Has the relationship between community poverty and child maltreatment report rates become stronger or weaker over time?

BACKGROUND: Poverty is among the most powerful predictors of child maltreatment risk and reporting. To date, however, there have been no studies assessing the stability of this relationship over time. OBJECTIVE: To examine whether the county-level relationship between child poverty rates and child maltreatment report (CMR) rates changed over time in the United States in 2009-2018, overall and across of child age, sex, race/ethnicity, and maltreatment type. PARTICIPANTS AND SETTING: U.S. Counties in 2009-2018. METHODS: Linear multilevel models estimated this relationship and its longitudinal change, while controlling for potential confounding variables. RESULTS: We found that the county-level relationship between child poverty rates and CMR rates had intensified almost linearly from 2009 to 2018. Per one-percentage-point increase in child poverty rates, CMR rates significantly increased by 1.26 per 1000 children in 2009 and by 1.74 per 1000 children in 2018, indicating an almost 40 % increase in the poverty-CMR relationship. This increasing trend was also found within all subgroups of child age and sex. This trend was found among White and Black children, but not among Latino children. This trend was strong among neglect reports, weaker among physical abuse reports, and not found among sexual abuse reports. CONCLUSIONS: Our findings highlight the continued, perhaps increasing importance of poverty as a predictor of CMR. To the degree that our findings can be replicated, they could be interpreted as supporting an increased emphasis on reducing child maltreatment incidents and reports through poverty amelioration efforts and the provision of material family supports.

Prescription Drug Monitoring and Child Maltreatment in the United States, 2004-2018.

OBJECTIVE: To test whether a policy approach aimed at decreasing prescription drug misuse, specifically, state monitoring of controlled substance prescriptions-prescription drug monitoring programs (PDMPs)-were associated with changes in Child Protective Services-reported maltreatment prevalence. STUDY DESIGN: Using a difference-in-differences design and maltreatment data (2004-2018) from 50 states and the District of Columbia, we compared the prevalence of total maltreatment incidents and total victims, in states with and without PDMPs, before and after implementation. Exploratory analyses further examined models disaggregated by maltreatment type (neglect, physical abuse, sexual abuse, psychological abuse) and among different racial/ethnic groups. Quasi-Poisson models included state-level covariates, state- and year-fixed effects, and cluster-robust standard errors. RESULTS: Difference-in-differences models identified greater relative reductions in PDMP states relative to controls (total prevalence ratio, 0.87; 95% CI, 0.80, 0.940; victimization prevalence ratio, 0.92; 95% CI, 0.85-0.98) over the observation period. Decreases seemed to be driven by changes in neglect (prevalence ratio, 0.87; 95% CI, 0.80-0.93) and physical abuse (prevalence ratio, 0.78; 95% CI, 0.71-0.87) incidents, and may have been especially salient for American Indian/Alaskan Native children (prevalence ratio, 0.78; 95% CI, 0.65-0.94). CONCLUSIONS: We found evidence supporting an association between prescription drug monitoring and reduced maltreatment prevalence at the state level. Policies aimed at restricting the prescribing and dispensing of controlled substances may have indirect implications for child welfare.

Ateneo General de la Residencia de Psicopedagogía: Huellas de las promesas incumplidas: el devenir del aprendizaje en contextos violentos / Atheneaum Psychopedagogic Residence: Traces of unfulfilled promises: the evolution of learning in violent contexts

Ateneo del Equipo de Psicopedagogía del Centro de Salud Nº 13, del Área Programática del Hospital General de Agudos P. Piñero, de la Ciudad de Buenos Aires, centrado en la problemática de la violencia en la clínica psicopedagógica con niños/as, y en cómo se verán atravesados los procesos de aprendizaje de los/as niños/as víctimas o testigos de violencia con los/as que trabaja el Equipo. Se realiza un breve recorrido histórico del concepto de violencia, para intentar una posible conceptualización de la misma, y se analiza la dimensión socio-cultural e histórica de la violencia, enmarcada en el sistema patriarcal e influida por las relaciones de poder. Se hace hincapié en la violencia familiar y, más particularmente en la violencia de género y se profundiza en las distintas formas de maltrato infantil.

Violence and abuse experiences and associated risk factors during the COVID-19 outbreak in a population-based sample of Norwegian adolescents.

