Children of incarcerated parents run a high risk for poor health and marginalisation across development where positive parenting comprises an essential protective factor. The For Our Children's Sake ...(FOCS) intervention is delivered with incarcerated parents in Sweden to support parenting and healthy child development. This study aimed to explore the effects of the FOCS intervention on relationship quality between parent and child, parent criminal attitude and interest in treatment, while investigating intervention fidelity.
The non-randomised non-blinded pragmatic controlled study was carried out during 2019-2020 in 15 prisons with 91 parents throughout Sweden. Group allocation was based on the set operation planning at each prison. Prisons delivering FOCS during the study period were recruited to the intervention group, whereas prisons delivering FOCS later were recruited to the control group. Outcomes were measured through parent-report at baseline September-December 2019 (T0), after intervention (T1) in January-April 2020, and at three-months follow-up in April-July in 2020 (T2). The primary outcome was relationship quality between incarcerated parent and child and secondary outcomes were criminal attitude, interest in other treatment programmes, and child-parent contact. Fidelity to intervention delivery was monitored through objectively rated audio recorded sessions by researchers, and by group-leader-reported logs. Group differences on outcome over time and at each time point were explored using mixed-model regression with repeated measures with an intention-to-treat approach and per protocol.
The intention-to-treat analysis showed favourable intervention effects over time for relationship quality, explained by a higher intervention group score at T2. An intervention effect was found for parental interest in other prison-delivered treatments at T2. The analysis per protocol found similar but stronger effects on the relationship quality and an additional intervention effect over time for criminal attitude, also explained by a significant group difference at T2. The effect on treatment interest did not reach statistical significance in the analysis per protocol. Group leaders reported that all sessions had been performed and the objective ratings of fidelity rendered overall acceptable delivery of the intervention.
The FOCS intervention had beneficial effects on relationship quality, and outcomes related to criminality which suggests that a parenting intervention for incarcerated parents has the potential to influence both parenting outcomes and outcomes related to a criminal lifestyle. Future studies should investigate intervention effectiveness on long-term outcomes related to both child health and parental recidivism. Further development of intervention components is suggested with the hypothesis to increase intervention effectiveness.
ClinicalTrials.gov: No. NCT04101799, prospectively registered on September 24, 2019, Identifier: https://clinicaltrials.gov/ct2/show/NCT04101799, The authors confirm that all ongoing and related trials for this intervention are registered.
Children of incarcerated parents run a high risk of ill-health and future delinquency, whereas positive parenting can support children's healthy development. The For Our Children's Sake (FOCS) ...parenting intervention for parents in prison was evaluated as a controlled trial during 2019-2021 within The Swedish Prison and Probation Service (SPPS). This study reports on the process evaluation and aimed to describe how parents perceived their participation and aspects that influenced implementation of the FOCS intervention.
This convergent mixed-methods study (QUAL + quan) included qualitative interview data after participation in the FOCS intervention group (12 parents), and quantitative questionnaire data from intervention and control groups (46 parents). Qualitative data were analysed using inductive qualitative content analysis and quantitative data using descriptive and non-parametric statistics.
An integrated synthesis of the qualitative and quantitative results showed three joint concepts that provided an extended understanding of the importance of a child and parent focused intervention available to parents in prison, where FOCS was perceived as the only place where inmates could openly reflect, and express sensitive feelings and thoughts related to the children and being a parent. Also, that the SPPS as an organisation entails partly unsupportive organisational norms with irregular individual staff engagement, which made FOCS invisible in prisons, and the importance of engagement and motivation from all participants and group leaders in the group was essential for a successful FOCS group.
This study showed that availability of a child and parent focused intervention in prison is perceived as very important, and at the same time dependent on a trustful relationship in the group to be rewarding to the participants, where organisational norms within the SPSS need amendments for successful implementation of FOCS. These findings can guide further implementation of similar interventions in prison.
Considering the financial connections between sport and the gambling industry, more should be learned about gambling and problem gambling in this setting. This study explores how male athletes, ...coaches, and sports managers experience gambling activities and problems in their sports. Interviews were conducted with 30 male elite athletes, coaches, and managers in four sports. The interviews were analysed using content analysis, and the results indicated two main themes: 1) desire for and concerns with money and 2) in the shadow of performance, and three categories. The first main theme emerged as a result of the respondents recurring reference to money as the reason to different actions: It is important to win money,’too little’ or ‘too much’ money is described as reason for gambling, athletes status is affected by money and sponsor money from the gambling companies are considered important. ‘In the shadow of the performance’ captures the reason to and value of performance: The thrill and money are rewards for the gambling performance, everyday sporting life emphasizes performance both in training and matches. Lack of successful performance is perceived as a threat and evokes a fear of being seen as weak and being ejected from the team. This study identifies gambling as normalized within male elite sport. Preventing gambling problems calls for action at all levels of the involved socio-ecological framework. Management, coaches, and athletes need more knowledge of gambling and how to create a sustainable framework to prevent gambling problems.
