The Association between Treatment Components and Mental Health Outcomes Among Young Children Exposed to Violence.

Background: When treating violence-exposed children, clinicians often modify psychotherapy protocols or use only a subset of treatment components (e.g., a clinical technique, strategy). However, there is little evidence of the effectiveness of individual treatment components. Our study aimed to determine: i) the best fitting factor structure of individual treatment components; ii) the association of child characteristics (i.e., demographics, treatment dosage, environmental risk factors) with mental health outcomes (i.e., post-treatment internalizing and externalizing symptoms); and iii) the association of individual treatment factors (i.e., sets of treatment components) with mental health outcomes. Methods: A sample of 459 violence-exposed children aged 1.5-5 years was examined. Principal component analyses were conducted to factor-analyze 22 child treatment components and 18 caregiver treatment components, respectively. Multiple linear regression analyses were conducted to determine the relationship between child and caregiver treatment factors and outcomes. Results: Children who received grief work showed significant improvement in externalizing symptoms. Children of caregivers who received parent training, attachment skills building, psychoeducation about domestic violence, safety planning, and anger management training showed significantly less externalizing symptom improvement. Gender, race/ethnicity, and treatment dosage were also associated with outcomes. Conclusion: This is the first study to examine treatment components in a sample of young children exposed to violence with a standardized quantitative measure. Our findings suggest that acknowledging children's loss and sorrow expressed through externalizing behavior and helping them process bereavement may help alleviate their symptoms. Clinical recommendations are discussed.

Brief report of protective factors associated with family and parental well-being during the COVID-19 pandemic in an outpatient child and adolescent psychiatric clinic.

Families of children with mental health challenges may have been particularly vulnerable to emotional distress during the COVID-19 pandemic. This cross-sectional study surveyed 81 parents of children ages 6-17 years receiving mental health treatment in an outpatient clinic during the pandemic. We sought to characterize the impact of the pandemic on family relationships and parental well-being. Additionally, regression and ANCOVA models examined associations between four potentially protective factors-parents' psychological resilience, perceived social support, positive family experiences during the pandemic, and children's use of cognitive or behavioral coping strategies-with family relationships and parental well-being. Findings suggest that families of children with mental health conditions experienced remarkable challenges to family relationships, parental well-being, and parents' perceived capacity to support their children's mental health. Nearly 80% of parents reported a negative impact of the pandemic on their own well-being, and 60% reported reduced ability to support their children's mental health. Simultaneously, protective factors appeared to mitigate the negative impact of the pandemic. Particularly, support within the family (e.g., co-parenting) and from external sources (e.g., mental health services) were associated with better self-reported well-being for parents and their capacity to support their children. Children's use of coping tools, likely enhanced by mental health treatment, was also positively related to better family relationships and parental ability to support children with mental health challenges. Our findings highlight the need for enhancing supports for families at multiple levels including individual skill-building, family-based/parenting support, and community-based support.