Between 20% and 57% of patients at community mental health centers miss their first mental health appointment, resulting in wasted resources and longer wait times for other patients. To date, only one peer-reviewed quantitative study examined the relationship between appointment reminder practices and children's and adolescents' first appointment attendance rates for community mental health centers. The purpose of this quantitative study was to examine the relationship between first appointment wait times, electronic appointment reminders, phone appointment reminders, and first appointment attendance for U.S. community mental health centers, along with the potential moderating effects of age, ethnicity, and gender. Blumer's symbolic interaction theory served as the theoretical framework. Secondary data on was collected from 12 Texas-based community mental health centers covering 5,260 patients. Binary logistic regression uncovered the following key study findings: (a) wait time and message type significantly predicted appointment attendance; (b) e-mail appointment and text reminders were significantly more effective than were phone reminders; and (c) age, gender, and ethnicity moderated the relationship between wait time and message type, and first appointment attendance. The implications for positive social change include improving our understanding of the optimal appointment reminder tactics that increase children's and adolescents' mental health appointment attendance rates, improve operating efficiency of community health centers, and increase the likelihood that children and adolescents will receive needed mental health services.

Doctor of Philosophy (Phd) / Despite general agreement that severely emotionally disturbed children and adolescents are an "at risk" group, and that ongoing evaluation and research into the effectiveness of services provided for them is important, very little outcome evaluation actually takes place. The absence of well-conducted and appropriately interpreted studies is particularly notable for day or residential treatment programs, which cater for the most severely emotionally disturbed youths. This thesis outlines the main areas of conceptual, pragmatic and methodological confusion and neglect which impede progress in research in this area. It argues for plurality of data analytic strategies and research designs. It then critically reviews the reported findings about the effectiveness of day and residential treatment in specialist facilities, and the predictors of good outcomes for this treatment type. This review confirms that there is very little to guide practice. Having argued for the legitimacy of its methods and the necessity to address basic questions, the thesis reports the results of a naturalistic study based on data accumulated during a decade-long evaluative research program taking place at Arndell Child and Adolescent Unit, Sydney. The study addresses the question of what child, family and treatment variables predict outcome for 159 children and adolescents treated at this facility from 1990 to 1999. Statistically significant results with large effect size were obtained. Among the most disturbed subgroup of forty three children, (a) psychodynamic milieu-based treatment was shown to be more effective than the “empirically-validated” cognitive-behavioural treatment which superseded it in 1996, and (b) children from step-families showed better outcome than those from other family structures. Furthermore, it was found for the study sample as a whole that severe school-based problem behaviours were associated with a limited trajectory of improvement in home-based problem behaviour. These results are discussed with regard to implications for treatment, research methodology, policy and further studies.

Doctor of Philosophy (Phd) / Despite general agreement that severely emotionally disturbed children and adolescents are an "at risk" group, and that ongoing evaluation and research into the effectiveness of services provided for them is important, very little outcome evaluation actually takes place. The absence of well-conducted and appropriately interpreted studies is particularly notable for day or residential treatment programs, which cater for the most severely emotionally disturbed youths. This thesis outlines the main areas of conceptual, pragmatic and methodological confusion and neglect which impede progress in research in this area. It argues for plurality of data analytic strategies and research designs. It then critically reviews the reported findings about the effectiveness of day and residential treatment in specialist facilities, and the predictors of good outcomes for this treatment type. This review confirms that there is very little to guide practice. Having argued for the legitimacy of its methods and the necessity to address basic questions, the thesis reports the results of a naturalistic study based on data accumulated during a decade-long evaluative research program taking place at Arndell Child and Adolescent Unit, Sydney. The study addresses the question of what child, family and treatment variables predict outcome for 159 children and adolescents treated at this facility from 1990 to 1999. Statistically significant results with large effect size were obtained. Among the most disturbed subgroup of forty three children, (a) psychodynamic milieu-based treatment was shown to be more effective than the “empirically-validated” cognitive-behavioural treatment which superseded it in 1996, and (b) children from step-families showed better outcome than those from other family structures. Furthermore, it was found for the study sample as a whole that severe school-based problem behaviours were associated with a limited trajectory of improvement in home-based problem behaviour. These results are discussed with regard to implications for treatment, research methodology, policy and further studies.

