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OBJECTIVE: Police officers experience many traumatic events over the course of their career, often resulting in posttraumatic stress disorder (PTSD) and associated psychological distress. Studies have investigated the efficacy of interventions aimed at reducing symptoms of PTSD experienced by police officers, but lacking are studies investigating the impact of PTSD on positivity, a construct we define as a latent variable estimated using self-report measures of optimism, gratitude, self-compassion, and mindfulness. The present study carried out a path analysis of a model testing the hypothesis that PTSD would be associated with increased psychological distress and decreased positivity, both of which influence well-being. The model also evaluated associations between constructs that could be modified through interventions to increase well-being-associations between posttraumatic growth, social support, physical activity and psychological distress, positivity, and well-being. METHOD: Police officers (n = 506) completed an online survey that included self-report measures of the constructs included in the model being tested. RESULTS: The model tested produced fit indices of root mean square error of approximation (RMSEA) = .089; comparative fit index (CFI) = .960; Tucker-Lewis index (TLI) = .93; standardized root mean square residual (SRMR) = .041 and R² = .79. Results found that neither PTSD or psychological distress had a direct effect on well-being. Psychological distress indirectly influenced well-being by lowering levels of positivity, while positivity was associated with higher scores on the measure of well-being. CONCLUSIONS: The implication of the results is that interventions aimed at enhancing positivity could be expected to improve well-being in police officers and offering traditional therapies together with positivity enhancing therapies may have additional benefits over either alone. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Objectives Despite a large evaluation literature for interventions aiming to improve the lives of families affected by parent substance misuse, very few studies have examined how families change when engaged with treatment. This study examines the interactive process of change in parent psychopathology and mindful parenting during participation in the Parents under Pressure (PuP) program for parents engaged in community addiction services. Methods Parents (n = 164) provided baseline, mid- and end-treatment measures of parent psychopathology and mindful parenting. Cross-lagged modelling was used to examine therapeutic process of change. Results Parent psychopathology decreased, and mindful parenting increased from baseline to end-treatment (ps p = .005). Examination of the mindful parenting dimensions revealed variation in the therapeutic process of change. While higher levels of Non-Judgemental Acceptance of Parental Functioning (NJAPF) at baseline predicted lower psychopathology at mid-treatment (p = .03), higher levels of Compassion for Child (CC) at baseline predicted greater psychopathology at mid-treatment (p = 0.004). Higher levels of NJAPF mid-treatment predicted lower psychopathology upon treatment completion (p = .023), yet higher levels of Emotional Awareness of Child (EAC) at mid-treatment predicted greater psychopathology upon treatment completion (p = .023). Lower parent psychopathology at mid-treatment predicted higher levels of LFA, EAC, Self-Regulation in Parenting and NJAPF upon completion of the PuP program (ps Conclusions The findings highlight the importance of reducing parent psychopathology as a precursor to more mindful parenting and also provide new evidence regarding the way in which variation in mindful parenting dimensions influences the therapeutic process of change.

Background: Anterior cruciate ligament (ACL) rupture is a common debilitating injury that can cause instability of the knee. We aimed to investigate the best management strategy between reconstructive surgery and non-surgical treatment for patients with a non-acute ACL injury and persistent symptoms of instability. Methods: We did a pragmatic, multicentre, superiority, randomised controlled trial in 29 secondary care National Health Service orthopaedic units in the UK. Patients with symptomatic knee problems (instability) consistent with an ACL injury were eligible. We excluded patients with meniscal pathology with characteristics that indicate immediate surgery. Patients were randomly assigned (1:1) by computer to either surgery (reconstruction) or rehabilitation (physiotherapy but with subsequent reconstruction permitted if instability persisted after treatment), stratified by site and baseline Knee Injury and Osteoarthritis Outcome Score—4 domain version (KOOS4). This management design represented normal practice. The primary outcome was KOOS4 at 18 months after randomisation. The principal analyses were intention-to-treat based, with KOOS4 results analysed using linear regression. This trial is registered with ISRCTN, ISRCTN10110685, and ClinicalTrials.gov, NCT02980367. Findings: Between Feb 1, 2017, and April 12, 2020, we recruited 316 patients. 156 (49%) participants were randomly assigned to the surgical reconstruction group and 160 (51%) to the rehabilitation group. Mean KOOS4 at 18 months was 73·0 (SD 18·3) in the surgical group and 64·6 (21·6) in the rehabilitation group. The adjusted mean difference was 7·9 (95% CI 2·5–13·2; p=0·0053) in favour of surgical management. 65 (41%) of 160 patients allocated to rehabilitation underwent subsequent surgery according to protocol within 18 months. 43 (28%) of 156 patients allocated to surgery did not receive their allocated treatment. We found no differences between groups in the proportion of intervention-related complications. Interpretation: Surgical reconstruction as a management strategy for patients with non-acute ACL injury with persistent symptoms of instability was clinically superior and more cost-effective in comparison with rehabilitation management. Funding: The UK National Institute for Health Research Health Technology Assessment Programme.

