A non-randomized controlled study to assess the impact of the "Appui Parental", an early and intensive support programme for vulnerable families: Study protocol.

INTRODUCTION: Early home visit programmes have been developed to help parents build an adequate relationship with their baby and to prevent child developmental delays and affective disorders. The "Appui Parental" programme is an intervention carried out by nursery nurses to provide intensive parental support to vulnerable families. Before extending this programme, it seemed necessary to evaluate its impact objectively. OBJECTIVES: The main aim is to determine the impact of the "Appui Parental" programme on the change in the child's symptoms. The secondary objectives are to evaluate its effects on mother-child interactions, self-assessed parental competence, perception of social support, primary caregiver's anxiety-depression symptoms, alliance with the nursery nurse, frequency of out-of-home placements, and nursery nurses' stress. METHOD: This non-randomized prospective multicentre study would include 44 families who receive the "Appui Parental" intervention for a one to 20-month-old child (intervention group) and 44 families with the same vulnerability criteria who receive care as usual by the maternal and child protection services (control group). The child, parents, mother-child interaction, nursery nurse-mother alliance, and nursery nurse's stress will be assessed at month one and month 18 after inclusion. Comparisons between groups will be performed. CONCLUSION: This study should provide the public authorities with objective data on this programme's impact and allow them to pursue its generalization. For professionals, the study should confirm the interest in close early parental support through home visits or should lead to rethinking some aspects of the programme.

1. Victims of Enforced Disappearances: Absent Bodies, Inner Presences: 1. Victims of Enforced Disappearances: Absent Bodies, Inner Presences1.

Enforced disappearance represents the quintessence of human rights violations with a strong psychological component. Bodies vanishing have a deterrent effect by terrorizing and paralyzing the entire society. However, the absence of those bodies is overly present in the inner experience of the families of the disappeared, who are victims in their turn. A state of severe psychological deterioration affects the relatives of the disappeared: depression, anxiety, powerlessness, guilt, post-traumatic stress disorder, inability to mourn, even suicide are the consequences of the unbearable uncertainty about the fate of the loved one. But the disappeared persons, notwithstanding the absence of their bodies, continue to be more present than ever in the inner experience of those who have loved them. For the families of the disappeared, to regain psychological equilibrium is a fine balance between the need to remember and the necessity to forget. The author affirms that, at a social and political level, to cultivate a collective memory of enforced disappearance is an ethical duty which validates the actual occurrence of the atrocities, helps prevent repetition and alleviates the transgenerational transmission of trauma.

Les disparitions forcées représentent la quintessence des violations des droits humains avec une forte composante psychologique. Les corps que l'on ne retrouve pas sont un moyen de dissuasion qui opère en terrorisant et paralysant la société toute entière. L'absence de ces corps est excessivement présente dans l'expérience intérieure des familles de ces disparus ; elles deviennent des victimes à leur tour. Un état de détérioration psychologique aigu affecte les membres de la famille du disparu : dépression, angoisse, sentiment d'impuissance, culpabilité, syndrome post-traumatique, incapacité à faire le deuil, et même le suicide sont les conséquences de l'insupportable incertitude concernant le destin de la personne aimée. Les personnes disparues, du fait de l'absence de leur dépouille, continuent d'être plus que jamais présentes dans l'expérience intérieure de ceux qui les ont aimées. Pour les familles des disparus, retrouver une stabilité psychologique se trouve dans un équilibre délicat entre le besoin de se souvenir et la nécessité d'oublier. L'auteur soutient qu'au niveau social et politique, cultiver une mémoire collective des disparitions forcées est un devoir éthique qui confirme que des atrocités ont bien eu lieu, qui aide à en prévenir la répétition et qui allège la transmission transgénérationnelle du traumatisme.

La desaparición forzada representa la quintaesencia de las violaciones de derechos humanos con un fuerte componente psicológico. La desaparición de cuerpos tiene un efecto disuasorio al aterrorizar y paralizar a toda la sociedad. Sin embargo, la ausencia de esos cuerpos está excesivamente presente en la experiencia interior de las familias de los desaparecidos, que son víctimas a su vez. Un estado de grave deterioro psicológico afecta a los familiares de los desaparecidos: depresión, ansiedad, impotencia, culpabilidad, trastorno de estrés postraumático, incapacidad para el duelo, incluso suicidio son las consecuencias de la insoportable incertidumbre sobre la suerte del ser querido. Pero las personas desaparecidas, a pesar de la ausencia de sus cuerpos, siguen estando más presentes que nunca en la experiencia interior de quienes las han amado. Para las familias de los desaparecidos, recuperar el equilibrio psicológico es un delicado equilibrio entre la necesidad de recordar y la necesidad de olvidar. La autora afirma que, a nivel social y político, cultivar una memoria colectiva de la desaparición forzada es un deber ético que valida la ocurrencia real de las atrocidades, ayuda a prevenir su repetición y alivia la transmisión transgeneracional del trauma.

Randomized controlled trial of a prenatal focused coparenting consultation for unmarried black fathers and mothers: One-year infant and family outcomes.

In the infant mental health field, scant conceptual attention has been given to coparenting and family adaptations of non-white family systems, with no evidence-based, community-informed coparenting interventions responsive to unmarried Black mothers' and fathers' life circumstances. This study examined 1-year post-partum child and family outcomes of a novel, modest dosage (six sessions) prenatal focused coparenting consultation (FCC) using randomized controlled trial methodology. One-hundred-thirty-eight expectant families (one or both parents identified as Black/African American) were randomized to an intervention (N = 70) or treatment-as-usual (TAU; control) condition (N = 68). TAU families received navigational support in accessing existing community services for pregnant families. Intervention families received TAU plus 6 dyadic FCC sessions led by a Black male-female Community Mentor team. When infants were three and 12 months old, parents reported on coparenting, father engagement, interparental aggression, depressive symptoms, and infant social and emotional adjustment. Intent-to-treat analyses focusing on 12-month post-partum data indicated significant intervention effects on coparenting, interparental psychological aggression, and infants' emotional adjustment. Improvement was also seen in depression and father engagement, with gains for both groups. Results suggest FCC delivered by same-race Community Mentors to unmarried Black coparents transitioning to parenthood supports infant and family adaptation during the first year of life.