BACKGROUND: The lockdowns occurring across society because of the COVID-19 pandemic have had far-reaching consequences for children and adolescents. One immediate concern was what the impact of the comprehensive disease control measures on rates of violence and abuse against children and adolescents would be. OBJECTIVE: We aimed to establish rates of child abuse and degree of family conflict during the first COVID-19 lockdown spring 2020. Additionally, we aimed to investigate associations between preexisting and concurrent risk factors and abuse during these unique times. PARTICIPANTS AND SETTING: A total of 3545 Norwegian 13- to 16-year-olds participated in this study. A total of 1944 of these had provided data 1 year before the lockdown. METHODS: We used a web survey format to assess abuse exposure and associated risk factors. The survey was administered in schools during school hours in June 2020, shortly after the reopening of schools after the first lockdown. RESULTS: In this sample 8.2% reported psychological abuse during lockdown, 2.4% had experienced physical abuse and 1.4% sexual abuse. For online sexual abuse, the rate was 5.6% during this time period. Adolescents did not report an increase in family conflict. Concurrently perceived family affluence and family risk factors were most strongly associated with physical abuse during lockdown (OR = 11.01(95% CI 5.32-22.84); OR = 5.36 (95% CI 2.69-10.67)), but also other types of child maltreatment. Analyses across assessment points suggested that prior victimization was the most accurate predictor of abuse experiences during lockdown (OR = 3.84 (95% CI 2.85-5.20)). CONCLUSIONS: The negative consequences of the COVID-19 preventative measures struck the adolescent population unevenly. The findings underscore the need for targeted measures to mitigate the negative outcomes of health-related crises for adolescents in risk groups such as those with low family affluence and prior abuse experiences.

Calculating the impact of COVID-19 pandemic on child abuse and neglect in the U.S.

BACKGROUND: COVID-19 has had a major impact on child abuse and neglect (CAN) in the U.S. leading to a change in the number of reported screened-in CAN investigations, missed prevention cases, and missed CAN cases. OBJECTIVES: To estimate the deficit number of CAN investigations and resultant estimated number of missed prevention and CAN cases due to the COVID-19 pandemic in the U.S. from March 2020 to December 2020. METHODS: Secondary data analyses of administrative child welfare data from January 2013 to December 2020 from New York City, Florida, New Jersey and Wisconsin were conducted. Spline regression modeling controlling for autocorrelation was utilized to explore any significant changes once the pandemic began in March 2020 in the number of screened-in CAN investigations. The seven-year monthly average of screen-in CAN investigations for March through December from 2013 to 2019 was calculated and compared to the numbers of CAN investigations for March 2020 to December 2020. The resultant number of missed prevention cases and CAN cases was estimated for the four jurisdictions and used to approximate the number of missed prevention cases and CAN cases in the U.S., as well as the projected estimation of national lifetime economic costs. RESULTS: Prior to the pandemic, there were insignificant monthly increases of 0.7 CAN investigations in NYC and 6.2 CAN investigations in Florida, a significant monthly increase 4.2 CAN investigations in New Jersey and an insignificant monthly decrease in 0.6 CAN investigations in Wisconsin. Once the pandemic began, there were significant monthly decreases (p < .001) in each of the four jurisdictions, including 1425.6 fewer CAN investigations in NYC, 3548.0 fewer CAN investigations in Florida, 963.0 fewer CAN investigations in New Jersey and 529.1 fewer CAN investigations in Wisconsin. There were an estimated 60,791 fewer CAN investigations in these four jurisdictions from March 2020 to December 2020 of which there were approximately 18,540 missed prevention and CAN cases suggesting up to $4.2 billion in lifetime economic costs. It was estimated that were 623,137 children not investigated for CAN in the U.S. during the same 10-month period. This suggests that there were an estimated 85,993 children were missed for prevention services and about 104,040 children were missed for CAN with a potential lifetime economic impact of up to $48.1 billion in the U.S. CONCLUSIONS: The COVID-19 pandemic has led to a precipitous drop in CAN investigations where almost 200,000 children are estimated to have been missed for prevention services and CAN in a 10-month period. There are opportunities for the child welfare jurisdictions to work with partner education, public health, social service and other providers to strategically approach this very grave issue in order to mitigate its impact on this very vulnerable population.

A comparison of child abuse and neglect encounters before and after school closings due to SARS-Cov-2.