Introduction A core tenet of occupational therapy is that engagement in meaningful activities is integral for a person’s health and wellbeing. Childhood adversity can have lifelong impacts on physical and mental health; however, the effects of childhood experiences are dependent on the presence of susceptibility factors, including sensory processing sensitivity. To date, the effects of childhood adversity and sensory processing sensitivity have not been investigated for meaningful activity engagement. This study seeks to determine whether childhood adversity is related to engagement in meaningful activities in adulthood and whether this relationship is moderated by sensory processing sensitivity. Method Using convenience snowball sampling, a cross-sectional online survey was conducted with 328 adults. Participants completed a battery of questionnaires, including the Risky Families Questionnaire, Highly Sensitive Person Scale and Engagement in Meaningful Activities Scale. Results Correlational analyses found that childhood adversity was related to significantly less meaningful activity engagement in adulthood, but this relationship was not moderated by sensory processing sensitivity. Conclusion This study showed, for the first time, that a history of childhood adversity is linked to less engagement in meaningful activities in adulthood. While further research is needed, supporting meaningful activity engagement may be necessary for adults who experienced childhood adversity.

Introduction Autonomic nervous system functioning is theorised to underpin individual differences in sensory processing, with a small amount of supporting evidence. Despite recognition of the need to measure the balance between sympathetic and parasympathetic activity, most studies have measured only one of these systems. This study investigated whether sensory processing patterns are related to autonomic balance for young adults at rest and in response to a sensory-based stressor. Method In this cross-sectional laboratory study, 100 young adults completed the adolescent/adult sensory profile. Heart rate variability and pre-ejection period were recorded before, during and after a coldpressor task. Results Relationships between sensory processing patterns and autonomic balance varied by gender. In males, low sensory thresholds were generally related to a state of reciprocal sympathetic activation. In females, low thresholds were associated with greater autonomic reactivity in response to the coldpressor. Conclusion This study showed, for the first time in young adults, that sensory processing patterns may be linked to patterns of autonomic balance. Therapists should be aware that young men with low sensory thresholds may be more likely than others to exhibit a resting state of sympathetic hyperarousal and further research should investigate whether this impacts their daily functioning and wellbeing.

HR pathway mutations

Purpose: A significant number of women with serous ovarian cancer are intrinsically refractory to platinum-based treatment. We analyzed somatic DNA copy number variation and gene expression data to identify key mechanisms associated with primary resistance in advanced-stage serous cancers.Experimental Design: Genome-wide copy number variation was measured in 118 ovarian tumors using high-resolution oligonucleotide microarrays. A well-defined subset of 85 advanced-stage serous tumors was then used to relate copy number variation to primary resistance to treatment. The discovery-based approach was complemented by quantitative-PCR copy number analysis of 12 candidate genes as independent validation of previously reported associations with clinical outcome. Likely copy number variation targets and tumor molecular subtypes were further characterized by gene expression profiling.Results: Amplification of 19q12, containing cyclin E (CCNE1), and 20q11.22-q13.12, mapping immediately adjacent to the steroid receptor coactivator NCOA3, was significantly associated with poor response to primary treatment. Other genes previously associated with copy number variation and clinical outcome in ovarian cancer were not associated with primary treatment resistance. Chemoresistant tumors with high CCNE1 copy number and protein expression were associated with increased cellular proliferation but so too was a subset of treatment-responsive patients, suggesting a cell-cycle independent role for CCNE1 in modulating chemoresponse. Patients with a poor clinical outcome without CCNE1 amplification overexpressed genes involved in extracellular matrix deposition.Conclusions: We have identified two distinct mechanisms of primary treatment failure in serous ovarian cancer, involving CCNE1 amplification and enhanced extracellular matrix deposition. CCNE1 copy number is validated as a dominant marker of patient outcome in ovarian cancer.

