The Coronavirus Impact Scale: Construction, Validation, and Comparisons in Diverse Clinical Samples.

Objective: This report is of the construction and initial psychometric properties of the Coronavirus Impact Scale in multiple large and diverse samples of families with children and adolescents. The scale was established to capture the impact of the coronavirus pandemic during its first wave. Differences in impact between samples and internal structure within samples were assessed. Method: A total of 572 caregivers of children and adolescents or expecting mothers in diverse clinical and research settings completed the Coronavirus Impact Scale. Samples differed in regard to developmental stage, background, inpatient/outpatient status, and primary research or clinical setting. Model free methods were used to measure the scale's internal structure and to determine a scoring method. Differences between samples in specific item responses were measured by multivariate ordinal regression. Results: The Coronavirus Impact Scale demonstrated good internal consistency in a variety of clinical and research populations. Across the groups studied, single, immigrant, predominantly Latinx mothers of young children reported the greatest impact of the pandemic, with noteworthy effects on food access and finances reported. Individuals receiving outpatient or inpatient care reported greater impacts on health care access. Elevated scores on the Coronavirus Impact Scale were positively associated with measures of caregiver anxiety and both caregiver- and child-reported stress at a moderate effect size. Conclusion: The Coronavirus Impact Scale is a publicly available scale with adequate psychometric properties for use in measuring the impact of the coronavirus pandemic in diverse populations.

The protective effects of social support and family functioning on parenting stress among Hispanic/Latino/a American immigrant parents with traumatic life experiences: A mediation analysis.

Despite high rates of traumatic experiences reported among Hispanic/Latino/a immigrants in the U.S., the effect of post-traumatic stress on parenting stress among Hispanic/Latino/a immigrant parents with young children has been overlooked. The present study tested the direct and indirect relationships of self-reported maternal post-traumatic stress symptoms on parenting stress, and the mediating role of protective factors among Hispanic/Latino/a mothers with young children. Baseline data collected from mothers participating in a community-based child-parent dyadic intervention were analyzed. Measures included the post-traumatic stress disorder (PTSD) Checklist, the Protective Factors Survey, and the Parenting Stress Index-Short Form (PSI). The sample included 80 mothers with a child between ages 0-6 years. About 75% of these mothers were migrants from Central America. A multivariate regression analysis showed that maternal post-traumatic stress symptoms predicted higher levels of PSI, and two protective factors (social support and family functioning/resilience) fully mediated the relationship between maternal post-traumatic stress symptoms and PSI. Higher social support and family functioning/resiliency may have protective effects on Hispanic/Latino/a mothers with post-traumatic stress, leading to lower levels of stress related to parenting. Findings underscore the importance of interventions that enhance access to social support and promote family functioning/resilience for Hispanic/Latino/a immigrant mothers with trauma histories to cope better with parenting stress.

A pesar de las altas tasas de experiencias traumáticas entre inmigrantes hispano/latinos/as en Estados Unidos, el efecto del estrés postraumático en la crianza entre progenitores inmigrantes hispano/latinos/as con niños pequeños ha pasado desapercibido. El presente estudio puso a prueba las directas e indirectas relaciones de síntomas de estrés postraumático materno auto reportado sobre el estrés de crianza, así como el papel mediador de factores de protección entre madres hispano/latinas con niños pequeños. Se analizaron los datos de referencia obtenidos de madres participantes en una intervención diádica progenitor-niño con base comunitaria. Entre las medidas se incluyeron la lista de verificación de Trastorno de Estrés Postraumático (PTSD), la Encuesta de Factores de Protección, así como el Formulario Corto del Índice de Estrés de Crianza (PSI). El grupo muestra contaba con 80 madres con un niño entre 0 y 6 años de edad. Cerca del 75% de estas madres eran inmigrantes de América Central. Un análisis de regresión multivariado mostró que los síntomas de estrés postraumático materno predecían más altos niveles de PSI, y dos factores de protección (apoyo social y funcionamiento y resiliencia familiar) completamente mediaron la relación entre los síntomas de estrés postraumático materno y PSI. Un más alto apoyo social y funcionamiento y resiliencia de la familia pudiera tener efectos de protección sobre madres hispanas/latinas con estrés postraumático, llevando a más bajos niveles de estrés relacionado con la crianza. Los resultados resaltan la importancia de mejorar el acceso al apoyo social y promover el funcionamiento y resiliencia de la familia para madres inmigrantes hispanas/latinas con un historial de trauma y así poder arreglárselas mejor con el estrés de crianza.

