JoAnn Robinson’s research while affiliated with University of Connecticut and other places

More nuanced and comprehensive approaches are needed in preventive healthcare to have a larger impact on the social determinants of health that influence health and well-being over the life course. Using data from a nine-site study of pediatric health care innovations focused on screening, referring, and linking families of infants to services for social needs, we examined the clustering of risk and resilience reported by 888 parents at infant age birth to 6 months using latent profile analysis (LPA). We then examined how risk and resilience profiles were associated with children’s health status and family unmet need for social supports 1 year later. The study was conducted in three states in 2018–2020 with recruitment in pediatric clinics serving low-income families. Results found four distinct family profiles of risk and resilience, and families in one profile (high household/relational risk and lower strengths) reported worse health outcomes compared to the low-risk, high strengths profile. Public benefits need—income assistance, health insurance, housing, and food assistance—at 1 year continued to be heightened among all groups compared with the low risk, high-strength group, highlighting the importance of screening for social needs early in life as risk and resilience profiles are predictive of future need. Study findings point to the need to include risk and resilience screening in the strategies used by pediatric healthcare to predict health outcomes and design preventive approaches.

Infant and early childhood home visiting models are gaining prominence as effective programs for families. Most U.S. state infant mental health associations (IMHAs) recommend reflective supervision (RS) and Infant Mental Health (IMH‐E®) Endorsement® as components of home visitor professional development. These efforts may promote workforce professional quality of life. It is unknown whether a workplace policy to provide RS improves the likelihood that best practice guidelines, especially core components of a reflective supervisory relationship, are experienced by the workforce. We sought to investigate associations between home visitor well‐being indicated by professional quality of life (i.e., burnout, secondary traumatic stress, compassion satisfaction) and a workplace policy providing RS, consistent experience of core components of a reflective supervisory relationship, and engagement in endorsement. We also examined differences in consistently experiencing core components of the reflective supervisory relationship in home visitors who reported having a workplace policy for providing RS and those who did not, and for home visitors engaged or not engaged in the endorsement process. A Workplace Supports Survey was designed to investigate these associations; we report findings from a sample of home visitor respondents (N = 139). A policy to provide RS was not associated with professional quality of life. However, analyses suggest an association between a policy to provide RS and consistently experiencing core components of a reflective supervisory relationship. Unanticipated positive associations between engagement in endorsement and burnout and secondary traumatic stress were also found. Finally, engagement in endorsement was associated with less consistent experience of these core components. Implications for future inquiry about the purposes of RS and IECMH Endorsement® as strategies to promote workforce development and well‐being are discussed.

This study investigates the reliability and construct validity of the Functional Impact of Toxic Stress for Parents (FITS-P) measure in an online crowdsourced pilot sample (n=202) and a pediatric clinic sample (n=889). The objective of the FITS-P is to provide a low burden (i.e., four items) measure for capturing aspects of the parental side of the toxic stress equation, specifically defining toxic stress as being severe enough to go beyond feelings of overwhelm to functional impairment in major domains of life. Patterns of item endorsement were analyzed in both samples, and construct validity was assessed in the clinic sample in relation to a series of measures of parental stress and psychological resources also administered to parents. Overall, analyses supported reliability and validity, and suggest utility of this new measure. Most importantly, it was found that only a single FITS-P item endorsed was sufficient to produce a significant increase in risk for most of the construct validity measures. This suggests that, as hoped, functional impact may capture parental variance in the toxic stress constellation more efficiently and effectively than typical methods such as life event stress, adverse childhood experiences, or perceived stressfulness of only the parenting role. Results are discussed in terms of the promise of the FITS-P as a low-burden assessment that can be used in two-generational approaches to ameliorating toxic stress.

