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1.
School Psych Rev ; 53(1): 1-16, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38487040

RESUMEN

Many racial-ethnic minoritized individuals are repeatedly exposed to subtle actions reflecting racial slights, termed racial microaggressions (RMAs), which are associated with adjustment problems in early adult and adult populations. Early adolescence represents a unique developmental period when minoritized youth begin their racial-ethnic identity exploration and are subjected to stereotypes and prejudice, thereby making them vulnerable to RMAs. Based upon the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist, a systematic literature search, screening and review of RMA literature focusing on high schoolers and younger youth was conducted and yielded 54 publications. This paper reviewed the publications and identified gaps in the field such as the need for systematic research on early adolescents including the frequency and severity of RMAs and the important contributions of peers, parents and teachers for RMA victims, and the need for more evidence-based programming for middle schoolers. Findings suggest that developing school-based microaggression anti-racism programs is clearly needed for minoritized and White youth.

2.
J Child Fam Stud ; 32(7): 1882-1894, 2023 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-37484688

RESUMEN

Peer victimization can be detrimental to youth. This study examines a particular type of peer victimization, relational peer victimization, and its effect on students' engagement in the classroom. We specifically investigate the longitudinal relationship between relational peer victimization and academic engagement in a sample of 204 Black 3rd through 5th grade elementary school students by utilizing multiple informants: students and their parents reported on relational peer victimization, and teachers reported on students' academic engagement. Our findings showed convergence between student and parent reports of relational peer victimization and revealed that experiencing relational peer victimization during the beginning of the school year (fall) negatively predicts teacher reported academic engagement towards the end of the school year (spring). Our study suggests that relational peer victimization is a critical issue that educators and researchers should consider when trying to foster academic engagement. There is also a need for further research regarding the role that families play in providing support to Black relationally victimized youth.

3.
Int J Bullying Prev ; 5(1): 79-87, 2023 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-37066126

RESUMEN

There is currently limited research on the relation between forms of empathy and subsequent cyberbullying in middle childhood, a stage in which cyberbullying behaviors are likely to develop. The purpose of this study was to examine the extent to which affective empathy (experiencing someone else's emotions) and cognitive empathy (perspective-taking) predicted subsequent cyberbullying perpetration in middle childhood. Participants were 105 fourth-and fifth-grade students from two urban elementary schools (M age = 9.66 years, SD = .68). The sample was 66% African American or Black, 15.2% biracial or multiracial, 7.6% Asian or Asian American, and 6.7% Hispanic or Latinx. The sample was evenly divided by gender (51.4% male). Youth completed surveys in the fall (time 1) and spring (time 2) of one school year. Contrary to hypotheses, affective empathy at time 1 did not uniquely predict any form of bullying perpetration (relational, overt, or cyber) at time 2. Cognitive empathy did not predict overt or relational bullying perpetration at time 2. However, higher cognitive empathy at time 1 predicted lower levels of cyberbullying perpetration at time 2. Results suggest promoting cognitive empathy should be a cyberbullying prevention strategy during middle childhood.

4.
Prev Sci ; 23(4): 552-562, 2022 05.
Artículo en Inglés | MEDLINE | ID: mdl-35089506

RESUMEN

The Preventing Relational Aggression in Schools Everyday (PRAISE) Program is a school-based program that has shown promise for reducing aggression. PRAISE, 20-session classroom-based universal prevention program, was designed to be appropriate and responsive to the needs of youth within the urban school context. A preliminary trial of PRAISE evinced positive effects for girls but was less effective for boys. Following the trial, the PRAISE program was adapted to enhance its impact for boys while maintaining its impact for girls. The current paper describes the changes and a new 3-school trial of the PRAISE program that examines its impact on subgroups. Results indicate that girls in PRAISE classrooms showed improvements in knowledge of social problem-solving strategies (SIP), reductions in hostile attributions (HAB), decreases in relational aggression, and suppression of overt aggression. Boys in PRAISE classrooms showed decreases in relational aggression and improvements in academic engagement, but no improvement in knowledge of SIP or HAB. Pooled analyses comparing boys' results from the initial trial and the current trial showed significant improvements in relational aggression and relational HAB with no differences in overt aggression, overt HAB, or SIP knowledge. Taken together, this iterative adaptation of PRAISE overcame many subgroup differences in program effects.


