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Building Healthy Children: A preventive intervention for high-risk young families
Abstract
The Building Healthy Children (BHC) home-visiting preventive intervention was designed to provide concrete support and evidence-based intervention to young mothers and their infants who were at heightened risk for child maltreatment and poor developmental outcomes. This paper presents two studies examining the short- and long-term effectiveness of this program at promoting positive parenting and maternal mental health, while preventing child maltreatment and harsh parenting. It also examines the intervention's sustained effect on child symptomatology and self-regulation. At baseline, young mothers and their infants were randomly assigned to receive BHC or Enhanced Community Standard. Families were assessed longitudinally across four time points. Data were also collected from the child's teacher at follow-up. Mothers who received BHC evidenced significant reductions in depressive symptoms at mid-intervention, which was associated with improvements in parenting self-efficacy and stress as well as decreased child internalizing and externalizing symptoms at postintervention. The follow-up study found that BHC mothers exhibited less harsh and inconsistent parenting, and marginally less psychological aggression. BHC children also exhibited less externalizing behavior and self-regulatory difficulties across parent and teacher report. Following the impactful legacy of Dr. Edward Zigler, these findings underline the importance of early, evidence-based prevention to promote well-being in high-risk children and families.
... Evaluation of BHC participants, when compared with families who received screening and referrals for services rather than the comprehensive BHC package, demonstrated that BHC intervention families had significantly better compliance with well-child medical care and high engagement in services (Paradis et al., 2013). Subsequent analyses demonstrated that those receiving intervention demonstrated significantly lower depressive symptoms by mid-intervention assessments when children were 2 years of age and that these reductions in depression predicted lower parenting stress and greater parenting self-efficacy as well as less internalizing and externalizing behavior when children turned three (Demeusy et al., 2021). The mediational role of reducing maternal depression in improving parent and child functioning is similar to the results of the IPT evaluation , and underscores the importance of addressing parental mental health to ameliorate negative family outcomes. ...
... A follow-up of BHC during school-aged years underscored the sustained benefits of the program over time and in a subsequent developmental period. Results obtained 3-7 years postintervention demonstrated that parents in the BHC group utilized significantly less inconsistent and harsh parenting than comparison families (Demeusy et al., 2021). Children in the BHC group were reported by both parents and teachers to have significantly less externalizing behavior problems, and parents rated children as having lower internalizing behavior problems as well (Demeusy et al., 2021). ...
... Results obtained 3-7 years postintervention demonstrated that parents in the BHC group utilized significantly less inconsistent and harsh parenting than comparison families (Demeusy et al., 2021). Children in the BHC group were reported by both parents and teachers to have significantly less externalizing behavior problems, and parents rated children as having lower internalizing behavior problems as well (Demeusy et al., 2021). These findings are especially compelling, given the longitudinal design of the study and the multi-informant approach in which teachers, who had no knowledge of families' service histories, rated children who participated in BHC during infancy and toddlerhood more positively than those who received only screenings and referrals. ...
In this article, we celebrate Dante Cicchetti’s extensive contributions to the discipline of developmental psychopathology. In his seminal article, he articulated why developmental psychopathology was imperative to create research portfolios that could inform the causes, consequences, and trajectories for adults often initiated by early lived experiences (Cicchetti, 1984). In this three-part article, we share our transdisciplinary efforts to use developmental psychopathology as a foundational theory from which to develop, implement, and evaluate interventions for populations who experienced early adversity or who were at risk for child abuse and neglect. After describing interventions conducted at Mt. Hope Family Center that spanned over three decades, we highlight the criticality of disseminating results and address policy implications of this work. We conclude by discussing future directions to facilitate work in developmental psychopathology. Currently, one of three national National Institute of Child Health and Human Development-funded child abuse and neglect centers, we look forward to continuing to build upon Dante’s efforts to disseminate this important work to improve society for our children, our nation’s often most vulnerable and forgotten citizens.
... Adaptive, multicomponent programs that can flexibly provide treatments that match the needs of individuals is a promising approach to intervention and prevention. The Building Healthy Children program (Demeusy et al., 2021;Paradis et al., 2013) is an example of an adaptive model of home-visitation prevention services that includes a variety of treatment components including supporting maternal depression, maternal trauma, mother-child attachment, parenting skills, and families' concrete needs; it has been shown to have positive short and long term benefits for mothers and their young children (Demeusy et al., 2021). Although adaptive, multicomponent prevention programs may initially require a greater investment in training and evaluation, they have the potential for ultimately providing communities with effective and efficient solutions (Supplee & Duggan, 2019). ...
... Adaptive, multicomponent programs that can flexibly provide treatments that match the needs of individuals is a promising approach to intervention and prevention. The Building Healthy Children program (Demeusy et al., 2021;Paradis et al., 2013) is an example of an adaptive model of home-visitation prevention services that includes a variety of treatment components including supporting maternal depression, maternal trauma, mother-child attachment, parenting skills, and families' concrete needs; it has been shown to have positive short and long term benefits for mothers and their young children (Demeusy et al., 2021). Although adaptive, multicomponent prevention programs may initially require a greater investment in training and evaluation, they have the potential for ultimately providing communities with effective and efficient solutions (Supplee & Duggan, 2019). ...
The current Special Issue marks a major milestone in the history of developmental psychopathology; as the final issue edited by Cicchetti, we have an opportunity to reflect on the remarkable progress of the discipline across the last four decades, as well as challenges and future directions for the field. With contemporary issues in mind, including rising rates of psychopathology, health disparities, and international conflict, as well as rapid growth and accessibility of digital and mobile technologies, the discipline of developmental psychopathology is poised to advance multidisciplinary, developmentally- and contextually- informed research, and to make substantial progress in supporting the healthy development of individuals around the world. We highlight key future directions and challenges for the next generation of developmental psychopathology research including further investigation of culture at multiple levels of analysis, incorporation of macro-level influences into developmental psychopathology research, methods advances to address heterogeneity in translational research, precision mental health, and the extension of developmental psychopathology research across the lifespan.
... These include technological limitations, lack of awareness, privacy concerns, and resistance to change among healthcare providers and patients (Bar-Zeev et al., 2018). Limited access to high-speed internet and digital devices, particularly in rural areas, restricts the effectiveness of digital healthcare tools (Apollaro et al., 2022;Demeusy et al., 2021). Solution: Governments and stakeholders must invest in infrastructure development to enhance digital accessibility. ...
During the Covid-19 pandemic, individuals in China with mental health challenges faced significant stigma, exacerbating stress and social isolation. To address this issue, a study was conducted in China using digital media arts as a framework. Researchers randomly distributed 1,300 surveys utilizing a five-point Likert scale, expecting a 50% response rate. However, only 500 responses were deemed suitable for analysis using Partial Least Squares Structural Equation Modeling (PLS-SEM). The study highlighted the critical role of digital health tools in improving mental health and their adoption within China’s healthcare system. It focused on the implementation of digital healthcare innovations, a previously underexplored area in mental health research. The findings have significant theoretical and practical implications for enhancing mental health systems through digital technologies while raising awareness about digital healthcare tools. Overall, the pandemic underscored the necessity of prioritizing mental health, making these findings crucial for policymakers seeking to integrate digital solutions into healthcare frameworks.
... Strengthening parental involvement through timely access to academic performance is essential for fostering student success. Preventive intervention enables proactive responses that can significantly mitigate potential problems, allowing parents to address academic issues early (Demeusy et al., 2021). With timely access, parents can also provide holistic support, addressing not only academic challenges but also underlying emotional and physical health concerns that may impact a student's school performance (Edwards-Fapohunda & Adediji, 2024). ...
This study examines the effect of the iBoard system on parental involvement in monitoring the academic performance of Grade 12 ABM students at Tacurong National High School. By providing real-time access to academic records, the iBoard system addresses challenges parents face in engaging with their children’s education and bridges communication gaps with the school. The respondents are 89 parents who utilized the iBoard system three or more times per week. Employing a quantitative, non-experimental design with descriptive-correlation techniques, the research utilizes statistical tools such as mean calculations and multiple regression analysis. Results revealed very high levels of iBoard usability, performance communication, satisfaction, and parental involvement in monitoring academic performance. Regression analysis shows that iBoard usability, performance communication, and satisfaction significantly influence parental involvement in monitoring ABM students’ academic performance. This highlights the importance of effective communication and timely updates in fostering parental involvement, which ultimately contributes to better academic outcomes for students. Based on the results of the study, the proposed implementation framework will focus on maximizing utilization through system sustainability and adaptation mechanisms, further strengthening iBoard’s impact and promoting active parental involvement, in line with the Department of Education’s goals.
