"It brought my family more together": Mixed-methods study of low-income U.S. mothers during the pandemic.

Objective: We sought to understand challenges and positive experiences of low-income families during the pandemic. Background: Strength-based perspectives of economically disadvantaged mothers are missing from literature on the impact of the COVID-19 pandemic. Although it is imperative to recognize disparities that were highlighted by the pandemic, strengths-based approaches and a resilience framework can help professionals build upon and learn from ways families manage during those times. Method: We used a mixed-method approach to gain understanding of the unique experiences of 15 low-income mothers at the height of the pandemic. We administered a brief COVID-19 stress screener, the Five-Minute Speech Sample measure, and an open-ended question about potential positive experiences during the pandemic. Results: We learned that strength and resilience supersede the liabilities brought on by COVID-19 that are so often focused on. We found highly divergent experiences across mothers in terms of stress; even mothers with high levels of stress readily identified positive aspects of life during the pandemic. Mothers' responses were indicative of greater feelings of warmth and tenderness than negativity about their children. Conclusion and Implications: We discuss findings in terms of strengths-based practices and policies for mothers receiving public assistance and provide suggestions for continued research on resilience of mothers during the pandemic.

Integrating Behavioral Health Care into an Urban Hospital-Based Pediatric Primary Care Setting.

Integration of behavioral health into pediatric primary care clinics is a recommended practice with potential to address the mental health needs of underserved children. We describe our process of integrating a behavioral health team into our hospital-based pediatric practice that serves a low-income, ethnically diverse, and underserved population of children and youth in the southeastern U.S. We provide a summary of our four-year program evaluation of feasibility and acceptability of embedding a behavioral health team in our practice. We also discuss the challenges faced, including staff turnover and difficulty with billing for sustainability. Finally, we provide recommendations for pediatric clinics that seek to integrate behavioral health care into their practices.

Safer Sex Communication and Sexual Health Behaviors Among a Representative Statewide Sample of Homeless Adolescents.

Homeless adolescents are at substantial risk of human immunodeficiency virus (HIV), other sexually transmitted infections (STIs), and unplanned pregnancy; however, little research has assessed factors, such as safer sex communication, that may protect homeless adolescents against these negative outcomes. Using the 2015 North Carolina Youth Risk Behavior Survey (YRBS; unweighted N = 5,486; ages 12 to 18; 5% homeless), we compared homeless adolescents' primary safer sex communication sources (i.e., health care providers, parents, teachers, peers, religious leaders) to housed adolescents' communication sources and assessed how these sources relate to sexual health behaviors, including condom use, HIV testing, and number of sexual partners. Most homeless adolescents (61%), and 46% of housed adolescents reported having questions about sex. Further, twice as many homeless adolescents communicated primarily with health care providers compared to housed adolescents. Importantly, among homeless adolescents, communicating primarily with health care providers or teachers was related to greater likelihood of condom use and communicating primarily with religious leaders was related to greater likelihood of HIV testing. Parent communication was unrelated to homeless adolescents' sexual health behaviors. Last, communicating primarily with peers was associated with reduced likelihood of HIV testing. Having nonparental adult communication sources, including health care providers, teachers, and religious leaders, may be critical for encouraging safer sex behaviors among homeless adolescents.

Practitioners' Perceptions of and Use of Triple P.

A challenge of large-scale adoptions of Triple P is low uptake among accredited practitioners. The purpose of this study was to understand facilitators to program use among 249 practitioners in seven counties involved in a large-scale adoption of Triple P. In an adjusted ordinal logistic regression including length of accreditation and county, the frequency with which practitioners used Triple P was higher among those who perceived a more positive parent response to Triple P services and among those practitioners who perceived Triple P to fit better within their typical services. Agency support was not associated with frequency of use.

Three-year Trajectories of Emotional Expressiveness among Maltreating Mothers: The Role of Life Changes.