Asunto(s)
Agresión , Relaciones Interpersonales , Adolescente , Femenino , Humanos , Masculino , Grupo Paritario , Instituciones Académicas
5.
School Ment Health ; 14(3): 709-723, 2022 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-37077431

RESUMEN

Relational aggression is characterized by attempts to damage another's relationships or social status and is a major concern affecting academic, socioemotional, behavioral, and health outcomes, particularly for urban, minority youth. Teachers and peers frequently disagree about which students are relationally aggressive. Factors associated with peer and teacher discordant and concordant identification of relationally aggressive students were explored including prosocial behavior, perceived popularity, academic competence, and gender. Participants included 178 3rd-5th grade students across 11 urban classrooms. Findings revealed that students were more likely to be rated as relationally aggressive by their peers but not their teacher as scores on peer nominations for prosocial behavior decreased, while teacher-rated academic motivation/participation increased. Female students were more likely to be concordantly identified by peers and teachers as relationally aggressive when ratings for overt aggression increased. These results highlight the utility of obtaining ratings from multiple informants as well as the difficulty in accurately identifying all students who may benefit from interventions targeting relational aggression. Findings also suggest factors that may be related to the potential shortcomings of current measures and provide avenues for additional research to improve detection of relationally aggressive students.

6.
School Psych Rev ; 50(2-3): 454-468, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-35027784

RESUMEN

Peer bullying occurs frequently among middle school youth, negatively impacting students and the broader school climate. However, during these years there is a gap in translating empirically supported prevention science into school-based practices. This paper describes how the evidence-based Free2B bullying prevention multi-media assembly was disseminated by a team of educators, researchers, and technologists to over 14,000 students in 40 middle schools across the state. This dissemination and scaling effort was conducted in partnership with the state's government officials and Office of Safe Schools in order to ensure that each school and district across the state had equal access in applying for the programming. Over half of participating students expressed concerns about school bullying, with 36% reporting victimization and 17% reporting perpetration of bullying in the past month. Significant improvements were found in problem-solving knowledge, confidence in being a positive bystander, and sympathy for peer victims. We discuss gender and community setting differences (urban, suburban, rural) in the findings, implications for dissemination and implementation science, and school psychologists' role in disseminating bullying prevention practices.

7.
J Fam Psychol ; 35(3): 410-416, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32790468

RESUMEN

Despite research emphasizing the importance of parents in addressing children's bullying perpetration, there has been little prior research that explored how parental knowledge, particularly from child-initiated disclosure of their daily behaviors and experiences, may impact the child's overt, relational, and cyberbullying perpetration longitudinally. The current study examined the longitudinal relations between parent-reported child disclosure and the child's overt, relational, and cyberbullying perpetration, and the roles of parent-teacher connection in moderating the relations. This study utilized data gathered from 110 fourth to 5th grade children (M age = 10.35 years, SD = 8.75 months) and their parents/caregivers from 2 urban public schools in the United States. The analyses revealed that for children with high disclosure in the fall, stronger parent-teacher connection in the fall was significantly associated with less relational and cyberbullying perpetration in the spring. These findings suggest that high child-initiated disclosure itself might not be adequate in addressing children's bullying involvement and strong parent-teacher connection serves to protect children from increased covert bullying when they openly communicate with parents about their behaviors. This highlights the long-term importance of connections between teachers and parents in addressing relational and cyberbullying behaviors in underresourced urban schools. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Asunto(s)
Acoso Escolar/psicología , Conducta Infantil/psicología , Adolescente , Acoso Escolar/prevención & control , Niño , Revelación/estadística & datos numéricos , Femenino , Humanos , Relaciones Interpersonales , Estudios Longitudinales , Masculino , Padres/psicología , Sector Público , Maestros/psicología , Instituciones Académicas , Estados Unidos , Población Urbana
8.
J Interpers Violence ; 36(5-6): 2478-2497, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-29514551