En dépit de taux élevés d'expériences traumatiques rapportés chez les immigrés hispaniques/latinos et latinas aux Etats-Unis d'Amérique l'effet du stress post-traumatique sur le stress de parentage chez les parents hispaniques/latinos et latinas immigrés avec de jeunes enfants est souvent oublié. Cette étude a testé les relations directes et indirectes des symptômes de stress post-traumatique maternel auto-rapporté sur le stress de parentage et le rôle médiateur de facteurs de protection chez les mères hispaniques/latinas avec de jeunes enfants. Les données de base recueillies de mères participant à une intervention dyadique enfant-parent Communautaire ont été analysées. Les mesures ont inclus la Checklist TSPT, le Sondage de Facteurs Protecteurs (Protective Factors Survey), et le Formulaire Court de l'Index de Stress de Parentage (Parenting Stress Index-Short Form, soit PSI). L'échantillon a inclus 80 mères avec un enfant entre l'âge de 0-6 ans. A peu près 75% de ces mères avaient immigré de l'Amérique Centrale. Une analyse de régression multivariée a montré que les symptômes de stress post-traumatique maternel a prédit des niveaux plus élevés de PSI et seuls deux facteurs protecteurs (le soutien social et le fonctionnement/la résilience familial(e) ont totalement médiatisé la relation entre les symptômes de stress post-traumatique et le PSI. Un soutien social plus élevé et le fonctionnement/la résilience familial(e) peuvent avoir des effets protecteurs sur les mères hispaniques/latinas avec du stress post-traumatique, menant à des niveaux moins élevés de stress lié au parentage. Les résultats soulignent l'importance des interventions qui renforcent l'accès au soutien social et promeuvent le fonctionnement/la résilience familial(e) pour les mères hispaniques/latinas avec un passé de trauma pour mieux faire face au stress de parentage.

Parenting stress and competence among mothers of young children with substance use disorders: The roles of trauma and reflective functioning.

Posttraumatic stress symptoms are prominent in the lives of parents of young children with substance use disorders (SUD). Parenting experiences, particularly stress and competence, impact parenting behaviors and concomitant child growth and development. Factors that promote positive experiences of parenting, such as parental reflective functioning (PRF), and protect the mother and child from negative outcomes are crucial to understand to develop effective therapeutic interventions. The current US study analyzed baseline data from a parenting intervention evaluation to examine how length of substance misuse, PRF, and trauma symptoms were associated with parenting stress and parenting sense of competence among mothers in treatment for SUDs. Measures included the Addiction Severity Index, PTSD Symptom Scale-Self Report, Parental Reflective Functioning Questionnaire, Parenting Stress Index/Short Form, and Parenting Sense of Competence Scale. The sample included 54 predominantly White mothers with SUDs who had young children. Two multivariate regression analyses found that (1) lower parental reflective functioning and higher posttraumatic stress symptoms were associated with higher parenting stress, and (2) only higher posttraumatic stress symptoms were associated with lower levels of parenting sense of competence. Findings underscore the importance of addressing trauma symptoms and PRF when aiming to improve parenting experiences for women with an SUD.

Los síntomas de estrés postraumático son prominentes en las vidas de progenitores de niños pequeños con trastornos de uso de sustancias (SUD). Las experiencias de crianza, particularmente el estrés y la competencia, ejercen un impacto en el comportamiento de crianza y el inherente crecimiento y desarrollo del niño. Los factores que promueven las positivas experiencias de crianza, tales como el funcionamiento con reflexión del progenitor (PRF), y protegen a la madre y al niño de resultados negativos, son cruciales para comprender cómo desarrollar intervenciones terapéuticas eficaces. El presente estudio en Estados Unidos analizó datos de referencia de una evaluación de intervención de crianza para examinar cómo la duración del mal uso de sustancias, PRF y los síntomas de trauma estaban asociados con el estrés de crianza y el sentido de competencia en la crianza entre madres bajo tratamiento por SUD. Entre las medidas se incluyeron el Índice de Severidad de la Adicción, la Escala de Auto Reporte de Síntomas de PTSD, el Cuestionario del Funcionamiento con Reflexión del Progenitor, el Índice de Estrés de Crianza/Forma Abreviada, así como la Escala del Sentido de Competencia en la Crianza. El grupo muestra incluyó 54 madres predominantemente blancas con SUD, que tenían niños pequeños. Dos análisis de regresión multivariados observaron que 1) un más bajo funcionamiento con reflexión del progenitor y unos más altos síntomas de estrés postraumático se asociaban con un más alto estrés de crianza y 2) sólo los más altos síntomas de estrés postraumático se asociaban con niveles más bajos de sentido de competencia en la crianza. Las observaciones subrayan la importancia de hablar sobre los síntomas de trauma y PRF cuando se busca mejorar las experiencias de crianza para mujeres con un SUD.

