Anti-Racism Strategies in Pediatric Psychology: Using STYLE Can Help Children Overcome Adverse Experiences With Police.

Black children are exposed to police violence at alarming rates. Such stress impacts development and treatment of physical health problems. In the current discourse, we introduce STYLE (Self-examination, Talk about community-police relations and racism, Yield space and time to anti-racism work, Learn about how structural racism impacts child health, Evaluate policies and practices through an anti-racism lens). STYLE offers a framework through which professionals in pediatric psychology can engage in anti-racist work across contexts from clinical care to academic and advocacy settings. Pediatric psychologists have a responsibility to be on the frontline as interventionists, educators, researchers, organizers, and advocates for racial justice through anti-racism practices. The current paper introduces STYLE in clinical care, community service, training/supervision, and academic and advocacy contexts. Case examples are provided. Professionals in pediatric psychology must first focus on changing their STYLE to promote individual and infrastructural change consistent with anti-racism work.

Optimizing Medical-Legal Partnerships in Pediatric Psychology to Reduce Health Disparities.

OBJECTIVE: To provide a topical review of the literature on the use of medical-legal partnerships (MLPs) to address social determinants of health (SDH) needs as a means to reduce health disparities, and to make recommendations for the implementation of MLPs within pediatric psychologists' clinical work, research, and training. METHODS: We conducted a topical review of the research on the intersection of MLPs, SDH needs, and health disparities among pediatric populations. Given the scarcity of literature available, both empirical and theoretical articles were included in the review. RESULTS: Though limited, the extant literature suggests that use of MLPs may help address the SDH needs that perpetuate disparities among pediatric populations. To date, MLPs are not as frequently incorporated in the training and work of pediatric psychologists as they may be in other related fields (e.g., medicine). CONCLUSIONS: MLPs provide an opportunity for psychologists to broaden their interdisciplinary collaborations, to more aptly meet the social and legal needs of their patients to assist in reducing inequities among underserved pediatric populations. The systematic incorporation of MLPs into pediatric psychology training may help to increase the utilization of these services moving forward.

A cidade e a infância: possibilidades da saúde mental na atenção básica / The city and the childhood: mental health care possibilities in primary care / La ciudad y la infancia: posibilidades de salud mental en atención primaria

Este estudo se configura como um relato de experiência sobre o encontro entre infância e Atenção Primária à Saúde, a partir do trabalho em uma Unidade de Saúde da Família do município de Porto Alegre, por meio do núcleo profissional da psicologia. Essa vivência faz parte do percurso formativo do Programa Atenção Básica da Residência Integrada em Saúde da Escola de Saúde Pública do Estado do Rio Grande do Sul. A partir do encontro com as demandas relativas à saúde mental de crianças nesse contexto, que frequentemente se apresentavam como questões individuais, comportamentais, e carregavam expectativa de correção, buscou-se problematizar as lógicas de cuidado em tensionamento nesse cenário, considerando a realidade do cotidiano de trabalho. Sobretudo, buscou-se problematizar as possibilidades de acompanhamento de crianças, para além do encaminhamento, na atenção primária em saúde. Para tal, apresentamos concepções ampliadas com relação à infância, considerando que esse período não trata apenas de um corpo orgânico em desenvolvimento, mas também de um sujeito em constituição. Assim, como possibilidade de intervenção com as crianças na Atenção Básica, utilizou-se um dispositivo grupal que se mostrou uma potente estratégia de acolhimento e de envolvimento da equipe na escuta das questões da infância na Unidade de Saúde.(AU)

This study is a report about the intersection of childhood and Primary Health Care based experience, in a Family Health Unit in the municipality of Porto Alegre, based on the Psychology professional center. This experience is part of the educational path at the Primary Care Program of the Integrated Health Residency from the Public Health School of the state of Rio Grande do Sul. From the Mental Health demands of children in this context, which often presented themselves as individual, behavioral issues, and carried an expectation of being corrected, we sought to problematize the logics of care in tension in this scenario, considering the reality of the everyday job. Above all, we aimed to problematize the possibilities of follow up on the children, beyond the referral, in Primary Care. To this end, we presented expanded conceptions regarding childhood, considering that, this period is not just about a developing organic body, but also a subject in constitution. Thus, as a possibility of intervention with children in Primary Care, the use of group device proved to be a powerful strategy for welcoming and involving the team in listening to childhood issues in the Health Unit.(AU)