Behavior problems are common among children and place a high disease and financial burden on individuals and society. Parenting interventions are commonly used to prevent such problems, but little is ...known about their possible longer-term economic benefits. This study modelled the longer-term cost-effectiveness of five parenting interventions delivered in a Swedish context: Comet, Connect, the Incredible Years (IY), COPE, bibliotherapy, and a waitlist control, for the prevention of persistent behavior problems.
A decision analytic model was developed and used to forecast the cost per averted disability-adjusted life-year (DALY) by each parenting intervention and the waitlist control, for children aged 5-12 years. Age-specific cohorts were modelled until the age of 18. Educational and health care sector costs related to behavior problems were included. Active interventions were compared to the waitlist control as well as to each other.
Intervention costs ranged between US$ 14 (bibliotherapy) to US$ 1,300 (IY) per child, with effects of up to 0.23 averted DALYs per child (IY). All parenting interventions were cost-effective at a threshold of US$ 15,000 per DALY in relation to the waitlist control. COPE and bibliotherapy strongly dominated the other options, and an additional US$ 2,629 would have to be invested in COPE to avert one extra DALY, in comparison to bibliotherapy.
Parenting interventions are cost-effective in the longer run in comparison to a waitlist control. Bibliotherapy or COPE are the most efficient options when comparing interventions to one another. Optimal decision for investment should to be based on budget considerations and priority settings.
Parent management training (PMT) programmes and child cognitive behavioural therapy are recommended approaches for treatment of oppositional defiant disorder in children, and combining these may be ...effective. However, little is known regarding the economic efficiency of this additive effect. A within-trial cost-effectiveness analysis was carried out in Sweden including 120 children aged 8–12 who screened positive for disruptive behaviour disorders, within a psychiatric care setting, and their parents. They were randomly assigned to either the Swedish group-based PMT Comet, or to an enhanced version, where an additional child component was provided, the Coping Power Programme (CPP). Child behaviour problems as well as healthcare and educational resource use were measured at baseline, post-test and at two-year follow-up. A net benefit regression framework was used to estimate differences in costs and health outcomes between the two intervention arms during the two-year period. Comet with CPP cost on average 820 EURO more per family than Comet only. At the 2-year follow-up, there were 37% recovered cases of ODD in Comet with CPP, in comparison to 26% in the Comet only arm. At a willingness-to-pay of approximately 62,300 EURO per recovered case of ODD, Comet with CPP yielded positive net benefits, in comparison to Comet only. Offering children the CPP simultaneously as their parents receive PMT, in comparison to only providing PMT, yields clinically relevant gains. Despite the relatively small cost for CPP, investment in combining PMT and CPP should be guided by resource prioritisation. Trial registration number: ISRCTN10834473, date of registration: 23/12/2015
Background and purpose: Parenting concerns can be a major source of distress for patients with cancer who are parents of dependent children; however, these are often not addressed in health care. The ...Parenting Concerns Questionnaire (PCQ) is an instrument designed to assess parents’ worries about the impact of cancer on their children and their ability to parent during this time. The Swedish version of the PCQ has, however, not been evaluated. This study therefore aimed to examine the psychometric properties of the PCQ in a sample of Swedish parents with cancer. Material and methods: A sample of 336 patients with cancer having dependent children (≤18 years) were included in a cross-sectional web-based survey. Participants completed questionnaires assessing parenting concerns, depression, anxiety, and stress symptoms (DASS); self-efficacy, family functioning (FAD-GF); and sociodemographic and clinical characteristics. Descriptive analyses, as well as reliability and validity analyses, were conducted followed by a confirmatory factor analysis of the factor structure proposed by the authors of the original version of the PCQ. Results: The majority were mothers (94.9%) with breast cancer (66.4%) aged 40–50 years (59.5%). The results showed evidence for convergent, criterion, and known group’s validity, but the original three-factor structure of the PCQ was not fully supported by confirmatory factor analysis. Interpretation: Evaluating parenting concerns may be an important step towards identifying patients who could benefit from targeted psychosocial interventions. However, the PCQ may require some further refinement to fully capture the breadth of parenting concerns in parents with cancer in different settings.
