Effects of prenatal opioid exposure on infant sympathetic and parasympathetic nervous system activity.

Prenatal opioid exposure has been associated with developmental problems, including autonomic nervous system dysregulation. However, little is known about the effects of prenatal opioid exposure on the autonomic nervous system beyond the first days of life, particularly across both the parasympathetic and sympathetic branches, and when accounting for exposure to other substances. The present study examined the effects of prenatal exposure to opioid agonist therapy (OAT, e.g., methadone) and other opioids on infant autonomic nervous system activity at rest and in response to a social stressor (the Still-Face Paradigm) at six months among 86 infants varying in prenatal opioid and other substance exposure. Results indicated that OAT and other opioids have unique effects on the developing autonomic nervous system that may further depend on subtype (i.e., methadone versus buprenorphine) and timing in gestation. Results are discussed in the context of theoretical models of the developing stress response system.

Probing the content of affective semantic memory following caregiving-related early adversity.

Cognitive science has demonstrated that we construct knowledge about the world by abstracting patterns from routinely encountered experiences and storing them as semantic memories. This preregistered study tested the hypothesis that caregiving-related early adversities (crEAs) shape affective semantic memories to reflect the content of those adverse interpersonal-affective experiences. We also tested the hypothesis that because affective semantic memories may continue to evolve in response to later-occurring positive experiences, child-perceived attachment security will inform their content. The sample comprised 160 children (ages 6-12 at Visit 1; 87F/73 M), 66% of whom experienced crEAs (n = 105). At Visit 1, crEA exposure prior to study enrollment was operationalized as parental-reports endorsing a history of crEAs (abuse/neglect, permanent/significant parent-child separation); while child-reports assessed concurrent attachment security. A false memory task was administered online ∼2.5 years later (Visit 2) to probe the content of affective semantic memories-specifically attachment schemas. Results showed that crEA exposure (vs. no exposure) was associated with a higher likelihood of falsely endorsing insecure (vs. secure) schema scenes. Attachment security moderated the association between crEA exposure and insecure schema-based false recognition. Findings suggest that interpersonal-affective semantic schemas include representations of parent-child interactions that may capture the quality of one's own attachment experiences and that these representations shape how children remember attachment-relevant narrative events. Findings are also consistent with the hypothesis that these affective semantic memories can be modified by later experiences. Moving forward, the approach taken in this study provides a means of operationalizing Bowlby's notion of internal working models within a cognitive neuroscience framework. RESEARCH HIGHLIGHTS: Affective semantic memories representing insecure schema knowledge (child needs + needs-not-met) may be more salient, elaborated, and persistent among youths exposed to early caregiving adversity. All youths, irrespective of early caregiving adversity exposure, may possess affective semantic memories that represent knowledge of secure schemas (child needs + needs-met). Establishing secure relationships with parents following early-occurring caregiving adversity may attenuate the expression of insecure semantic memories, suggesting potential malleability. Affective semantic memories include schema representations of parent-child interactions that may capture the quality of one's own attachment experiences and shape how youths remember attachment-relevant events.

Is Attachment and Biobehavioral Catch-up effective for parents with insecure attachment states of mind?

Prior research suggests that attachment-based interventions, including Attachment and Biobehavioral Catch-up (ABC), may be less effective at enhancing parenting quality among parents who self-report having an insecure attachment style. The current study tested whether effects of ABC on parental behavior were moderated by categorical and dimensional measures of attachment obtained via Adult Attachment Interviews with 454 parents who were approximately 34 years old, primarily female, and predominantly White or African American. Parents randomized to ABC exhibited higher sensitivity and positive regard, and lower intrusiveness shortly after the intervention than parents randomized to the control intervention (|ß|s = .10-.27). The effect of ABC on intrusiveness persisted 2 years later. Effects at either timepoint were not significantly moderated by parents' attachment representations.

Preliminary examination of the effects of an early parenting intervention on amygdala-orbitofrontal cortex resting-state functional connectivity among high-risk children: A randomized clinical trial.