Este estudio es un reporte de experiencia sobre el encuentro entre la infancia y la Atención Primaria de Salud, a partir del trabajo en una Unidad de Salud Familiar en la ciudad de Porto Alegre, a través del núcleo profesional de Psicología. Esta experiencia es parte del curso de especialización del Programa de Atención Primaria de la Residencia Integrada en Salud de la Escuela de Salud Pública del Estado de Rio Grande do Sul (ESP / RS). A partir del encuentro con las demandas relacionadas con la Salud Mental de los niños en este contexto, que a menudo se presentaron como problemas de comportamiento individuales y tenían la expectativa de corrección, buscamos problematizar la lógica de la atención en tensión en este contexto, considerando la realidad de la vida cotidiana de trabajo. Sobre todo, buscamos problematizar las posibilidades de acompañar a los niños, además de la derivación, en Atención Primaria de Salud. Con este fin, presentamos conceptos ampliados en relación con la infancia, considerando que este período no es solo un cuerpo orgánico en desarrollo, pero también de un sujeto en constitución. Así, como una posibilidad de intervención con niños en Atención Primaria, se utilizó un dispositivo grupal, que resultó ser una potente estrategia para acoger e involucrar al equipo en la escucha de los problemas de la infancia en la Unidad de Salud.(AU)

Clinical, financial and social impacts of COVID-19 and their associations with mental health for mothers and children experiencing adversity in Australia.

BACKGROUND: Australia has maintained low rates of SARS-COV-2 (COVID-19) infection, due to geographic location and strict public health restrictions. However, the financial and social impacts of these restrictions can negatively affect parents' and children's mental health. In an existing cohort of mothers recruited for their experience of adversity, this study examined: 1) families' experiences of the COVID-19 pandemic and public health restrictions in terms of clinical exposure, financial hardship family stress, and family resilience (termed 'COVID-19 impacts'); and 2) associations between COVID-19 impacts and maternal and child mental health. METHODS: Participants were mothers recruited during pregnancy (2013-14) across two Australian states (Victoria and Tasmania) for the 'right@home' trial. A COVID-19 survey was conducted from May-December 2020, when children were 5.9-7.2 years old. Mothers reported COVID-19 impacts, their own mental health (Depression, Anxiety, Stress Scales short-form) and their child's mental health (CoRonavIruS Health and Impact Survey subscale). Associations between COVID-19 impacts and mental health were examined using regression models controlling for pre-COVID-19 characteristics. RESULTS: 319/406 (79%) mothers completed the COVID-19 survey. Only one reported having had COVID-19. Rates of self-quarantine (20%), job or income loss (27%) and family stress (e.g., difficulty managing children's at-home learning (40%)) were high. Many mothers also reported family resilience (e.g., family found good ways of coping (49%)). COVID-19 impacts associated with poorer mental health (standardised coefficients) included self-quarantine (mother: ß = 0.46, child: ß = 0.46), financial hardship (mother: ß = 0.27, child: ß = 0.37) and family stress (mother: ß = 0.49, child: ß = 0.74). Family resilience was associated with better mental health (mother: ß = -0.40, child: ß = -0.46). CONCLUSIONS: The financial and social impacts of Australia's public health restrictions have substantially affected families experiencing adversity, and their mental health. These impacts are likely to exacerbate inequities arising from adversity. To recover from COVID-19, policy investment should include income support and universal access to family health services.

He knew more than we wanted him to know: Parent perceptions about their children's sense of pediatric cancer-related financial problems.

