Timeliness of Early Identification and Referral of Infants with Social and Environmental Risks.

The Early Intervention Parenting Partnerships (EIPP) program is a home visiting program that provides home visits, group services, assessments and screenings, and referrals delivered by a multidisciplinary team to expectant parents and families with infants who experience socioeconomic barriers, emotional and behavioral health challenges, or other stressors. The present study examines whether EIPP successfully meets its aims of screening families for social and environmental factors that may increase the risk of children's developmental delays and connect them to the larger statewide early intervention (EI) system relative to families with similar background characteristics who do not receive EIPP. Coarsened exact matching was used to match EIPP participants who enrolled between 2013 and 2017 to a comparison group of families identified from birth certificates. Primary study outcomes including EI referrals, evaluations, and service receipt for children from 3 months to 3 years were measured using EI program data. Secondary outcomes included EI referral source, EI eligibility criteria (e.g., presence of biological, social, or environmental factors that may increase later risk for developmental delay), and information on service use. Impacts were assessed by fitting weighted regression models adjusted for preterm birth and maternal depression and substance use. EIPP participants were more likely than the comparison group to be referred to, evaluated for, and receive EI services. EIPP facilitated the identification of EI-eligible children who are at risk for developmental delays due to social or environmental factors, such as violence and substance use in the home, child protective services involvement, high levels of parenting stress, and parent chronic illness or disability. EIPP serves as an entry point into the EI system, helping families attain the comprehensive supports they may need to optimize their well-being and enhance children's development.

Self-Regulation Development Among Young Spanish-English Dual Language Learners.

Despite strong evidence self-regulation skills are critical for school readiness, there remains a dearth of longitudinal studies that describe developmental trajectories of self-regulation, particularly among low-resource and underrepresented populations such as Spanish-English dual-language learners (DLLs). The present study examined individual differences in trajectories of self-regulation among 459 Spanish-English DLLs who were Hispanic from four different samples and three geographic locations in the U.S. Self-regulation was assessed in all samples using repeated administration of the Head-Toes-Knees-Shoulders (HTKS) task from early childhood through early elementary school. Results of latent growth curve analyses revealed that growth was best represented by quadratic trajectories. Latent class growth analyses captured significant individual differences in self-regulation trajectories. One group of children (41%) started with higher HTKS scores and displayed rapid early growth in performance. A similar percentage of children (41%) displayed intermediate growth in self-regulation, starting with lower HTKS scores but displaying rapid growth commencing arrange 4.5 years. Finally, about 18% of the sample did not display growth in HTKS performance until after entry to elementary school, around age 6 years. Girls were half as likely as boys to be in this later developing group. Likewise, children from families at the upper end of the socioeconomic distribution in this low-income sample were significantly less likely to be in the later developing group relative to children from families with lower SES. Study findings indicate the importance of monitoring growth rates in self-regulation as a means of identifying children at risk for entering school without the requisite self-regulation skills.

Children's early school attendance and stability as a mechanism through which homelessness is associated with academic achievement.

Unfortunately, family homelessness is a crisis in the United States. The majority of families experiencing homelessness are headed by single mothers and half of children who experience homelessness are less than five years of age. In the current study, we investigated whether children's school attendance and stability mediated the association between early experiences of homelessness (in infancy and toddlerhood) with children's school performance on standardized assessments of math and English language arts administered in the spring of third grade in a sample of children of young mothers. We used a person-centered analytic technique (i.e., repeated measures latent class analysis) to identify three classes of children's patterns of school attendance and stability from kindergarten through third grade that consisted of (a) High Absenteeism, (b) Decreasing Absenteeism, and (c) Low Absenteeism classes. Early experiences of homelessness were directly and indirectly associated with math, but not English language arts scores, through the three identified classes. The results of the current study have important implications for young children who experience homelessness and suggest promoting school attendance as one avenue to support academic achievement. In addition, supporting families and children early (i.e., before they begin pre-kindergarten) will be key in ensuring that young children who experience homelessness are successful in educational environments.

