Evaluation in primary prevention: a must, II, The child psychiatry point of view

The evaluation of any antenatal prevention program of child abuse and neglect is limited for statistical and ethical reasons, as shown in the first part of the present study (cf., The obstetrical viewpoint by G. Soumenkoff). The authors propose a child psychiatry model of evaluation. Use of the model is illustrated by a 4-year survey of 374 selected high-risk pregnant women followed in the antenatal out-patient department of St. Pieters Hospital in Brussels. A child psychiatrist worked together with several gynecologists, supporting the high-risk couples as well as their children. Several indirect evaluation methods of the quality of screening and the efficiency of the work are analyzed. Long-term evaluation of the children is an absolute necessity. In order to evaluate this type of approach, a simple questionnaire concerning the quality of life of the children under study was derived from a model used in pediatric oncology by the EORTC and adapted to the problems of abused children. One part was answered by the parents which allowed the researchers to evaluate their perception of the child. The second part was filled out by the sociomedical professionals who followed the child. The combination of these two views is rich in information concerning the patient as well as the parents' attitude toward their child.     

Effects of stress inoculation training on self-report, behavioural and psychophysiological reactions to abseiling

The study examined the effect of stress inoculation training on the level of self-reported stress and anxiety, overt signs of distress and the physiological impact of the stress of abseiling. Twenty volunteer subjects were randomly assigned to either a 'no training' control group or a stress inoculation training group, following which both groups of subjects had to complete a test abseil from the roof of a 21.2 m building. Prior to descent, two self-report measures were taken: an intensity score derived from the word or phrase chosen by subjects from the Perceived Stress Index to best describe their feelings and a state anxiety score from Spielberger's State Trait Anxiety Inventory. Overt distress was also evaluated by a 'blind' observer also using the Perceived Stress Index. In addition, heart rate was monitored just prior to and throughout the abseil using a telemetry system. The stress inoculation group showed significantly less self-reported anxiety and stress and less behavioural signs of distress as judged by the observer. However, there were no significant differences between the groups in terms of heart rate. In addition, while self-report and the assessment of the observer were highly inter-correlated, these measures were poorly correlated with heart rate.