Professional quality of life in home visitors: Core components of the reflective supervisory relationship and IMH-E® Endorsement® engagement.

Infant and early childhood home visiting models are gaining prominence as effective programs for families. Most U.S. state infant mental health associations (IMHAs) recommend reflective supervision (RS) and Infant Mental Health (IMH-E® ) Endorsement® as components of home visitor professional development. These efforts may promote workforce professional quality of life. It is unknown whether a workplace policy to provide RS improves the likelihood that best practice guidelines, especially core components of a reflective supervisory relationship, are experienced by the workforce. We sought to investigate associations between home visitor well-being indicated by professional quality of life (i.e., burnout, secondary traumatic stress, compassion satisfaction) and a workplace policy providing RS, consistent experience of core components of a reflective supervisory relationship, and engagement in endorsement. We also examined differences in consistently experiencing core components of the reflective supervisory relationship in home visitors who reported having a workplace policy for providing RS and those who did not, and for home visitors engaged or not engaged in the endorsement process. A Workplace Supports Survey was designed to investigate these associations; we report findings from a sample of home visitor respondents (N = 139).  A policy to provide RS was not associated with professional quality of life. However, analyses suggest an association between a policy to provide RS and consistently experiencing core components of a reflective supervisory relationship. Unanticipated positive associations between engagement in endorsement and burnout and secondary traumatic stress were also found. Finally, engagement in endorsement was associated with less consistent experience of these core components. Implications for future inquiry about the purposes of RS and IECMH Endorsement® as strategies to promote workforce development and well-being are discussed.

Los modelos de visitas a casa en el campo de la infancia y la temprana niñez han adquirido importancia como programas eficaces para familias. La mayoría de las asociaciones estatales de salud mental infantil en Estados Unidos promueven la supervisión con reflexión (RS) y en Endoso® de Salud Mental Infantil (IMH-E®) como recursos de desarrollo profesional. RS y el Endoso® IMH-E® pudieran también promover la calidad de vida de la fuerza laboral profesional. Se desconoce si una política laboral de proveer RS se asocia con la experiencia de la fuerza laboral y las mejores directrices en la práctica, incluyendo los componentes centrales de una relación de supervisión con reflexión (CCRSR). Investigamos las asociaciones entre la calidad de vida profesional del visitante a casa (v.g. cansancio, estrés traumático secundario, satisfacción en la compasión) y una política laboral para RS, la experiencia consistente de CCRSR y la participación en el endoso. Una Encuesta sobre los Apoyos Laborales se diseñó para investigar estas asociaciones; nosotros reportamos los resultados de un grupo muestra de visitadores a casa (N = 139). Una política para ofrecer RS no se asoció con la calidad de vida profesional. Sin embargo, los análisis indican una asociación entre una política para ofrecer RS y experimentar consistentemente CCRSR. Se observaron asociaciones positivas no anticipadas entre la participación en el endoso y el cansancio y estrés traumático secundario. Finalmente, la participación en el endoso se asoció con una menos consistente experiencia de CCRSR. Se discuten las implicaciones para consulta futura acerca de los propósitos de RS y el Endoso® IECHM como estrategias para promover el desarrollo y bienestar de la fuerza laboral.