Effects of a Home Visiting Program on Parenting: Mediating Role of Intimate Partner Violence.

Young women aged 18 to 24 years are in the highest risk group for intimate partner violence (IPV), and adolescent mothers are at particularly high risk for IPV and for risky health behaviors. Exposure to IPV may contribute to parenting stress and risky behaviors, and may compromise parenting behavior and healthy child development. The present study examined whether program effects of a statewide home visiting program for adolescent parents on young mothers' parenting stress and risky behaviors measured 2 years post program enrollment were mediated by program effects on their exposure to IPV measured 1 year post enrollment. Using longitudinal data from a subsample of young mothers (n = 448; 58% program, 42% control) who participated in a randomized controlled trial evaluation of a statewide home visiting program, Healthy Families Massachusetts (HFM), we estimated path analyses to examine whether home visiting program effects observed on IPV mediated home visiting program effects on subsequent assessments of parenting distress and mothers' risky behaviors. Findings indicated that IPV mediated associations between home visiting program effects on mothers' parenting distress and risky behavior. Although most newborn home visiting programs do not have an explicitly stated goal of reducing IPV, helping mothers and their partners to reduce violent behavior can have further-reaching impacts on other key goals of home visiting programs, such as parenting stress and risky behaviors.

Aspects of Parent-Child Interaction from Infancy to Late Adolescence Are Associated with Severity of Childhood Maltreatment through Age 18.

Childhood maltreatment (CM) is a pervasive public health problem worldwide, with negative health consequences across the lifespan. Despite these adverse outcomes, identifying children who are being maltreated remains a challenge. Thus, there is a need to identify reliably observable features of parent-child interaction that indicate risk for CM and that can instigate strategically targeted family supports. The aim of this longitudinal study was to assess multiple aspects of observed mother-child interaction from infancy to late adolescence as risk indicators of the overall severity of CM by age 18. Mother-child dyads were assessed in infancy (N = 56), at age 7 years (N = 56), and at age 19 years (N = 56/110). Severity of CM through age 18 was indexed by combined prospective and retrospective assessments. Interactions associated with severity of CM by age 18 included maternal hostility in infancy, maternal withdrawal in infancy and middle childhood, child disorganized attachment behavior in middle childhood and late adolescence, as well as hostile and role-confused interactions in late adolescence. This study identifies new indices of maternal and child behavior as important risk indicators for the severity of CM. These indices could be used to improve early identification and tailor preventive interventions for families at risk for CM.

Diversity of adverse childhood experiences among adolescent mothers and the intergenerational transmission of risk to children's behavior problems.

RATIONALE: It is important to investigate the diversity and variability among adverse childhood experiences (ACEs) in young mothers because they are likely to experience considerable adverse exposures during childhood as well as challenging environments following childbirth. OBJECTIVE: The current study used latent class analysis with a diverse sample of young mothers to identify subgroups of mothers based on their adverse childhood experiences (ACEs). Subsequent analyses were conducted to examine class specific differences in maternal mental health postpartum and their children's socio-emotional functioning at eight years of age. RESULTS: Four classes of participants were identified based on mothers' ACEs, including a high, multiple-risk class, a low-risk class, a high-risk for abuse class, and a high-risk for household dysfunction class. These classes were associated with differences in maternal and child functioning. The low-risk class showed significantly better maternal and child health and well-being than the high-risk class. However, nuanced differences were seen for mothers and their children across all classes; for example, children of mothers in the high-risk for abuse class scored significantly better on internalizing behaviors than children from the high, multiple-risk class, but not better on externalizing behaviors. Further, children of mothers in the high-risk for household dysfunction class scored better than the high, multiple-risk class on externalizing behaviors but not better on scores of internalizing behaviors. CONCLUSION: Understanding the differences in how certain types of childhood adversity are associated with mothers' and their children's later health and well-being will bolster the use of only a sum score of ACEs for both how we research risk and in supporting clinicians to provide targeted care.

Maternal Engagement in a Home Visiting Program as a Function of Fathers' Formal and Informal Participation.

