Exploring a model for infant and early childhood mental health consultation in early childhood home visiting.

Home-visiting programs have experienced a rapid expansion as a strategy for providing support to vulnerable families with young children. As the evidence base for home-visiting effectiveness has grown, the need for providing additional support to home visitors in addressing attachment issues and working with families with mental health concerns has become clear. One model for providing this support is Infant and Early Childhood Mental Health Consultation (IECMHC). This study contributes to the nascent evidence base for mental health consultation in home-visiting programs, and describes the results from a pilot study of a model that incorporates another evidence-based approach to early childhood mental health, Early Childhood Positive Behavior Intervention and Supports (ECPBIS) as a framework for consultation. We present data collected in a pilot project implementing an IECMHC-ECPBIS model within a Healthy Families America home-visiting program, including a description of the approach and home-visiting staff outcomes over a 24-month period. Home visitors reported significant increases in knowledge of children's mental health, knowledge of adult mental health, confidence in involving parents as partners, and program leadership around addressing early childhood mental health issues. Program and staff benefits suggest promise for this enhanced home-visiting program model.

Los programas de visita a casa han experimentado una rápida expansión como una estrategia para proveer apoyo a familias vulnerables con niños pequeños. A medida que la base de evidencia para la eficacia de visitas a casa ha crecido, la necesidad de proveer apoyo adicional a quienes hacen las visitas a casa en cuanto a cómo dirigir los asuntos de afectividad y trabajar con familias con preocupaciones de salud mental se ha hecho más evidente. Un modelo para proveer este apoyo es la Consulta de Salud Mental del Infante y la Temprana Niñez (IECMHC). Este estudio es una contribución a la naciente base de evidencia para la consulta de salud mental en programas de visita a casa, y el mismo describe los resultados de un estudio piloto de un modelo que incorpora otro acercamiento a la salud mental en la temprana niñez basado en la evidencia, la Intervención y Apoyos de Comportamiento Positivo en la Temprana Niñez (ECPBIS) como un marco de trabajo de consulta. Presentamos información recogida en un proyecto piloto que implementa un modelo IECMHC-ECPBIS dentro de un programa de visitas a casa de América de Familias Sanas (HFA), incluyendo una descripción del acercamiento y resultados del personal de visitas a casa a lo largo de un período de 24 meses. Los visitadores a casa reportaron significativos aumentos en el conocimiento de salud mental de los niños, conocimiento de la salud mental en adultos, confianza en incluir a los padres como compañeros en el trabajo, y el liderazgo del programa en cuanto a dirigir asuntos de salud mental en la temprana niñez. Los beneficios del Programa y del personal son prometedores para este modelo de programa de visitas a casa aumentado.

Les programmes de visites à domicile ont connu une expansion rapide en tant que stratégie permettant d'apporter un soutien aux familles vulnérables avec de jeunes enfants. Comme la base des données factuelles pour l'efficacité des visites à domicile a grandi, le besoin de soutien supplémentaire aux visiteurs à domicile pour ce qui concerne le fait de répondre aux problèmes d'attachement ainsi que leur travail avec des familles ayant des problèmes de santé mentale est devenu plus clair et évident. Un modèle de ce soutien est la Consultations de Santé Mentale de la Jeune Enfance (soit en anglais Early Childhood Mental Health Consultation, IECMHC). Cette étude contribue aux données sur la consultation de santé mentale dans les programmes de visites à domicile et décrit les résultats d'une étude pilote sur un modèle qui incorpore une autre approche empirique sur la santé mentale de la jeune enfance, les Interventions et Soutiens de Comportement Positif de la Petite Enfance, (en anglais Early Childhood Positive Behavior Interventions and Supports, ECPBIS) en tant que structure pour la consultation. Nous présentons les données relevées durant un projet pilote de mise en place du modèle IECMHC-ECPBIS au sein d'un programme de visite à domicile de Familles Américaines en Bonne Santé (abrégé en anglais HFA), y compris une description de l'approche et des résultats avec les professionnels effectuant les visites sur une période de 24 mois. Les visiteurs à domicile ont fait état d'augmentations importantes dans leurs connaissances sur la santé mentale des enfants, dans leur connaissance de la santé mentale adulte, dans leur confiance à faire participer les parents en tant que partenaires, et dans la direction du programme concernant les problèmes de santé mentale de la petite enfance. Le programme et les bénéfices des employés suggèrent des résultats prometteurs pour ce modèle amélioré de programme de visite à domicile.

