All people experience pain and for some people, acute pain may over time develop into long-term disabling problems. Already at an early stage, it is possible to identify people at risk for long-term problems and psychologically oriented interventions have been shown to successfully prevent future disability. However, not all people are helped by treatment and there is room for improvement. Moreover, subgroups of people suffering from pain, with different profiles of psychological factors have been identified, indicating that people with pain problems differ. The first aim of this dissertation was to improve the understanding of how people differ. The second aim was to use these individual differences and to match people to psychological treatment based on their psychological profile. The third aim was to explore what happens during treatment that might be important for treatment outcome. The findings show that people who belonged to subgroups with elevated levels of psychological factors had less favorable outcomes over time, despite treatment, than people with no elevations. Moreover, people with elevations in several psychological factors had even less favorable outcomes. Psychological treatments aimed at preventing future disability performed well, but using profiles to match people to treatment did not improve outcomes further; people who were matched to a treatment and people who were unmatched had similar outcomes. However, the profiles used for matching were unstable over time and there is need to improve the identification of psychological variables used for treatment matching. Finally, a number of psychological factors were shown to be valuable targets for treatment; if the treatments successfully produced change in people’s thoughts and emotions related to pain the treatment outcomes were better. The findings were summarized in a flow chart showing the recommended clinical approach to people seekinghealth care for acute pain problems.

Background: Behaviour difficulties are one of the commonest problems for which parents seek professional advice. Behaviour difficulties in early childhood are associated with poorer educational and social outcomes in later life (Loeber & Dishion, 1983). The importance of early intervention and preventative work to support behaviour difficulties has been stressed in the literature and is a priority in the government’s strategy for promoting positive outcomes for children. It is now generally accepted that parenting programmes (PPs) are an effective mechanism for supporting children with behaviour difficulties. A review of the literature suggests that while there are numerous evaluations of PPs there is limited evidence of PPs that are successful outside of a clinic setting and even less evidence on particular aspects of PPs and how parents view them. Aims: The main aim of this research was to explore a community based PP (the Holding Hands Group Programme (HHGP)) in terms of both its outcomes and the perceptions of the parents involved. The aim of paper one was to investigate whether families who undergo the HHGP, notice any improvement in child behaviour, parental stress and parental confidence. A second aim was to compare the HHGP to the previously evaluated Holding Hands Individual Programme (HHIP). The aim of paper two was to examine the process elements of the Holding Hands Group Programme (HHGP), seeking new insights and a detailed descriptive portrayal of how parents experience the HHGP. Methods: The study utilised a pragmatic approach to evaluation, with mixed methods and differing methodologies. Paper 1 involved a fixed quasi-experimental design using a pre-test, post-test single group evaluation. Outcome data was gathered from 34 parental responses to a range of psychometric measures completed on each of three occasions. Paper 2 involved semi-structured interviews being carried out with 15 parents prior to, and on completion of, the HHGP. The interviews focused on parent’s experiences of the programme and what they liked/disliked. Results: Paper 1: At the start of the HHGP parents typically reported high levels of intensity of behaviour, behaviour that was a problem and stress levels. They also reported low levels of parental confidence. By the end of the HHGP parents reported significantly increased confidence and significantly reduced stress, intensity of behaviour and behaviour that was problem. These positive results were maintained beyond the end of the programme as indicated at follow-up meetings. The findings indicate that the HHGP was effective for all identified subgroups of the sample. These findings broadly mirror the findings of the evaluation of the HHIP, although results do show some significant differences between the HHIP and the HHGP. Paper 2: The interviews conducted with fifteen parents were analysed using a rigorous approach to thematic analysis to identify emerging themes. Six themes were identified from parental accounts: support, new knowledge, reconstructing, awareness, changes and interactions. Alongside these themes was a practical element about ‘what worked’. Prior to the HHGP parents gave detailed descriptions about the difficulties that they were experiencing with their child, were able to identify what they wanted to achieve through the group and seemed able to predict what might be useful to them. After the sessions parents discussed what they had gained from taking part and were able to give suggestions for what had caused any changes. Extensions and Implications: On methodological grounds it would be desirable to undertake further work with either a control group, or baseline wait list. A further extension would be to use a longer follow up period or to contact the current participants to see how this cohort is coping when they start school. This study relied on self report data, therefore future work could consider the use of videoing interactions. It would also be useful to extend the interview process to include the follow up period. The results of this study imply that PPs can be delivered effectively to groups in non-clinic settings, and this suggests a route to more cost-effective delivery of PPs. However, as the results indicate that the HHGP was not successful for all, it reminds us that practitioners need to be vigilant in attempting to identify those families that are not helped and flexible in trying to assist them in other ways - perhaps via booster sessions or through the use of self-guided written materials.