BACKGROUND: Treatment for pediatric cancer generates costs that place sizeable demands on family finances relative to household income. Little is known about whether children sense that their cancer has created financial problems for the family. The study purpose was to describe parents' perceptions about whether their child sensed that pediatric cancer created financial problems for their family. PROCEDURE: Family Communications Theory informed our study. We used descriptive statistics and content analysis to examine parents' (n = 417) responses to questions about the child's sense of pediatric cancer-related financial problems from a larger survey study. RESULTS: Approximately 56.2% of parents indicated that their child had no sense of the pediatric cancer-related financial problems and 44.1% indicated their child had some. Proportions of children perceived to sense these financial problems steadily increased with age grouping, while proportions perceived to have none declined. With content analysis, we identified cognitive capacity as the key child factor influencing children's sense of these problems. Influential context factors included social norms, observed changes in family routines and spending patterns, and overheard conversations between adults. Child psychological outcomes included guilt, anxiety about money, and feelings of being a burden. CONCLUSION: Pediatric oncology professionals and staff should be mindful of parent preferences about burdening children with sensitive financial information, and modify their behaviors and processes accordingly. They can also provide anticipatory guidance and psycho-education about psychological responses related to the effects of pediatric cancer on family finances and the role of cognitive development in the evolution of children's awareness of those effects.

Cognitive flexibility and parental education differentially predict implicit and explicit racial biases in bilingual children.

Prior research has suggested that bilingual children demonstrate reduced social bias relative to their monolingual peers. In particular, they exhibit less implicit bias against racial outgroups. However, the cognitive determinants of racial bias in bilingual children remain unclear. In the current study, relationships between racial bias and three cognitive factors (inhibitory control, cognitive flexibility, and perspective-taking ability), along with language proficiency and parental education, were investigated in a sample of bilingual preschoolers (N = 55). Children were bilingual learners of English and Mandarin. Results demonstrated that implicit bias was predicted by cognitive flexibility, independent of variation in inhibitory control, second language vocabulary, perspective taking, and parental education. In contrast, explicit bias was predicted by parental education alone and not by cognitive or linguistic factors. Findings suggest that increased cognitive flexibility, often thought to be an outgrowth of bilingual experience, may also be associated with a reduction in implicit bias. Findings are discussed in terms of specific mechanisms that may link cognitive factors, bilingualism, and racial bias.

Justice Sensitivity in Middle Childhood: Measurement and Location in the Temperamental and Social Skills Space.

Research suggested that justice sensitivity (JS)-the tendency to perceive and negatively respond to injustice-may already manifest in middle childhood, but empirical evidence is sparse. We, therefore, examined the measurement of JS in this age range and its associations with prosocial behavior, aggressive behavior, temperamental traits, and social skills. We had 361 children between 6 and 10 years of age and/or their parents rate the children's JS and its potential correlates. We replicated the JS-factor structure with three correlated subscales in both child and parent-ratings that showed strict measurement invariance. In line with previous findings in older age groups, victim JS positively predicted aggressive and negatively predicted prosocial behavior, whereas observer and perpetrator JS positively predicted prosocial and perpetrator JS negatively predicted aggressive behavior. The JS perspectives showed expected links with temperamental traits. All three subscales were positively related to empathy and theory of mind, but victim JS was negatively related to affective self-regulation. Findings suggest that interpersonal differences in JS may reliably and validly be measured in middle childhood and that JS is associated with aggressive and prosocial behavior already in childhood. Thus, future research should consider the role of JS for moral and personality development and developmental psychopathology.

[Parenting capacity: Definitions, indicators, and assessment]. / Elterliche Erziehungsfähigkeit: Definitionen, Indikatoren und Erfassungsmöglichkeiten.

Parenting capacity: Definitions, indicators, and assessment Abstract. Parenting capacity is a broadly defined term that refers to the ability of parents to meet their children's needs. The assessment of parenting capacity is crucial to child-protection concerns and often an essential task in psychological evaluations for family law proceedings. Despite the relevance of the construct as a factor influencing child development and its frequent use in normative legal decisions, there is little consensus in the psychological literature regarding the definition of the construct. This literature review identifies, analyzes, and systemizes the national and international definitions of parenting capacity and the associated indicators. Following a comprehensive literature search, we included the work of 12 authors in this analysis. After checking for overlaps in content, we were able to categorize 58 indicators of parenting capacity into 29 different groups of indicators. The literature review also identifies German instruments that assess the construct of parenting capacity and its limitation. No instrument exists in the German literature which explicitly measures the parenting capacity as a construct. We did, however, identify five instruments that measure related constructs. We evaluated these instruments for their psychometric quality and their applicability in the context of psychological evaluation in family law. We discuss the diagnostic relevance of the identified definitions and indicators of parenting capacity as well as the practicality of the assessment instruments for psychological evaluations in family law proceedings.