Les symptômes de stress post-traumatiques sont importants dans les vies de parents de jeunes enfants avec des troubles liés à l'usage d'une substance (TUS) de toxicomanie. Les expériences de parentage, particulièrement le stress et la compétence, ont un impact sur les comportements de parents et la croissance concomitante de l'enfant et son développement. Les facteurs qui promeuvent des expériences positives de parentage, comme le fonctionnement de réflexion parentale (ici abrégé FRP), et protègent la mère et l'enfant de résultats négatifs sont essentiels à comprendre pour développer des interventions thérapeutiques efficaces. Cette étude américaine a analysé les données de base de l'évaluation d'une intervention de parentage pour examiner comment la durée de l'utilisation de substance, le FRP et les symptômes de trauma sont liés au stress de parentage et au sens de compétence de parentage chez les mères étant traitée pour des TUS. Les mesures ont inclus l'Index de Sévérité de Dépendance, l'Échelle d'évaluation des symptômes du TSPT - Déclaration personnelle, le Questionnaire de Fonctionnement de Réflexion Parental, l'Indice de Stress de Parentage/Formulaire Abrégé, et l'Echelle de Sens de Compétence de Parentage. L'échantillon a inclus 54 mères en grande partie blanches ave des TUS qui avaient de jeunes enfants. Deux analyses de régression multivariées ont trouvé que 1) un fonctionnement de réflexion parentage moins élevé et des symptômes de stress post-traumatiques plus élevés étaient liés à un stress de parentage plus élevé et 2) seuls les symptômes de stress post-traumatiques plus élevés étaient liés à des niveaux plus bas de sens de compétence de parentage. Les résultats soulignent l'importance qu'il y a à traiter les symptômes de trauma et le FRP lorsqu'on essaie d'améliorer les expériences de parentage de femmes avec un TUS.

The Family is the Patient: Promoting Early Childhood Mental Health in Pediatric Care.

Advances in developmental psychology, child psychiatry, and allied disciplines have pointed to events and experiences in the early years as the origin of many adult mental health challenges. Yet, children's mental health services still largely lack a developmental or prevention-focused orientation, with most referrals to mental health professionals occurring late, once problems are well established. An early childhood mental health system rooted in the principles of life-course health development would take a very different approach to designing, testing, and implementing prevention and intervention strategies directed toward early child mental health. Priorities for such a system include supporting healthy family environments, parent-child and family relationships, parents' emotional/behavioral health, and family routines as a means of providing the best possible neurobiological foundation for mental health across the life span. The system would include proactive, trauma-informed, multidisciplinary care, with integrated mental health and social services support embedded in pediatric primary care settings. Novel intervention approaches in need of further research include 2-generational dyadic interventions designed to improve the mental health of parents and children, mental health-oriented telemedicine, and contingency management (CM) strategies. Integral to this Life Course Health Development reformulation is a commitment by all organizations supporting children to primordial and primary prevention strategies to reduce racial and socioeconomic disparities in all settings. We contend that it is the family, not the individual child, that ought to be the identified target of these redesigned approaches, delivered through a transformed pediatric system with anticipated benefits for multiple health outcomes across the life course.

Locating Infant and Early Childhood Mental Health at the Heart of Social Work.