Home visiting programs support new and expecting parents by strengthening parenting practices, improving parental and child health and well-being, and preventing child maltreatment. Participant retention is often a challenge for home visitation, particularly for young families, potentially reducing program impact. Father engagement in services may be one avenue for supporting continued program take-up for young parents. The current study examined associations between fathers' formal and informal participation in an infant home visiting program and mothers' take-up of home visits and whether these associations differed depending on mothers' relationship status at enrollment or timing of enrollment. Results showed that fathers' participation in home visiting supported maternal retention, particularly when fathers were formally enrolled. These associations depended on mothers' relationship status at enrollment but not on whether they enrolled pre- or postnatally. These findings have direct implications for home visiting programs, both in supporting maternal retention and in informing the recruitment and engagement of fathers.

Recurrence of Maltreatment After Newborn Home Visiting: A Randomized Controlled Trial.

OBJECTIVES: To investigate whether a newborn home visiting program for primiparous adolescent mothers (aged 16-20 years at childbirth) reduced recurrence of child maltreatment in child protective services (CPS) reports. METHODS: We conducted a randomized controlled trial of Healthy Families Massachusetts, a statewide home visiting program for young parents. A total of 704 first-time young mothers were randomly assigned to a home visiting group, or to a control group who we referred to other services and who received child development and parenting information. The outcome variable was CPS reports (2008-2016) available for 688 families-specifically, rereports following an initial report (up to mean child age of 7 years). RESULTS: Of the 52% of families who experienced initial CPS reports, 53% experienced additional CPS reports. Children of mothers in the home visiting group were less likely to receive a second report and had a longer period of time between initial and second reports. CONCLUSIONS: The home visiting program reduced the recurrence of CPS maltreatment report by 32% and increased the length of time between initial and additional CPS reports. Home visiting parenting support and prevention programs may reduce the likelihood of recurrent maltreatment following completion of program services.

Intimate Partner Violence in the First 2 Years of Life: Implications for Toddlers' Behavior Regulation.

Intimate partner violence (IPV) is prevalent in families with young children and challenges their healthy development. This study examined characteristics of IPV (e.g., mother- vs. partner-perpetrated, types and severity) and investigated potential effects of IPV on toddlers' behavioral regulation in a sample of families at risk for IPV. We also examined whether maternal depression and child-rearing attitudes and behavior would moderate IPV-child behavior links. These questions were addressed in a sample ( N = 400) of first-time adolescent mothers and their toddlers (1-2 years of age). Families were visited in their homes; data were collected via maternal report and observations. Partner- and self-perpetrated IPV was assessed using the Conflict Tactics Scale questionnaire; child behavior regulation was measured using the Brief Infant-Toddler Social and Emotional Assessment questionnaire. Approximately 80% of families experienced psychological aggression; almost one third reported physical assault in the past year. Both physical and psychological IPV were associated with greater toddler behavior problems. Neither maternal depression, mothers' attitudes about corporal punishment, nor nonhostile interaction moderated IPV-behavior problem links, though mothers' reports of maltreating behavior did. Among children whose mothers did not use corporal punishment/physical violence, IPV did not differentially affect behavior problems. Children whose mothers used corporal punishment/physical violence with them showed behavior problems in the context of IPV (severe psychological aggression). Results underscore the importance of exposure to IPV during the first year of life, and the prevalence of IPV perpetrated by both mothers and their partners in families with adolescent mothers.

Maternal mind-mindedness and toddler behavior problems: The moderating role of maternal trauma and posttraumatic stress.

