
April Idalski Carcone- PhD, MSW
- Professor at Wayne State University
April Idalski Carcone
- PhD, MSW
- Professor at Wayne State University
About
86
Publications
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Introduction
Behavioral health researcher focused on at-risk youth living with chronic illnesses. I develop and test behavioral interventions to support illness management. eHealth and the translation of evidence-based practices into real world settings using implementation science are current foci. I'm also very interested in clinical communication with an emphasis on understanding how Motivational Interviewing works. I'm collaborating with computer scientists to automate coding with machine learning.
Current institution
Additional affiliations
August 2018 - present
September 2010 - present
Education
September 2006 - December 2010
September 1999 - December 2000
September 1993 - April 1997
Publications
Publications (86)
Background: Poor diabetes self-management in emerging adulthood (age 18-25 years) is associated with poorer diabetes health and diabetes complications. Emerging adults’ focus on individuation and independence underlies their poor diabetes outcomes, offering a lever for behavior change. Self-determination theory (SDT) suggests that interventions lev...
Medical care providers' use of Motivational Interviewing (MI) is linked to improved medication adherence, viral load, and associated behaviors in adolescents and young adults living with HIV. Mastering MI is difficult for busy providers; however, tailoring MI training to the specific MI communication strategies most relevant for HIV treatment conte...
Objective:
The goal of this research is to develop a machine learning supervised classification model to automatically code clinical encounter transcripts using a behavioral code scheme.
Methods:
We first evaluated the efficacy of eight state-of-the-art machine learning classification models to recognize patient-provider communication behaviors...
BACKGROUND
Emerging adulthood is a high-risk period during which many with type 1 diabetes (T1D) demonstrate suboptimal diabetes management and glycemic control. There is a need for effective and scalable interventions designed specifically for this population. Technology-based approaches are readily accessed by this age group. Further, interventio...
Purpose
The Healthy Hearts pilot study evaluated the effect of an eHealth motivational interviewing-framed intervention on cardiomyopathy screening-related knowledge, health beliefs, intrinsic motivation, and behavioral action steps among adult survivors of childhood cancer.
Methods
We consented N = 73 survivors to participate in a single-arm pilo...
Background
Obesity is a common, serious and costly chronic disease. Current clinical practice guidelines recommend that providers augment the longitudinal care of people living with obesity with consistent support for the development of self-efficacy and motivation to modify their lifestyle behaviors. Lifestyle behavior change aligns with the goals...
Objective
Due to systemic inequities, Black adolescents with type 1 diabetes are more likely to have suboptimal glycemic control and high rates of diabetes distress, but tailored interventions for this population are lacking. In primary outcomes of a randomized clinical trial, a family-based eHealth intervention improved glycemic control in Black a...
BACKGROUND
Obesity is a common, serious and costly chronic disease. Current clinical practice guidelines recommend that providers augment the longitudinal care of people living with obesity with consistent support for the development of self-efficacy and motivation to modify their lifestyle behaviors. Lifestyle behavior change aligns with the goals...
Childhood cancer survivors have a higher risk of developing cardiomyopathy than members of the general population. Screening echocardiograms can facilitate early detection and treatment of cardiomyopathy. Furthermore, motivational interviewing can increase uptake of cardiac screening. However, such approaches are time- and resource-intensive, which...
Background
Emerging adults (EAs; age 18-30 years) with type 1 diabetes (T1D) have more challenges with diabetes management and glycemic control than other age groups. Living in a rural community introduces additional unique diabetes care challenges due to limited access to specialty care and ancillary support services. Yet, few interventions have b...
Objectives
Adolescents with type 1 diabetes (T1D) and their caregivers endorse high diabetes distress (DD). Limited studies have documented the impact of DD on Black youth. The aims of the present study were to (1) describe DD among a sample of Black adolescents with T1D and their caregivers, (2) compare their DD levels with published normative sam...
Background
Black adolescents with type 1 diabetes (T1D) are at increased risk for suboptimal diabetes health outcomes; however, evidence-based interventions for this population are lacking. Depression affects a high percentage of youth with T1D and increases the likelihood of health problems associated with diabetes.
Objective
Our aim was to test...
Purpose:
To evaluate referral rates and factors associated with referrals to a community agency for children evaluated for an asthma exacerbation at a pediatric emergency department (PED) and compare PED visits for asthma the following year between those referred and not referred.
Methods:
We reviewed electronic health records of children 2-18 y...
Background
Adherence to intervention training implementation strategies is at the foundation of fidelity; however, few studies have linked training adherence to trainee attitudes and leadership behaviors to identify what practically matters for the adoption and dissemination of evidence-based practices. Through the conduct of this hybrid type 3 eff...