Infant and early childhood mental health (IECMH)-an interdisciplinary field dedicated to advancing understanding of early relationships, socioemotional development, and cultural and contextual influences on caregiving-offers essential tools for social workers to support the well-being of infants, toddlers, preschoolers, and their families. Even though social worker Selma Fraiberg was a founder of the field, and social workers are central to the work of assessment and intervention with young children and their caregivers in many settings, few schools of social work offer training in IECMH, and few social workers are familiar with its core principles, scholarship, and intervention approaches. In this article, faculty members from four U.S. social work programs address the vital role of IECMH in social work training, research, and practice as well as issue a call to the field to recover and renew commitment to a practice perspective and knowledge base with roots in social work. Twenty-five years ago, Social Work published a similar call, but the request has gone largely unheeded. The authors examine the changing landscape and argue that it is more important and timelier than ever for social workers to learn and integrate the relationship-based approach to promotion, prevention, intervention, and treatment offered by IECMH.

Secrecy Versus Disclosure: Women with Substance Use Disorders Share Experiences in Help Seeking During Pregnancy.

OBJECTIVES: Substance misuse during pregnancy can be harmful to the health of both mothers and infants. Existing recovery services or prenatal care for pregnant women with substance use disorders (SUD) in the U.S. and other countries typically fall short in providing the necessary specialized care women with SUDs need. Disclosure of substance misuse is one key factor in gaining access to specialized prenatal care; yet, barriers such as social stigma and internal shame and guilt lead many women to under-report any substance misuse during their pregnancy. This study sought to understand the process of how and why pregnant women with SUDs choose to disclose or not disclose their substance misuse to their providers when seeking prenatal care. METHODS: Data were collected through interviews with N = 21 women with SUDs in the northeast U.S. whose young children had been exposed to opioids, cocaine, or MAT in utero. Thematic, inductive analysis using line-by-line coding was conducted to understand the perspectives of the women. RESULTS: The women's narratives suggested a clear tension regarding whether to disclose their substance misuse to any providers during their pregnancy. Four themes describing the process of disclosure or non-disclosure were found, including reasons for and ways of being secret or choosing to disclose their substance misuse during pregnancy. CONCLUSIONS FOR PRACTICE: The centrality of shame, guilt, and stigma regarding substance misuse must be addressed by medical and mental health providers in order to increase disclosure and improve access to care for women with SUDs.

Innovations in Child Welfare Interventions for Caregivers with Substance Use Disorders and Their Children.

Families who enter the Child Welfare System (CWS) as a result of a caregiver's substance use fare worse at every stage from investigation to removal to reunification (Marsh et. al 2007). Intervening with caregivers with Substance Use Disorders (SUDs) and their children poses unique challenges related to the structure and focus of the current CWS. Research demonstrates that caregivers with SUDs are at a greater risk for maladaptive parenting practices, including patterns of insecure attachment and difficulties with attunement and responsiveness (Suchman, 2006). Caregivers with SUDs have also often experienced early adversity and trauma. However, traditional addiction services generally offer limited opportunities to focus on parenting or trauma, and traditional parenting programs rarely address the special needs of parents with SUDs. This article details four innovative interventions that integrate trauma-informed addiction treatments with parenting for families involved in the child welfare system. Common mechanisms for change across programs are identified as critical components for intervention. This work suggests the need for a paradigm shift in how cases involving caregivers with substance use disorders are approached in the child welfare system.

A randomized clinical trial of a postdeployment parenting intervention for service members and their families with very young children.

OBJECTIVE: Parenting through the deployment cycle presents unique stressors for military families. To date, few evidence-based and military-specific parenting programs are available to support parenting through cycles of deployment separation and reintegration, especially for National Guard/Reserve members. The purpose of this research was to test the efficacy of a parenting program developed specifically to support military families during reintegration. METHOD: Within 1 year of returning from deployment to Afghanistan or Iraq, 115 service members with very young children were randomly assigned to receive either the Strong Families Strong Forces Parenting Program at baseline or after a 12-week waiting period. Using a home-based modality, service members, at-home parents, and their young child were assessed at baseline, 3 months posttreatment/wait period, and 6 months from baseline. RESULTS: Service member parents in Strong Families evidenced greater reductions in parenting stress and mental health distress relative to those in the waitlist comparison group. Service members with more posttraumatic stress symptoms reported higher levels of perceived parental efficacy in the intervention group than service members in the comparison group. Intervention also resulted in enhanced parental reflective capacity, including increased curiosity and interest in the young child among those in the intervention group relative to comparison. CONCLUSION: Service member parents and their spouses demonstrated high interest in participating in a postdeployment parenting program targeting families with very young children. Findings point to the feasibility, appeal, and efficacy of Strong Families in this initial trial and suggest promise for implementation in broader military and community service systems. (PsycINFO Database Record

Yoga versus education for Veterans with chronic low back pain: study protocol for a randomized controlled trial.