Les modèles de visite à domicile du nourrisson/de la petite enfance ont gagné en importance en tant que programmes efficaces pour les familles. La plupart des associations de santé mentale du nourrisson au niveau des états aux USA font la promotion de la supervision réflective (RS) et de l'adoption Infant Mental Health (IMH-Eâ) en tant que ressources de développement professionnel. La RS et l'adoption IMH-Eâ peuvent aussi promouvoir la qualité de vie professionnelle des effectifs. On ne sait pas si le fait d'offrir la RS au travail est lié à l'expérience des effectifs des lignes directrices des pratiques exemplaires y compris les composants essentiels d'une relation de supervision réflective (CCRSR). Nous avons étudié les liens entre la qualité de vie professionnelle d'un visiteur à domicile (i.e. burnout, stress traumatique secondaire, satisfaction de compassion) et le fait d'avoir la RS au travail, l'expérience constante de la CCRSR et l'engagement dans l'adoption. Un Questionnaire de Soutien du Lieu de Travail a été conçu pour étudier ces liens. Nous faisons état des résultats à partir d'un échantillon de visiteurs à domicile (N = 139). Le fait d'offrir la RS n'était pas lié à la qualité de vie professionnelle. Cependant les analyses suggèrent un lien entre le fait d'offrir la RS et le fait de faire l'expérience de la CCRSR avec constance. Des liens positifs inattendus entre l'engagement d'adoption et le burnout et le stress traumatique secondaires ont été observés. Enfin, l'engagement d'adoption était lié à une expérience moins constante de la CCRSR. Les implications pour des recherches futures sur les objectifs de la RS et de l'adoption IECMH en tant que stratégies de promotion du développement et du bien-être au travail sont discutées.

A Longitudinal and Multidimensional Examination of the Associations Between Temperament and Self-Restraint During Toddlerhood.

Developing self-restraint, or the inhibition of behavior in response to a prohibition, is an important process during toddlerhood. The objective of this study was to gain a better understanding of individual differences in the development of self-restraint during toddlerhood by examining stable elements and growth of temperament (i.e., attentional control, behavioral inhibition, negative emotionality), general intelligence, and self-restraint. Participants were 412 same-sex twin pairs (approximately 90% European American) from predominately middle-class households in Colorado. Data were collected at 14, 20, 24, and 36 months. Results indicated that higher behavioral inhibition, attentional control, and intelligence were independently associated with better self-restraint, whereas higher negative emotionality was an independent predictor of lower self-restraint. The associations between temperament and self-restraint generally appeared to be stable from 14 to 36 months.

IS REFLECTIVE SUPERVISION ENOUGH? AN EXPLORATION OF WORKFORCE PERSPECTIVES.

Infant mental health practice requires the performance of intense emotional labor. Professionals comprising the infant mental health (IMH) field are largely women at seminal points in adult life-span development. The purpose of this article is to explore the day-to-day challenges faced by clinical infant mental health professionals and their perspectives on the supports available for effective job performance. We review reflective supervision as a long-cherished professional support in the IMH field designed to hold the practitioner's fears, worries, and ambivalence, so that she may return to the work fortified to remain in therapeutic alliance with families despite unsolvable problems and an unknowable future (Weatherston, D., 2009). Yet, we propose that reflective supervision alone may not be an adequate protective measure for a workforce performing intensive emotional labor for extended periods and therefore at potentially increased risk for burnout and high turnover (Hochschild, A.R. ; C. Maslach, , C.M. Brotheridge & A.A. Grandey, 2009; A.S. Wharton, ). We suggest that structural factors concerning organizational culture, flexibility in scheduling, and professional growth and versatility bear deeper examination for their merits in supporting the IMH workforce. Finally, we contend that the overrepresentation of women in practitioner positions in IMH leaves an empirical gap where little is known about the experience of male IMH practitioners and the ramifications of their performance of emotional labor.

Longitudinal pathways from early maternal depression to children's dysregulated representations: a moderated mediation analysis of harsh parenting and gender.

There is some evidence linking maternal depression, harsh parenting, and children's internal representations of attachment, yet, longitudinal examinations of these relationships and differences in the developmental pathways between boys and girls are lacking. Moderated mediation growth curves were employed to examine harsh parenting as a mechanism underlying the link between maternal depression and children's dysregulated representations using a nationally-representative, economically-vulnerable sample of mothers and their children (n = 575; 49% boys, 51% girls). Dysregulation representations were measured using the MacArthur Story Stem Battery at five years of age (M = 5.14, SD = 0.29). Harsh parenting mediated the association between early maternal depression and dysregulated representations for girls. Though initial harsh parenting was a significant mediator for boys, a stronger direct effect of maternal depression to dysregulated representations emerged over time. Results are discussed in terms of their implications for intervention efforts aimed at promoting early supportive parenting.