En el campo de salud mental infantil, se le ha puesto escasa atención conceptual a la compartida crianza y a las adaptaciones familiares en sistemas de familias no blancas, sin intervenciones sobre la compartida crianza basadas en la evidencia o con información comunitaria que sean sensibles a las circunstancias de mamás y papás de raza negra no casados. Este estudio examinó los resultados en el niño y la familia al año después del parto de la novedosa, prenatal Consulta de Enfoque en la Compartida Crianza (FCC) con número modesto de 6 sesiones, usando metodología de ensayo controlado al azar. Se asignó al azar ciento treinta y ocho familias durante el embarazo (uno o ambos progenitores identificados como negro o afroamericano) a una condición de intervención (N = 70) o de Tratamiento Usual (TAU; control) (N = 68). Las familias del grupo TAU recibieron apoyo direccional para lograr acceso a los servicios comunitarios existentes para familias durante el embarazo. Las familias del grupo de Intervención recibieron TAU más 6 sesiones diádicas de FCC dirigidas por un equipo comunitario de mentores compuesto por un hombre y una mujer negros. Cuando los infantes tenían tres y 12 meses de edad, los progenitores reportaron acerca de la compartida crianza, la participación del papá, la agresión entre progenitores, síntomas depresivos, y el ajuste social y emocional del infante. Los análisis con Intención de Tratar enfocados en los datos a 12 meses después del parto indicaron significativos efectos de la intervención en la compartida crianza, la agresión sicológica entre progenitores y el ajuste emocional de los infantes. También se notó mejoría en la depresión y en la participación del papá, con beneficios para ambos grupos. Los resultados indican que la FCC que dirigen mentores comunitarios de la misma raza a parejas negras no casadas en transición a ser padres apoya la adaptación del infante y la familia durante el primer año de vida.

Dans le domaine de la santé mentale du nourrisson peu d'attention conceptuelle a été donnée au co-parentage et aux adaptations de la famille dans des systèmes familiaux non-blancs, avec aucune intervention basée sur l'évidence et informée par la communauté répondant aux circonstances de vie des mères et des pères noirs. Cette étude a examiné les résultats pour l'enfant à un mois post-partum et la famille d'un nouveau dosage modéré (6 session) de la Consultation Ciblée de Co-parentage (en anglais Focused Coparenting Consultation, soit FCC) prénatale en utilisant une méthodologie d'essai contrôlé randomisé. Cent trente-huit familles attendant un enfant (un ou les deux parents identifié(s) comme Américains noirs/africains) ont été randomisés pour une intervention (N = 70) ou une condition Traitement-Comme d'Habitude (TCH; contrôle) (N = 68). Les familles TCH ont reçu du soutien à la navigation pour accéder aux services communautaires pour les familles enceintes. Les familles de l'intervention ont reçu le TCH plus 6 session FCC dyadiques menées par une équipe de Mentor Communautaire noire et formée d'un homme et d'une femme. Quand les bébés ont eu trois et 12 mois, les parents ont fait état du co-parentage, de l'engagement du père, de l'agression inter-parentale, de symptômes dépressifs, et de l'ajustement social et émotionnel du bébé. Des analyses en intention de traiter portant sur les données post-partum à 12 mois ont indiqué des effets importants de l'intervention pour le co-parentage, l'agression psychologique inter-parentale, et l'ajustement émotionnel des bébés. Des améliorations ont également été vues dans la dépression et l'engagement du père, avec des gains pour les deux troupes. Les résultats suggèrent que la FCC faite par des Mentors Communautaires de la même race à des coparents noirs non mariés transitionnant à la parentalité soutient le bébé et l'adaptation de la famille durant la première année de la vie.

Preventing early harsh parenting and toddler behavior problems: The role of neighborhood collective efficacy among low-income Latine families.

Harsh parenting behaviors are alarmingly prevalent during infancy and toddlerhood. From an ecological perspective, predicting and preventing harsh parenting requires probing not only micro- and exosystem-level processes but also the interactions among them. In the current longitudinal study, we examined associations among maternal depressive symptoms, harsh parenting, and neighborhood collective efficacy in 142 low-income Latina mothers and their infants (Mchild age = 14.11 months, SD = 3.60). We hypothesized that there would be a mediated pathway from maternal depressive symptoms to harsh parenting to toddler behavior problems, and that neighborhood collective efficacy would moderate this pathway. As predicted, maternal depressive symptoms predicted toddler behavior problems, and harsh parenting significantly mediated this association. Moreover, neighborhood collective efficacy was a significant moderator such that this indirect pathway was maintained in the context of low neighborhood collective efficacy only. When collective efficacy was high, this pathway was not significant. Results are discussed in terms of the buffering potential of neighborhood collective efficacy. Tentative implications for leveraging neighborhood supports to prevent early harsh parenting are suggested.

Las duras conductas de crianza son alarmantemente prevalentes durante la infancia y la primera etapa de la niñez. Desde una perspectiva ecológica, predecir y prevenir la dura crianza requiere investigar no sólo los procesos de micro niveles y niveles de exosistemas, sino también las interacciones entre ellos. En el presente estudio longitudinal, examinamos las asociaciones entre los síntomas depresivos maternos, la dura crianza y la colectiva efectividad del vecindario en 142 mujeres latinas de bajos recursos económicos y sus infantes (M edad del niño = 14.11 meses, SD = 3.60). Nuestra hipótesis fue que habría un camino mediador entre los síntomas depresivos maternos y la dura crianza y los problemas de conducta del pequeño infante, y que la efectividad colectiva del vecindario moderaría este camino. Tal como se predijo, los síntomas depresivos maternos predijeron los problemas de conducta de los pequeños infantes, y la dura crianza significativamente medió esta asociación. Es más, la efectividad colectiva del vecindario fue un moderador significativo, de tal manera que este indirecto camino se mantuvo sólo dentro del contexto de la baja efectividad colectiva del vecindario. Cuando la efectividad colectiva fue alta, este camino no fue significativo. Los resultados se discuten en términos de la potencialidad amortiguadora de la efectividad colectiva del vecindario. Se sugieren tentativas implicaciones para la nivelación de los apoyos del vecindario para prevenir una temprana dura crianza.

Des comportements de parentage durs sont extrêmement prévalents durant la petite enfance (bébés et jeunes enfants). D'une perspective écologique, prédire et prévenir le parentage dur exige un examen non seulement des processus au niveau du microsystème et de l'exosystème mais aussi des interactions entre ces systèmes. Dans cette étude longitudinale nous avons examiné les liens entre les symptômes dépressifs maternels, le parentage dure et l'efficacité collective du voisinage chez 142 mères hispaniques ayant de faibles revenus et leurs bébés (M âge de l'enfant = 14,11 mois, SD = 3,60). Nous avons pris comme hypothèse qu'il y aurait une voie de médiation des symptômes dépressifs maternels au parentage dur et aux problèmes de comportement du petit enfant, et que l'efficacité collective du voisinage modérerait cette voie. Comme on l'avait prédit les symptômes dépressifs maternels ont prédit les problèmes de comportement du petit enfant, et le parentage dur a médiatisé ce lien. De plus, l'efficacité collective du voisinage s'est avéré être un modérateur important, à un tel point que cette voie indirecte était maintenue dans le contexte d'une efficacité collective de voisinage même faible. Quand l'efficacité collective était élevée cette voie n'était pas importante. Les résultats sont discutés en termes de potentiel de mise en tampon de l'efficacité collective du voisinage. De possibles implications pour tirer partie des soutiens des voisinages afin de prévenir un parentage dur précoce sont suggérées.