Made available in DSpace on 2016-04-28T20:40:07Z (GMT). No. of bitstreams: 1 Renata Jordani Barbosa.pdf: 1136816 bytes, checksum: 5597799f6e5b8ecbc1c9110deee31434 (MD5) Previous issue date: 2009-05-29 / Introduction: Resilience is a human potential, present in individuals in all cultures and in all times, it is part of an evolutionary process and can be promoted since the birth. Studies about resilience aim the comprehension of how children, teen-agers and adults are capable of surviving and overcome obstacles, despite living in poverty, domestic violence and other risky situations. In modern society changes are increasingly fast and deep, requiring constant efforts of adaptation and, therefore, making resilience a challenge of this new age. The current paper is relevant to psychology professional because intends to translate and validate a scale of resilience for children and teenagers, given that there are still no instrument validated specifically for these populations. Objective: Translate, adapt and validate to the Portuguese language and the Brazilian population the original version of the Resiliency Scales for Children & Adolescents (RSCA), by Sandra Prince-Embury (2007). Method: The assumptions of Hambleton e Patsula (1999) were utilized for the translation and trans-cultural adaptation of the scale. Data gathering for the research was made in three schools (two public and one private) located in different communities in the city of Sao Paulo The sample size was 1226 children and teen-agers from 9 to 18 year old, 51% of those female. Outcomes: In order to verify the factors that compound the sub-scales CO, CR e RA, the author used factorial analysis for principal components and Varimax rotation. Factorial charges equal or greater than 0.3 were assumed and the adequacy of factorial analysis was verified according to KMO coefficient and Bartlett sphere test. Alpha Cronbach scores found in the Brazilian version (CO = 0.83, CR = 0.90 e RA = 0.87) were considered satisfactory compared to the results related by Prince- Embury (2007), indicating good internal consistent of the tool. The alpha coefficients were considered relevantly lower that the original ones in only three factors (adaptability, comfort and tolerance). Several concepts defined in this paper are theoretically related to themselves, reason why the formation of some factors shows that the items are ambiguous. This ambiguity was reflected in the factorial analysis. The factors that showed this relation were: optimism and self-efficacy (CO scale); trust and support (CR scale) / Introdução: A resiliência é um potencial humano, presente nos indivíduos em todas as culturas e em todos os tempos, é parte de um processo evolutivo e pode ser promovida desde o nascimento. Os estudos sobre resiliência procuram compreender como crianças, adolescentes e adultos são capazes de sobreviver e superar adversidades, apesar de viverem em condições de pobreza, violência familiar, ou em diversas outras situações de risco. Na sociedade moderna as mudanças estão cada vez mais rápidas e profundas, exigindo constantes esforços de adaptação e, portanto tornando a resiliência um desafio dessa nova era. O presente trabalho tem relevância para os profissionais de Psicologia, pois pretende traduzir e validar uma escala de resiliência para crianças e adolescentes, visto que ainda não existe instrumento validado especificamente para essa população. Objetivo: Traduzir, adaptar e validar para a língua portuguesa e para a população brasileira a versão original da escala Resiliency Scales for Children & Adolescents (RSCA) de Sandra Prince-Embury (2007). Método: Para a tradução e a adaptação transcultural da escala foram utilizadas as diretrizes propostas por Hambleton e Patsula (1999). A coleta de dados da pesquisa foi feita em três escolas situadas em diferentes distritos da cidade de São Paulo, duas da rede pública de ensino e uma particular. A amostra foi composta por 1226 crianças e adolescentes de 9 a 18 anos, sendo que 51% pertenciam ao sexo feminino. Resultados: Para verificar os fatores que compõem as subescalas CO, CR e RA, utilizou-se a análise fatorial por componentes principais e rotação varimax. Admitiu-se cargas fatoriais iguais ou maiores que 0,30 e a aplicabilidade da análise fatorial foi julgada de acordo com o coeficiente KMO e teste de esfericidade de Bartlett. Os escores de Alpha de Cronbach encontrados nas escalas (CO = 0.83, CR = 0.90 e RA = 0.87) na versão brasileira se mostraram satisfatórios em relação ao que foi relatado por Prince-Embury (2007), indicando boa consistência interna do instrumento. Apenas em três fatores (adaptabilidade, conforto e tolerância) os coeficientes alpha encontrados foram consideravelmente mais baixos do que os do original. Vários dos conceitos definidos neste estudo estão teoricamente relacionados entre si, razão pela qual a formação de alguns fatores mostra que os itens estão ambíguos, e esta ambiguidade conceitual refletiu na análise fatorial. Os fatores que demonstraram esta relação foram: na escala CO: otimismo e auto-eficácia; na escala CR: confiança e apoio