Objective:
Urban children with asthma are at risk for frequent emergency department (ED) visits and suboptimal asthma management. ED visits provide an opportunity for referrals to community-based asthma management services. Electronic medical record-based referral portals have been shown to improve quality of care but use of these portals by healt...
Objectives:
Black youth with type 1 diabetes (T1D) are at heightened risk for suboptimal glycemic control. Studies of neighborhood effects on the health of youth with T1D are limited. The current study investigated the effects of racial residential segregation on the diabetes health of young Black adolescents with T1D.
Methods:
A total of 148 pa...
Emerging adults (EAs, age 18-25) with type 1 diabetes (T1D) have more challenges with diabetes management (DM) and glycemic control compared to other age groups. EAs with T1D living in rural communities face unique diabetes care challenges due to limited access to specialty care and ancillary support services. Despite this, few interventions focus...
Background
Understanding the barriers and facilitators of implementation completion is critical to determining why some implementation efforts fail and some succeed. Such studies provide the foundation for developing further strategies to support implementation completion when scaling up evidence-based practices (EBPs) such as Motivational Intervie...
Background
Contextual fit is an important variable in the implementation of evidence-based programs (EBPs). The objectives of the current study were to examine the psychometric properties of the adapted Self-Assessment of Contextual Fit (SACF) measure for HIV clinical care settings (calling it SACF-HIV) and explore how perceptions of contextual fit...
Despite advances in evidence-based practices (EBP) to support HIV prevention and treatment, youth ages 13–24 experience significant disparities in HIV risk and outcomes. An important factor in this disparity is poor EBP implementation, yet implementation research is limited, particularly in youth-serving settings. This study used the Exploration, P...
Adolescence is a high-risk period during which youth with T1D often experience declines in illness management and increases in HbA1c. Black youth with T1D have higher HbA1cs and are more likely to engage in suboptimal management compared to White youth, elevating their risk. Parental monitoring, i.e., direct supervision of adolescents' daily diabet...
Studies testing the effects of neighborhoods on the health of Black youth with T1D are limited. Racial residential segregation (RRS) is a form of structural racism that may affect health through various pathways, including limiting access to resources and increasing exposure to stress. The present study tested associations between RRS, diabetes man...
BACKGROUND
Asthma causes substantial morbidity and mortality in the U.S., particularly among African American emerging adults (AAEA; ages 18-30), but very few asthma programs have targeted this population. Interventions that provide education and address underlying motivation for managing asthma may be most effective. However, intensive, face-to-fa...
Background:
Asthma causes substantial morbidity and mortality in the United States, particularly among African American emerging adults (AAEAs; aged 18-30 years), but very few asthma programs have targeted this population. Interventions that provide education and address underlying motivation for managing asthma may be the most effective. However,...
Approximately 83% of Emerging Adults (EAs) fail to meet glycemic recommendations, in part due to gaps in health care access and over-reliance on the emergency health care services. Developmental factors such as identity exploration, increasing independence, exploration of opportunities and choices, and decreasing reliance on parental oversight also...
This brief report describes results of piloted Tailored Motivational Interviewing (TMI). Tailoring focused on site-specific training needs, target patient behaviors, and implementation facilitators and barriers that staff anticipated. Participating staff (N = 31) at two adolescent HIV clinics completed a pre-training qualitative interview (N = 27),...
BACKGROUND
Motivational interviewing is an effective strategy to mitigate chronic disease risk through promotion of health behavior changes. However, multiple barriers impede its delivery to and uptake by patients. mHealth-based versions of motivational interviewing interventions, or technology-delivered adaptations of motivational interviewing (TA...
Background:
Motivational interviewing (MI) can increase health-promoting behaviors and decrease health-damaging behaviors. However, MI is often resource intensive, precluding its use with people with limited financial or time resources. Mobile health-based versions of MI interventions or technology-delivered adaptations of MI (TAMIs) might increas...
Understanding the implementation process is critical to disseminating effective interventions that reduce HIV risk and improve self-management in youth populations. As part of a multi-center implementation study, providers (N = 128) from 13 HIV prevention and care sites were surveyed to capture their perspectives on evidence-based practices (EBPs)...
Objective:
This study investigated the links between naturalistically observed and self-reported interpersonal problems, diabetes management, and glucose levels in older adolescents and young adults with type 1 diabetes.
Design:
Sixty-eight older adolescents and young adults (aged 17-20 years) participated in a cross-sectional study that consist...
