%0 Journal Article %J Residential Treatment for Children & Youth %D 2016 %T Therapeutic Residential Care for Children and Youth: A Consensus Statement of the International Work Group on Therapeutic Residential Care %A Whittaker, James K. %A Holmes, Lisa %A Del Valle, Jorge F. %A Ainsworth, Frank %A Andreassen, Tore %A Anglin, James %A Bellonci, Christopher %A Berridge, David %A Bravo, Amaia %A Canali, Cinzia %A Courtney, Mark %A Currey, Laurah %A Daly, Daniel %A Gilligan, Robbie %A Grietens, Hans %A Harder, Annemiek %A Holden, Martha %A James, Sigrid %A Kendrick, Andrew %A Knorth, Erik %K Children -- Institutional care %K Foster Home Care %K Group homes for children %K Institutional care %K Residential care %X

 The article focuses on the consensus statement on therapeutic residential care developed jointly by an international consortium of experts on residential care. It highlights the efforts of British Prime Minister David Cameron in reviewing the role and purpose of residential placements within the wider child welfare system. Information about the working definition of therapeutic residential care is also offered.

%B Residential Treatment for Children & Youth %V 33 %P 89-106 %8 Apr-Jun2016 %G eng %N 2 %R 10.1080/0886571X.2016.1215755 %0 Journal Article %J J Evid Based Soc Work %D 2013 %T Achieving placement stability. %A Carnochan, Sarah %A Moore, Megan %A Austin, Michael J %K Adoption %K Child %K Child Welfare %K Decision Making %K Emotions %K Family %K Foster Home Care %K Government Agencies %K Humans %K Parent-Child Relations %K Parents %K Problem Solving %K Social Work %X

Placement stability as an outcome goal in child welfare performance measurement is grounded in the importance of providing stability for children as they are developing attachments and relationships to caregivers. Research shows that many children are vulnerable to placement instability, especially those who have been in long term foster care. This literature review provides an overview of the federal placement stability measure. It then summarizes the diverse set of factors has been found to be associated with placement instability, including characteristics of the child and family of origin, placement type and quality, and the child welfare system and services. Promising practices aimed at promoting placement stability are summarized, followed by questions designed to foster discussion about the relationship of the evidence to child welfare practice.

%B J Evid Based Soc Work %V 10 %P 235-53 %8 2013 %G eng %N 3 %R 10.1080/15433714.2013.788953 %0 Journal Article %J J Evid Based Soc Work %D 2013 %T Achieving timely adoption. %A Carnochan, Sarah %A Moore, Megan %A Austin, Michael J %K Adoption %K Age Factors %K Child %K Child Welfare %K Foster Home Care %K Government Agencies %K Humans %K Parents %K Sex Factors %K Social Work %K Socioeconomic Factors %K Time Factors %X

While family reunification is the primary permanency objective for children who must be placed temporarily outside of their homes, reunification is not possible for all children. For those children who do not return to their parents and cannot find permanent homes with other family members, adoption is the favored outcome. This review examines the composite measure in the federal Child and Family Services Review that measures agency performance related to the timeliness of adoptions of foster children. It summarizes the multiple factors that research has found to be associated with increased risk for adoption delay and disruption. These include child characteristics, family of origin and adoptive family characteristics, and features of child welfare services and systems. Practices that have been broadly linked to adoption timeliness or address risk factors associated with delays in adoption are described, including social worker activities and agency or system-wide practice.

%B J Evid Based Soc Work %V 10 %P 210-9 %8 2013 %G eng %N 3 %R 10.1080/15433714.2013.788950 %0 Journal Article %J Health Educ Res %D 2013 %T The impact of school alcohol policy on student drinking. %A Evans-Whipp, Tracy J %A Plenty, Stephanie M %A Catalano, Richard F %A Herrenkohl, Todd I %A Toumbourou, John W %K Adolescent %K Adolescent Behavior %K Alcohol Drinking %K Binge Drinking %K Cross-Cultural Comparison %K Female %K Guideline Adherence %K Humans %K Longitudinal Studies %K Male %K Organizational Policy %K Risk Reduction Behavior %K Schools %K Self Report %K Social Class %K Students %K Victoria %K Washington %X