We examined the long-term causal effects of an evidence-based parenting program delivered in infancy on children's emotion regulation and resting-state functional connectivity (rs-fc) during middle childhood. Families were referred to the study by Child Protective Services (CPS) as part of a diversion from a foster care program. A low-risk group of families was also recruited. CPS-involved families were randomly assigned to receive the target (Attachment and Biobehavioral Catch-up, ABC) or a control intervention (Developmental Education for Families, DEF) before infants turned 2. Both interventions were home-based, manualized, and 10-sessions long. During middle childhood, children underwent a 6-min resting-state functional MRI scan. Amygdala seed-based rs-fc analysis was completed with intervention group as the group-level predictor of interest. Fifty-seven children (NABC = 21; NDEF = 17; NCOMP = 19; Mage = 10.02 years, range = 8.08-12.14) were scanned successfully. The DEF group evidenced negative left amygdala↔OFC connectivity, whereas connectivity was near zero in the ABC and comparison groups (ABCvsDEF: Cohen's d = 1.17). ABC may enhance high-risk children's regulatory neurobiology outcomes ∼8 years after the intervention was completed.

Using randomized controlled trials to ask questions regarding developmental psychopathology: A tribute to Dante Cicchetti.

Dante Cicchetti, the architect of developmental psychopathology, has influenced so many of us in profound ways. One of his many contributions was in demonstrating the power of randomized controlled trials (RCTs) to study the effects of Child-Parent Psychotherapy (CPP). These RCTs have shed light on causal mechanisms in development. Following Cicchetti and colleagues' work, we designed a brief home visiting program, Attachment and Biobehavioral Catch-up (ABC), to help parents respond in sensitive, nurturing ways, so as to enhance children's attachment and self-regulatory capabilities. In the current study, we assessed adolescents' reports of the closeness of their relationships with their mothers 12 years after their mothers completed the intervention. A total of 142 adolescents participated (47 randomized to ABC, 45 randomized to a control intervention, and 50 from a low-risk comparison group). Adolescents whose mothers had been randomized to ABC reported closer relationships with their mothers than adolescents randomized to the control condition, with significant differences seen on approval, support, companionship, and emotional support subscales. Consistent with Cicchetti et al.'s work, these results provide powerful evidence of the long-term effects of an early parenting intervention.

Posttraumatic stress disorder, Veterans Health Administration use, and care-seeking among recent-era U.S. veterans.

The current study investigated the associations among probable posttraumatic stress disorder (PTSD), recent Veterans Health Administration (VHA) health care use, and care-seeking for PTSD in U.S. military veterans. Analyses were conducted among 19,691 active duty military personnel enrolled in the Millennium Cohort Study who separated from the military between 2000 and 2012 and were weighted to the 1,130,103 active duty personnel who separated across this time period. VHA utilization was identified from electronic medical records in the year before survey completion, and PTSD care-seeking and PTSD symptoms were assessed through self-report on the 2014-2016 survey; thus, the observation period regarding care-seeking and VHA use encompassed 2013-2016. Veterans with probable PTSD were more likely to use VHA services than those without probable PTSD, aOR = 1.12, 95% CI [1.01, 1.24], although the strongest association with recent VHA use was a depression diagnosis, aOR = 2.47, 95% CI [2.26, 2.70]. Among veterans with probable PTSD, the strongest predictor of care-seeking was recent VHA use compared to community care, aOR = 4.01, 95% CI [3.40, 4.74); reporting a diagnosis of depression was the second strongest predictor of PTSD care-seeking, OR = 2.99, 95% CI [2.53, 3.54]. However, the absolute number of veterans with probable PTSD who were not seeking care was approximately equivalent between veterans using VHA services and those not using VHA services. Additionally, certain groups were identified as being at risk of not seeking care, namely Air Force veterans and veterans with high physical and mental functioning despite substantial PTSD symptoms.

Emotion dysregulation and reward responsiveness as predictors of autonomic reactivity to an infant cry task among substance-using pregnant and postpartum women.

