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*** Henggeler, S. W., Melton, G. B., & Rodrigue, J. R. (1992). Pediatric and adolescent AIDS: Research findings from the social sciences. Newbury Park, CA: Sage. (Book)

6.  DeLoye, G. J., Henggeler, S. W., & Daniels, C. M. (1993). Developmental and family correlates of children's knowledge and attitude regarding AIDS. Journal of Pediatric Psychology, 18, 209-219

217.  Jones, R.T., Ribbe, D.P., Cunningham, P.B., Weddle, J.D.,Langley, A.K. (2002). Psychological impact of fire disaster on children and their parents. Journal of Behavior Modification, 26(2), 163-186.

218.  Jones, R.T., Randall, J. (2002). How children cope in a fire emergency. Journal of Fire Engineering, February 2002, 85-96.

237.  Ellis, D. A., Naar-King, S., Frey, M., Rowland, M.D., & Greger, N. (2003). Case study: Feasibility of multisystemic therapy as a treatment for urban adolescents with poorly controlled type 1 diabetes. Journal of Pediatric Psychology, 28(4), 287-293.

238.  Henggeler, S.W. (2003). Commentary on Ellis et al.: Adapting multisystemic therapy for challenging clinical problems of children and adolescents. Journal of Pediatric Psychology, 28(4) 295-297.

267.  Ellis, D.A., Frey, M.A., Naar-King, S., Templin, T., Cunningham, P.B., Cakan, N. (in press). The effects of multisystemic therapy on diabetes stress in adolescents with chronically poorly controlled type II diabetes: Findings from a randomized controlled trial. Pediatrics.

268.  Ellis, D.A., Frey, M.A., Naar-King, S., Templin, T., Cunningham, P.B., Cakan, N. (2005). Use of multisystemic therapy to improve regimen adherence among adolescents with Type 1 diabetes in chronic poor metabolic control: A randomized controlled trial. Diabetes Care, 28(7), 1604-1610.

271.  Cunningham, P.B., Narr-King, S., Ellis, D.A., Pejuan, S., Secord, E. (2006).  Achieving adherence to antiretroviral medications for pediatric HIV disease using empirically supported treatment:  A case report. Journal of Developmental and Behavioral Pediatrics, 27(1), 44-50.

272.  Ellis, D.A., Narr-King, S., Cunningham, P.B., Secord, E. (2006).  Use of multisystemic therapy to improve antiretroviral adherence and health outcomes in HIV-infected pediatric patients: Evaluation of a pilot program.  AIDS, Patient Care, and STD’s, 20(2), 112-121.

278.  Ellis, D. A., Naar-King, S., Frey, M., Templin, T., Rowland, M.D., Cakan, N. (2005).  Multisystemic treatment of poorly controlled type 1 diabetes:  Effects on medical resource utilization.  Journal of Pediatric Psychology, 30(8), 656-666.

283.  Naar-King, S., Idalski, A., Ellis, D., Frey, M., Templin, T., Cunningham, P.B., Cakan, N. (2005). Gender differences in adherence and metabolic control in urban youth with poorly controlled type 1 diabetes: The mediating role of the mental health symptoms.  Journal of Pediatric Psychology (Dec.) pp. 1-10.

297.   Ellis, D.A., Templin, T., Naar-King, S., Frey, M.A., Cunningham, P.B., Podolski, C., Cakan, N. (2007). Multisystemic therapy for adolescents with poorly controlled type 1 diabetes: Stability of treatment effects in a randomized controlled trial. Journal of Consulting and Clinical Psychology, 75, 168-174.

299.   Ellis, D.A., Yopp, J., Templin, T., Naar-King, S., Frey, M.A., Cunningham, P.B., Idalski, A., Niec, L.N. (2007). Family mediators and moderators of treatment outcomes among youths with poorly controlled type 1 diabetes: Results from a randomized controlled trial. Journal of Pediatric Psychology, 32(2), 194-205.

304.  Ellis, D.A., Naar-King, S., Templin, T., Frey, M.A., Cunningham, P.B. (2007). Improving health outcomes among youth with poorly controlled type I diabetes: The role of treatment fidelity in a randomized clinical trial of multisystemic therapy. Journal of Family Psychology, 21(3), 363-371.