Although it is common for secondary schools to implement alcohol policies to reduce alcohol misuse, there has been little evaluation of the efficacy of these policies. The purpose of this study was to test the impact of the degree and type of alcohol policy enforcement in state representative samples of secondary students in Washington State, USA, and Victoria, Australia (n = 1848). Multivariate logistic regressions were used to examine the prospective association between student reports of school alcohol policy in Grade 8 and self-reported alcohol use in Grade 9, controlling for age, gender, state, family socio-economic status and Grade 8 alcohol use. The likelihood of students drinking on school grounds was increased when students perceived lax policy enforcement. Student perceptions of harm minimization alcohol messages, abstinence alcohol messages and counselling for alcohol policy violators predicted reduced likelihood of binge drinking. Students perceiving harm minimization messages and counselling for alcohol policy violators had a reduced likelihood of experiencing alcohol-related harms. Perceptions of harsh penalties were unrelated to drinking behaviour. These results suggest that perceived policy enforcement may lessen drinking at school 1 year later and that harm minimization messages and counselling approaches may also lessen harmful drinking behaviours as harm minimization advocates suggest.

%B Health Educ Res %V 28 %P 651-62 %8 2013 Aug %G eng %N 4 %R 10.1093/her/cyt068 %0 Journal Article %J Soc Work Public Health %D 2013 %T Science-based prevention through Communities That Care: A model of social work practice for public health. %A Haggerty, Kevin P %A Shapiro, Valerie B %K Alcoholism %K Community Medicine %K Continuity of Patient Care %K Evidence-Based Practice %K Guidelines as Topic %K Humans %K Models, Organizational %K Public Health Practice %K Risk Factors %K Social Work %K Substance-Related Disorders %X

This article describes a public health orientation to drug and alcohol abuse prevention; reviews the state of the science underlying a risk and protective factor approach to alcohol and drug abuse prevention; describes Communities That Care, a community practice model that makes use of this evidence; and considers how this model reflects four important principles of social work practice. The intent of this article is to provide guidance to social workers who support the National Association of Social Work's intention to make prevention practice central to the provision of alcohol and drug abuse services by social workers.

%B Soc Work Public Health %V 28 %P 349-65 %8 2013 %G eng %N 3-4 %R 10.1080/19371918.2013.774812 %0 Journal Article %J JAMA Pediatr %D 2013 %T Twelve-month follow-up of cognitive behavioral therapy for children with functional abdominal pain. %A Levy, Rona L %A Langer, Shelby L %A Walker, Lynn S %A Romano, Joan M %A Christie, Dennis L %A Youssef, Nader %A DuPen, Melissa M %A Ballard, Sheri A %A Labus, Jennifer %A Welsh, Ericka %A Feld, Lauren D %A Whitehead, William E %K Abdominal Pain %K Adaptation, Psychological %K Adolescent %K Adult %K Child %K Cognitive Therapy %K Female %K Follow-Up Studies %K Gastrointestinal Diseases %K Humans %K Illness Behavior %K Linear Models %K Male %K Middle Aged %K Pain Measurement %K Parent-Child Relations %K Prospective Studies %K Treatment Outcome %X

OBJECTIVE: To determine whether a brief intervention for children with functional abdominal pain and their parents' responses to their child's pain resulted in improved coping 12 months later.

DESIGN: Prospective, randomized, longitudinal study.

SETTING: Families were recruited during a 4-year period in Seattle, Washington, and Morristown, New Jersey.

PARTICIPANTS: Two hundred children with persistent functional abdominal pain and their parents.

INTERVENTIONS: A 3-session social learning and cognitive behavioral therapy intervention or an education and support intervention.

MAIN OUTCOME MEASURES: Child symptoms and pain-coping responses were monitored using standard instruments, as was parental response to child pain behavior. Data were collected at baseline and after treatment (1 week and 3, 6, and 12 months after treatment). This article reports the 12-month data.