Preventing relapse into violence and its destructive consequences among persistent re-offenders is a primary concern in forensic settings. The Risk-Need-Responsivity framework models the best current ...practice for offender treatment, focused on building skills and changing pro-criminal cognitions. However, treatment effects are often modest, and the forensic context can obstruct the delivery of interventions. Developing treatments for offenders should focus on the best method of delivery to make “what works work.” Virtual reality (VR)-assisted treatments such as Virtual Reality Aggression Prevention Training (VRAPT) are a new and innovative approach to offender treatment. This pilot study followed 14 male violent offenders who participated in VRAPT in a Swedish prison context and measured changes from pre-treatment to post-treatment and 3-month follow-up in targeted aggression, emotion regulation, and anger. It also investigated potential impact factors (pro-criminal cognitions, externalizing behaviors, psychosocial background, and childhood adverse experiences). In Bayesian linear mixed effects models, participants showed a high probability of change from pre-treatment to post-treatment and to follow-up on all outcome measures. All outcome measures demonstrated a low probability of change from post-treatment to follow-up. Analysis of reliable change showed that participants’ results ranged from recovery to deterioration. We discuss the implications of the study for VRAPT’s impact on the target group, those who might benefit from the approach, and suggested foci for future studies in the field of VR-assisted offender treatment. The study was preregistered at the International Standard Randomized Controlled Trial Number registry (
https://doi.org/10.1186/ISRCTN14916410
).
Background and purpose: As many as one in four adults with cancer have children under 18 years. Balancing parenting and cancer is challenging and can be a source of psychological distress. This study ...aimed to examine psychological distress in parents with cancer and its associations with parenting concerns, self-efficacy, and emotion regulation. Materials and methods: This was a cross-sectional questionnaire study of 406 parents (aged 25–60 years) diagnosed with cancer within the last 5 years, with at least one dependent child (≤ 18 years). Parents completed questionnaires on psychological distress (DASS-21), parenting concerns (PCQ), self-efficacy (GSE), emotion regulation (ERQ), mental and physical health, and sociodemographics. Data were analysed using multiple logistic regressions on depression (yes/no), anxiety (yes/no), and stress (yes/no). Results: Higher parenting concerns were associated with greater odds of depression (OR = 2.33, 95% CI: 1.64–3.31), anxiety (OR = 2.30, 95% CI: 1.64–3.20), and stress (OR = 3.21, 95% CI: 2.20–4.69) when adjusting for health and sociodemographic factors. Poorer self-efficacy was associated with increased odds of anxiety (OR = 0.94, 95% CI: 0.89–0.99, p < 0.05), whereas lower use of cognitive reappraisal and higher use of expressive suppression increased the odds of depression (OR = 0.76, 95% CI: 0.59–0.98 | OR = 1.46, 95% CI: 1.18–1.80). Interpretation: The findings highlight the complexity of parental well-being in relation to parenthood and cancer, stressing the need for interventions that address relevant psychological factors to improve overall mental health in this population.
The objective was to (i) assess the long-term cost-effectiveness of acceptance and commitment therapy (ACT), a workplace dialog intervention (WDI), and ACT+WDI compared to treatment as usual (TAU) ...for common mental disorders and (ii) investigate any differences in cost-effectiveness between diagnostic groups.
An economic evaluation from the healthcare and limited welfare perspectives was conducted alongside a randomized clinical trial with a two-year follow-up period. Persons with common mental disorders receiving sickness benefits were invited to the trial. We used registry data for cost analysis alongside participant data collected during the trial and the reduction in sickness absence days as treatment effect. A total of 264 participants with a diagnosis of depression, anxiety, or stress-induced exhaustion disorder participated in a two-year follow-up of a four-arm trial: ACT (N=74), WDI (N=60), ACT+WDI (N=70), and TAU (N=60).
For all patients in general, there were no statistically significant differences between interventions in terms of costs or effect. The subgroup analyses suggested that from a healthcare perspective, ACT was a cost-effective option for depression or anxiety disorders and ACT+WDI for stress-induced exhaustion disorder. With a two-year time horizon, the probability of WDI to be cost-saving in terms of sickness benefits costs was 80% compared with TAU.
ACT had a high probability of cost-effectiveness from a healthcare perspective for employees on sick leave due to depression or anxiety disorders. For participants with stress-induced exhaustion disorder, adding WDI to ACT seems to reduce healthcare costs, while WDI as a stand-alone intervention seems to reduce welfare costs.
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