Maternal substance use may interfere with optimal parenting, lowering maternal responsiveness during interactions with their children. Previous work has identified maternal autonomic nervous system (ANS) reactivity to parenting-relevant stressors as a promising indicator of real-world parenting behaviors. However, less is known about the extent to which individual differences in emotion dysregulation and reward processing, two mechanisms of substance use, relate to maternal ANS reactivity in substance-using populations. The current study examined associations among emotion dysregulation, reward responsiveness, and ANS reactivity to an infant cry task among 77 low-income and substance-using women who were either pregnant (n = 63) or postpartum (n = 14). Two indicators of ANS functioning were collected during a 9 min computerized infant cry task (Crybaby task): respiratory sinus arrhythmia (RSA) and pre-ejection period. Mothers also completed self-reported measures of emotion dysregulation and reward responsiveness. Analyses revealed that trait emotion regulation was associated with RSA reactivity to the Crybaby task, such that greater emotion dysregulation was associated with greater RSA reduction during the infant cry task than lower emotion dysregulation. Reward responsiveness was not significantly associated with either indicator of ANS reactivity to the task. Findings revealed distinct patterns of associations linking emotion dysregulation with ANS reactivity during a parenting-related computerized task, suggesting that emotion regulation may be a key intervention target for substance-using mothers.

Preliminary investigation of objective and subjective experiences of relatives of individuals with hoarding behaviors.

OBJECTIVE: Families of individuals with hoarding symptoms report substantial burden; however, there has been no investigation of potential positive experiences. The objective of this study was to examine the experiences reported by individuals with a relative with elevated hoarding symptoms using a cross-sectional design. The current investigation expands on the literature in this area by incorporating a detailed interview of experiences in conjunction with validated measures of hoarding symptomology. METHODS: Twenty-nine adults with relatives with elevated hoarding symptoms completed self-report measures of hoarding severity for themselves and their relative and a clinician-administered assessment of their experiences with their family member with hoarding symptoms. RESULTS: Participants endorsed significant burden across a range of areas, including permanent changes in their daily routine. The majority (93%) of participants reported at least one positive experience, with 69% endorsing companionship as a benefit of the relationship. Greater symptom severity of the relative with hoarding symptoms was associated with greater subjective burden and decreased positive experiences. CONCLUSION: Our results add further evidence to the potential for interpersonal psychotherapy to lead to a reduction in hoarding symptomology.

An invited commentary on mentoring in infant mental health: A symposium commemorating Robert N. Emde.

This paper is based on a symposium on mentoring in infant mental health that took place at the 18th World Association for Infant Mental Health (WAIMH) conference. The symposium commemorated Robert N. Emde who was one of the founders of the field of Infant Mental Health, and devoted much of his career to mentorship. From an IMH perspective, mentoring experiences are best thought of as relationships, significant for both mentor and mentee, with positive mentoring experiences crucial for the development of IMH clinicians and researchers. The symposium participants, two pairs of mentor-mentee dyads, first gave an opening statement about what mentoring meant for them generally and personally, and then addressed three issues: the goodness of fit between mentor and mentee, "light and shadow" in mentoring relationships, and balancing old wisdom with new trends in mentoring. The paper brings the participants' views and personal experiences regarding these issues in their own words, highlighting key personal and professional issues related to mentorship from the perspectives of both mentor and mentee.

Cet article est basé sur un symposium sur le Mentorat en Santé Mentale de la Petite Enfance qui s'est tenu lors de la 18ème conférence de l'Association Mondiale pour la Santé Mentale de la Petite Enfance (World Association Infant Mental Health ­ WAIMH). Ce symposium a commémoré Robert N. Emde qui fut l'un des fondateurs du domaine de la Santé Mentale de la Petite Enfance et a consacré une large partie de sa carrière au mentorat. Du point de vue de la Santé Mentale de la Petite Enfance les expériences de mentorat sont davantage considérées comme des relations, importantes pour à la fois le et le ou la mentoré(e), avec des expériences de mentorat positives et cruciales pour le développement des cliniciens et des chercheurs IMH. Les participants au symposium, deux paires de dyades mentor­mentoré, ont d'abord fait un discours d'ouverture sur ce que le mentorat signifiait pour eux généralement et personnellement, et ont ensuite parlé de trois défis: le bon ajustement entre mentor et mentoré, « la lumière et l'ombre ¼ dans la relation de mentorat et l'équilibre de la vieille sagesse avec les nouvelles tendances dans le mentorat. Cet article récapitule les vues et les expériences personnelles des participants pour ce qui concerne ces défis, avec leurs propres mots, mettant en valeur les défis personnels et professionnels clés liés au mentorat de la perspective d'à la fois le mentor et le mentoré.