RESULTS: Relative to children in the education and support group, children in the social learning and cognitive behavioral therapy group reported greater baseline to 12-month follow-up decreases in gastrointestinal symptom severity (estimated mean difference, -0.36; 95% CI, -0.63 to -0.01) and greater improvements in pain-coping responses (estimated mean difference, 0.61; 95% CI, 0.26 to 1.02). Relative to parents in the education and support group, parents in the social learning and cognitive behavioral therapy group reported greater baseline to 12-month decreases in solicitous responses to their child's symptoms (estimated mean difference, -0.22; 95% CI, -0.42 to -0.03) and greater decreases in maladaptive beliefs regarding their child's pain (estimated mean difference, -0.36; 95% CI, -0.59 to -0.13).

CONCLUSIONS: Results suggest long-term efficacy of a brief intervention to reduce parental solicitousness and increase coping skills. This strategy may be a viable alternative for children with functional abdominal pain.

TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00494260.

%B JAMA Pediatr %V 167 %P 178-84 %8 2013 Feb %G eng %N 2 %R 10.1001/2013.jamapediatrics.282 %0 Journal Article %J Am J Public Health %D 2013 %T Using genetically informed, randomized prevention trials to test etiological hypotheses about child and adolescent drug use and psychopathology. %A Brody, Gene H %A Beach, Steven R H %A Hill, Karl G %A Howe, George W %A Prado, Guillermo %A Fullerton, Stephanie M %K Adolescent %K Child %K Gene-Environment Interaction %K Genetics, Behavioral %K Humans %K Molecular Biology %K Psychopathology %K Randomized Controlled Trials as Topic %K Research Design %K Risk Factors %K Substance-Related Disorders %X

In this essay, we describe a new era of public health research in which prevention science principles are combined with genomic science to produce gene × intervention (G × I) research. We note the roles of behavioral and molecular genetics in risk and protective mechanisms for drug use and psychopathology among children and adolescents, and the results of first-generation genetically informed prevention trials are reviewed. We also consider the need for second-generation research that focuses on G × I effects on mediators or intermediate processes. This research can be used to further understanding of etiological processes, to identify individual differences in children's and adolescents' responses to risk, and to increase the precision of prevention programs. We note the caveats about using genetic data to select intervention participants.

%B Am J Public Health %V 103 Suppl 1 %P S19-24 %8 2013 Oct %G eng %R 10.2105/AJPH.2012.301080 %0 Journal Article %J Addiction %D 2012 %T Brief motivational feedback and cognitive behavioral interventions for prevention of disordered gambling: a randomized clinical trial. %A Larimer, Mary E %A Neighbors, Clayton %A Lostutter, Ty W %A Whiteside, Ursula %A Cronce, Jessica M %A Kaysen, Debra %A Walker, Denise D %K Adult %K Biofeedback, Psychology %K Cognitive Therapy %K Cost of Illness %K Female %K Gambling %K Humans %K Internal-External Control %K Male %K Patient Compliance %K Treatment Outcome %K Young Adult %X

AIMS: The purpose of the current study was to evaluate feasibility and efficacy of two promising approaches to indicated prevention of disordered gambling in a college population.

DESIGN: Randomized clinical trial with assignment to a personalized feedback intervention (PFI), cognitive-behavioral intervention (CBI) or assessment-only control (AOC). PFI was delivered individually in a single session and included feedback regarding gambling behavior, norms, consequences and risk-reduction tips, delivered in a motivational interviewing style. CBI was delivered in small groups over four to six sessions and included functional analysis and brief cognitive correction, as well as identification of and alternatives for responding to gambling triggers.

SETTING: College campus.

PARTICIPANTS: At-risk or probable pathological gamblers (n = 147; 65.3% male; group assignment: PFI, n = 52; CBI, n = 44; AOC, n = 51).

MEASUREMENTS: Self-reported gambling quantity, frequency, consequences, psychopathology, normative perceptions and beliefs.

