Magister Public Health - MPH / Adolescents living with HIV (ALHIV) are notably underserved by national HIV programmes globally due to their unique needs. Of particular concern is limited access to and availability of adolescent-friendly ART services, which contributes to poor ART adherence and retention in care in many sub-Saharan African countries. Poor adherence in adolescents has been associated with medicine side effects, pill fatigue, non-disclosure of status to the child, inadequate information on HIV, caregiver-child communication, caregiver’s health beliefs and stigma, and lack of knowledge on the rationale of taking medicines. Several interventions have been developed to improve ART adherence and retention in care amongst ALHIV through peer groups and psychosocial support. The Teen Club intervention was introduced in 2010 at Intermediate Hospital Katutura Paediatric ART clinic in Windhoek to improve ART adherence and retention in care amongst ALHIV by providing psychosocial support in a group environment. However, to date no formal evaluation of the effectiveness of the Teen Club intervention in Namibia has been conducted. The aim of the study was to compare the effects of the Teen Club intervention against standard care on treatment outcomes for ART (i.e. adherence, retention in care and viral suppression) in adolescents at Intermediate Hospital Katutura Paediatric ART clinic in Namibia. Methods: A retrospective cohort analysis of HIV positive adolescents aged 10-19 years, who were accessing ART between 1 July 2015 and 30 June 2017 was conducted. Patient data was extracted from the electronic Patient Monitoring System (ePMS), individual Patient Care Booklets and the teen club attendance register. Adherence to ART was measured through pill counts; and retention by kept clinic visits. Viral load results were assessed to measure levels of viral suppression. Adolescents with viral loads ≥ 1000 copies/ml were classified as not virally suppressed whilst those with viral loads <1000 are virally suppressed (with those <40 fully suppressed). Results: The total sample was 385 participants; with 78 of them in the Teen Club (exposed) and 307 adolescents in standard care (unexposed).

Background: During an age of fiscal constraint and increasing pressure to provide timely access to effective, efficient and evidence based care, there is an increased need for research to develop empirically based prevention and intervention strategies for complex psychological difficulties which often present during childhood and adolescence. Child and Adolescent Mental Health Services (CAMHS) are under significant pressure to deliver timely access to services, with demand frequently outstripping capacity to deliver. These challenges have highlighted the need for services to ensure that planning supports continued improvement in quality and delivers the best possible outcomes for service users. Systematic Review: A systematic review of the literature on the efficacy of group based interventions for adolescents with features or a diagnosis of Borderline Personality Disorder (BPD) was conducted. Seven articles met the inclusion criteria and underwent detailed quality analysis. All included studies reported a significant improvement in psychopathology and symptoms of distress as well as an improvement in quality of life for both group based interventions and treatment as usual. Overall, the results hold promise for current work with adolescents with BPD and highlight the importance for future research in this developing area. However, more rigorous research is required to identify the active ingredients of treatments for BPD in adolescents with a view to developing standardised treatment protocols. Empirical Study: A Delphi study was conducted to explore perceptions on the relevance, practicalities, importance and feasibility of implementing nationally agreed CAMHS referral criteria from the perspective of clinicians working in CAMHS in the North of Scotland. In addition, the study aimed to explore and gain consensus on possible factors which support clinicians working in specialist services. A three round electronic Delphi survey, an iterative structured process used to gather information and gain group consensus, was completed by twenty-eight clinicians working in CAMHS. Eight open ended questions in Round 1, were analysed using content analyses resulting in ninety-eight statements to be rated by the same group of clinicians in Round 2 and fifteen statements in Round 3. Of the ninety-eight statements, eighty-four reached consensus. Results indicate that the guidelines are viewed by many clinicians as both acceptable and important, however, implementation of the guidelines can present services with significant challenges and have highlighted the importance of services having the correct infrastructure before it is possible to implement the referral criteria in a consistent and meaningful way.