Purpose: Women with epithelial ovarian cancer generally have a poor prognosis; however, a subset of patients has an unexpected dramatic and durable response to treatment. We sought to identify clinical, pathological, and molecular determinants of exceptional survival in women with high-grade serous cancer (HGSC), a disease associated with the majority of ovarian cancer deaths.Experimental Design: We evaluated the histories of 2,283 ovarian cancer patients and, after applying stringent clinical and pathological selection criteria, identified 96 with HGSC that represented significant outliers in terms of treatment response and overall survival. Patient samples were characterized immunohistochemically and by genome sequencing.Results: Different patterns of clinical response were seen: long progression-free survival (Long-PFS), multiple objective responses to chemotherapy (Multiple Responder), and/or greater than 10-year overall survival (Long-Term Survivors). Pathogenic germline and somatic mutations in genes involved in homologous recombination (HR) repair were enriched in all three groups relative to a population-based series. However, 29% of 10-year survivors lacked an identifiable HR pathway alteration, and tumors from these patients had increased Ki-67 staining. CD8+ tumor-infiltrating lymphocytes were more commonly present in Long-Term Survivors. RB1 loss was associated with long progression-free and overall survival. HR deficiency and RB1 loss were correlated, and co-occurrence was significantly associated with prolonged survival.Conclusions: There was diversity in the clinical trajectory of exceptional survivors associated with multiple molecular determinants of exceptional outcome in HGSC patients. Concurrent HR deficiency and RB1 loss were associated with favorable outcomes, suggesting that co-occurrence of specific mutations might mediate durable responses in such patients. Clin Cancer Res; 24(3); 569–80. ©2017 AACR.See related commentary by Peng and Mills, p. 508

Revised Supplementary Data, containing Supplementary Methods, Supplementary Figures, Supplementary Tables Supplementary Figure S1. Outline of cohort selection and analyses. Supplementary Figure S2. Clinical response and therapy course of 96 patients with exceptional responses to chemotherapy. Supplementary Figure S3. Distribution and type of TP53 mutations. Supplementary Figure S4. RB1 protein expression altered by genomic inactivation. Supplementary Figure S5. Characterization of CD8 and Ki-67 in tumors according to homologous recombination mutation status. Supplementary Table S2 Immunohistochemical analysis: primary antibodies and staining conditions Supplementary Table S3 Homologous recombination and DNA repair panel Supplementary Table S6 Comparison of molecular alteration prevalence between clinical subgroups Supplementary Table S7 Patient characteristics of tissue microarray cohort

Supplementary Data from Integrated Genome-Wide DNA Copy Number and Expression Analysis Identifies Distinct Mechanisms of Primary Chemoresistance in Ovarian Carcinomas

Background and aims Family‐focused interventions can improve family functioning when parents have substance use problems. However, there has been little focus upon potential predictors of change and analysis of mechanisms of change. This study aims to identify mediators and moderators of change in a pragmatic, multi‐site, randomized controlled trial of the Parents under Pressure (PuP) programme, a family‐focused intervention for parents with substance use and other problems, and treatment‐as‐usual (TAU). Design Secondary analysis of data: multi‐level modelling was used to investigate moderators of treatment outcome; mediation was tested with cross‐lagged models. Setting Community‐based family support services in the United Kingdom. Participants Parents (n = 100) attending community‐based addiction services with children aged 2.5 years or younger. Measurements Predictors of the primary outcome, child abuse potential, were: baseline child age and gender, composite family risk score, parental substance use and parental emotional dysregulation. Mediation was tested across three time‐points with the observed variables parental emotion dysregulation and child abuse potential. Findings Increased child age [Z = 2.14, 95% confidence interval (CI) = 0.01, 0.33] at baseline was associated with greater reductions in child abuse potential for PuP programme participants compared with TAU. Poorer parental emotional regulation (Z = 2.48, 95% CI = –2.76, −0.32) was associated with greater reductions in child abuse potential for all participants. Parental substance use (either recent use or primary substance of concern) did not alter any treatment effects on child abuse potential. The mediation analysis showed that PuP produced greater improvements in emotional regulation at post‐treatment (P

Parents can be essential change-agents in their children’s lives. To support parents in their parenting role, a range of programs have been developed and evaluated. In this paper, we provide an overview of the evidence for the effectiveness of parenting interventions for parents and children across a range of outcomes, including child and adolescent mental and physical health, child and adolescent competencies and academic outcomes, parental skills and competencies, parental wellbeing and mental health, and prevention of child maltreatment and family violence. Although there is extensive research showing the effectiveness of evidence-based parenting programs, these are not yet widely available at a population level and many parents are unable to access support. We outline how to achieve increased reach of evidence-based parenting supports, highlighting the policy imperative to adequately support the use of these supports as a way to address high priority mental health, physical health, and social problems.