FINDINGS: Relative to control, results at 6-month follow-up indicated reductions in both interventions for gambling consequences (PFI d = 0.48; CBI d = 0.39) and DSM-IV criteria (PFI d = 0.60; CBI d = 0.48), reductions in frequency for PFI (d = 0.48). CBI was associated with reduced illusions of control, whereas PFI was associated with reduced perceptions of gambling frequency norms. Reductions in perceived gambling frequency norms mediated effects of PFI on gambling frequency.

CONCLUSIONS: A single-session personalized feedback intervention and a multi-session cognitive-behavioral intervention may be helpful in reducing disordered gambling in US college students.

%B Addiction %V 107 %P 1148-58 %8 2012 Jun %G eng %N 6 %R 10.1111/j.1360-0443.2011.03776.x %0 Journal Article %J Social Service Review %D 2012 %T Child Protection Systems: International Trends and Orientations. %A Whittaker, James K. %K Child protection services %K Child Protection Systems: International Trends & Orientations (Book) %K Gilbert, Neil %K Nonfiction %X

The article reviews the book "Child Protection Systems: International Trends and Orientations," by Neil Gilbert.

%B Social Service Review %8 2012/06/ %G eng %0 Journal Article %J Clin Ther %D 2012 %T Efficacy and safety profile of fluticasone furoate administered once daily in the morning or evening: a randomized, double-blind, double-dummy, placebo-controlled trial in adult and adolescent patients with persistent bronchial asthma. %A Medley, Hilary %A Orozco, Socorro %A Allen, Ann %K Administration, Inhalation %K Adolescent %K Adult %K Analysis of Variance %K Androstadienes %K Asthma %K Bronchodilator Agents %K Chile %K Double-Blind Method %K Drug Administration Schedule %K Equipment Design %K Europe %K Female %K Forced Expiratory Volume %K Glucocorticoids %K Humans %K Hydrocortisone %K Lung %K Male %K Mexico %K Middle Aged %K Models, Biological %K Nebulizers and Vaporizers %K Peak Expiratory Flow Rate %K South Africa %K Time Factors %K Treatment Outcome %K Young Adult %X

BACKGROUND: Fluticasone furoate (FF) is an inhaled corticosteroid that is structurally and functionally distinct from fluticasone propionate and is under development as a once-daily therapy for asthma.

OBJECTIVE: The objective of this study was to estimate the treatment differences (with 95% CI) in efficacy and safety profile between FF administered once daily in the morning and evening via Rotadisk Diskhaler (see text) in patients with persistent asthma. No hypothesis testing was performed for this comparison.

METHODS: This was a randomized, double-blind, double-dummy, placebo-controlled, parallel-group study. Patients (ages 16-55 years; peak expiratory flow [PEF] 50%-90% predicted) were randomized to receive 1 of 3 doses of FF Rotadisk or placebo daily for 4 weeks. The sponsor, GlaxoSmithKline, designed the study and selected the study sites. The primary end point was change from baseline in daily trough (pretreatment, prebronchodilator) PEF during the treatment period with FF Rotadisk 100 μg once daily in the morning compared with 100 μg once daily in the evening. Other end points included change from baseline in forced expiratory volume in 1 second, asthma symptom score, adverse events (AEs), 24-hour urinary cortisol excretion, and FF pharmacokinetics.

RESULTS: Five hundred and seventy-five patients (mean age 36.6 years, 56.9% female) formed the intent-to-treat population and were randomly allocated to FF Rotadisk 100 μg once daily in the morning (n = 144), FF Rotadisk 100 μg once daily in the evening (n = 146), FF Rotadisk 250 μg once daily in the evening (n = 142), or placebo (n = 143). Of these patients, 526 (91.5%) completed the study. A smaller proportion of patients in the placebo group (86.7%) than in the active treatment groups completed the study. Mean difference in PEF change from baseline with FF Rotadisk 100 μg once daily in the morning relative to evening was +13.4 L/min (95% CI, 2.3-24.4). However, morning trough values might have been affected by higher placebo response after morning dosing (18.8 vs 8.8 L/min). Trough PEF improved relative to placebo (P ≤ 0.005), with little difference between FF Rotadisk 100 μg morning (19 L/min) and evening (16 L/min) dosing, as with other efficacy measures. Frequencies of all-cause AEs were similar with FF Rotadisk (32%-39%, 2 serious AEs) and placebo (37%, 1 serious AE). No serious AEs were deemed by the investigator to be related to study treatment. Twenty-four-hour urinary cortisol increased from baseline in all groups, but the increase was significantly lower with FF Rotadisk 250 μg group than placebo.