Home visitor perspectives on implementing a precision approach to home visiting in communities serving Native American families.

Family Spirit (FS) is a federally endorsed evidence-based home visiting programs serving as a key prevention strategy for expectant families and families with young children. Like other home-visiting programs, it shares client challenges in retention and engagement during implementation. We assessed (1) the feasibility and acceptability of implementing a precision approach to FS; and (2) differences in approaches to FS delivery. Home visitors, serving primarily Native American families, that delivered a standard (N = 6) or a precision approach (N = 6) to FS across four study sites each participated in up to four virtual focus group discussions (FGDs) (N = 16). Facilitators and barriers to implementation were identified across the curriculum approach, relational and contextual levels. Facilitators: Relevant and culturally sensitive lessons, lesson structure, client-home visitor relationship, client buy-in, home visitor autonomy, leadership support, flexible funding, and training. Barriers: Irrelevant lessons, substance use content, missing topics, families experiencing crises, client and home visitor availability, client feedback, nonsupportive leadership, inadequate funding, and organizational policies and practices. The precision approach offers (1) tailoring of lessons that supports relevance of content to clients; and (2) a target timeframe that supports flexibility in lesson delivery. This model structure may improve client participation and retention.

Espíritu de Familia (FS) es un programa de visitas a casa con base en la evidencia y respaldado federalmente, el cual sirve como una estrategia clave de prevención para familias con niños pequeños que esperan otro niño. Tal como otros programas de visitas a casa, éste comparte los retos de los participantes en cuanto a retención y participación activa durante la implementación. Evaluamos 1) la factibilidad y accesibilidad de implementar un acercamiento de precisión a FS; y 2) las diferencias en cuanto al acercamiento del ofrecimiento de FS. Los visitadores a casa, quienes primariamente les sirven a familia nativo-americanas, y que ofrecieron un acercamiento estándar (N = 6) o uno de precisión (N = 6) a FS a través de 4 lugares de estudio, cada uno participó en un máximo de 4 discusiones virtuales de grupos de enfoque (N = 16). Los aspectos que facilitaron y las barreras a la implementación se identificaron a lo largo de los niveles de acercamiento, relacionales y contextuales del currículo. Aspectos que facilitaron: lecciones relevantes y culturalmente sensibles, estructura de lecciones, la relación entre el participante-casa y el visitador, la aceptación por parte del participante, la autonomía del visitador a casa, el apoyo de liderazgo, la flexibilidad de los fondos, así como el entrenamiento. Barreras: lecciones irrelevantes, contenido sobre uso de sustancias, temas que no se incluyeron, las familias que experimentaban una crisis, la disponibilidad del participante y del visitador, información aportada por el participante, falta de apoyo del liderazgo, fondos inadecuados, así como las políticas y prácticas organizacionales. El acercamiento de precisión ofrece 1) moldear las lecciones que apoyan la relevancia del contenido a los participantes; y 2) un definido marco de tiempo que apoya la flexibilidad del ofrecimiento de las lecciones. Esta estructura de modelo pudiera mejorar la participación y retención de participantes.

Le programme Family Spirit (FS, soit Esprit de Famille) est une programme américain, basé sur des données probantes, avalisé par le gouvernement américain, de visite à domicile, servant de stratégie de prévention clé pour les familles attendant un enfant ou les familles avec de jeunes enfants. Comme d'autres programmes de visite à domicile, ce programme partage des difficultés dans la rétention et l'engagement des clients durant la mise en oeuvre. Nous avons évalué 1) la fiabilité et l'acceptabilité de la mise en œuvre d'une approche de précision du FS; et 2) des différences dans les approches de l'application du FS. Les visiteurs à domicile, servant principalement des familles amérindiennes américaines, qui ont présenté une approche standard (N = 6) ou une approche de précision (N = 6) du FS et au travers de 4 sites d'étude chacun ont participé à jusqu'à 4 discussions de groupe d'étude virtuels (n = 16). Les aspects facilitateurs et les barrières à la mise en place ont été identifiés au travers de l'approche du curriculum, des niveaux relationnels et contextuels. Aspects de facilitation: leçons pertinentes et culturellement sensibles, structure de la leçon, relation client-visiteur à domicile, adhésion du client, autonomie du visiteur à domicile, soutient des dirigeants, budget flexible, formation. Barrières: leçons n'étant pas pertinentes, contenu d'usage de substance, sujets qui manquent, familles faisant l'expérience de crises, disponibilité du client et du visiteur à domicile, retour du client, dirigeants qui n'offrent aucun soutien, budget inadéquat, et politiques et pratiques organisationnelles. L'approche de précision offre 1) une adaptation sur mesure des leçons qui soutient la pertinence du contenu pour les clients; et 2) un délai ciblé qui soutient la flexibilité de l'enseignement. Cette structure de modèle peut améliorer la participation et la rétention.

Comparison of Responsive Feeding Practices in Child Care and Home Environments in Nova Scotia.

Purpose: The values, beliefs and practices between the family home and child care environment can play a role in shaping a responsive food environment for young children, but few studies have explored the differences across these settings. The purpose of this study was to compare responsive feeding practices in child care and home environments through the framework of the 2019 Canada Food Guide healthy eating recommendations.Methods: Nova Scotia families and child care providers completed an online survey on responsive feeding. Independent-samples t-tests explored the differences between family and child care respondents on variables related to the 2019 Canada's Food Guide, including: food variety, mindfulness, eating with others, cooking more often, and enjoyment of food. A directed content analysis was used to code the open-ended qualitative questions.Results: Family respondents (n = 603) were more likely to report offering a variety of foods, repeated exposures to new foods, and asking children about fullness. Child care respondents (n = 253) were more likely to sit with children during meals and less likely to encourage children to finish their food.Conclusions: The results identify potential points of intervention, including the importance of increasing communication to ensure mutually supportive messages and environments for healthy eating.

Posted to Germany: Early Cold War Canadian Military Policy and Its Impact on One Family's Experience.