... 664 estudiantes. Demeusy et al. 2021 Ensayo controlado aleatorio para comprobar la eficacia a corto y largo plazo del programa de visitas domiciliarias Building Healthy Children (BHC) para promover la crianza positiva y salud mental de la madre, así como la prevención del maltrato infantil y la crianza severa. ...
La parentalidad positiva se presenta como un nuevo reto para la sociedad actual en la que profesionales de la salud mental y profesionales del ámbito psicoeducativo proporcionan a las familias programas parentales, para fortalecer el funcionamiento familiar y empoderar a los progenitores con relación a la crianza de sus hijos. El presente trabajo busca describir un conjunto de publicaciones científicas para tratar de buscar correlaciones significativas entre la parentalidad positiva y la prevención del fututo de la población infanto-juvenil con relación a su salud mental, a partir del fortalecimiento del funcionamiento familiar y la reducción del impacto de las experiencias adversas durante la infancia y la adolescencia. Se realizó una revisión sistemática exploratoria del tema con un cribado de los parámetros “Positive parenting AND Mental disorders AND Prevention” a través de artículos de investigación publicados en revistas arbitradas y con revisión en cuatro bases de datos —Redalyc, la Biblioteca Virtual de Salud (BVS), PubMed y SciencieDirect—, de las que se examinaron 229, 31, 20 y 48 artículos, respectivamente. Los artículos fueron seleccionados basándose en criterios predefinidos y haciendo uso de limitadores. Finalmente, se seleccionaron un total de 61 artículos que fueron analizados y categorizados en los apartados correspondientes planteados.
... In our study, no significant moderators were identified for parenting outcomes, potentially highlighting the flexibility of trauma-informed parenting programs we included. For instance, Demeusy et al. (2021), one of the included studies, described a parenting program where intensive trauma-focused components are provided based on the need and interest of the participating families. ...
Parents who have been exposed to trauma face distinct challenges in parenting that can lead to negative child developmental outcomes and intergenerational transmission of trauma. Parenting programs for traumatized parents seem promising, but the existing evidence on their effectiveness has not yet been synthesized. This study aimed to examine the overall effect of trauma-informed parenting programs on (a) parenting and (b) parental mental health outcomes by conducting two three-level meta-analyses. Moderator analyses were performed to identify whether program components, delivery techniques, and other study and program characteristics were associated with effectiveness. A literature search conducted up to August 2024 yielded 15 studies reporting on 110 effect sizes. Significant overall effects were found of trauma-informed parenting programs on both parenting outcomes (d = 0.75, 95% CIs = [0.09, 1.15], p = .027) and parental mental health outcomes (d = 0.21, 95% CIs = [0.09, 0.32], p < .001). The first meta-analysis on parenting found no significant moderators, while the second meta-analysis on parental mental health indicated that programs emphasizing child disciplining skills yielded smaller effects (d = 0.04) compared to programs without this component (d = 0.31). Programs using modeling techniques yielded larger effects (d = 0.32) compared to programs without (d = 0.14). Larger program effects on parental mental health were also found for programs with longer durations and when individual sessions were used. Thus, evidence supports the effectiveness of trauma-informed parenting programs in improving parenting and reducing parental mental health problems.
... The primary prevention of child maltreatment must be a public health priority both in the United States and globally, given these programs' potential for numerous downstream effects, including the prevention of psychopathology and suicidal behaviors during adolescence. Several programs have shown promise for the primary prevention of maltreatment in the United States, including the Nurse-Family Partnership (Olds, 2008) and the Building Healthy Children program (Demeusy et al., 2021). The prevention of child maltreatment can, and should be, considered a form of universal suicide prevention. ...
Experiences of child abuse and neglect are risk factors for youth suicidal thoughts and behaviors. Accordingly, suicide risk may emerge as a developmental process that is heavily influenced by the rearing environment. We argue that a developmental, theoretical framework is needed to guide future research on child maltreatment and youth (i.e., adolescent and emerging adult) suicide, and to subsequently inform suicide prevention efforts. We propose a developmental model that integrates principles of developmental psychopathology and current theories of suicide to explain the association between child maltreatment and youth suicide risk. This model bears significant implications for future research on child maltreatment and youth suicide risk, and for suicide prevention efforts that target youth with child maltreatment experiences.
... Home visiting may be particularly beneficial for young mothers with a history of out-of-home care, as many aspects of home visiting align with known areas of vulnerability for this population (Demeusy et al., 2021). For example, a strong interpersonal support network is known to lessen the effects of maternal depression on child outcomes (Goodman & Gotlib, 1999), and social support is an identified area of need for young adults with a history of out-of-home care (Greeson et al., 2015). ...
Women previously in out‐of‐home care (i.e., foster care) experience poorer health and psychosocial outcomes compared to peers, including higher pregnancy rates and child protective services involvement. Home visiting programs could mitigate risks. Studies examining home visiting enrollment for women with a history of out‐of‐home care are needed. Women previously in out‐of‐home care based on child welfare administrative data between 2012 and 2017 (n = 1375) were compared to a demographically matched sample (n = 1375) never in out‐of‐home care. Vital records data identified live births in the two groups. For those who had given live birth (n = 372), linked administrative data were used to determine and compare rates of referral and enrollment into home visiting, and two indicators of engagement: number of days enrolled, and number of visits received. Women previously in out‐of‐home care were referred for home visiting more often than their peers. There were no differences in rates of enrollment. Women previously in out‐of‐home care remained enrolled for shorter durations and completed fewer home visits than peers. Findings suggest barriers to home visiting enrollment and retention in home visiting programs for women previously in out‐of‐home care. Studies with larger samples and more complete assessments of outcomes are warranted.
... This result underscores the need for primary prevention of child maltreatment, and namely the prevention of childhood neglect. Preventive interventions that work with parents and infants to increase parenting skills, provide necessary resources, and prevent child maltreatment, such as the Building Healthy Children program (Demeusy et al., 2021) and the Nurse-Family Partnership (Olds, 2008), may have downstream effects on ameliorating rates of psychopathology for adolescents and emerging adults (for a review, see Toth et al., 2016). Additionally, we found that youth exposed to environments characterized by both threat and deprivation were at risk for developing higher lability-negativity, which in turn led to an increased likelihood of exhibiting externalizing symptoms in emerging adulthood. ...
Childhood maltreatment is a toxic stressor that occurs in the family context and is related to adverse outcomes including elevations in internalizing symptomology and externalizing symptomology. In the present study, we tested the role of threat and deprivation dimensions of child maltreatment in the etiology of comorbid psychopathology in emerging adulthood. Additionally, we investigated emotion regulation and emotion lability/negativity as mechanisms underlying the relationship between child maltreatment dimensions and emerging adult psychopathology. To address these aims, we used a longitudinal sample of emerging adults (N = 413, Mage = 19.67, 78.0% Black, 51.1% female) who had previously participated in research assessments at age 10-12. Using a person-centered approach with latent profile analysis, we identified three classes of emerging adulthood psychopathology characterized by different levels of symptom severity and comorbidity between internalizing and externalizing symptoms. Emerging adults who experienced deprivation only, compared to those who were not maltreated, were more likely to belong to a comorbid and severe psychopathology class versus the other identified psychopathology classes. There was also a significant indirect pathway from experiences of both threat and deprivation to a high externalizing class via emotion lability/negativity. Our results contribute to current models of childhood adversity and psychopathology and have implications for interventions to prevent psychopathology among emerging adults exposed to child maltreatment.