343.   Ellis, D.E., Naar-King, S., Templin, T., Frey, M.A., & Cunningham, P.B. (2007). Improving health outcomes among youth with poorly controlled type I diabetes: The role of treatment fidelity in a randomized clinical trial of multisystemic therapy. Journal of Family Psychology, 21(3), 363-371.

352.  Naar-King, S., Ellis, D., Kolmodin, K., Cunningham, P.B., Jen, C., Saelens, B. & Brogan, K. (2009). A randomized pilot study of Multisystemic therapy targeting obesity in african-american adolescents. Journal of Adolescent Health, 45(4), 317-319. doi: 10.1016/j.jadohealth.2009.03.022

353.  Naar-King, S., Ellis, D., Kolmodin, K., Cunningham, P.B., & Secord, E. (2009). Feasibility of adapting multisytemic therapy to improve illness management behaviors and reduce asthma morbidity in high risk african american youth: A case series. Journal of Child and Family Studies, 18(5), 564-573. doi: 10.1007/s10826-009-9259-9

354.  Cunningham, P. B., Ellis, D. A., & Naar-King, S. (2010). Treating pediatric obesity using an empirically supported treatment: A case report. Journal of clinical child and Adolescent Psychology, 39(1), 141-150.

357.  Ellis, D. A., Naar-King, S., Frey, M., Templin, T., Rowland, M. & Greger, N. (2004) Use of multisytemic therapy to improve regimen adherence among adolescents with type 1 diabetes in poor metabolic control: A pilot investigation. Journal of Clinical Psychology in Medical Settings, 11(4), 315-324.

358.  Ellis, D. A., Naar-King, S., Templin, T., Frey, M., Cunningham, P., Sheidow, A., Cakan, N., Idalski, A. Multisystemic therapy for adolescents with poorly controlled type 1 diabetes. Diabetes Care, 31(9), 1746-1747.

360.  Letourneau, E. J., Ellis, D. A., Naar-King, S., Cunningham, P. B., & Fowler, S. L. (2010). Case study: Multisystemic therapy for adolescents who engage in HIV transmission risk behaviors. Journal of Pediatric Psychology, 35(2), 120-127.   

378.  Letourneau, E. J., Chapman, J. E., Schoenwald, S. K., (2008). Treatment outcome and criminal offending by youth with sexual behavior problems. Child Maltreatment, 13(2), 133-144. doi: 10.1177/1077559507306717

380.   Ellis, D. A., Naar-King, S., Templin, t., Grey, M. A., Cunningham, P. B., Sheidow, A., Cakan, N. (2008). MST for adolescents with poorly controlled type 1 diabetes: Reduced DKA admissions and related costs over 24 months. Diabetes Care, 31(9), 1746-7.

395.  Carcone, A. I., MacDonell, K. E., Naar-King, S., Ellis, D. E., Cunningham, P. B., Kaljee, L. (2011). Treatment engagement in a weight-loss intervention for African American adolescents and their families. Children’s Health Care, 40, 1-21.

405.
  Schechter, J. C., Brennan, P. A., Cunningham, P. B., Foster, S. L. & Whitmore, E. (2012). Stress, cortisol, and externalizing behavior in adolescent males: An examination in the context of multisystemic therapy. Journal of Abnormal Child Psychology, 40, 913-922.

412.  Ellis, D. A., Naar-King, S., Chen, X., Moltz, K., Cunningham, P. B., & Idalski-Carcone, A. (2012). Multisystemic therapy compared to telephone support for youth with poorly controlled diabetes: Findings from a randomized controlled trial. Annals of Behavioral Medicine. Published online May 30.

449.  Taylor, L., Reves, C., McCart, M. R., Jensen, S., Elkin, D., Brown, R., Boll, T., & Simpson, K. (2007). A preliminary investigation of cognitive late effects and the impact of disease versus treatment among pediatric brain tumor patients. Children’s Health Care, 36(4), 373-384.  