Protocolo preventivo da terapia de regulação infantil: estudo piloto no ambiente escolar / Preventive protocol of terapia de regulação infantil: pilot study in the school environment / Protocolo preventivo de terapia de regulação infantil: estudio piloto en el entorno escolar

A qualidade da educação relaciona-se com o investimento na aprendizagem acadêmica e com o desenvolvimento socioemocional dos alunos. Esse artigo objetiva avaliar os efeitos do protocolo preventivo da Terapia de Regulação Infantil (TRI-P) nas habilidades socioemocionais de crianças. A TRI-P tem como propósito desenvolver competências emocionais e sociais nas escolas. Utilizou-se delineamento quasi-experimental com avaliação pré e pós teste. Participaram 28 crianças de sete a nove anos, estudantes de uma escola particular no interior do Rio Grande do Sul. Aplicou-se as escalas Social Skills Rating System para a avaliação de habilidades sociais e comportamentos problemáticos e Emotional Regulation Checklist para avaliar regulação e labilidade emocional. Os resultados, após intervenção, apontam diminuição nos níveis de problema de comportamento e aumento nos escores de regulação emocional e habilidades sociais. Percebe-se que a implementação de programas de habilidades socioemocionais pode ser promissora frente à importância do cuidado com saúde mental no ambiente escolar.

The quality of education is related to the investment in students' academic learning and socio-emotional development. This article aims to evaluate the effects of the preventive protocol of Terapia de Regulação Infantil: (TRI-P) on children's socioemotional skills. TRI-P aims to develop socioemocional skills in schools. A quasi-experimental design with pre and posttest evaluation was used. Twenty-eight children from 7 to 9 years old, students from a private school in a country town of Rio Grande do Sul, participated in the study. The Social Skills Rating System scales were used to assess social skills and problem behaviors, and the Emotional Regulation Checklist to evaluate regulation and emotional lability. The results, after the intervention, indicated a decrease in behavior problem levels and an increase in emotional regulation and social skills scores. The implementation of socioemotional skills programs can be promising considering the importance of mental health care in the school environment.

La calidad de la educación está relacionada con la inversión en el aprendizaje y el desarrollo socioemocional de los estudiantes. Este artículo tiene como objetivo evaluar los efectos del protocolo de la terapia de regulación infantil (TRI-P) en habilidades socioemocionales de los niños. TRI-P tiene como objetivo desarrollar habilidades emocionales y sociales en las escuelas. Se utilizó un diseño cuasiexperimental con evaluación previa y posterior a la prueba. Veintiocho niños de 7 a 9 años de una escuela privada participaron en el estudio. Las escalas Social Skills Rating System se utilizaron para evaluar habilidades sociales y comportamientos problemáticos, la Emotional Regulation Checklist para evaluar regulación y labilidad emocional. Los resultados indican una disminución en los niveles de problemas de conducta y aumento en la regulación emocional y los puntajes de habilidades sociales. La implementación de programas de habilidades socioemocionales puede ser prometedora.

Associations between individual variations in visual attention at 9 months and behavioral competencies at 18 months in rural Malawi.

Theoretical and empirical considerations suggest that individual differences in infant visual attention correlate with variations in cognitive skills later in childhood. Here we tested this hypothesis in infants from rural Malawi (n = 198-377, depending on analysis), who were assessed with eye tracking tests of visual orienting, anticipatory looks, and attention to faces at 9 months, and more conventional tests of cognitive control (A-not-B), motor, language, and socioemotional development at 18 months. The results showed no associations between measures of infant attention at 9 months and cognitive skills at 18 months, either in analyses linking infant visual orienting with broad cognitive outcomes or analyses linking specific constructs between the two time points (i.e., switching of anticipatory looks and manual reaching responses), as correlations varied between -0.08 and 0.14. Measures of physical growth, and family socioeconomic characteristics were also not correlated with cognitive outcomes at 18 months in the current sample (correlations between -0.10 and 0.19). The results do not support the use of the current tests of infant visual attention as a predictive tool for 18-month-old infants' cognitive skills in the Malawian setting. The results are discussed in light of the potential limitations of the employed infant tests as well as potentially unique characteristics of early cognitive development in low-resource settings.

