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Background Measurement-Based Care (MBC) is the routine administration of measures, clinicians’ review of the feedback and discussion of the feedback with their clients, and collaborative evaluation of the treatment plan. Although MBC is a promising way to improve outcomes in clinical practice, the implementation of MBC faces many barriers, and its uptake by clinicians is low. The purpose of this study was to investigate whether implementation strategies that were developed with clinicians and aimed at clinicians had an effect on (a) clinicians’ uptake of MBC and (b) clients’ outcomes of MBC. Methods We used an effectiveness-implementation hybrid design based on Grol and Wensing’s implementation framework to assess the impact of clinician-focused implementation strategies on both clinicians’ uptake of MBC and outcomes obtained with MBC for clients in general mental health care. We hereby focused on the first and second parts of MBC, i.e., the administration of measures and use of feedback. Primary outcome measures were questionnaire completion rate and discussion of the feedback with clients. Secondary outcomes were treatment outcome, treatment length, and satisfaction with treatment. Results There was a significant effect of the MBC implementation strategies on questionnaire completion rate (one part of clinicians’ uptake), but no significant effect on the amount of discussion of the feedback (the other part of clinicians’ uptake). Neither was there a significant effect on clients’ outcomes (treatment outcome, treatment length, and satisfaction with treatment). Due to various study limitations, the results should be viewed as exploratory. Conclusions Establishing and sustaining MBC in real-world general mental health care is complex. This study helps to disentangle the effects of MBC implementation strategies on differential clinician uptake, but the effects of MBC implementation strategies on client outcomes need further examination.

A meta-analytic review was conducted to explain divergent findings on the relation between children's aggressive behavior and hostile attribution of intent to peers. Forty-one studies with 6,017 participants were included in the analysis. Ten studies concerned representative samples from the general population, 24 studies compared nonaggressive to extremely aggressive nonreferred samples, and 7 studies compared nonreferred samples with children referred for aggressive behavior problems. A robust significant association between hostile attribution of intent and aggressive behavior was found. Effect sizes differed considerably between studies. Larger effects were associated with more severe aggressive behavior, rejection by peers as one of the selection criteria, inclusion of 8- to-12-year-old participants, and absence of control for intelligence. Video and picture presentation of stimuli were associated with smaller effect sizes than was audio presentation. Staging of actual social interactions was associated with the largest effects. The importance of understanding moderators of effect size for theory development is stressed.

We examined (1) the extent to which the family-centered program Intensive Family Treatment (IFT) succeeds in realizing beneficial parental psychological empowerment and child behavioral outcomes both in single-parent and two-parent families and (2) how these outcomes are influenced by the presence of a co-caregiver as a potential source of empowerment. A group of 140 single-mother and 156 mother–father families was compared. Information about empowerment of parents and children’s behavioral problems was collected at the start and end of IFT and analyzed with cross-lagged panel analyses. Although single mothers and mothers in two-parent families were comparable in the extent of improvements in psychological empowerment (effect sizes were respectively 0.52 and 0.57) and child behavioral problems (effect sizes were both 0.49), they differ in how these improvements were achieved. For single-parent families, more maternal empowerment at the start of IFT was directly related to positive changes in child behavioral problems (β = −0.246, p < 0.01). Among two-parent families, more paternal empowerment at the start was directly related to improved maternal empowerment (β = 0.249, p < 0.001) but maternal empowerment at the start was not directly related to changes in the father’s empowerment. This study stresses the importance of taking into account the presence or absence of a co-caregiver as a potential source of psychological empowerment during family-centered programs as IFT.HighlightsPsychological empowerment of parents increases during Intensive Family Treatment (IFT).Child behavioral problems decreases during IFT.Single-mothers’ empowerment at the start effects children’s behavior at the end.Paternal empowerment at the start effects maternal empowerment at the end.