Each year, millions of families with children in the United States (US) come into contact with the criminal legal system (CLS), the deleterious consequences of which are well documented. Families exposed to the CLS often face many stressors and may benefit from supports and services designed to enhance parent–child relationships and connect them to health-promoting resources and services. Early childhood family home visiting (FHV) is a two-generation strategy to support pregnant women and families with infants and young children, many of whom encounter the CLS. Yet, little is known about the CLS experiences of families receiving FHV. This scoping review summarizes the published research on CLS experiences among FHV-enrolled families in the US. Seven online databases were used to identify research published between 1967 and 2022. Following PRISMA guidelines, articles were required to focus on FHV and CLS involvement. Twenty-eight articles met inclusion criteria; five were systematic reviews or meta-analyses, 22 were primary sources with quantitative measures of CLS, and one was a qualitative study. Among the primary quantitative sources, more than half (55%) included CLS measures to describe the sample and the others included CLS variables as outcomes. CLS involvement was a common experience among families receiving FHV services. This scoping review provides an important first step in describing the existing research on FHV participants’ CLS involvement and can inform future efforts to serve this group of families.
Physical punishment is the most common form of violence against children worldwide and is associated with an increased risk of long-term adverse outcomes. Interventions targeting parents/caregivers are frequently implemented to prevent and reduce the use of physical punishment. This scoping review aimed to map the existing literature on evidence-informed parenting interventions targeting physical punishment. A scoping review following the World Health Organization (WHO) Review Guide, the Joanna Briggs Institute (JBI) 2020 Guide for scoping reviews, was conducted to address the objective of this review. An academic health sciences librarian systematically searched electronic databases (EBSCO, MEDLINE, EMBASE, SCOPUS) for peer-reviewed journal articles. Two reviewers independently screened titles and abstracts, followed by a full-text review according to inclusion and exclusion criteria following the Participants, Concept, and Context framework. Eighty-one studies were included for full-text eligibility. The results suggest that most interventions examined were conducted in North America, targeted mothers and fathers, and were delivered in person. The results from this scoping review describe the state of evidence-informed parenting interventions to prevent and reduce physical punishment. This review found opportunities for future research to implement effective parenting interventions on a larger societal scale and use mixed methods approaches to evaluate parenting interventions.
Child maltreatment has been a prominent topic on the political agenda for the past decade. However, while there are several types of interventions that can potentially benefit the prevention of child maltreatment, uncertainties remain regarding the transferability of these interventions to different contexts and their overall impact. Consequently, we conducted a systematic review of intervention studies aimed at preventing child maltreatment. We searched for studies published between 2016 and 2021, using predefined keywords from various bibliographical databases including PsycINFO, SocINDEX, Social Care Online, Web of Science, and ASSIA. The initial literature search yielded 3221 studies based on titles and abstracts, after removing duplicates. Out of these, 251 studies were screened based on full texts, resulting in the selection of 56 studies that met our inclusion criteria and were retained for extraction and analysis. The screening and data extraction processes were conducted by at least two independent reviewers. Given the heterogeneity of the included studies, we performed a narrative synthesis and categorized the 56 studies based on intervention type, control condition, outcomes, effects and quality. The results indicated that most of the studies employed individual randomization, with the control group most often receiving treatment as usual. Home visiting programs and educational interventions emerged as the most prevalent types of interventions. The review also demonstrated that a significant number of the included studies reported positive effects on one or more outcomes, such as indicators of maltreatment, suboptimal parenting practices, and problematic child behaviors. While nearly one-third of the studies did not report an effect size, those that did reported varying types of effect sizes. Additionally, only a few studies met the assessed quality criteria.
Objectives: During the COVID-19 pandemic, Chinese people with mental health difficulties faced a major issue of mental health stigma. The pandemic's constant stress and social isolation intensified the stigma attached to people suffering from mental illnesses. To address this issue, a study was done in China to investigate mental health stigma in the context of digital media arts. Methods: The study involves randomly distributing 1300 questionnaires on a 5-point Likert scale. Only 500 questionnaires, however, were found adequate for data analysis using partial least squares (PLS). Results: Digital health innovation and adoption are crucial for enhancing mental health. The study's focus was confined to the adoption of innovation in mental healthcare in China because this sector received less attention in previous research that sought to establish a link between digital health innovation and digital mental healthcare. Conclusion: The study has important theoretical and practical implications for improving people's lives by strengthening their mental health systems with digital technologies and raising awareness of digital healthcare tools. The findings are important for policymakers to make people aware of the importance of caring for their mental health by digital healthcare tools.
This review summarizes the implementation characteristics of parenting interventions to promote early child development (ECD) outcomes from birth to 3 years. We included 134 articles representing 123 parenting trials (PROSPERO record CRD42022285998). Studies were conducted across high‐income (62%) and low‐and‐middle‐income (38%) countries. The most frequently used interventions were Reach Up and Learn, Nurse Family Partnership, and Head Start. Half of the interventions were delivered as home visits. The other half used mixed settings and modalities (27%), clinic visits (12%), and community‐based group sessions (11%). Due to the lack of data, we were only able to test the moderating role of a few implementation characteristics in intervention impacts on parenting and cognitive outcomes (by country income level) in the meta‐analysis. None of the implementation characteristics moderated intervention impacts on cognitive or parenting outcomes in low‐ and middle‐income or high‐income countries. There is a significant need in the field of parenting interventions for ECD to consistently collect and report data on key implementation characteristics. These data are needed to advance our understanding of how parenting interventions are implemented and how implementation factors impact outcomes to help inform the scale‐up of effective interventions to improve child development.
As a founder of the field of applied developmental psychology, Dr Edward Zigler promoted public policy that translated scientific knowledge into real-world programs to improve the outcomes of high-risk children and families. Many researchers, practitioners, and public policy proponents have sought to carry on his legacy through integration of empirical research, evidence-based prevention and intervention, and advocacy to address a range of challenges facing families with young children. To advance the field of child maltreatment, a multidisciplinary team of investigators from the Universities of Rochester and Minnesota partnered with the Eunice Kennedy Shriver National Institute of Child Health and Human Development to create the T ranslational R esearch that A dapts N ew S cience FOR M altreatment Prevention Center (Transform). Building on state-of-the-art research methodologies and clinical practices, Transform leverages theoretically grounded research and evidence-based interventions to optimize outcomes for individuals across the life span who have experienced, or may be at risk for, maltreatment. Inspired by the work of Dr Zigler, Transform is committed to bridging science and real-world practice. Therefore, in addition to creating new science, Transform's Community Engagement Core provides translational science to a broad audience of investigators, child-serving professionals, and parental and governmental stakeholders. This article describes Transform's purpose, theoretical framework, current activities, and future directions.
This study evaluated the efficacy of cognitive–behavioral therapy (CBT) and interpersonal psychotherapy (IPT) with depressed adolescents in Puerto Rico. Seventy-one adolescents meeting Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev.; American Psychiatric Association, 1987) criteria for a diagnosis of depression were randomly assigned to 1 of 3 conditions: CBT, IPT, or wait list (WL). Pretreatment, posttreatment, and 3-month follow-up measures of depression symptoms, self-esteem, social adjustment, family emotional involvement and criticism, and behavioral problems were completed. Results suggest that IPT and CBT significantly reduced depressive symptoms when compared with the WL condition. IPT was superior to the WL condition in increasing self-esteem and social adaptation. Clinical significance tests suggested that 82% of adolescents in IPT and 59% of those in CBT were functional after treatment. The results suggest that both IPT and CBT are efficacious treatments for depressed Puerto Rican adolescents. IPT's impact in other levels of outcome is discussed in terms of its consonance with Puerto Rican cultural values.
To foster the study of emotion regulation beyond infancy and toddlerhood, a new criterion Q-sort was constructed. In Study 1, Q-scales for emotion regulation and autonomy were developed, and analyses supported their discriminant validity. Study 2 further explored the construct validity of the Emotion Regulation Q-Scale within a sample of 143 maltreated and 80 impoverished children, aged 6 to 12 years. A multitrait–multimethod matrix and confirmatory factor analyses indicated impressive convergence among the Emotion Regulation Q-Scale and established measures of affect regulation. This new scale also was discriminable from measures of related constructs, including Q-sort assessments of ego resiliency. The use of this new measure was further supported by its ability to distinguish between maltreated and comparison children and between groups of well-regulated versus dysregulated children.
