is valued by parents and is associated with improved therapy outcomes (Case-Smith et al. Therefore, another major role of pediatric occupational and physical therapists is to work with children and families to identify the barriers preventing children with disabilities from doing the activities they want or need to do and means of removing or circumventing these barriers. For children with hemiplegic cerebral palsy, there is some evidence that intensive activity-based, goal-directed interventions such as constraint-induced movement therapy and bimanual training, as well as goal-directed home occupational therapy programs, are effective in improving skills (Sakzewski et al. In recent years, occupational therapy practitioners have increasingly taken advantage of telehealth technologies to assist clients with developing skills; using assistive devices; and creating new routines for participating in school, home, or community activities. While preliminary research indicates that occupational therapy services received via telehealth are effective, a variety of barriers currently hinder greater implementation of this model. Assistive Technology Services Many children with disabilities benefit from the use of assistive technology devices to accommodate for a lack of functioning. The term "assistive technology device" was first defined at the federal level6 as "any item, piece of equipment or product system-whether acquired commercially, modified, or customized-that is used to increase, maintain, or improve functional capabilities of individuals with disabilities" (Wise, 2012). Physical, occupational, and speech therapists, as well as pediatric rehabilitative medicine specialists, neurodevelopmental pediatricians and other clinicians, may recommend the use of equipment to aid children in their daily lives. Assistive technologies may partially or fully mitigate the effects of impairments on everyday completion of daily activities, allow a child to participate successfully, and lessen the need for a caregiver to provide direct assistance (Nicolson et al. For example, nearly one-third of children aged 1218 wear corrective lenses for visual impairments, making eyeglasses the most ubiquitous assistive device used by children. For children with severe but correctable visual acuity deficits, wearing glasses keeps them from having activity limitations or being restricted in participation (Kemper et al. As is true for corrective eyewear, a team approach to evaluation for, procurement of, and training in the use of most assistive devices is necessary. 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The functionality matrix proposed 12 specific areas for program evaluation, and a scoring process with which to assess. In 2012, the United States Government convened a two-day Evidence Summit that included participants from low- and middle-income countries, U. Government and non-governmental agencies, bilateral and multilateral agencies, and academic institutions to discuss existing evidence and make recommendations for policy, practice, and future research. A number of publications resulted from that conference, both in the grey literature and in the peer-reviewed literature. Three Evidence Review Teams produced extensive reports summarizing various issues. It also noted the need for strong monitoring and evaluation systems that can inform programs, enabling them to adjust to needs and problems as they emerge at the local level and at various higher levels of management. Participants shared state-of-the-art lessons and experiences as well as progress made in individual countries. Engage with and empower communities to build viable and resilient community health systems with strong links to health and other relevant sectors. Build integrated, resilient community health systems based on recognized frontline health workers. Implement national community health programs at scale, guided by national policy and local systems context, to ensure impact. Ensure that sufficient and sustainable financing for community health systems is available from national and international resources and that the private sector participates in financing. Ensure that communities facing a humanitarian crisis receive essential healthcare, particularly at the community level. Invest in the development of inclusive partnerships to leverage and coordinate diverse civil society and 9. Integrate community data into the health information system, including investment in innovative technologies. What they have done has been a major accomplishment that merits our deep gratitude. By purpose, these case studies are only descriptive, leaving analyses, critiques, and commentaries for others who are invited to use them as a starting point for further analysis and synthesis. The global pendulum swing towards community health workers in low- and middle-income countries: a scoping review of trends, geographical distribution and programmatic orientations, 2005 to 2014. Community health workers delivering primary health care: opportunities and challenges. Resolution adopted by the General Assembly on 10 October 2019: Political declaration of the high-level meeting on universal health coverage. Case Studies of Large-Scale Community Health Worker Programs: Examples from Afghanistan, Bangladesh, Brazil, Ethiopia, India, Indonesia, Iran, Nepal, Niger, Pakistan, Rwanda, Zambia, and Zimbabwe. Developing and Strengthening Community Health Worker Programs at Scale: A Reference Guide and Case Studies for Program Managers and Policymakers. Baltimore, Maryland: Johns Hopkins University Press in Association with Future Generations; 2002: 88-101. The National Village Health Guide Scheme in India: lessons four decades later for community health worker programs today and tomorrow. The Government Family Welfare Assistants, and Community Health Care Providers in Bangladesh. Community-based health workers can safely and effectively administer injectable contraceptives: conclusions from a technical consultation. The Community Health Worker: Forty Years of Experience in an Integrated Primary Rural Health Care System in Brazil. Achieving child survival goals: potential contribution of community health workers. The national Village Health Guide Scheme in India: Lessons four decades later for community health work programs today and tomorrow. Global Health Evidence Summit: Community and Formal Health System Support for Enhanced Community Health Worker Performance. Final Report of Evidence Review Team 1: Which Community Support Activities Improve the Performance of Community Health Workers? Final Report of Evidence Review Team 2: Which Health System Support Activities Improve the Performance of Community Health Workers? Final Report of Evidence Review Team 3: Enhancing Community Health Worker Performance through Combining Community and Health Systems Approaches.