BackGroundStudies on feedback in youth mental health care are scarce and implementation of feedback into clinical practice is problematic.ObjectiveTo investigate potentially effective components of feedback from Routine Outcome Monitoring (ROM) in youth mental health care in the Netherlands through a three-arm, parallel-group, randomized controlled trial in which a literature-based, multi-faceted implementation strategy was used.MethodParticipants were randomly allocated to three conditions (basic feedback about symptoms and quality of life; basic feedback supplemented with clinical support tools; discussion of the feedback of the second condition with a colleague while following a standardized format for case consultation) using a block randomization procedure, stratified by location and participants’ age. The youth sample consisted of 225 participants (mean age = 15.08 years; 61.8% female) and the parent sample of 234 mothers and 54 fathers (mean age of children = 12.50 years; 47.2% female). Primary outcome was symptom severity. Secondary outcomes were quality of life and end-of-treatment variables. Additionally, we evaluated whether being Not On Track (NOT) moderated the association between condition and changes in symptom severity.ResultsNo significant differences between conditions and no moderating effect of being NOT were found. This outcome can probably be attributed to limited power and implementation difficulties, such as infrequent ROM, unknown levels of viewing and sharing of feedback, and clinicians’ poor adherence to feedback conditions.ConclusionsThe study contributes to our limited knowledge about feedback from ROM and underscores the complexity of research on and implementation of ROM within youth mental health care.Trial registration Dutch Trial Register NTR4234 .

In this study, the construct validity and reliability of the Empowerment questionnaire (EMPO) that was developed in Dutch youth care was examined. The 12-item EMPO focuses on measuring parental empowerment in raising their children. The three components of psychological empowerment (intrapersonal, interactional, and behavioral) form the rationale for the EMPO. Non-clinical ( n  = 673) and clinical ( n  = 1,212) data were used. Construct validity was tested by the factorial structure, measurement invariance, correlations with other instruments (PSQ-S and SDQ), and empowerment differences between the two groups. Reliability was determined by testing the internal consistency and test-retest reliability. The results show that the factorial validity of the EMPO was sufficient to good, the EMPO was measurement invariant for various subgroups, and the EMPO scales were negatively correlated with parenting stress (PSQ-S) and child behavioral problems scales (SDQ). Furthermore, the clinical group was less empowered, and the correlation between parental empowerment and child behavioral problems was stronger in this group. In addition, both groups of parents had relatively high scores on the interactional component. In the clinical group, however, parental scores on the interactional component were less correlated with scores on the intrapersonal and behavioral components. Finally, reliability analyses showed a largely sufficient to good internal consistency and test-retest reliability. The EMPO seems to be an instrument with sufficient to good construct validity and reliability. Further research is recommended regarding the underlying assumptions, other aspects of validity, representativeness, and the way it should be used as a tool by professionals for supporting parental empowerment.

Background The Evidence-Based Practice Attitude Scale (EBPAS) was developed in the United States to assess attitudes of mental health and welfare professionals toward evidence-based interventions. Although the EBPAS has been translated in different languages and is being used in several countries, all research on the psychometric properties of the EBPAS within youth care has been carried out in the United States. The purpose of this study was to investigate the psychometric properties of the Dutch version of the EBPAS. Methods After translation into Dutch, the Dutch version of the EBPAS was examined in a diverse sample of 270 youth care professionals working in five institutions in the Netherlands. We examined the factor structure with both exploratory and confirmatory factor analyses and the internal consistency reliability. We also conducted multiple linear regression analyses to examine the association of EBPAS scores with professionals’ characteristics. It was hypothesized that responses to the EBPAS items could be explained by one general factor plus four specific factors, good to excellent internal consistency reliability would be found, and EBPAS scores would vary by age, sex, and educational level. Results The exploratory factor analysis suggested a four-factor solution according to the hypothesized dimensions: Requirements, Appeal, Openness, and Divergence. Cronbach’s alphas ranged from 0.67 to 0.89, and the overall scale alpha was 0.72. The confirmatory factor analyses confirmed the factor structure and suggested that the lower order EBPAS factors are indicators of a higher order construct. However, Divergence was not significantly correlated with any of the subscales or the total score. The confirmatory bifactor analysis endorsed that variance was explained both by a general attitude towards evidence-based interventions and by four specific factors. The regression analyses showed an association between EBPAS scores and youth care professionals’ age, sex, and educational level. Conclusions The present study provides strong support for a structure with a general factor plus four specific factors and internal consistency reliability of the Dutch version of the EBPAS in a diverse sample of youth care professionals. Hence, the factor structure and reliability of the original version of the EBPAS seem generalizable to the Dutch version of the EBPAS.