BACKGROUND: Chronic low back pain is the most frequent pain condition in Veterans and causes substantial suffering, decreased functional capacity, and lower quality of life. Symptoms of post-traumatic stress, depression, and mild traumatic brain injury are highly prevalent in Veterans with back pain. Yoga for low back pain has been demonstrated to be effective for civilians in randomized controlled trials. However, it is unknown if results from previously published trials generalize to military populations. METHODS/DESIGN: This study is a parallel randomized controlled trial comparing yoga to education for 120 Veterans with chronic low back pain. Participants are Veterans ≥18 years old with low back pain present on at least half the days in the past six months and a self-reported average pain intensity in the previous week of ≥4 on a 0-10 scale. The 24-week study has an initial 12-week intervention period, where participants are randomized equally into (1) a standardized weekly group yoga class with home practice or (2) education delivered with a self-care book. Primary outcome measures are change at 12 weeks in low back pain intensity measured by the Defense and Veterans Pain Rating Scale (0-10) and back-related function using the 23-point Roland Morris Disability Questionnaire. In the subsequent 12-week follow-up period, yoga participants are encouraged to continue home yoga practice and education participants continue following recommendations from the book. Qualitative interviews with Veterans in the yoga group and their partners explore the impact of chronic low back pain and yoga on family relationships. We also assess cost-effectiveness from three perspectives: the Veteran, the Veterans Health Administration, and society using electronic medical records, self-reported cost data, and study records. DISCUSSION: This study will help determine if yoga can become an effective treatment for Veterans with chronic low back pain and psychological comorbidities. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02224183.

"We're all in this together": A qualitative study of predominantly low income minority participants in a yoga trial for chronic low back pain.

OBJECTIVE: To explore the experiences of low-income minority adults taking part in a yoga dosing trial for chronic low back pain. DESIGN: Individual semi-structured interviews were conducted with nineteen participants recruited from a randomized yoga dosing trial for predominantly low-income minority adults with chronic low back pain. Interviews discussed the impact of yoga on low back pain and emotions; other perceived advantages or disadvantages of the intervention; and facilitators and barriers to practicing yoga. Interviews were audio taped and transcribed, coded using ATLAS.ti software, and analyzed with inductive and deductive thematic analysis methods. SETTING: Boston Medical Center, Boston, MA, USA. RESULTS: Participants viewed yoga as a means of pain relief and attributed improved mood, greater ability to manage stress, and enhanced relaxation to yoga. Overall, participants felt empowered to self-manage their pain. Some found yoga to be helpful in being mindful of their emotions and accepting of their pain. Trust in the yoga instructors was a commonly cited facilitator for yoga class attendance. Lack of time, motivation, and fear of injury were reported barriers to yoga practice. CONCLUSIONS: Yoga is a multidimensional treatment for low back pain that has the potential to favorably impact health in a predominantly low-income minority population.

Differential responsiveness to a parenting intervention for mothers in substance abuse treatment.

This study examines the relationship between levels of psychological distress in substance-dependent mothers and their differential response to a dyadic parent-child intervention. A sample of 66 mothers who were receiving treatment for substance abuse, as well as a simultaneous parenting intervention, were interviewed pre and post-treatment on measures of psychological distress, adult and child trauma history, parental reflective functioning, and child social-emotional development. Additionally, clinicians provided assessments of the parent-child relationships. As anticipated, trauma histories for mothers and children, children's social emotional development, and parental reflective functioning were associated with aspects of maternal psychological distress. Kruskal-Wallis and subsequent Wilcoxson signed rank tests revealed that women with highest levels of baseline psychological distress showed significant improvements in psychological functioning post-treatment while women with moderately elevated levels of psychological distress did not. Women who were most distressed at baseline showed increased levels of parental reflective functioning post-treatment while women with moderate and lower levels of baseline psychological distress showed improvements on clinician-rated assessments of parent-child relationships. Chi Square analyses showed that parents who endorsed the highest levels of distress at baseline reported that their children's risk status regarding social-emotional development decreased post-treatment. Despite similarities in substance dependence, mothers in this sample had different needs and outcomes in the context of this parenting intervention due to variation in mental health. Given this variation, parenting interventions for substance-dependent mothers need to account for the individual differences in levels of psychological distress.