Este artículo se basa en un simposio sobre Consejería en el campo de la Salud Mental Infantil que se llevó a cabo en el Decimoctavo Congreso de la Asociación Mundial para la Salud Mental Infantil (WAIMH). El simposio fue dedicado a Robert N. Emde, uno de los fundadores del campo de Salud Mental Infantil, quien dedicó gran parte de su carrera a la consejería y guía profesional. Desde una perspectiva de IMH, la mejor interpretación de las experiencias de consejería es verlas como una significativa relación tanto para el consejero como para el aconsejado, considerando que las positivas experiencias son cruciales para el desarrollo de los profesionales clínicos e investigadores de IMH. Los participantes en el simposio, dos pares de díadas consejero­aconsejado, dieron primero una presentación de apertura sobre lo que significaba para ellos la consejería general y personalmente, para entonces abordar tres asuntos: la bondad de ajuste entre consejero y aconsejado, "Luz y Sombra" en la relación de consejería, así como el equilibrio en la consejería entre la vieja sabiduría y los nuevos acercamientos. El ensayo presenta los puntos de vista y experiencias personales de los participantes sobre estos asuntos en sus propias palabras, subrayando asuntos personales y profesionales claves relacionados con la consejería desde la perspectiva tanto del consejero como del aconsejado.

Emotion transmission in peer dyads in middle childhood.

This study investigated emotion transmission among peers during middle childhood. Participants included 202 children (111 males; race: 58% African American, 20% European American, 16% Mixed race, 1% Asian American, and 5% Other; ethnicity: 23% Latino(a) and 77% Not Latino(a); Mincome  = $42,183, SDincome  = $43,889; Mage  = 9.49; English-speaking; from urban and suburban areas of a mid-Atlantic state in the United States). Groups of four same-sex children interacted in round-robin dyads in 5-min tasks during 2015-2017. Emotions (happy, sad, angry, anxious, and neutral) were coded and represented as percentages of 30-s intervals. Analyses assessed whether children's emotion expression in one interval predicted change in partners' emotion expression in the next interval. Findings suggested: (a) escalation of positive and negative emotion [children's positive (negative) emotion predicts an increase in partners' positive (negative) emotion], and (b) de-escalation of positive and negative emotion (children's neutral emotion predicts a decrease in partners' positive or negative emotion). Importantly, de-escalation involved children's display of neutral emotion and not oppositely valenced emotion.

Associations between cortical thickness and anxious/depressive symptoms differ by the quality of early care.

A variety of childhood experiences can lead to anxious/depressed (A/D) symptoms. The aim of the present study was to explore the brain morphological (cortical thickness and surface area) correlates of A/D symptoms and the extent to which these phenotypes vary depending on the quality of the parenting context in which children develop. Structural magnetic resonance imaging (MRI) scans were acquired on 45 children with Child Protective Services (CPS) involvement due to risk of not receiving adequate care (high-risk group) and 25 children without CPS involvement (low-risk group) (rangeage = 8.08-12.14; Mage = 10.05) to assess cortical thickness (CT) and cortical surface area (SA). A/D symptoms were measured using the Child Behavioral Checklist. The association between A/D symptoms and CT, but not SA, differed by risk status such that high-risk children showed decreasing CT as A/D scores increased, whereas low-risk children showed increasing CT as A/D scores increased. This interaction was specific to CT in prefrontal, frontal, temporal, and parietal cortical regions. The groups had marginally different A/D scores, in the direction of higher risk being associated with lower A/D scores. Results suggest that CT correlates of A/D symptoms are differentially shaped by the quality of early caregiving experiences and should be distinguished between high- and low-risk children.

The generational impact of household clutter.