453.
 Ryan, S. R., Brennan, P. A., Cunningham, P. B., Foster, S. L., Brock, R. L. & Whitmore, E. (2013). Biosocial processes predicting multisystemic therapy treatment response. Biological Psychology, 92, 373-379.

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  Pediatric Abstracts

6.  Developmental and family correlates of children’s knowledge and attitudes regarding AIDS

Assessed developmental and family variables associated with children’s knowledge of and emotional attitudes toward AIDS. Participants included 65 first to sixth graders from two private elementary schools and their mothers. Between groups comparisons showed that children knowledgeable about AIDS, a relatively negative attitude toward AIDS was associated with a negative attitude toward illness in general. Moreover, the children’s attitude toward AIDS was more negative than their attitudes toward other serious illnesses. Family relations and maternal AIDS-related knowledge and attitudes were linked with neither children’s knowledge not their attitudes.

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217.  Psychological impact of fire disaster on children and their parents

Six weeks following a major wildfire, children's psychosocial functioning was examined. Employing a multimethod assessment approach, the short term mental health consequences of the fire were evaluated. Individual adjustment was compared between families who reported high levels of loss as a result of the fire (high-loss group) and families who reported relatively low levels of loss resulting from the fire (low-loss group). Standardized assessment procedures were employed for children and adolescents as well as their parents. In general, high-loss participants reported slightly higher levels of post traumatic stress disorder (PTSD) symptoms and significantly higher scores on the Impact of Events Scale. PTSD symptoms reported by parents were generally significantly correlated with (but nor concordant with) PTSD symptoms reported by their children. The high-loss group scored significantly higher on Resource Loss Index than did the low-loss group. Preexisting and comorbid disorders and previous stressors are described. A methodological framework for future studies in this area is discussed.

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268.  Use of multisystemic therapy to improve regimen adherence among adolescents with type 1 diabetes in chronic poor metabolic control a randomized controlled trial

OBJECTIVE—The aim of this study was to determine whether multisystemic therapy (MST), an intensive, home-based psychotherapy, could improve adherence and metabolic control and decrease rates of hospital utilization among adolescents with chronically poorly controlled type 1 diabetes.

RESEARCH DESIGN AND METHODS—A randomized controlled trial was conducted with 127 adolescents with type 1 diabetes and chronically poor metabolic control (HbA1c [A1C] 8% for the past year) who received their diabetes care in a children’s hospital located in a major Midwestern city. Participants randomly assigned to MST received treatment for 6 months. Data were collected at baseline and at 7 months posttest (i.e., treatment termination). Changes in A1C adherence, as measured by semistructured interviews and blood glucose meters and hospital admissions and emergency department visits, were assessed.

RESULTS—In intent-to-treat analyses, participation in MST was associated with significant improvements in the frequency of blood glucose testing as assessed by blood glucose meter readings (F[1,125] = 16.75, P = 0.001) and 24-h recall interviews (F[1,125] = 6.70, P = 0.011). Participants in MST also had a decreasing number of inpatient admissions, whereas the number of inpatient admissions increased for control subjects (F[1,125] = 6.25, P = 0.014). Per protocol analyses replicated intent-to-treat analyses but also showed a significant improvement in metabolic control for adolescents receiving MST compared with control subjects (F[1,114] = 4.03, P = 0.047).

CONCLUSIONS—Intensive, home-based psychotherapy improves the frequency of blood glucose testing and metabolic control and decreases inpatient admissions among adolescents with chronically poorly controlled type 1 diabetes.

Abbreviations: CPMC, chronically poor metabolic control, DKA, diabetic ketoacidosis, MST, multisystemic therapy.

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271. Achieving adherence to antiretroviral medications for pediatric HIV disease using empirically supported treatment:  A case report

Adherence to antiretroviral medication regimens among human immunodeficiency virus positive-children is influenced by a number of psychological factors including characteristics of the child, the caregiver, the medical team, and the medications.  To address the factors requires treatment approaches that are flexible and comprehensive.  One such treatment approach is multisystemic therapy (MST), an empirically supported intensive home-based treatment approach that has been proven effective with other chronic pediatric conditions.  This case report describes the use of MST with a poorly adherent, perinatally infected adolescent.

