Patricia L. Kohl’s research while affiliated with Washington University in St. Louis and other places

Objective Child maltreatment is a complex and preventable public health problem that cannot be effectively addressed by a single organization or sector. We examined a network of organizations working to prevent childhood maltreatment before and during COVID-19, including members of the Parents and Children Together–St. Louis Collaborative. The Collaborative is an initiative with the purpose of strengthening ties among service agencies and was new when the COVID-19 shutdowns began. Design and Participants In September 2020, we surveyed 62 agencies working on childhood maltreatment prevention in the public health, health, or social service sectors. We asked about frequency of contact between organizations before (pre-COVID) and during COVID (in-COVID). We used descriptive and inferential network methods to examine network properties and changes. Results There were 360 ties among organizations in the pre-COVID network (density = 0.19) and 321 ties among organizations (density = 0.17) during COVID. The median number of ties per organization decreased from pre- to in-COVID for most organizations and most notably for smaller and newer organizations and mental health care organizations. The only organization type that increased connections was substance abuse organizations. Pre- and in-COVID odds of connection were significantly higher for mental health care, substance abuse, health care, child welfare, and legal-advocacy organizations compared to multisector organizations. Odds of a connection between 2 organizations were significantly higher pre-COVID and in-COVID if one or both organizations were Collaborative members. Conclusions Disruptions during COVID-19 coincided with fewer connections among organizations. Collaborative members had higher odds of connection before and during COVID-19, suggesting a potential strategy for building and maintaining a cross-sector service network. Understanding network structure and change in the early stages of COVID-19 provides an opportunity to work on building and sustaining inter-organizational connections essential in violence prevention and child well-being and other areas of public health.

It is evident that father engagement in parenting contributes to child well-being, and fatherhood programs effectively enhance father engagement and employment outcomes. However, program effectiveness can be compromised if participating fathers drop out. This study investigates factors associated with program engagement (i.e., initiating treatment) and completion (i.e., attending 75% or more sessions) with a sample of primarily African American fathers recruited from a community-based organization in the United States (n=691). The analysis showed that nearly one-third (31%) of enrolled fathers did not attend any program session, and just over half (55%) of those who attended at least one session completed the program. Being older was associated with program engagement, while having a high school diploma and being ordered by the court to pay child support were associated with program completion. Fathers expressed several barriers to program participation, including programmatic and institutional issues (Rules and Staff, Fit Misaligned with Needs), as well as scheduling and external factors (Job-Related Conflict, Logistic Issues, Challenging Life Events). These findings highlight the importance of identifying participant motivation, addressing life challenges, and implementing strengths-based practices in fatherhood programs to make fathers feel seen, welcomed, and supported.

Children living in poverty and facing related forms of adversity are at higher risk for experiencing concurrent and later psychopathology. Although negative psychological outcomes can be improved by enhancing sensitive and responsive caregiving early in development, interventions targeting the caregiver–child dyad are not readily accessible. The present study investigated the feasibility and effectiveness of delivering a shortened eight-session form of Parent–Child Interaction Therapy-Emotion Development (PCIT-ED) in-person or remotely as an early intervention for 3–6-year-old children (N = 62) at elevated risk for psychopathology who were growing up in low-income communities. Caregiver–child dyads were randomized to eight-sessions of PCIT-ED or online parenting education. Relative to parenting education, children receiving PCIT-ED exhibited lower externalizing symptoms and functional impairment and more positive peer relationships following the intervention. Findings support the effectiveness of this shortened form of PCIT-ED, delivered in-person or remotely, as an early intervention to improve symptoms of psychopathology and functioning in high-risk children living in poverty. Trial registration Clinicaltrials.gov; NCT04399629.

We used National Child Abuse and Neglect Data System and Census data to examine Black–White and Hispanic–White disparities in reporting, substantiation, and out-of-home placement both descriptively from 2005–2019 and in multivariate models from 2007–2017. We also tracked contemporaneous social risk (e.g., child poverty) and child harm (e.g., infant mortality) disparities using non-child protective services (CPS) sources and compared them to CPS reporting rate disparities. Black–White CPS reporting disparities were lower than found in non-CPS risk and harm benchmarks. Consistent with the Hispanic paradox, Hispanic–White CPS reporting disparities were lower than risk disparities but similar to harm disparities. Descriptive and multivariate analyses of data from the past several years indicated that Black children were less likely to be substantiated or placed into out-of-home care following a report than White children. Hispanic children were slightly more likely to be substantiated or placed in out-of-home care than White children overall, but this difference disappeared in multivariate models. Available data provide no evidence that Black children were overreported relative to observed risks and harms reflected in non-CPS data. Reducing reporting rates among Black children will require addressing broader conditions associated with maltreatment.