Home visiting during early childhood can improve a range of outcomes for children and families. As evidence‐based models are implemented across the nation, two questions have emerged. First, can home visiting improve outcomes more efficiently? Second, can overall effects be strengthened for specific subgroups of families? For the past several decades, research focused on testing the average effects of home visiting models on short‐ to long‐term outcomes has found small impacts. These effects are not the same for all families. The field needs new evidence produced in new ways to overcome these challenges. In this article, we provide an overview of the evidence in this field, including what works and for whom. Next, we explain precision approaches to various fields and how this approach could be used in home visiting programs. Research on precision home visiting focuses on the ingredients of home visiting models, collaborating with practitioners to identify the ingredients and testing them on near‐term outcomes, and using innovative study designs to learn more quickly what works best for which families. We conclude by proposing four pillars of research that will help achieve precision home visiting services.
Background:
Women with depression and childhood sexual abuse histories constitute more than 20% of the female patient population in publicly funded community mental health centers (CMHCs). Interventions are needed that address depression and posttraumatic stress disorder (PTSD) symptoms and social health.
Method:
We compared Interpersonal Psychotherapy-Trauma (IPT-T), an IPT adaptation for this population and setting, to Clinic Psychotherapy (CP). CP clinicians were free to implement the psychotherapy of choice. Women (n = 162; 54% White, 10.5% Hispanic; 52.2% Medicaid-insured) with a major depressive episode (MDE) and history of sexual abuse before 18 were randomly assigned to IPT-T or CP. Participants were offered 16 free sessions of IPT-T or CP. Outcomes were MDE remission, improved depression (Beck Depression Inventory, Hamilton Depression Rating Scale) and PTSD symptoms (Modified PTSD Symptom Scale), and improved social health (e.g., UCLA Loneliness Scale). Weighted generalized estimating equations were used to examine outcomes at 8 (primary) and 20 (secondary) months postrandomization.
Results:
IPT-T led to greater improvements in PTSD symptoms and many social health indicators, including loneliness and social support, at both 8- and 20-month follow-up. Effect sizes ranged from .18 to .39 at the primary endpoint (8 months). IPT-T and CP yielded comparable improvements in depression symptoms and MDE remission.
Conclusion:
Evidence-based psychotherapies like IPT-T are needed in CMHCs, where some of the most vulnerable patients receive treatment. With comparable findings for depression, IPT's superior improvements in social health and PTSD symptoms are cause for optimism. IPT-T should be evaluated in dissemination trials. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
The present study applied a semiparametric mixture model to a sample of 284 low-income boys to model developmental trajectories of overt conduct problems from ages 2 to 8. As in research on older children, 4 developmental trajectories were identified: a persistent problem trajectory, a high-level desister trajectory, a moderate-level desister trajectory, and a persistent low trajectory. Follow-up analyses indicated that initially high and low groups were differentiated in early childhood by high child fearlessness and elevated maternal depressive symptomatology. Persistent problem and high desister trajectories were differentiated by high child fearlessness and maternal rejecting parenting. The implications of the results for early intervention research are discussed, with an emphasis on the identification of at-risk parent - child dyads.
Although the merits of parents using corporal punishment to discipline children have been argued for decades, a thorough understanding of whether and how corporal punishment affects children has not been reached. Toward this end, the author first presents the results of meta-analyses of the association between parental corporal punishment and 11 child behaviors and experiences. Parental corporal punishment was associated with all child constructs, including higher levels of immediate compliance and aggression and lower levels of moral internalization and mental health. The author then presents a process-context model to explain how parental corporal punishment might cause particular child outcomes and considers alternative explanations. The article concludes by identifying 7 major remaining issues for future research.
Using a developmental cascades framework, the current study investigated whether treating maternal depression via interpersonal psychotherapy (IPT) may lead to more widespread positive adaptation for offspring and mothers including benefits to toddler attachment and temperament, and maternal parenting self-efficacy. The participants ( N = 125 mother – child dyads; mean mother age at baseline = 25.43 years; 54.4% of mothers were African American; mean offspring age at baseline = 13.23 months) were from a randomized controlled trial of IPT for a sample of racially and ethnically diverse, socioeconomically disadvantaged mothers of infants. Mothers were randomized to IPT ( n = 97) or an enhanced community standard control group ( n = 28). The results of complier average causal effect modeling showed that engagement with IPT led to significant decreases in maternal depressive symptoms at posttreatment. Moreover, reductions in maternal depression posttreatment were associated with less toddler disorganized attachment characteristics, more adaptive maternal perceptions of toddler temperament, and improved maternal parenting efficacy 8 months following the completion of treatment. Our findings contribute to the emerging literature documenting the potential benefits to children of successfully treating maternal depression. Alleviating maternal depression appears to initiate a cascade of positive adaptation among both mothers and offspring, which may alter the well-documented risk trajectory for offspring of depressed mothers.
Compiled in this Special Section are recommendations from multiple experts on how to maximize resilience among children at risk for maladjustment. Contributors delineated processes with relatively strong effects and modifiable by behavioral interventions. Commonly highlighted was fostering the well-being of caregivers via regular support, reduction of maltreatment while promoting positive parenting, and strengthening emotional self-regulation of caregivers and children. In future work, there must be more attention to developing and testing interventions within real-world settings (not just in laboratories) and to ensuring feasibility in procedures, costs, and assessments involved. Such movement will require shifts in funding priorities—currently focused largely on biological processes—toward maximizing the benefits from large-scale, empirically supported intervention programs for today's at-risk youth and families.
Importance
Several widely held beliefs about child abuse and neglect may be incorrect. It is most commonly assumed that some forms of abuse (eg, physical and sexual abuse) are more harmful than others (eg, emotional abuse and neglect); other assumptions are that each form of abuse has specific consequences and that the effects of abuse differ across sex and race.Objective
To determine whether widely held assumptions about child abuse and neglect are valid by testing the hypothesis that different types of child maltreatment (CM) actually have equivalent, broad, and universal effects.Design, Setting, and Participants
This observational study assessed 2292 racially and ethnically diverse boys (1254 [54.7%]) and girls (1038 [45.3%]) aged 5 to 13 years (mean [SD] age, 9.0 [2.0] years) who attended a research summer camp program for low-income, school-aged children from July 1, 1986, to August 15, 2012. Of these children, 1193 (52.1%) had a well-documented history of maltreatment. Analysis was conducted from September 25, 2013, to June 1, 2015.Main Outcomes and Measures
Various forms of internalizing and externalizing personality and psychopathologic traits were assessed using multiple informant ratings on the California Child Q-Set and Teacher Report Form as well as child self-reported depression and peer ratings of aggression and disruptive behavior.Results
Structural analysis showed that different forms of CM have equivalent psychiatric and behavioral effects, ranging from anxiety and depression to rule-breaking and aggression. We also found that nonsexual CM alters 2 broad vulnerability factors, internalizing (β = 0.185; SE = 0.028; P < .001) and externalizing (β = 0.283; SE = 0.023; P < .001), that underlie multiple forms of psychiatric and behavioral disturbance. We show that CM has comparable consequences for boys and girls of different races, and our results allowed us to describe a base rate and co-occurrence issue that makes it difficult to identify the unique effects of child sexual abuse. Conclusions and Relevance
Our findings challenge widely held beliefs about how child abuse should be recognized and treated—a responsibility that often lies with the physician. Because different types of child abuse have equivalent, broad, and universal effects, effective treatments for maltreatment of any sort are likely to have comprehensive psychological benefits. Population-level prevention and intervention strategies should emphasize emotional abuse, which occurs with high frequency but is less punishable than other types of child maltreatment.
Childhood maltreatment represents a complex stressor, with the developmental timing, duration, frequency, and type of maltreatment varying with each child (Barnett, Manly, & Cicchetti, 1993; Cicchetti & Manly, 2001). Multiple brain regions and neural circuits are disrupted by the experience of child maltreatment (Cicchetti & Toth, in press; DeBellis et al., 2002; McCrory & Viding, 2010; Teicher, Anderson, & Polcari, 2012). These neurobiological compromises indicate the impairment of a number of important cognitive functions, including working memory and inhibitory control. The present study extends prior research by examining the effect of childhood maltreatment on neurocognitive functioning based on developmental timing of maltreatment, including onset, chronicity, and recency, in a sample of 3- to 9-year-old nonmaltreated (
n
= 136) and maltreated children (
n
= 223). Maltreated children performed more poorly on inhibitory control and working-memory tasks than did nonmaltreated children. Group differences between maltreated children based on the timing of maltreatment and the chronicity of maltreatment also were evident. Specifically, children who were maltreated during infancy, and children with a chronic history of maltreatment, exhibited significantly poorer inhibitory control and working-memory performance than did children without a history of maltreatment. The results suggest that maltreatment occurring during infancy, a period of major brain organization, disrupts normative structure and function, and these deficits are further instantiated by the prolonged stress of chronic maltreatment during the early years of life.