Historically, quality measurement analyses utilize manual chart abstraction from data collected primarily for administrative purposes. These methods are resource-intensive, time-delayed, and often lack clinical relevance. Electronic Medical Records (EMRs) have increased data availability and opportunities for quality measurement. However, little is known about the effectiveness of Measurement Feedback Systems (MFSs) in utilizing EMR data. This study explores the effectiveness and characteristics of EMR-enabled MFSs in tertiary care. The search strategy guided by the PICO Framework was executed in four databases. Two reviewers screened abstracts and manuscripts. Data on effect and intervention characteristics were extracted using a tailored version of the Cochrane EPOC abstraction tool. Due to study heterogeneity, a narrative synthesis was conducted and reported according to PRISMA guidelines. A total of 14 unique MFS studies were extracted and synthesized, of which 12 had positive effects on outcomes. Findings indicate that quality measurement using EMR data is feasible in certain contexts and successful MFSs often incorporated electronic feedback methods, supported by clinical leadership and action planning. EMR-enabled MFSs have the potential to reduce the burden of data collection for quality measurement but further research is needed to evaluate EMR-enabled MFSs to translate and scale findings to broader implementation contexts.

Bilateral acetabular fractures following epileptic seizures are a rare but known occurrence in adults, with an 18.5% mortality rate. These fractures occurring post epileptic seizures have not been previously documented in children. We report a case of a 13-year-old boy who presented to hospital via ambulance following two violent generalised tonic–clonic seizures in a postictal state, metabolically acidotic and a low haemoglobin. Acute abdomen was suspected, and the patient underwent a CT scan which showed bilateral acetabular fractures with central dislocations of both femoral heads and free fluid in the abdomen. The patient underwent initial damage control intervention with insertion of bilateral distal femur skeletal traction. Definitive fixation of the acetabular fractures occurred 1 week later with an open reduction internal fixation with novel supra- pectineal plates using a Pfannenstiel incision. We use this report to increase awareness of significant pelvic injuries in paediatric patients post epileptic seizures.

Effective parent functioning is a key predictor of functional outcomes for children with persistent pain. It is therefore important to identify factors that support or limit functioning in parents of these children. Child and parent attachment and child sensory processing patterns have been identified as risk-factors for parent functioning in healthy samples. Our study extends current research by examining whether parent and child attachment patterns and child sensory processing patterns are related to parent functioning in families of children with persistent pain. Using a cross-sectional design, data was collected at a tertiary pain management clinic from 98 parent-child dyads (i.e., a child or adolescent with persistent pain and one parent). Standardized questionnaires were used to assess parent and child attachment patterns, child sensory processing patterns, child pain intensity, and eight domains of parent functioning. Regression analyses revealed that parent attachment avoidance was significantly related to poorer overall parent functioning and three functioning domains: depression, partner relationship, and leisure. Child attachment avoidance was related to higher parental strain and the use of fewer protective parenting behaviors. Parent and child attachment anxiety and child sensory processing patterns were not significantly related to parent functioning. Findings suggest that parent and child attachment avoidance warrant further consideration with regards to parent functioning in clinical settings where children present with persistent pain. This may aid in identifying parents who are at-risk of poorer functioning and could guide the use of attachment-informed interventions for families of children with persistent pain.

Severe and persistent conduct problems in children during the primary school years are associated with school exclusion, increased risk of delinquency and early substance abuse. Literature reviews and consultation with experts in the field were used to better understand the factors that contribute to severe and persistent conduct problems and to identify the principles and potential methods to be included in a new intervention. Grounded in an ecological perspective, an innovative, multimodal intervention, the Helping Families Programme, has been developed. It uses a modular approach to systematically address parent behaviour, cognition and emotion across five key risk factor domains: parental mood and dysregulation; parent-child, family and school relationships; substance misuse; social support and networks; and managing life events and crises. Initial piloting of the Programme has offered early support for the potential value of the underlying principles and methods of the Programme.