The chapter addresses violence prevention opportunities related to child maltreatment, intimate partner violence, and community violence. Healthy relationships are an antidote to violence. Social work has a long history of strengthening dyadic, family, and community relationships, and these are valuable for preventing and curtailing violence. This chapter provides a framework for centering relationships at the heart of our national fight against violence, and offers an array of ideas for macro and interpersonal practices that social workers—and their allies—can use to reduce violence. These interventions must also be trauma informed and should empower victims, including policies that improve household resources and access to affordable housing, the broader use of safety assessments in working with couples using violence, and using relationship-strengthening strategies safely, such as counseling, mediation, and restorative practices.

Adverse experiences superseding a child’s capacity to sustain regulation of emotion and adaptive function are theorized to constitute “toxic stressors” when they induce a deleterious biological response within an individual. We ascertained presumptive parameters of toxic stress among 164 low-income infants and toddlers (ages 4–48 months) from 132 families enrolled in Early Head Start (EHS). We randomized a subset of these families into a pilot intervention arm of parenting education (the Incredible Years, TIY), which supplemented the EHS curriculum. Official report child abuse and neglect (CAN) and child behavior were serially ascertained over the course of the study. We observed relatively low associations among maternal depression, CAN, caregiver-child relationship quality, hair cortisol, and adverse child behavioral outcomes. Moreover, despite poverty and the high prevalence (51%) of CAN in this sample, the frequency of clinical-level internalizing and externalizing behavior among the children did not exceed that of the general population, by their parents’ report. The pilot supplementation of EHS with TIY improved attendance in group meetings but did not significantly reduce adverse behavioral outcomes or CAN. This study revealed marked independence of standard indices of toxic stress (child maltreatment, maternal depression, caregiver emotional unavailability) which have been presumed to be risk factors for the development of psychopathology. That they were weakly inter-correlated, and only modestly predictive of child behavioral outcomes in this EHS sample, caution against presumptions about the toxicity of individual stressors, highlight the importance of ascertaining risk (and compensatory influences) comprehensively, suggest buffering effects of programs like EHS, and demonstrate the need for greater understanding of what parameterizes resilience in early childhood.

Background Poor child growth and development outcomes stem from complex relationships encompassing biological, behavioral, social, and environmental conditions. However, there is a dearth of research on integrated approaches targeting these interwoven factors. The Grandi Byen study seeks to fill this research gap through a three-arm longitudinal randomized controlled trial which will evaluate the impact of an integrated nutrition, responsive parenting, and WASH (water, sanitation and hygiene) intervention on holistic child growth and development. Methods We will recruit 600 mother-infant dyads living in Cap-Haitien, Haiti and randomize them equally into one of the following groups: 1) standard well-baby care; 2) nutritional intervention (one egg per day for 6 months); and 3) multicomponent Grandi Byen intervention (responsive parenting, nutrition, WASH + one egg per day for 6 months). Primary outcomes include child growth as well as cognitive, language, motor, and social-emotional development. The study also assesses other indicators of child health (bone maturation, brain growth, diarrheal morbidity and allergies, dietary intake, nutrient biomarkers) along with responsive parenting as mediating factors influencing the primary outcomes. An economic evaluation will assess the feasibility of large-scale implementation of the interventions. Discussion This study builds on research highlighting the importance of responsive parenting interventions on overall child health, as well as evidence demonstrating that providing an egg daily to infants during the complementary feeding period can prevent stunted growth. The multicomponent Grandi Byen intervention may provide evidence of synergistic or mediating effects of an egg intervention with instruction on psychoeducational parenting and WASH on child growth and development. Grandi Byen presents key innovations with implications for the well-being of children living in poverty globally. Trial registration NCT04785352. Registered March 5, 2021 at https://clinicaltrials.gov/

The objective of this study was to examine differences in parenting, psychological well-being, and economic outcomes between fathers receiving two different programs offered by Fathers & Families Support Center for economically disadvantaged fathers: (a) Family Formation (FF), a 6-week/240-h program focused on economic stability/mobility, responsible fatherhood, and healthy relationships, with case management and legal services; (b) Economic Stability (ES), a 4-week/80-h program focused only on economic stability with limited case management and legal services. A randomized controlled trial (RCT) was used to compare fathers in FF (n = 350) vs. ES (n = 342). Surveys were administered at enrollment and 3- and 12-months postintervention. Linear and generalized linear mixed models were used to assess changes in program outcomes over time and across study groups. Four hundred and eighty-two fathers responded to either follow-up survey (251 FF, 231 ES). Nearly all (98%) were non-white (93% Black, 5% other/mixed race) and were on average 34 years old. Approximately 46% attended ≥75% of program sessions (FF 48% vs. ES 44%). Both FF and ES groups experienced improvements in parenting, psychological well-being, and financial outcomes after the programs, but changes in outcomes over time did not differ significantly by program. The lack of difference in outcomes between fathers in FF and ES groups could be due to a similar core focus on employment-related curriculum for both groups. Gaining financial stability could have contributed to positive improvements in other fatherhood domains. Implications for future research and practice are discussed herein.