It's not as simple as it sounds: Problems and solutions in accessing and using administrative child welfare data for evaluating the impact of early childhood interventions.

In recent years, there has been increasing interest in using administrative data collected by state child welfare agencies as a source of information for research and evaluation. The challenges of obtaining access to and using these data, however, have not been well documented. This study describes the processes used to access child welfare records in six different states and the approach to combining and using the information gathered to evaluate the impact of the Early Head Start program on children's involvement with the child welfare system from birth through age eleven. We provide "lessons learned" for researchers who are attempting to use this information, including being prepared for long delays in access to information, the need for deep understanding of how child welfare agencies record and code information, and for considerable data management work for translating agency records into analysis-ready datasets. While accessing and using this information is not easy, and the data have a number of limitations, we suggest that the benefits can outweigh the challenges and that these records can be a useful source of information for policy-relevant child welfare research.

The effect of Early Head Start on child welfare system involvement: A first look at longitudinal child maltreatment outcomes.

The high societal and personal costs of child maltreatment make identification of effective early prevention programs a high research priority. Early Head Start (EHS), a dual generational program serving low-income families with children prenatally through age three years, is one of the largest federally funded programs for infants and toddlers in the United States. A national randomized trial found EHS to be effective in improving parent and child outcomes, but its effectiveness in reducing child maltreatment was not assessed. The current study used administrative data from state child welfare agencies to examine the impact of EHS on documented abuse and neglect among children from seven of the original seventeen programs in the national EHS randomized controlled trial. Results indicated that children in EHS had significantly fewer child welfare encounters between the ages of five and nine years than did children in the control group, and that EHS slowed the rate of subsequent encounters. Additionally, compared to children in the control group, children in EHS were less likely to have a substantiated report of physical or sexual abuse, but more likely to have a substantiated report of neglect. These findings suggest that EHS may be effective in reducing child maltreatment among low-income children, in particular, physical and sexual abuse.

A multilevel analysis of consultant attributes that contribute to effective mental health consultation services.

A positive relationship between the mental health consultant (MHC) and early care and education staff is considered important for achieving positive early childhood mental health consultation outcomes, but little is known about the attributes of MHCs that contribute to relationships with staff and to staff-reported child outcomes. This study was a secondary analysis of 57 MHCs and 407 Head Start staff who responded to the Head Start Mental Health Services Survey. Hierarchical linear models examined the relationship between five attributes of MHCs and staff reports of improved child outcomes and a positive relationship with the MHC. The results suggest that MHC reports of positive relationships with staff, positive relationships with families, and high levels of supervision and support are positively associated with staff reports of positive relationships with the MHC (p < .05). None of the MHC-reported attributes were associated with staff-reported child outcomes.

Does attachment style influence social support or the other way around? A longitudinal study of Early Head Start mothers.

Understanding the association between attachment style and social support is important for informing programs that seek to improve outcomes for families by intervening with either or both of these systems. The present study examines whether increasing levels of social support among 181 low-income, primarily African American mothers leads to changes in their self-reported attachment style, or whether attachment style influences the extent to which they perceive others as supportive. Results suggest that whereas scores on the avoidant attachment dimension were relatively stable and led to decreasing perceptions of social support over time, scores on the anxious dimension were more malleable, at least under conditions of low stress. For mothers who experienced fewer stressful life events, increasing social support led to decreased attachment anxiety over time. However, when life stress was high, social support had no such positive influence. Implications for the need to attend to mothers' attachment styles in providing appropriate and effective intervention are discussed.