Background: The bioSocial Cognitive Theory (bSCT) hypothesizes two pathways linking dimensions of impulsivity to substance use. The first predicts that the association between reward sensitivity and substance use is mediated by positive outcome expectancies. The second predicts that the relationship between rash impulsiveness and substance use is mediated by refusal self-efficacy. This model has received empirical support in studies of alcohol use. The present research provides the first application of bSCT to a cannabis treatment population and aims to extend its utility to understanding cannabis use and severity of dependence. Design: 273 patients referred for cannabis treatment completed a clinical assessment that contained measures of interest. Setting: A public hospital alcohol and drug clinic. Measurements: The Sensitivity to Reward Scale, Dysfunctional Impulsivity Scale, Cannabis Expectancy Questionnaire, Cannabis Refusal Self-Efficacy Questionnaire and Severity of Dependence Scale–Cannabis were completed, along with measures of cannabis consumption. Findings: The bSCT model provided a good fit to the data for cannabis use and severity of dependence outcomes. The association between reward sensitivity and each cannabis outcome was fully mediated by positive cannabis expectancies and cannabis refusal self-efficacy. The relationship between rash impulsiveness and each cannabis outcome was fully mediated by cannabis refusal self-efficacy. Conclusions: Findings support the application of the bSCT model to cannabis use and dependence severity and highlight the important role of social cognitive mechanisms in understanding the association between impulsivity traits and these outcomes. The differential association of impulsivity traits to social cognition may assist targeted treatment efforts.

Pre-birth risk assessment is a process by which circumstances affecting an unborn child can be identified and support for mother and infant embedded. This mixed methods study describes a community-based pre-birth assessment and care pathway that utilised the Parents Under Pressure (PuP) programme to assess parenting capacity and provide support pre- and post-birth for ‘at risk’ women. Sixty-eight pregnant women referred to children's social care services were allocated to the pre-birth assessment and care pathway (n = 35) or to routine care (n = 33). Standardised measures of psychological distress, social support and alcohol measured change for the women in the assessment and care pathway. Twenty women who provided pre- and post-data reported significant improvements on all measures except alcohol use. Safeguarding outcomes at 12 months were obtained for both groups using administrative data. Forty-two per cent of the infants whose mothers received the pre-birth assessment and care pathway showed an improvement in child protection status compared to 14 per cent of the routine care infants. Safeguarding status deteriorated or stayed the same in 52 per cent of the routine cases compared to 26 per cent of those receiving the pathway. Qualitative data revealed that the pathway was acceptable and helpful to service users and service providers. Copyright © 2017 John Wiley & Sons, Ltd. ‘Describes a community-based pre-birth assessment and care pathway that utilised the Parents Under Pressure (PuP) programme’ Key Practitioner Messages The current project found that a community-based pre-birth assessment and care pathway with high-risk pregnant women was feasible and acceptable for practitioners and service users. The pathway began mid-pregnancy and support was provided following the birth of the infant for up to 12 months. Over 40 per cent of infants whose mothers were allocated to the pre-birth risk assessment pathway showed improvements in child safeguarding status at 12 months.

Background Growing evidence shows that children with fetal alcohol spectrum disorder (FASD) can benefit from interventions, and specifically interventions focused on improving self-regulation. However, novel ways of improving outcomes for children with FASD need further investigation so that programs target not only the individual child but also the family context, which includes the parent–child relationship. Aims The current study aimed to evaluate the feasibility of an adapted version of the Parents under Pressure (PuP) program that addresses self-regulatory processes, through improving the parent–child relationship and the use of mindfulness-based strategies for both children and parents. Methods This was a mixed methods study. Feasibility was examined by evaluating recruitment, data collection/outcome measures, and intervention procedures. The study used a phenomenological approach to obtain qualitative information from caregivers and a single-case experimental design to evaluate the preliminary participant responses to the intervention. Results Two out of three families completed treatment. The recruitment and intervention procedures were found to be suitable for and acceptable to the families involved. Some concerns were identified regarding the outcome measures that would need to be addressed in future research. Quantitative and qualitative outcomes were positive. Conclusions and implications The results provide preliminary support for the feasibility of an adapted version of the PuP program. Thus, offering a potential multi-component option, that aims to improve self-regulatory skills for children with FASD, through focusing on improving the parent-child relationship and incorporating mindfulness-based techniques for both parents and children.

In this article, the findings of research that had, as one aim, the exploration of the role of decision-making tools and practice frameworks in supporting the decision making of practitioners working with children and families in non-government agencies in Queensland are presented. Semi-structured interviews were conducted with 30 frontline practitioners in three agencies in five different locations. A general finding was that practitioners used a range of different tools and frameworks and found them supportive. The pertinence of these findings is discussed in relation to recent developments in the provision of services for children and families in Queensland, namely the new funding of non-government agencies to provide early intervention supportive services to children and families and the implementation of a single practice framework to guide practice across the sector. Areas for future research in Queensland are identified to further investigate the role of tools in frontline practice with children and families and which may also contribute to debates more broadly about the development and implementation of practice frameworks to support practitioners.

