Screening for Housing Instability and Homelessness Among Families Undergoing Child Maltreatment Investigation.

This paper reports results of mixed methods, population survey of housing instability, and homelessness. Child welfare personnel conducted the Quick Risks and Assets for Family Triage (QRAFT), a three-question screening tool intended to identify housing instability and homelessness. The QRAFT requires users to assess family housing history, current housing arrangement, and current housing condition, on a four-point scale from "asset/not a risk" to "severe risk." The QRAFT was completed among 6828 families undergoing new child maltreatment investigations. Approximately 5.4% of families demonstrated significant to severe housing problems; approximately one-third exhibited moderate housing risk. Housing problems and homelessness were significantly associated with the outcome of child welfare investigations; among families with substantiated child welfare determinations, 21% demonstrated significant to severe housing risk, a significantly higher proportion than among families where the investigation outcome was unsubstantiated or differential response (i.e., voluntary services). Of significant to severe housing risk families, 15.7% later met eligibility criteria for a supportive housing intervention, suggesting that housing concerns combined with substantial parent and child functional difficulties. Qualitative data indicated the QRAFT was perceived as easy to administer, effective as a screening tool, and useful to "apply the housing lens" early in child welfare involvement.

Integrated Solutions for Intertwined Challenges: A Statewide Collaboration in Supportive Housing for Child Welfare-Involved Families.

This paper describes Connecticut's Supportive Housing for Families (SHF) program, which is one of five national sites comprising a federally- funded demonstration of housing and child welfare. Evaluations of supportive housing (SH) interventions are complicated by contextual factors that make it difficult to isolate their effects. 'Ihese and other challenges complicate efforts to conduct rigorous research and establish external validity, and to date, few studies examine the impact of SH interventions for child- welfare involved families. We describe retrospectively the development of SHF using. six stages of imple- mentation articulated within an implementation science framework, noting both the core components of the program and its expansion from a small pilot exploration, to a statewide initiative, and now to the center of a systems change effort with potential to influence national policy and implementation.

Parent adaptation and family functioning in relation to narratives of children with chronic illness.

BACKGROUND: This study assessed the experience of parents who have a child diagnosed with chronic illness and whether children's narratives mirror these experiences. METHOD: A total of 66 parents completed assessments about adaptation and family functioning. Children with type 1 diabetes or asthma participated in a story-stem narrative task. RESULTS: Forty-one percent of parents were unresolved about their child's diagnosis, regardless of time since diagnosis. Unresolved parents reported lower family functioning, and children in these families had more family conflict themes. CONCLUSIONS: Parental/Child narratives may provide unique insights into family adjustment. Future work may consider interventions related to family communication and expression of emotion.

A preliminary investigation of the relationship between sensory processing and social play in autism spectrum disorder.

There are well-documented play deficits in autism beginning with infant object and social play. To create effective interventions, the predictors of play deficits in autism must be established. Individuals with autism spectrum disorder (ASD) frequently report sensory processing difficulties including poor praxis; however, these are potential predictors of play that have not been well studied. Using a data set of 162 individuals with ASD, this study examined the direct and indirect relationships between sensory processing and social play performance via structural equation modeling. The best fitting model suggested that sensory system functions predict praxis and play in combination, providing preliminary evidence that sensory functions are related to social play in combination with praxis in children with ASD. The findings suggest future avenues for research. [OTJR: Occupation, Participation and Health 2013;33(3):159-167.].

Stress, anxiety, and health-related quality of life in BRCA1/2-positive women with and without cancer: A comparison of four US female samples.

Introduction: Women with BRCA1/2 mutations have a 11-72% increased risk of breast/ovarian cancers throughout their lifetime. The current study examines psychosocial differences between the current sample of BRCA1/2-positive women with and without cancer histories and three comparable United States (US) female samples without BRCA1/2 mutations. Methods: Sixty BRCA1/2-positive women (with and without cancer histories) were recruited through multiple private online support groups in the US. Participants completed an online survey outlining sociodemographic and genetic counseling information, and anxiety, stress, and health-related quality of life (HRQoL) outcomes. Outcomes were compared to three similar US female normative samples via independent samples t-test analyses. Results: State and trait anxiety (p = 0.00) and stress (p = 0.001) were significantly worse in the current sample of BRCA1/2-positive women compared comparable US female samples. All HRQoL domains were significantly better in the current sample except energy/vitality, which was significantly lower (p = 0.02) in the current sample. Results were stratified by cancer and recurrence status. Conclusions: This study provides insight into how a sample of BRCA1/2-positive women both with and without cancer fare post-genetic counseling as compared to three normative female populations. Results infer the need for additional education, patient-provider training, and mental health referrals to support this population in order to circumvent unintended consequences and to improve psychosocial health in those being tested for, and those who test positive for, BRCA1/2 genetic mutations.

Perceptions and care Recommendations from Previvors: Qualitative analysis of female BRCA1/2 mutation Carriers' experience with genetic testing and counseling.

