Factors Associated with Clinician Participation in TF-CBT Post-workshop Training Components.

For proficiency in an evidence-based treatment (EBT), mental health professionals (MHPs) need training activities extending beyond a one-time workshop. Using data from 178 MHPs participating in a statewide TF-CBT dissemination project, we used five variables assessed at the workshop, via multiple and logistic regression, to predict participation in three post-workshop training components. Perceived in-workshop learning and client-treatment mismatch were predictive of consultation call participation and case presentation respectively. Attitudes toward EBTs were predictive of trauma assessment utilization, although only with non-call participants removed from analysis. Productivity requirements and confidence in TF-CBT skills were not associated with participation in post-workshop activities.

Low-Level Symptoms of Depression in Mothers of Young Children are Associated with Behavior Problems in Middle Childhood.

OBJECTIVES: Examine the association between mothers' low- and high-level depressive symptoms in early childhood and children's behavior problems in middle childhood. METHODS: We used data from 1844 families in a multi-site, longitudinal study beginning when children were 14 months and continuing to age 11 years. Children's internalizing and externalizing behavior problems at age 11 were assessed using the child behavior checklist for ages 6-18. Mothers' scores on the Center for Epidemiological Studies-Depression Scale when children were 14 months were used to classify them into three groups: 'no depressive symptoms', 'low-level depressive symptoms (below the clinical cut-off)' and 'clinically significant depressive symptoms (above the clinical cut-off).' RESULTS: Mothers were racially/ethnically diverse, including Caucasian (38.9 %), African-American (34.4 %), Hispanic (21.6 %), or other (5.1 %). More than one-third (39.2 %) were teenaged mothers, and 46.0 % did not complete high school. Of the 1844 families, 1172 had age 11 child outcome data. Logistic regression analyses controlling for family demographics revealed a significant association between early maternal depressive symptoms and later child behavioral outcomes. Both low level and clinically significant symptoms were associated with internalizing and externalizing behavior problems. For example, children whose mothers had low-level depressive symptoms were twice as likely to have clinically elevated internalizing problems compared with children whose mothers never had symptoms of depression. CONCLUSIONS: Children whose mothers experience low-level depressive symptoms early in their development have increased risk for later behavioral problems, suggesting a possible need for new screening and intervention strategies for mothers with lower than clinically elevated symptoms.

Promoting adolescent behavioral adjustment in violent neighborhoods: supportive families can make a difference!

This study examined the moderating effects of family cohesion on the relationship between community violence and child internalizing and externalizing problems at age 18. The study sample consisted of 728 children and families who were part of the Infant Health and Development Program, an intervention study for low-birthweight, preterm infants. Six of eight sites in the Infant Health and Development Program were in large metropolitan areas; two served rural and urban areas. About half of the sample was African American. Research teams collected data from caregivers multiple times in the first 3 years of the target child's life, and at 4, 5, 6½, 8, and 18 years. Caregivers reported on community violence, neighborhood problems with (a) drug users/sellers; (b) delinquent gangs; and (c) crime, assaults, and burglaries reports when children were 4, 5, and 8 years of age. Family cohesion was assessed twice, at ages 6½ and 8 years, using caregiver reports on the Family Environment Scale. Adolescent self-report of Internalizing and Externalizing Behavior Problems at age 18 were assessed using the Behavior Problems Index. In this study, the association between adolescent psychosocial outcomes and community violence were moderated by family cohesion and gender such that being in a highly cohesive family as a child protected male children from the negative effects of community violence. Findings demonstrate the long-term protective effects of family cohesion on child behavioral development for male children but suggest a need to examine additional supports for females exposed to community violence during childhood.

Child and family factors associated with teacher-reported behavior problems in young children of substance abusers.

BACKGROUND: We examined child and family factors associated with teacher-reported behavior problems in 79 children of substance abusers (COSAs). METHOD: Using regression models, we examined the impact of four family risk factors, cumulatively and individually, on children's behavior and explored children's engagement of adults as a protective factor. RESULTS: More than half (55%) of children had clinically elevated behavior problems. Cumulative family risks were associated with increased problems, whereas the presence of a father in the home and the child's ability to engage adults were protective. CONCLUSIONS: These findings may help explain the variation in behavioral outcomes of COSAs.