The purpose of the present work was to study hand impairments and manual ability in children with cerebral palsy (CP) as well as to clarify their relationship. Appraising the degree of hand impairments requires normative data to differentiate the real dysfunctions of CP children from the normal difficulties according to their age, sex, or handedness. As there is no normative data for gross manual and fine finger dexterity, a first experiment focused on the normal development of manipulative functions was conducted to establish these norms. A second experiment was carried out to develop and validate through the Rasch model a measure of manual ability in children with CP since such a measure was not yet available. The invariance of the ABILHAND-Kids questionnaire was also tested across relevant demographic and clinical subgroups of CP children. Finally, a third experiment was performed to quantify the hand impairments in children with CP and to investigate their relationship with manual ability as measured with the ABILHAND-Kids questionnaire. Hand motor impairments, markedly more prevalent than hand sensory impairments, were moderately correlated with manual ability measures and predicted 58% of their variance. Consequently, manual ability cannot simply be inferred from hand impairments and should be measured and treated per se. / L'objectif de ce travail était d'étudier les déficiences de la main et l'habileté manuelle chez les enfants infirmes moteurs d'origine cérébrale (IMOC) ainsi que de clarifier leur relation. Apprécier la gravité des déficiences de la main nécessite des données normatives afin de différencier les dysfonctionnements réels des enfants IMOC des difficultés normales compte tenu de leur âge, sexe, ou latéralité. Etant donné l'absence de normes quant à la dextérité manuelle grossière et la dextérité digitale fine, une première étude a été réalisée afin d'examiner le développement normal de ces deux types de dextérité. Des normes sur les dextérités manuelle grossière et digitale fine ont ainsi pu être établies. Une deuxième étude a été effectuée afin de développer et valider à travers le modèle de Rasch une mesure de l'habileté manuelle chez les enfants IMOC. L'invariance du questionnaire ABILHAND-Kids a également testée à travers différents sous-groupes démographiques et cliniques d'enfants IMOC. Enfin, une troisième étude a été réalisée afin de quantifier les déficiences de la main chez les enfants IMOC et d'investiguer leur relation avec l'habileté manuelle. Les déficiences motrices de la main, plus prévalentes que les déficiences sensitives, étaient modérément corrélées avec les mesures d'habileté manuelle et prédisaient 58% de leur variance. En conséquence, l'habileté manuelle ne peut être simplement inférée à partir des déficiences de la main et devrait donc être mesurée et traitée pour elle-même.

The purpose of the present work was to study hand impairments and manual ability in children with cerebral palsy (CP) as well as to clarify their relationship. Appraising the degree of hand impairments requires normative data to differentiate the real dysfunctions of CP children from the normal difficulties according to their age, sex, or handedness. As there is no normative data for gross manual and fine finger dexterity, a first experiment focused on the normal development of manipulative functions was conducted to establish these norms. A second experiment was carried out to develop and validate through the Rasch model a measure of manual ability in children with CP since such a measure was not yet available. The invariance of the ABILHAND-Kids questionnaire was also tested across relevant demographic and clinical subgroups of CP children. Finally, a third experiment was performed to quantify the hand impairments in children with CP and to investigate their relationship with manual ability as measured with the ABILHAND-Kids questionnaire. Hand motor impairments, markedly more prevalent than hand sensory impairments, were moderately correlated with manual ability measures and predicted 58% of their variance. Consequently, manual ability cannot simply be inferred from hand impairments and should be measured and treated per se. / L'objectif de ce travail était d'étudier les déficiences de la main et l'habileté manuelle chez les enfants infirmes moteurs d'origine cérébrale (IMOC) ainsi que de clarifier leur relation. Apprécier la gravité des déficiences de la main nécessite des données normatives afin de différencier les dysfonctionnements réels des enfants IMOC des difficultés normales compte tenu de leur âge, sexe, ou latéralité. Etant donné l'absence de normes quant à la dextérité manuelle grossière et la dextérité digitale fine, une première étude a été réalisée afin d'examiner le développement normal de ces deux types de dextérité. Des normes sur les dextérités manuelle grossière et digitale fine ont ainsi pu être établies. Une deuxième étude a été effectuée afin de développer et valider à travers le modèle de Rasch une mesure de l'habileté manuelle chez les enfants IMOC. L'invariance du questionnaire ABILHAND-Kids a également testée à travers différents sous-groupes démographiques et cliniques d'enfants IMOC. Enfin, une troisième étude a été réalisée afin de quantifier les déficiences de la main chez les enfants IMOC et d'investiguer leur relation avec l'habileté manuelle. Les déficiences motrices de la main, plus prévalentes que les déficiences sensitives, étaient modérément corrélées avec les mesures d'habileté manuelle et prédisaient 58% de leur variance. En conséquence, l'habileté manuelle ne peut être simplement inférée à partir des déficiences de la main et devrait donc être mesurée et traitée pour elle-même.

No / This paper considers the ethical tensions present when engaging in in-depth interviews with convicted sex offenders. Many of the issues described below are similar to those found in other sensitive areas of research. However, confidentiality and public protection are matters that require detailed consideration when the desire to know more about men who have committed serious and harmful offences is set against the possibility of a researcher not disclosing previously unknown sensitive information that relates to the risk of someone being harmed.