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For these drug tests, the study gathered hair and urine samples from participants at the same time the questionnaires were administered and once again, during the next year. Psychiatric symptoms were measured using the Externalizing and Internalizing scales of the Young Adult Self-Report. In this case, treatment as usual was primarily centered on referrals to youth for such services as anger management courses and individual counseling. Key Evaluation Findings Three related studies of serious juvenile offenders and their families (Henggeler et al. Another set of related studies of serious juvenile offenders and their families (Borduin et al. The therapists are organized into "teams" of two to four; each team of therapists receives on-site supervision, usually by a Ph. Furthermore, positive outcomes were shown to persist for two to four years after treatment began. Although they found improvement in substance use outcomes, the effect was not statistically significant and it is not clear whether the improvement was due to multisystemic therapy. Rather, these later studies indicate the difficulties that program implementers may face as they attempt to expand the program. Contact Information For further information about program development, treatment model dissemination, and training, contact: Marshall E. Henggeler Family Services Research Center Department of Psychiatry and Behavioral Sciences Medical University of South Carolina 326 Calhoun St. Bibliography Aos, Steve, Polly Phipps, Robert Barnoski, and Roxanne Lieb, the Comparative Costs and Benefits of Programs to Reduce Crime, Olympia, Wash. Williams, "Multisystemic Treatment of Serious Juvenile Offenders: Long-Term Prevention of Criminality and Violence," Journal of Consulting and Clinical Psychology, Vol. Hall, Lynn Cone, and Bethany Fucci, "Effects of Multisystemic Therapy on Drug Use and Abuse in Serious Juvenile Offenders: A Progress Report from Two Outcome Studies," Family Dynamics of Addiction Quarterly, Vol. Smith, "Family Preservation Using Multisystemic Therapy: An Effective Alternative to Incarcerating Serious Juvenile Offenders," Journal of Consulting and Clinical Psychology, Vol. Hanley, "Family Preservation Using Multisystemic Treatment: Long-Term Follow-Up to a Clinical Trial with Serious Juvenile Offenders," Journal of Child and Family Studies, Vol. Hanley, "Multisystemic Therapy with Violent and Chronic Juvenile Offenders and Their Families: the Role of Treatment Fidelity in Successful Dissemination," Journal of Consulting and Clinical Psychology, Vol. Brondino, "Multisystemic Treatment of Substance-Abusing and -Dependent Delinquents: Outcomes, Treatment Fidelity, and Transportability," Mental Health Services Research, Vol. Pickrel, "Four-Year Follow-Up of Multisystemic Therapy with Substance-Abusing and Substance-Dependent Juvenile - 320 - Offenders," Journal of the American Academy of Child and Adolescent Psychiatry, Vol. Ward, "Treatment Costs for Youth Receiving Multisystemic Therapy or Hospitalization After a Psychiatric Crisis," Psychiatric Services, Vol. Mitchel, "An Independent Effectiveness Trial of Multisystemic Therapy with Juvenile Justice Youth," Journal of Clinical Child and Adolescent Psychology, Vol. Over 100,000 young people have completed the program since it was launched in 1993. The participants live at the program site, often a military base, during the first two phases. The curriculum for the Residential Phase focuses on eight core components of positive youth development: leadership/fellowship, responsible citizenship, service to community, lifecoping skills, physical fitness, health and hygiene, job skills, and academic excellence. At the end of the Residential Phase, participants work with staff to arrange post-residential placement, such as employment, education, or military service. During the Post-Residential Phase, participants return to their families and receive structured mentoring from qualified mentors identified by themselves within their own community. During the study period of 2005-2007, 2,320 applicants across 10 program sites were assigned to the treatment group and 754 applicants were assigned to the control group. Program sites were not selected randomly, but rather were selected for stable staffing and a tendency to receive more applications to participate than spaces available. Baseline data were collected via a two-page questionnaire shortly before the applicants were randomly assigned.
