Longing to belong: The ambiguous loss of Indigenous fostered/adopted individuals.

BACKGROUND: Indigenous fostered/adopted individuals report high levels of grief because of their foster care/adoption. Little has been done, however, to explore how grief is experienced and the factors that contribute to said grief for fostered/adopted Indigenous individuals. OBJECTIVE: This study examined the experiences of loss and grief of Indigenous individuals fostered/adopted during childhood. PARTICIPANTS AND SETTING: Participants were 102 Indigenous fostered/adopted individuals who described the experiences of loss and grief related to adoption. METHODS: This study utilized secondary data from the Fostered and Adopted Individuals Project. Inductive thematic analysis was conducted on open-ended survey data. RESULTS: Two themes emerged: (1) ambiguous loss as a result of foster care and adoption and (2) the effects of the ambiguous loss that stem from foster care and adoption. Indigenous fostered/adopted persons experienced ambiguous loss in foster care and adoption. Their loss remained unresolved due to a loss of access to information about their family and tribe of origin. Although family of origin, tribal community, and culture were not physically present due to separation by foster care/adoption, they remained psychologically present. As a result of ambiguous loss, participants experienced disenfranchised grief, wondering and longing to belong, and mental health and substance abuse. CONCLUSION: This study is the first of its kind to explore the loss and grief experiences of fostered/adopted Indigenous individuals using ambiguous loss theory. Ambiguous loss theory offers a framework for contextualizing the loss and grief that begins at separation and is present in adulthood.

The hole in my heart is closing: Indigenous relative reunification identity verification.

OBJECTIVE: The current study explored the experience of reunification as place identity verification for Indigenous individuals who were fostered/adopted as youth. BACKGROUND: Research on reunification tends to focus on disproportionality in child welfare and the factors associated with reunification. Few studies focus on experiences of reunification among Indigenous individuals including their perceptions and comprehensions about the reunification experience. METHOD: Data from 70 fostered/adopted Indigenous individuals that reunified during adulthood were analyzed from the Experiences of Adopted and Fostered Individuals Project. Inductive thematic analysis was used to examine open-ended survey data about experience of reunification. RESULTS: Three themes inductively emerged including: (1) relative reunification, (2) perceptions about reunification, and (3) comprehensions about reunification. During relative reunification, participants reunified with parent(s), extended caregiver(s), grandparent(s), sibling(s), cousin(s), niece(s)/nephew(s), and tribe. Participant's perceptions about reunification included happiness, relief, anger, mourning, and anxiety/excitement. Participant's comprehensions about reunification related to belonging, sense of place, history/heritage, healing, and resemblance. All five functions of place identity verification were met in reunification according to the Indigenous participant's voices. CONCLUSIONS: This study explored the experience of relative reunification of Indigenous individuals who were separated from their families of origin during childhood by foster care and adoption.

"I'm fighting with BPD instead of my partner": A dyadic interpretative phenomenological analysis of the lived experience of couples navigating borderline personality disorder.

Borderline personality disorder (BPD) is associated with romantic relationship distress and dissolution. The complex interaction between BPD and romantic relationships warrants further attention. Dyadic interviews (N = 10) were conducted to examine the experience and impact of BPD on couples' relationships. The results of interpretative phenomenological analysis consisted of two superordinate themes describing the couple experience of navigating BPD: (a) the shared experience of BPD as a relational stressor; and (b) adaptive dyadic coping in the context of BPD. Although BPD was experienced as a relational stressor, dyadic coping and shared externalization of BPD emerged as central components to adaptive couple functioning. Most couples reported that therapy was a critical external resource in their journey toward adaptively functioning in the context of BPD, both intrapersonally and interpersonally. The lived experiences of these couples provides therapists with an increased understanding of the resources that support adaptive dyadic coping with BPD.

I can still hear my baby crying: The ambiguous loss of American Indian/Alaska Native birthmothers.