A qualitative approach was used to explore the perceptions of parents and therapists in early intervention regarding sensory diets and their efficacy, particularly their goodness of fit within family routines and occupations. Open-ended interviews were conducted with therapist and parent participants and analysis of the data resulted in a model depicting how sensory diets became a "way of life" for families. The Sensory Diet "Way of Life" Model revealed seven themes that illustrated how occupational therapists in early intervention enter the homes of the families they serve and establish a "partnership" with parents to address a child's needs. Once this "partnership" is established, knowledge is transferred to parents who then transform their "vision" of their child and are empowered to generalize knowledge of sensory processing and sensory diets to ever enlarging environments. Ultimately, the sensory diet became a "way of life" for these families. Implications for the field of occupational therapy were given following the presentation of the model.

Thesis deals with the legislation of institutional care for delinquent youth and the possibilities of saving measures in response to wrongdoing committed by adolescents or otherwise of a criminal offense a child younger than 15 years. The work also includes analysis of the situation and socio-pathological development of young people after leaving the institutional care. The last part deals with implementation of the Early Intervention System and Youth team as an effective tool in combating children and adolescents crime in the Czech Republic.

A pesquisa investiga as concepções e modo de atuação das profissionais envolvidas no atendimento em estimulação precoce, com bebês de zero a um ano completo de idade e verifica como elas visualizam a interação mãe-filho no referido atendimento. Foram entrevistadas vinte e duas profissionais (sete professoras, seis fonoaudiólogas, cinco fisioterapeutas e quatro psicólogas), em seis escolas de ensino especial, da cidade de Curitiba, Paraná. Após análise qualitativa dos dados, observa que as profissionais: a) seguem um modelo de atuação com enfoque tecnicista, focalizado na criança e em sua deficiência, com ênfase em atividades e exercícios terapêuticos; b) desconhecem a facilitação da interação mãe-filho como importante na promoção do desenvolvimento infantil, relegando a presença da mãe no atendimento a um segundo plano; c) sentem falta de mais formação na área em que atuam e reconhecem que não estão preparadas para lidar com a família. Conclui propondo uma mudança do enfoque atual do atendimento em estimulação precoce, por outro focalizado na criança e na mãe, a fim de facilitar a interação entre ambos e dessa forma promover o desenvolvimento infantil. Sugere que a atuação direta com o bebê seja feita por um único profissional, especializado em estimulação, embora essa participação única não deva excluir a equipe de trabalho. Propõe também, entre outras medidas, a mobilização da universidade para que participe ativamente na melhoria do ensino especial, propiciando tanto cursos em estimulação precoce como inserindo-a como disciplina nos cursos de educação especial, levando em conta o enfoque proposto na presente pesquisa. / The research examines conceptions and approaches of professionals attending babies with disabilities in early intevention during ages 0 to 1 year old, while verifying the interaction of mother-child during sessions. Twenty two professionals were interviewed (seven teachers, six speech-language therapists, five physiotherapists and four psychologists), in six different institutions in the city of Curitiba, Paraná. After qualitative analysis of the data, the following has been observed in the professionals: a) they have put emphasis on a technical approach, aiming at the disability and the child, with emphasis in several activities and therapeutic exercises; b) they do not consider or it is a unknown to them the benefits of the interaction mother-child in promoting the infantile development, therefore not taking into consideration the presence of mother in the first plan but at the second; c) they have lack of know-how and understanding in the specific area they are acting and recognize that they are not prepared to deal with the family issues. Therefore, the conclusion is to propose a change in the actual emphasis in dealing with early intervention, by taking into consideration the mother-child interaction with the objective to facilitate the interaction of both and thus promoting development of the child. It is recommended that only one specialized professional acts on the child. Although this does not mean that a team-work approach is excluded in the early intervention. Also, it is recommended, among other measures, the involvement of the universities in improving the quality of this specialised field of early intervention, as well as offering courses with special education and emphasis in this thesis.