Maternal mind-mindedness (MM) reflects a caregiver's tendency to view a child as an individual with an independent mind. Research has linked higher MM with more favorable parenting and child adaptation. The aim of this study was to examine whether MM was associated with toddlers' behavior problems and competence, and the moderating role of trauma and posttraumatic stress disorder (PTSD) in a sample (N = 212) of adolescent mothers and their toddlers. MM was coded from maternal utterances during free play; mothers completed the University of California at Los Angeles Trauma and Posttraumatic Stress Disorder Reaction Index and reported on children's behavior problems and competence using the Brief Infant-Toddler Social and Emotional Assessment. The majority of mothers (84%) experienced trauma; 45% of these mothers met criteria for partial or full PTSD. Trauma was related to greater behavior problems, and PTSD moderated MM-child functioning relations. When mothers experienced full PTSD, there was no relation between MM and behavior problems. With child competence, when compared to children of mothers with no trauma exposure, children of mothers experiencing partial PTSD symptoms were more likely to have delays in competence when mothers made more MM comments. Results are discussed in light of how MM, in the context of trauma and PTSD, may affect parenting.

Intergenerational transmission of child abuse and neglect: Do maltreatment type, perpetrator, and substantiation status matter?

A maternal history of childhood maltreatment is thought to be a potent risk factor for child abuse and neglect, yet the extent of continuity across generations is unclear, with studies reporting vastly different rates of intergenerational transmission. Disparate findings may be due to lack of attention to the nature of maltreatment experiences in each generation. We sought to expand the current literature by examining the role of maltreatment type, perpetrator identity, and substantiation status of reports to child protective services (CPS) on intergenerational maltreatment among adolescent mothers (n=417) and their children. We found that when mothers had at least one report of childhood maltreatment (substantiated or not), the odds that they maltreated their children increased by 72% (OR=2.52), compared to mothers who are not maltreated, but the odds were considerably lower when we limited analysis to substantiated reports. Both a maternal history of substantiated neglect and multiple type maltreatment (neglect and physical or sexual abuse) were associated with increased risk of child maltreatment, yet the likelihood of children experiencing multiple maltreatment perpetrated with their mothers identified as perpetrators increased over 300% when mothers had a childhood history of multiple maltreatment.

Depression Trajectories of Antenatally Depressed and Nondepressed Young Mothers: Implications for Child Socioemotional Development.

OBJECTIVES: This study explores the longitudinal trajectories of depressive symptoms in young mothers and investigate the consequences of maternal depression for children's birth outcomes and behavioral adjustment. HYPOTHESIS: Antenatal depression puts children of young mothers at risk for adjustment difficulties by adversely impacting birth outcomes and maternal symptoms after birth. METHODS: Data were drawn from a three-wave randomized, controlled trial of a statewide home visiting program for young primiparous women. A subsample of women (n = 400) who were prenatal at intake was used in the analysis. Mothers were divided into an antenatally depressed group (ADG; 40%) and a healthy group (HG) based on their symptoms at intake. Mothers reported depressive symptoms at intake and 12- and 24-month follow-up, and filled out a checklist of child behavior problems at 24 months follow-up. Perinatal and birth outcomes were derived from the Electronic Birth Certificate collected by the State Department of Public Health at discharge from the hospital. RESULTS: ADG and HG had similar pregnancy characteristics and birth outcomes, but ADG reported more child behavioral problems. Multigroup latent growth curve analysis provided evidence for distinct depression trajectories. A mediation hypothesis was not supported. In both groups, steeper increase in symptoms over time predicted more mother-reported child behavioral problems. CONCLUSIONS: Findings are consistent with studies linking antenatal depression with post-birth symptoms, underscoring the importance of prenatal screening for depression.

Patterns of depression among adolescent mothers: Resilience related to father support and home visiting program.

The negative consequences of maternal depression are a major public health concern, both for mothers and for their children. Despite the high prevalence of depression among adolescent mothers, little is known about the patterns of adolescent mothers' depression in the early parenting years. The present study examined mothers' depression during the first 2 years following childbirth in a sample of 428 young mothers (20 or younger at first childbirth) who were participants in a randomized controlled trial of a home visiting parenting support program. Depressive symptoms were assessed using the self-reported Center for Epidemiological Studies Depression Scale (CES-D). Mothers were classified into groups based on whether their depressive symptoms were below or above the cutoff for clinically significant symptomatology. Depression groups (stable nondepressed, stable depressed, remitted depression) were associated with variations in mothers' satisfaction with support from the baby's father and enrollment in the home visiting program. Maternal depression was more likely to remit when mothers were satisfied with father support; assignment to the home visiting program was associated with mothers remaining mentally healthy. Results have clinical and policy implications for prevention and intervention programs.