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272.  Use of multisystemic therapy to improve antiretroviral adherence and health outcomes in HIV-infected pediatric patients: Evaluation of a pilot program

The purpose of the current study was to evaluate a clinical program that used multisystemic therapy (MST) to improve regimen adherence and health outcomes among children with perinatally acquired HIV who exhibited high viral loads in the absence of viral resistance. MST is an intensive, home-based family therapy previously used for the treatment of serious antisocial behavior. Goals of the study were to assess the feasibility of the MST program and its effectiveness for improving health outcomes among children who were treated. The study was conducted by retrospective chart review. Ninety percent of children and families referred to the program accepted the referral and 95% received a full dose of treatment, suggesting high program feasibility. Nineteen children participated in the program. General HIV knowledge on the part of caregivers improved significantly over the course of treatment. Although caregiver-reported adherence did not change, viral loads were found to significantly decrease from referral to the end of MST treatment, with the mean change reflecting a greater than 1 log10 decrease. The majority of children maintained these improvements during the 3 months after treatment termination. Results suggest that MST holds promise as an intervention for improving health outcomes among pediatric patients with HIV.

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278. Multisystemic treatment of poorly controlled type 1 diabetes:  Effects on medical resource utilization

Objective  To determine whether multisystemic therapy (MST), an intensive, home-based psychotherapy, could decrease rates of hospital utilization and related costs of care among adolescents with poorly controlled type diabetes.  Methods  Thirty-one adolescents were randomly assigned to receive either MST or standard care.  MST lasted approximately 6 months, and all participants were followed for 9 months.  Rates of inpatient admissions and emergency room (ER) visits were calculated for a nine-month prestudy period and during the 9 months of study participation.  The relationship between changes in inpatient admissions and changes in metabolic control was also investigated.  Results  Intervention participants had a decreasing number of inpatient admissions from the baseline period to the end of the study, whereas the number of inpatient admissions increased for controls.  Use of the emergency room did not differ.  Related medical charges and direct care costs were significantly lower for adolescents receiving MST.  Correlational analysis conducted with a subset of participants indicated that decreases in inpatient admissions were associated with improved metabolic control for MST but not control participants.  Conclusions  Findings suggest that MST has the potential to decrease inpatient admissions among adolescents with poorly controlled type 1 diabetes.

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283.  Gender differences in adherence and metabolic control in urban youth with poorly controlled type 1 diabetes: The mediating role of the mental health symptoms

Objective  To examine gender differences in adherence and metabolic control and test the mediating role of mental health symptoms in a sample of predominantly African-American, low-income youth with chronically poor metabolic control.  Methods   Baseline questionnaire data from an intervention study were collected from 119 youth and their primary caregiver.  Results Boys had worse adherence than girls, but there were no gender differences in hemoglobin A1C (HbA1C). Boys had more externalizing symptoms, whereas girls had more anxiety; there were no gender differences in depression.  Externalizing symptoms were associated with poor adherence and metabolic control.  Although anxiety was correlated with poor adherence, this relationship was not significant in the invariate analysis.  Results of  structural equation modeling (SEM) suggested that externalizing symptoms mediated the relationship between gender and adherence.  Conclusions  Results suggest that gender differences in adherence may be attributed, in part, to gender differences in externalizing symptoms in urban youth with poor metabolic control.  Interventions targeting these symptoms may be necessary to improve adherence and HbA1C in both boys and girls.

Key words  adherence; diabetes; gender; mental health; youth.