EMOTIONAL/BEHAVIORAL PROBLEMS of 238 deaf Dutch children ages 4–18 years were studied. Parental reports indicated that 41% had emotional/behavioral problems, a rate nearly 2.6 times higher than the 16% reported by parents of a Dutch normative sample. Mental health problems seemed most prevalent in families with poor parent-child communication. Deaf children ages 12–18 showed more problems with anxiety and depression and more social problems than those ages 4–11. Deaf children with relatively low intelligence showed more social problems, thought problems, and attention problems than those with relatively high intelligence. The authors stress the need to get information on deaf children’s mental health functioning not just from parents but from other informants such as teachers and the children themselves. An expansion assessment of deaf children, and of special services and treatments for deaf children and adolescents with emotional/behavioral problems, is recommended.

Background The work of group care workers in residential youth care is often described as professional parenting. Pedagogical interventions of group care workers influence the quality of care for looked-after children. Objective The aim of the current study was to observe the pedagogical interventions of group care workers within residential youth care and their associations with child behaviors. Methods Group care worker interventions and child behaviors were videotaped during structured observations. Participants included 95 children (64 % boys, M age  = 9.19) and 53 group care workers (74 % female, M age  = 33.79 years). A coding system was developed to code pedagogical interventions and child behaviors. Results It showed that group care workers mainly used positive pedagogical interventions (warmth/support and positive control) and seldom used negative pedagogical interventions (permissiveness and negative control). Frustration and anger of children was associated with positive controlling interventions and permissiveness of group care workers. The hypothesis that child anxiety and nervousness is associated with warm and supportive interventions could not be confirmed. Conclusions Pedagogical interventions should be part of education, training, and supervision of group care workers.

Background In 2005 a new compulsory residential treatment program was developed for adolescents in need for protection against themselves or their environment. Objective The aim of the present study was to examine the association of structural treatment characteristics of this new residential treatment program (i.e., duration of treatment, discharge status, and group composition in terms of sex) with post-treatment functioning. Additionally, the number of pre-treatment risk factors was included in the model. Method A total of 301 adolescents (174 boys, 127 girls), with a mean age at time of admittance of 15.50 (SD = 1.26) participated in this study. The number of risk factors was derived from treatment files of the adolescents at time of entrance. Six months after discharge, adolescents participated in a telephone interview to measure ten post-treatment variables indicating how well they were doing. Results The results showed that duration of treatment was related to post-treatment living situation, in that adolescents who were in treatment for shorter durations were more likely to live on their own after treatment. For discharge status, findings suggested that adolescents who were regularly discharged had more frequent contact with their family; however, they also showed higher alcohol consumption 6 months after treatment. Group composition was related to the girls’ official offending, indicating that girls placed in mixed-sex groups showed significantly fewer official police contacts than did girls in girls-only treatment groups. Conclusion Overall, structural treatment characteristics were hardly related to the adolescents’ functioning after treatment. Suggestions for future research are discussed.

Boys with aggressive behavior problems are frequently taught to \"stop and think\" before they act. In provocative situations, pausing to monitor their own feelings, to consider the feelings of others, or to delay their response is believed to reduce aggressive behavior. This study aimed to test these assumptions. Thirty-two highly aggressive boys in special education and 31 normal comparison boys were presented vignettes concerning provocation by a peer and given specific cognitive assignments. Participants were either asked to (1) monitor and regulate their own emotions, (2) consider the provocateur's emotions and intentions, (3) wait 10 s, or (4) answer a factual question. The cognitive assignments differentially affected response aggressiveness. Monitoring and regulation of own emotions reduced aggressiveness in the aggressive group. Considering the peer's emotions and intentions tended to decrease aggressiveness in the normal comparison group and increase aggressiveness in the aggressive group. Delay increased response aggressiveness in the aggressive group as well. Answering factual questions had no effect on response aggressiveness. Implications for cognitive-behavioral interventions for aggressive boys are discussed.