A linguagem oral e as habilidades do processamento fonológico, consciência fonológica, memória fonológica e acesso rápido ao léxico, são pré-requisitos para a aquisição da linguagem escrita. Dessa forma, crianças com dificuldades na aquisição e desenvolvimento da linguagem oral e/ou dificuldades em uma ou mais habilidades do processamento fonológico, podem ser consideradas como de risco para dificuldades de leitura, mesmo esta criança estando, ainda, na idade pré-escolar. O objetivo deste estudo foi o de elaborar, aplicar e analisar um programa de intervenção de decodificação fonológica para crianças com risco para dificuldade de leitura. Participaram desse estudo 30 crianças de ambos os sexos, com idades de seis anos a sete anos e 11 meses. Trata-se de uma pesquisa experimental, na qual o grupo estudado de crianças com risco para dificuldade de leitura (formado por 10 crianças), foi submetido ao programa de intervenção de decodificação fonológica, para a comparação com o grupo controle de crianças com risco para dificuldade de leitura (formado por 10 crianças) e com o grupo controle de crianças sem risco para dificuldade de leitura (formado por 10 crianças), não submetidos ao programa de intervenção. O programa foi elaborado a partir da proposta de intervenção utilizada por Rivers, Lombardino e Thompson e por Rivers e Lombardino, o programa contém 24 sessões, sendo que as 12 primeiras sessões são realizadas em grupos de 2 a 3 crianças e as demais individualmente, as sessões apresentaram duração de 50 minutos e foram realizadas duas vezes por semana. Foram desenvolvidas habilidades como: nomeação e produção do som das letras na forma maiúscula e minúscula; consciência fonológica no nível de consciência de palavras e sílabas, e no nível de consciência fonêmica; leitura com objetivo de compreensão de pequenos livros; leitura de palavras monossilábicas de estrutura silábica do tipo consoante-vogal-consoante. Os resultados revelaram que as crianças com risco para dificuldade de leitura, submetidas ao programa de intervenção de decodificação fonológica, demonstraram melhora na avaliação após intervenção estatisticamente significativa para o desempenho das habilidades de: nomeação de letras; relação grafema-fonema; consciência fonológica; memória de trabalho fonológica para não palavras; memória de trabalho fonológica para dígitos na ordem direta; escrita do alfabeto em sequência; escrita sob ditado de palavras e pseudopalavras; leitura de palavras e pseudopalavras. Portanto, o Programa de Intervenção de Decodificação Fonológica mostrou ser um instrumento benéfico para a intervenção de crianças com risco para dificuldade de leitura, visto que aprimorou as habilidades estimuladas (nomeação de letras, associação letra-som/grafema-fonemas, consciência fonológica e leitura de palavras e pseudopalavras), e, também, aprimorou as habilidades de memória de trabalho fonológica e de escrita de palavras e pseudopalavras, que não foram diretamente estimuladas pelo programa. / The oral language and phonological processing skills, phonological awareness, phonological memory and fast access to the lexicon, are prerequisites for the acquisition of written language. Thus, children with difficulties in the acquisition and development of oral language and/or difficulties in one or more of phonological processing skills may be considered at risk for reading difficulties, the same child is standing still in preschool. The purpose of this study was to elaborate, apply and analyze a program of phonological decoding in children at risk for reading difficulties. Participated in this study were 30 children of both genders, with aged six and seven years and 11 months. This is an experimental study in which the studied group of children at risk for reading difficulties (formed by 10 children) underwent the phonological decoding intervention program, for comparison with the control group of children at risk for reading difficulty (formed by 10 children) and the control group of children without risk for reading difficulties (formed by 10 children), not submitted to the intervention program. The program was elaborated from the intervention proposal used by Rivers, Lombardino and Thompson and Rivers and Lombardino, the program contains 24 sessions, wherein the first 12 sessions were performed in groups of 2 to 3 children and other sessions were conducted individually, the sessions had 50 minutes and were held twice a week. Skills have been developed such as: naming and production of the sounds of the letters in uppercase and lowercase form; phonological awareness at the level of consciousness of words and syllables, and the level of phonemic awareness; reading with the aim of understanding of small books; read monosyllabic words syllable structure type consonant-vowel-consonant. The results revealed that children at risk for reading difficulty, submitted to phonological decoding intervention program showed improvement in the evaluation after intervention statistically significant for the performance of skills: naming letters; grapheme-phoneme relationship; phonological awareness; phonological memory to not words; phonological memory for digits in the forward; writing the alphabet in sequence; written under dictation of words and pseudowords; reading words and pseudowords. Therefore, the phonological decoding intervention program showed to be a beneficial tool for intervention of children at risk for reading difficulty, since was increased of the skills stimulated (naming letters, letter-sound association / grapheme-phoneme, phonological awareness and reading words and pseudowords), and also increased the working memory phonological and writing words and pseudo skills that were not stimulated directly by the program.

