Evaluation of a pilot interprofessional education programme for eating disorder training in mental health services.

OBJECTIVE: To evaluate the effectiveness of an Interprofessional Education (IPE) programme in eating disorders for mental health practitioners using a case-based learning approach. METHODS: A total of 25 mental health clinicians were asked to evaluate their IPE programme as part of training for the National Clinical Programme in Eating Disorders. They completed a Readiness for Interprofessional Learning Scale (RIPLS), a learner reaction questionnaire after each session and a final open evaluation at 4 months. Non-parametric statistical analysis was employed to analyse learner attitudes and reactions, and qualitative information was coded. RESULTS: A total of 23 (92%) clinicians from five disciplines participated. Baseline attitudes towards IPE were positive on all RIPLS subscales, and those with prior IPE experience had most positive views as to its benefits for teamwork and patient care (p=0.036). Learner reactions on content, delivery, outcome and structure indicated that individual learning experience was strongly positively endorsed. Change in clinical practice behaviour was reported in terms of communication, clinical activity, outcome evaluation and confidence. Barriers included other demands on time, organisational support, not having enough patients or co-workers to practice skills, and knowledge differentials between learners. CONCLUSIONS: IPE using a case based learning approach is an effective and acceptable means of developing specialist training across existing service, team and professional boundaries. It has potential for positive impact on knowledge, clinical behaviour and service delivery. Recommendations include the introduction of IPE group guidelines, wider circulation of learning points and content, and the use of self-competency ratings and reflective logs.

The impact of news media on child abuse reporting.

This study explores the relationship between news stories on child abuse and neglect and reports of child abuse and neglect made to a mandated agency. Academic literature on crime news is reviewed to provide a context for interpretation. News stories from metropolitan daily newspapers were compared with child maltreatment reports made to mandated agencies on a local and national basis were surveyed over 25 years. The results suggested that both child maltreatment reports and news coverage increased over the period surveyed. However, rather than media stories increasing prior to increases in mandated reports and therefore contributing to the rise in reported cases, they appeared to increase at the same time. It is suggested that the initial cause of both increases may be national policy changes. More recent increases in child abuse reports may be due to economic downturns and other widespread societal changes rather than media attention.

The Early Infancy Temperament Questionnaire.

Although there are several scales routinely used for assessment of temperament during the first year of life, none of them is well suited to the infant younger than 4 months old. The Early Infancy Temperament Questionnaire (EITQ) was designed to meet this need. The EITQ is a 76-item parent questionnaire for assessing the nine New York Longitudinal Study temperament characteristics in 1- to 4-month-old infants. The majority of the items were adapted from the Revised Infant Temperament Questionnaire to be developmentally appropriate for the very young infant. The standardization population consisted of 404 infants from one pediatric practice. Means for the nine categories were calculated separately for infants from 1 to 2 months and 3 to 4 months old. Internal consistency for the nine categories ranged from .42 to .76. Test-retest scores, completed between 2 to 3 weeks after the first rating, ranged from .43 to .87, with generally increasing retest levels in the older age group. None of the categories showed significant differences between male and female infants. This newly developed instrument should enhance the ability of both researchers and clinicians to assess temperament reliably and to understand better its contribution to clinical problems in the very young child.

Temperamental factors associated with rapid weight gain and obesity in middle childhood.

Studies of the perplexing problem of childhood obesity have considered etiological factors in the child and environment, but have largely ignored the child's temperament or style of interaction with the environment. In this report, a significant relationship is demonstrated between temperament and both rapid weight gain and actual obesity in middle childhood. In a longitudinal study of 138 children, weight-for-height percentile gains between 4 to 5 years and 8 to 9 years were significantly correlated with eight of nine difficult temperament characteristics and with a cumulative "index of difficulty." A separate cross-sectional study of 21 obese (greater than or equal to the 95th percentile weight for height) 6- to 12-year-old children found them to be significantly less rhythmical/predictable and lower in persistence/attention span than matched controls. These normal behavioral style characteristics, interacting with metabolic, dietary, and environmental factors, may predispose some children to inappropriate eating habits or make it harder to maintain a dietary plan to remedy the problem.

The middle childhood temperament questionnaire.

The Middle Childhood Temperament Questionnaire is a 99-item parent questionnaire for assessing the New York Longitudinal Study temperament traits in 8- to 12-year-old children. The nine characteristics measured are the same except that biological rhythmicity has been replaced by predictability. The scale was standardized on 506 children in a pediatric and a school district. Internal consistency and retest reliability are satisfactory, respectively 0.81 and 0.88 for median category values. Together with the Infant Temperament Questionnaire, the Toddler Temperament Scale, and the Behavioral Style Questionnaire this completes a series of scales for gathering more objective and organized temperament data for 4 months to 12 years.

Differentiating minimal brain dysfunction and temperament.

After referral to a pediatric neurologist for problems in behavior and learning, 61 children aged from three to seven years were assigned to one of four diagnostic groups: (1) minimal brain dysfunction (MBD); (2) hyperactivity; (3) learning disability; and (4) other criteria. Their temperament profiles were determined by the Behavioral Style Questionnaire. The disproportionately large number of children with more difficult temperament diagnoses in the referred population indicates that teachers and physicians may have mininterpreted a less adaptive behavioral style as evidence of neurological dysfunction. Those diagnosed clinically as having MBD were less adaptable, less persistent, more active and more negative than the control population. This suggests that MBD overlaps with difficult temperament. Children in the other three groups were temperamentally similar to the MBD group, which raises doubt about the advisability of diagnosing MBD on the basis of behavior alone. A comprehensive neurobehavioral profile is necessary to separate clearly the various factors contributing to problems in school performance.

Revision of the Infant Temperament Questionnaire.

The Infant Temperament Questionnaire, originally published in 1970, has been revised to improve its psychometric characteristics. The number of items was increased from 70 to 95, rating options were increased from three to six, more items have high-low reversals, and they are randomized as to content area. The new form was standardized on 203 4- to 8-month-old infants. Good test-retest reliability was maintained and internal consistency of the nine categories was raised to a higher level, thereby assuring a greater reliability of the instrument. These improvements should enhance the questionnaire's use in clinical and research applications.

Temperament as a factor in early school adjustment.

Infant temperament profiles of "difficult," "intermediate," and "easy" in a randomly selected group of 51 children were shown to correlate with impulsivity and school adjustment at ages 5 1/2 to 7 years. However, the nonlinear relationship makes this a finding of uncertain significance. On the other hand, contemporaneous temperament determinations using the Behavioral Style Questionnaire completed by the children's mothers showed a significant correlation between the adaptability subscale and teacher judgments of school adjustment. This latter finding adds support to the view that temperament is a significant factor in school adjustment and that it can be measured by a clinical instrument appropriate for pediatric use.

Adaptive behavior scale, part II: a cautionary note and suggestions for revisions.

Problems were discussed in interpretation of Part II of the Adaptive Behavior Scale based on skewness of distribution and the grouping of items used in the scoring procedure. Suggestions were made for possible future revisions of Part II of the scale.