Parents are perhaps the most direct and profound influences on children's development of emotional competence. For example, how and what emotions parents express in the family has implications for children's ability to understand and regulate their emotions. What is less well understood is what potential environmental or contextual factors impact parents' emotional expressiveness, particularly in high-risk samples prone to atypical emotional expressiveness (e.g., deficits in the production and recognition of emotional expressions). The present longitudinal study examined the association between life changes and parents' expression of positive and negative emotions, as well as, how these associations changed over time in a sample of maltreating mothers. Eighty-eight mothers with a substantiated history of physical abuse completed measures of emotional expressiveness and life changes experienced over the past 6 months when their children were in preschool, kindergarten, and first grade. Results indicated that life changes decreased over time, while parental emotional expressiveness remained stable. Moreover, life changes were associated across time with the expression of negative emotions, but were unrelated to expressions of positive emotions. Findings have important implications for understanding emotional expressiveness in high-risk samples.

Mental Health of Homeless Youth: Moderation by Peer Victimization and Teacher Support.

The link between youth homelessness and mental health functioning was examined using state population-representative 2015 Youth Risk Behavior Survey (YRBS) data. The moderating role of victimization and perceived teacher support also was examined. Consistent with hypotheses, results indicated that homelessness was associated with greater mental health challenges, more victimization, and less teacher support. The association between homelessness and mental health was not moderated by perceived teacher support. However, victimization experiences served as a moderator such that more victimization exacerbated the effect of homelessness on mental health challenges. This study supports the utility of the YRBS for gaining understanding of the experiences and needs of youth experiencing homelessness and adds to the growing literature on predictors of individual differences in mental health functioning of these vulnerable youth.

Longitudinal associations between physically abusive parents' emotional expressiveness and children's self-regulation.

The present study took a developmental psychopathology approach to examine the longitudinal association between parents' emotional expressiveness and children's self-regulation. Data collection spanned from 2004 to 2008. Ninety-two physically abusive parents completed yearly assessments of their emotional expressiveness, as well as their children's self-regulation abilities. Observational and behavioral measures were also obtained yearly to capture both parents' emotional expressiveness and children's self-regulation. Specifically, parents participated in a parent-child interaction task, which provided insight into their levels of flat affect. A puzzle box task was completed by each child to assess self-regulation. Results indicated, first, that greater parental expression of negative emotions predicted poorer self-regulation in children, both concurrently and across time. Second, parental expressions of positive emotions and parents' flat affect were unrelated to children's self-regulation. Findings inform our understanding of parental socialization of self-regulation and provide insight into the roles of distinct components of emotional expressiveness. Moreover, findings have crucial implications for understanding emotional expressiveness in high-risk samples and increase our understanding of within-group functioning among maltreating families that may serve as a means to direct intervention efforts.

The Student-Teacher Relationship Quality of Abused Children.

Considering the association between children's quality of relationships with teachers and their academic adjustment, information pertaining to how abused children are functioning in their relationships with teachers could be useful in promoting their academic success- yet there has been limited research in this area. The purpose of this study was to use cluster analyses to explore within-group differences in relational schemas and quality of student-teacher relationships for 70 abused children. Two clusters of abused children emerged, and as hypothesized, there were significant differences in student-teacher relationships for the two clusters. The cluster with more positive relational schemas had less conflict and less dependency reported by their teachers compared to the cluster with negative relational schemas. However, there were no differences between the clusters in terms of closeness with teachers. Implications for practice in schools is discussed.

Physically Abused Children's Adjustment at the Transition to School: Child, Parent, and Family Factors.

Childhood physical abuse predicts emotional/behavioral, self-regulatory, and social problems. Yet factors from multiple ecological levels contribute to children's adjustment. The purpose of this study was to examine the degree to which the social-emotional adjustment of physically abused children in first grade would be predicted by a set of child-, parent-, and family-level predictors in kindergarten. Drawing on a short-term longitudinal study of 92 physically abused children and their primary caregivers, the current study used linear regression to examine early childhood child (i.e., gender, IQ, child perceptions of maternal acceptance), parent (i.e., parental mental health), and family relationship (i.e., sensitive parenting, hostile parenting, family conflict) factors as predictors of first grade internalizing and externalizing symptomatology, emotion dysregulation, and negative peer interactions. We used a multi-method, multi-informant approach to measuring predictors and children's adjustment. Internalizing symptomatology was significantly predicted by child IQ, parental mental health, and family conflict. Externalizing symptomatology and emotion dysregulation were predicted by child IQ. Although a large proportion of variance in measures of adjustment was accounted for by the set of predictors, few individual variables were unique predictors of child adjustment. Variability in the predictors of adjustment for physically abused children underscores the need for individualized treatment approaches.