The relationship between integrated pediatric psychology and primary care visit length, revenue, content over 24 months.

Introduction: Integrating behavioral health providers into pediatric primary care to provide behavioral health (BH) services is both effective and efficient; however, the impact of pediatric integrated services on the operational and financial outcomes of primary care provider (PCP) visits has not been thoroughly investigated. The present study examined whether length of practice integration predicts the relationship between BH content addressed in a PCP visit, visit length, and revenue generation. Method: A total of 1,209 pediatric encounters with 25 PCPs across 7 primary care offices in a predominantly rural health system were abstracted for the presence or absence of BH content, visit length, duration of integration, and revenue. χ2 analyses and the generalized linear model framework were used to address the study objectives. Results: Integration was associated with more PCP visits with a BH topic discussed at 6-11 months of integration but not at 14-24 months. Visits with a BH topic were longer than medical-only visits and shorter when a practice was integrated for 6-11 months but not at 14-24 months of integration. Public insurance and integration were associated with lower revenue generation per minute. Visit content was not associated with PCP revenue. Discussion: Results suggest a relationship between integration and the operational and financial outcomes of PCP visits. This study shows that initial efficiencies or improvements (e.g., time, cost, content) associated with integrating BH may be lost over time. Future studies should evaluate sustainability in relation to program impact. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

State Insurance Mandates and the Workforce for Children With Autism.

BACKGROUND: State mandates have required insurance companies to provide coverage for autism-related child health care services; however, it has not been determined if insurance mandates have improved the supply of child health care providers. We investigate the effect of state insurance mandates on the supply of child psychiatrists, pediatricians, and board-certified behavioral analysts (BCBAs). METHODS: We used data from the National Conference of State Legislatures and Health Resources and Services Administration's Area Health Resource Files to examine child psychiatrists, pediatricians, and BCBAs in all 50 states from 2003 to 2017. Fixed-effects regression models compared change in workforce density before versus one year after mandate implementation and the effect of mandate generosity across 44 US states implementing mandates between 2003 and 2017. RESULTS: From 2003 to 2017, child psychiatrists increased from 7.40 to 10.03 per 100 000 children, pediatricians from 62.35 to 68.86, and BCBAs from 1.34 to 29.88. Mandate introduction was associated with an additional increase of 0.77 BCBAs per 100 000 children (95% confidence interval [CI]: 0.18 to 1.42) one year after mandate enactment. Mandate introduction was also associated with a more modest increase among child psychiatrists (95% CI: 0.10 to 0.91) and was not associated with the prevalence of pediatricians (95% CI: -0.76 to 1.13). We also found evidence that more generous mandate benefits were associated with larger effects on workforce supply. CONCLUSIONS: State insurance mandates were associated with an ∼16% increase in BCBAs from 2003 to 2017, but the association with child psychiatrists was smaller and nonsignificant among pediatricians. In these findings, it is suggested that policies are needed that specifically address workforce constraints in the provision of services for children with autism spectrum disorder.

Introduction to the Special Issue: Addressing Health Disparities in Pediatric Psychology.

This introduction to the special issue on Addressing Health Disparities in Pediatric Psychology provides context for why this special issue is needed, reviews key findings of the accepted articles, and discusses future directions for advancing the field. This special issue, one of three on this topic area that has been put forth in the history of this journal, comes at a critical point in our world. This is a time when the COVID-19 pandemic is systematically infecting Black, Indigenous, and People of Color and when there has been increased attention to systemic racism and intersecting violence inherent in multiple systems, including the justice, health, and educational systems. Using Kilbourne et al. (2016) framework, this special issue focuses on Phase 2 and Phase 3 research. Rather than only identifying health disparities (Phase 1), this issue focuses on understanding mechanisms and translating such understanding into interventions and policy changes. The accepted articles span a wide gamut from obesity to autism to rural populations. Furthermore, the articles provide methods for advancing the field beyond simply noting that systematic differences exist toward strategies to address these inequities. We conclude this introduction by discussing next steps for future research, with hopes that it inspires the next generation to study issues of disparities and inequity in deeper, more meaningful, and impactful ways.