abstract: This study examined an adverse effect of an adolescent group intervention. Group interventions represent one of the most economical, convenient, and common solution to adolescent behavior problems, although prior findings from program evaluation studies have suggested that these groups can unexpectedly increase the externalizing behaviors that they were designed to reduce or prevent. The current study used data from a longitudinal, randomized controlled trial of the Bridges to High School / Puentes a La Secundaria Program, a multicomponent prevention program designed to reduce risk during the middle school transition, which has demonstrated positive effects across an array of outcomes. Data were collected at the beginning of 7th grade, with follow-up data collected at the end of the 7th, 8th, 9th, and 12th grade from a sample of Mexican American adolescents and their mothers. Analyses evaluated long-term effects on externalizing outcomes, trajectories of externalizing behaviors across adolescence, and potential mediators of observed effects. Results showed that the adverse effect that was originally observed based on adolescent self-report of externalizing symptoms at 1-year posttest among youth with high pretest externalizing symptoms was not maintained over time and was not reflected in changes in adolescents' trajectories of externalizing behaviors. Moreover, neither of the peer mediators that theory suggests would explain adverse effects were found to mediate the relationship between intervention status and externalizing symptoms at 1-year posttest. Finally, only beneficial effects were found on externalizing symptoms based on mother report. Together, these findings suggest that the Bridges intervention did not adversely affect adolescent problem behaviors and that future studies should use caution when interpreting unexpected adverse effects. / Dissertation/Thesis / Doctoral Dissertation Psychology 2015

The purpose of this study was to examine the effects of a combined narrative and expository language intervention on third graders' oral language. The participants included 96 third-grade students from two schools in the Mountain West region of the United States. In a quasi-experimental design, all third-grade students in one school (n = 46) were assigned to a treatment condition and all third-grade students in another school in the same school district (n = 50) were assigned to a control condition. Both treatment and control groups received large group oral narrative language intervention led by classroom teachers. The treatment group received additional large group expository language intervention led by the investigators. At posttest, students' narrative retells were analyzed for story grammar and language complexity. Primary and generalized expository outcomes were also analyzed for text structure and language complexity at posttest. Performances of the treatment and control groups were compared using ANCOVA across all measures. The results indicated that the control group and the treatment group did not have statistically significantly different narrative outcomes. However, the treatment group did make statistically significant improvements in expository text structure and some features of expository language complexity across both the primary and generalized expository measures when compared to the control group. This early efficacy study demonstrated the effects of a combined narrative and expository language intervention on expository language of third-grade students over and above narrative language intervention alone. It is possible that a dual focus on narrative and expository oral language instruction will not only impact students' oral language, but also reading comprehension and writing. Future research with a stronger experimental design should investigate the effect of narrative and expository oral language instruction on such distal outcomes.