Objectives:
Adolescents of color are underrepresented in behavioral health research. Study aims were to quantify the amount and types of outreach effort needed to recruit young Black adolescents with type 1 diabetes and their primary caregiver into a clinical trial evaluating a parenting intervention and to determine if degree of recruitment diffi...
While individual and family risk factors that contribute to health disparities in children with type 1 diabetes have been identified, studies on the effects of neighborhood risk factors on glycemic control are limited, particularly in minority samples. This cross‐sectional study tested associations between family conflict, neighborhood adversity an...
The use of systematic dose-finding designs to develop behavioral health interventions is lacking. In contrast, drug development research consistently follows a prescribed, regulated, and iterative pathway that begins with empirically establishing optimal drug dose. Adapting dose-finding methodologies from the drug development literature offers seve...
Objective:
The goal of this study was to explore the impact of 5 decision rules for removing outliers from adolescent food frequency questionnaire (FFQ) data.
Design:
This secondary analysis used baseline and 3-month data from a weight loss intervention clinical trial.
Participants:
African American adolescents (n = 181) were recruited from ou...
BACKGROUND
Poor diabetes self-management in emerging adulthood (age 18-25 years) is associated with poorer diabetes health and diabetes complications. Emerging adults’ focus on individuation and independence underlies their poor diabetes outcomes, offering a lever for behavior change. Self-determination theory (SDT) suggests that interventions leve...
Dramatic decreases in HIV transmission are achievable with currently available biomedical and behavioral interventions, including antiretroviral therapy and pre-exposure prophylaxis. However, such decreases have not yet been realized among adolescents and young adults. The Adolescent Medicine Trials Network (ATN) for HIV/AIDS interventions is dedic...
Purpose: Examine changes in systolic blood pressure (SBP) and whether physical activity and obesity status predicted SBP change for African-American adolescents (n=181) participating in a behavioral weight control trial.
Methods: Data were collected at baseline, 7-months (end-of-treatment), and 9-months (2-month follow-up).
Results: Nearly half...
Communication science approaches to develop effective behavior interventions, such as motivational interviewing (MI), are limited by traditional qualitative coding of communication exchanges, a very resource-intensive and time-consuming process. This study focuses on the analysis of e-Coaching sessions, behavior interventions delivered via email an...
Background
Minority adolescents are at highest risk for obesity and extreme obesity; yet, there are few clinical trials targeting African American adolescents with obesity.
Purpose
The purpose of the study was to develop an adaptive family-based behavioral obesity treatment for African American adolescents using a sequential multiple assignment ra...
Motivational interviewing (MI) is an evidence-based strategy for communicating with patients about behavior change. Although there is strong empirical evidence linking “MI-consistent” counselor behaviors and patient motivational statements (i.e., “change talk”), the specific counselor communication behaviors effective for eliciting patient change t...
Background and Objective
The negative effects of stress on persons with type 1 diabetes (T1D) are well‐established, but effective interventions to reduce stress among emerging adults with T1D are limited. The study objective was to conduct a pilot randomized controlled trial (RCT) to obtain preliminary data on the efficacy of mindfulness‐based stre...
Communication science approaches to develop effective behavior interventions, such as motivational interviewing (MI), are limited by traditional qualitative coding of communication exchanges, a very resource-intensive and time-consuming process. This study focuses on the analysis of e-Coaching sessions, behavior interventions delivered via email an...
Objective:
Successful weight loss interventions for African-Americans adolescents are lacking. Cognitive-behavioral interventions seek to develop weight loss skills (e.g., counting calories, goal setting, managing one's environment). Little is known about how well adolescents implement such skills in their daily lives. Study aims were to (1) exami...
Background: The Exploration, Preparation, Implementation, and Sustainment (EPIS) model is an implementation framework for studying the integration of evidence-based practices (EBPs) into real-world settings. The EPIS model conceptualizes implementation as a process starting with the earliest stages of problem recognition (Exploration) through the c...
BACKGROUND
The Exploration, Preparation, Implementation, and Sustainment (EPIS) model is an implementation framework for studying the integration of evidence-based practices (EBPs) into real-world settings. The EPIS model conceptualizes implementation as a process starting with the earliest stages of problem recognition (Exploration) through the co...
The problem of analyzing temporally ordered sequences of observations generated by molecular, physiological or psychological processes to make predictions about the outcome of these processes arises in many domains of clinical informatics. In this paper, we focus on predicting the outcome of patient-provider communication sequences in the context o...
