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Biomedical subjects

L Kroll

Publications and source records attributed to L Kroll.

At least 19 recordsLinked to original sources
PubMed2005

Psychosocial needs of boys in secure care for serious or persistent offending.

BACKGROUND: The mental health of child offenders who are detained in secure settings is a matter of great public and professional concern but there has been little systematic longitudinal research on the outcomes of these problems once the young person has returned to the community. The aims of the present study were to describe the psychosocial outcomes of boys in secure care and to establish if these outcomes were correlated with criminal outcomes. METHOD: Prospective cohort study of 97 boys whose average age was 14 years when they were admitted to secure units in the North West of England. The boys were followed up on average 2 years later, when outcome data were obtained on 81/97 (83%) cases. The main outcome measure was a standardised assessment of mental health, social and educational needs obtained by interview with the young person and corroborated in most cases by information from informants. All data were then reviewed by experienced clinicians who made best-estimate ratings of need 'blind' to the findings from the first phase of the study. RESULTS: The average number of needs requiring an intervention at follow-up (mean=3.4, sd=3.0) was much lower than before admission to secure care (mean=8.2, sd=2.5) (mean difference 4.9 needs, 95% CI 4.0 to 5.7). Educational and occupational needs were particularly well dealt with. However, many mental health problems persisted or worsened. For example, 31% had a need for treatment of substance abuse, a significant increase compared with when they were in secure care (percentage difference 21%, 95% CL 9.0% to 32.7%). No mental disorder predicted subsequent offending. CONCLUSIONS: Boys who have been in secure care continue to have a high rate of mental health problems. The mental health needs of this group are not, however, static but change over time and with changing circumstances. Services need to be designed to meet these changing needs.

Adolescent↗
PubMed2002

Mental health needs of boys in secure care for serious or persistent offending: a prospective, longitudinal study.

BACKGROUND: The mental health needs of children and adolescents in secure care are a matter of concern, but little systematic research has been done. Our aim was to assess the mental health, social, and educational needs of these young people in a prospective, longitudinal study. METHODS: We enrolled 97 boys aged 12-17 years who had been admitted to secure care. We assessed their needs (n=97) at the time of admission and 3 months later (n=90) with standardised interviews and psychometric tests. RESULTS: 26 (27%) boys had an intelligence quotient (IQ) of less than 70. The need for psychiatric help was high on admission to a secure unit, with the most frequent disorders being depression and anxiety. There were high rates of aggression, substance misuse, self harm, and social, family, and educational problems, and associated needs. The mean number of needs was 8.5 (SD 2.9) on admission and 2.9 (SD 2.4) after 3 months (mean difference 5.6, 95% CI 5.0-6.3). Areas in which needs were mostly met included education, substance misuse, self care, and diet. Areas where the frequency of need fell substantially, but remained high, were social and family problems, and aggressive behaviours. Psychological needs persisted, with new onsets of depression, anxiety problems, and post-traumatic-stress symptoms shortly after admission. The most frequently required interventions were psychological assessment and cognitive behavioural work. INTERPRETATION: Boys in secure care have many needs and a high rate of psychiatric morbidity. During the admission period, secure care units address some domains of need, but others remain unchanged or get worse. Psychological and psychiatric provision in secure units need to be improved.

Adolescent↗
PubMed2001

Health gain and outcome predictors during inpatient and related day treatment in child and adolescent psychiatry.

OBJECTIVE: To investigate health gain and its predictors during inpatient and associated day patient treatment. METHOD: Consecutive admissions to two inpatient units for children and young adolescents in northwest England were studied (N = 55). Ascertainments were made from multiple perspectives, including family, teacher, clinician, and an independent researcher. Measures were taken at referral, admission, discharge, and 6-month follow-up; health gain was inferred from change scores on measures. Recruitment lasted from late 1995 to 1997; follow-up was completed during 1998. Independent variables tested as predictors included assessments of presenting symptoms, therapeutic alliance, and family functioning. RESULTS: Significant health gain during hospitalization was found on most measures and sustained to follow-up. There was no symptom change during the waiting-list control condition. Health gain was predicted independently by child and parental therapeutic alliance with the unit early in hospitalization and by preadmission family functioning. Externalizing problems did well if accompanied by good alliance. CONCLUSIONS: Assessment of health gain from multiple perspectives is possible and valuable. Inpatient treatment has significant therapeutic effect. Predictors for health gain lie in process variables of therapeutic alliance and family functioning rather than presenting symptoms. The results are discussed in relation to clinical practice and future research.

Adolescent↗
PubMed2000

Qualitative interview study of communication between parents and children about maternal breast cancer.