Objective:
Exposure to trauma reminders has been considered imperative in psychotherapy for posttraumatic stress disorder (PTSD). The authors tested interpersonal psychotherapy (IPT), which has demonstrated antidepressant efficacy and shown promise in pilot PTSD research as a non-exposure-based non-cognitive-behavioral PTSD treatment.
Method:
The authors conducted a randomized 14-week trial comparing IPT, prolonged exposure (an exposure-based exemplar), and relaxation therapy (an active control psychotherapy) in 110 unmedicated patients who had chronic PTSD and a score >50 on the Clinician-Administered PTSD Scale (CAPS). Randomization stratified for comorbid major depression. The authors hypothesized that IPT would be no more than minimally inferior (a difference <12.5 points in CAPS score) to prolonged exposure.
Results:
All therapies had large within-group effect sizes (d values, 1.32-1.88). Rates of response, defined as an improvement of >30% in CAPS score, were 63% for IPT, 47% for prolonged exposure, and 38% for relaxation therapy (not significantly different between groups). CAPS outcomes for IPT and prolonged exposure differed by 5.5 points (not significant), and the null hypothesis of more than minimal IPT inferiority was rejected (p=0.035). Patients with comorbid major depression were nine times more likely than nondepressed patients to drop out of prolonged exposure therapy. IPT and prolonged exposure improved quality of life and social functioning more than relaxation therapy.
Conclusions:
This study demonstrated noninferiority of individual IPT for PTSD compared with the gold-standard treatment. IPT had (nonsignificantly) lower attrition and higher response rates than prolonged exposure. Contrary to widespread clinical belief, PTSD treatment may not require cognitive-behavioral exposure to trauma reminders. Moreover, patients with comorbid major depression may fare better with IPT than with prolonged exposure.
Successful treatment of parental depression may have a positive effect on the functioning and psychopathology of their children. We conducted a meta-analysis to examine the effects of psychotherapy for depressed mothers on their children and parental functioning. We used a database of randomized controlled trials examining the effects of psychotherapy for adult depression and selected trials comparing psychotherapy and control conditions in depressed mothers and reporting outcomes in their children and parental functioning. Nine studies were included. The quality of these studies was not optimal and the outcome instruments differed considerably from each other. The therapies resulted in significantly decreased levels of depression (g = 0.66) in the mothers. In the seven studies that reported outcomes on the mental health of children, a significant effect size was also found (g = 0.40). The eight studies examining mother–child interactions resulted in a significant effect size of g = 0.35, and the five studies examining parenting/marital distress had a pooled effect size of g = 0.67. We found that psychotherapy leads to decreased levels of depression in depressed mothers and also found indications that psychotherapy may have a positive effect on the mental health of their children and parenting/marital distress. However, more high-quality research is needed before a definite answer can be given.
This study examined the mediating effect of parents' psychological aggression in the relationship between parenting stress and children's internalizing (anxiety/depression, withdrawal) and externalizing (aggression, delinquency) problem behaviors 1 year later. Using a sample of 311 intact 2-parent Chinese families with preschoolers, findings revealed that maternal parenting stress had direct effects on children's internalizing and externalizing problem behavior and indirect effects through maternal psychological aggression. However, neither direct nor indirect effects of fathers' parenting stress on children's internalizing and externalizing problem behavior were found. The findings highlight the importance of simultaneously studying the effects of both mothers' and fathers' parenting on their children within a family systems framework. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
For this study, we evaluated the independent and additive predictive effects of psychological maltreatment on an array of behavioral problems, symptoms, and disorders in a large national sample of clinic-referred children and adolescents drawn from the National Child Traumatic Stress Network Core Data Set (CDS; see Layne, Briggs-King, & Courtois, 2014). We analyzed a subsample of 5,616 youth with lifetime histories of 1 or more of 3 forms of maltreatment: psychological maltreatment (emotional abuse or emotional neglect), physical abuse, and sexual abuse. Measures included the University of California, Los Angeles Posttraumatic Stress Disorder–Reaction Index (Steinberg et al., 2004), Child Behavior Checklist (Achenbach & Rescorla, 2004), and 27 diagnostic and CDS-specific clinical severity indicators. Psychologically maltreated youth exhibited equivalent or greater baseline levels of behavioral problems, symptoms, and disorders compared with physically or sexually abused youth on most indicators. The co-occurrence of psychological maltreatment with physical or sexual abuse was linked to the exacerbation of most outcomes. We found that the clinical profiles of psychologically maltreated youth overlapped with, yet were distinct from, those of physically and/or sexually abused youth. Despite its high prevalence in the CDS, psychological maltreatment was rarely the focus of intervention for youth in this large national sample. We discuss implications for child mental health policy; educational outreach to providers, youth, and families; and the development or adaptation of evidence-based interventions that target the effects of this widespread, harmful, yet often overlooked form of maltreatment.
Adolescent parenthood is associated with a range of adverse outcomes for young mothers, including mental health problems such as depression, substance abuse, and posttraumatic stress disorder. Teen mothers are also more likely to be impoverished and reside in communities and families that are socially and economically disadvantaged. These circumstances can adversely affect maternal mental health, parenting, and behavior outcomes for their children. In this report, we provide an overview of the mental health challenges associated with teen parenthood, barriers that often prevent teen mothers from seeking mental health services, and interventions for this vulnerable population that can be integrated into primary care services. Pediatricians in the primary care setting are in a unique position to address the mental health needs of adolescent parents because teens often turn to them first for assistance with emotional and behavioral concerns. Consequently, pediatricians can play a pivotal role in facilitating and encouraging teen parents' engagement in mental health treatment.
A randomized clinical trial was conducted to evaluate the efficacy of interpersonal psychotherapy (IPT) for ethnically and racially diverse, economically disadvantaged women with major depressive disorder. Non-treatment-seeking urban women (N = 128; M age = 25.40, SD = 4.98) with infants were recruited from the community. Participants were at or below the poverty level: 59.4% were Black and 21.1% were Hispanic. Women were screened for depressive symptoms using the Center for Epidemiologic Studies Depression Scale; the Diagnostic Interview Schedule was used to confirm major depressive disorder diagnosis. Participants were randomized to individual IPT or enhanced community standard. Depressive symptoms were assessed before, after, and 8 months posttreatment with the Beck Depression Inventory-II and the Revised Hamilton Rating Scale for Depression. The Social Support Behaviors Scale, the Social Adjustment Scale-Self-Report, and the Perceived Stress Scale were administered to examine mediators of outcome at follow-up. Treatment effects were evaluated with a growth mixture model for randomized trials using complier-average causal effect estimation. Depressive symptoms trajectories from baseline through postintervention to follow-up showed significant decreases among the IPT group compared to the enhanced community standard group. Changes on the Perceived Stress Scale and the Social Support Behaviors Scale mediated sustained treatment outcome.
The association between poverty and compromised development, particularly in the early years, has been well documented. Many early childhood programs have been X designed to promote positive parenting and more enriched home environments in order to enhance children's development. We describe findings from a multisite, randomized evaluation of the Parents as Teachers (PAT) program with 665 families, which was designed specifically to investigate the program's effectiveness with low-income families. The observed effects of the PAT program on parenting and child development outcomes were generally small, with few statistically significant effects. More consistent positive effects were noted for very low-income parents and their children relative to more moderate income parents. The discussion focuses on the policy implications of the findings for the design and implementation of early childhood parenting programs for low-income families and future research.
Psychological maltreatment appears to be more prevalent and potentially more destructive than other forms of child abuse and neglect. However, it receives little attention from the public or professional sector and is seldom the target of research or intervention. This article reviews the literature and concludes that psychological maltreatment is the core issue in child maltreatment and poses a serious mental health threat that should be brought to the forefront of psychology’s efforts in policy development, research, intervention, and prevention.