Fostering collaboration and instilling core competencies across the diverse Infant Mental Health systems and understanding their training needs are crucial endeavors to support the delivery of evidence-based care and treatment continuity for infants and their families. This paper details the Connecticut Association for Infant Mental Health's use of a comprehensive infant mental health training series as a vehicle to achieve these aims. The training series, and the steps taken to execute and evaluate it are described to provide a framework for future collaborative training initiatives. Evaluation efforts were designed to address knowledge sought and gained and included pre and posttraining tests, participant reports of their training goals and needs, and interviews with trainers regarding the series' strengths and limitations. Findings suggest significant improvements in participants' knowledge of training content across trainings. Participants indicated a desire for trainings on working with the whole family and their plan to integrate skills from the training into their work. Recommendations from trainers and evaluators are provided to spark future trainings and collaborative efforts.

Infant mental health (IMH) as an interdisciplinary field relies on relationships to heal past trauma and promote secure parent-infant attachment. Stress related to performing IMH work has gained more attention in workforce development/well-being literature. Yet, IMH workforce engagement in self-care practices to manage work stress is left unexplored. This qualitative investigation examines a purposive sample (N = 21) of clinical IMH practitioners in two U.S. states to answer the following research questions: a) What self-care practices do clinical IMH practitioners perform? b) Do clinical IMH practitioners rely on reflective supervision as a professional self-care practice? Data include: a) open-ended interviews with clinical IMH practitioners and b) an inventory measuring burnout. Results indicate that on average, the sample reported moderate to high levels of burnout. Yet the majority of the sample engaged in personal and professional self-care practices to manage work-related stress. Saturation of themes: a) heavy reliance on individual coping, b) reflective supervision is insufficient on its own, c) organizational supports may facilitate engagement in self-care and d) competing care demands impede self-care; suggests that individual engagement in self-care outside of work, may not sufficiently manage work-related stress in this group of social service professionals. Highlighted themes offer an ecological framework for considering the interplay between individuals and organizations in promoting IMH workforce well-being. Recommendations for systematic investigation of the role individuals and organizations play in promoting self-care practice and well-being in the broader IMH workforce, employing quantitative methods of inquiry are discussed.

Background Health care administrators must promote effective partnerships with community agencies to address social determinants of health, including reducing exposure to chronic stress in early childhood. Important targets for mitigating “toxic” levels of young child exposures are through reducing parents’ experiences of chronic stress as well as protecting children from direct experiences of harm such as physical or sexual abuse. Conducting screening to identify when parents and children are exposed to early life adversity is a first step; bringing in or referring out families to needed support services is an essential component. This paper describes a multi-modal investigation of health care systems innovations to engage and support parents to prevent and mitigate children’s toxic stress exposures through pediatric primary care and community services partnerships.Methods Key study features include: 1) multi-component, multi-site study in five U.S. communities of pediatric health care clinics and the families they serve, 2) a developmental evaluation approach that describes how systems innovations are experienced over time at three levels (community systems, pediatric providers, and families), and 3) rapid cycle feedback in partnership with communities, clinics and families to co-interpret data and findings. The methodology includes: 1) focus groups and interviews with community stakeholders, clinic staff, and families, 2) electronic health record and Medicaid services data extracted to assess health care quality, and 3) clinic-recruitment of 908 parents of newborns in a longitudinal survey.ResultsThe sample is briefly characterized based on responses to the enrollment phase of the parent survey.Conclusions We discuss the study design elements’ contribution to generate evidence needed by innovators, communities, and clinics to modify and sustain investments in these innovations.

Background. Health care administrators must establish and promote effective partnerships with community agencies to address social determinants of health, including reducing exposure of infants and young children to chronic stress. Because infants’ experiences are inextricably tied to their caregivers, an important target for mitigating “toxic” stress exposure in early childhood is through reducing parents’ experiences of chronic stress in addition to protecting children from direct experiences of harm such as physical or sexual abuse. Conducting screening to identify when children are exposed to early life adversity is a first step; connecting families to needed support services is an essential component to addressing identified challenges. This paper presents the methodology of a three-year study of health care systems innovations designed to engage and support parents of infants to prevent and mitigate children’s toxic stress exposures. Methods. Key study features included: 1) multi-component study in five U.S. communities and nine pediatric health care clinics and the families they serve, 2) a developmental evaluation approach to describe how innovations are experienced over time at three levels—community systems, pediatric providers, and families, and 3) rapid cycle feedback conducted with communities, clinics and families to co-interpret data and findings. Data sources included: 1) focus groups and interviews with community stakeholders, clinic staff, and families, 2) electronic health record and Medicaid services data extracted to assess health care quality, utilization, and financial impact, and 3) clinic-recruitment of 908 parents of infants in a longitudinal survey. Results. The sample is briefly characterized based on responses to the enrollment phase of the parent survey. Conclusions. We discuss the study design elements’ contribution to generating evidence needed by innovators, communities, and clinics to modify and sustain investments in these innovations to prevent or mitigate the effects of exposure to toxic stress on young children.

