A Renaissance in Academic Medicine-Using a Coach Approach to Develop Early-Career Faculty.

This Viewpoint discusses contemporary approaches to mentoring and coaching new physicians.

Mental Health Outreach to Persons Who are Homeless: Implications for Practice from a Statewide Study.

In order to help states establish best practice standards for mental health outreach and engagement teams for persons who are homeless, this study aimed to identify key functional elements needed to effectively address the multiple needs of these persons. A statewide survey across six representative outreach programs was initiated in Connecticut. Focus groups with staff and clients, interviews with program administrators, shadowing of outreach workers on their rounds, and review of relevant written materials were conducted. Four main functional themes regarding optimal outreach work-constructive outreach team characteristics; availability of a wide range of services and resources for clients; navigation of multiple service systems; and favorable work demands and training opportunities-were identified through thematic analysis. The article concludes with recommendations for incorporating these four essential functional elements into mental health outreach and engagement practice to effectively meet the varied needs of the target group.

Considering child care and parenting needs in Veterans Affairs mental health services.

Child care and parenting needs of adults with mental illness are of growing concern, especially among those seeking Department of Veterans Affairs (VA) mental health services. One area of interest concerns the possible benefits that on-site child care could have for improving veterans' access to VA mental health care. Child care programs are currently being piloted at the VA for the first time, although the need for them has not been evaluated. We conducted a brief survey of a convenience sample of 147 veterans (132 men, 15 women) seeking mental health care at outpatient clinics and/or at a psychiatric rehabilitation center at one VA. Participants were asked about their attitudes and experiences regarding child care and parenting support at the VA. Of the 52 (35.4%) participants who responded and had children under 18, the majority of both men and women surveyed agreed that the VA should offer child care services and that they would use child care services at the VA if it were available. These results are based on a small sample of participants, but they may contribute to ongoing discussion and efforts to develop "family-friendly" mental health services.

Dismissing children's perceptions of their emotional experience and parental care: preliminary evidence of positive bias.

The tendency to perceive caregivers in highly positive terms and to perceive the self as strong and problem-free are two facets of the positive bias characteristic of a dismissing attachment classification in adulthood. However, this link has not yet been examined in children. We evaluated the association between dismissing attachment and positive bias in school-aged children's reports of their own emotional experience and their parental care, hypothesizing that: (1) compared to secure children, dismissing children would underreport their subjective distress relative to physiological indicators of distress, and (2) dismissing children would report that their parents were warmer/more caring than would secure children. Ninety-seven children between the ages of 8 and 12 completed the Child Attachment Interview, reports of maternal and paternal care, and a psychophysiological threat paradigm. Compared to secure children, dismissing children reported less distress than their startle responses during threat would suggest. In other words, dismissing children showed a greater divergence between subjective and physiological emotional response. Dismissing children rated their parents as warmer and more caring as compared to secure children's ratings. Results provide support for the association between dismissing attachment and inflated positivity on child-report measures of parental care and emotional experience. Implications of the study's findings for attachment theory are discussed.

IMPLICATIONS OF HOMELESSNESS FOR PARENTING YOUNG CHILDREN: A PRELIMINARY REVIEW FROM A DEVELOPMENTAL ATTACHMENT PERSPECTIVE.

Although it has been well-documented that parents and children who experience homelessness often have compromised health and well-being, few studies have examined the potential implications of homelessness on the process of parenting young children. In this review, we consider how parents of young children might function under the circumstances of homelessness. We begin with a brief overview of the psychological, social, and medical characteristics of homeless mothers and their young children. Using a developmental attachment perspective, we next briefly review the central tasks of parenting during the first 5 years of life, including emotion regulation and fostering of child autonomy, with an eye toward how homelessness may compromise a mother's ability to complete these tasks. Finally, we provide suggestions for further research that incorporate a developmental attachment perspective and other relevant viewpoints. Because of the paucity of research in this area, our review seeks to provide a heuristic framework for future research, intervention development, and policy.

Sensation seeking, coping with stress, and readiness to engage in therapy: does ego development influence the psychosocial functioning of substance-abusing mothers?

Ego development, the capacity to derive coherent, nuanced meaning from one's life experiences, often has significant impact on psychosocial adjustment during adulthood. Research with nonclinical populations has indicated links between higher ego development and healthy emotional coping and interpersonal relationships. Emerging research with substance-abusing mothers suggests that higher levels of ego development are associated with improved parenting but also with increased rates of psychopathology. Less is known about how ego development is related to other psychosocial factors important for substance-abusing mothers' functioning and capacity to parent, including the proclivity to engage in risky behaviors, adaptive coping behaviors, and readiness to engage in psychotherapy. The present study examines these links. Participants included 182 methadonemaintained women who expressed interest in a randomized clinical trial testing the efficacy of a relational parenting intervention for substance-abusing mothers (Luthar, Suchman, & Altomare, 2007). Data were analyzed using a series of MANCOVAs and ANCOVAs controlling for maternal IQ and depression. Mothers with higher levels of ego development reported more adaptive coping techniques and greater readiness to engage in psychotherapy but also reported a heightened desire for strong sensations. Findings are discussed in light of mothers' psychological processes and parenting capacities. The significance of findings for developing parenting interventions for substance-abusing mothers is also discussed.