CONCLUSION: FF Rotadisk administered once daily in the morning or evening was well tolerated and associated with improvements in lung function and asthma symptoms compared with placebo. Improvements seen for FF Rotadisk 100 μg appear to be comparable for morning and evening dosing. Clinical.trials.govNCT01499446.

%B Clin Ther %V 34 %P 1683-95 %8 2012 Aug %G eng %N 8 %R 10.1016/j.clinthera.2012.06.024 %0 Journal Article %J Child Welfare %D 2012 %T Family Group Decision Making (FGDM) with Lakota families in two tribal communities: tools to facilitate FGDM implementation and evaluation. %A Marcynyszyn, Lyscha A %A Bear, Pete Small %A Geary, Erin %A Conti, Russ %A Pecora, Peter J %A Day, Priscilla A %A Wilson, Stephen T %K Child %K Child Welfare %K Community-Institutional Relations %K Culture %K Decision Making %K Family %K Female %K Follow-Up Studies %K Grief %K Humans %K Indians, North American %K Intergenerational Relations %K Male %K Models, Organizational %K Personal Satisfaction %K Program Evaluation %K Social Work %K South Dakota %K Stress, Psychological %X

This article describes an adapted Family Group Decision Making (FGDM) practice model for Native American communities, the FGDM family and community engagement process, and FGDM evaluation tools as one example for other native communities. Challenges and successes associated with the implementation and evaluation of these meetings are also described in the context of key historical and cultural factors, such as intergenerational grief and trauma, as well as past misuse of data in native communities.

%B Child Welfare %V 91 %P 113-34 %8 2012 %G eng %N 3 %0 Journal Article %J J Womens Health (Larchmt) %D 2012 %T Mediators of adverse birth outcomes among socially disadvantaged women. %A Gavin, Amelia R %A Nurius, Paula %A Logan-Greene, Patricia %K Adolescent %K Adult %K Cohort Studies %K Diagnostic and Statistical Manual of Mental Disorders %K Female %K Gestational Age %K Health Behavior %K Healthcare Disparities %K Humans %K Insurance Coverage %K Mental Disorders %K Middle Aged %K Pregnancy %K Pregnancy Outcome %K Pregnant Women %K Prenatal Care %K Prospective Studies %K Social Class %K Stress, Psychological %K Substance-Related Disorders %K Surveys and Questionnaires %K United States %K Vulnerable Populations %X

BACKGROUND: Numerous studies find that socially disadvantaged women are more likely than socially advantaged women to deliver infants that weigh less than normal and/or are born weeks prior to their due date. However, little is known about the pathways that link maternal social disadvantage to birth outcomes. Using data from a prospective cohort study, we examined whether antenatal psychosocial stress, substance use, and maternal health conditions in pregnancy mediated the pathway between maternal social disadvantage and birth outcomes.

METHODS: Analyses used structural equation modeling to examine data from a community clinic-based sample (n=2168) of pregnant women who completed questionnaires assessing psychosocial functioning and health behaviors as well as sociodemographic characteristics, which were matched with subsequent birth outcome data.

RESULTS: Analyses revealed maternal social disadvantage predicted poorer birth outcomes through a mediated pathway including maternal health conditions in pregnancy.

CONCLUSIONS: The findings demonstrate that maternal social disadvantage is associated with poor health status in pregnancy, which in turn adversely affects birth outcomes. Results argue for more systematic attention to the roles of social disadvantage, including life course perspectives that trace social disadvantage prior to and through pregnancy.

