***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: ABSTRACT . The US Preventive Services Task Force ( USPSTF ) has recommended depression screening for adults . Screening mothers has special importance to pediatricians because of the impact of maternal depression on children . The two screening questions endorsed by the USPSTF may allow pediatricians to screen mothers during routine well child care . This study explores the feasibility and yield of interview- and paper-based pediatric screening for maternal depression during well child visits . A structured interview script was developed to inquire about maternal depression . It included the two- question screen and required less than 1 minute to administer . An alternative paper-based screen asked the two questions after a brief written introduction providing the rationale . Four community pediatric practice s in New Hampshire and Maine were trained in both screening approaches and developed plans on how to respond to positive screens ( either question positive ) . The 11 providers at these sites tested the two approaches on two different series of mothers at well child visits . The pediatricians also reported barriers to the screening inquiries , maternal responses , and subsequent clinician actions and referrals . The pediatricians screened 250 mothers via the scripted interview .  In a second trial , 223 women had paper-based depression screening .  Yields from the paper-based screen were 22.9 % versus 5.7 % for the interview-based screener . Pediatricians also took on the new role of discussion of possible depression in about two thirds of cases . Subsequently , 7.6 % of all women with paper-based screening were referred to mental health versus 1.6 % with the interview-based screening . With the interview , mothers of children younger than 1 year of age were less likely to screen positive than those with older children ( 1.9 % vs. 8.5 % , p = .04 ) . With the paper-based screener , no age differences in positive screen rates occurred . While both approaches to screening were feasible in primary care , the yield from the two different approaches differed substantially . This finding deserves exploration in future studies . With either of these screening approaches , pediatricians could enhance their detection of mothers at risk of depression . The outcomes of pediatrician screening and the best approach to follow-up care still need to be determined CONTEXT Adolescent offspring of depressed parents are at markedly increased risk of developing depressive disorders . Although some smaller targeted prevention trials have found that depression risk can be reduced , these results have yet to be replicated and extended to large-scale , at-risk population s in different setting s. OBJECTIVE To determine the effects of a group cognitive behavioral ( CB ) prevention program compared with usual care in preventing the onset of depression . DESIGN , SETTING , AND PARTICIPANTS A multicenter r and omized controlled trial conducted in 4 US cities in which 316 adolescent ( aged 13 - 17 years ) offspring of parents with current or prior depressive disorders were recruited from August 2003 through February 2006 . Adolescents had a past history of depression , current elevated but subdiagnostic depressive symptoms , or both . Assessment s were conducted at baseline , after the 8-week intervention , and after the 6-month continuation phase . INTERVENTION Adolescents were r and omly assigned to the CB prevention program consisting of 8 weekly , 90-minute group sessions followed by 6 monthly continuation sessions or assigned to receive usual care alone . MAIN OUTCOME MEASURE Rate and hazard ratio ( HR ) of a probable or definite depressive episode ( ie , depressive symptom rating score of > or = 4 ) for at least 2 weeks as diagnosed by clinical interviewers . RESULTS Through the postcontinuation session follow-up , the rate and HR of incident depressive episodes were lower for those in the CB prevention program than for those in usual care ( 21.4 % vs 32.7 % ; HR , 0.63 ; 95 % confidence interval [ CI ] , 0.40 - 0.98 ) . Adolescents in the CB prevention program also showed significantly greater improvement in self-reported depressive symptoms than those in usual care ( coefficient , -1.1 ; z = -2.2 ; P = .03 ) . Current parental depression at baseline moderated intervention effects ( HR , 5.98 ; 95 % CI , 2.29 - 15.58 ; P = .001 ) . Among adolescents whose parents were not depressed at baseline , the CB prevention program was more effective in preventing onset of depression than usual care ( 11.7 % vs 40.5 % ; HR , 0.24 ; 95 % CI , 0.11 - 0.50 ) , whereas for adolescents with a currently depressed parent , the CB prevention program was not more effective than usual care in preventing incident depression ( 31.2 % vs 24.3 % ; HR , 1.43 ; 95 % CI , 0.76 - 2.67 ) . CONCLUSION The CB prevention program had a significant prevention effect through the 9-month follow-up period based on both clinical diagnoses and self-reported depressive symptoms , but this effect was not evident for adolescents with a currently depressed parent . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00073671 Background Preterm-born or asphyxiated term-born children who received neonatal intensive care show more emotional and behavioral problems than term-born children without a medical condition . It is uncertain whether regular parenting intervention programs to which the parents of these children are usually referred , are effective in reducing child problem behavior in this specific population . Our objective was to investigate whether a regular , brief parenting intervention , Primary Care Triple P , is effective in decreasing emotional and behavioral problems in preterm-born or asphyxiated term-born preschoolers . Methods For this pragmatic , open r and omized clinical trial , participants were recruited from a cohort of infants admitted to the neonatal intensive care units ( NICU ) of two Dutch hospitals . Children born with a gestational age < 32 weeks or birth weight < 1500 g and children born at a gestational age 37–42 weeks with perinatal asphyxia were included . After screening for a t-score ≥60 on the Child Behavior Checklist ( CBCL ) , children were r and omly assigned to Primary Care Triple P ( n = 34 ) or a wait-list control group ( n = 33 ) . The primary outcome was child emotional and behavioral problems reported by parents on the CBCL , 6 months after the start of the trial . Results There was no effect of the intervention on the CBCL at the trial endpoint ( t64 = 0.54 , P = .30 ) . On secondary measurements of child problem behavior , parenting style , parenting stress , and parent perceived child vulnerability , groups either did not differ significantly or the intervention group showed more problems . In both the intervention and control group there was a significant decrease in emotional and behavioral problems during the trial . Conclusions Primary Care Triple P , a brief parenting intervention , is not effective in reducing child emotional and behavioral problems in preterm-born children or term-born children with perinatal asphyxia . Trial registration Netherl and s National Trial Register ( NTR ) : Aims : To assess the effectiveness of a parenting programme , delivered by health visitors in primary care , in improving the mental health of children and their parents  among a representative general practice population . Methods : Parents of children aged 2–8 years who scored in the upper 50 % on a behaviour inventory were r and omised to the Webster-Stratton 10 week parenting programme delivered by trained health visitors , or no intervention . Main outcome measures were the Eyberg Child Behaviour Inventory and the Goodman Strengths and Difficulties Question naire to measure child behaviour , and the General Health Question naire , Abidin ’s Parenting Stress Index , and Rosenberg ’s Self Esteem Scale to measure parents ’ mental health . These outcomes were measured before and immediately after the intervention , and at six months follow up . Results : The intervention was more effective at improving some aspects of the children ’s mental health , notably conduct problems , than the no intervention control condition . The Goodman conduct problem score was reduced at immediate and six month follow up , and the Eyberg Child Behaviour Inventory was reduced at six months . The intervention also had a short term impact on social dysfunction among parents . These benefits were seen among families with children scoring in the clinical range for behaviour problems and also among children scoring in the non- clinical ( normal ) range . Conclusion : This intervention could make a useful contribution to the prevention of child behaviour problems and to mental health promotion in primary care IMPORTANCE Children with known exposure to intimate partner violence ( IPV ) or maternal depression are at risk for negative mental health outcomes as early as preschool age . Active ongoing surveillance for these risk factors can lead to earlier mental health intervention for children . OBJECTIVE To examine the association between parent reports of IPV and depressive symptoms within the first 3 years of a child 's life with subsequent mental health conditions and psychotropic drug treatment .  DESIGN Prospect i ve cohort study linking parental IPV and depression with subsequent billing and pharmacy data between November 1 , 2004 , and June 7 , 2012 . SETTING Four pediatric clinics . PARTICIPANTS A total of 2422 children receiving care from clinics that implemented the Child Health Improvement Through Computer Automation ( CHICA ) system .  