BACKGROUND: Risk factors for child abuse and neglect and commonly used reporting mechanisms were highly affected by SARS-Cov-2 pandemic; yet, little is known about the effects of SARS-Cov-2 on rates of child abuse and neglect. OBJECTIVE: To compare overall rates, demographics, types of abuse and acuity of child abuse and neglect encounters seen at one university health system for the 6 months before and after school closings due to the SARS-Cov-2 pandemic. PARTICIPANTS AND SETTING: Data was extracted from a database of billed ICD10 codes for child abuse and neglect including sexual abuse codes. There were 579 encounters for patients <18 years of age and 476 unique patients. METHODS: In addition to ICD10 code and pre/post school closing, each encounter was identified to be inpatient, outpatient and/or emergency department. Demographic data such as age, gender, ethnicity, and race were extracted. Incident rate ratios in addition to descriptive statistics, Mann-Whitney U test, two-sample t-test, or the chi-square test of association were used in the analysis. RESULTS: No significant differences were identified for total rates of child abuse and neglect encounters (p = .08), physical abuse (p = .91) nor child maltreatment (p = .86) codes or in the age (p = .46), gender (p = .58), and race/ethnicity (p = .15) of patient encounters pre- versus post-school closings. The sexual abuse incidence and inpatient encounters increased by 85% (IRR = 1.85, p < .0001; IRR = 1.85, p = .004, respectively). CONCLUSIONS: Our findings provide a unique contribution to the existing literature in that we identified a significant increase in the incidence of sexual abuse and higher patient acuity as evidenced by higher rates of inpatient encounters after school closing due to SARS-Cov-2.

Childhood Emotional Incest Scale (CEIS): Development, validation, cross-validation, and reliability.

Describing a maladaptive parent-child relationship wherein a parent turns to a child for the satisfaction of emotional and/or relational needs, emotional incest remains an underinvestigated phenomenon. This is partly due to a lack of an empirically based measure of childhood emotional incest, and as a result, a 2-factor, 12-item scale was created based on expert opinion and a preliminary study of 319 university students. Each consisting of 6 items, the factors were called "Surrogate Spouse" and "Unsatisfactory Childhood." A follow-up study conducted with a second sample of 415 participants supports the 2-factor structure as a good fit to the data as well as the invariance of the scale across genders. The Childhood Emotional Incest Scale (CEIS) demonstrates good convergent validity with childhood emotional neglect (r = .58) and emotional abuse (r = .52) as well as good divergent validity with early memories of warmth and safeness (r = -0.54). The CEIS has also been found to be a stronger predictor of decreased life satisfaction and increased anxiety than the Parent-Focused Parentification subscale. Based on the values of internal consistency, composite reliability, and test-retest reliability, both factor and total scores of the CEIS can also be considered reliable. Therefore, as a measure of childhood emotional experiences for the retrospective assessment of adults, the 12-item CEIS can be utilized in the research of counseling, psychology, and education, particularly with regard to expanding knowledge into the roots and consequences of emotional incest and promoting parenting practices and marital/relational dynamics that are more functional. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Childhood maltreatment history for guiding personalized antidepressant choice in major depressive disorder: Preliminary results from a systematic review.

Childhood maltreatment (CM) is a predictor of poor outcome across treatments for major depressive disorder (MDD), while its potential role as a predictor of differential responses to specific antidepressants has received little attention. The present systematic review examined pharmacological studies (published up to June 30th, 2020) that included head-to-head comparisons of antidepressant treatments among adult MDD patients with a reported history of CM or no history to evaluate if CM may help clinicians choose antidepressants with greatest likelihood of successful outcome. Only three studies were included, providing limited and provisional results. These preliminary findings suggest that sustained-release bupropion (alone or in combination) or aripiprazole-augmentation as next-step intervention did not demonstrate differential outcome among MDD patients with or without a history of childhood adversity. Further, sertraline and the group of antidepressants with low affinity for the serotonin transporter may be less suitable for MDD patients with childhood abuse history than escitalopram, venlafaxine-XR, or antidepressants with high affinity for the serotonin transporter. The critical question of the most potentially efficacious treatment regimens for adult MDD with CM history requires further large-sample studies involving a greater number of medications, specifically designed to analyse the moderating effects of different types of CM, and possibly including objective biomarkers.

