The Association Between Patterns of Trauma Exposure, Family Dysfunction, and Psychopathology Among Adolescent Females With Depressive Symptoms From Low-Income Contexts.

Distinguishing profiles of trauma exposure among low-income adolescent females with depressive symptoms is important for understanding comorbidity, family relationships, and treatment. Specifically, child maltreatment is essential to examine in comparison to other traumas. Participants included 170 adolescent females (65.3% Black; 21.2% White; 13.5% other race; 14.1% Latina/x) with depressive symptoms and their primary caregiver from low-income families. Latent class analysis (LCA) identified three trauma classes. Probabilities of endorsing different subtypes of maltreatment (physical abuse, physical neglect, emotional abuse, emotional neglect, and sexual abuse), number of subtypes of maltreatment, and non-maltreatment traumas (accident, experiencing or witnessing physical assault, death or injury of loved one, medical trauma) varied among groups. Higher levels of family dysfunction and traumatic stress symptoms were reported in both classes with maltreatment exposure as compared to the class with only non-maltreatment trauma exposure. Findings have implications for family-focused interventions for maltreated adolescent females with depressive symptoms from low-income contexts.

The Development of a Mental Health Program for Unaccompanied Minors in the United States.

The unique needs of unaccompanied children (UC) and unaccompanied refugee minors (URM) often make it challenging for them to engage in traditional mental health services. This paper describes the development and implementation of a mental health program for UC and URM using a collaborative approach with key stakeholders. In the Exploration phase, we conducted an assessment of youths' mental health needs, barriers to, and recommendations for care through discussions with community partners. Next, we describe the Preparation phase in which we designed the program around three major domains: 1) training and consultation, 2) cross-sector collaboration, and 3) direct services. Discussion of the Implementation phase includes a description of youth served and program materials. Finally, the Sustainment phase focuses on recommendations for best practice informed by successes and challenges of program implementation. Findings have implications for future mental health programming for UC/URM.

Longitudinal Outcomes of Child Parent Psychotherapy: Response to Commentaries.

In response to the commentaries provided by Chu et al. (2020), Harmon et al. (2020), and McMahon & Maxwell (2020) on our longitudinal follow-up of Child-Parent Psychotherapy (CPP) with mothers with depression and their children, we focus on two domains: accessibility and scalability of CPP and identifying empirically supported mechanisms of change in attachment intervention research. In considering the accessibility and scalability of CPP, we discuss issues related to attrition, length of intervention, and implementation with caregivers with depression. Our discussion of mechanisms of change in attachment interventions explores active comparison conditions, theorized mediators, intervention modalities, assessment methods, and longitudinal research designs. This conversation is intended to highlight important areas for future research in the field of attachment interventions, with the goal of informing clinical and systems-level policies and practices.

Attachment and Affect between Mothers with Depression and their Children: Longitudinal Outcomes of Child Parent Psychotherapy.

The present investigation examined the longitudinal effects of Child-Parent Psychotherapy (CPP) for toddlers and their mothers with depression on: a) maternal affective expression, b) child affective expression, and c) mother-child cohesion. Mothers with depression (Mage = 31.7 years; 92.8% White, 3.5% Black, 2.1% Hispanic, 2.3% other) and their toddlers were randomized to receive CPP (DI; n = 66) or to a control group (DC; n = 64). Mothers without depression and their toddlers (NC; n = 68) were recruited as an additional comparison group. Dyads were assessed at baseline (T1; 20 months old), post-intervention (T2; 36 months old), and follow-up (T3; 9 years old). Data from a mother-child conflict task was coded as a measure of observed outcome variables. Change in post-intervention attachment security assessed via the Strange Situation was evaluated as a mediator between intervention condition and maternal and child affective expression and dyadic cohesion at T3. Change to secure attachment post-intervention significantly mediated the association between intervention condition and T3 maternal warmth and child anger/problem behavior. Toddlers of mothers with depression who received CPP showed higher rates of change to secure attachment compared to those in both the DC and NC groups. Dyads who changed to secure attachment at T2 displayed higher levels of maternal warmth at T3 and lower levels of child anger and problem behavior at T3. Implications for the use of CPP as a preventive intervention and the importance of attachment as a mediator of long-term outcomes are discussed.