OBJECTIVES: Hoarding disorder can create long-term problems for adult children of individuals with hoarding symptoms; however, the extent of the psychosocial consequences of growing up in a cluttered household are not yet fully understood. This study investigated the extent to which generational clutter (i.e., parent/caregiver and grandparent) influenced individuals' self-reported hoarding severity and psychiatric and psychosocial functioning. METHODS: A total of 1306 adults completed an online survey that included measures of hoarding, anxiety, depression, companionship and emotional support. A subsample (n = 198) reported on parent and grandparent household clutter, as well as family impact from hoarding. We used correlations, t-tests, linear and hierarchical regressions and mediation analyses to investigate whether hoarding symptoms were predicted by parent or grandparent hoarding. RESULTS: Parent clutter level significantly predicted participant hoarding symptoms. For participants who reported having caregivers with elevated clutter, self-reported psychosocial functioning was lower overall. Self-reported behaviour modification due to family hoarding symptoms (accommodation) was a significant predictor of participant hoarding symptoms. CONCLUSIONS: Parent clutter and family accommodation behaviours may be a risk factor for future clutter in adult children. Further comparisons between parents and children are needed to determine whether this association increases children's risk for future hoarding symptoms.

Telehealth delivery of modified attachment and biobehavioral catch-up: feasibility, acceptability, and lessons learned.

The COVID-19 pandemic necessitated dramatic shifts in the delivery and evaluation of attachment-based home-visiting services. The pandemic disrupted a pilot randomized clinical trial of modified Attachment and Biobehavioral Catch-Up (mABC), an attachment-based intervention adapted for pregnant and peripartum mothers with opioid use disorders. We transitioned from in-person to telehealth delivery of mABC and modified Developmental Education for Families, an active comparison intervention targeting healthy development. Of 40 mothers then enrolled in study interventions, 30 participated in telehealth, completing an average of 4.7 remote sessions each (SD = 3.0; range = 1-11). Following the transition to telehealth, 52.5% of randomized cases and 65.6% of mothers maintaining custody completed study interventions, comparable to pre-pandemic rates. Overall, telehealth delivery was feasible and acceptable, and mABC parents coaches' ability to observe and comment on attachment-relevant parenting behaviors was preserved. Two mABC case studies are presented and lessons learned for future telehealth implementation of attachment-based interventions are discussed. .

Perceived locus of control for clutter: Reported reasons for clutter in adults with and without hoarding symptoms.

OBJECTIVES: The goal of the current investigation was to expand on previous work on reasons for saving/discarding in the context of hoarding by examining individuals' perceived locus of control for household clutter. METHODS: Participants were asked to list their perceived reasons for clutter and assign each reason a percentage rating reflecting the extent to which they judged the reason to be responsible for their household clutter. RESULTS: Lack of time was an almost universally endorsed reason for clutter. Clinically severe hoarding levels were associated with lower responsibility ratings for time-related reasons and increased endorsement of distress-related reasons. CONCLUSIONS: Future research should examine whether insight level affects how individuals with clinically severe hoarding perceive the locus of control for household clutter. PRACTITIONER PONITS: Perception of lack of time may influence individuals' sense of locus of control for their household clutter levels. Hoarding severity is associated with being more likely to attribute distress around discarding or decision making as the reason for clutter.

Effects of an attachment-based intervention on autonomic regulation among opioid-exposed infants.

Little is known about whether postnatal intervention enhances autonomic regulation among infants at risk for dysregulation due to prenatal opioid exposure. The present study evaluated the effects of modified Attachment Behavioral Catch-up (mABC) on autonomic regulation for opioid-exposed infants in a pilot randomized clinical trial. We hypothesized that, compared to a control intervention (modified Developmental Education for Families [mDEF]), mABC would be associated with higher resting respiratory sinus arrhythmia (RSA) and pre-ejection period (PEP) as well as greater reactivity to and recovery from a social stressor (Still-Face Paradigm). Pregnant or peripartum women receiving opioid agonist therapy (61 mothers of 64 infants; final N = 36 infants) were randomly assigned to mABC or mDEF, 12-session home visiting programs beginning in the third trimester; mABC targets sensitive parenting, and mDEF targets cognitive and motor development. mABC was associated with significantly greater RSA reactivity and marginally greater PEP reactivity. In models accommodating missing data, mABC was additionally associated with significantly greater RSA recovery. In sensitivity analyses removing siblings, mABC predicted significantly enhanced PEP reactivity. Overall, in these preliminary analyses, mABC was associated with healthier autonomic regulation during a social stressor than mDEF. Thus, mABC may be a promising strategy to promote autonomic regulation among opioid-exposed infants through parenting intervention.

Timing of adoption is associated with electrophysiological brain activity and externalizing problems among children adopted internationally.