1.1 The problem, condition or issue Prenatal alcohol exposure (PAE) is associated with profound and lifelong disability. The umbrella term fetal alcohol spectrum disorder (FASD) describes a spectrum of impairments resulting from the deleterious effects of PAE (Chudley et al., 2005). Historically, the spectrum comprised four disorders: fetal alcohol syndrome (FAS), Partial FAS (pFAS), alcohol‐related neurodevelopmental disorder (ARND), and alcohol‐related birth defects (ARBD; Lange, Rovet, Rehm, & Popova, 2017). All four disorders shared PAE as their etiological base and all but ARBDs were associated with neurological deficits (ARBD comprizing physical defects). More recently, the Australian Guidelines to the diagnosis of FASD have been published (Bower & Elliot, 2016). While the core aspects of the condition remain unchanged, the Australian guidelines comprise two diagnostic categories for FASD: (a) FASD with three sentinel facial features or (b) FASD with less than three sentinel facial features.

Objective: Research has highlighted the role of gender in the expression of aggression. While boys display higher levels of physical aggression, girls appear to display higher levels of relational aggression. It is proposed that the expression of relational aggression may be associated, at least in part, with a child's development of language skills. The aim of the present study was to investigate the role of expressive and receptive language in the expression of relational aggression. Method: A sample of 106 four to six-year-old Iranian children completed a test of language ability while their teachers completed a rating scale measuring the children's expression of relational aggression. Results: Results supported the hypothesis that language skills play an important role in the development of relational aggression. Teachers reported that girls displayed significantly more relational aggression that boys. Girls were also found to have higher receptive and expressive language than boys. Finally, a mediation analysis found that language skills mediated the relationship between gender and relational aggression. Conclusions: The results suggest that gender differences in the expression of relational aggression may be related to gender differences in the development of language as opposed to gender per se.

Interest in the application of mindfulness-based intervention for the treatment of psychological disorders and promotion of wellbeing has grown exponentially in recent years. Mindfulness-based interventions have been found to be beneficial for treatment of various forms of psychopathology as well as improve psychological wellbeing and enhance physical health. Little research has investigated for whom and under what conditions training people to use mindfulness-based therapeutic techniques is most effective. Recent studies have found evidence that individual differences in personality traits are associated with mindfulness. For example, neuroticism has been found to be negatively associated with mindfulness. These associations raise the possibility that individual differences in personality may potentially moderate the effectiveness of mindfulness-based interventions. In the present study we draw on Gray's revised Reinforcement Sensitivity Theory (r-RST) to examine relationships between personality traits, mindfulness and psychological distress. We found that the Flight, Fight, Freeze system mediated the relationship between trait mindfulness and psychological distress, while trait mindfulness moderated the relationship between the Flight, Fight, Freeze system and psychological distress. Both results are consistent with the suggestion that acquiring the skills from learning and practicing mindfulness techniques is potentially useful, particularly for threat-sensitive individuals with low to moderate levels of trait mindfulness.

The over-representation of Aboriginal and Torres Strait Islander children in the child protection is a serious concern in Australia. A proportion of this group of children may have been removed from families who are providing an adequately safe and nurturing environment, reflecting false positive errors in decision making. Assuming this to be true, we draw on the decision-making ecology model of judgement and decision making in child protection to speculate on possible causes of such errors. This model suggests that false positive errors would occur if the level of risk children face is estimated to be higher than is actually the case or if the decision threshold applied in making decisions to remove children from their family are too low. We present a discussion of factors that could potentially influence judgements and decision thresholds, which has implications for practice. It is argued that false positive errors are most likely to be avoided through more thorough and accurate assessments families. When assessing Aboriginal and Torres Strait Islander families, we argue that this requires a theoretically grounded, culturally informed framework to improve assessments and decrease the likelihood of false positive errors in decisions involving Aboriginal and Torres Strait Islander children in Australia.