OBJECTIVE: To examine parents' communication with their children about the diagnosis and initial treatment of breast cancer in the mother. DESIGN: Qualitative interview study within a cross-sectional cohort. SETTING: Two breast cancer treatment centers. PARTICIPANTS: 32 women with stage I or stage II breast cancer with 56 school-aged children. Main outcome measures Semistructured interview regarding timing and extent of communication with children about the diagnosis and initial treatment of the mother's illness, reasons for talking to children or withholding information, and help available and requested from health professionals. RESULTS: Women were most likely to begin talking to their children after their diagnosis had been confirmed by biopsy, but a few waited until after surgery or said nothing at all. Family discussion did not necessarily include mention of cancer. There was considerable consistency in the reasons given for either discussing or not discussing the diagnosis. The most common reason for not communicating was to avoid children's questions, particularly those about death. Although most women had helpful discussion with a physician concerning their illness, few were offered help with talking to their children; many would have liked help, particularly the opportunity for both parents to talk to a health professional with experience in understanding and talking to children. CONCLUSION: Parents diagnosed with cancer or other serious illnesses should be offered help to think about whether, what, and how to tell their children and about what children can understand, especially as they may well be struggling themselves to come to terms with their illness.

Adolescent↗
PubMed1999

Reliability of the Salford Needs Assessment Schedule for Adolescents.

BACKGROUND: For adolescents, there is no specific needs assessment instrument that assesses significant problems that can benefit from specified interventions. A new instrument (S.NASA) was developed by incorporating and adapting three well established adult needs assessment instruments. The S.NASA covers 21 areas of functioning including social, psychiatric, educational and life skills. METHOD: Client and carer interviews were conducted by different researchers. A week later the interviews were repeated using a crossover design. Significant (cardinal) problems were generated from the clinical interviews using a pre-defined algorithm. Final need status (three categories) was made by clinicians assessing the cardinal problems against defined interventions. The interventions were generated from discussions with clinicians and a survey of appropriate professionals working with adolescents. RESULTS. Pre-piloting led to the final version being administered to 40 adolescents from secure units, forensic psychiatric and adolescent psychiatric services. There were 25 males and 15 females, mean age 15.5 years. Overall there were moderate to good inter-rater and test-retest reliability coefficients, the test-retest reliability coefficients for the total scores on the needs assessment interviews ranged from 0.73 to 0.85. Consensual and face validity was good, the adolescents and staff finding the instrument useful and helpful. CONCLUSIONS: This new needs assessment instrument shows acceptable psychometric properties. It should be of use in research projects assessing the needs and the provision of services for adolescents with complex and chronic problems.

Adolescent↗
PubMed1999

Children's perceptions of parental drinking: the eye of the beholder.

OBJECTIVE: Children learn about alcohol and about how to drink through modeling experience, in part. Modeling is typically studied by asking parents to describe their drinking behavior. However, children's perception of parents' drinking may differ from the way parents describe it. This study examined the degree to which children's perceptions and parents' reports agreed. METHOD: A sample of 177 grade-school children and their parents was drawn from a public school in Kentucky. Children completed questionnaires inquiring about their perceptions of the quantity, frequency and the positive and negative consequences of their parents' drinking. Their parents completed similar questionnaires describing their own drinking and its consequences. RESULTS: As hypothesized, first and second grade children's perceptions of parents' drinking were unrelated to parents' self-reports: Most of these children perceived their parents as nondrinkers even though parents reported drinking. Also as hypothesized, children's perceptions and parents' reports were significantly correlated for third through sixth grade students. However, there was a great deal of reliable, but unshared variance between these older children's perceptions and parents' reports. Children's perceptions and parents' reports were consistently quite different, even when both child and parent described the parent as a drinker. CONCLUSIONS: Studies of modeling influences on children regarding drinking should assess children's perceptions of their parents' behavior rather than parents' self-reports.

Age Factors↗
PubMed1998

Communication about parental illness with children who have learning disabilities and behavioural problems: three case studies.

Parental illness can have a profound impact on family relationships and children's behaviour. The amount and nature of communication between parents and children about the illness can play an important role, both positively and negatively, in mediating the outcomes. When children have a disability, families can be reluctant to communicate with them about family difficulties. They are often concerned about the impact that parental unavailability may have on their child's life. This paper reports on three families in which the mother was diagnosed with breast cancer and one child in the family had a disability. The extent and specific characteristics of their communication about the maternal illness with their children, behavioural changes in the children, explanations of communication strategies and attributions of behavioural changes are described. Family coping strategies are examined with reference to Lazarus's process model of stress and coping and the use of either problem-focused or emotion-focused strategies. Implications for possible clinical interventions are proposed. In particular it is suggested that families be offered consultation about: what children might understand; ways in which to communicate effectively; and strategies for coping with the long-term implications of serious parental illness.