Text in Afrikaans / This research dealt with the contribution of psychodynamic group interventions to organisational development (OD). The research consists of a qualitative investigation and was based on a case-study design with the use of multiple cases. Three different cases were presented, namely where a psychodynamic group intervention was used together with another intervention, where obstacles in a group were to be solved and as an in-house working conference. Random sampling was also done within the cases. Three interventions were done, data was gathered and analysed by means of content analysis, and the results were reported. It was found in all three cases that a unique contribution was made. Regarding the first case, the intervention was the beginning of a process of change whereby the participants were enabled to develop their identity as a group, from a family business to a company. Participants became aware of underlying conflict, started to own their roles in it, and to take responsibility for addressing the dynamics themselves. In the context in which the intervention was used, the contribution was, however, restricted because its value was only experienced after the intervention. Regarding the second case, the obstacles influencing the functioning of the team were addressed efficiently after the intervention. Participants were authorised to manage their boundaries more efficiently and to address role differentiation, leading to more open communication and a better work climate. Regarding the third case, it was found suitable especially for learning diagnostic competencies from a psychodynamic paradigm. Learning occurred on a personal level resulted in the ability of participants to identify dynamics in their organisation and to present similar interventions in their work place. Recommendations were made for the use of psychodynamic group interventions from a qualitative paradigm, as well as regarding the necessary competencies and a training programme for presenting psychodynamic group interventions. / Hierdie navorsing hande! oor die bydrae van psigodinamiese groepintervensies tot organisasie-ontwikkeiing (00). Die behoefte om onbewuste dinamika in organisasies aan te spreek, hettot hierdie navorsing aanleiding gegee. Die navorsing is in die vorm van 'n kwalitatiewe ondersoek en is gebaseer op 'n gevallestudie-navorsingsontwerp waarin daar van meervoudige gevalle gebruik gemaak is. Drieverskillendegevalleisaangebied, naamlikwaar'n psigodinamiese groepintervensie saam met 'n ander intervensie gebruik is, waar blokkasies in 'n groep opgelos moes word en as 'n in-huise werkskonferensie. Daar is ook van ewekansige steekproefneming binne elke geval gebruik gemaak. Drie intervensies is uitgevoer, data is ingesamel en deur middel van inhoudsontleding ontleed. Daar is bevind dat al drie gevaiie 'n unieke bydrae gelewer het. Ten opsigte van die eerste geval was die intervensie die begin van 'n veranderingsproses waardeur die deelnemers in staat gestel is om vanuit 'n familiebesigheid hu! identiteit as 'n maatskappy te ontwikkel. Deelnemers het bewus geword van onderliggende konflik, begin om hulle rolle daarin te eien, en verantwoordelikheid te aanvaar om die dinamika self aan te spreek. In die konteks waarin die intervensie gebruik was, was die bydrae egter beperk omdat die waarde daarvan eers na afloop van die intervensie ervaar is. Ten opsigte van die tweede geval is die blokkasie wat die funksionering van die span bei'nvloed het na afloop van die intervensie doeltreffend aangespreek. Deelnemers is bemagtig om hul grense meer doeltreffend te bestuur en roldifferensiasie aan te spreek, wat tot meer openlike kommunikasie en 'n beter werksklimaat aanleiding gegee het. Ten opsigte van die derde geval is bevind dat dit veral geskik was vir die aanleer van diagnostiesebevoegdhedevanuit'n psigodinamiese paradigma.Leerwatoppersoonlike vlak plaasgevind het, het tot gevolg gehad dat deelnemers in staatwas om die dinamika in hul organisasie te identifiseeren om self soortgelyke intervensies in hul werkplek aan te bied. Aanbevelings virdiegebruikvanpsigodinamiesegroepintervensiesvanuit'nkwaiitatiewe benadering tot 0 0 is gemaak, sowel as aanbevelings oordie noodsaaklike bevoegdhede en 'n opleidingsprogram vir die aanbied van psigodinamiese groepintervensies deur bedryfsielkundiges. / Industrial and Organisational Psychology / D.Admin. (Industrial and Organisational Psychology)