%B J Womens Health (Larchmt) %V 21 %P 634-42 %8 2012 Jun %G eng %N 6 %R 10.1089/jwh.2011.2766 %0 Journal Article %J Health Educ Res %D 2012 %T Process and outcome constructs for evaluating community-based participatory research projects: a matrix of existing measures. %A Sandoval, Jennifer A %A Lucero, Julie %A Oetzel, John %A Avila, Magdalena %A Belone, Lorenda %A Mau, Marjorie %A Pearson, Cynthia %A Tafoya, Greg %A Duran, Bonnie %A Iglesias Rios, Lisbeth %A Wallerstein, Nina %K Community-Based Participatory Research %K Forecasting %K Group Processes %K Humans %K Models, Theoretical %K Outcome and Process Assessment (Health Care) %K Reproducibility of Results %K Research Design %X

Community-based participatory research (CBPR) has been widely used in public health research in the last decade as an approach to develop culturally centered interventions and collaborative research processes in which communities are directly involved in the construction and implementation of these interventions and in other application of findings. Little is known, however, about CBPR pathways of change and how these academic-community collaborations may contribute to successful outcomes. A new health CBPR conceptual model (Wallerstein N, Oetzel JG, Duran B et al. CBPR: What predicts outcomes? In: Minkler M, Wallerstein N (eds). Communication Based Participatory Research, 2nd edn. San Francisco, CA: John Wiley & Co., 2008) suggests that relationships between four components: context, group dynamics, the extent of community-centeredness in intervention and/or research design and the impact of these participatory processes on CBPR system change and health outcomes. This article seeks to identify instruments and measures in a comprehensive literature review that relates to these distinct components of the CBPR model and to present them in an organized and indexed format for researcher use. Specifically, 258 articles were identified in a review of CBPR (and related) literature from 2002 to 2008. Based on this review and from recommendations of a national advisory board, 46 CBPR instruments were identified and each was reviewed and coded using the CBPR logic model. The 46 instruments yielded 224 individual measures of characteristics in the CBPR model. While this study does not investigate the quality of the instruments, it does provide information about reliability and validity for specific measures. Group dynamics proved to have the largest number of identified measures, while context and CBPR system and health outcomes had the least. Consistent with other summaries of instruments, such as Granner and Sharpe's inventory (Granner ML, Sharpe PA. Evaluating community coalition characteristics and functioning: a summary of measurement tools. Health Educ Res 2004; 19: 514-32), validity and reliability information were often lacking, and one or both were only available for 65 of the 224 measures. This summary of measures provides a place to start for new and continuing partnerships seeking to evaluate their progress.

%B Health Educ Res %V 27 %P 680-90 %8 2012 Aug %G eng %N 4 %R 10.1093/her/cyr087 %0 Journal Article %J Lancet %D 2012 %T Seizing the opportunities of adolescent health. %A Resnick, Michael D %A Catalano, Richard F %A Sawyer, Susan M %A Viner, Russell %A Patton, George C %K Adolescent %K Adolescent Medicine %K Goals %K Humans %K United Nations %B Lancet %V 379 %P 1564-7 %8 2012 Apr 28 %G eng %N 9826 %R 10.1016/S0140-6736(12)60472-3 %0 Journal Article %J Lancet %D 2012 %T Worldwide application of prevention science in adolescent health. %A Catalano, Richard F %A Fagan, Abigail A %A Gavin, Loretta E %A Greenberg, Mark T %A Irwin, Charles E %A Ross, David A %A Shek, Daniel T L %K Adolescent Medicine %K Child %K Global Health %K Government Programs %K Health Behavior %K Health Status %K Humans %K Public Health %K Young Adult %X

The burden of morbidity and mortality from non-communicable disease has risen worldwide and is accelerating in low-income and middle-income countries, whereas the burden from infectious diseases has declined. Since this transition, the prevention of non-communicable disease as well as communicable disease causes of adolescent mortality has risen in importance. Problem behaviours that increase the short-term or long-term likelihood of morbidity and mortality, including alcohol, tobacco, and other drug misuse, mental health problems, unsafe sex, risky and unsafe driving, and violence are largely preventable. In the past 30 years new discoveries have led to prevention science being established as a discipline designed to mitigate these problem behaviours. Longitudinal studies have provided an understanding of risk and protective factors across the life course for many of these problem behaviours. Risks cluster across development to produce early accumulation of risk in childhood and more pervasive risk in adolescence. This understanding has led to the construction of developmentally appropriate prevention policies and programmes that have shown short-term and long-term reductions in these adolescent problem behaviours. We describe the principles of prevention science, provide examples of efficacious preventive interventions, describe challenges and potential solutions to take efficacious prevention policies and programmes to scale, and conclude with recommendations to reduce the burden of adolescent mortality and morbidity worldwide through preventive intervention.