RESUMEN

Unlike the overt nature of physical aggression, which lends itself to simpler and more direct methods of investigation, the often-masked nature of relational aggression has led to difficulties and debate regarding the most effective tools of study. Given concerns with the accuracy of third-party relational aggression reports, especially as individuals age, self-report measures may be particularly useful when assessing experiences with relational aggression. However, it is important to recognize validity concerns-in particular, the potential effects of item order presentation-associated with self-report of relational aggression perpetration and victimization. To investigate this issue, surveys were administered and completed by 179 young adults randomly assigned to one of four survey conditions reflecting manipulation of item order. Survey conditions included presentation of (a) perpetration items only, (b) victimization items only, (c) perpetration items followed by victimization items, and (d) victimization items followed by perpetration items. Results revealed that participants reported perpetrating relational aggression significantly more often when asked only about perpetration or when asked about perpetration before victimization, compared with participants who were asked about victimization before perpetration. Item order manipulation did not result in significant differences in self-reported victimization experiences. Results of this study indicate a need for greater consideration of item order when conducting research using self-report data and the importance of additional investigation into which form of item presentation elicits the most accurate self-report information.


Asunto(s)
Acoso Escolar , Víctimas de Crimen , Agresión , Humanos , Autoinforme , Encuestas y Cuestionarios , Adulto Joven
9.
Front Psychiatry ; 11: 679, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32765319

RESUMEN

OBJECTIVE: The objective of the current article is to highlight an example of a new paradigm, Scientific Edutainment. The manuscript describes how educational researchers and technologists worked together to develop a multi-media bullying prevention experience, called Free2B for middle school students paying particular attention to ensure that the programming was not only relevant to all students but also was appealing and responsive to the needs of urban youth. Bullying is the most common form of aggression experienced among school-aged youth, which impairs students' learning and social-emotional functioning and has financial costs to society. Given that the prevalence of bullying is highest in middle school, finding brief and feasible methods for motivating and sustaining change at this age is critically important, especially in the case of urban, under-resourced schools. METHOD: In response to this challenge, multidisciplinary bullying prevention researchers collaborated with international technologists to develop the Free2B multi-media bullying prevention experience through an iterative Community-Based Participatory Research (CBPR) approach. In addition, the research team conducted a series of pilot studies to iteratively develop and initially evaluate the multi-media program, helping to ensure relevance specifically for urban middle school youth. RESULTS: Results from the pilot studies indicated that the vast majority of middle school students found the Free2B multi-media bullying prevention experience to be enjoyable, relevant to their needs, and addressed important strategies to handle peer bullying and victimization. In addition, the brief prevention experience was associated with increases in problem-solving knowledge, prosocial attitudes about bullying, increased sympathy, and confidence in handling peer conflicts. CONCLUSION: The current paper illustrates the use of a new paradigm, termed Scientific Edutainment, as a way to combine evidenced-based developmental science with the latest in entertainment technology to provide innovative, engaging, and technologically-sophisticated educational programming.

11.
J Sch Violence ; 18(3): 362-374, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31462897

RESUMEN

Peer report of aggression has typically been obtained through peer nominations. The purpose of this study was to identify the extent to which peer nominations and peer ratings identified the same children as aggressive and to explore whether the two methods were equally accurate in identifying children at risk for poor social adjustment. Participants were 1051 students in third, fourth, or fifth grade and were predominantly African American (76.6%). Participants provided self-report of sympathy and peer nominations and ratings of overt and relational aggression, prosocial behavior, and leadership. Teachers reported on participants' school adjustment. Peer nominations and peer ratings of aggressive behavior were closely related. Peer ratings of overt and relational aggression emerged as a unique predictor of all indicators of adjustment, whereas peer nominations were uniquely associated with three of six outcomes of interest. Peer ratings are a promising approach to assessing aggression and may address problems of consumer acceptance.

12.
Psychol Serv ; 15(4): 386-397, 2018 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-30382734

RESUMEN

This study examined the efficacy of the Juvenile Justice Anger Management (JJAM) Treatment for Girls, an anger management and aggression reduction treatment designed to meet the unique needs of adolescent girls in residential juvenile justice facilities. This randomized controlled trial of JJAM compared changes in levels of anger and aggression among girls who participated in the JJAM treatment with those of girls who participated in treatment as usual (TAU) at the facilities. This study also investigated the theoretical model underlying the JJAM treatment, which proposed that reductions in hostile attribution biases, development of emotion regulation skills, and improvement in social problem solving would serve as mechanisms of action in JJAM. Participants were 70 female youth who ranged in age from 14 to 20 years (M = 17.45, SD = 1.24) and were placed at 1 of 3 participating juvenile justice facilities; 57 youth completed the study and were included in analyses. Results revealed greater reductions in anger, reactive physical aggression, and reactive relational aggression among girls in the JJAM treatment condition when compared to girls in the TAU control condition. The proposed theoretical model was partially supported via significant mediation findings; changes in hostile attribution bias were identified as a significant mechanism of action in the JJAM treatment. Results suggest that JJAM is a promising treatment to effectively reduce anger and reactive aggression among adolescent girls in juvenile justice placements. (PsycINFO Database Record (c) 2018 APA, all rights reserved).