Longitudinal Influence of Paternal Distress on Children's Representations of Fathers, Family Cohesion, and Family Conflict.

A parent's distress is known to color children's experiences of their families. Studies, however, have rarely focused on the levels of distress experienced by fathers, and in particular, as they affect the emotional experiences of their children. We examine the impact that fathers' experience of distress throughout their children's early years has on children's emerging narrative representations of father-child relationships and of family conflict and cohesion. In this longitudinal investigation, fathers of young children reported their distress on two occasions in relation to self, the marital relationship, and the family climate. Fathers also concurrently reported on their children's temperament, specifically negative emotionality. Children responded to story stem beginnings about challenging situations in the family and their narratives were scored for dysregulated negative-disciplinary and positive parental behaviors of fathers, family conflict themes, and family harmony themes. It was hypothesized that children of more distressed fathers would represent greater dysregulated fathering and higher levels of family conflict, and lower levels of positive fathering and family harmony than children of less distressed fathers. Further, the study examined whether this effect was mediated through the fathers' reports of their children's negative emotionality. Results partially supported the hypothesized direct and indirect effects. Children's narratives of negative-disciplinary fathering and family conflict were more common in boys when fathers reported greater distress, and temperament ratings fully mediated this effect. However, their narratives of positive fathering and family harmony were not significantly affected. That positive family features were preserved in children's narratives even in the face of greater father distress suggests that families may be able to build resilience to internalized distress through these positive narrative features.

Testing alternative hypotheses regarding the association between behavioral inhibition and language development in toddlerhood.

Studies have reported an inverse association between language development and behavioral inhibition or shyness across childhood, but the direction of this association remains unclear. This study tested alternative hypotheses regarding this association in a large sample of toddlers. Data on behavioral inhibition and expressive and receptive language abilities were collected from 816 twins at ages 14, 20, and 24 months. Growth and regression models were fit to the data to assess the longitudinal associations between behavioral inhibition and language development from 14 to 24 months. Overall, there were significant associations between behavioral inhibition and expressive language, and minimal associations with receptive language, indicating that the association is better explained by reticence to respond rather than deficient language development.

Parent adaptation and family functioning in relation to narratives of children with chronic illness.

BACKGROUND: This study assessed the experience of parents who have a child diagnosed with chronic illness and whether children's narratives mirror these experiences. METHOD: A total of 66 parents completed assessments about adaptation and family functioning. Children with type 1 diabetes or asthma participated in a story-stem narrative task. RESULTS: Forty-one percent of parents were unresolved about their child's diagnosis, regardless of time since diagnosis. Unresolved parents reported lower family functioning, and children in these families had more family conflict themes. CONCLUSIONS: Parental/Child narratives may provide unique insights into family adjustment. Future work may consider interventions related to family communication and expression of emotion.

Autonomic correlates of children's concern and disregard for others.

Psychophysiological research on empathy and prosociality in children has focused most often on cardiac activity, heart rate (HR), and HR deceleration in particular. We examined these processes in 7-year-old children during two empathy mood inductions. We independently assessed children's responses to others' distress in two different contexts: structured probes (simulated pain) and maternal interviews. We identified three groups of children who showed either (1) concern for others in distress (i.e., empathy and prosocial behaviors), (2) active disregard (i.e., anger/hostility and antisocial behavior), or (3) passive disregard (i.e., little or no concern). We compared groups on HR and HR deceleration. The active disregard group consistently showed the lowest HR both when groups were based on structured probes and on mothers' reports. Children who showed passive disregard displayed little self-distress during other's distress and different patterns of association of self-distress and HR than the other two groups. Active and passive disregard thus may reflect two different aspects of lack of concern for others. HR deceleration was seen for all three groups, suggesting it is not necessarily a cardiac index of concern for others. Interdisciplinary approaches and multiple-systems analysis are needed to better understand psychobiological substrates.

The magnitude of genetic and environmental influences on parental and observational measures of behavioral inhibition and shyness in toddlerhood.