Context
Home visitation to families with young children has been promoted as
an effective way to prevent child maltreatment, but few studies have examined
the conditions under which such programs meet this goal.Objective
To investigate whether the presence of domestic violence limits the
effects of nurse home visitation interventions in reducing substantiated reports
of child abuse and neglect.Design
Fifteen-year follow-up study of a randomized trial.Setting
Semirural community in upstate New York.Participants
Of 400 socially disadvantaged pregnant women with no previous live births
enrolled consecutively between April 1978 and September 1980, 324 mothers
and their children participated in the follow-up study.Interventions
Families were randomly assigned to receive routine perinatal care (control
group; n = 184 participated in follow-up), routine care plus nurse home visits
during pregnancy only (n = 100), or routine care plus nurse home visits during
pregnancy and through the child's second birthday (n = 116).Main Outcome Measures
Number of substantiated reports over the entire 15-year period involving
the study child as subject regardless of the identity of the perpetrator or
involving the mother as perpetrator regardless of the identity of the child
abstracted from state records and analyzed by treatment group and level of
domestic violence in the home as measured by the Conflict Tactics Scale.Results
Families receiving home visitation during pregnancy and infancy had
significantly fewer child maltreatment reports involving the mother as perpetrator
(P = .01) or the study child as subject (P = .04) than families not receiving home visitation. The number of
maltreatment reports for mothers who received home visitation during pregnancy
only was not different from the control group. For mothers who received visits
through the child's second birthday, the treatment effect decreased as the
level of domestic violence increased. Of women who reported 28 or fewer incidents
of domestic violence (79% of sample), home-visited mothers had significantly
fewer child maltreatment reports during the 15-year period than mothers not
receiving the longer-term intervention (P = .01).
However, this intervention did not significantly reduce child maltreatment
among mothers reporting more than 28 incidents of domestic violence (21% of
sample).Conclusions
The presence of domestic violence may limit the effectiveness of interventions
to reduce incidence of child abuse and neglect.
Figures in this Article
The prevention of child abuse and neglect is an urgent public health
concern. Annually, about 1 million abused children—15 of every 1000
children—are identified in the United States.1
Home visitation has been widely promoted in recent years as a promising approach
to preventing health and developmental problems among children, and thousands
of home visitation programs have been started during the past decade.2 The role of visitation in preventing child abuse and
neglect perhaps has received the most attention. This emphasis stems in part
from the magnitude of this social problem and the limited success of prevention
efforts in the past. Policy makers and child advocates have actively promoted
home-visitation services3- 4 despite
limited evidence supporting their effectiveness in reducing child maltreatment.5
Much of the enthusiasm for home visitation as a tool to prevent child
abuse stems from the early findings of a randomized trial conducted more than
20 years ago in Elmira, NY. Home visitation by nurses prenatally and for 2
years postnatally resulted in a significant reduction in the rate of verified
Child Protective Services (CPS) cases among a subsample of poor, unmarried
teenaged mothers when the children were aged 2 years.6
Four percent of the nurse-visited families had a verified maltreatment report
before the child's second birthday, in contrast to 19% in a comparison group
receiving routine perinatal care. Support continued for home visitation despite
the fact that differences in child maltreatment were no longer significant
by the time the children in the Elmira trial reached age 4 years,7 perhaps because of increased surveillance of the families
by the nurses.8
A recent review offers ambiguous support for the relation between home
visitation and reductions in child maltreatment.2
The findings from several large-scale home-visitation efforts have shown disappointing
short-term results in reducing family violence and child maltreatment.4,9 A 15-year follow-up study of the Elmira
trial families, however, provided the first evidence from a randomized trial
for the long-term effects of home visitation on reducing child maltreatment.10 Results from the follow-up showed that nurse-visited
families had half as many child maltreatment reports as families in the comparison
group.
In addition to assessing the impact of home-visitation services on child
maltreatment, it is also important to specify for whom and under what conditions
these services are effective. Preventive interventions often find that treatment
effects for certain outcomes vary across subgroups of study participants.11- 12 In this study, we examine how domestic
violence limits the effectiveness of the home-visitation program in preventing
maltreatment. There are several reasons why domestic violence might interfere
with the success of a home-visitation intervention. Research suggests that
children in households with domestic violence may be at an increased risk
for child maltreatment.13- 16
Although some child maltreatment may be caused directly by the male perpetrators
of domestic violence, other incidents may result from the effects of domestic
violence on the mothers' caregiving capacities (eg, through injury, mental
distress, and restricted mobility). Data17
also suggest that mothers who are in violent relationships often act violently
themselves, either as initiators of the violence or in self-defense. Such
reciprocally violent relationships may place children at even greater risk
as violence spreads throughout the household. Children witnessing domestic
violence may also exhibit more internalizing and externalizing problems,18- 19 which, in turn, may make them more
difficult to parent. We predicted that the intervention would be less effective
in reducing child maltreatment in the presence of domestic violence.
Context.
—Home-visitation services have been promoted as a means of improving maternal and child health and functioning. However, long-term effects have not been examined.
This chapter reviews what is currently known about the relations between attachment and psychopathology in childhood. This review focuses on the more common externalizing and internalizing disorders of childhood and does not cover developmental disabilities. The chapter begins with general comments on the role of attachment in the development of psychopathology. It then addresses 2 fundamental questions. First, how has the study of attachment contributed to the understanding of childhood disorders? The answer includes a review of how attachment has been linked to childhood difficulties, a discussion of modes of transmission and differential pathways of influence, and the presentation of a heuristic model for understanding the role of attachment relations. The second question is this: How can the field of childhood psychopathology enrich the further study of attachment? The chapter closes with suggestions for future research. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Posted 3/30/2001. There as has been great progress in research on the prevention of psychological disorders in childhood. The programs reviewed by M. T. Greenberg, C. Domitrovich, and B. Bumgarger (2001) are promising. Most of the programs reduced risk factors and/or symptoms of psychological disorders. Despite this progress, however, there is little evidence for the prevention of psychological disorders. We outline several recommendations for future research, including some noted by Greenberg et al (2001). In particular, we emphasize the need for longer term follow-up, the evaluation of intervention ingredients, mediators and moderators, and the evaluation of intervention providers. These recommendations are illustrated with recent research on depression prevention. Finally, we discuss the need for more research on the prevention of internalizing disorders and the limits of current interventions designed to prevent depression in children and adolescents. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The IQ score has been the most frequently utilized outcome measure in evaluations of early childhood intervention programs. Reasons for the popularity of the IQ as an assessment tool are discussed, and problems raised by employing the IQ in this manner are noted. The importance of accurate outcome evaluation of programs with clearly defined goals is related to both the social science and policy-making arenas. The authors argue that social competence, rather than IQ, should be the primary measure of the success of intervention efforts. Difficulties in defining and assessing social competence are discussed. An index of social competence is suggested that includes measures of physical health, IQ, school achievement, certain motivational and emotional variables, and such molar social expectancy variables as school attendance and incidence of juvenile delinquency. (59 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Teenage childbearing (age 15–19 years) represents a significant public health issue that can generate considerable deleterious, multigenerational consequences for teen-childbearing mothers and their offspring. However, few studies have examined the potential mediating mechanisms that may explain if and how teen childbearing is associated with the development of offspring psychopathology. The current study used a developmental model to test the mediating role of chronic child maltreatment in the relationship between teen childbearing and offspring internalizing symptoms in childhood and emerging adulthood. The study participants were 384 individuals from socioeconomically disadvantaged, ethnically diverse backgrounds, assessed across two longitudinal waves of data (i.e., ages 10–12 and 18–20). The sample included maltreated and nonmaltreated children, all of whom were comparable in terms of family income. Structural equation modeling was conducted to test direct and indirect pathways from teen childbearing to offspring psychopathology. A multigenerational developmental cascade was found such that individuals born to mothers who began their childbearing in adolescence were more likely to experience chronic maltreatment during childhood, which in turn predicted greater internalizing symptoms throughout childhood and emerging adulthood. Using a developmental psychopathology framework, the results are discussed with regard to implications for prevention and early intervention.