Asunto(s)
Conducta del Adolescente/fisiología , Agresión/fisiología , Terapia de Manejo de la Ira/métodos , Ira/fisiología , Delincuencia Juvenil/prevención & control , Evaluación de Resultado en la Atención de Salud , Adolescente , Adulto , Femenino , Humanos , Modelos Psicológicos , Adulto Joven
14.
Behav Modif ; 40(4): 589-610, 2016 07.
Artículo en Inglés | MEDLINE | ID: mdl-27222262

RESUMEN

Girls often harm others' social standing by starting rumors about peers or by excluding others from peer group activities, which is called relational aggression. Although relational aggression is not a new phenomenon, there have been relatively few interventions designed to address this, especially for urban ethnic minority girls. The Friend to Friend (F2F) program, developed through an iterative participatory action research process, has proven to be effective in improving targeted relationally aggressive urban girls' social problem-solving knowledge and decreasing levels of relational aggression, with effects being maintained 1 year after treatment. In the current article, we examine the broader effects of the F2F program. Findings suggest that the indicated F2F program has broader effects such as increasing prosocial behaviors, decreasing relational and physical aggression, and improving teacher-student relationships among non-targeted boys. In addition, the program demonstrated some effects for non-targeted girls including an increase in prosocial behaviors and improved teacher-student relationships. Implications for examining the cost-effectiveness of indicated interventions such as F2F are discussed.


Asunto(s)
Agresión/psicología , Terapia Conductista/métodos , Conducta Infantil/psicología , Amigos/psicología , Relaciones Interpersonales , Distancia Psicológica , Niño , Femenino , Humanos , Masculino
15.
JAMA Pediatr ; 170(1): 70-7, 2016 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-26571032

RESUMEN

Pediatric health care networks serve millions of children each year. Pediatric illness and injury are among the most common potentially emotionally traumatic experiences for children and their families. In addition, millions of children who present for medical care (including well visits) have been exposed to prior traumatic events, such as violence or natural disasters. Given the daily challenges of working in pediatric health care networks, medical professionals and support staff can experience trauma symptoms related to their work. The application of a trauma-informed approach to medical care has the potential to mitigate these negative consequences. Trauma-informed care minimizes the potential for medical care to become traumatic or trigger trauma reactions, addresses distress, provides emotional support for the entire family, encourages positive coping, and provides anticipatory guidance regarding the recovery process. When used in conjunction with family-centered practices, trauma-informed approaches enhance the quality of care for patients and their families and the well-being of medical professionals and support staff. Barriers to routine integration of trauma-informed approaches into pediatric medicine include a lack of available training and unclear best-practice guidelines. This article highlights the importance of implementing a trauma-informed approach and offers a framework for training pediatric health care networks in trauma-informed care practices.


Asunto(s)
Servicios de Salud del Niño , Redes Comunitarias , Personal de Salud/psicología , Pacientes/psicología , Pediatría/métodos , Pediatría/tendencias , Heridas y Lesiones , Adaptación Psicológica , Niño , Servicios de Salud del Niño/organización & administración , Servicios de Salud del Niño/normas , Servicios de Salud del Niño/tendencias , Redes Comunitarias/normas , Redes Comunitarias/tendencias , Familia , Humanos , Atención Dirigida al Paciente/métodos , Atención Dirigida al Paciente/normas , Atención Dirigida al Paciente/tendencias , Pediatría/normas , Trauma Psicológico/etiología , Trastornos por Estrés Postraumático/psicología , Heridas y Lesiones/complicaciones
16.
Prog Community Health Partnersh ; 9(4): 549-60, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-26639381