How COVID-19 Is Placing Vulnerable Children at Risk and Why We Need a Different Approach to Child Welfare.

The onset of the COVID-19 pandemic brings new worries about the welfare of children, particularly those of families living in poverty and impacted other risk factors. These children will struggle more during the pandemic because of financial pressures and stress placed on parents, as well as their limited access to services and systems of support. In this commentary, we explain how current circumstances reinforce the need for systemic change within statutory child welfare systems and the benefits that would accrue by implementing a continuum of services that combine universal supports with early intervention strategies. We also focus on promising approaches consistent with goals for public health prevention and draw out ideas related workforce development and cross-sector collaboration.

Prevalence of childhood trauma measured by the short form of the Childhood Trauma Questionnaire in people with substance use disorder: A meta-analysis.

BACKGROUND: Substance use disorder is known to be associated with childhood trauma, yet prevalence estimates have varied markedly due to methodological differences. The meta-analysis presented here aimed to estimate prevalence rates of childhood trauma for people with substance use disorder using the short form of the Childhood Trauma Questionnaire (CTQ-SF). METHODS: Four major public databases (PubMed, Embase, The Cochrane Library and PsycINFO) were searched for eligible studies until April 2nd, 2018. RESULTS: Ten studies were included with a total sample size of 1,310 across six countries. The prevalence estimates of each subtype of childhood trauma across all substance use disorder samples were: emotional abuse (38%, 95% CI: 28%-48%); physical abuse (36%, 95% CI: 27%-45%); sexual abuse (31%, 95% CI: 23%-41%); emotional neglect (31%, 95% CI: 18%-45%) and physical neglect (32%, 95% CI: 25%-40%). Subgroup analysis by continent demonstrated that the highest prevalence rates of emotional abuse were found in North America and South America (45%). Compared with other continents, the prevalence rates of North America were the highest for physical abuse, sexual abuse, emotional neglect and physical neglect (39%-44%). CONCLUSIONS: Childhood trauma is prevalent among substance use disorder samples compared to the general population. Different continents have different levels of prevalence of childhood trauma, which may be due in part to socioeconomic, cultural and definitional variations.

Childhood maltreatment and impact on clinical features of major depression in adults.

OBJECTIVES: This study examined: 1) the prevalence of childhood maltreatment (CMT) in individuals with chronic and/or recurrent depression, 2) the association between CMT and depressive symptoms, 3) the link between CMT and worse clinical presentation of depression, 4) the effects of accumulation of different types of CMT, and 5) the relationship between the age at CMT and depression. METHODS: We analyzed the baseline data of 663 individuals from the CO-MED study. CMT was determined by a brief self-reported questionnaire assessing sexual abuse, emotional abuse, physical abuse, and neglect. Correlational analyses were conducted. RESULTS: Half of the sample (n = 331) reported CMT. Those with CMT had higher rates of panic/phobic, cognitive and anhedonic symptoms than those without CMT. All individual types of maltreatment were associated with a poorer clinical presentation including: 1) earlier MDD onset; 2) more severe MDD, 3) more suiccidality, 4) worse quality of life, and functioning, and 5) more psychiatric comorbidities. Clinical presentation was worse in participants who reported multiple types of CMT. CONCLUSIONS: In chronic and/or recurrent depression, CMT is common, usually of multiple types and is associated with a worse clinical presentation in MDD. The combination of multiple types of CMT is associated with more impairment.

Childhood maltreatment and adult mental disorders - the prevalence of different types of maltreatment and associations with age of onset and severity of symptoms.

Childhood maltreatment (CM) is a risk factor for numerous mental disorders. However, the specificity of CM types in mental disorders is still being discussed. The present study examined the prevalence of five CM types in patients with schizophrenia/schizoaffective disorder (SZ; n = 107), bipolar disorder (BD; n = 103), depression (MDD; n = 604; with the two subgroups Persistent Depressive Disorder (PDD) and non-chronic MDD), and in healthy controls (HC; n = 715). Additionally, associations between CM types, symptom severity, and age of onset were investigated. The prevalence of all CM types was higher in the patient groups compared to HC. Emotional neglect, emotional abuse, and physical neglect were reported most frequently in all groups. Notably, patients with PDD reported more CM of all types than patients with non-chronic MDD. The severity of depression was associated with emotional abuse and neglect; anxiety with emotional abuse, emotional neglect, and sexual abuse; positive SZ symptoms with physical neglect; negative symptoms with emotional and physical neglect; and mania with sexual abuse and physical neglect. CM was associated with a younger age of onset in MDD and BD. The high prevalence of CM in patients with severe mental disorders highlights the importance of considering this issue in the treatment of such patients.