The quality of caregiving is often compromised when mothers have co-occurring difficulties such as substance misuse and problems associated with extreme emotional dysregulation. These, in turn, are associated with poor child outcomes. The aim of the current study was twofold. First, to investigate the potential differences in risk factors associated with poor child outcome by comparing three groups: substance misusing mothers (Substance Misusing Mothers; SMM); mothers matched on demographic characteristics (Matched Comparison Mothers; MCM) and mothers recruited from the community (Matched Control Comparison; MCC). Second, to investigate the underlying mechanisms which are associated with poor child outcome by testing a mediated moderation model to ascertain (i) whether environmental risk and borderline psychopathology was a mediator between maternal childhood trauma and quality of caregiving and (ii) maternal substance misuse status moderated outcome. There were no significant differences found between the SMM and MCM groups on the key variables, but significant differences on all variables for both SMM and MCM compared to CCM. The moderated mediation analysis found that while there was significant mediation of environmental risk and borderline pathology between maternal childhood trauma and child outcome, this was not moderated by maternal substance abuse status. The importance of environmental-risk as a mechanism leading to reduced caregiving quality suggest treatment programs need to consider targeting these factors in high risk families. Refereed/Peer-reviewed

BACKGROUND A large quantity of data is collected during the delivery of cancer care. However, once collected, these data are difficult for health professionals to access to support clinical decision making and performance review. There is a need for innovative tools that make clinical data more accessible to support health professionals in these activities. One approach for providing health professionals with access to clinical data is to create the infrastructure and interface for a clinical dashboard to make data accessible in a timely and relevant manner. OBJECTIVE This study aimed to develop and evaluate 2 prototype dashboards for displaying data on the identification and management of lymphedema. METHODS The study used a co-design framework to develop 2 prototype dashboards for use by health professionals delivering breast cancer care. The key feature of these dashboards was an approach for visualizing lymphedema patient cohort and individual patient data. This project began with 2 focus group sessions conducted with members of a breast cancer multidisciplinary team (n=33) and a breast cancer consumer (n=1) to establish clinically relevant and appropriate data for presentation and the visualization requirements for a dashboard. A series of fortnightly meetings over 6 months with an Advisory Committee (n=10) occurred to inform and refine the development of a static mock-up dashboard. This mock-up was then presented to representatives of the multidisciplinary team (n=3) to get preliminary feedback about the design and use of such dashboards. Feedback from these presentations was reviewed and used to inform the development of the interactive prototypes. A structured evaluation was conducted on the prototypes, using Think Aloud Protocol and semistructured interviews with representatives of the multidisciplinary team (n=5). RESULTS Lymphedema was selected as a clinically relevant area for the prototype dashboards. A qualitative evaluation is reported for 5 health professionals. These participants were selected from 3 specialties: surgery (n=1), radiation oncology (n=2), and occupational therapy (n=2). Participants were able to complete the majority of tasks on the dashboard. Semistructured interview themes were categorized into engagement or enthusiasm for the dashboard, user experience, and data quality and completeness. CONCLUSIONS Findings from this study constitute the first report of a co-design process for creating a lymphedema dashboard for breast cancer health professionals. Health professionals are interested in the use of data visualization tools to make routinely collected clinical data more accessible. To be used effectively, dashboards need to be reliable and sourced from accurate and comprehensive data sets. While the co-design process used to develop the visualization tool proved effective for designing an individual patient dashboard, the complexity and accessibility of the data required for a cohort dashboard remained a challenge.

Background There is growing interest in the provision of parenting support to substance misusing parents. Methods This pragmatic, multi-center randomized controlled trial compared an intensive one-to-one parenting program (Parents under Pressure, PuP) with Treatment as Usual (TAU) in the UK. Parents were engaged in community-based substance misuse services and were primary caregivers of children less than 2.5 years of age. The primary outcome was child abuse potential, and secondary outcomes included measures of parental emotional regulation assessed at baseline, 6 and 12-months. A prospective economic evaluation was also conducted. Results Of 127 eligible parents, 115 met the inclusion criteria, and subsequently parents were randomly assigned to receive PuP (n = 48) or TAU (n = 52). Child abuse potential was significantly improved in those receiving the PuP program while those in TAU showed a deterioration across time in both intent-to-treat (p Conclusions Up to one-third of substance dependent parents of children under 3-years of age can be supported to improve their parenting, using a modular, one-to-one parenting program. Further research is needed.