MAIN OUTCOME MEASURES Any report of IPV and /or parental depressive symptoms from birth to age 3 years , mental health diagnoses made with International Classification of Diseases , Ninth Revision criteria , and any psychotropic drug treatment between ages 3 and 6 years . RESULTS Fifty-eight caregivers ( 2.4 % ) reported both IPV and depressive symptoms before their children were aged 3 years , 69 ( 2.8 % ) reported IPV only , 704 ( 29.1 % ) reported depressive symptoms only , and 1591 ( 65.7 % ) reported neither exposure . Children of parents reporting both IPV and depressive symptoms were more likely to have a diagnosis of attention-deficit/hyperactivity disorder ( adjusted odds ratio = 4.0 ; 95 % CI , 1.5 - 10.9 ) , even after adjusting for the child 's sex , race/ethnicity , and insurance type . Children whose parents reported depressive symptoms were more likely to have been prescribed psychotropic medication ( adjusted odds ratio = 1.9 ; 95 % , CI 1.0 - 3.4 ) . CONCLUSIONS AND RELEVANCE Exposure to both IPV and depression before age 3 years is associated with preschool-aged onset of attention-deficit/hyperactivity disorder ; early exposure to parental depression is associated with being prescribed psychotropic medication . Pediatricians play a critical role in performing active , ongoing surveillance of families with these known social risk factors and providing early intervention to negate long-term sequelae Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more In a r and omized prevention trial , 238 recently separated mothers and their young sons were assigned to either Parent Management Training ( PMT ) or a comparison group . Families were intensively assessed at baseline and at each 6-month interval through 30 months . To underst and the effects of PMT , we first evaluated effect sizes among family variables over time . Second , because observed parenting was the target of PMT , we hypothesized a sequential pattern of structured changes within and between individuals . Using constructs with mismatched sources of data , we conducted a set of latent growth mediational analyses to test hypothesized mechanisms explaining change . Effect sizes indicated that parenting changed first within 12 months , followed by changes in boy behaviors and finally changes in maternal depression within 30 months . Unique follow-up findings indicated that intervention effects on reductions in maternal depression were mediated by reductions in boy externalizing ; intervention effects on externalizing were mediated by reductions in boy depression . As expected , increases in effective parenting predicted reductions in child behavior problems .  PMT effects on internalizing were direct and indirect , partially mediated by parenting practice s. Results are discussed from a system 's perspective on PMT amplifiers OBJECTIVE : To assess the efficacy of collaborative care for behavior problems , attention-deficit/hyperactivity disorder ( ADHD ) , and anxiety in pediatric primary care ( Doctor Office Collaborative Care ; DOCC ) . METHODS : Children and their caregivers participated from 8 pediatric practice s that were cluster r and omized to DOCC ( n = 160 ) or enhanced usual care ( EUC ; n = 161 ) . In DOCC , a care manager delivered a personalized , evidence -based intervention . EUC patients received psychoeducation and a facilitated specialty care referral . Care processes measures were collected after the 6-month intervention period . Family outcome measures included the V and erbilt ADHD Diagnostic Parent Rating Scale , Parenting Stress Index-Short Form , Individualized Goal Attainment Ratings , and Clinical Global Impression-Improvement Scale . Most measures were collected at baseline , and 6- , 12- , and 18-month assessment s. Provider outcome measures examined perceived treatment change , efficacy , and obstacles , and practice climate . RESULTS : DOCC ( versus EUC ) was associated with higher rates of treatment initiation ( 99.4 % vs 54.2 % ; P < .001 ) and completion ( 76.6 % vs 11.6 % , P < .001 ) , improvement in behavior problems , hyperactivity , and internalizing problems ( P < .05 to .01 ) , and parental stress ( P < .05–.001 ) , remission in behavior and internalizing problems ( P < .01 , .05 ) , goal improvement ( P < .05 to .0 
    Output:
    
Fixed effects models showed statistically significant reductions in parental distress at 6-month and 12-month post-intervention in favor of the intervention group .
Family therapy model , intervention level , delivery modality , and dosage moderated intervention impacts on parental distress .
Fixed effects models showed statistically significant reductions in parental depressive symptoms and in dysfunctional parent – child interaction in favor of the intervention group .
Family therapy interventions can be successfully embedded in general pediatric primary care , and intended outcomes are achieved in this setting .