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The study found that younger adolescents were especially prone to communicate with strangers. Participants who communicated more frequently were less likely to communicate with a stranger, whereas those who communicated at more length were more likely to talk with strangers. Adolescents were also more likely to talk to strangers if they communicated online to meet people to assuage boredom and to compensate for their lack of social skills. Those who communicated online to maintain relationships were less likely to talk to strangers. In perhaps the only experimental study on this topic, a cyberball task (the computer equivalent of playing catch) to simulate social inclusion or exclusion was followed by either an instant message conversation with an unknown opposite-sex peer or by solitary computer game play. Among the participants who were excluded, online communication with an unknown peer facilitated recovery from negative affect better than solitary computer game play. The author suggests that the contact with unknown peers in forums such as chat rooms and social networking sites might help adolescents cope with threats to "belonging" in their offline lives. She goes on to write that "policies are needed to promote the creation and maintenance of safe spaces for youth to interact online. The Internet is filled with anonymous discussion groups and bulletin boards devoted to all kinds of topics of interest to youth, from music groups and bands, television shows, and fan fiction to sports, health, sexuality, and even college admissions. One reason why teens might like to get their health-related information online is the anonymity of such communication. Young people may feel more comfortable asking strangers sensitive health-related questions than they Online Communication and Adolescent Relationships would asking a parent or physician in person. Another advantage of online bulletin boards and discussion groups is their full-time availability. A study of the personal Web pages of adolescent cancer patients found that they often expressed a strong desire to help other young cancer patients through providing information, sharing personal experiences, and giving advice. The guest books found on most of the Web pages (which are analogous to electronic bulletin boards) indicated that the pages were producing cyber communities providing patient-to-patient support for cancer victims. Lalita Suzuki and Jerel Calzo investigated a popular health support website that used a peer-generated bulletin board format to facilitate the discussion of adolescent health and social issues. Their analyses of two health bulletin boards -one on teen issues and one on sexual health -concluded that bulletin boards were a valuable forum of personal opinions, actionable suggestions, concrete information, and emotional support, and that they allowed teens to candidly discuss sensitive topics, such as sexuality and interpersonal relations. Although the anonymous and public natures of these online forums may provide benefits to youth, they may also disinhibit users and lead to negative content in their online interactions. Racial slurs and comments were much more common, for example, in unmonitored chat rooms frequented by older adolescents than in the monitored chat rooms frequented by younger adolescents. Race and ethnicity were often mentioned in the chat conversations: thirty-seven out of thirty-eight half-hour transcripts had at least one reference to race or ethnicity. But the monitor is a relatively weak social control: even a frequency of one in five Internet sessions seems an extremely high rate of racist remarks; it is hard to imagine such a high rate offline. It is also hard to imagine the extent of the psychological damage that such remarks do. These findings were validated by a study that interviewed adolescents recruited by instant messaging from a teen chat room. Participants reported exposure to negative stereotypes and racial prejudice against their own and other ethnic groups online. Hate groups reach out to young people online by a number of means, including the creation of Web pages specifically geared to children and teens. Online contact with strangers also puts adolescents at risk for sexual solicitation and sexual exploitation by predators, though such risks were far higher in the earlier days of the Internet before the widespread recognition of the potential dangers inherent to online stranger contact. Indeed, a recent study has found that over a five-year period, reports of unwanted sexual solicitation and harassment have declined, a trend that the authors speculate is a result of better education and more effective law enforcement. Again, despite these small numbers, it is important to understand which youth may be at risk for such victimization. These behaviors included aggressive behavior in the form of rude or nasty comments, embarrassing others, meeting people in multiple ways (for example, on an online dating site or when instant messaging), and talking about sex with strangers. Electronic multitasking has become pervasive, sometimes at the expense of face-to-face family interaction, among siblings as well as with parents. Larry Rosen points out that the advent of social networking sites such as MySpace has made most research findings on how Internet use affects social relations obsolete. For parents of teens who spent more than two hours a day on MySpace, the share rose to one-half.