Improving Adolescent Parenting: Results From a Randomized Controlled Trial of a Home Visiting Program for Young Families.

OBJECTIVES: Our aim was to estimate the effects of Healthy Families Massachusetts, a statewide home visiting program serving first-time adolescent parents, on parenting, child development, educational attainment, family planning, and maternal health and well-being. METHODS: We used a randomized controlled trial design to randomly assign the 704 participants to a group receiving home visiting services or a control group. Between 2008 and 2012, telephone and in-person interviews were conducted and administrative data obtained at 12 and 24 months after enrollment. Intention-to-treat analyses compared group differences across 5 outcome domains: parenting, child health and development, educational and economic achievement, family planning, and parental health and well-being. RESULTS: The home visiting program had a positive influence on parenting stress, college attendance, condom use, intimate partner violence, and engagement in risky behaviors. No negative findings were observed. CONCLUSIONS: A paraprofessional home visiting program specifically targeting young mothers appears effective in domains of particular salience to young parents and their infants and toddlers. Expanding participation in the program appears a worthy goal for program administrators and policymakers.

Relationship types among adolescent parents participating in a home-visiting program: A latent-transition analysis.

Young parents (less than 25 years of age) have been shown to have especially low rates of father involvement and union stability. However, research has also shown that parenting experiences of young fathers may not be uniform. There is a need for more research that assesses both the multidimensionality of relationship typologies and their temporality. Using a large longitudinal sample of low-income, young mothers enrolled in a randomized control study of a home-visitation program (n = 704; 61% program, 39% control), we evaluated how mother-father relationship dynamics changed over time. Ten mother-reported indicators of relationships (e.g., coresidence, marital status, types of father support) were used to conduct a latent-class analysis of relationship types. A 4-class solution was identified at each time point: Single Parent, Supportive Nonresident Partner, Supportive Resident Partner, and Questioning/Ambivalent Coupling. Latent-transition analyses were used to evaluate stability of relationships across 2 years. At each transition, a large proportion of women moved from one relationship class to another, indicating heterogeneity in relationship dynamics of adolescent parents. Results revealed the potential of a home-visiting program targeted at young parents to favorably promote more stable and supportive mother-father relationships and coparenting arrangements.

PATTERNS OF EMOTIONAL AVAILABILITY IN MOTHER-INFANT DYADS: ASSOCIATIONS WITH MULTIPLE LEVELS OF CONTEXT.

This study explored emotional availability (EA)- an individual's emotional responsiveness and attunement to another's needs and goals (R.N. Emde, 1980)- among a high social risk group of 226 adolescent mothers and their infants (average = 12 months old). The aim was to identify dyadic patterns of EA and to examine their association with multiple indicators of the ecological context. Maternal sensitivity, maternal nonhostility, and child responsiveness were assessed with the Emotional Availability Scales, Third Edition (Z. Biringen, J. Robinson, & R.N. Emde, 1998) during free play and teaching observations at home. Four EA patterns were identified using k-means cluster analysis: (a) "low functioning," (b) "high functioning," (c) "low functioning dyads with nonhostile mothers," and (d) "inconsistently sensitive mother and responsive child." These patterns had distinct associations with (a) mothers' parenting attitudes regarding children's power and independence and parent-child role reversal, (b) mothers' strategies in conflict resolution with their partners and their children, and (c) the dyads' living arrangements. This study makes a contribution to the understanding of the mother-child relationship from a systemic and relational perspective and explores the association of EA patterns with the dyads' relational context. Implications for programs and treatment approaches aimed at supporting dyads at social risk are discussed.

The moderating effect of relationships on intergenerational risk for infant neglect by young mothers.