Psychometric properties of the Spanish version of the Ages & Stages Questionnaires: Social-Emotional in a nationally representative sample.

The Ages & Stages Questionnaires: Social-Emotional (ASQ-SE) is a developmental screening test used around the world. However, research assessing the psychometric properties of the Spanish version or in nationally representative samples is scarce. The aim of this study is to evaluate the psychometric properties of ASQ-SE in Spanish, and to characterize the socio-emotional scores by sex and socioeconomic status. We administered the ASQ-SE, the Child Behavior Checklist 1 ½ - 5 and the Ages and Stages Questionnaires (3rd version) to a nationally representative sample of children in Uruguay aged 0-3 years old. A floor effect was observed in most of the age ranges for ASQ-SE, specifically in the questionnaires for younger infants. Internal consistency was acceptable. The sensitivity and specificity of the instrument was good when using cut-off scores based on the sample of this study rather than on the original United States sample. Boys and children of lower socioeconomic status had more socio-emotional problems. ASQ-SE in Spanish presents a uni-factorial structure with adequate internal consistency, sensitivity, specificity, and criterion validity. ASQ-SE has adequate psychometric properties to detect children whose social and emotional development requires further evaluation or continuous monitoring.

Commentary: Reflections on the COVID-19 Pandemic and Health Disparities in Pediatric Psychology.

The COVID-19 (2019 novel coronavirus) pandemic has had a significant economic, social, emotional, and public health impact in the United States. A disturbing trend is that Black, Indigenous, and/or People of Color (BIPOC) are disproportionately contracting coronavirus, as well as dying from COVID-19. Objective/Methods The pandemic has the potential to entrench and magnify existing health disparities and families marginalized across multiple demographic intersections such as race/ethnicity, class, immigration status, are especially vulnerable. These inequities have been further underscored by the recent murders of Black Americans by police and a resulting spotlight on racial injustice in the United States. Results Efforts to lessen the spread of the virus, have resulted in changes in pediatric primary and subspecialty service delivery which may affect access for BIPOC communities. BIPOC trainees including those with debt or caregiving responsibilities may be faced with new barriers resulting in delays in completion of their training. Further, clinical, community-based, and translational research has been disrupted by heightened safety precautions and social distancing which may affect BIPOC representation in research downstream. Conclusion In our roles as clinicians, supervisors, trainees, and researchers in primary and subspecialty care as well as in academia, pediatric psychologists have an ethical responsibility to address the disproportionate burden of this pandemic on vulnerable communities and to allocate our time and resources to ensuring health equity now and in the aftermath of COVID-19.

[Telepsychiatry in adults and adolescents: a useful tool against CoViD-19.] / Telepsichiatria negli adulti e negli adolescenti: uno strumento utile contro la CoViD-19.

CoViD-19 is a disease caused by the novel coronavirus (SARS-CoV-2), originated from China in December 2019. In March 2020, CoViD-19 was declared a pandemic, having spread all over the word. The psychological impact of CoViD-19 disease must be recognized alongside the physical symptoms for all those affected. Furhermore quarantine for coronavirus has serious psychological side effects, such as depression and anxiety that are more likely to occur and worsen. Furhermore quarantine reduces the availability of psychiatric and psychological interventions. The evidence base for telepsychiatry is growing in adults and adolescents. A growing body of literature suggests that use of telepsychiatry to provide mental health services has the potential to remove geographic barriers between patients and providers and improves quality care. It has increased the volume of patients that physicians can reach and diagnose, as well as allowing them to treat patients.

Establishing a Parenting Program for Transnationally Separated Chinese Immigrant Families: Community-Based Pilot Program.

Children who experience transnational separation (TS) from their parents, often referred to as "satellite babies," endure a relatively common but underdiscussed experience. To date, no evaluations of clinical interventions to specifically support transnationally separated families have been described. This column describes implementation of a group therapy pilot program for parents to address parenting and emotional concerns related to TS at a social services agency in Boston's Chinatown. Parent and therapist interviews indicated increased skills in negotiating parental feelings of guilt, shame, and regret caused by TS. These insights can guide practitioners and researchers who wish to address family separation in their communities.