The role of consultative alliance in infant and early childhood mental health consultation: Child, teacher, and classroom outcomes.

Young children's social-emotional development is powerfully shaped by their early environments, which for many includes early childhood education (ECE). Infant and Early Childhood Mental Health Consultation (IECMHC) pairs teachers and infant and early childhood mental health (IECMH) consultants to promote teachers' capacity to foster positive social-emotional development in ECE. Although the outcomes of IECMHC have been well studied, little research has investigated how this model leads to changes for teachers and children. According to theory, the quality of the relationship between teachers and IECMH consultants, termed consultative alliance (CA), is a key mechanism of change. This study analyzed the role of CA on 6-month outcomes of IECMHC in a sample of 316 children, 289 teachers, and 62 IECMH consultants. Results from multilevel models suggested that stronger CA predicted greater improvements in teacher-child closeness and teacher-rated child attachment behaviors. In addition, a strong CA was related to greater improvement in classroom climate, teachers' self-efficacy, and teachers' perceptions of their jobs. This study upholds the centrality of relationship-building and parallel process in mental health consultation, and by advancing understanding of the mechanisms of change for IECMHC may provide salient implications for policy and practice.

El desarrollo socio-emocional de los niños pequeños es formado de manera poderosa por sus tempranos ambientes, los cuales, para muchos incluyen la educación en la temprana niñez (ECE). La Asesoría de Salud Mental del Infante y la Temprana Niñez (IECMHC) empareja maestros y Asesores de la Salud Mental del Infante y la Temprana Niñez (IECMH) para promover la capacidad de los educadores de crear un positivo desarrollo socio-emocional en ECE. A pesar de que los resultados de IECMHC han sido bien estudiados, poca investigación se ha enfocado en cómo este modelo conduce a cambios para educadores y niños. De acuerdo con la teoría, la calidad de la relación entre educadores y Asesores de IECMH, llamada Alianza Consultiva (CA), es un mecanismo clave para el cambio. Este estudio analizó el papel de la Alianza Consultiva en resultados de seis meses de IECMHC en un grupo muestra de 316 niños, 289 educadores y 62 Asesores de IECMH. Los resultados de modelos de multiniveles sugieren que una más fuerte CA predijo mayores mejoras en la cercanía entre educador y niño y las conductas de afectividad del niño evaluadas por el educador. Adicionalmente, una más fuerte CA se relacionó con una mayor mejora en el ambiente del aula de clases, la auto-efectividad de los educadores y las percepciones que los educadores tenían de su trabajo. Este estudio apoya la centralidad de establecer una relación y un proceso paralelo en la asesoría de salud mental, y por medio del avance en la comprensión de los mecanismos de cambio para IECMHC, pudiera proveer implicaciones destacadas para la política y la práctica.

Le développement socio-émotionnel des jeunes enfants est fortement formé par leurs premiers environnements, ce qui pour bien d'entre eux inclut l'enseignement préscolaire. L'approche IECMHC (Infant and Early Childhood Mental Health Consultation soit Consultation en Santé Mentale du Nourrisson et de la Petite Enfance) jumelle des enseignants et des consultants IECHM (Santé Mentale du Nourrisson et de la Petite Enfance) afin de promouvoir la capacité des enseignements à cultiver et à favoriser un développement socio-émotionnel positif dans l'enseignement préscolaire. Bien que les résultats de l'approche IECMHC aient été bien étudiés il existe peu de recherches sur la manière dont ce modèle mène à des changements pour les enseignants et les enfants. Selon la théorie, la qualité de la relation entre les enseignants et les Consultants IECMH, appelée Alliance Consultative (AC), est un mécanisme clé de changement. Cette étude a analysé le rôle de l'Alliance Consultative sur les résultats à six mois de la IECMHC chez un échantillon de 316 enfants, 289 enseignants, et 62 Consultants IECMH. Les résultats de modèles multi-niveaux ont suggéré qu'une AC plus forte prédisait des améliorations plus importantes dans le rapprochement enseignant-enfant et dans les comportements d'attachement de l'enfant évalués par l'enseignant. De plus une AC plus forte était liée à une amélioration plus importante du climat de la salle de classe, de l'auto-efficacité des enseignements et des perceptions que les enseignants se faisaient de leur travail. Cette étude maintient la centralité de la construction de la relation et du processus parallèle dans la consultation de santé mentale. En faisant progresser la compréhension des mécanismes de changement pour la IECMHC elle présente aussi des implications importantes pour les décisions stratégiques et la pratique.

Perceptions of Mindfulness in a Low-income, Primarily African American Treatment-Seeking Sample.