In the summer of 1954, military surgeon Major Robert Elliott was posted to the British Military Hospital in Iserlohn, Germany, to provide medical care to Canadian soldiers, members of the 5,500-strong Canadian Brigade that had earlier been stationed there as part of Canada's commitment to the North Atlantic Treaty Organization. Like many other military families, Elliott's family had to remain behind until suitable accommodation for them could be found. Based on the letters that Elliott wrote home to his wife during their eight-month separation, this article provides a glimpse of how both old and new Canadian military policies during the early Cold War period had an impact on his work and his family. The Canadian government's decision to place the Brigade under British control reflected, in part, the long-standing attachment to Britain, but Elliott was often frustrated with how imperial/colonial relations played out in the hospital setting. And the military's initial reluctance to officially allow dependents to join their loved ones overseas, a new phenomenon in Canadian military life, undoubtedly contributed to his confusion and anxiety over when family quarters would finally be finished.

At the feet of storytellers: Equity in early relational health conversations.

Early Relational Health (ERH) focuses attention on family-baby relationships during the first 1000 days of life. Positive ERH enhances child health and development and family wellbeing. Universal, early identification of RH and vulnerability could add value to care. How to screen, when, where, and with whom is the question. Tools and models for screening are practitioner-centered. Bias can affect family engagement and outcomes. This may be problematic for African American families. Authors present findings of a discourse analysis and phenomenological study of experiences of African American families' and HealthySteps Specialists' (HSS) of color with screening ERH in Washington, D.C., USA (N = 13). Findings indicate relevance, acceptance and utility may be influenced by positionality, cultural context, issues of equity, and engagement in mutual reflection. A family-centered approach that opened space for non-dominant knowledge about ERH made positive differences in engagement and utility for families and practioners alike. Health and vulnerability were detected reliably using this approach. Outcomes include new theories about ERH-focused visits with African American families and infants, and a new model for centering ERH in pediatric practice, entitled Early Relational Health Conversations. ERH-C is a family reflection model, not necessarily dyadic. It may have value for other populations. Future directions in ERH-C research are suggested.

La Temprana Salud de la Relación (ERH) enfoca su atención en las relaciones entre la familia y el bebé durante los primeros 1000 días de vida. Una positiva ERH mejora la salud y el desarrollo del niño y el bienestar de la familia. Una identificación universal y temprana de RH y la vulnerabilidad pudieran ser valiosas para el cuidado. La pregunta es cómo detectar, cuándo, dónde y con quién. Las herramientas y los modelos para la detección se centran en los profesionales de la práctica. Los prejuicios pueden afectar la participación familiar y los resultados. Esto pudiera ser problemático para familias afroamericanas. Los autores presentan resultados de un análisis discursivo y un estudio fenomenológico de experiencias de las familias afroamericanas y los especialistas de HealthySteps (HSS) de raza negra con respecto a la detección de ERH en Washington, D.C. (N = 13). Los resultados indican relevancia, aceptación y utilidad para las familias afroamericanas y que circunstancias de posición, contexto cultural, asuntos de equidad y participación en reflexión mutua pudieran influir a los HSS. Un acercamiento centrado en la familia que abrió la oportunidad para el conocimiento no dominante acerca de ERH produjo diferencias positivas en la participación y utilidad tanto para las familias como los profesionales de la práctica. La salud y la vulnerabilidad se detectaron confiablemente usando este acercamiento. Los resultados incluyen nuevas teorías sobre los acercamientos a la detección y un nuevo modelo de detección: Las Conversaciones de la Temprana Salud de la Relación (ERH-C). ERH-C es un modelo de reflexión familiar, no necesariamente diádico. El mismo pudiera ser valioso para otros grupos de población. Se aportan futuras directrices en la investigación de ERH-C.

La Santé Relationnelle Précoce (SRP en français) met l'attention sur les relations famille-bébé durant les 1000 premiers jours de la vie. Une SRP positive renforce la santé de l'enfant, le développement, et la santé de la famille. Une identification universelle et précoce de la Santé Relationnelle et de la vulnérabilité pourrait ajouter de la valeur aux soins. La question se pose: comment dépister, quand, où et avec qui. Les outils et les modèles de dépistages sont centrés sur les praticiens. La partialité peut affecter l'engagement de la famille et les résultats. Ceci peut s'avérer problématique pour les familles noires. Les auteurs présentent les résultats d'une analyse de discours et d'une étude phénoménologique des expériences des familles noires et des Spécialistes de Healthy Steps (HSS) racialisés avec le dépistage ERH à Washington DC aux Etats-Unis (N = 13). Les résultats indiquent que la pertinence, l'acceptation et l'utilité peuvent être influencées par la position, le contexte culturel, les problèmes d'équité et l'engagement dans une réflexion mutuelle. Une approche centrée sur la famille qui a ouvert un espace pour des connaissances non-dominantes à propos de la SRP a fait une différence positive dans l'engagement et l'utilité pour les familles ainsi que pour les praticiens. La santé et la vulnérabilité ont été détectés avec fiabilité en utilisant cette approche. Les résultats incluent de nouvelles théories sur les visites centrées sur la SRP avec des familles noires et leurs nourrissons, et un nouveau modèle de centrage de la SRP dans la pratique pédiatrique, appelée Conversations sur la Santé Relationnelle Précoce. La C-SRP est un modèle de réflexion familiale, pas nécessairement dyadique. Ce modèle peut avoir une valeur pour d'autres populations. Des directions futures pour des recherches sur la C-SRP sont suggérées.

[Involuntary admission to psychiatry at the request of caregivers: The point of view of caregivers]. / Les soins psychiatriques à la demande d'un tiers : le point de vue du tiers.

OBJECTIVES: In France, the family and friends of a patient with a psychiatric disorder can legally be involved in the decision to involuntary admission to psychiatry through care at the request of a third party. This involvement has been questioned in recent years, notably to protect this third party. The main objective of this work was to assess whether providing the third party with information on care without consent when providing care at the request of a third party (SDT) had an impact on the third party's experience. The secondary objectives were to identify other factors that might impact the third party's experience of the SDT, and to assess the impact of the SDT on the relationship between the third party and his or her hospitalized relative, as well as the factors that might influence it. METHODS: The study was based on a questionnaire, constructed after meeting several members of an association of relatives of patients with psychiatric disorders : UNAFAM. This questionnaire questioned the context of hospitalization, the information provided concerning care without consent, the experience of the third party at the time of hospitalization and at a distance, and the impact of hospitalization on the relationship between the third party and his or her hospitalized relative, both at the time of hospitalization and at a distance. This questionnaire was then sent to UNAFAM members in three randomly selected regions. It was specified that it was only intended for people who had already been a third party during SDT. The results were received anonymously. RESULTS: Among the 166 respondents, 85 (51.2 %) had received information about involuntary admission, and there was more frequent relief at the time of hospitalization (P<0.01) and at a distance (P<0.01), and less frequent feelings of violence towards their loved one at a distance from hospitalization (P=0.02) compared to those who had not received information. The negative impact of hospitalization on the relationship between the third party and their hospitalized relative was lower (P=0.04) among third parties who received information. The fact that the doctor was perceived as being mainly responsible for the decision to hospitalize also preserved the third party's experience and relationship with his or her relative. However, third parties who understood their involvement as an administrative necessity reported less frequent relief (P=0.01), and the negative impact of hospitalization on their relationship with their relative was higher (P=0.01). Conversely, the fact that they felt integrated into the care and listened to by the health care team was correlated with a better experience of the situation by the third party, and a lesser negative impact of hospitalization on the relationship between the third party and their relative. CONCLUSIONS: Providing information to the third party about involuntary admission at the time of an SDT could improve his or her experience of the situation and limit the negative impact of hospitalization on his or her relationship with his or her loved one. Although it seems important for the third party to feel that the majority of the decision to hospitalize is made by the physician, including him/her in this decision could improve his/her experience of the situation and limit the negative impact of hospitalization on the relationship between the third party and his/her family member.