Behavioral inhibition is a temperamental trait that refers to slow approach to novel items, shyness towards new people, and fearfulness in new situations, and individuals may develop inhibited response styles by as early as 2 years of age. There are important methodological considerations in the assessment of early temperament, with parental report and observational measures providing both corroborative and unique data. The present study examined behavioral inhibition measured by parental report and observational measures in a genetically informative sample to delineate the agreement between the methods and the uniqueness of each method, and to estimate the magnitude of genetic and environmental influences on the common and unique variance. The biometric, psychometric, and rater bias models were conducted to study the covariance between measurement modalities. Overall, the results suggested a common phenotype was assessed by both parents and observers. The latent phenotype underlying parental and observational measures of behavioral inhibition was moderately to substantially heritable.

Developmental trajectories in toddlers' self-restraint predict individual differences in executive functions 14 years later: a behavioral genetic analysis.

We examined whether self-restraint in early childhood predicted individual differences in 3 executive functions (EFs; inhibiting prepotent responses, updating working memory, and shifting task sets) in late adolescence in a sample of approximately 950 twins. At ages 14, 20, 24, and 36 months, the children were shown an attractive toy and told not to touch it for 30 s. Latency to touch the toy increased with age, and latent class growth modeling distinguished 2 groups of children that differed in their latencies to touch the toy at all 4 time points. Using confirmatory factor analysis, we decomposed the 3 EFs (measured with latent variables at age 17 years) into a Common EF factor (isomorphic to response inhibition ability) and 2 factors specific to updating and shifting. Less-restrained children had significantly lower scores on the Common EF factor, equivalent scores on the Updating-Specific factor, and higher scores on the Shifting-Specific factor than did the more-restrained children. The less-restrained group also had lower IQ scores, but this effect was entirely mediated by the EF components. Twin models indicated that the associations were primarily genetic in origin for the Common EF variable but split between genetics and nonshared environment for the Shifting-Specific variable. These results suggest a biological relation between individual differences in self-restraint and EFs, one that begins early in life and persists into late adolescence.

Mothers' resolution of their young children's psychiatric diagnoses: associations with child, parent, and relationship characteristics.

Maternal resolution of a child's diagnosis relates to sensitive caregiving and healthy attachment. Failure to resolve is associated with maternal distress, high caregiving burden, and the quality of marital and social support. This study examined maternal resolution of diagnosis in a child psychiatric population utilizing the Reaction to Diagnosis paradigm. Thirty-three mothers of children ages 2­7 years with psychiatric disorders were interviewed using the Reaction to Diagnosis Interview. Slightly over half of the sample was classified as resolved. Associations between maternal resolution status, maternal depression, childrearing stress, and child functioning were examined and a predictive model for maternal resolution status was tested. Specific findings included a significant association between childrearing stress and maternal resolution status with support for some additional predictive power for maternal depression on resolution status. Child functioning was not significantly associated with resolution status, and may exert influence indirectly through its association with childrearing stress. There were no significant associations between maternal or child demographic characteristics and maternal resolution status. Clinical and research implications are discussed.

Empathy in early childhood: genetic, environmental, and affective contributions.

We investigated the genetic and environmental origins of children's empathy toward a distress victim and its correlates with emotional symptoms and affective knowledge. The cognitive (hypothesis testing) and affective (empathic concern) empathy of 122 twin pairs in response to simulated pain by an adult examiner was observed at 3.5 years of age. Moderate (0.19 to 0.44) heritabilities were estimated for individual differences in empathy, and the nonshared environment and error accounted for the rest of the variance. Hypothesis testing and empathic concern were moderately correlated, mainly through overlapping genetic effects. Although children's affective knowledge did not correlate with their empathy, affective knowledge interacted with mother-rated emotional symptoms in predicting empathy; knowledge about emotions was associated with greater empathy in children low in emotional symptoms. In contrast, among children with high degrees of emotional symptoms, those with better affective knowledge tended to show lower empathy.

The developmental origins of a disposition toward empathy: Genetic and environmental contributions.