Individuals with low socioeconomic status (SES) and members of racial/ethnic minority groups often experience profound disparities in mental health and physical well-being. Mindfulness-based interventions show promise for improving mood and health behaviors in higher-SES and non-Latino White populations. However, research is needed to explore what types of adaptations, if any, are needed to best support underserved populations. This study used qualitative methods to gain information about a) perceptions of mindfulness, b) experiences with meditation, c) barriers to practicing mindfulness, and d) recommendations for tailoring mindfulness-based interventions in a low-income, primarily African American treatment-seeking sample. Eight focus groups were conducted with 32 adults (16 men and 16 women) currently receiving services at a community mental health center. Most participants (91%) were African American. Focus group data were transcribed and analyzed using NVivo 10. A team of coders reviewed the transcripts to identify salient themes. Relevant themes included beliefs that mindfulness practice might improve mental health (e.g., managing stress and anger more effectively) and physical health (e.g., improving sleep and chronic pain, promoting healthier behaviors). Participants also discussed ways in which mindfulness might be consistent with, and even enhance, their religious and spiritual practices. Results could be helpful in tailoring mindfulness-based treatments to optimize feasibility and effectiveness for low-SES adults receiving mental health services.

[Domestic violence as a threat to maternal and child well-being in an urban migrant community in Peru].

OBJECTIVE: To examine the impact that domestic violence (DV) has on hindering the success of urban migrants in Peru and any association with maternal depression, impaired parenting, social capital, and child development. METHODS: This was a cross-sectional study consisting of structured interviews with 97 mothers and their school-aged children in El Porvenir, a predominantly migrant area of the city of Trujillo, Peru. Data collection occurred in February-June 2011. Proven tools previously validated for use in Spanish were used to assess the following variables: maternal depression, social capital, domestic violence, parenting behaviors, child socioemotional development, and child cognitive development. Correlational, multiple regression, tests of interaction, and indirect/mediator models were used for analysis. RESULTS: Sixty-five percent of women reported currently experiencing DV. DV strongly predicted depression (P < 0.001). Women who reported DV were less likely to be employed (P < 0.05), had lower cognitive social capital (P < 0.01), engaged in fewer caregiving activities (P < 0.05), had less maternal energy (P < 0.05), and were less warm (P < 0.05). DV was associated with internalizing behaviors in children (P < 0.01), with impaired parenting partially mediating this relationship. CONCLUSIONS: DV compromises women's mental health and parenting ability. High rates of DV among urban migrants affect the whole community by hindering employment potential and reducing trust among community members. Interventions targeting DV-related variables (e.g., substance abuse and limited job opportunities for men) could reduce the deleterious effects of DV on urban migrant communities across Latin America.

Domestic violence as a threat to maternal and child well-being in an urban migrant community in Peru / La violencia doméstica como una amenaza para el bienestar maternoinfantil en una comunidad urbana de migrantes del Perú

OBJECTIVE: To examine the impact that domestic violence (DV) has on hindering the success of urban migrants in Peru and any association with maternal depression, impaired parenting, social capital, and child development. METHODS: This was a cross-sectional study consisting of structured interviews with 97 mothers and their school-aged children in El Porvenir, a predominantly migrant area of the city of Trujillo, Peru. Data collection occurred in February-June 2011. Proven tools previously validated for use in Spanish were used to assess the following variables: maternal depression, social capital, domestic violence, parenting behaviors, child socioemotional development, and child cognitive development. Correlational, multiple regression, tests of interaction, and indirect/mediator models were used for analysis. RESULTS: Sixty-five percent of women reported currently experiencing DV. DV strongly predicted depression (P < 0.001). Women who reported DV were less likely to be employed (P < 0.05), had lower cognitive social capital (P < 0.01), engaged in fewer caregiving activities (P < 0.05), had less maternal energy (P < 0.05), and were less warm (P < 0.05). DV was associated with internalizing behaviors in children (P < 0.01), with impaired parenting partially mediating this relationship. CONCLUSIONS: DV compromises women's mental health and parenting ability. High rates of DV among urban migrants affect the whole community by hindering employment potential and reducing trust among community members. Interventions targeting DV-related variables (e.g., substance abuse and limited job opportunities for men) could reduce the deleterious effects of DV on urban migrant communities across Latin America.