Provision of mental health services immediately following a natural disaster: Experiences after Hurricane Maria in Puerto Rico.

OBJECTIVE: The increased risk of mental health disorders in the months and years following a natural disaster highlights the need for more immediate preventive intervention. The objective of the current study was to learn from a real-time implementation of a natural disaster response following the Hurricane Maria in Puerto Rico to identify strategies for providing mental health services immediately after a natural disaster. METHODS: Two focus groups were held with faculty (n = 6) and graduate students (n = 4) from a graduate psychology program at the Universidad Carlos Albizu, Centro Universitario Mayagüez. An additional key informant interview was conducted with two faculty member participants. Data were analyzed qualitatively using thematic analysis. RESULTS: The delivery of mental health services was organized into three major themes: (1) finding a way to communicate, (2) targeting key access points for outreach and centralization of resources, and (3) providing triaged mental health care based on level of need. CONCLUSIONS: Findings are used to guide recommendations for mental health response preparation in future natural disaster contexts.

Developmental pathways from maternal history of childhood maltreatment and maternal depression to toddler attachment and early childhood behavioral outcomes.

The current study examined the development of toddler attachment and early childhood behavior among children of mothers with a history of childhood maltreatment and current major depressive disorder. Maternal depression, maternal sensitivity, and toddler attachment were assessed as mediators of the association between maternal history of childhood maltreatment and child internalizing and externalizing behavior. Participants were from a low-income, largely racial minority urban sample and included 123 mothers with (n = 69) and without (n = 54) major depressive disorder at baseline and their children assessed at 12, 26, and 36 months old. Findings suggest maternal depression and maternal sensitivity mediated the association between maternal history of childhood maltreatment and disorganized attachment. Maternal depression, but not disorganized attachment, mediated the association between maternal history of childhood maltreatment and child symptomatology. Results suggest that supporting mothers through depression and processing their adverse childhood experiences are critical in fostering positive child development.

The effect of maternal depression on mental representations and child negative affect.

BACKGROUND: Maternal depression is a widely recognized public health concern with significant implications for child functioning, including the development of negative child affect and risk for later depression. Negative mental representations may partially account for the association between maternal depression and child negative affect. METHODS: The effect of depression on low-income mothers' representations of their child, self, and mother was assessed via Expressed Emotion (EE) during Five-Minute Speech Samples. Direct and indirect pathways between maternal depression, EE, and child negative affect were examined. Mothers (M = 24 years old) who had experienced a major depressive episode (n = 144) since child's birth, non-depressed comparison mothers (n = 62), and their children participated. RESULTS: Examination of between-group differences revealed that depressed mothers had higher levels of overall self EE. Trend results also suggest depressed mothers may have higher overall EE toward their children and their own mothers. Novel coding systems for EE toward self (Identity and Depressotypic Cognitions) and EE toward mother (Source of Concrete Support and Resolution of Past Adversity) were also developed and tested. A significant indirect relation was found between maternal baseline depression and child negative affect at 26 months via the mother's level of EE-Criticism of her mother. LIMITATIONS: Certain EE subcodes may need to be adapted for young children and high-risk, low-income participants. CONCLUSIONS: Findings highlights the importance of relational interventions that focus on maternal representations for women with depression and their children.

Six-Month Follow-up of the Families on Track Intervention Pilot Trial for Children With Fetal Alcohol Spectrum Disorders and Their Families.