Adolescent↗
PubMed1998

Theoretical and epidemiological aspects of attention deficit and overactivity in deaf children.

Disorders of attention deficit and overactivity, ADHD (DSM-IV), and hyperkinetic syndrome (ICD-10) are common and disabling. However, a number of factors in deaf children's development make the assessment of these disorders in deaf children problematic. The prevalence of ADHD and hyperkinetic disorder does not appear to be higher than expected in children with inherited deafness alone but does appear to be higher in children with acquired deafness and/or additional impairments. Data from a re-analysis of an earlier epdemiological study of psychiatric disorder in deaf children and adolescents suggests that these disorders are commoner than expected in deaf children and share the features of ADHD and hyperkinetic disorder seen in hearing children.

Journal Article↗
PubMed1998

Which depressed patients respond to cognitive-behavioral treatment?

OBJECTIVE: To identify predictors of remission from major depression in adolescent patients given cognitive-behavioral therapy (CBT). METHOD: The study was based on 50 patients aged between 10 and 17 years who were obtained from two studies of CBT. A wide range of possible predictors was examined. RESULTS: Sixty percent remitted by the end of treatment. In multivariate analyses remission was associated with younger age and less social impairment. CONCLUSIONS: Depressed patients who respond to CBT tend to be younger and less severely impaired than those who do not respond.

Adolescent↗
PubMed1996

Pilot study of continuation cognitive-behavioral therapy for major depression in adolescent psychiatric patients.

OBJECTIVE: To determine whether continuation of cognitive-behavioral therapy (CBT-C) could prevent relapse in adolescent psychiatric patients who had remitted from major depressive disorder (MDD). METHOD: Seventeen patients who continued to have CBT-C for 6 months after remission from MDD were compared with a historical control group of 12 cases who had no further treatment after remission. RESULTS: Only 1 of the 17 cases who continued with CBT-C dropped out. The cumulative relapse risk during CBT-C was significantly lower (0.2) than it had been in the historical control group (0.5). CONCLUSIONS: CBT-C warrants further investigation in a randomized, controlled trial.

Cognitive Behavioral Therapy↗
PubMed1996

The psychosocial characteristics of juvenile sexual offenders referred to an adolescent forensic service in the UK.

Criminal statistics indicate that a high percentage of sexual offences are committed by perpetrators under the age of 18 years. Descriptive data based on a retrospective case note study of 121 juvenile sexual offender referrals to an adolescent forensic unit are presented. The results suggest that adolescents commit an array of offences and present with generalized adjustment difficulties. Conduct disorder was the most common diagnosis, while rates of mental illness were lower than in earlier studies. Abused as opposed to non-abused offenders experienced more dysfunctional upbringings and demonstrated higher rates of personal disturbance. Theoretical and treatment implications are discussed in relation to the available literature on adolescent sexual offending.

Adolescent↗
PubMed1995

Properties of the mood and feelings questionnaire in adolescent psychiatric outpatients: a research note.

This study examined the psychometric properties of the Mood and Feelings Questionnaire (MFQ) in 104 adolescent outpatients attending a psychiatric clinic. The clinic offers a special assessment and treatment service for young people with depressive disorders. In this sample the self-report version of the MFQ had acceptable reliability and was a satisfactory screen for major depressive disorder diagnosed by a standardised interview with the child. It was also a useful measure of clinical remission.

Adolescent↗
PubMed1994

Risk factors at delivery and the need for skilled resuscitation.

A prospective study was devised to investigate how risk factors at delivery contribute to outcome at birth as measured by the type of resuscitation required ('skilled' or 'not skilled') and the Apgar score. In addition the number of unexpected 'crash calls' was recorded. In a 3-month sample, neonatologists attended 494 (38.6%) of 1279 deliveries. Of those attended, 188 (37.2%) required skilled resuscitation including 5 of 20 crash calls. Four risk factors at delivery were associated with skilled resuscitation: meconium, emergency caesarean section, prematurity and multiple births. Following the implementation of a revised resuscitation policy, a subsequent 3-month sample showed that 299 (24.8%) of 1206 deliveries were attended. A total of 175 (58.5%) required skilled resuscitation including 8 of 16 crash calls. The revised resuscitation policy, in our unit, proved to be safe and led to a reduction of attendance by neonatologists at deliveries.

Apgar Score↗