OBJETIVO: Analizar la repercusión de la violencia doméstica como obstáculo para el éxito de los migrantes urbanos del Perú, y su asociación con la depresión materna, el deterioro de la crianza, el capital social y el desarrollo infantil. MÉTODOS: Se realizó un estudio transversal que constaba de entrevistas estructuradas dirigidas a 97 madres y sus hijos en edad escolar residentes en El Porvenir, una zona predominantemente migratoria de la ciudad de Trujillo (Perú). Se recopilaron datos de febrero a junio del 2011. Se emplearon instrumentos comprobados, validados anteriormente para su uso en español, con objeto de evaluar las siguientes variables: la depresión materna, el capital social, la violencia doméstica, los comportamientos de crianza, y el desarrollo socioemocional y cognoscitivo de los niños. Para el análisis se utilizaron diseños correlacionales y de regresión múltiple, pruebas de interacción y modelos indirectos o de mediadores. RESULTADOS: El 65% de las mujeres notificaron que eran víctimas de algún tipo de violencia doméstica en aquel momento, y esta predijo intensamente la depresión (P < 0,001). Las mujeres que notificaron violencia doméstica tenían menores probabilidades de tener un empleo (P < 0,05), poseían un capital social cognoscitivo inferior (P < 0,01), realizaban menos actividades de cuidado de otras personas (P < 0,05), tenían menos energía para la crianza (P < 0,05), y eran menos afectuosas (P < 0,05). La violencia doméstica se asoció con comportamientos de internalización en niños (P < 0,01), y el deterioro de la crianza mediaba parcialmente esta relación. CONCLUSIONES: La violencia doméstica compromete la salud mental y la capacidad de crianza de las mujeres. Las tasas elevadas de esta entre los migrantes urbanos afectan a toda la comunidad al entorpecer su potencial para lograr un empleo y reducir la confianza entre los miembros de la comunidad. Las intervenciones que actúen sobre las variables relacionadas con la violencia doméstica (por ejemplo, el consumo de sustancias psicoactivas y las limitadas oportunidades de trabajo para los hombres) podrían reducir los efectos nocivos de la violencia doméstica en las comunidades de migrantes urbanos en América Latina.

A Pilot Study of a Family-Focused Intervention for Children and Families Affected by Maternal Depression.

A non-experimental pilot study examined child, mother, and family outcomes of a 10-session multi-family group intervention designed to reduce risk and promote resilience for mothers with depression and their families. Positive changes following the Keeping Families Strong intervention included mother-reported decreases in child behavior and emotional problems, improvements in the quality of family interactions and routines, and improvements in their own well being and support from others. Children (9-16 years) reported decreased internalizing symptoms, improved coping, increased maternal warmth and acceptance, and decreased stressful family events. Attendance and mother-reported satisfaction were high, indicating the perceived value of the intervention.

Development of a family-based program to reduce risk and promote resilience among families affected by maternal depression: theoretical basis and program description.

Depression is a family matter. It not only diminishes the quality-of-life of the depressed person, but also strains the resources of the family unit and increases the children's risk of developing significant problems that start early and persist into adulthood. Although treatment of a parent's depression is critical, many families also need professional intervention to reduce children's risk. This article reviews the evidence on needs of these families and shows that the theoretical and clinical evidence exists to support the design of interventions for families affected by maternal depression. A preventive intervention developed from this foundation is described, the Keeping Families Strong (KFS) program, that is designed to promote resilience and reduce the risk for psychological disorders in children of parents with depression. The pilot study on the KFS program, conducted in adult mental health outpatient settings, is described. Families participate in 10 meetings 90 min each, with a group for parents and for children (10 years and older) conducted concurrently. The program structure and content are described, the challenges of implementing a family preventive intervention in actual clinical settings are discussed, and a case example is provided, as well as preliminary outcome data on ten families. In sum, we provide a strong rationale for the potential of preventive interventions for families affected by maternal depression.

The utility of elementary school TOCA-R scores in identifying later criminal court violence among adolescent females.

OBJECTIVE: To evaluate the utility of a teacher-rating instrument (Teacher Observation of Classroom Adaptation-Revised [TOCA-R]) of aggressive behavior during elementary school years in identifying girls at risk of later criminal court violence. METHOD: A community epidemiological sample of 845 urban public school girls was rated at six time points during elementary school regarding their level of aggressive/disruptive behavior (75% of whom were African American). Criminal violence was measured using juvenile court records. Logistic regression was used to study the strength of the association between early indicators of aggressive behavior and adolescent females' violent outcomes. An extension of the traditional receiver operating characteristics analysis was used to study the accuracy of identifying girls at risk of violence under three different screening and intervention scenarios. RESULTS: For girls, teacher ratings of aggression were a strong and consistent predictor of later violence across grades 1-5 and were strongest in fifth grade. Three screening scenarios were compared to determine the optimal identification threshold. The screening scenario with a focus on minimizing false negatives yielded the highest value (kappa = 0.803). CONCLUSIONS: This study supports other studies indicating that early levels of aggressive behavior are strong and robust predictors of later violence among girls but are of limited utility in the early identification of girls at risk, especially when the focus is on reducing both false positives and negatives.