Posted to Germany: Early Cold War Canadian Military Policy and Its Impact on One Family's Experience.

In the summer of 1954, military surgeon Major Robert Elliott was posted to the British Military Hospital in Iserlohn, Germany, to provide medical care to Canadian soldiers, members of the 5,500-strong Canadian Brigade that had earlier been stationed there as part of Canada's commitment to the North Atlantic Treaty Organization. Like many other military families, Elliott's family had to remain behind until suitable accommodation for them could be found. Based on the letters that Elliott wrote home to his wife during their eight-month separation, this article provides a glimpse of how both old and new Canadian military policies during the early Cold War period had an impact on his work and his family. The Canadian government's decision to place the Brigade under British control reflected, in part, the long-standing attachment to Britain, but Elliott was often frustrated with how imperial/colonial relations played out in the hospital setting. And the military's initial reluctance to officially allow dependents to join their loved ones overseas, a new phenomenon in Canadian military life, undoubtedly contributed to his confusion and anxiety over when family quarters would finally be finished.

Promoting parent-infant responsiveness in families experiencing homelessness.

My Baby's First Teacher is an intervention designed specifically for parents with infants staying in emergency homeless shelters. Infants are overrepresented in shelter populations and face considerable risk to their development, including mental health. We utilized a randomized controlled design across three family shelters to evaluate the program's effectiveness with 24 dyads assigned to the intervention compared to 21 dyads in care-as-usual. Dyads were randomized by round at each site to account for shelter effects. We used path analysis to illustrate change over time and in relation to intervention assignment.

El Primer Maestro de mi Bebé es una intervención diseñada específicamente para progenitores con infantes que se alojan en refugios de emergencia para personas sin casa. En la población de los refugios, los infantes están sobrerrepresentados y enfrentan un considerable riesgo en cuanto a su desarrollo, incluyendo la salud mental. Utilizamos un diseño de control al azar a través de tres refugios de familias para evaluar la eficacia del programa con 24 díadas asignadas al grupo de intervención que fueron comparadas con 21 díadas bajo el cuidado usual. A las díadas se les colocó al azar por etapas en cada lugar para tener en cuenta los efectos del refugio. Usamos un análisis de trayectoria para ilustrar el cambio a través del tiempo y en relación con la asignación de intervención. Resultados claves: los resultados indicaron mejoras en la observada sensibilidad de progenitor-infante relacionada con la intervención en el lugar, con un control en cuanto a los niveles iniciales de sensibilidad. Los resultados fueron consistentes entre un modelo de intención de tratar y un modelo para probar la participación cierta en la intervención. No encontramos ningún efecto significativo para el estrés de crianza o la ansiedad del progenitor, aunque las tendencias sugirieron más altos puntajes para las familias de la intervención. Implicaciones para la práctica y las políticas: presentamos los resultados considerando retos específicos en contextos de casos sin casa para la salud mental infantil. Este trabajo puede servir de base para los esfuerzos de quienes proveen servicios y encuentran familias que experimentan el estar sin casa, así como también las políticas sobre los recursos para programaciones en albergues de emergencia.

Le Premier Enseignant de Mon Bébé est une intervention conçue spécialement pour les parents dont les bébés restent dans des foyers d'urgence pour sans-abris. Les bébés sont sur-représentés dans les populations de ces foyers et ils font face à un risque considérable pour leur développement, y compris pour ce qui concerne leur santé mentale. Nous avons utilisé un schéma expérimental contrôlé pour 3 trois foyers familiaux afin d'évaluer l'efficacité du programme avec 24 dyades désignées pour l'intervention comparé à 21 dyades dans le groupe de soins habituels. Les dyades ont été randomisées par ronde sur chaque site afin de contrôler les effets du foyer. Nous avons utilisé une analyse causale pour illustrer le changement au fil du temps et en relation au groupe d'intervention. Constatations Clés: Résultats a indiqué des améliorations dans la réaction observée parent-bébé liée à l'intervention en fin d'étude, contrôlant les niveaux initiaux de réaction. Les résultats sont cohérents entre un modèle intention-de-traiter et un modèle testant la véritable participation à l'intervention. Nous n'avons trouvé aucun effet important pour le stress de parentage ou la détresse du parent, bien que des tendances suggèrent des scores plus élevés pour les familles d'intervention. Nous présentons des résultats en considérant les défis uniques aux contextes de la vie des sans-abris pour la santé mentale du nourrisson. Ce travail peut orienter les efforts des prestataires de services qui rencontrent des familles faisant l'expérience d'une vie sans abri ainsi que les lois et pratiques concernant les ressources pour des programmes dans des foyers d'accueil d'urgence.

Translating "protein foods" from the new Canada's Food Guide to consumers: knowledge gaps and recommendations.

The revised version of Canada's Food Guide, released in January 2019, issued new guidance by combining meat and alternatives with milk and alternatives into a single group called "protein foods" and emphasized selecting plant-based foods from this category more often. Though the changes represent a simple depiction of a healthy plate, the new Food Guide has opened knowledge gaps about protein foods and exposed new concerns about the interpretation and implementation of the Food Guide among vulnerable groups, particularly children and the elderly. To address key knowledge and research gaps, nutrition leaders need to reach a consensus on key messages to best inform the development of tools and resources to support practitioners in translating messages to consumers, including foodservice standards. Among consumers, families with young children are a primary target for these resources as they develop their life-long habits to ensure they have the knowledge and skills to select, prepare, and consume nutrient-rich protein foods. The new Food Guide provides an opportunity to address the existing knowledge gaps, develop tools and resources to support health professionals, and design interventions that will help Canadian families choose, prepare, and eat nutrient-rich protein foods. Novelty An updated Canadian regulatory framework is needed for protein labelling and content/health claims. There are knowledge gaps about protein foods consumption and food literacy needed to optimize nutritional health. Mandatory nutrition policies are needed to safeguard the provision of high-quality protein foods across institutions that serve children and older adults.

