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BackgroundEarly detection of melanoma improves survival. Since many melanoma patients and their spouses seek the care of a physician after discovering their melanoma, an ongoing study will determine the efficacy of teaching at-risk melanoma patients and their skin check partner how to conduct skin self-examinations (SSEs). Internet-based health behavior interventions have proven efficacious in creating behavior change in patients to better prevent, detect, or cope with their health issues. The efficacy of electronic interactive SSE educational intervention provided on a tablet device has not previously been determined. ObjectiveThe electronic interactive educational intervention was created to develop a scalable, effective intervention to enhance performance and accuracy of SSE among those at-risk to develop melanoma. The intervention in the office was conducted using one of the following three methods: (1) in-person through a facilitator, (2) with a paper workbook, or (3) with a tablet device used in the clinical office. Differences related to method of delivery were elucidated by having the melanoma patient and their skin check partner provide a self-report of their confidence in performing SSE and take a knowledge-based test immediately after receiving the intervention. MethodsThe three interventions used 9 of the 26 behavioral change techniques defined by Abraham and Michie to promote planning of monthly SSE, encourage performing SSE, and reinforce self-efficacy by praising correct responses to knowledge-based decision making and offering helpful suggestions to improve performance. In creating the electronic interactive SSE educational intervention, the educational content was taken directly from both the scripted in-person presentation delivered with Microsoft PowerPoint by a trained facilitator and the paper workbook training arms of the study. Enrollment totaled 500 pairs (melanoma patient and their SSE partner) with randomization of 165 pairs to the in-person, 165 pairs to the workbook, and 70 pairs to electronic interactive SSE educational intervention. ResultsThe demographic survey data showed no significant mean differences between groups in age, education, or income. The tablet usability survey given to the first 30 tablet pairs found that, overall, participants found the electronic interactive intervention easy to use and that the video of the doctor-patient-partner dialogue accompanying the dermatologist’s examination was particularly helpful in understanding what they were asked to do for the study. The interactive group proved to be just as good as the workbook group in self-confidence of scoring moles, and just as good as both the workbook and the in-person intervention groups in self-confidence of monitoring their moles. While the in-person intervention performed significantly better on a skill-based quiz, the electronic interactive group performed significantly better than the workbook group. The electronic interactive and in-person interventions were more efficient (30 minutes), while the workbook took longer (45 minutes). ConclusionsThis study suggests that an electronic interactive intervention can deliver skills training comparable to other training methods, and the experience can be accommodated during the customary outpatient office visit with the physician. Further testing of the electronic interactive intervention’s role in the anxiety of the pair and pair-discovered melanomas upon self-screening will elucidate the impact of these tools on outcomes in at-risk patient populations. ClinicalTrialClinicalTrials.gov NCT01013844; http://clinicaltrials.gov/show/NCT01013844 (Archived by WebCite at http://www.webcitation.org/6LvGGSTKK).

Children in out-of-home care due to familial maltreatment and other developmental and behavioral problems remain at risk for abuse and neglect in the very placements designed for care and treatment. The background of federal involvement in Child Abuse Prevention and Treatment Act (CAPTA) requirements, as well as the states' responses for addressing protective service responsibilities for residential care, is overviewed. The shift away from direct federal oversight of eligibility standards for child protective systems mandated by CAPTA has apparently contributed to a double standard in protective service activities. The purpose of this study was to provide knowledge of current state child protective services policies and practice regarding out-of-home care through a national survey of state child protective services. Findings of the study suggest that out-of-home protective services would benefit from renewed awareness from social work and child welfare professionals. Calling on states to review their systems for protective services of out-of-home care, the authors recommend collaborative system review between state protective services and the federally funded protection and advocacy programs.

Children with autism were selected to be in high-approach and low-approach groups based on a median split of their proximity-seeking behavior with adults (looking at, approaching and touching adults) during videotaped interactions. The same videotapes of those two sets of interactions were then coded and analyzed for the adult partners' behaviors. The adult interaction partner of high-approach children showed more looking at child, smiling at child, moving toward child, inviting child to play, imitating child in play and being playful. (Contains 3 tables.)