The authors investigated the development of a disposition toward empathy and its genetic and environmental origins. Young twins' (N = 409 pairs) cognitive (hypothesis testing) and affective (empathic concern) empathy and prosocial behavior in response to simulated pain by mothers and examiners were observed at multiple time points. Children's mean level of empathy and prosociality increased from 14 to 36 months. Positive concurrent and longitudinal correlations indicated that empathy was a relatively stable disposition, generalizing across ages, across its affective and cognitive components, and across mother and examiner. Multivariate genetic analyses showed that genetic effects increased, and that shared environmental effects decreased, with age. Genetic effects contributed to both change and continuity in children's empathy, whereas shared environmental effects contributed to stability and nonshared environmental effects contributed to change. Empathy was associated with prosocial behavior, and this relationship was mainly due to environmental effects.

Story stem narratives with young children: moving to clinical research and practice.

Story stem narrative methods have demonstrated reliability and validity as assessments of the young child's representations of parent - child and peer relationships. Most, but not all, prior research has been conducted with samples of typically developing children. Growing interest in the method from clinical researchers and child psychiatry clinics brings forward a number of critical issues in its use with children referred for severe behavioural disruption and mood disorder. This special issue of Attachment & Human Development provides a collection of papers that demonstrates some of the unique theoretical contributions of the method for clinical research. Practical aspects of using story stem methods with the referred child are also considered.

Story stem responses of preschoolers with mood disturbances.

Observing the young child's affect regulation and thought processes during a clinic assessment visit is of critical importance although challenging for children referred for mood disturbance. In this study, parents reported symptoms using standardized clinical interviews and story stems narratives were administered to 20 referred and 12 typically developing preschool age children. Comparison of the referred and typically developing children in our sample showed that specific story contexts varied in eliciting responses reflecting disorganization and thought disturbance from the referred children. The experience of using story stem narratives in the clinical assessment process suggests it provides a valuable complement to parent report for children referred for mood disturbance and mania symptoms but additional development and study of the method is necessary.

Outcome of a randomized multifaceted intervention with low-income families of wheezing infants.

OBJECTIVE: To evaluate the outcome of a secondary intervention conducted with infants at risk for asthma. DESIGN: Families of wheezing infants were randomized to a 1-year intervention or control group; outcome evaluation occurred from April 1, 2000, through September 30, 2003, when children reached 4 years of age. SETTING: Home intervention and clinic evaluation. PARTICIPANTS: A total of 149 children from low-income urban families with multiple wheezing episodes before the age of 2 years. INTERVENTION: Nurse home visitors provided a multifaceted intervention (environmental allergen and tobacco smoke reduction as well as illness management) that lasted 12 months, with the goal of decreasing asthma onset and/or severity when children reached 4 years of age. MAIN OUTCOME MEASURES: Asthma status (parent-reported symptoms, impulse oscillometry, and documented asthma diagnosis), caregiver quality of life, medication use, and emergency department visits. RESULTS: A total of 46.0% of children from the intervention group and 54.9% from the control group met criteria for asthma at the age of 4 years (P = .33). Caregiver quality of life was better for the intervention group (P = .01). Children in the intervention group were less likely to have reactive airways (prebronchodilator-postbronchodilator decrease in impulse oscillometry resistance at 10 Hz of > or =15%; P = .07). Outcome was modified by baseline illness severity; among children with low severity, odds of developing asthma by the age of 4 years were 3 times lower for intervention children than controls (P = .04), and symptom severity was lower for intervention children (P = .03). CONCLUSIONS: Multifaceted intervention did not decrease asthma among children with early wheezing illness as a whole, but only for children with low illness severity in infancy. Despite having an impact on only less severely ill children, results demonstrate the possibility of ameliorating illness burden for some inner-city families with children at high risk for poor asthma outcomes.

Short-term impact of a randomized multifaceted intervention for wheezing infants in low-income families.