This study investigated middle childhood resting electroencephalography (EEG) and behavioral adjustment in 35 internationally adopted children removed from early caregiving adversity between 6 and 29 months of age. Older age of adoption was associated with more immature or atypical profiles of middle childhood cortical function, based on higher relative theta power (4-6 Hz), lower relative alpha power (7-12 Hz), lower peak alpha frequency, and lower absolute beta (13-20 Hz) and gamma (21-50 Hz) power. More immature or atypical EEG spectral power indirectly linked older age of adoption with increased risk for externalizing problems in middle childhood. The findings add to existing evidence linking duration of early adverse exposures with lasting effects on brain function and behavioral regulation even years after living in a stable adoptive family setting. Findings underscore the need to minimize and prevent children's exposures to early caregiving adversity, especially in the first years of life. They call for innovative interventions to support neurotypical development in internationally adopted children at elevated risk.

Introduction of Special Section of Infant Mental Health Journal: Meeting the needs of vulnerable infants and families during COVID-19: Moving to a telehealth approach for home visiting implementation and research.

Parents of infants and young children who experience harsh circumstances are among those most vulnerable to the added stressors associated with COVID-19. Home visiting models have been shown to enhance outcomes for parents and infants when delivered in person, but in many parts of the world, the pandemic rendered in-person home visits difficult or impossible. In this special section, we examine adaptations made by home visiting programs to allow continued service delivery through telehealth, and strategies for assessing whether interventions maintain reach and fidelity when implemented remotely. In the first paper, Bullinger et al. (program implementers of SafeCare) provide evidence of the increased risk of maltreatment during COVID-19 for many families, and thus the need for home visiting services. Rybinska et al., developers and implementers of Family Connects, present evidence regarding their success in reaching families through telehealth. Roben and colleagues, in the third paper, report that clinicians implementing Attachment and Biobehavioral Catch-up through telehealth maintained fidelity at similar rates seen through in-person implementation. Finally, Tabachnick et al. describe procedures for collecting physiological data from infants and parents while conducting assessments remotely.

Transitioning to telehealth due to COVID-19: Maintaining model fidelity in a home visiting program for parents of vulnerable infants.

Maintaining treatment fidelity when implementing evidence-based interventions is a significant challenge. The inability to deliver in-person services due to the COVID-19 pandemic critically challenged the foundation of implementation fidelity for home visiting programs across the globe. The Attachment and Biobehavioral Catch-Up (ABC) program is an evidence-based home visiting intervention designed to increase sensitivity in parents of infants who have experienced early adversity. ABC's community effectiveness is due to rigorous fidelity monitoring and supervision. Fidelity is measured by microanalytic coding of parenting opportunities and "in-the-moment" commenting, the active ingredient of ABC. In this study, we examined intervention fidelity among parent coaches implementing ABC through telehealth. Random 5-min clips from 510 telehealth ABC session videos conducted by 91 parent coaches at 48 agencies were coded for their frequency and quality of in-the-moment comments. On average, parent coaches were able to exceed in-person commenting fidelity standards when implementing ABC through the telehealth format. The active fidelity monitoring and supervision inherent to ABC's dissemination afforded a smooth transition to implementing ABC through telehealth while adhering to fidelity standards. Procedural and clinical challenges to telehealth implementation are discussed, along with future directions for telehealth program effectiveness.

Mantener la fidelidad al tratamiento cuando se implementan intervenciones con base en la evidencia es un reto significativo. La inhabilidad de ofrecer servicios en persona debido a la pandemia del COVID-19 representó un reto crítico a la base de la fidelidad de implementación para los programas de visitas a casa en el mundo. El programa de Afectividad y Bio-conducta de Ponerse el Día (ABC) es una intervención de visitas a casa con base en la evidencia diseñada para aumentar la sensibilidad en los progenitores de infantes que han experimentado temprana adversidad. La eficacia comunitaria de ABC se debe a la rigurosa inspección y supervisión de la fidelidad (Caron et al., 2016). La fidelidad se mide por medio de codificación micro analítica de las oportunidades de crianza y por el comentario " en el momento," ingrediente activo de ABC. En este estudio, examinamos la fidelidad de intervención entre progenitores entrenadores que implementaban ABC a través de salud a distancia. Segmentos de video de 5 minutos de 510 sesiones de salud a distancia ABC al azar, llevadas a cabo por 91 progenitores entrenadores en 48 agencias se codificaron en cuanto a su frecuencia y calidad de los comentarios del momento. En promedio, los progenitores entrenadores pudieron exceder los estándares de fidelidad de comentarios en persona cuando implementaban ABC a través del formato de salud a distancia. La activa inspección y supervisión de la fidelidad inherente a la divulgación de ABC permitió una transición fluida a la implementación de ABC a través de salud a distancia, manteniendo la adhesión a los estándares de fidelidad. Se discuten los retos de procedimiento y clínicos a la implementación de salud a distancia, junto con futuras directrices para la eficacia de programas de salud a distancia.