Emotion dysregulation and emerging psychopathology: A transdiagnostic, transdisciplinary perspective - Volume 31 Special Issue - Theodore P. Beauchaine, Dante Cicchetti
The goal of this Special Issue is to introduce prevention scientists to an emerging form of healthcare, called precision medicine. This approach integrates investigation of the mechanisms of disease and health-compromising behaviors with prevention, treatment, and cure resolved at the level of the individual. Precision Medicine and its derivative personalized prevention represents a promising paradigm for prevention science as it accounts for response heterogeneity and guides development of targeted interventions that may enhance program effect sizes. If successfully integrated into prevention science research, personalized prevention is an approach that can inform the development of decision support tools (screening measures, prescriptive algorithms) and enhance the utility of mobile health technologies that will enable practitioners to use personalized consumer data to inform decisions about the best type and/or intensity of a prevention strategy for particular individuals or subgroups of individuals. In this special issue, we present conceptual articles that provide a heuristic framework for precision-based, personalization prevention research and empirical studies that address research questions exemplary of a new generation of precision-based personalized preventive interventions focused on children’s mental health, behavioral health, and education.
Objectives—This report presents 2015 data on U.S. births according to a wide variety of characteristics. Data are presented for maternal age, live-birth order, race and Hispanic origin, marital status, attendant at birth, method of delivery, period of gestation, birthweight, and plurality. Selected data by mother's state of residence and birth rates by age and race of father also are shown. Trends in fertility patterns and maternal and infant characteristics are described and interpreted. Methods—Descriptive tabulations of data reported on the birth certificates of the 3.98 million births that occurred in 2015 are presented. Results—In 2015, 3,978,497 births were registered in the United States, down less than 1% from 2014. The general fertility rate was 62.5 per 1,000 women aged 15–44, a decline of 1% from 2014. The birth rate for teenagers aged 15–19 fell 8% in 2015, to 22.3 per 1,000 females. Birth rates declined for women in their 20s but increased for women in their 30s and early 40s. The total fertility rate (estimated number of births over a woman’s lifetime) declined to 1,843.5 births per 1,000 women in 2015. The birth rate for unmarried women declined for the seventh straight year to 43.5 per 1,000. The cesarean delivery rate declined for the third year in a row to 32.0%. The preterm birth rate increased slightly from 2014, to 9.63% in 2015, as did the rate of low birthweight (8.07% in 2015). The twin birth rate declined to 33.5 per 1,000; the triplet and higher-order multiple birth rate was down 9% to 103.6 per 100,000. © 2017, National Center for Health Statistics. All rights reserved.
In this chapter, we provide an overview of the historical issues accompanying the study of child maltreatment and address advances and challenges that have emerged over decades of research in this area. A developmental psychopathology perspective provides a framework for discussing etiological models, psychological and biological sequelae, and methodological considerations, as well as for highlighting implications for intervention and social policy. The utilization of a multilevel perspective that integrates socioemotional, cognitive, psychophysiological, neurobiological, and genetic levels of analysis infused throughout our discussion of research. We conclude by proffering recommendations for research initiatives that will continue to advance the field and ultimately improve the lives of children who have been victimized by abuse and neglect.
Background Psychotherapy is widely used for depressed adolescents, but evidence supporting its efficacy is sparse. Methods In a controlled, 12-week, clinical trial of Interpersonal Psychotherapy for Depressed Adolescents (IPT-A), 48 clinic-referred adolescents (aged 12-18 years) who met the criteria for DSM-III-R major depressive disorder were randomly assigned to either weekly IPT-A or clinical monitoring. Patients were seen biweekly by a "blind" independent evaluator to assess their symptoms, social functioning, and social problem-solving skills. Thirty-two of the 48 patients completed the protocol (21 IPT-A–assigned patients and 11 patients in the control group). Results Patients who received IPT-A reported a notably greater decrease in depressive symptoms and greater improvement in overall social functioning, functioning with friends, and specific problem-solving skills. In the intent-to-treat sample, 18 (75%) of 24 patients who received IPT-A compared with 11 patients (46%) in the control condition met recovery criterion (Hamilton Rating Scale for Depression score ≤6) at week 12. Conclusions These preliminary findings support the feasibility, acceptability, and efficacy of 12 weeks of IPT-A in acutely depressed adolescents in reducing depressive symptoms and improving social functioning and interpersonal problem-solving skills. Because it is a small sample consisting largely of Latino, low socioeconomic status adolescents, further studies must be conducted with other adolescent populations to confirm the generalizability of the findings.
The effectiveness of a parent education and support program (Parents As Teachers [PAT]) was evaluated for middle-class participants by employing a quasi-experimental longitudinal design. Outcomes were assessed for mothers and fathers, and for children at ages 1, 2, and 3 years. PAT homes were found to be more responsive and stimulating for children, and PAT parents perceived greater support from their communities than comparison group parents, but children's abilities were nearly identical in the two groups.
Purpose
Although a purported risk factor for early pregnancy is abuse history, the strength of this association has been inconsistent across studies and may vary as a function of abuse type. The purpose of this meta-analysis was to examine the extent to which sexual, physical, and emotional abuse, as well as neglect, increased the risk of adolescent pregnancy.
Methods
A search of studies through MEDLINE, EMBASE, PsycINFO, Social Work Abstracts, and Web of Science was conducted. Studies were retained if they included (1) women who became pregnant before 20 years of age; (2) a comparison group of nonpregnant adolescents; and (3) abuse experience (<18 years of age).
Results
Thirty-eight independent samples provided 70 estimates of effect sizes, derived from 75,390 participants. Both sexual and physical abuse were associated with an increased risk of adolescent pregnancy (odds ratio [OR], 2.06; 95% confidence interval [CI], 1.75–2.38 and OR, 1.48; CI, 1.24–1.76, respectively). The strongest effect was for the co-occurrence of sexual and physical abuse (OR, 3.83; CI, 2.96–4.97]). Nonsignificant effect sizes were found for emotional abuse (OR, 1.01; CI, .70–1.47) and neglect (OR, 1.29; CI, .77–2.17]), although these were moderated by journal impact factor, that is, greater effect sizes were reported in higher impact journals.
Conclusions
The results of this meta-analysis reveal that the strength of the association between abuse and adolescent pregnancy varies as a function of abuse subtype. Sexual and physical abuse were associated with increased risk for adolescent pregnancy, whereas emotional abuse and neglect were not.
Abstract— Most studies on parental sensitivity are based on Western samples, and the cross‐cultural applicability of this construct has been subject to debate. This article reports on a systematic literature review on observational studies of parental sensitivity in ethnic minority families with young children. It shows that parental sensitivity is generally lower in ethnic minority families than in majority families. The evidence suggests that the main cause for this difference is family stress due to socioeconomic disadvantage. The review found little evidence for cultural explanations. Most importantly, the review shows that parental sensitivity is related to positive child development in ethnic minority families. Interventions attempting to improve ethnic minority children’s well‐being should focus on both reducing family stress and enhancing parental sensitivity.
Half a century of research and program evaluation has fueled a diverse landscape of early childhood policies and practices that produce a range of positive effects on the life prospects of children who face the burdens of significant adversity. Drawing on advances in neurobiology, developmental psychology, developmental psychopathology, and prevention science, this paper presents a framework for elucidating underlying causal mechanisms that explain differences in outcomes, formulating enhanced theories of change about how to shift developmental trajectories, designing creative interventions and rethinking the concept of a two-generation strategy to produce breakthrough impacts, and launching a new era of investment in young children and their families that will achieve greater reductions in intergenerational disparities in learning, behavior, and health than those produced by current best practices. Particular attention is focused on the hypothesis that substantially better outcomes for vulnerable, young children could be achieved by greater attention to strengthening the resources and capabilities of the adults who care for them rather than by continuing to focus primarily on the provision of child-focused enrichment, parenting education, and informal support. Central to achieving this goal is the need to establish an innovation-friendly environment that embraces fast-cycle sharing, supports risk taking, and celebrates learning from failure.
Home visiting is an important mechanism for minimizing the lifelong effects of early childhood adversity. To do so, it must be informed by the biology of early brain and child development. Advances in neuroscience, epigenetics, and the physiology of stress are revealing the biological mechanisms underlying well-established associations between early childhood adversity and suboptimal life-course trajectories. Left unchecked, mediators of physiologic stress become toxic, alter both genome and brain, and lead to a vicious cycle of chronic stress. This so-called "toxic stress" results a wide array of behavioral attempts to blunt the stress response, a process known as "behavioral allostasis." Although behaviors like smoking, overeating, promiscuity, and substance abuse decrease stress transiently, over time they become maladaptive and result in the unhealthy lifestyles and noncommunicable diseases that are the leading causes of morbidity and mortality. The biology of toxic stress and the concept of behavioral allostasis shed new light on the developmental origins of lifelong disease and highlight opportunities for early intervention and prevention. Future efforts to minimize the effects of childhood adversity should focus on expanding the capacity of caregivers and communities to promote (1) the safe, stable, and nurturing relationships that buffer toxic stress, and (2) the rudimentary but foundational social-emotional, language, and cognitive skills needed to develop healthy, adaptive coping skills. Building these critical caregiver and community capacities will require a public health approach with unprecedented levels of collaboration and coordination between the healthcare, childcare, early education, early intervention, and home visiting sectors.