Background. Health care administrators must establish and promote effective partnerships with community agencies to address social determinants of health, including reducing exposure of infants and young children to chronic stress. Because infants’ experiences are inextricably tied to their caregivers, an important target for mitigating “toxic” stress exposure in early childhood is through reducing parents’ experiences of chronic stress in addition to protecting children from direct experiences of harm such as physical or sexual abuse. Conducting screening to identify when children are exposed to early life adversity is a first step; connecting families to needed support services is an essential component to addressing identified challenges. This paper presents the methodology of a three-year study of health care systems innovations designed to engage and support parents of infants to prevent and mitigate children’s toxic stress exposures. Methods. Key study features included: 1) multi-component study in five U.S. communities and nine pediatric health care clinics and the families they serve, 2) a developmental evaluation approach to describe how innovations are experienced over time at three levels—community systems, pediatric providers, and families, and 3) rapid cycle feedback conducted with communities, clinics and families to co-interpret data and findings. Data sources included: 1) focus groups and interviews with community stakeholders, clinic staff, and families, 2) electronic health record and Medicaid services data extracted to assess health care quality, utilization, and financial impact, and 3) clinic-recruitment of 908 parents of infants in a longitudinal survey. Results. The sample is briefly characterized based on responses to the enrollment phase of the parent survey. Conclusions. We discuss the study design elements’ contribution to generating evidence needed by innovators, communities, and clinics to modify and sustain investments in these innovations to prevent or mitigate the effects of exposure to toxic stress on young children.

The present study examined empathy deficits in toddlerhood (age 14 to 36 months) as predictors of antisocial personality disorder (ASPD) symptoms and psychopathy measured by the Levenson Self-Report Psychopathy scale (Levenson, Kiehl, & Fitzpatrick, 1995) in adulthood (age 23 years) in 956 individuals from the Colorado Longitudinal Twin Study. Consistent with the hypothesis that antisocial behavior is associated with “active” rather than “passive” empathy deficits, early disregard for others, not lack of concern for others, predicted later ASPD symptoms. Early disregard for others was also significantly associated with factor 1 of the Levenson Self-Report Psychopathy Scale, which includes items assessing interpersonal and affective deficits, but not with factor 2, which includes items assessing impulsivity and poor behavioral control. The association between early disregard for others and psychopathy factor 2 was near zero after controlling for the shared variance between psychopathy factors 1 and 2. These results suggest that there is a propensity toward adulthood ASPD symptoms and psychopathy factor 1 that can be assessed early in development, which may help identify individuals most at risk for stable antisocial outcomes.

Although 3-year-olds in the United States may attend prekindergarten prior to formal school entry in kindergarten, few investigations focus on the socioemotional foundations of classroom learning at age 3 and their relationship to later achievement. This study examined the relationship between age 3 readiness for group-based learning, modeled as the latent constructs, effortful control and social communication, and age 5 classroom adjustment and pre-academic outcomes. Data from the Early Head Start Research and Evaluation Project in the United States ( n = 797) included observations, direct assessment, and examiner and teacher report. Children’s effortful control predicted classroom adjustment and their social communication predicted pre-academic outcomes. Readiness for group-based learning provides a way to describe key constructs of early skill development and a framework to support children’s classroom learning. Implications include promoting parents’ and educators’ capacities to support early developmental foundations for later adjustment and learning by fostering infants’ and toddlers’ effortful control and social communication. Efforts to support these skills simultaneously across diverse experiences in the home and classroom by focusing on children’s individual needs may prove advantageous.