Introduction: It is estimated that 12.5% of women will be diagnosed with breast cancer and 1.10% with ovarian cancer during their lifetime. Although less common, women with these mutations have a 11-72% increased risk of breast/ovarian cancers and are hereditary. Genetic testing/counseling presents the opportunity to identify carriers of BRCA1/2 genetic mutations before a cancer diagnosis. Methods: Thirty-four BRCA1/2-positive women (with and without histories of breast/ovarian cancers) were recruited through online national support groups to gain a better understanding of their genetic testing/counseling perceptions and experiences. After confirming eligibility, they were invited to participate in either a telephone or webcam interview. Interview transcripts were analyzed using qualitative thematic text analysis and descriptive coding techniques. Results: Six major themes emerged, capturing the perceptions and experiences of genetic testing/counseling for these women: 1) Emotional Reactions to Results and Genetic Counseling, 2) Future Recommendations, 3) Family Solidarity and Support, 4) Experiences with the Healthcare System, 5) Preventive Concerns and Decisions, and 6) Sources Affecting Perceived Risk. Two subthemes also emerged within the first theme, which are termed "Pre-vivor," and "Testing Intuition." Conclusions: Participants indicated that genetic testing/counseling improvements would be helpful for women in this population surrounding quality care, including sensitivity training for healthcare professionals involved in testing/counseling, additional educational resources, and increased emotional and financial support. Although these recommendations may be beneficial, more widespread research with greater generalizability to disparate groups may be necessary prior to implementation.

Predictors of children's emotion regulation outcomes during COVID-19: Role of conflict within the family.

Objective: This work aimed to analyze the role of family conflict on children's emotion regulation and stress outcomes during the COVID-19 pandemic. Background: The COVID-19 pandemic brought novel stress to families. The stress experienced could impact family relationships-specifically, perceptions of closeness and patterns of conflict. Positive family environment and high-quality family relationships are associated with adaptive coping and lower levels of stress among children. Method: Data were collected online from 110 participants at baseline and again 30 days later. Associations between parent-child relationship, sibling relationships, and child stress and emotion regulation outcomes 30 days later were tested through multiple stepwise regression. Results: Both significant regression models suggest that parent-child conflict is the strongest predictor of child stress and negativity over the 30-day assessment period. Sibling conflict predicted child stress but not negativity. Conclusion: Family conflict during the COVID-19 pandemic influenced children's emotion regulation outcomes as seen through significant associations between child-parent conflict, sibling conflict, perceived child stress, and children's negativity. Implications: Family scientists and practitioners should consider interventions that help parents teach their children how to cope with their own stresses and emotions after conflict.

Effects of Parental Acceptance-Rejection on Children's Internalizing and Externalizing Behaviors: A Longitudinal, Multicultural Study.

Background: Grounded in interpersonal acceptance-rejection theory, this study assessed children's (N=1,315) perceptions of maternal and paternal acceptance-rejection in nine countries (China, Colombia, Italy, Jordan, Kenya, the Philippines, Sweden, Thailand, and the United States) as predictors of children's externalizing and internalizing behaviors across ages 7-14 years. Methods: Parenting behaviors were measured using children's reports on the Parental Acceptance-Rejection Questionnaire. Child externalizing and internalizing behaviors were measured using mother, father, and child reports on the Achenbach System of Empirically-Based Assessment. Results: Using a multilevel modeling framework, we found that in cultures where both maternal and paternal indifference/neglect scores were higher than average-compared to other cultures -children's internalizing problems were more persistent. At the within-culture level, all four forms of maternal and paternal rejection (i.e., coldness/lack of affection, hostility/aggression, indifference/neglect, and undifferentiated rejection) were independently associated with both externalizing and internalizing problems across ages 7-14 even after controlling for child gender, parent education, and each of the four forms of parental rejection. Conclusions: Results demonstrate that the effects of perceived parental acceptance-rejection are panculturally similar.

Mothers' resolution of their young children's psychiatric diagnoses: associations with child, parent, and relationship characteristics.

Maternal resolution of a child's diagnosis relates to sensitive caregiving and healthy attachment. Failure to resolve is associated with maternal distress, high caregiving burden, and the quality of marital and social support. This study examined maternal resolution of diagnosis in a child psychiatric population utilizing the Reaction to Diagnosis paradigm. Thirty-three mothers of children ages 2­7 years with psychiatric disorders were interviewed using the Reaction to Diagnosis Interview. Slightly over half of the sample was classified as resolved. Associations between maternal resolution status, maternal depression, childrearing stress, and child functioning were examined and a predictive model for maternal resolution status was tested. Specific findings included a significant association between childrearing stress and maternal resolution status with support for some additional predictive power for maternal depression on resolution status. Child functioning was not significantly associated with resolution status, and may exert influence indirectly through its association with childrearing stress. There were no significant associations between maternal or child demographic characteristics and maternal resolution status. Clinical and research implications are discussed.

The promise of primary prevention home visiting programs: a review of potential outcomes.

Home visitation (HV) is a promising service delivery model, despite a history of mixed documented results. Compiling results on the promising family and child development outcomes in the HV literature has utility for current programs and those under development. We review traditional outcomes (e.g., child maltreatment prevention) from the literature on HV, but we also present nontraditional outcomes (e.g., community connection) that may be relevant for future evaluations. Programs that document their implementation and study their outcomes through a thoughtful, planned process may capture important and much needed information on strengthening families through HV.