Testing maternal depression and attachment style as moderators of Early Head Start's effects on parenting.

This study examined maternal depression, attachment avoidance, and attachment anxiety as moderators of Early Head Start's effects on four parenting outcomes assessed at age three. Participants (N = 947) were drawn from six sites of the Early Head Start National Research and Evaluation Project, a multi-site randomized trial. Findings suggest more positive program effects for mothers with less initial attachment avoidance or attachment anxiety. First, baseline attachment avoidance moderated Early Head Start program effects on observed maternal supportiveness, such that program mothers with lower baseline attachment avoidance were rated as more supportive of their three-year-olds than program mothers with higher baseline attachment avoidance. Second, program effects on spanking varied depending on mothers' baseline attachment anxiety.

Root shock revisited: perspectives of early head start mothers on community and policy environments and their effects on child health, development, and school readiness.

Racial differences in school readiness are a form of health disparity. By examining, from the perspective of low-income minority families participating in an Early Head Start study, community and policy environments as they shape and inform lived experiences, we identified several types of social and economic dislocation that undermine the efforts of parents to ready their children for school. The multiple dislocations of community triggered by housing and welfare reform and "urban renewal" are sources of stress for parents and children and affect the health and development of young children. Our findings suggest that racial differences in school readiness result not from race but from poverty and structural racism in American society.

The role of interagency collaboration for substance-abusing families involved with child welfare.

Meeting the needs of families involved with the child welfare system because of a substance abuse issue remains a challenge for child welfare practitioners. In order to improve services to these families, there has been an increasing focus on improving collaboration between child welfare, treatment providers, and the court systems. This paper presents the results from qualitative interviews with 104 representatives of these three systems that explore how the collaborative process works to benefit families, as well as the barriers and supports for building successful collaborations. Results indicate that collaboration has at least three major functions: building shared value systems, improving communication, and providing a "team" of support. Each of these leads to different kinds of benefits for families as well as providers and has different implications for building successful collaborative interventions. Despite these putative benefits, providers within each system, however, continue to struggle to build effective collaborations, and they face such issues as deeply ingrained mistrust and continued lack of understanding of other systems' values, goals, and perspectives. Challenges that remain for successful collaborations are discussed.

Accessing substance abuse treatment: issues for parents involved with child welfare services.

The complex issues associated with barriers to treatment entry for parents who are involved with child welfare has not been well explored. Accessing timely treatment is now critical for these parents since the introduction of the Adoption and Safe Families Act of 1997, limiting the time until a permanency decision is made. Using a longitudinal, qualitative approach, substance-abusing parents from 15 families, their relevant family members, and service providers were interviewed approximately every 3 months over an 18-month period. The experiences of these parents add to our knowledge of the unique barriers this population faces, and expands our understanding of the mechanisms by which certain barriers may delay treatment.

How do relationships support parenting? Effects of attachment style and social support on parenting behavior in an at-risk population.

The importance of supportive relationships for new parents has been the focus of both research and parenting interventions. Attachment style, typically viewed as a relatively stable trait reflecting one's comfort in social relationships, as well as social support, or one's perception of the social context, have both been found to be important for fostering engaged, involved parenting. Less is known, however, about how these variables work together to influence parenting behavior, especially in families at higher risk for negative child outcomes. Data were collected from 152 urban, predominantly African American, low-income parents when their children were 14 and 36 months of age. Results suggest that parents with more social support show greater increases in the frequency of positive parent-child activities over time, but that this effect is mediated by mothers' attachment style, specifically, their level of anxious/ambivalent attachment. Mothers with more social support tended to be less anxious/ambivalent about close relationships, and this in turn led to increases over time in the frequency of parent-child interactions. Mothers' tendency to avoid close relationships, however, while correlated with social support, was unrelated to changes in parenting behavior. Implications of these findings for program development, parenting, and the malleability of attachment style based on social context are discussed.