OBJECTIVE: To present an interim analysis of the effect of a home-based intervention with low-income caregivers of wheezing infants at risk for childhood asthma on mediating variables. METHOD: Infants aged 9 to 24 months with 3 or more physician-documented wheezing episodes were randomly assigned to environmental support intervention (ES) (n = 90) or control (n = 91) groups. Nurse home visitors intervened for 1 year to decrease allergen and environmental tobacco smoke exposure and improve symptom perception and management. Assessments at baseline and 12 months included allergens in house dust, infant urinary cotinine levels, caregivers' symptom reports, quality of life, illness management, and quality of caregiving. Medical records were coded for hospitalizations, emergency department visits, and corticosteroid bursts. RESULTS: Within the ES group, cockroach allergen levels were significantly reduced and there was a trend toward reduction in dog dander levels. Among infants with detectable urinary cotinine, levels were significantly reduced in the ES group. Caregiver psychological resources modified the impact, and low-resource ES caregivers were the most strongly affected. Asthma knowledge and provider collaboration improved significantly in the ES group. Neither reports of infant symptoms nor emergency department visits or hospitalizations showed positive intervention effects. Number of corticosteroid bursts for infants was significantly higher for the ES group. CONCLUSIONS: The Childhood Asthma Prevention Study intervention was effective in reducing several environmental exposures and improving illness management. However, even with an intensive home-based intervention, we failed to reduce respiratory symptoms or medical use in the ES group relative to the control group, illustrating the difficulty of changing the course of early asthma development among low-income infants.

Maternal preconceptions about parenting predict child temperament, maternal sensitivity, and children's empathy.

This study examined the influence of maternal preconceptions on child difficult temperament at 6 months and maternal sensitivity at 12-15 months and whether all 3 variables predicted children's empathy at 21-24 months. Within a low-income, ethnically diverse sample of 175 mother-child dyads, path models were tested with 3 empathy indices (prosocial, indifference, inquisitive) as outcomes. Results indicated that maternal preconceptions significantly predicted child difficult temperament, maternal sensitivity, and children's empathy. Temperament mediated the link between maternal preconceptions and inquisitiveness, and maternal sensitivity mediated the link between preconceptions and prosocial responses. Group modeling techniques revealed no significant differences across gender or ethnicity. Correlations suggested contextual effects based on the familiarity of the person in distress. The implications and utility of developing parenting interventions are discussed.

Morbidity patterns among low-income wheezing infants.

OBJECTIVE: This study describes morbidity attributable to wheezing illness in a multi-ethnic sample of low-income infants younger than age 2, and examines biological, environmental, and psychosocial correlates of morbidity indexes. METHOD: Infants 9 to 24 months old, considered at risk for developing asthma on the basis of having had 3 or more health care contacts with documented wheezing, received comprehensive evaluations as part of an environmental intervention study. Baseline evaluations with the infants, their families, and their home environments focused on biological, environmental, and psychosocial factors that would potentially increase asthma risk for the children. At study entry, prior morbidity attributable to wheezing illness was assessed with caregiver reports of symptom frequency and severity and medication use, caregiver quality of life, and medical record documentation of hospitalizations and emergency department (ED) visits. RESULTS: Forty-six percent of the infants had 1 or more hospitalizations and 59% had 2 or more ED visits since birth for wheezing illness. Foreign-born Hispanic families had significantly more ED visits for their children's wheezing illness than US-born Hispanic families, whites, or blacks, although they used fewer controller medications and they reported less illness severity. Multivariate analyses showed 3 biological factors, respiratory syncytial virus, elevated child IgE, and cockroach allergen in the home, were independently associated with hospitalizations within this sample. Similar analyses showed that ED visits were not associated with biological variables, but rather with caregivers with single parent status and smokers. Caregiver reports of wheezing illness severity were correlated with ED visits, but not with hospitalizations. Severity ratings were higher for children of mothers with asthma and for those whose caregivers had higher anxiety and stress. The only correlate of caregiver ratings of poor quality of life was high caregiver anxiety. CONCLUSIONS: Ethnic and immigrant status was an important factor in morbidity attributable to infant wheezing illness. In addition to respiratory infection, both allergic processes and social variables were associated with morbidity as measured by health care utilization. Caregiver reports of illness severity were significantly correlated with psychosocial factors.