The problem of analyzing temporally ordered sequences of observations generated by molecular, physiological or psychological processes to make predictions about the outcome of these processes arises in many domains of clinical informatics. In this paper, we focus on predicting the outcome of patient-provider communication sequences in the context o...
Objective
The purpose of the study was to assess the acceptability and feasibility of Mindfulness-Based Stress Reduction (MBSR), a group-delivered intervention, to reduce stress and improve illness management among urban, older adolescents, and young adults with poorly controlled type 1 diabetes (T1D).
Method
Ten older adolescents and young adults...
Objective:
To adapt an evidence-based intervention targeting diabetes management in adolescents with poorly controlled type 1 diabetes for use in a community setting by community health workers (CHWs) and to conduct pilot testing of the new intervention, REACH for Control (RFC). The study was conducted as a collaboration between university researc...
Background:
African American adolescents with type 1 diabetes (T1D) are at elevated risk for poor diabetes management and metabolic control. Parental supervision and monitoring of adolescent diabetes management have been shown to promote better diabetes management among adolescents, but parents typically decrease their oversight during the transit...
Recently, distributed word embeddings trained by neural language models are commonly used for text classification with Convolutional Neural Networks (CNNs). In this paper, we propose a novel neural language model, Topic-based Skip-gram, to learn topic-based word embeddings for biomedical literature indexing with CNNs. Topic-based Skip-gram leverage...
KEY POINTS
Patient–provider communication is a key clinical skill linked to better patient satisfaction
and improved outcomes for both patients and providers.
Motivational interviewing (MI) is a patient-centered, yet directive method of communica-
tion suitable for most clinical encounters.
Emphasizing behavior change autonomy is important, p...
Objective We sought to examine communication between counselors and caregivers of adolescents with obesity to determine what types
of counselor behaviors increased caregivers’ motivational statements regarding supporting their child’s weight loss. Methods We coded 20-min Motivational Interviewing sessions with 37 caregivers of African American 12–1...
Communication research is inherently limited by its resource intensive methodology. Most studies rely upon qualitative text analysis, an iterative, lengthy process dependent upon human judgment. Rapid development of computational technology in the past decade offers an efficient alternative. This research examines the utility of two technological a...
Objective:
We conducted an exploratory mixed methods study to describe the ambivalence African-American adolescents and their caregivers expressed during motivational interviewing sessions targeting weight loss.
Methods:
We extracted ambivalence statements from 37 previously coded counseling sessions. We used directed content analysis to categor...
We propose Latent Class Allocation (LCA) and Discriminative Labeled Latent Dirichlet Allocation (DL-LDA), two novel interpretable probabilistic latent variable models for automatic annotation of clinical text. Both models separate the terms that are highly characteristic of textual fragments annotated with a given set of labels from other non-discr...
We propose Latent Class Allocation (LCA) and Discriminative Labeled Latent Dirichlet Allocation (DL-LDA), two novel interpretable probabilistic latent variable models for automatic annotation of clinical text. Both models separate the terms that are highly characteristic of textual fragments annotated with a given set of labels from other non-discr...
Purpose: The purpose of this study was to assess the feasibility of a three-session computer intervention to improve diabetes management among African-American youth with type 1 diabetes. Methods: The 3 Ms (Medication, Meter, and Meals) intervention was based on the Information-Motivation-Behavioral Skills model of health behavior change and Motiva...
Parental monitoring of adolescent diabetes care is an important predictor of adolescent regimen adherence. To date, no studies have investigated whether socio-demographic factors are associated with low levels of parental monitoring or differences in parental monitoring styles, and their moderating effects in families of adolescents with type 1 dia...
The purpose of this study was to determine if multisystemic therapy (MST), an intensive, home and community-based family treatment, significantly improved patient-provider relationships in families where youth had chronic poor glycemic control. One hundred forty-six adolescents with type 1 or 2 diabetes in chronic poor glycemic control (HbA1c ≥8 %)...
Parental monitoring of daily diabetes care is a significant predictor of glycemic control; yet, parents commonly withdraw their involvement as youth enter adolescence, particularly non-white caregivers. Brief motivation-enhancing interventions have successfully targeted parental monitoring for children with behavioral difficulties and for health-re...
The purpose of this study was to develop an adaptive behavioral treatment for African American adolescents with obesity. In a sequential multiple assignment randomized trial, 181 youth ages 12-16 years with primary obesity and their caregiver were first randomized to 3 months of home-based versus office-based delivery of motivational interviewing p...
The aim of this study was to assess the accuracy of thin slices to characterize the verbal communication behavior of counselors and patients engaged in Motivational Interviewing sessions relative to fully coded sessions.Methods
Four thin slice samples that varied in number (four versus six slices) and duration (one- versus two-minutes) were extract...