Background: Individuals with fetal alcohol spectrum disorders (FASDs) can experience profoundimpairments and long-term adverse outcomes. This systematic review adopts a life span perspectiveproviding an extensive analysis of the available literature. Methods: Studies were identified from PsycInfo, PubMed, Scopus, Web of Knowledge, CINAHL,ERIC, The Cochrane Central Register of Controlled Trials, and gray literature. Two reviewers independentlyscreened the title and abstract of each reference, and the methodological rigor of the includedstudies was assessed using the Effective Public Health Project assessment tool. Results: Thirty-two studies met the inclusion criteria, of which the vast majority targeted early tomiddle childhood. Two studies focused on early intervention in the postnatal period, and 6 studiesaimed to improve attention and/or self-regulation in childhood. Three of these provided promising evidenceon improving self-regulatory difficulties for children with FASDs. Nine studies focused onimproving specific areas of dysfunction. Six studies addressed social skills; 3 of these used an adaptationof a well-validated social skills program. Three studies provided promising initial evidence that parentsand caregivers could benefit from support with child behavior and a further 4 studies provided educationand advocacy for parents/caregivers, teachers, or child welfare workers. The final 2 studies wereaimed at supporting parents who were themselves affected by prenatal alcohol exposure. Conclusions: There is growing evidence for interventions that improve outcomes for early to middlechildhood. However, a lack of research exists outside of this developmental period. This lack ofresearch is concerning given the potential positive impact of early intervention, for individuals and,financially, for governments. In addition, the lack of interventions for adolescents and adults furtherhighlights the widening developmental gap and the potential influence of secondary disabilities for thisat-risk population. Refereed/Peer-reviewed

Children living in families with parental substance abuse are at high risk of child maltreatment and associated adverse outcomes. A trial of methadone-maintained parents randomised to the Parents under Pressure (PuP) parenting programme reported significant improvements in family functioning relative to standard care or a brief intervention, as indicated by a reduction in scores on the Child Abuse Potential Inventory. We sought to determine the cost-effectiveness of the PuP programme to inform policy and programme implementation. The cost per expected case of child maltreatment prevented was calculated and compared with the estimated lifetime costs of maltreatment and sensitivity analyses were conducted. Compared to usual care, the PuP programme costs an additional AU$8777 (£4880) per family to deliver. Assuming the most conservative estimate of one in five cases of maltreatment prevented, a cost-effectiveness estimate of AU$43 975 (£24 451) per case of potential maltreatment prevented for the PuP group was obtained. This is significantly less than the estimated mean lifetime cost of a case of child maltreatment of AU$200 000 (2013 present value) (£110 000). For 100 families in this population treated with PuP, there would be a net present value saving of an estimated AU$3.1 million (£1.7 million).

Objective: To explore the differences in baseline respiratory sinus arrhythmia (RSA) between children with fetal alcohol spectrum disorder (FASD) and typically developing children (TDC) and to investigate whether children with FASD have the capacity to engage in a brief mindfulness exercise. Methods: Participants were 14 children with FASD and 20 TDC. RSA was measured at baseline, during, and following a mindfulness exercise. A mindfulness compliance checklist was completed to ascertain if children could follow the task instructions. Results: Both groups obtained high scores on the mindfulness compliance checklist. There was a trend for children with FASD to have lower baseline RSA compared to TDC. Children in both groups demonstrated an increase in RSA during the mindfulness task. Conclusions: Children with FASD could engage in a mindfulness task, and both groups showed an increase in RSA. Further research is needed to establish whether prolonged mindfulness practice could be beneficial.

Objectives The aim of this study was to test a new theoretical model of cannabis use incorporating biologically-based personality traits and social cognition. This biosocial cognitive theory (bSCT) has robust support in alcohol studies, but has not been applied to cannabis. The model proposes two pathways linking dimensions of impulsivity to cannabis use. The first predicts that the association between Reward Sensitivity (SR) and cannabis use is mediated by positive outcome expectancies. The second predicts that the relationship between Rash Impulsiveness (RI) and cannabis use is mediated by cannabis refusal self-efficacy. An extended version of this model was also tested and included a third pathway linking Punishment Sensitivity (SP) to cannabis use via higher negative outcome expectancies. Method Participants were 252 18-to-21-year-olds who completed questionnaires assessing cannabis use, personality and social cognition. Theoretical models were tested using structural equation modeling. Results The bSCT model provided a good fit to the data (CFI = 0.95; RMSEA = 0.07; SRMR = 0.06). Positive cannabis expectancies and refusal self-efficacy partially mediated the association between SR and cannabis use (p < 0.05). Cannabis refusal self-efficacy fully mediated the relationship between RI and cannabis use (p < 0.05). The addition of a third SP pathway did not improve model fit. Conclusions Consistent with alcohol studies, the association between impulsivity and cannabis use is largely mediated by social cognition. The bSCT may provide novel insights to inform prevention and treatment of problematic cannabis use.