Family Care Curriculum: A Parenting Support Program for Families Experiencing Homelessness.

Purpose In the United States, families with children characterize the fastest growing portion of the homeless population. Parenting for families experiencing homelessness presents unique challenges since families facing homelessness are disproportionately more likely to experience a myriad of interpersonal and contextual stressors that heighten the risk of parents engaging in suboptimal parenting approaches. This article describes the development and implementation of the Family Care Curriculum (FCC) train-the-trainer parenting support program specifically designed to support positive parenting in families experiencing homelessness. Description The FCC is a 6-week theory-based parenting intervention aimed to create positive shifts in parental attitudes to enhance sensitive and nurturing parenting and positive parent-child relationships. FCC assists parents in reflecting on how their own experiences contribute to some of their parenting beliefs, patterns, and behaviors. Parents are coached to imagine and understand the emotions, attachment, and developmental needs behind their children's behaviors so they can maintain empathic and nurturing parenting responses in the context of cumulative and chronic stress. Parents are supported through learning to engage in self-care. A unique and important feature of the FCC is the inclusion of a culturally sensitive approach that takes into consideration the effects of racism, classism, and oppression on parent-child relationships. Conclusion FCC was designed, implemented, and championed by expert providers in the fields of family therapy, social work, and pediatrics to support parents experiencing homelessness. FCC adds to the body of effective attachment-based, trauma-informed, and culturally sensitive parenting interventions for improving parent-child relations and family health amongst vulnerable populations.

Providing medical evaluations for possible child maltreatment to children with special health care needs.

OBJECTIVE: Children with special health care needs are known to be at increased risk of all forms of child maltreatment when compared to children without such needs. We describe a health care team's experience providing medical evaluations for suspected child maltreatment to children with special health care needs. METHOD: Consecutive cases seen as outpatients in the Abuse Referral Clinic for Children with Disabilities were abstracted and analyzed. Mail and telephone follow-up contact was attempted after the medical evaluation to determine adherence with treatment recommendations. A subsample of cases for which complete financial information was available was reviewed to determine a reimbursement rate. RESULTS: During the study, 49 children received complete outpatient evaluations. Ages ranged from 3 to 16 years old, and 54% were males. Special needs spanned a wide range of physical, developmental/cognitive and behavioral conditions. The largest number of referrals came from child protective services (42%) followed by referrals from physicians (27%). After the team's comprehensive evaluation, 18% of the children were found to have a history or physical examination that was diagnostic for child maltreatment, 13% were thought to be at high risk, 25% were thought to be at low risk and 44% were thought to have non-abusive etiologies. The collection rate was 14% for an average reimbursement of $38 per case. Only 29 caregivers could be found at follow-up and 22 remembered the recommendations made by the team. Of the 25 cases that were referred for outpatient mental health counseling, 12 (48%) complied. CONCLUSION: Children with a wide range of special health care needs were evaluated in an outpatient special health care needs clinic that offered comprehensive medical evaluations for possible child maltreatment. Medical evaluation services for this group of children were poorly reimbursed. Mental health services were frequently recommended but often not accessed. Child maltreatment teams seeking to serve children with special health care needs will need to plan for service delivery to a potentially diverse group of children and families who may experience difficulty in carrying through on the team's treatment recommendations.

Investigating hypoxic tumor physiology through gene expression patterns.

Clinical evidence shows that tumor hypoxia is an independent prognostic indicator of poor patient outcome. Hypoxic tumors have altered physiologic processes, including increased regions of angiogenesis, increased local invasion, increased distant metastasis and altered apoptotic programs. Since hypoxia is a potent controller of gene expression, identifying hypoxia-regulated genes is a means to investigate the molecular response to hypoxic stress. Traditional experimental approaches have identified physiologic changes in hypoxic cells. Recent studies have identified hypoxia-responsive genes that may define the mechanism(s) underlying these physiologic changes. For example, the regulation of glycolytic genes by hypoxia can explain some characteristics of the Warburg effect. The converse of this logic is also true. By identifying new classes of hypoxia-regulated gene(s), we can infer the physiologic pressures that require the induction of these genes and their protein products. Furthermore, these physiologically driven hypoxic gene expression changes give us insight as to the poor outcome of patients with hypoxic tumors. Approximately 1-1.5% of the genome is transcriptionally responsive to hypoxia. However, there is significant heterogeneity in the transcriptional response to hypoxia between different cell types. Moreover, the coordinated change in the expression of families of genes supports the model of physiologic pressure leading to expression changes. Understanding the evolutionary pressure to develop a 'hypoxic response' provides a framework to investigate the biology of the hypoxic tumor microenvironment.