Effects of home visiting on adolescent mothers' parenting attitudes.

We examined the impact of a home visiting intervention on 227 adolescent mothers' parenting attitudes. At enrollment, half of mothers were at risk for child maltreatment. Mothers assigned to intervention (n = 161) received home visits and case management. Intervention and comparison mothers (n = 66) participated in monthly peer group meetings. Regression analyses controlling for enrollment differences indicated that intervention group mothers had significant improvements in 3 of 5 subscales and in total Adult-Adolescent Parenting Inventory-2 scores relative to the comparison group.

Improved classroom quality and child behavior in an Arkansas early childhood mental health consultation pilot project.

The aim of the current study was to examine the effects of early childhood mental health consultation (ECMHC) on teacher-level and child-level outcomes in the context of a partnership between community mental health centers in three regions of Arkansas and publically funded early education programs (14 intervention sites and 4 comparison sites). From 2005 to 2008, 193 teachers participated in the study, along with 1,448 children. Data-collection activities included structured classroom observations, teacher ratings of children's strengths and behavior, and teacher surveys to assess satisfaction with ECMHC services. Results suggest that teachers were highly satisfied with the consultation services and that teachers receiving the intervention had lower levels of permissiveness and detachment, with a trend toward higher levels of sensitivity in interactions with children in their classroom. In terms of child outcomes, we found that by the third year of the project, children at intervention sites were rated by their teachers as having fewer behavior problems and more protective factors.

Triple risk: do difficult temperament and family conflict increase the likelihood of behavioral maladjustment in children born low birth weight and preterm?

OBJECTIVE: This study examined the impact of family conflict on internalizing and externalizing behavior at age 8 for children born low birth weight (LBW) and preterm (PT), with specific attention to the moderating role of early temperament. METHODS: The sample included 728 families enrolled in the longitudinal study of the Infant Health and Development Program. The study relied on maternal reports of child temperament at age 1, family conflict at age 6(1/2) years and 8 years, and child behavior at age 8 years. RESULTS: Children exposed to high levels of family conflict had more internalizing problems. Child temperament assessed in infancy moderated the impact of family conflict on externalizing but not internalizing problem behavior. DISCUSSION: LBW/PT children with a difficult temperament are more at risk for poor developmental outcomes, such as externalizing behavior problems, when exposed to family conflict than children with a less difficult temperament.

Maternal substance abuse and children's exposure to violence.

This article focuses on exposure to violence and violence-related activities (i.e., crime and drug use) in 70 children whose mothers are addicted to alcohol or other drugs and explores maternal characteristics associated with violence exposure. Results suggest that exposure to violence is relatively common for these children, with many exposed to repeated violence in both the home and community. Findings also suggest higher levels of exposure to violence among children whose mothers reported fewer symptoms of posttraumatic stress disorder and held beliefs and attitudes about child rearing that have been associated with abusive and neglectful parenting. Levels of violence exposure were also higher when mothers reported more severe drug use in the recent past. These findings point to the need for assessment and treatment for children whose mothers abuse alcohol and other drugs.

Assessing adverse experiences from infancy through early childhood in home visiting programs.

The general aim of early intervention and home visiting programs is to support families to minimize Adverse Childhood Experiences (ACEs). However, assessing children's exposure to these risks is complicated because parents serve as the conduit for both measurement and intervention. The primary aims of the study were to develop an assessment of children's exposure to ACEs and to examine concurrently measured parental child abuse and neglect potential and child social-emotional functioning. Home visiting programs in a southern state implemented the Family Map Inventories (FMI) as comprehensive family assessment and child screenings (N=1,282) within one month of enrollment. Children (M=33 months of age, SD=20) were exposed at rates of 27% to one, 18% to two, 11% to three, and 12% to four or more FMI-ACEs. FMI-ACEs were associated with increased parental beliefs and behaviors associated with child abuse and neglect. FMI-ACEs also significantly predicted the likelihood of the child having at-risk social-emotional development; children with 4 or more FMI-ACEs were over 6 times more likely than those with none to have at-risk scores. The findings add to our understanding of the negative impact of trauma on children and families. Assessing these risks as they occur in a family-friendly manner provides a platform for early intervention programs to work with families to increase family strengths and reduce the impacts of adverse experiences for their children.