RESUMEN

BACKGROUND: Although the partnership between academic researchers and community members is paramount to community-based research efforts, a limited number of measures exist to evaluate this construct. Of those in existence, no assessment measures include a comprehensive coverage of the many dimensions of partnerships. In addition, these measures were not designed through an extensive community-based participatory research (CBPR) model, in which the strengths of traditional assessment techniques were integrated with input from stakeholders. OBJECTIVES: The purpose of this article was to describe the creation of a measure to evaluate key dimensions of partnerships forged between researchers and community members using a CBPR approach to measurement development. METHODS: The iterative process of developing this measure consisted of integrating valuable feedback from community partners and researchers, via multiple rounds of item sorting and qualitative interviewing. RESULTS: The resultant measure, titled Partnership Assessment In community-based Research (PAIR), consists of 32 items, and comprises 5 dimensions: communication, collaboration, partnership values, benefits, and evaluation. The innovative process of using CBPR in the development of measures, the benefits of this approach, and the lessons learned are highlighted. CONCLUSIONS: PAIR was developed out of a need identified jointly by community members and researchers, and is intended to characterize the range of relationships between researchers and community members engaging in community-based research and programming.


Asunto(s)
Investigación Participativa Basada en la Comunidad/organización & administración , Relaciones Comunidad-Institución , Evaluación de Programas y Proyectos de Salud/métodos , Universidades/organización & administración , Comunicación , Investigación Participativa Basada en la Comunidad/normas , Conducta Cooperativa , Humanos , Evaluación de Programas y Proyectos de Salud/normas
17.
Matern Child Health J ; 19(2): 314-23, 2015 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-24907024

RESUMEN

To describe the development and psychometric evaluation of the Core Competency Measure (CCM), an instrument designed to assess professional competencies as defined by the Maternal Child Health Bureau (MCHB) and targeted by Leadership Education in Neurodevelopmental and Related Disabilities (LEND) programs. The CCM is a 44-item self-report measure comprised of six subscales to assess clinical, interdisciplinary, family-centered/cultural, community, research, and advocacy/policy competencies. The CCM was developed in an iterative fashion through participatory action research, and then nine cohorts of LEND trainees (N = 144) from 14 different disciplines completed the CCM during the first week of the training program. A 6-factor confirmatory factor analysis model was fit to data from the 44 original items. After three items were removed, the model adequately fit the data (comparative fit indices = .93, root mean error of approximation = .06) with all factor loadings exceeding .55. The measure was determined to be quite reliable as adequate internal consistency and test-retest reliability were found for each subscale. The instrument's construct validity was supported by expected differences in self-rated competencies among fellows representing various disciplines, and the convergent validity was supported by the pattern of inter-correlations between subscale scores. The CCM appears to be a reliable and valid measure of MCHB core competencies for our sample of LEND trainees. It provides an assessment of key training areas addressed by the LEND program. Although the measure was developed within only one LEND Program, with additional research it has the potential to serve as a standardized tool to evaluate the strengths and limitations of MCHB training, both within and between programs.


Asunto(s)
Discapacidades del Desarrollo/terapia , Personal de Salud/educación , Liderazgo , Centros de Salud Materno-Infantil/organización & administración , Competencia Profesional , Adulto , Niño , Discapacidades del Desarrollo/diagnóstico , Femenino , Investigación sobre Servicios de Salud , Humanos , Estudios Interdisciplinarios , Masculino , Desarrollo de Programa , Evaluación de Programas y Proyectos de Salud , Psicometría , Reproducibilidad de los Resultados , Estados Unidos
18.
Psychol Violence ; 5(4): 433-443, 2015 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-30079272

RESUMEN

OBJECTIVE: To determine the effectiveness of the Friend to Friend (F2F) aggression intervention through a clinical trial with urban African American girls. METHOD: A randomized parallel-group study design was conducted comparing the effectiveness of F2F to an attention control condition (called Homework Study Skills and Organization, HSO) among relationally aggressive girls from six urban low-income elementary schools. Analyses of covariance were utilized for comparing post-test measurement between the two conditions while adjusting for pre-test measurement. For those outcomes with significant intervention effects between the two conditions at post-test, we examined whether the effects were maintained from post-test to follow-up among girls in the F2F group. RESULTS: Results suggest that aggressive girls in F2F decreased their levels of relational aggression and increased their knowledge of social problem solving skills as compared to similar girls randomized to HSO, both of which were maintained at the one-year follow up. CONCLUSION: Programs developed through extensive partnership-based approaches, such as the F2F Program, may have promise for addressing the needs of urban high-risk girls in an acceptable and culturally-sensitive manner.