%B Lancet %V 379 %P 1653-64 %8 2012 Apr 28 %G eng %N 9826 %R 10.1016/S0140-6736(12)60238-4 %0 Journal Article %J Child Welfare %D 2011 %T Context matters: real-world and utilization-focused evaluation strategies to support change and improvement in child welfare. %A Ward, Kristin J %A Maher, Erin J %A Marcynyszyn, Lyscha A %A Ellis, Mei Ling K %A Pecora, Peter J %K Achievement %K Child %K Child Welfare %K Education %K Employment %K Guidelines as Topic %K Humans %K Program Evaluation %K Social Support %K United States %X

This article examines the importance of context in evaluative inquiry. Following guidelines from real-world and utilization-focused evaluation frameworks, four projects are described to illustrate one foundation's pragmatic approach to evaluation that values collaboration, methodological appropriateness, and utilization. The authors contend that such an approach helps to ensure meaningful and actionable results in child welfare because it is responsive to local agency information and capacity needs while simultaneously contributing to the knowledge base of the field.

%B Child Welfare %V 90 %P 29-47 %8 2011 %G eng %N 2 %0 Journal Article %J BMC Complement Altern Med %D 2008 %T Complementary and alternative medicine use and cost in functional bowel disorders: a six month prospective study in a large HMO. %A van Tilburg, Miranda A L %A Palsson, Olafur S %A Levy, Rona L %A Feld, Andrew D %A Turner, Marsha J %A Drossman, Douglas A %A Whitehead, William E %K Abdominal Pain %K Adult %K Complementary Therapies %K Constipation %K Cost-Benefit Analysis %K Delivery of Health Care, Integrated %K Diarrhea %K Female %K Ginger %K Health Maintenance Organizations %K Humans %K Irritable Bowel Syndrome %K Male %K Massage %K Middle Aged %K Patient Satisfaction %K Phytotherapy %K Professional-Patient Relations %K Prospective Studies %K Surveys and Questionnaires %K United States %K Yoga %X

BACKGROUND: Functional Bowel Disorders (FBD) are chronic disorders that are difficult to treat and manage. Many patients and doctors are dissatisfied with the level of improvement in symptoms that can be achieved with standard medical care which may lead them to seek alternatives for care. There are currently no data on the types of Complementary and Alternative Medicine (CAM) used for FBDs other than Irritable Bowel Syndrome (IBS), or on the economic costs of CAM treatments. The aim of this study is to determine prevalence, types and costs of CAM in IBS, functional diarrhea, functional constipation, and functional abdominal pain.

METHODS: 1012 Patients with FBD were recruited through a health care maintenance organization and followed for 6 months. Questionnaires were used to ascertain: Utilization and expenditures on CAM, symptom severity (IBS-SS), quality of life (IBS-QoL), psychological distress (BSI) and perceived treatment effectiveness. Costs for conventional medical care were extracted from administrative claims.

RESULTS: CAM was used by 35% of patients, at a median yearly cost of $200. The most common CAM types were ginger, massage therapy and yoga. CAM use was associated with female gender, higher education, and anxiety. Satisfaction with physician care and perceived effectiveness of prescription medication were not associated with CAM use. Physician referral to a CAM provider was uncommon but the majority of patients receiving this recommendation followed their physician's advice.

CONCLUSION: CAM is used by one-third of FBD patients. CAM use does not seem to be driven by dissatisfaction with conventional care. Physicians should discuss CAM use and effectiveness with their patients and refer patients if appropriate.

%B BMC Complement Altern Med %V 8 %P 46 %8 2008 %G eng %R 10.1186/1472-6882-8-46