"I didn't fight for my life to be treated like this!": The relationship between the experience of cancer and intimate partner abuse.

The current article seeks to further understanding of the high frequency of intimate partner abuse among cancer patients through qualitative analysis of semistructured interviews with 20 women and one man facing cancer and intimate partner abuse concurrently. Participants described a range of abusive and unsupportive behaviors by their intimate partners over the course of cancer treatment, which contributed to their reassessing and makinig changes in their relationships. Important factors in this process of change appear to be participants' increased focus on their own health, discovery of greater inner strength, and increased social support. Barriers to making changes in their relationships during their cancer treatment also were described. Participants who made significant changes in or left an abusive relationship usually did so after having recovered from cancer treatment. Implications of these findings for social workers in health care are discussed, as are directions for future research.

Yoga vs. physical therapy vs. education for chronic low back pain in predominantly minority populations: study protocol for a randomized controlled trial.

BACKGROUND: Chronic low back pain causes substantial morbidity and cost to society while disproportionately impacting low-income and minority adults. Several randomized controlled trials show yoga is an effective treatment. However, the comparative effectiveness of yoga and physical therapy, a common mainstream treatment for chronic low back pain, is unknown. METHODS/DESIGN: This is a randomized controlled trial for 320 predominantly low-income minority adults with chronic low back pain, comparing yoga, physical therapy, and education. Inclusion criteria are adults 18-64 years old with non-specific low back pain lasting ≥ 12 weeks and a self-reported average pain intensity of ≥ 4 on a 0-10 scale. Recruitment takes place at Boston Medical Center, an urban academic safety-net hospital and seven federally qualified community health centers located in diverse neighborhoods. The 52-week study has an initial 12-week Treatment Phase where participants are randomized in a 2:2:1 ratio into i) a standardized weekly hatha yoga class supplemented by home practice; ii) a standardized evidence-based exercise therapy protocol adapted from the Treatment Based Classification method, individually delivered by a physical therapist and supplemented by home practice; and iii) education delivered through a self-care book. Co-primary outcome measures are 12-week pain intensity measured on an 11-point numerical rating scale and back-specific function measured using the modified Roland Morris Disability Questionnaire. In the subsequent 40-week Maintenance Phase, yoga participants are re-randomized in a 1:1 ratio to either structured maintenance yoga classes or home practice only. Physical therapy participants are similarly re-randomized to either five booster sessions or home practice only. Education participants continue to follow recommendations of educational materials. We will also assess cost effectiveness from the perspectives of the individual, insurers, and society using claims databases, electronic medical records, self-report cost data, and study records. Qualitative data from interviews will add subjective detail to complement quantitative data. TRIAL REGISTRATION: This trial is registered in ClinicalTrials.gov, with the ID number: NCT01343927.

Perceived Instrumentality and Normativeness of Corporal Punishment Use among Black Mothers.

Corporal punishment (CP) remains highly prevalent in the U.S. despite its association with increased risk for child aggression and physical abuse. Five focus groups were conducted with parents (n=18) from a community at particularly high risk for using CP (Black, low socioeconomic status, Southern) in order to investigate their perceptions about why CP use is so common. A systematic qualitative analysis was conducted using grounded theory techniques within an overall thematic analysis. Codes were collapsed and two broad themes emerged. CP was perceived to be: 1) instrumental in achieving parenting goals and 2) normative within participants' key social identity groups, including race/ethnicity, religion, and family of origin. Implications for the reduction of CP are discussed using a social ecological framework.

Evaluating a home-based dyadic intervention: Changes in postpartum depression, maternal perceptions, and mother-infant interactions.