Text in Afrikaans / This research dealt with the contribution of psychodynamic group interventions to organisational development (OD). The research consists of a qualitative investigation and was based on a case-study design with the use of multiple cases. Three different cases were presented, namely where a psychodynamic group intervention was used together with another intervention, where obstacles in a group were to be solved and as an in-house working conference. Random sampling was also done within the cases. Three interventions were done, data was gathered and analysed by means of content analysis, and the results were reported. It was found in all three cases that a unique contribution was made. Regarding the first case, the intervention was the beginning of a process of change whereby the participants were enabled to develop their identity as a group, from a family business to a company. Participants became aware of underlying conflict, started to own their roles in it, and to take responsibility for addressing the dynamics themselves. In the context in which the intervention was used, the contribution was, however, restricted because its value was only experienced after the intervention. Regarding the second case, the obstacles influencing the functioning of the team were addressed efficiently after the intervention. Participants were authorised to manage their boundaries more efficiently and to address role differentiation, leading to more open communication and a better work climate. Regarding the third case, it was found suitable especially for learning diagnostic competencies from a psychodynamic paradigm. Learning occurred on a personal level resulted in the ability of participants to identify dynamics in their organisation and to present similar interventions in their work place. Recommendations were made for the use of psychodynamic group interventions from a qualitative paradigm, as well as regarding the necessary competencies and a training programme for presenting psychodynamic group interventions. / Hierdie navorsing hande! oor die bydrae van psigodinamiese groepintervensies tot organisasie-ontwikkeiing (00). Die behoefte om onbewuste dinamika in organisasies aan te spreek, hettot hierdie navorsing aanleiding gegee. Die navorsing is in die vorm van 'n kwalitatiewe ondersoek en is gebaseer op 'n gevallestudie-navorsingsontwerp waarin daar van meervoudige gevalle gebruik gemaak is. Drieverskillendegevalleisaangebied, naamlikwaar'n psigodinamiese groepintervensie saam met 'n ander intervensie gebruik is, waar blokkasies in 'n groep opgelos moes word en as 'n in-huise werkskonferensie. Daar is ook van ewekansige steekproefneming binne elke geval gebruik gemaak. Drie intervensies is uitgevoer, data is ingesamel en deur middel van inhoudsontleding ontleed. Daar is bevind dat al drie gevaiie 'n unieke bydrae gelewer het. Ten opsigte van die eerste geval was die intervensie die begin van 'n veranderingsproses waardeur die deelnemers in staat gestel is om vanuit 'n familiebesigheid hu! identiteit as 'n maatskappy te ontwikkel. Deelnemers het bewus geword van onderliggende konflik, begin om hulle rolle daarin te eien, en verantwoordelikheid te aanvaar om die dinamika self aan te spreek. In die konteks waarin die intervensie gebruik was, was die bydrae egter beperk omdat die waarde daarvan eers na afloop van die intervensie ervaar is. Ten opsigte van die tweede geval is die blokkasie wat die funksionering van die span bei'nvloed het na afloop van die intervensie doeltreffend aangespreek. Deelnemers is bemagtig om hul grense meer doeltreffend te bestuur en roldifferensiasie aan te spreek, wat tot meer openlike kommunikasie en 'n beter werksklimaat aanleiding gegee het. Ten opsigte van die derde geval is bevind dat dit veral geskik was vir die aanleer van diagnostiesebevoegdhedevanuit'n psigodinamiese paradigma.Leerwatoppersoonlike vlak plaasgevind het, het tot gevolg gehad dat deelnemers in staatwas om die dinamika in hul organisasie te identifiseeren om self soortgelyke intervensies in hul werkplek aan te bied. Aanbevelings virdiegebruikvanpsigodinamiesegroepintervensiesvanuit'nkwaiitatiewe benadering tot 0 0 is gemaak, sowel as aanbevelings oordie noodsaaklike bevoegdhede en 'n opleidingsprogram vir die aanbied van psigodinamiese groepintervensies deur bedryfsielkundiges. / Industrial and Organisational Psychology / D.Admin. (Industrial and Organisational Psychology)