Professionals' decision-making about out-of-home placements following instances of child abuse.

OBJECTIVE: The goal of this research was to study how different groups of child welfare professionals prioritize and use information to make placement decisions following instances of child abuse. METHOD: A total of 90 juvenile court judges and guardians ad litem, Court Appointed Special Advocates (CASA), social workers, and mental health professionals responded to a detailed questionnaire describing four case studies of child physical abuse in which a parent was the perpetrator, the child was either 2 years or 6 years of age, and the abuse was either first time or chronic. Participants rated the impact of specific pieces of information regarding child, family, and system-level characteristics on their decision-making process. RESULTS: Analyses of reactions to these vignettes demonstrate that professional groups use different kinds of information when making decisions about foster care placements. Social workers and mental health providers rely on information about the severity and pattern of abuse and on information about services offered in the past and parental responses to those services. Judges and guardians ad litem rely more heavily on information about the likelihood of a reoccurrence of abuse and the child's ability to recount the abuse, whereas CASA volunteers rely on information about the stability of the family. CONCLUSIONS: Professional group membership, rather than factors such as age or ethnicity of the child or chronicity of abuse, accounts for different patterns of prioritizing and using information when making decisions about whether a child should remain in the home or be placed in foster care. The implications for community-based training and intervention efforts are discussed.

The teaching of primary prevention: concluding thoughts and a call to action.

Commentary is provided on the papers in this special issue on the teaching of primary prevention. We present further thoughts on prevention curricula, and we conclude with the need to elevate the importance of prevention training within our professional organizations.

Intervention type matters in primary prevention of abusive head injury: event history analysis results.

PURPOSE: The current study sought to compare interventional materials intended to raise public awareness of the caregiving practices connected to Shaken Baby Syndrome (SBS). Two hundred and sixty four adults (mean age 32 years) were recruited for participation through convenience sampling at a large Northeastern university. Participants fell into two groups-those who regularly cared for children (46%) and those who did not (54%). METHODS: SBS awareness was surveyed prior to an educational intervention and at three times points (2, 6, and 12 weeks post-intervention) longitudinally. Three intervention levels were used: Two different video conditions, each with an informational brochure, and the brochure-only condition. Survey responses were combined into five factor scores. Changes in factor score over time were modeled using event history analysis to predict the conditional probability of change in awareness as a discreet event. RESULTS: The resulting models show consistent results for three of the five factors, predicting the highest likelihood of increased awareness for a teaching video intervention, followed by a testimonial video, and the lowest probability for increased awareness for the use of an intervention using only a brochure. Negative change, or decreased awareness, was not predicted by the type of intervention materials. Demographic variables were not significant predictors of either positive or negative change. CONCLUSION: The results indicate that the addition of video materials, and in particular material focusing on teaching alternative behaviors, significantly increases the likelihood of positive changes in SBS awareness over interventions which use only a brochure. IMPLICATIONS FOR PRACTICE OR RESEARCH: The present study uses a two by three design to describe levels of improved awareness of Shaken Baby Syndrome across two groups of participants (those who regularly care for children and those who do not) and type of educational material (a brochure versus two different videos each in combination with the brochure). Results show a differential effect for each intervention level, and indicate a need for careful selection of educational materials for intervention programs concerned with preventing SBS through public awareness.

Development and preliminary validation of the caregiving behavior system: association with child attachment classification in the preschool strange situation.

The Marvin and Britner system for classifying caregiver behavior patterns in the preschool Strange Situation is presented to complement the Cassidy and Marvin (1992) preschool child-parent attachment classification system. Participants were 110 mothers and their preschool children (aged 2 to 4 years) with medical risks (epilepsy or mild cerebral palsy) or no diagnosis (i.e., healthy). As coded by reliable, independent raters, there was a highly significant level of concordance between the 5-category caregiver and child classifications in the preschool Strange Situation across the medical risk levels. In comparison to other caregivers, mothers classified as secure in their caregiving behavior pattern were rated as more sensitive; they also showed greater delight and were more supportive of their children's exploration. Combinations of the ten, 9-point caregiver rating scales were useful in discriminating among the insecure caregiver patterns.

Child-parent attachment following early institutional deprivation.

Child-parent attachment quality with an adoptive caregiver at age 4 years was examined in a sample of 111 children adopted into the United Kingdom following early severe deprivation in Romania and a comparison group of 52 nondeprived within-United Kingdom adoptees. Findings indicated that, compared with nondeprived adoptees, children who experienced early severe deprivation were less likely to be securely attached and more likely to show atypical patterns of attachment behavior; ordinary forms of insecure attachment were not associated with deprivation. Within the sample of deprived adoptees, there was a dose-response association between duration of deprivation and disturbances in attachment behavior. In addition, a minority of children who experienced severe early deprivation were classified as avoidant, secure, or dependent using conventional classification strategies, despite also exhibiting atypical patterns of attachment behaviors, and this was also more likely among children exposed to prolonged deprivation. The results raise both theoretical and methodological implications for attachment research on very deprived children.