Research & Action Report, Fall/Winter 2015
“Development of a technology-based behavioral vaccine to prevent adolescent depression: A health system integration model,” by Benjamin Van Voorhees, Tracy Gladstone, Stephanie Cordel, Monika Marko-Holguin, William Beardslee, Sachiko Kuwabara, Mark Kaplan, Joshua Fogel, Anne Diehl, Chris Hansen, and Carl Bell, in Internet Intervention (in press), focuses on the development of the CATCH-IT (Competent Adulthood Transition with Cognitive-behavioral, Humanistic and Interpersonal Training) Intervention. Efforts to prevent depression have become a key health system priority. Currently, there is a high prevalence of depression among adolescents, and treatment has become costly due to the recurrence patterns of the illness, impairment among patients, and the complex factors needed for a treatment to be effective. Primary care may be the optimal location to identify those at risk by offering an Internet-based preventive intervention to reduce costs and improve outcomes. Few practical interventions have been developed. The models for Internet intervention development that have been put forward focus primarily on the Internet component rather than how the program fits within a broader context. This paper describes the conceptualization for developing technology based preventive models for primary care by integrating the components within a behavioral vaccine framework. CATCH-IT has been developed and successfully implemented within various health systems over a period of 14 years among adolescents and young adults aged 13–24.
Gladstone was also an author of “Prevention of depression in at-risk adolescents— A randomized controlled trial: Impact of a cognitive behavioral prevention program on depressive episodes, depression-free days, and developmental competence six years after the intervention,” (Brent, D. A., Brunwasser, S. M., Hollon, S. D., Weersing, V. R., Clarke, G. N., Dickerson, J. F., Beardslee, W. R., Gladstone, T. R., Porta, G., Lynch, F. L., Iyengar, S., & Garber, J.) in JAMA Psychiatry. Adolescents whose parents have a depression history are at risk for developing depression and functional impairment. The long-term effects of prevention programs on adolescent depression and functioning are not known. This study helped to determine if a cognitive behavior prevention program (CBP) reduced the incidence of depressive episodes, increased depression-free days (DFDs), and improved developmental competence six years after intake. The Depression Symptoms Rating scale was used to assess the primary outcome, new onsets of depressive episodes, and to calculate DFDs. A modified Status Questionnaire assessed developmental competence (e.g., academic, interpersonal) in young adulthood. Results showed that CBP’s preventive effect on new onsets of depression was strongest early, but maintained across follow-up; developmental competence was positively affected six years later; CBP’s effectiveness may be enhanced by additional booster sessions and concomitant treatment of parental depression.
Gladstone was lead author of “Increasing understanding in children of depressed parents: Predictors and moderators of intervention response,” (Gladstone, T.R.G., Forbes, P., Diehl, A., & Beardslee, W.R.) in Depression Research and Treatment (in press), focuses on the Family Talk intervention, and about characteristics in adults and in families that predict response to a family-based depression prevention program. The research team evaluated predictors and moderators of differential response to two family-based depression prevention programs for families with a depressed parent: a clinician-facilitated intervention and a lecture group intervention. Individual and family-level variables were examined using regression analyses with generalized estimating equations. For the outcome of child understanding of depression, parental changes in child-related behaviors and attitudes predicted greater child understanding; for the parent outcome of behavior and attitude change, across intervention conditions, younger parent age, female parent gender, more chronic and severe parental depression history, lower socioeconomic status, and single-parent status were associated with better outcomes across conditions. Findings from this study can help identify intervention strategies that are appropriate for different types of at-risk individuals and families.
Gladstone also co-authored chapters with Research Associates Maria DiFonte and Emily Crain, currently in press. “Children of Parents with Mental Illness” (DiFonte, M. and Gladstone, T.), will be published in the Handbook of Childhood Behavioral Issues: Evidence-Based Approaches to Prevention and Treatment, 2nd Edition (Gullotta, T. & Blau, G., eds). “Parental Affective Disorder,” (Crain, E. and Gladstone, T.) will be published in Children & Young People’s Response to Parental Illness: A Handbook of Assessment & Practice (Morley, D., Li, X., & Jenkinson, C., eds).