Buffering the negative effects of maternal alcohol problems on child behavior.

Our objective was to examine how mothers' warmth can protect children from the negative effects of maternal alcohol problems on children's externalizing behavior and, alternately, how harsh parenting can exacerbate the problem. We used data from 1,563 families eligible for Early Head Start and assessed when children were age 5 and again at age 11. We examined whether mothers' warmth or harsh parenting at age 5 moderated the effect of maternal alcohol problems on children's behavior problems at age 11. Results indicated that mothers' symptoms of alcohol problems when children were age 5 predicted greater externalizing behavior problems (aggression and rule breaking) when children were age 11. Aggression and rule-breaking behaviors, externalizing behaviors commonly associated with maternal alcohol problems, were lessened when mothers were warm and did not engage in harsh parenting techniques. Our findings highlight the importance of positive parenting techniques in high-risk families.

Low-level depressive symptoms reduce maternal support for child cognitive development.

OBJECTIVE: The objective of this study was to examine the relationship between low-level depressive symptoms in mothers and their support for child cognitive development. METHODS: Participants included 913 low-income mothers of preschool-age children who were screened for maternal depression and interviewed about support for learning in the child's home environment. RESULTS: Of the 770 mothers in the analysis, 21.5% reported low-level depressive symptoms (below the cutoff on the screening tool indicating clinically elevated symptoms). Logistic regression analyses revealed that children of mothers with low-level depressive symptoms were significantly less likely to experience six of seven types of support for learning compared with children of mothers with no depressive symptoms. CONCLUSIONS: Results suggest that children whose mothers experience even low-level depressive symptoms are less likely to receive important supports for cognitive development and school readiness, pointing to the need for screening and interventions to address maternal depression at all levels of severity.

Maternal low- and high-depressive symptoms and safety concerns for low-income preschool children.

OBJECTIVES: Our objective was to examine the relationship between low- and high-level depressive symptoms in mothers' and children's risks in the areas of home and car safety, monitoring, and exposure to violence. METHODS: Participants included 978 mothers of preschool-age children who were interviewed about their home environment and screened for maternal depression. RESULTS: Whereas only 5.7% scored at high depressive levels on the screen, another 21.3% scored at low depressive levels. Logistic regression analyses controlling for demographics revealed that children were significantly more likely to experience home safety risks in 6 of 7 areas when mothers reported either low or high levels of depressive symptoms. CONCLUSIONS: Results suggest that children whose mothers experience even low-level depressive symptoms are at increased risk for safety problems in the home environment, pointing to the need for screening and interventions to reduce the risk of injury.

Growing up in violent communities: do family conflict and gender moderate impacts on adolescents' psychosocial development?

This study examined the moderating effects of family conflict and gender on the relationship between community violence and psychosocial development at age 18. The study sample consisted of 728 children and families who were part of the Infant Health and Development Program study of low-birth-weight, pre-term infants. In this sample, adolescent psychosocial outcomes were predicted by community violence differently for male and female children and based on their experiences of conflict at home. For male children, being in a high conflict family as a child exacerbated the negative effects of community violence such that internalizing problems (depression and anxiety) and risk-taking behaviors increased as community violence increased, while being in a low conflict family protected the child against the negative impacts of the community. For female adolescents, there were no moderating effects of family conflict on the relationship between community violence and externalizing problems. Moderating effects for internalizing problems demonstrated that being in low conflict families did not serve as protection against community violence for girls as was demonstrated for boys. These findings demonstrate the long-term effects of community violence on child development, highlighting the importance of gender and family context in the development of internalizing and externalizing problems.