BACKGROUND: When the primary disabilities associated with fetal alcohol spectrum disorders (FASD) are not well supported, individuals are at higher risk for mental health problems and other secondary conditions. The Families on Track (FOT) intervention was designed to prevent secondary conditions and improve family functioning in children with FASD. Promising results from a pilot study demonstrated positive effects on child and caregiver outcomes immediately following the intervention. The objective of this study was to examine the sustainability of these effects 6 months postintervention. METHODS: Thirty children (ages 4 to 8) with prenatal alcohol exposure and their caregivers were enrolled in the original study. Families were randomized to the FOT intervention or an active comparison group that provided comprehensive assessment and individualized feedback. The intervention integrated a positive parenting curriculum and a child skills group. Families were assessed at baseline, postintervention, and 6-month follow-up visits. Follow-up data were available for 24 families on child and caregiver outcomes. Data were analyzed using effect size calculations and analysis-of-variance techniques. RESULTS: Relative to the comparison group, intervention families showed continued gains in parenting efficacy and maintained prior improvements in FASD knowledge over the follow-up period. Although intervention families reported a decrease in their needs being met over the follow-up period, they continued to report their needs being met to greater extent than those in the comparison group. Consistent with postintervention outcomes, children in both groups exhibited similar decreases in child disruptive behavior 6 months following the intervention. Unfortunately, positive gains seen at postintervention for child self-esteem and emotion regulation were attenuated at follow-up. CONCLUSIONS: This pilot study yielded promising effects on important areas of caregiver functioning. However, the intervention's impact on child functioning waned over time, suggesting the need for sustained or alternate child intervention.

"I'm Doing My Part, I Just Need Help From the Community": Intervention Implications of Foster and Adoptive Parents' Experiences Raising Children and Young Adults With FASD.

Individuals with fetal alcohol spectrum disorders (FASD) have high rates of health care service utilization. It is vital that health care professionals understand FASD and associated family experiences to strengthen their ability to respond to family needs and tailor family-focused interventions. This study included 24 foster and adoptive parents of children and adults (aged 3-33 years) with FASD. Data were collected via individual interviews and focus groups and analyzed thematically. Consistent with a developmental psychopathology perspective, parents' experiences interacted with the individual (with FASD), family, and broader systems ecological levels. Parents undertook protective actions in an attempt to prevent secondary conditions, support their child and family, and mitigate systems barriers. They also experienced stressors at each level, and stress was increased by protective actions. The overall parenting experience was fueled by a protective parenting attitude. Findings can strengthen family-focused care practices with individuals with FASD and their families and inform novel family interventions.

Interventions in fetal alcohol spectrum disorders: An international perspective.

Fetal alcohol spectrum disorders (FASD) are present across countries and cultures, with prevalence rates threatening to rise in the coming years. In order to support children and families with FASD around the world, researchers must work to disseminate and implement evidence-based interventions. However, each cultural context presents unique elements and barriers to the implementation process. This review considers the challenges of addressing FASD in an international context. It summarizes existing FASD interventions that have empirical support in the domains of parenting and education, attention and self-regulation, adaptive functioning, and nutrition and medication. It then outlines cultural barriers pertaining to FASD that may impede the implementation process and makes suggestions for using purveyors as cultural liaisons between researchers and local stakeholders. The review concludes with recommendations for moving forward with international dissemination and implementation of FASD interventions.

Fostering secure attachment in low- and middle-income countries: Suggestions for evidence-based interventions.

Children struggling with the effects of trauma in low- and middle-income countries (LMIC) face a substantial mental health resource gap that limits their opportunities for positive psychosocial development. Multidisciplinary interventions working to close this gap may benefit from incorporating an empirically supported treatment (EST) into their approach that targets a universal mechanism implicated in resilience, like attachment. ESTs should be selected based on their level of empirical support and cultural adaptability, and then modified on the basis of qualitative evaluations conducted with the local population and stakeholders. This paper will provide an overview of attachment as a mechanism of resilience, a critical analysis of existing attachment-based ESTs, and recommendations for overcoming EST implementation barriers in LMIC.