Internal working models and adjustment of physically abused children: the mediating role of self-regulatory abilities.

BACKGROUND: Abused children's internal working models (IWM) of relationships are known to relate to their socioemotional adjustment, but mechanisms through which negative representations increase vulnerability to maladjustment have not been explored. We sought to expand the understanding of individual differences in IWM of abused children and investigate the mediating role of self-regulation in links between IWM and adjustment. METHODS: Cluster analysis was used to subgroup 74 physically abused children based on their IWM. Internal working models were identified by children's representations, as measured by a narrative story stem task. Self-regulation was assessed by teacher report and a behavioral task, and adjustment was measured by teacher report. RESULTS: Cluster analyses indicated two subgroups of abused children with distinct patterns of IWMs. Cluster membership predicted internalizing and externalizing problems. Associations between cluster membership and adjustment were mediated by children's regulation, as measured by teacher reports of many aspects of regulation. There was no support for mediation when regulation was measured by a behavioral task that tapped more narrow facets of regulation. CONCLUSIONS: Abused children exhibit clinically relevant individual differences in their IWMs; these models are linked to adjustment in the school setting, possibly through children's self-regulation.

Parent emotional expressiveness and children's self-regulation: associations with abused children's school functioning.

OBJECTIVE: Identifying factors associated with school functioning of abused children is important in prevention of long-term negative outcomes associated with school failure. The purpose of this study was to examine the degree to which parent emotional expressiveness and children's self-regulation predicted early school behavior of abused children. METHODS: The sample included 92 physically abused children ages 4-7 and one of their parents (95.7% mothers). Parents completed a measure of their own emotional expressiveness, and parents and teachers provided reports of children's self-regulatory skills. Children's school functioning was measured by observations of playground aggression and teacher reports of aggression and classroom behavior. RESULTS: Parents' expression of positive and negative emotions was associated with various aspects of children's self-regulation and functioning in the school setting. Links between self-regulation and children's school adjustment were robust; poor self-regulation was associated with higher aggression and lower cooperation and self-directed behavior in the classroom. There was minimal support for a mediating role of children's self-regulation in links between parent expressiveness and children's behavior. PRACTICE IMPLICATIONS: Findings point to the relevance of parent emotional expressivity and children's self-regulatory processes in understanding physically abused children's functioning at the transition to school. Although further research is needed, findings indicate that increasing parental expression of positive emotion should be a focus in treatment along with reduction in negativity of abusive parents. Further, addressing children's self-regulation could be important in efforts to reduce aggression and enhance children's classroom competence.

Longitudinal study of self-regulation, positive parenting, and adjustment problems among physically abused children.

OBJECTIVE: Research using normative and high-risk samples indicates a significant link between problems with self-regulation and child maladjustment. Nevertheless, little is known about the processes that may modify the link between self-regulation and maladjustment. This longitudinal study examined the joint contributions of child self-regulation and positive parenting behaviors to the development of externalizing and internalizing symptomatology spanning from preschool to 1st grade. METHODS: Data were collected on a total of 95 physically abused children (58% boys); our longitudinal analyses involved 43 children at Time 1 (preschool), 63 children at Time 2 (kindergarten), and 54 children at Time 3 (1st grade). Children's self-regulation was measured by parent report, and their externalizing and internalizing symptomatology was evaluated by teachers. Parents completed self-report measures of positive parenting. RESULTS: Our structural equation modeling analyses revealed positive parenting as a protective factor that attenuated the concurrent association between low self-regulation and externalizing symptomatology among physically abused children. Our findings regarding longitudinal changes in children's externalizing symptomatology supported the differential susceptibility hypothesis: Physically abused children who were at greater risk due to low levels of self-regulation were more susceptible to the beneficial effects of positive parenting, compared to those with high levels of self-regulation. CONCLUSIONS: Findings suggest that although physical abuse presents formidable challenges that interfere with the development of adaptive self-regulation, positive parenting behaviors may ameliorate the detrimental effects of maladaptive self-regulation on the development of externalizing symptomatology. In addition, the positive and negative effects of caregiving behaviors were more prominent among physically abused children at great risk due to low self-regulation. PRACTICE IMPLICATIONS: Findings from the present study highlight the importance of attending to positive parenting behaviors and child self-regulation when working with physically abused children who are exhibiting externalizing symptomatology.