[Integrating close relatives of people experiencing schizophrenia in the mental health system]. / Améliorer la participation et le vécu des proches de personnes atteintes de schizophrénie dans le parcours de soins en santé mentale.

OBJECTIVES: Schizophrenia is a long-term, stigmatized disease which often leads to social impairment, unemployment and isolation, with heavy negative social and psychological consequences both on patients and their families. Close relatives' perceptions of the illness have an impact on their mood, and then on the course of the patient's disease itself. In this context, our objective is to evaluate the perceptions of French close relatives of people with schizophrenia or schizophrenia spectrum disorders, about the disease itself, as well as their experience within the mental healthcare system. METHODS: Our population is constituted of close relatives of people experiencing schizophrenia or schizophrenia spectrum disorders, recruited through an active patient and families association. We used a French translation of a standardized questionnaire, the Brief Illness Perception Questionnaire, as well as an extensive semi-structured interview assessing the experience of the mental healthcare system (diagnosis divulgation, information about disease and treatment, family psychoeducation, hospitalization experience, and access to health professionals). Some questions in the last were open-ended questions, which allowed us to gather detailed and personal responses, in order to be able to illustrate our quantitative findings with brief clinical cases. RESULTS: Among the 27 close relatives included in our research, results to the standardized questionnaires show threatening perceptions of the disease, in particular regarding the probable duration of the disease and the frequency of symptoms. In our study, a better access to diagnosis is associated with a shorter perceived probable duration of the disease, while an easier communication with healthcare professionals (in particular nurses) is associated with the perception of a better efficiency of the treatment. Family psychoeducation seems to be associated with the perception of less frequent symptoms. When the patient lives independently or is older, close relatives of our sample perceive a higher risk of chronicity of the disease. Our results tend to confirm the available literature on the subject of information towards families in psychiatric services: indeed, studies, especially in the field of nursing research, have shown that families tend to feel excluded from care processes and from useful information exchanges about the patient's illness. Our study also confirms the fact that family psychoeducation seems to reduce the frequency of present symptoms in the patient as perceived by the close relative. This effect could be caused by a better understanding of the real symptoms or by an enhancement of the family mood and functioning. Even if the patient's hospitalization was a difficult or very difficult experience for close relatives, it showed no relationship with their illness negative perceptions. Sociodemographic variables of the patient, such as age or the fact of living in an independent household, were associated in our research with the close relatives' view of a higher potential chronicity of the illness; this could be explained by a different stage of acceptation of the illness when compared to close relatives taking care of a younger or still dependent patient. CONCLUSIONS: Our results plead for further research on a larger and less homogeneous sample. Confirming our findings could help build useful recommendations leading to better integrated families who currently seem to feel relatively isolated and exclused in the healthcare process, despite the strategic role they could play and despite the many recommendations of public health policies in that matter. Efforts should continue to be made to reach the goal of a better inclusion of families and close relatives of people experiencing schizophrenia or schizophrenia spectrum disorders, in particular in the field of information and communication with health professionals, both areas which seem to have a potential effect on close relatives' illness negative perceptions. Family psychoeducation deserves more attention and should be more systematically proposed to French families with an easier and free access.

Reconceiving the field: Infant mental health, intersectionality, and reproductive justice.

The field of infant mental health is conventionally comprised of professional discourses including developmental science, psychology, and psychiatry, among others, and involves spheres of practice as wide-ranging as pediatrics, maternal/child health, early intervention, early care and education, and child welfare. The World Association of Infant Mental Health [WAIMH] put out its position paper on the rights of infants in 2014 (amended in March 2016) in recognition of the human rights implications of professional understanding of infants' unique, yet universal, developmental capacities and needs. This article links the policy issues outlined in the WAIMH position paper with critical issues in the field of reproductive justice, extending the reach of WAIMH's call to action on behalf of infants' rights, and pointing the way toward potent alliances among interconnected movements. Connecting the dots among economic injustice, race-based health disparities, and gender inequities, the article demonstrates that it is not possible to safeguard infant mental health unless we make reproductive justice a reality.

El campo de la salud mental infantil está convencionalmente compuesto de temas profesionales que incluyen a la ciencia del desarrollo, la sicología y la siquiatría, entre otras, e involucra esferas de práctica que varían de un extremo al otro como la pediatría, la salud materno-infantil, la intervención temprana, el temprano cuidado y educación, y el bienestar del niño. La Asociación Mundial de Salud Mental Infantil [WAIMH] presentó su posición en cuanto a los derechos de los infantes en un ensayo en 2014 (corregido y aumentado en marzo de 2016) en reconocimiento de las implicaciones de los derechos humanos sobre la comprensión profesional de las distintivas y universales capacidades y necesidades de desarrollo de los infantes. Este artículo conecta los asuntos relacionados con políticas descritas en el ensayo que presentó la posición de WAIMH con asuntos críticos en el campo de la justicia reproductiva, extendiendo así el alcance de la llamada que hace WAIMH para actuar en beneficio de los derechos infantiles, y señalando el camino hacia fuertes alianzas entre movimientos interconectados. Conectar los puntos entre la injusticia económica, las disparidades de salud basadas en la raza, así como las desigualdades de género, el artículo demuestra que no es posible resguardar la salud mental infantil a menos que hagamos de la justicia reproductiva una realidad.

Le domaine de la santé mentale du nourrisson est traditionnellement constitué de discours professionnels qui comprennent la science liée au développement, la psychologie, et la psychiatrie parmi tant d'autres, et inclut des sphères de pratique aussi étendues que la pédiatrie, la santé maternelle et la santé de l'enfant, l'intervention précoce, les soins précoces et l'éducation, et le bien-être de l'enfant. L'Association Mondiale de la Santé Mentale du Nourrisson et du jeune enfant, abrégée en anglais WAIMH a diffusé un exposé de position sur les droits des nourrissons en 2014 (modifié en mars 2016) en reconnaissant les implications liées aux droits de l'homme de la compréhension professionnelle des capacités et des besoins uniques mais aussi universels des nourrissons. Cet article lie les questions stratégiques délinéées dans l'exposé de position de la WAIMH à des problèmes cruciaux dans le domaine de justice reproductive, élargissant ainsi la portée de l'appel à l'action de la WAIMH au nom des droits des nourrissons, et montrant la voie vers des alliances fortes entre les mouvements reliés entre eux. Faisant le lien entre l'injustice économique, les disparités de santé basées sur la santé et les inéquités entre les sexe, cet article démontre qu'il n'est pas possible de protéger la santé mentale du nourrisson si nous ne faisons pas de la justice reproductive une réalité.

Parenting and toddler self-regulation in low-income families: What does sleep have to do with it?