Le maintien de la fidélité au traitement en mettant en place des interventions basées sur des données factuelles est un défi important. L'incapacité à offrir des services en personne du fait de la pandémie du Covid19 a présenté un défi critique pour la fondation de la mise en place de la fidélité pour les programmes de visite domicile dans le monde entier. Le programme ABC (selon l'anglais Attachment and Biobehavioral Catch-Up, soit Rattrapage de l'Attachement et Rattrapage Biocomportemental) est une intervention de visites à domicile basée sur des données factuelles conçue pour augmenter la sensibilité chez les parents de bébés ayant fait l'expérience d'une adversité précoce. L'efficacité de la communauté de l'ABC est attribuable à un contrôle rigoureux de la fidélité et de la supervision (Caron et al., 2016). La fidélité est mesurée par un codage micro-analytique des opportunités de parentage et des commentaires "au moment", l'ingrédient actif de l'ABC. Dans cette étude nous avons examiné la fidélité de l'intervention chez les entraîneurs de parents mettant en place l'ABC au travers de la télésanté. Des clips de 5-minute randomisés de 510 sessions vidéos de télésanté ABC faites avec 91 entraîneurs de parents de 48 agences ont été codé pour leur fréquence et la qualité des commentaires "au moment". En moyenne les entraîneurs de parent étaient capables d'excéder les standards de fidélité de commentaire en personne en mettant en place l'ABC au travers du format de télésanté. Le contrôle actif de fidélité et de la supervision propre ã la dissémination de l'ABC a permis une transition facile à la mise en place de l'ABC au travers de la télésanté tout en adhérant aux standards de fidélité. Les défis de procédure et les défis cliniques à la mise en place par télésanté sont discutés ainsi que les directions futures pour l'efficacité du programme par télésanté.

Adapting psychophysiological data collection for COVID-19: The "Virtual Assessment" model.

The COVID-19 pandemic has significantly disrupted research activities globally. Researchers need safe and creative procedures to resume data collection, particularly for projects evaluating infant mental health interventions. Remote research is uniquely challenging for psychophysiological data collection, which typically requires close contact between researchers and participants as well as technical equipment frequently located in laboratory settings. In accordance with public health guidance, we adapted procedures and developed novel protocols for a "virtual assessment" in which women and infants provided behavioral and psychophysiological data from their own homes while researchers coordinated remotely. Data collected at virtual visits included video-recorded parent-child interactions and autonomic nervous system data. Adaptations were designed to optimize safety and data quality while minimizing participant burden. In the current paper, we describe these adaptations and present data evaluating their success across two sites in the United States (University of Delaware and University of Utah), focusing specifically on autonomic nervous system data collected during the well-validated Still-Face Paradigm (SFP). We also discuss advantages and challenges of translating traditional lab procedures into the virtual assessment model. Ultimately, we hope that disseminating these procedures will help other researchers resume safe data collection related to infant mental health during the COVID-19 pandemic and beyond.