Childhood trauma, alexithymia, and mental states recognition among individuals with alcohol use disorder and healthy controls.

BACKGROUND: Although prior work indicates a link between childhood trauma, alexithymia, and mental states recognition, empirical support is limited. Moreover, findings based on adult samples are mixed. Previous studies demonstrate that childhood trauma might either enhance, preserve, or reduce mental states recognition in selected at-risk populations. The current study investigates whether alcohol use disorder (AUD) status moderates the association between childhood trauma, alexithymia, and mental states recognition in a treatment-seeking AUD sample and non-AUD healthy adults. METHODS: Data comes from 255 individuals participating in an ongoing project that compares emotional and behavioral functioning of patients treated in an inpatient setting for AUD and a comparison sample of 172 healthy controls (HCs). Mental states recognition was measured using a computerized version of the Reading the Mind in the Eyes Task (RMET). The presence of childhood trauma was assessed with the Childhood Trauma Questionnaire. Alexithymia was measured with the Toronto Alexithymia Scale (TAS-20). Demographic information, as well as alcohol drinking and psychopathological symptoms were assessed. A moderated mediation model was estimated whereby alexithymia was included as a mediator in the association between childhood trauma and RMET performance, with AUD diagnosis status moderating the link between alexithymia and RMET performance. RESULTS: Findings provide support for moderated mediation. Childhood emotional trauma impacted negative mental states recognition performance via difficulty describing feelings, but only among HCs (p < 0.01). CONCLUSIONS: Findings highlight the impact that AUD status has on the association between early life emotional trauma and difficulty describing feelings on individual differences in mental states recognition.

The history of multiple adverse childhood experiences in patients with schizophrenia is associated with more severe symptomatology and suicidal behavior with gender-specific characteristics.

The current study aims to compare the prevalence of adverse childhood experiences (ACEs) between patients with schizophrenia and non-psychiatric control group, and to analyze the association of having suffered multiple ACEs with clinical symptoms of schizophrenia and suicidal behavior. A multicenter, cross-sectional study was conducted across three facilities in Buenos Aires, Argentina. One-hundred patients with schizophrenia and 50 healthy subjects were assessed with the Adverse Childhood Experiences questionnaire (ACE-Q), the Positive and Negative Syndrome Scale (PANSS), and the Columbia-Suicide Severity Rating Scale (C-SSRS). We observed that the prevalence of at least one ACE in schizophrenic patients was almost double in comparison with the non-psychiatric control group. Multiple ACEs were associated with persistent auditory hallucinations and lower negative symptoms in both sexes. Higher frequency of death ideation and a higher number of suicide attempts were reported among women. The strength of this study is the possibility of comparing the presence of ACEs between schizophrenic patients and non-psychiatric control using the same questionnaire in an under-reported sample of low socio-economic patients assisted in public hospitals. A limitation is that the history of ACEs relied on the retrospective assessment of childhood experiences, and adults could over-report ACEs because of recall bias.

Childhood maltreatment type and severity predict depersonalization and derealization in treatment-seeking women with posttraumatic stress disorder.

The dissociative subtype of posttraumatic stress disorder (D-PTSD) is estimated to occur in approximately 14% of those with posttraumatic stress disorder (PTSD), and is characterized by clinically significant dissociative symptoms in addition to typical PTSD symptoms. Prior research has found childhood maltreatment contributes to dissociation and D-PTSD susceptibility, but more nuanced questions about the nature of childhood maltreatment remain unexplored. We investigated how childhood maltreatment type and severity are associated with the dissociative symptoms of D-PTSD among women with PTSD (N = 106) receiving psychiatric care at a program specializing in trauma-related disorders. Participants completed self-report surveys of psychiatric symptoms and prior trauma exposure including the PTSD Checklist for DSM-5, the Dissociative Subtype of PTSD Scale, and the Childhood Trauma Questionnaire. We used multivariate linear regression to model the association of childhood maltreatment types and dissociation. In our final model childhood emotional abuse and physical abuse significantly predicted the dissociative symptoms of D-PTSD. This suggests childhood maltreatment type and severity, in particular of emotional and physical abuse, are associated with the dissociative symptoms of D-PTSD. This work points toward potential etiological contributions to D-PTSD.