Attachment dismissal predicts frontal slow-wave ERPs during rejection by unfamiliar peers.

Attachment representations are thought to provide a cognitive-affective template, guiding the way individuals interact with unfamiliar social partners. To examine the neural correlates of this process, we sampled event-related potentials (ERPs) during exclusion by unfamiliar peers to differentiate insecure-dismissing from securely attached youth, as indexed by the child attachment interview. Thirteen secure and 10 dismissing 11- to 15-year-olds were ostensibly connected with two peers via the Internet to play a computerized ball-toss game. Actually, peers were computer generated, first distributing the ball evenly, but eventually excluding participants. Afterward children rated their distress. As in previous studies, distress was related to a negative left frontal slow wave (500-900 ms) during rejection, a waveform implicated in negative appraisals and less approach motivation. Though attachment classifications were comparable in frontal ERPs and distress, an attachment-related dismissal dimension predicted a negative left frontal slow wave during rejection, suggesting that high dismissal potentially involves elevated anticipation of rejection. As expected, dismissal and self-reported distress were uncorrelated. Yet, a new approach to quantifying the dissociation between self-reports and rejection-related ERPs revealed that dismissal predicted underreporting of distress relative to ERPs. Our findings imply that evaluations and regulatory strategies linked to attachment generalize to distressing social contexts in early adolescence.

Supported Parenting to Meet the Needs and Concerns of Mothers with Severe Mental Illness.

Women with serious mental illness often parent without adequate support from psychiatric and behavioral health providers. The lack of such services is significant, given that women with SMI have children at the same or higher rates as women without psychiatric disabilities. In this call to action, we argue that the need to develop supported parenting initiatives for women with SMI is necessary and long overdue. First, we describe numerous social and systemic barriers in the U.S. that have hindered the development of parenting supports for women with SMI over the last century. We next describe recent qualitative and quantitative findings regarding the parenting needs and strengths of these mothers. Finally, we conclude with suggestions for future research, program development, and systems-level policy changes to support mothers with SMI in parenting most effectively.

Attachment and emotion in school-aged children.

One of the primary functions of the attachment behavioral system is to regulate emotional experience under conditions of threat. Although research supports this association among infants and adults, few studies examine the relation between emotion and attachment in middle childhood. This study examined the concurrent associations among children's attachment organization and three indices of emotion reactivity/regulation: self- and parent-assessments of emotion, neuroendocrine reactivity, and fear-potentiated startle response. Ninety-seven 8- to 12-year-old children completed the Child Attachment Interview (CAI) and a fear-potentiated startle paradigm on separate occasions, with salivary cortisol assessed before and after each assessment. Greater attachment security was related to greater child-reported positive trait- and state-level emotion, lower pre-CAI cortisol levels, higher initial startle magnitude during threat, and a faster decrease in startle magnitude during threat. The findings provide initial support that attachment security is related to select measures of emotion, though different methods of assessment yielded discrepant findings. The findings are discussed in terms of their contribution to theory and research examining attachment and emotion.

Exclusion and micro-rejection: event-related potential response predicts mitigated distress.

We studied time-based neural activity with event-related potentials (ERPs) in young adults during a computer-simulated ball-toss game. Experiencing fair play initially, participants were ultimately excluded by other players. Dense-array ERPs showed time-dependent associations between slow-wave activity (580-900 ms) in left prefrontal/medial frontal cortical regions for exclusion events and self-reported distress. More subtle 'micro-rejections' during fair play showed a similar distress to ERP association (420-580 ms). In both cases, greater positive amplitude neural activity was associated with less post-exclusion distress. Findings suggest that rapidly occurring neural responses to social exclusion events are linked to individual differences in ostracism-related distress. Relations emerged even during fair play, providing a window into the neural basis of more subtle social-cognitive perceptual processes.

DIFFERENTIAL ATTACHMENT RESPONSES OF MALE AND FEMALE INFANTS TO FRIGHTENING MATERNAL BEHAVIOR: TEND OR BEFRIEND VERSUS FIGHT OR FLIGHT?

Taylor and colleagues (2000) proposed that males tend to display fight or flight responses to threat while females are more likely to display affiliative "tend or befriend" responses. In light of this hypothesis, gender differences in infant attachment behaviors were examined in a sample of 65 low-income mother-infant dyads, half of whom were referred to a home-based intervention service because of concerns about the quality of caregiving. Attachment behaviors were assessed in the Ainsworth Strange Situation when infants were 18 months old, and maternal behaviors were coded both for frightened or frightening behaviors, using the Main and Hesse (1992) coding inventory, and for disrupted affective communication using the Atypical Maternal Behavior Instrument for Assessment and Classification assessment tool (AMBIANCE; Lyons-Ruth, Bronfman, & Parsons, 1999). Results indicated that as maternal behavior became more frightening, female infants tended to approach their mothers more than male infants. These gender differences in response to maternal frightening behavior also were evident in the clinically referred subsample. The results suggest that gender-based differences in tendencies to show affiliative behaviors to threat may complicate interpretation of attachment behavior in clinical contexts.