Toddlerhood is a sensitive period in the development of self-regulation, a set of adaptive skills that are fundamental to mental health and partly shaped by parenting. Healthy sleep is known to be critical for self-regulation; yet, the degree to which child sleep alters interactive child-parent processes remains understudied. This study examines associations between observed parenting and toddler self-regulation, with toddler sleep as a moderator of this association. Toddlers in low-income families (N = 171) and their mothers were videotaped during free play and a self-regulation challenge task; videos were coded for mothers' behavior and affect (free play) and toddlers' self-regulation (challenge task). Mothers reported their child's nighttime sleep duration via questionnaire. Results revealed significant Sleep × Maternal Negative Affect and Sleep × Maternal Negative Control interactions. Children who did not experience negative parenting had good self-regulation regardless of their nighttime sleep duration. For children who did experience negative parenting, self-regulation was intact among those who obtained more nighttime sleep, but significantly poorer among children who were getting less nighttime sleep. Thus, among children who were reported to obtain less nighttime sleep, there were more robust associations between negative parenting and poorer self-regulation than among toddlers who were reported to obtain more sleep.

Los primeros años de la niñez son un período sensible en el desarrollo de la auto-regulación, un grupo de habilidades adaptables que son fundamentales para la salud mental y a las que en parte les da forma la crianza. Es sabido que el dormir bien es esencial para la auto-regulación y, aun así, el nivel al que el sueño del niño altera los procesos interactivos entre progenitor y niño permanece poco estudiado. Este estudio examina las asociaciones entre la crianza observada y la auto-regulación del niño pequeño, tomando como moderador de tal asociación el proceso de dormir del niño pequeño. Se grabó en video a niños pequeños de familias de bajos ingresos (N=171) y sus madres durante una sesión de juego libre y una tarea de auto-regulación que suponía un reto; los videos fueron codificados en cuanto al comportamiento y afecto de las madres (juego libre) y la auto-regulación de los niños pequeños (tarea que suponía reto). Las madres reportaron acerca del sueño nocturno de sus niños por medio de un cuestionario. Los resultados revelaron interacciones significativas en cuanto al dormir y el negativo afecto materno, así como el dormir y el negativo control materno. Los niños que no experimentaron una crianza negativa tenían una buena auto-regulación independientemente de la duración de su sueño nocturno. En el caso de los niños que experimentaron una crianza negativa, la auto-regulación quedó intacta en aquellos que lograban más tiempo nocturno de dormir, pero fue significativamente más pobre en los niños que tenían menos tiempo de sueño nocturno. Por tanto, en el caso de los niños indicados en el reporte con menos tiempo de dormir nocturno, se dieron asociaciones más robustas entre la crianza negativa y una más pobre auto-regulación que entre los niños pequeños indicados en el reporte con más tiempo de dormir.

La petite enfance est une période sensible dans le développement de l'auto-régulation, un ensemble de compétences qui sont fondamentales pour la santé mentale et en partie formées par le parentage. L'on sait qu'un sommeil sain est critique pour l'auto-régulation et pourtant la mesure dans laquelle le sommeil de l'enfant altère les processus interactifs enfant-parent demeure peu étudiée. Cette étude examine les liens entre le parentage observé et l'auto-régulation du petit enfant, le sommeil de l'enfant ayant un effet modérateur dans ce lien. Des jeunes enfants de familles issues de milieux défavorisés (N=171) et leurs mères ont été filmés durant un jeu libre et un exercice de défi d'auto-régulation. Les vidéos ont été codées pour le comportement des mères et l'affect (jeu libre) et l'auto-régulation des jeunes enfants (exercice de défi). Les mères ont fait état de la durée de sommeil nocturne de leur enfant au moyen d'un questionnaire. Les résultats ont révélé que : sommeil significatif x l'affect négatif maternel et le sommeil x négatif maternel contrôle les interactions. Les enfants qui n'avaient pas fait l'expérience d'un parentage négatif avaient une bonne auto-régulation quelle qu'ait été la durée du sommeil nocturne. Pour les enfants ayant fait l'expérience d'une parentage négatif, l'auto-régulation était intacte chez ceux ayant plus dormi, mais bien moindre chez les enfants qui avaient moins dormi. Donc, chez les enfants ayant moins de sommeil nocturne les liens bien plus robustes ont été découverts entre le parentage négatif et une moindre auto-régulation que chez les petits enfants dormant plus durant la nuit.

Parenting self-efficacy in the context of poverty and HIV in Eastern Uganda: A qualitative study.

We sought to understand social representations of effective parenting and parenting self-efficacy among female HIV-affected caregivers in rural Eastern Uganda. We conducted in-depth interviews (n = 21) to describe parenting experiences and caregivers' perceptions of their own parenting abilities and to create vignettes for use in directed focus groups. We carried out open focus groups (n = 2) to gain social perspectives on parenting, and directed focus groups (n = 2) concentrated on parenting self-efficacy. Analysis involved memoing and inductive and deductive coding of transcripts. Caregivers' perceptions of their own parenting were grounded in parenting values such as providing children with basic needs, having well-behaved children, and having good relationships with children. Caregivers' perceptions were influenced by challenges, including single parenthood, living with HIV, limited family resources, and mental health problems. When facing challenges, caregivers relied on social support and faith as well as their own parenting confidence. Caregivers' perceptions of their parenting abilities were influenced by how they felt others perceived them, their satisfaction in the parenting role, their perseverance despite challenges, and the extent to which they had a vision for their family. Our findings contextualize parenting self-efficacy within parenting values, challenges, and social perceptions among HIV-affected caregivers in rural Uganda.

Nos propusimos comprender las representaciones sociales de la crianza eficaz y la auto-efectividad en la crianza entre mujeres afectadas con VIH y que prestan cuidados en el área rural del este de Uganda. Realizamos entrevistas profundas (n = 21) para describir las experiencias de crianza y las percepciones de las cuidadoras sobre sus propias habilidades de crianza y para crear esbozos para usar en grupos de enfoque dirigidos. Llevamos a cabo grupos de enfoque a puertas abiertas (n = 2) para conocer las perspectivas sociales acerca de la crianza y dirigimos los grupos de enfoque (n = 2) concentrados en la auto-efectividad de la crianza. Los análisis incluyeron la toma de notas con reflexión y la codificación inductiva y deductiva de las transcripciones. Las percepciones de las cuidadoras acerca de sus propias crianzas se basaron en los valores de la crianza tales como proveerles a los niños las necesidades básicas, tener niños que se comportan bien, así como mantener buenas relaciones con sus niños. Los retos influyeron las percepciones de las cuidadoras; entre ellos se incluyeron el ser una madre sin pareja, vivir con VIH, los limitados recursos familiares y los problemas de salud mental. Cuando se encontraron con retos, las cuidadoras confiaron en el apoyo social y en la fe, así como en la confianza en su propia crianza. Las percepciones de las cuidadoras acerca de sus habilidades de crianza estuvieron influidas por cómo ellas sentían que otros las veían, su satisfacción en el papel de crianza, su perseverancia a pesar de los retos, así como hasta qué punto tenían una visión para su familia. Nuestros resultados contextualizan la auto-efectividad de la crianza dentro de los valores, retos y perspectivas sociales de la misma entre mujeres afectadas por VIH que prestan cuidado en el área rural de Uganda.