Trends in Adverse Childhood Experiences (ACEs) in the United States.

BACKGROUND: It is important for those called upon to discuss major social determinants of health such as adverse childhood experiences (ACEs) to have accurate knowledge about generational trends in their prevalence. OBJECTIVE: To review available trend data on major forms of ACEs. METHODS: A search of academic data bases was conducted by combining the term "trend" with a variety of terms referring to childhood adversities. RESULTS: Available trend data on ACEs from the 20th century show multi-decade declines in parental death, parental illness, sibling death, and poverty, but multi-decade increases in parental divorce, parental drug abuse and parental incarceration. More recent trend data on ACEs for the first fifteen to eighteen years of the 21st century show declines in parental illness, sibling death, exposure to domestic violence, childhood poverty, parental divorce, serious childhood illness, physical abuse, sexual abuse, physical and emotional bullying and exposure to community violence. Two 21st century ACE increases were for parental alcohol and drug abuse. Overall, there appear to have been more historical and recent improvements in ACEs than deteriorations. But the US still lags conspicuously behind other developed countries on many of these indicators. CONCLUSION: Awareness of improvements, as well as persistent challenges, are important to motivate policy makers and practitioners and to prompt them to recognize the feasibility of success in the prevention of ACEs.

Childhood maltreatment, serotonin transporter gene, and risk for callous and unemotional traits: A prospective investigation.

Previous studies have reported associations between the serotonin transporter 5-HTTLPR genotype and antisocial and aggressive traits and between child maltreatment and antisocial traits. However, few studies have examined whether 5-HTTLPR moderates the influence of childhood maltreatment on callous and unemotional traits, a hallmark of psychopathy. Using a prospective cohort design, children with documented cases of maltreatment and matched controls were followed up and interviewed in adulthood. DNA was extracted from blood and saliva (N = 414) and callous-unemotional (CU) traits were assessed. Childhood maltreatment predicted higher CU scores in adulthood, whereas the effect of 5-HTTLPR was not significant. The effect of child maltreatment on CU traits did not differ by genetic risk (high or low activity 5-HTTLPR), whereas controls with the LL genotype had higher CU scores than controls with the SS genotype. Similar results were found for females and White, non-Hispanics, but not for males and Blacks. Variations in 5-HTTLPR did not affect the impact of child maltreatment on CU traits in adulthood. Genetic risk had a stronger effect on adults with lower environmental risk (controls). Having a history of child maltreatment or the LL genotype placed participants at risk for higher levels of callous and unemotional trait scores.

Refining social-information processing theory: Predicting maternal and paternal parent-child aggression risk longitudinally.

BACKGROUND: Clarifying the pathways leading parents to engage in parent-child aggression (PCA) would benefit child abuse prevention efforts during the perinatal period. OBJECTIVE: The present investigation empirically tested whether a social information processing (SIP) model could predict PCA risk from factors assessed in new mothers and fathers. PARTICIPANTS AND SETTING: This study recruited a diverse sample of 201 primiparous mothers in the last trimester of their pregnancy along with 151 fathers. METHODS: Using a prospective longitudinal study, the hypothesized SIP model was refined statistically using SIP factors measured prenatally to predict PCA risk when their children were 18 months. This refined model was then validated with SIP factors assessed when infants were 6 months to predict PCA risk when toddlers were 18 months. RESULTS: In general, findings indicated poor empathy related to greater overreactivity and more negative child behavior attributions. Moreover, approval of PCA use, negative child attributions, less knowledge of non-physical discipline alternatives, and higher child compliance expectations predicted subsequent PCA risk. The proposed SIP model for mothers demonstrated considerable stability. Although SIP processes predicted paternal risk, several SIP relations changed over time for fathers. CONCLUSIONS: Findings suggest comprehensive theoretical models like SIP theory can guide the specific processes to target for prevention and clarify how processes may be interconnected. SIP processes appear relevant and relatively stable targets for prevention and early intervention, particularly for mothers. SIP processes were applicable for fathers although the model was less consistent, suggesting work in examining paternal PCA risk remains an important research direction.