No description available.

In early childhood classrooms, transitions are often targeted as times of the day during which teachers encounter problems with deficiencies in child engagement, as well as frequent occurrences of challenging behavior. Studies to date on improving child behavior during in-class transitions have focused on providing supports for individual children, as well as on reducing transition duration. The present study evaluated the effects of systematic transition strategies, as applied to three Head Start preschool classrooms during targeted in-class transitions. Strategies encompassed an accumulation of antecedent and consequent manipulations and were selected on the basis of environmental fit with individual classroom environments. Participants included three Head Start preschool teachers and their respective students, all three to five years of age. The dependent measures examined in the study included mean percent classroom engagement and percent occurrence of challenging behavior, measured across all phases of the study (i.e., baseline, coaching and independent implementation). Results, evaluated in a multiple baseline probe across classrooms, indicated that with implementation of systematic transition strategies, mean percentages of classroom engagement within intervention phases (i.e., coaching and independent implementation) were higher and relatively more stable than those observed in baseline, within and across all three participating classrooms. Furthermore, mean percent occurrences of challenging behavior were lower and relatively more stable within phases of intervention (i.e., coaching and independent implementation) than those observed in baseline, within and across all three participating classrooms. Data on the accuracy with which teachers implemented selected strategies (i.e., treatment integrity) were also documented and presented in the context of results obtained. Implications for future research are discussed, in light of the limitations and findings of the current investigation.

Information collected from multiple domain child developmental assessments, known as five area assessments, are being used in early intervention for high stakes purposes such as program monitoring. As a result, it is important to examine variables that may affect test administration fidelity and its impact on obtaining valid data. The purpose of this study was to survey early intervention service providers in the state of Kentucky to determine possible independent variables that may affect their comfort level in administering five-domain tests. Surveys were made available to all early intervention service providers within the Kentucky First Steps early intervention program. Data were analyzed to determine the effect of independent variables such as: amount and format of training in administering assessments, amount and format of training in child development, years of experience, educational degree level, certification in interdisciplinary early childhood education, and discipline area on a provider’s comfort level in administering five area assessments. The results of the study indicated a statistically significant positive relationship between the amount of assessment training a provider received and their self-perceived comfort level in administering assessments.

The purpose of this research is to investigate the relationship between early intervention providers’ backgrounds, and their perceptions of caregiver coaching and auditory skill development, to develop professional development programs. An explanatory sequential design was used with participants of varying backgrounds and experience. In the first phase of the study, participants responded to a survey regarding their educational background, and their comfort with caregiver coaching and auditory skill development. Survey results were analyzed using Spearman’s Ranked Correlational Coefficient (Spearman’s rs) to form groups of participants from extreme cases. The second phase of the study consisted of participant interviews from each of the groups. Interviews were coded to identify themes present within and between groups. The information from both phases were analyzed to generate how professional preparation and certifications influence service delivery. Results were subsequently analyzed to determine potential improvements in the EI system, professional development, and policy.