Nous avons voulu comprendre la représentation sociale du parentage efficace et de l'auto-efficacité de parentage chez des femmes prenant soin d'enfants et affectées par le VIH dans l'Ouganda rural de l'est. Nous avons conduit des entretiens approfondis (n = 21) afin de décrire les expériences de parentage et les perceptions des personnes prenant soin d'enfants de leurs propres capacités au parentage et afin de créer des vignettes pouvant être utilisées dans des groupes de réflexion et de discussion dirigés (n = 1) se concentrant sur l'auto-efficacité de parentage. L'analyse a inclus l'enregistrement de notes et le codage inductif et déductif des retranscriptions. Les perceptions de personnes prenant soin des enfants de leur propre parentage étaient fondées sur les valeurs de parentage, telles que le fait d'offrir aux enfants les soins de base, d'avoir des enfants sages, et de maintenir de bonnes relations avec les enfants. Les perceptions des personnes prenant soin des enfants étaient influencées par les défis auxquelles elles faisaient face, y compris la monoparentalité, le fait de vivre avec le VIH, les ressources familiales limitées et les problèmes de santé mentale. Quand elles faisaient face à des défis, les femmes prenant soin d'enfants se reposaient sur le soutien social et leur foi, ainsi que sur leur propre confiance de parentage. Les perceptions de leurs capacités de parentage étaient influencées par la manière dont elles pensaient que les autres les percevaient, leur satisfaction dans leur rôle de parentage, leur persévérance en dépit des défis, et le degré auquel elles avaient une vision pour leur famille. Nos résultats contextualisent l'auto-efficacité de parentage au sein des valeurs de parentage, des défis et des perceptions sociales chez les femmes prenant soin d'enfants étant affectées par VIH dans l'Ouganda rural.

The early biopsychosocial development of boys and the origins of violence in males.

We apply a biopsychosocial approach to introduce early-in-life experiences that explain a significant part of the male preponderance in the perpetration of violence. Early caregiver abuse and neglect, father absence, and exposure to family and neighborhood violence exacerbate boys' greater risk for aggressive behavior and increase the probability of carrying out violent acts later in life. We examine the development of the psychological self and explore conditions that encourage physical aggression, focusing on the impact on the infant and toddler's emergent mental representation of self, others, and self-other relationships. Boys' slower developmental timetable in the first years of life may enhance their vulnerability for disorganization in emergent neurobiological networks mediating organization of socioemotional relationships. Emergent attachment and activation relationship systems may differentially affect risk and resilience in boys and girls, particularly in single-parent families. Evidence has suggested that the dramatic increase in single-parent families is especially linked to corresponding increases in behavioral undercontrol, antisocial behavior, and the emergence of violence in boys.

MEDIATING ROLE OF MATERNAL SENSITIVITY: ENHANCING LANGUAGE DEVELOPMENT IN AT-RISK FAMILIES.

Home-visiting programs have gained increasing importance in family-centered prevention and intervention. However, few studies have examined the mechanisms underlying early intervention treatment effects. The goal of this study is to analyze the mediating role of maternal sensitivity in enhancing language development with the home-visiting program Parents as Teachers (PAT). Data were collected and analyzed within the ongoing, long-term ZEPPELIN study, a randomized controlled trial with 251 participating at-risk families. Via longitudinal mediation analysis, we examined whether effects of the PAT on receptive and expressive language outcomes at 24 and 36 months were mediated by maternal sensitivity at 12 months. Within a moderated mediation framework, we investigated whether the level of family psychosocial stress affects this mediation. Results showed that intervention effects on language outcomes are mediated by maternal sensitivity-weakly and through specific pathways. Moderation and moderated mediation analyses indicated that effects of the PAT and also specific mediation effects increase with the level of psychosocial stress. Implications of the results for practice are discussed.

WIDENING THE SCOPE OF SOCIAL SUPPORT: THE FLORIDA MATERNAL, INFANT, AND EARLY CHILDHOOD HOME VISITING PROGRAM.

The Florida Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program is designed to support pregnant women and families in developing skills and utilizing resources necessary to promote their children's physical, social, and emotional development. Little evaluation attention has focused on large-scale, public policy driven home-visiting programs. Social support provision is a critical component of a successful home-visiting program; therefore, there is a need to better understand participants' perceptions of social support provided to them in this context. Forty-five home-visiting participants from five Florida MIECHV programs completed semistructured telephone interviews. Participants discussed their experiences with the MIECHV program, including descriptions of their interactions with home visitors. Content analysis revealed that participants experienced multilayered social support from home-visiting staff. Families needed and received substantial emotional, instrumental, informational, and appraisal support at the individual level. This support was embedded within and strengthened by the strategies and activities of the home-visiting model of service provision. Results highlight the powerful opportunity home visiting offers as a method of service delivery within the larger system of care to increase social support in families experiencing high risk for negative maternal and child health outcomes. Implications for policy and practice are discussed.

Translating to the Community (T2C): a protocol paper describing the development of Canada's first social epigenetic FASD biobank.

Translating to the Community (T2C) is a social biorepository designed to advance new diagnostic tools and realign community-clinical processes, with the aim to mitigate the short- and long-term impacts of fetal alcohol spectrum disorder (FASD) as well as prenatal alcohol exposure and its co-morbidities and behaviors. In this paper, we describe the evolution of this repository as a new translational partnership to advance a precision-medicine approach to FASD. Key to its evolution was a partnership between academic researchers, Indigenous communities, families, and a regional diagnostic clinic. We further describe the rationale for social biobanking, the type of banking, ethical engagement of families, communities, and clinics, their roles in repository design, governance, translation, and research activities, types of data collected from families, and how the study data are managed, reported, and accessed. The repository design includes biological samples, social-contextual health-survey data, and clinical data (which are linkable to administrative data) from community and clinical cohorts of diagnosed children, children prenatally exposed but not diagnosed, children suspected to have had a prenatal exposure, and related siblings, biological parents, and unrelated children and their parents. From these cohorts and families, potential studies drawing on this data will shed light on various risk factors, social and biological pathways, and service utilization issues, with the aim to implement primary and secondary prevention and intervention strategies.