Infant neglect is the form of child maltreatment that occurs most often, yet has been least amenable to prevention. A maternal history of childhood maltreatment is a potent risk factor for child neglect, yet most maltreated mothers break intergenerational cycles of child abuse and neglect. Little is known about what protective factors support discontinuity in intergenerational transmission. This study examined whether certain factors (positive childhood care, older maternal age, social support) buffer intergenerational risk for neglect among the infants of young mothers, a population at high risk of being victimized. For young mothers in the sample (<21 years at birth; n=447), the effect of a maternal history was assessed separately for different maltreatment types according to data on substantiated reports from Child Protective Services. Early risk for neglect was assessed using maternal self-report of parenting empathy. The results revealed that both infants and their mothers experienced neglect more often than any other maltreatment type. However, approximately 77% of maltreated mothers broke the cycle with their infants (<30 months). Maternal age moderated the relation between a maternal history of neglect and infant neglect, and social support moderated the relation between childhood neglect and maternal empathy. Neglected mothers had considerably higher levels of parenting empathy when they had frequent access to social support than when they had less frequent support, whereas the protective effect of social support was not nearly as strong for non-maltreated mothers. Study findings highlight resilience in parenting despite risk for infant neglect, but underscore the context specificity of protective processes.

Influence of mother's depression on her reports of father involvement and child behavioral problems: a latent state-trait approach.

Research on father involvement has shown positive effects on child development. Because fathers in high social risk samples may be hard to recruit or retain in studies, the literature often has relied on maternal report of father involvement. A major limitation of this approach is that unobserved traits of the reporting mothers may distort the real associations between father involvement and children's development. Using maternal data from a large, longitudinal sample (N = 704) of low-income, young mothers, we evaluated the degree to which a stable depressive trait affected the link between mother-reported measures of father involvement and child problems. Three waves of maternal depression data were used to fit a latent state-trait model of depression, allowing for separate estimates of occasion-specific symptoms and stable depressive trait. A latent regression analysis which did not control for this trait revealed a link between father involvement and child problems similar in magnitude to the links reported in the literature. However, this association disappeared once we accounted for the effect of maternal depressive trait. Results suggest that studies using maternal reports of both father and child behaviors should control for such confounding effects. We elaborate on these findings in the conclusion and offer suggestions for future research on the role of fathers in child development.

An ecological analysis of infant neglect by adolescent mothers.

To inform efforts to prevent child neglect, we investigated a wide range of risk factors that have been largely unexamined in relation to infant neglect, the most commonly occurring form of child maltreatment. Using an ecological model of child neglect, we assessed the influence of characteristics at the level of the child, the mother, the family, and broader childrearing contexts on adolescent mothers' likelihood of being a perpetrator in a substantiated case of neglect against their firstborn infants (n=383, M=12 months). Several factors were associated with infant neglect by young mothers: median block income, low infant birth weight, maternal smoking, maternal childhood history of neglect and of positive care, intimate partner violence (IPV) perpetrated by either the mother or her partner, and maternal use of mental health services. In multivariate models, income, a maternal childhood history of positive care, IPV by either a mother or her partner, and mental health service usage made significant contributions to the odds that a mother neglected her infant. Our findings suggest that these factors have particular salience to policymakers' and practitioners' efforts to identify high risk families and to intervene during the earliest months of life to prevent child neglect.

Parsing the construct of maternal insensitivity: distinct longitudinal pathways associated with early maternal withdrawal.

The current paper expands on Ainsworth's seminal construct of maternal sensitivity by exploring the developmental pathways associated with one particular form of insensitivity: maternal withdrawal. Drawing on longitudinal data from infancy to age 20 in a high-risk cohort, we highlight how maternal withdrawal over the first eight years of life is associated with child caregiving behavior and with maternal role confusion, as well as with features of borderline and antisocial personality disorders. We also present evidence for the specificity of this pathway in relation to other aspects of maternal insensitivity and other aspects of child adaptation. To illuminate these pathways we both review recent published work and report new findings on the middle childhood and adolescent components of these trajectories. Finally, we consider the implications for assessment of maternal behavior in high-risk samples and indicate directions for productive future work.