Independent and Interactive Contributions of Parenting Behaviors and Beliefs in the Prediction of Early Childhood Behavior Problems.

OBJECTIVE: This study examined interactions between parenting beliefs and parenting behaviors in the prediction of early childhood externalizing and internalizing symptoms. DESIGN: Negative intrusive and sensitive parenting behaviors during infancy and toddlerhood were observed in conjunction with self-reported maternal beliefs about the importance of discipline/control and concerns regarding spoiling in a community sample of 185 African American and European American mother-child dyads. Multiple regression techniques modeled interactions between parenting beliefs and observed behaviors to predict mother-reported internalizing and externalizing symptoms at 30 and 36 months. The analyses also explored the role of ethnicity as a moderator of these relations. RESULTS: The combination of low and average spoiling beliefs and low levels of sensitive parenting was associated with elevated internalizing symptoms. Negative parenting and beliefs reflecting concerns about spoiling were independent risk factors for elevated externalizing symptoms. CONCLUSION: Parenting beliefs and behaviors should be considered jointly to identify risks for the development of early behavior problems.

Exploration and validation of clusters of physically abused children.

OBJECTIVE: Cluster analysis was used to enhance understanding of heterogeneity in social adjustment of physically abused children. METHOD: Ninety-eight physically abused children (ages 5-10) were clustered on the basis of social adjustment, as measured by observed behavior with peers on the school playground and by teacher reports of social behavior. Seventy-seven matched nonabused children served as a comparison sample. Clusters were validated on the basis of observed parental sensitivity, parents' self-reported disciplinary tactics, and children's social information processing operations (i.e., generation of solutions to peer relationship problems and attributions of peer intentions in social situations). RESULTS: Three subgroups of physically abused children emerged from the cluster analysis; clusters were labeled Socially Well Adjusted, Hanging in There, and Social Difficulties. Examination of cluster differences on risk and protective factors provided substantial evidence in support of the external validity of the three-cluster solution. Specifically, clusters differed significantly in attributions of peer intent and in parenting (i.e., sensitivity and harshness of parenting). Clusters also differed in the ways in which they were similar to, or different from, the comparison group of nonabused children. CONCLUSIONS: Results supported the contention that there were clinically relevant subgroups of physically abused children with potentially unique treatment needs. Findings also pointed to the relevance of social information processing operations and parenting context in understanding diversity among physically abused children. PRACTICE IMPLICATIONS: Pending replication, findings provide support for the importance of considering unique treatment of needs among physically abused children. A singular approach to intervention is unlikely to be effective for these children. For example, some physically abused children might need a more intensive focus on development of prosocial skills in relationships with peers while the prosocial skills of other abused children will be developmentally appropriate. In contrast, most physically abused children might benefit from training in social problem-solving skills. Findings also point to the importance of promoting positive parenting practices in addition to reducing harsh discipline of physically abusive parents.

Protective and vulnerability factors for physically abused children: effects of ethnicity and parenting context.

OBJECTIVE: Although social maladjustment appears to be common among abused children, negative outcomes are not inevitable. This investigation was designed to determine whether ethnicity and features of the parenting context predicted children's social adjustment, and whether the strength and direction of these relations differed for abused and nonabused children. METHOD: Participants included 78 physically abused and 75 demographically matched nonabused children and one of their parents. Observations of parenting were used to measure parental sensitivity, and parent self-reports of depression were obtained using the SCL-90-R. Children's peer social adjustment was measured by teacher report. RESULTS: Using regression analysis, we tested whether each potential protective or vulnerability factor interacted with abuse status in prediction of social adjustment. Results indicated main effects of ethnicity and sensitivity for prosocial behavior, and a main effect of sensitivity for aggression. In addition, there was a significant interaction of ethnicity and abuse status for aggression such that there was a significant difference between abused and nonabused European American children but not between abused and nonabused African American children. CONCLUSIONS: Findings indicate that risk for aggressive behavior among abused children might be culturally specific rather than universal. In addition, results point to beneficial effects of parental sensitivity for maltreated children.