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No information on frequency of violence is available for violence during pregnancy. Changes over Time the questions on physical violence have not changed significantly over time. Till about 2005-06, however, the groups of acts of physical violence were organized somewhat differently. However, since most of the same acts were covered, this indicator is likely to be fairly comparable over time. Another change worth noting is that more recently, from about 2010-11, a question was added for women married more than once that asks specifically about their experience of physical violence by a previous husband/partner. For that question, "previous husband/partner" was one of several possible answer codes. Nonetheless, always, but particularly when making comparisons over time, users are strongly advised to check the questions in each survey. Women with missing information on ever experience of physical violence are excluded from the numerators and denominator. Notes and Considerations See Notes and Considerations for Percentage of women who have experienced physical violence, and who have experienced physical violence in the past 12 months. Changes over Time See Notes and Considerations for Percentage of women who have experienced physical violence, and who have experienced physical violence in the past 12 months. Notes and Considerations the number of questions from which information is taken for the numerator varies by the current marital status of women. The change that has a significant effect on comparability over time is the following: In some countries, a version of the module that included a question on whether first sex was wanted or not was implemented. The estimate of sexual violence in these surveys included women who said that their first sex was unwanted. Thus, when examining trends over time for this variable, the user should check to see if the earlier survey(s) included the question on unwanted first sex or not. If it was included, the percentage of women who have experienced sexual violence should be rerun to exclude the question on first sex being unwanted. Only then will the previous survey estimate be comparable to the estimate from the more recent survey. Additionally, ever-married women now are asked about sexual violence by a non-husband/partner whether or not they reported sexual violence by any husband/partner. In earlier surveys, only ever-married women who had not reported sexual violence by their current or most recent husband/partner were asked about sexual violence by anyone other than their husband/partner. Another more recent change is that in about 2010-11, a question was added for women married more than once that asks specifically about their experience of sexual violence by a previous husband/partner. Additionally, spousal sexual violence by the most recent husband/partner is, since about 2009, being measured through three questions instead of two. Given these changes, when making comparisons over time of sexual violence, users are strongly advised to check the questions in each survey. Handling of Missing Values Women with missing information on persons committing sexual violence are included in the denominator and are in a separate category for the numerators. Women with missing information on ever experience of sexual violence are excluded from the numerators and denominator. Notes and Considerations the maximum number of perpetrators of sexual violence that can be reported varies between ever-married and never married women. Ever-married women can report up to three perpetrators of sexual violence- their current or most recent husband, a former husband/partner if married more than once, and/or a nonhusband/partner who was the one who perpetrated the violence the first time it occurred. Never-married women can report only one perpetrator, namely the person who perpetrated the sexual violence the time it first occurred. See also Notes and Considerations for Percentage of women who have ever experienced sexual violence, and who experienced sexual violence in the 12 months preceding the survey. Changes over Time See Changes over Time for Percentage of women who have ever experienced sexual violence, and who experienced sexual violence in the 12 months preceding the survey. Coverage: Population base: All women age 15-49 selected and interviewed for the domestic violence module (v044= 1) Time period: Current status at the time of survey Numerators: 1) Number of women age 15-49 whose first experience of sexual violence occurred before they attained the specified age (10, 12, 15, 18, 22) (d126 in 1:49 & d126 < specified age) 2) Number of women age 15-49 who have not experienced sexual violence. Those who report any experience of violence are also asked the age at which the sexual violence first occurred.
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Silverman and Ollendick (2005) note that some available measures are better able than others for assessing different types of anxiety. Anxiety disorders are most likely to be comorbid with other internalizing disorders such as other anxiety disorders or depression. School refusal and subsequent academic problems, however, may appear at a later time. In fact, one of the first hypotheses to consider when somatic symptoms are present. Although it seems obvious, it should be stated that a medical evaluation should be conducted when somatic complaints are evident. Further assessment should be conducted on the factors that may influence treatment outcome. Research on this area of assessment is limited, but an approach that incorporates behavioral observation, rating scales, and/or self-monitoring is recommended (Silverman & Ollendick, 2005). A sample case illustrating this assessment approach for anxiety is provided in Box 18. He makes frequent self-deprecating statements and reportedly requires much attention and supervision to complete his homework. He tends to give up easily on academic activities, often refusing to complete them. He reportedly has trouble separating from his mother, and he often seeks attention in the classroom. On the positive side, he is described as endearing to teachers, creative, and artistically talented. Thomas was reportedly born three months preterm and weighed approximately three pounds at birth. His mother reported that he did not walk until 16 months, and he did not speak in single words until 24 months of age. His teachers have reportedly always indicated that he responds better in a structured classroom. According to his mother, Thomas often complains of headaches and stomachaches at school. During testing (with his mother in the room), he cried, tantrumed, threw objects, refused to answer questions, and responded impulsively. He did not display any of the previous behavior problems, and he did not make self-deprecating statements. His academic difficulties do not appear to be the result of a specific learning disability, although it is reasonable to expect that Thomas may struggle with some academic tasks, unless he is given some assistance in acquiring further academic skills. Based on findings from rating scales and historical information, Thomas was diagnosed with Separation Anxiety Disorder. This diagnosis was based on the rationale that he displayed the minimum of three symptoms for a minimum of four weeks. His teacher reported that Thomas only seems inattentive and distracted when faced with difficult tasks. On new or difficult tasks, Thomas seems to adjust better when given some initial guidance and feedback on his performance. Treatment recommendations were made that centered around ways for Thomas to cope with his anxiety, particularly regarding going to school and ways for his mother to facilitate his progress and not maintain his desire to avoid separation through tantruming or refusal to perform tasks. The results of the evaluation were also shared with school personnel, and a behavioral intervention plan for Thomas was developed at school. The less obvious nature of their symptomatology and the range of disorders related to anxiety and depression make identification of these problems a professional challenge. The nature of the symptomatology also points to the necessity of gathering selfreport information an additional challenge in the assessment of young children. As such, scales are not likely to differentiate between the two syndromes, necessitating efforts at scale refinement (Silverman & Rabian, 1999).