La pandemia del COVID-19 ha interrumpido significativamente las actividades de investigación globalmente. Los investigadores necesitan procedimientos seguros y creativos para reasumir la recolección de información, particularmente para proyectos con los que se evalúan intervenciones de salud mental infantil. La investigación remota es particularmente desafiante para recoger información psicofisiológica, lo cual típicamente requiere contacto cercano entre investigadores y participantes, así como también equipo técnico frecuentemente localizado en centros de laboratorio. De acuerdo con las directrices de salud pública, adaptamos procedimientos y desarrollamos protocolos novedosos para una "evaluación virtual," en la cual mujeres e infantes aportaron datos de conducta y psicofisiológicos desde sus propias casas mientras que los investigadores coordinaban remotamente. La información recogida en las visitas virtuales incluyó interacciones progenitor-niño grabadas en video e información del sistema nervioso autónomo. Se diseñaron las adaptaciones para optimizar la seguridad y la calidad de la información mientras que se reducía al mínimo la carga que conlleva la participación. En el presente estudio, describimos estas adaptaciones y presentamos información evaluativa del éxito en dos lugares de Estados Unidos (la Universidad de Delaware y la Universidad de Utah), con enfoque específico en la información obtenida acerca del sistema nervioso autónomo durante el ya bien validado Paradigma del Rostro Inmóvil. Discutimos también las ventajas y retos para transferir los procedimientos tradicionales de laboratorio al modelo de evaluación virtual. En última instancia, esperamos que al diseminar estos procedimientos ayudaremos a otros investigadores a reasumir la segura recolección de información relacionada con la salud mental infantil durante la pandemia del COVID-19 y posteriormente.

La pandémie du COVID-19 a perturbé de manière importante les activités de recherche au niveau global. Les chercheurs ont besoin de procédures sûres et créatives pour reprendre la collecte de données, particulièrement pour des projets évaluant des interventions en santé mentale du nourrisson. Les recherches à distance présentent un défi unique pour la collecte de données psychophysiologiques, qui typiquement exige un contact proche entre les chercheurs et les participants ainsi qu'un équipement technique fréquemment situé en contextes de laboratoire. En accord avec les directives de santé publique nous avons adapté les procédures et développés de nouveaux protocoles pour une « évaluation virtuelle ¼ durant laquelle les femmes et les bébés ont présenté des données comportementales et psychophysiologiques depuis leurs propres domiciles alors que les chercheurs coordonnaient le tout à distance. Les données recueillies durant les visites virtuelles ont inclus des interactions parent-enfant enregistrées à la vidéo et des données liées au système nerveux autonome. Les adaptations ont été conçues afin d'optimiser la sécurité et la qualité des données tout en minimisant le fardeau pour les participants. Dans cet article nous décrivons ces adaptations et présentons les données évaluant leur succès au travers de deux sites aux Etats-Unis (University of Delaware et University of Utah), en s'attachant plus spécifiquement aux données sur le système nerveux autonome obtenues durant le Paradigme de Visage Inexpressif, qui est bien validé. Nous discutons également les avantages et des défis qu'il y a à traduire des procédures traditionnelles de laboratoire en un modèle d'évaluation virtuel. Finalement nous espérons que le fait de disséminer ces procédures aidera d'autres chercheurs à reprendre de manière sûre la collecte de données liées à la santé mentale du nourrisson durant la pandémie du COVID-19 et plus loin.

Self-Coding of Fidelity as a Potential Active Ingredient of Consultation to Improve Clinicians' Fidelity.

A key goal for implementation science is the identification of evidence-based consultation protocols and the active ingredients within these protocols that drive clinician behavior change. The current study examined clinicians' self-coding of fidelity as a potential active ingredient of consultation for the Attachment and Biobehavioral Catch-up (ABC) intervention. It also examined two other potential predictors of clinician fidelity in response to consultation: dosage of consultation and working alliance. Twenty-nine clinicians (97% female, 62% White, M age = 34 years) participated in a year of weekly fidelity-focused ABC consultation sessions, for which clinicians self-coded fidelity and received consultant feedback on both their coding and their fidelity. Data from the ABC fidelity measure were available for 1067 sessions coded by consultants, and clinicians' self-coding accuracy was calculated from 1044 sessions coded by both clinicians and consultants. Alliance was measured with the Working Alliance Inventory-Trainee and Supervisor Versions. The study was observational, and fidelity and self-coding accuracy were modeled across time using hierarchical linear modeling. Clinicians' ABC fidelity, as well as their self-coding accuracy, increased over the course of consultation. Clinicians' self-coding accuracy predicted their initial fidelity and growth in fidelity. Working alliance was also linked to fidelity and self-coding accuracy. These results suggest that clinician self-coding should be further examined as an active ingredient of consultation. The study has important implications for the design of consultation procedures and fidelity assessments.