19.
Dev Psychopathol ; 26(3): 759-72, 2014 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-25047297

RESUMEN

Urban ethnic minority youth are often exposed to high levels of aggression and violence. As such, many aggression intervention programs that have been designed with suburban nonethnic minority youth have been used or slightly adapted in order to try and meet the needs of high-risk urban youth. The current study contributes to the literature base by examining how well a range of social-cognitive, emotional distress and victimization, and prosocial factors are related to youth aggression in a sample of urban youth. This study utilized data gathered from 109 9- to 15-year-old youth (36.7% male; 84.4% African American) and their parents or caregivers. A series of hierarchical multiple regressions were fit predicting youth aggression from social-cognitive variables, victimization and distress, and prosocial variables, controlling for youth gender and age. Each set of variables explained a significant and unique amount of the variance in youth aggressive behavior. The full model including all predictors accounted for 41% of the variance in aggression. Models suggest that youth with stronger beliefs supportive of violence, youth who experience more overt victimization, and youth who experience greater distress in overtly aggressive situations are likely to be more aggressive. In contrast, youth with higher self-esteem and youth who endorse greater leadership efficacy are likely to be less aggressive. Contrary to hypotheses, hostile attributional bias and knowledge of social information processing, experience of relational victimization, distress in relationally aggressive situations, and community engagement were not associated with aggression. Our study is one of the first to address these important questions for low-income, predominately ethnic minority urban youth, and it has clear implications for adapting aggression prevention programs to be culturally sensitive for urban African American youth.


Asunto(s)
Agresión/psicología , Liderazgo , Grupos Minoritarios/psicología , Autoeficacia , Percepción Social , Estrés Psicológico/psicología , Adolescente , Conducta del Adolescente/psicología , Negro o Afroamericano/psicología , Acoso Escolar/psicología , Niño , Cognición , Víctimas de Crimen/psicología , Femenino , Humanos , Masculino , Grupo Paritario , Violencia/prevención & control , Violencia/psicología
20.
Psychiatr Serv ; 65(3): 345-51, 2014 Mar 01.
Artículo en Inglés | MEDLINE | ID: mdl-24292685

RESUMEN

OBJECTIVE: This federally funded study examined implementation and outcomes of the Six Core Strategies for Reduction of Seclusion and Restraint (6CS) in 43 inpatient psychiatric facilities. METHODS: A prototype Inventory of Seclusion and Restraint Reduction Interventions (ISRRI) tracked fidelity over time. Outcome measures--seclusion and restraint events as percentages of total inpatient population and seclusion and restraint hours as percentages of total inpatient hours--conformed to licensed Behavioral Health Performance Measurement System specifications. Independent variables were facility and patient characteristics. Facilities were classified into five implementation types based on ISRRI scores: stabilized (N=28), continued (N=7), decreased (N=5), discontinued (N=1), or never implemented (N=2). For the stabilized group, linear modeling and random-effects meta-analysis compared the contribution of individual facilities to an overall effect. Subgroup analyses explored relationships between facility characteristics and outcomes. Dose-effect analysis tested the hypothesis that the stabilized group would have more positive outcomes. RESULTS: Overall, the stabilized group reduced the percentage secluded by 17% (p=.002), seclusion hours by 19% (p=.001), and proportion restrained by 30% (p=.03). The reduction in restraint hours was 55% but nonsignificant (p=.08). Individual facility effect sizes varied; some rates increased for some facilities. The dose-effect hypothesis was supported for two outcomes, seclusion hours and percentage restrained. The order of implementation group effects in relation to each outcome varied unpredictably. CONCLUSIONS: The 6CS was feasible to implement and effective in diverse facility types. Fidelity over time was nonlinear and varied among facilities. Further research on relationships between facility characteristics, fidelity patterns, and outcomes is needed.


Asunto(s)
Práctica Clínica Basada en la Evidencia/normas , Hospitales Psiquiátricos/normas , Aislamiento de Pacientes/normas , Servicio de Psiquiatría en Hospital/normas , Restricción Física/normas , Adulto , Estudios de Factibilidad , Implementación de Plan de Salud/normas , Investigación sobre Servicios de Salud , Humanos , Pacientes Internos/estadística & datos numéricos , Masculino , Evaluación de Resultado en la Atención de Salud , Evaluación de Programas y Proyectos de Salud , Factores de Tiempo
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