Stress och sömnsvårigheter är centrala faktorer i psykisk ohälsa. Många personer drabbade av dessa hälsobesvär är i behov av behandling, vilket skapar ett högt tryck på vården. I tillägg antas en tredjedel av alla somatiska symptom inom vården vara associerade med psykisk ohälsa. I denna studie utvärderades två gruppbaserade interventioner, en stresskola och en sömnskola, administrerade av psykologstudenter vid Umeå universitet. Skolorna bestod av fyra träffar och baserades på kognitiv beteendeterapi (KBT). Med utgångspunkt i tidigare forskning testades hypotesen att interventionerna har hälsogynnande korttidseffekter med avseende på stress och sömnsvårigheter, men också på psykisk ohälsa i form av ångest, depression, utbrändhet samt somatiska symptom. Även skillnader i korttidseffekter mellan stress- och sömnskolan undersöktes. I studien deltog 95 individer (71 kvinnor och 24 män) som hade sökt hjälp för stress- eller sömnrelaterade besvär inom primärvården i Umeå. Genomsnittsåldern var 40.1 år. Data samlades in med validerade självskattningsinstrument före och efter behandling. Data analyserades genom tvåvägsvariansanalyser med Behandling som inomgruppsfaktor (för- vs eftermätning) och Typ av skola (stress vs sömn) som mellangruppsfaktor. Analysen visade på signifikanta effekter på samtliga utfallsvariabler, vilket betyder att stress- och sömnskolorna hade hälsogynnande korttidseffekter. Inga signifikanta skillnader i effekt upptäcktes skolorna emellan. Studiens resultat ger stöd för att fortsätta med interventionerna inom hälso- och sjukvården i Umeå. / Stress and sleep disturbances are key factors in mental ill-health. Many individuals suffering from these conditions are in need of treatment, leading to high demands on the health care system. In addition, about one third of the somatic symptoms in healthcare are believed to be associated with mental ill-health. In the present study two group interventions were evaluated, aimed at managing stress and sleep disturbances respectively. These were administered by clinical psychology students at Umeå University, consisted of four sessions and were based on cognitive behavioural therapy (CBT). Building on previous research, the hypothesis tested in the present study was that the interventions have positive effects on stress and sleep disturbances as well as other related mental ill-health conditions such as anxiety, depression, burnout and somatic symptoms. Short term differences between the two interventions were also examined. The total sample consisted of 95 individuals (71 women and 24 men) who had seeked treatment due to stress or sleep disturbances in the primary care in Umeå, Sweden. The mean age was 40.1 years.  The data were collected before and after treatment from validated questionnaire instruments. Data were analyzed with two-way analysis of variance with treatment as a within subject factor and type of intervention as a between subject factor. The results showed that the participants were significantly improved on all outcome variables regarding health after treatment. No significant differences between the two interventions were found. The findings support further use of the treatment interventions within the health care system in Umeå.

Il presente progetto di ricerca si occupa degli interventi di gruppo per figli di genitori separati, con la finalità di operare una riflessione di stampo metodologico sui dispositivi che sono stati analizzati e studiati in letteratura, per poi approfondire alcuni aspetti dell’intervento Gruppi di Parola, attivo in Italia. L’articolazione in tre studi, di carattere qualitativo, ha permesso di avvicinare l’oggetto di ricerca secondo prospettive e metodologie differenti. Il primo studio coincide con una rassegna sistematica narrativa, condotta al fine di sistematizzare la letteratura di livello internazionale relativa agli interventi di gruppo per figli di genitori separati che sono stati analizzati attraverso un impianto di ricerca rigoroso. Gli altri studi approfondiscono rispettivamente due aspetti del dispositivo Gruppi di Parola: gli elementi teorico-pratici che lo fondano attraverso una prospettiva etnografica focalizzata (secondo studio) e le dinamiche interattive messe in movimento durante una specifica fase rituale del processo (l’accoglienza) per mezzo di una metodologia osservativa complessa (terzo studio). / The present research project deals with group interventions for children having separated parents. Its aim is a methodological reflection about the programs analyzed and studied in the literature in order to later deepen some aspects of the Italian intervention Gruppi di Parola. The organization in three qualitative studies has allowed the researcher to approach the research object according to different perspectives and methodologies. The first study corresponds to a Systematic Narrative Review, carried out in order to systematize the international literature about the group interventions for children having separated parents which have been analyzed through a rigorous research design. The other studies respectively deepen two aspects of the intervention Gruppi di Parola: the theoretical and practical underpinnings through a focused ethnographic perspective (second study) and the interactive dynamics activated during a specific ritual phase of the process (welcoming) by means of a complex observational methodology (third study).

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