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297.  Multisystemic therapy for adolescents with poorly controlled type 1 diabetes: Stability of treatment effects in a randomized controlled trial

The primary purpose of the present study was to determine whether multisystemic therapy (MST), anintensive, home-based psychotherapy, improved regimen adherence, metabolic control, and rates of hospitalization for diabetic ketoacidosis (DKA) among adolescents with chronically poorly controlled Type 1 diabetes 6 months after the completion of treatment. A randomized controlled trial was conducted with 127 adolescents and their families. Mean participant age was 13.2 years. Sixty-three percent of participants were African American, and 51% were female. Data were collected at baseline, treatment termination, and 6-month follow-up. Changes in glycated hemoglobin (HbA1c), frequency of blood glucose testing (BGT), and rate of DKA admissions were assessed. In intent-to-treat analyses, a main effect of MST on DKA admissions was found at both treatment termination and follow-up. Improvements in BGT were moderated by family composition; only 2-parent MST families maintained improvements at follow-up. Improvements in HbA1c for the MST group at treatment termination were lost at follow-up. Results show that intensive, home-based psychotherapy created stable reductions in serious lapses in adherence, as indexed by episodes of DKA, among youth with poorly controlled diabetes.

Keywords: multisystemic therapy, Type 1 diabetes, adolescents

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299.  Family mediators and moderators of treatment outcomes among youths with poorly controlled type 1 diabetes: Results from a randomized controlled trial

Objective To determine whether multisystemic therapy (MST) improved family relationships among youths with poorly controlled type 1 diabetes and whether these changes mediated MST effects on health outcomes. The moderating effect of family demographics on study outcomes was also assessed. Methods A randomized controlled trial was conducted with 127 youths. Changes in general family relationships and caregiver support for diabetes care from baseline to treatment completion were assessed. Structural equation modeling (SEM) was used to test whether changes in family relations mediated improvements in frequency of blood glucose testing (BGT) and metabolic control. Results MST increased support for diabetes care from both primary and secondary caregivers in two-parent but not in single-parent families. However, MST had the strongest effects on BGT and metabolic control in single-parent families. SEM did not support family relations as the mediator of improved BGT or metabolic control. Rather, MST had a direct effect on BGT for all participants. BGT mediated improvements in metabolic control among single-parent families. Conclusions MST improved family relationships for youths with diabetes in two-parent but not in single-parent families. Objective outcomes related to diabetes were strongest for single-parent families. Other processes such as increased parental monitoring may have been responsible for improved health outcomes among these families.

Key words diabetes; family functioning; multisystemic therapy.


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304. Improving health outcomes among youth with poorly controlled type I diabetes: The role of treatment fidelity in a randomized clinical trial of multisystemic therapy

The purpose of the study was to assess whether therapist treatment fidelity was a predictor of treatment outcome in a randomized clinical trial of multisystemic therapy with 10- to 16-year-old youths with chronically poorly controlled Type I diabetes (N= 40). Treatment fidelity was assessed by objective ratings of therapy sessions and questionnaires completed by caregivers and by therapists. Relationships between fidelity measures were assessed. Structural equation modeling (SEM) was used to test whether high fidelity would lead to improved regimen adherence and to improved metabolic control outcomes via regimen adherence. Objective ratings of treatment fidelity were significantly related to therapist-reported but not to caregiver-reported treatment fidelity. SEM resulted supported a completely mediated pathway between treatment fidelity and metabolic control, with regimen adherence mediating the relationship. Results suggest that conducting complex behavioral interventions with a high degree of fidelity can improve treatment outcomes among youths with chronic illnesses.

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343.  Improving health outcomes among youth with poorly controlled type I diabetes: The role of treatment fidelity in a randomized clinical trial of multisystemic therapy

The purpose of the study was to assess whether therapist treatment fidelity was a predictor of treatment outcome in a randomized clinical trial of multisystemic therapy with 10- to 16-year-old youths with chronically poorly controlled Type I diabetes (N=40). Treatment fidelity was assessed by objective ratings of therapy sessions and questionnaires completed by caregivers and by therapists. Relationships between fidelity measures were assessed. Structural equation modeling (SEM) was used to test whether high fidelity would lead to improved regimen adherence and to improved metabolic control outcomes via regimen adherence. Objective ratings of treatment fidelity were significantly related to therapist-reported but not to caregiver-reported treatment fidelity. SEM results supported a completely mediated pathway between treatment fidelity and metabolic control, with regimen adherence mediating the relationship. Results suggest that conducting complex behavioral interventions with a high degree of fidelity can improve treatment outcomes among youths with chronic illnesses.

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