Is the adoption and safe families act influencing child welfare outcomes for families with substance abuse issues?

The Adoption and Safe Families Act (ASFA) was designed to promote more timely permanent placements for children in the child welfare system. To date, however, available data have said little about whether ASFA is meeting its intended goals. This study looks at the impact of ASFA on parents struggling with substance abuse issues. The authors compared child welfare outcomes, pre- and post-ASFA, for children of more than 1,900 substance-abusing women with some treatment involvement. After the implementation of ASFA, children in this study spent less time in foster care, were placed in permanent settings more quickly, and were more likely to be adopted than remain in long-term foster care. The proportion of children who were reunified with their parent or parents stayed the same. These outcomes were apparent even controlling for case and family characteristics. Results are discussed in terms of the influence of ASFA on service delivery systems.

How effective are family treatment drug courts? Outcomes from a four-site national study.

Family treatment drug courts (FTDCs) are a rapidly expanding program model designed to improve treatment and child welfare outcomes for families involved in child welfare who have substance abuse problems. The present study compares outcomes for 250 FTDC participants to those of similar parents who did not receive FTDC services in four sites. Results show that FTDC parents, compared to comparison parents, entered substance abuse treatment more quickly, stayed in treatment longer, and completed more treatment episodes. Furthermore, children of FTDC parents entered permanent placements more quickly and were more likely to be reunified with their parents, compared to children of non-FTDC participants. Finally, the FTDC program appears to have a "value added" in facilitating positive child welfare outcomes above and beyond the influence of positive treatment experiences.

Understanding patterns of substance abuse treatment for women involved with child welfare: the influence of the Adoption and Safe Families Act (ASFA).

The passage of the federal Adoption and Safe Families Act (ASFA), which calls for timely permanency planning for children placed into state foster care systems, has led to increased attention to the need for timely and appropriate treatment services to families with substance abuse issues who are involved with child welfare. Using statewide administrative data collected before and after the implementation of ASFA, the present study explores the influence of ASFA, as well as other family characteristics, on patterns of treatment service utilization by child-welfare involved clients. Findings suggest that in the period following the ASFA legislation, mothers entered substance abuse treatment significantly more quickly after the start of their child welfare cases, and remained in treatment longer, compared to pre-ASFA. No differences in rates of treatment completion were found. Results are interpreted in terms of the changing treatment service context, enhanced collaboration between child welfare and treatment systems, and the possible influence of the legislation on parents' motivation to enter treatment.

"Come and take a walk": listening to Early Head Start parents on school-readiness as a matter of child, family, and community health.

We explored the perspectives and experiences of low-income, predominantly African American families regarding children's school-readiness. Our research, which involved qualitative interviews, ethnographic case studies, and "photovoice" methods, focused on families participating in the national evaluation of Early Head Start. While valuing academic skills, study parents emphasized the importance of social and emotional health in regard to both children's and parents' readiness to begin school. These developments are especially critical given the challenges parents perceive in local school environments. On the basis of a social ecology framework, we argue that psychological and environmental dimensions of school-readiness are public health matters and that understanding the perspectives of low-income and minority parents on such issues is a critical aspect of health communication dedicated to eliminating health disparities.

Parents, practitioners, and researchers: community-based participatory research with early head start.

Community-based participatory research (CBPR) is an approach to research and evaluation that is receiving increased attention in the field of public health. Our report discusses the application of this approach to research and evaluation with an Early Head Start (EHS) program in Pittsburgh, Pa. Our primary purpose is to illustrate the key elements that contributed to effective collaboration among researchers, EHS practitioners, and parents of EHS children in the conduct of the study. The focus is not on research findings but on research process. Our goal is to make the practices of CBPR visible and explicit so they can be analyzed, further developed, and effectively applied to a range of public health issues in a diversity of community contexts.