Diversity in adjustment of maltreated children: factors associated with resilient functioning.

Many decades of research indicate that physical abuse and neglect are associated with substantial risk for maladaptation across many developmental tasks of childhood, adolescence, and adulthood. Recent investigations, however, indicate that in spite of elevated risk for negative outcomes, some abused and neglected children demonstrate relatively positive adjustment and success in developmental tasks. An overview of studies of resilient functioning among maltreated children is provided, and results indicate that although a proportion of maltreated children do appear to be resilient to harsh and inadequate caretaking, resilient functioning might be short-lived and/or limited to single areas of functioning. A summary of factors associated with resilient functioning among abused and neglected children is provided. Such factors include individual child characteristics (e.g., self-regulatory processes), features of the child's family context (e.g., supportive parenting), and experiences in the broader environment (e.g., close friendships). Methodological considerations and recommendations for further research are provided, and implications of this literature for clinical and policy applications are presented.

Factor structure and validity of the parenting stress index-short form.

The psychometric properties of the Parenting Stress Index-Short Form (PSI-SF) were examined in a sample of 185 mothers and fathers. Factor analysis revealed 2 reasonably distinct factors involving parental distress and dysfunctional parent-child interactions. Both scales were internally consistent, and these scales were correlated with measures of parent psychopathology, parental perceptions of child adjustment, and observed parent and child behavior. PSI-SF scores were related to parent reports of child behavior 1 year later, and the Childrearing Stress subscale was a significant predictor of a parental history of abuse.

Subgroups of physically abusive parents based on cluster analysis of parenting behavior and affect.

Cluster analysis of observed parenting and self-reported discipline was used to categorize 83 abusive parents into subgroups. A 2-cluster solution received support for validity. Cluster 1 parents were relatively warm, positive, sensitive, and engaged during interactions with their children, whereas Cluster 2 parents were relatively negative, disengaged or intrusive, and insensitive. Further, clusters differed in emotional health, parenting stress, perceptions of children, and problem solving. Children of parents in the 2 clusters differed on several indexes of social adjustment. Cluster 1 parents were similar to nonabusive parents (n = 66) on parenting and related constructs, but Cluster 2 parents differed from nonabusive parents on all clustering variables and many validation variables. Results highlight clinically relevant diversity in parenting practices and functioning among abusive parents.

Child-related cognitions and affective functioning of physically abusive and comparison parents.

OBJECTIVE: The goal of this research was to utilize the cognitive behavioral model of abusive parenting to select and examine risk factors to illuminate the unique and combined influences of social cognitive and affective variables in predicting abuse group membership. METHODOLOGY: Participants included physically abusive parents (n=56) and a closely-matched group of comparison parents (n=62). Social cognitive risk variables measured were (a) parent's expectations for children's abilities and maturity, (b) parental attributions of intentionality of child misbehavior, and (c) parents' perceptions of their children's adjustment. Affective risk variables included (a) psychopathology and (b) parenting stress. A series of logistic regression models were constructed to test the individual, combined, and interactive effects of risk variables on abuse group membership. RESULTS: The full set of five risk variables was predictive of abuse status; however, not all variables were predictive when considered individually and interactions did not contribute significantly to prediction. A risk composite score computed for each parent based on the five risk variables significantly predicted abuse status. Wide individual differences in risk across the five variables were apparent within the sample of abusive parents. CONCLUSIONS: Findings were generally consistent with a cognitive behavioral model of abuse, with cognitive variables being more salient in predicting abuse status than affective factors. Results point to the importance of considering diversity in characteristics of abusive parents.