Psychotherapeutic treatments that focus on improving the relational processes between mothers with postpartum depression (PPD) and their infants, as well as the mother's individual therapeutic needs, have a great potential to positively impact the mother, her infant, and their relationship (K.J. Nylen, T.E. Moran, C.L. Franklin, & M. O'Hara, 2006). Utilizing pilot data from an evaluation of a home-based dyadic therapy for mothers with PPD and their infants, this article reports on a recent academic-community partnership study. The effectiveness of the intervention was examined, specifically regarding changes in mother's mood, parenting experience, and relationship with her infant. In addition, associations were examined among maternal self-report variables measuring change from pre- to posttreatment in PPD, psychological distress, and maternal perceptions of parenting and those variables measuring change in observer ratings of maternal-infant interactions. Results showed improvements in mothers' depression, distress, and perceptions of parenting as well as many ratings of mothers' interactions with their infants. However, only improvements in maternal perceptions of parenting, such as maternal self-esteem and parenting stress, were associated with better mother--infant interactions. Importance of this research for the field of infant mental health as well as clinical implications are discussed.

When a parent goes to war: effects of parental deployment on very young children and implications for intervention.

Young children (birth through 5 years of age) are disproportionately represented in U.S. military families with a deployed parent. Because of their developmental capacity to deal with prolonged separation, young children can be especially vulnerable to stressors of parental deployment. Despite the resiliency of many military families, this type of separation can constitute a developmental crisis for a young child. Thus, the experience may compromise optimal child growth and development. This article reviews what is known about the effects of the military deployment cycle on young children, including attachment patterns, intense emotions, and behavioral changes and suggests an ecological approach for supporting military families with infants, toddlers, and preschoolers. Specifically, home-based family focused interventions seem to warrant the most serious consideration.

Postpartum depression, suicidality, and mother-infant interactions.

To date, few studies have examined suicidality in women with postpartum depression. Reports of suicidal ideation in postpartum women have varied (Lindahl et al. Arch Womens Ment Health 8:77-87, 2005), and no known studies have examined the relationship between suicidality and mother-infant interactions. This study utilizes baseline data from a multi-method evaluation of a home-based psychotherapy for women with postpartum depression and their infants to examine the phenomenon of suicidality and its relationship to maternal mood, perceptions, and mother-infant interactions. Overall, women in this clinical sample (n = 32) had wide ranging levels of suicidal thinking. When divided into low and high groups, the mothers with high suicidality experienced greater mood disturbances, cognitive distortions, and severity of postpartum symptomotology. They also had lower maternal self-esteem, more negative perceptions of the mother-infant relationship, and greater parenting stress. During observer-rated mother-infant interactions, women with high suicidality were less sensitive and responsive to their infants' cues, and their infants demonstrated less positive affect and involvement with their mothers. Implications for clinical practice and future research directions are discussed.

Adult daughters and aging mothers: the role of guilt in the experience of caregiver burden.

Although guilt is often identified as being a common emotion experienced by family caregivers in the clinical literature and in small descriptive studies, it has only recently emerged as a construct in the empirical research focused on identifying predictors of caregiver distress. Using Pearlin's stress process model, and based on data from 66 midlife adult daughters caring for aging mothers, we explored the extent to which guilt contributes to caregiver burden. Hierarchical regression analysis revealed that guilt was positively correlated with burden and that it accounted for a significant amount of the variance in caregiver's sense of burden even after contextual and stressor variables were controlled. Our research suggests the importance of clinicians seeking to understand how individuals judge their caregiving performance and targeting negative self-appraisals, which affect individuals' mental health, for change. The challenge for clinicians is to help guilt-ridden caregivers revise their evaluative standards and engage in self-forgiveness and self-acceptance.

"For the dream of being here, one sacrifices...": voices of immigrant mothers in a home visiting program.

Fourteen Latina immigrants participating in an innovative home visiting program for mothers of infants and young children at risk of child maltreatment were interviewed about their experiences coming to the United States, conditions they were living in after arriving, and perceptions of the intervention. Findings from the qualitative analyses detail rich, descriptive information regarding the struggles and adaptations of the immigrant mothers and families. Poverty in home countries propelled these women to move to the United States, leaving close family and sometimes children behind. Harrowing journeys to a new country are chronicled as well as the women's isolation and depression, and the strengths they utilized in adapting to new lives. Findings provide insight into the role of the bilingual/bicultural home visitors who were overwhelmingly perceived as helpful in providing emotional support, case management/advocacy, translation, education, and friendship. Implications include the need for mental health and social service providers to (a) appreciate viscerally the histories of immigrant clients, (b) understand the role of the home visitor-client relationship in enhancing client engagement and retention, and (c) recognize the multi-dimensional contribution of paraprofessional home visitors.