The Building Healthy Children (BHC) collaborative has successfully integrated home visitation into medical care of infants born to young, low-income mothers. Patients receive parenting education, and therapy for parent-child trauma and maternal depression through home visitation. The goals are to avoid child maltreatment, improve parent and child health, and enhance family functioning.
This randomized trial tests combining 3 evidence-based services versus screening and referral to community services only. Patients of 3 primary care practices are screened for eligibility (no previous Child Protective Services indication, maternal age <21 at first delivery, and ≤2 children younger than age 3). Treatment families receive Parents as Teachers, child-parent psychotherapy, and interpersonal psychotherapy as needed. Outreach workers assist with concrete needs, including transportation to medical visits. Participant evaluations and reviews of pediatric medical charts are performed at regular intervals. Electronic medical record communications and BHC social workers ensure full integration with the medical home.
Of all eligible families approached, 75% (n = 497) enrolled in BHC and 85% remained enrolled by age 3. At baseline, 37% of mothers were victims of child abuse/neglect, 22% showed significant depressive symptoms, and 59% of children were exposed to domestic violence. Preliminary analyses demonstrate avoidance of indicated Child Protective reports and foster placement and high rates of preventive care for enrolled children.
BHC offers a unique model of evidence-based home visiting services integrated into primary care. This promising program demonstrates high retention rates and addresses the multidimensional needs of young at-risk families.
The Patient Protection and Affordable Care Act established the Maternal, Infant, and Early Childhood Home Visiting Program, which provides $1.5 billion to states over 5 years for home visiting program models serving at-risk pregnant women and children from birth to age 5. The act stipulates that 75% of the funds must be used for programs with evidence of effectiveness based on rigorous evaluation research. Home Visiting Evidence of Effectiveness reviewed the home visiting research literature and provided an assessment of the evidence of effectiveness for program models that serve families with pregnant women and children from birth to age 5.
Home Visiting Evidence of Effectiveness included a systematic search and screening process, a review of the research quality, and an assessment of program effectiveness. Reviewers rated studies' capacity to provide unbiased estimates of program impacts and determined whether a program met the Department of Health and Human Services' criteria for an evidence-based model.
As of July 2012, 32 models were reviewed, of which 12 met the Department of Health and Human Services criteria. Most of these models were shown to have favorable effects on child development. Other common favorable effects included health care usage and reductions in child maltreatment. Less common were favorable effects on birth outcomes.
Home visiting is a promising way to serve families who may be difficult to engage in supportive services. Existing rigorous research indicates that home visiting has the potential for positive results among high-risk families, particularly on health care usage and child development.
Objective. We estimate the correlation between interviewer-rated harshness of maternal physical discipline and parent-rated child externalizing problems and test whether it varies as a function of maternal warmth or mother - child genetic similarity. Design. Using a parent - offspring behavior genetic design, we included 297 3- to 8-year-old children in 169 biological and adoptive families. Parents completed ratings of child externalizing problems and their feelings of warmth toward their children. They were interviewed about discipline, and global ratings of maternal warmth following a home visit were made. Results. The correlation between interviewer-rated harshness of discipline and parent-rated child externalizing problems was. 27. However, this correlation was moderated by mothers' and observers' reports of maternal warmth: lower-warmth mothers, r =.36 to. 40; higher-warmth mothers, r =. 10 to. 19. This pattern held for genetically related and unrelated (i.e., adoptive) mother - child pairs regardless of child age, sex, or age of placement. Conclusion. The link between harsh parenting and child externalizing problems is strongest when the mother - child relationship lacks warmth. This result is consistent whether the mother and child are genetically similar, thus ruling out passive gene - environment correlation as an explanation.
Objective. Interventions designed to help parents and infants living in poverty could show greatest positive impacts on those participants who have multiple risks. In this study, we examine 2 maternal mental health risks (depression and insecure attitudes toward relationships) that were assessed prior to random assignment as potential moderators of 2 Early Head Start (EHS) programs impacts on parent-child interaction and child development. Design. 309 women were randomly assigned to either EHS program services plus developmental screenings (n = 158) or community services as usual plus developmental screenings (n = 151) following an enrollment interview; 272 provided data at 1 or more follow-up assessment visits. Results. Impacts of EHS on dimensions of parent-child interaction repeatedly observed between 14 and 36 months of child age were concentrated among depressed women (for maternal hostility) and among mothers who were depressed and had insecure relationship attitudes (for maternal sensitivity and child involvement of parent in play). Positive impacts on child language were concentrated among children of depressed mothers. Impacts on cognitive development assessed at 14, 24, and 36 months were not significant. Maternal depression at 36 months was not related to treatment condition as a main effect or moderated by depression and relationship attitudes. Conclusions. Parenting science continues to evolve models for identifying what works best for whom and under what circumstances. In this effort, programs are urged to identify mental health risks early in their alliance with families to support comprehensive service delivery.
Background:
Depressive symptoms and clinical depression are highly prevalent in low-income mothers and negatively affect their infants and toddlers.
Objectives:
The aim of this study was to test interpersonal psychotherapy combined with parenting enhancement on depressive symptoms and parenting behavior, compared with an equal attention-control condition.
Methods:
Mothers (n = 226) of Early Head Start infants and toddlers from the southeastern and northeastern United States were randomized to the intervention delivered in-home by psychiatric mental health advanced practice nurses or an equal attention-control condition delivered by generalist nurses. Rigorous clinical depressive symptom and depression assessments and videotaped, coded mother-child interactions were used as baseline and 14-, 22-, and 26-week postintervention measures.
Results:
Both the intervention and control groups had significantly reduced Hamilton Rating Scale for Depression scores at each subsequent time point compared with baseline (p < .0001). However, only mothers receiving the intervention showed a significant increase in positive involvement with their child, as measured by closeness, positive effect, affection, and warm touch at T4 (t = 2.22, df = 156, p < .03).
Discussion:
Both intervention and control conditions resulted in symptom reduction, but only the intervention mothers showed significant interaction changes with their child, an essential step in reducing the negative child outcomes associated with maternal depressive symptoms. Results suggest that a combination of generalist and specialist nurses could be used to treat depressive symptoms in these mothers. Further study with longer postintervention observation is needed to see if, over time, the intervention led to longer-lasting symptom reduction.
Objective:
Adolescent pregnancy is common and minority adolescents are at high risk. We sought the following: (1) to prospectively assess prevalence of antenatal depression (AND) and postpartum depression (PPD) in minority adolescents and (2) to examine the association of social support and adjustment, trauma, and stress on depression status.
Study design:
A total of 212 pregnant adolescents were recruited from public prenatal clinics and administered a prospective research survey during pregnancy and 6 weeks' postpartum. Depression was measured using the Edinburgh Postnatal Depression Scale. Univariate, bivariate, and multivariable analyses were performed using logistic regression to assess predictors of AND and PPD.
Results:
In our cohort, 20% screened positive for AND and 10% for PPD. The strongest predictor of PPD was AND (odds ratio [OR], 4.89; P < .001). Among adolescents with trauma history, there was a 5-fold increase (OR, 5.01) in the odds of AND and a 4-fold increase (OR, 3.76) in the odds of PPD. AND was associated with the adolescent's poor social adjustment (P < .001), perceived maternal stress (P < .001), less social support (P < .001), and a less positive view of pregnancy (P < .001). PPD was significantly associated with primiparity (P = .002), poor social adjustment (P < .001), less social support and involvement of the baby's father (P < .001), and less positive view of pregnancy (P < .001).
Conclusion:
Significant independent risk factors for PPD include AND, view of pregnancy, and social support. Trauma history was highly prevalent and strongly predicted AND and PPD. Point prevalence decreased postpartum, and this may be due to transient increased social support following the birth, warranting longer follow-up and development of appropriate interventions in future work.