Sari Pekkala Kerr contributed “Parental Leave Legislation and Women’s Work: A Story of Unequal Opportunities,” to the Journal of Policy Analysis and Management (doi: 10.1002/ pam.21875). U.S. federal and state family leave legislation requires employers to provide job-protected parental leave for new mothers covered under the legislation. In most cases the leave is unpaid, and rarely longer than 12 weeks in duration. This study evaluates disparities in parental leave eligibility, access, and usage across the family income distribution in the U.S. It also describes the links between leave-taking and women’s labor market careers. The focus is especially on low-income families, as their leave coverage and ability to afford taking unpaid leave is particularly poor. This study shows that the introduction of both state and federal legislation increased overall leave coverage, leave provision, and leave-taking. For example, the Family and Medical Leave Act (FMLA) leads to an increased probability of leave-taking by nearly 20 percentage points and increased average leave length by almost five weeks across all states. The new policies did not, however, reduce gaps between low- and high-income families’ eligibility, leave-taking, or leave length. In addition, the FMLA effects on leave-taking were very similar across states with and without prior leave legislation, and the FMLA did not disproportionately increase leave-taking for women who worked in firms and jobs covered by the new legislation, as these women were already relatively well covered by other parental leave arrangements.
The book chapter, “Immigrant Entrepreneurship,” is included in Measuring Entrepreneurial Businesses: Current Knowledge and Challenges, by Pekkala Kerr and William Kerr (NBER Book Series—Studies in Income and Wealth, University of Chicago Press). The researchers examine immigrant entrepreneurship and the survival and growth of immigrant- founded businesses over time relative to native-founded companies. Their work quantifies immigrant contributions to new firm creation in a wide variety of fields and using multiple definitions. While significant research effort has gone into understanding the economic impact of immigration into the United States, comprehensive data for quantifying immigrant entrepreneurship are difficult to assemble. They combine several restricted-access U.S. Census Bureau data sets to create a unique longitudinal data platform that covers 1992- 2008 and many states. The researchers describe differences in the types of businesses initially formed by immigrants and their medium-term growth patterns. They also consider the relationship of these outcomes to the immigrants’ age at arrival to the United States.
“Post-Secondary Education and Information on Labor Market Prospects: A Randomized Field Experiment,” was published online as a working paper by Pekkala Kerr, Tuomas Pekkarinen, Matti Sarvimäki, and Roope Uusitalo (http://aalto-econ.fi/sarvimaki/information.pdf). The researchers examine the impact of an information intervention offered to 97 randomly chosen high schools in Finland. Graduating students in treatment schools were surveyed and given information on the labor market prospects associated with detailed postsecondary programs. One-third of the students report that the intervention led them to update their beliefs. Experimental estimates suggest that it also affected the application behavior of the least informed students. However, this group of affected students is not sufficiently large for the intervention to have an average impact on applications or enrollment.
Out-of-School Time and Special Populations
“Practices and Approaches of Out-of-School Time Programs Serving Immigrant and Refugee Youth,” by Georgia Hall, Michelle Porche, Jennifer Grossman, and Sviatlana Smashnaya, is included in Journal of Youth Development, Volume 10, Number 2 (Summer 2015). Opportunity to participate in an outof- school time program may be a meaningful support mechanism towards school success and healthy development for immigrant and refugee children. This study extends existing research on best practices by examining the on-the-ground experiences of supporting immigrant and refugee youth in out-of-school time programs. Findings from semi-structured interviews with program directors in 17 Massachusetts and New Hampshire programs suggest a number of program strategies that were responsive to the needs of immigrant and refugee students, including support for the use of native language as well as English, knowing about and celebrating the heritage of the students’ homeland, including on staff or in leadership individuals with shared immigrant background, and giving consideration to the academic priorities of parents. The development of such intentional approaches to working with immigrant and refugee youth during the out-of-school time hours will encourage enrollment of, and enhance effectiveness with, this vulnerable population.
Privilege, Advantage and Disadvantage
“Extending the Knapsack: Using the White Privilege Analysis to Examine Conferred Advantage and Disadvantage,” by Peggy McIntosh, is included in Women in Therapy, Volume 38, Issue 2-3-3-4, a special issue focused on Whiteness and White Privilege in Psychotherapy, edited by Andrea Dottolo and Ellyn Kaschak. This articles derives from another McIntosh chapter, “An Exercise in Privilege and Disadvantage” included in a 2015 book, Clinical Supervision Activities for Increasing Confidence and Self-Awareness, edited by Roy Bean, et al., which describes a self-awareness activity that uses directed reading on privilege and small group format for discussing unearned disadvantage and unearned advantage in one’s life.
Recently McIntosh and six National SEED Project staff members published “Teacher Self-knowledge: The Deeper Learning,” an article in Independent School magazine. Coauthors are Peaches Gillette, Bob Gordon, Ruth Mendoza, Jondou Chase Chen, Pat Badger, and Hugo Mahabir. Each author testifies to some of their own experience of developing self-knowledge, in line with SEED co-director Emily Style’s metaphor of “balancing the scholarship on the shelves with the scholarship in the selves.”