This study included African Americans with asthma in emerging adulthood, a developmental period largely neglected in the research literature but known to be a time of great risk for asthma morbidity and mortality. We conducted thematic analysis of semi-structured interviews (N=19) to explore barriers to adherence in the context of the transition to...
This work addresses the problem of automatic annotation of clinical interview transcripts. We formulate this task as su-pervised machine learning problem and propose highly scal-able and efficient probabilistic classifiers based on generative latent variable models to solve it. Experimental results indi-cate that the proposed classifiers outperform...
(in press)
Background: African American youth are at increased risk for poor diabetes management. Parenting behaviors such as parental monitoring are significant predictors of youth diabetes management and metabolic control, but no intervention has targeted parental monitoring of daily diabetes care.
Objective: The purpose of the present study wa...
This study examined professional attitudes about kinship care and
the influence of those attitudes on removal decisions. A relationship
was found between attitudes and the number of children removed
from kinship homes. Professionals with more positive attitudes about
kinship care were less likely to remove a child for financial reasons.
Participant...
The goal of this research was to identify communication behaviors used by weight loss counselors that mostly strongly predicted black adolescents' motivational statements. Three types of motivational statements were of interest: change talk (CT; statements describing their own desires, abilities, reasons, and need for adhering to weight loss recomm...
Objective: Asthma medication adherence is low, particularly among African American adolescents, a high-risk group with respect to asthma prevalence, morbidity, and mortality. This study tested the utility of self-determination theory (SDT), a theory of motivation, to explain adherence to asthma medication regimens in African American adolescents. M...
Few interventions have effectively improved health outcomes among youth with diabetes in chronic poor metabolic control.
This study aims to determine whether multisystemic therapy (MST), an intensive, home-based, tailored family treatment, was superior to weekly telephone support for improving regimen adherence and metabolic control among adolescen...
This study examined a multivariate model of the relationship between caregiver strain and adolescent diabetes illness outcomes in a sample of caregivers of adolescents in chronically poor metabolic control (hemoglobin A1c ≥8.0% at enrollment and for previous 12 mo). Caregiver mental health symptoms were hypothesized to mediate the relationship betw...
This study used a descriptive, cross-sectional analysis to examine a social ecological model of obesity among African-American female adolescents residing in obesogenic environments. The goal was to identify factors that promote weight resilience, defined as maintaining a healthy body weight despite living in an environment that encourages inactivi...
We evaluated the psychometric properties of a revised version of the Parental Monitoring of Diabetes Care questionnaire (PMDC-R) designed to evaluate parental supervision and monitoring of adolescent diabetes care behaviors. The revised measure was intended to capture a broad range of ways used by parents to gather information about youth adherence...
Investigate effect of baseline motivation for change on treatment fidelity, therapeutic alliance, treatment dose, and treatment outcome in a randomized controlled trial of family therapy for youth with poorly controlled diabetes.
Seventy-four adolescents and caregivers completed measures of motivation for change. Measures of fidelity, alliance, dos...
The aim of this research study was to examine the relationship between 4 sources of social support (support for the adolescent from family, support for the adolescent from friends, support for the caregiver from another adult, and support to the family from the health care provider) and adolescents' diabetes outcomes (illness management behavior an...
African American adolescents are disproportionately affected by obesity. Few interventions target this group, produce sustainable results, and retain participants. Phenomenology was used to compare the treatment experiences of African American families in multisystemic therapy for weight loss. Families that discontinued treatment described life pro...
The study aim was to determine if multisystemic therapy (MST), an intensive home-based psychotherapy, could reduce hospital admissions for diabetic ketoacidosis (DKA) in youth with poorly controlled type 1 diabetes over 24 months. Potential cost savings from reductions in admissions were also evaluated.
A total of 127 youth were randomly assigned t...
The goal of the present study was to determine whether multisystemic therapy (MST) could decrease parental overestimation of adolescents' responsibility for completion of diabetes care. A randomized controlled trial was conducted with 127 adolescents with type 1 diabetes and their caregivers. Participants randomized to MST received treatment for ap...
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.
A randomized controlled trial was conducted with 127 youths. Changes i...
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.
Baseline questionnaire data from an intervention study were collected from 119 youth and their primary caregiver.
Boys had wor...
The diabetes illness management regimen is complex and demanding, requiring daily motivation and self-control. Adolescents with diabetes face unique risks for which social support may be one protective factor. The importance of social support from family and friends is well documented in the literature. Support for the caregiver and support from th...