This study captures the experiences of American Indian/Alaska Native birthmothers who lost a child to adoption and the impact of said loss on their health and wellbeing. Few studies examine the loss experiences of American Indian/Alaska Native birthmothers despite their increased probability to lose a child to foster care and adoption. American Indian/Alaska Native birthmothers are distinct from birthmothers of other races in their experiences of intergenerational and historical child loss, having disproportionately lost their children to systematic practices of child removal via boarding schools, the adoption era, and child welfare. Interview data from 8 American Indian/Alaska Native birthmothers were analyzed using inductive thematic analysis. Five themes emerged including: (1) the social context of losing a child to adoption for American Indian/Alaska Native birthmothers, (2) the ambiguous loss of a child to adoption, (3) grief reactions to the loss, (4) the impact of the loss on birthmother health and wellbeing, and (5) creating resiliency. Findings suggest that American Indian/Alaska Native birthmothers experience ambiguous loss, as well as elevated mental health problems and substance abuse following the loss of a child to adoption.

The transition to teletherapy in marriage and family therapy training settings during COVID-19: What do the data tell us?

In the wake of the COVID-19 pandemic, little is known about how university training programs transitioned to teletherapy. This study describes the transition of two university marriage and family therapy (i.e., master's and doctoral) training clinics to teletherapy and presents preliminary analyses of the types of clients and cases that converted to teletherapy. A series of chi-square analyses, a t-test, a logistic regression model, and a multiple linear regression model were employed. Four key findings emerged: (1) most cases converted to teletherapy; (2) Hispanic ethnicity was the only demographic characteristic to significantly predict conversion to teletherapy; (3) individual cases were significantly more likely to convert to teletherapy than relational cases; and (4) the number of prior in-person sessions attended significantly predicted conversion to teletherapy. Teletherapy conversion implications are discussed across four systemic levels: client, student trainee, supervision, and larger systems.

Are Parent- and Teacher-Reported Executive Function Difficulties Associated With Parenting Stress for Children Diagnosed With ADHD?

Objective: To examine the relationship between parenting stress and parent- and teacher-reported executive function difficulties (EFDs) for childhood ADHD. Method: A secondary analysis using linear regression was conducted on parent- and teacher-completed Behavior Rating Inventory of Executive Function and Parenting Stress Indexes for 5- to 12-year-olds (n = 243) with ADHD. Results: The linear combination of teacher- and parent-reported EFDs accounted for 49% of the variance in child-related parenting stress. Teacher-reported school-based EFDs were relatively inconsequential, having accounted for only 3% of this variance. This stress is best explained by EFDs with emotional control in the school environment and parent-reported EFDs with emotional control, inhibit, monitor, and shift. Conclusion: Parent-reported EFDs, and less so school-based EFDs, are related to parenting stress, but only in regard to EFDs likely underpinning behavioral outbursts and those likely underpinning the daily hassles of providing specialized care to children with ADHD.

Abuse after abuse: The recurrent maltreatment of American Indian children in foster care and adoption.

BACKGROUND: While maltreated children are at risk for recurrent maltreatment, less is known about the maltreatment recurrence of American Indian children in foster and adoptive homes. OBJECTIVE: This study examined the recurrent maltreatment of American Indian children in foster and adoptive homes, specifically the physical, emotional, sexual, and spiritual abuse subtypes, as well as poly-victimization of American Indian children in comparison to their White peers. PARTICIPANTS AND SETTING: Data originated from the Experiences of Adopted and Fostered Individuals Project. The sample (n = 230) consisted of 99 American Indian and 131 White participants who experienced foster care and/or adoption during childhood. METHOD: Chi-square analyses and a t-test were used to test differences in maltreatment recurrence. Ordinary least squares regression analysis was used to examine the factors that contributed to poly-victimization. RESULTS: Both American Indian and White participants reported high rates of emotional abuse. American Indian participants were particularly vulnerable to maltreatment recurrence in the forms of physical, sexual, and spiritual abuse, as well as poly-victimization in their foster and adoptive homes. CONCLUSIONS: Our findings reflect high rates of maltreatment recurrence in foster care and adoption, which may be the result of retrospective self-report, rather than measures of rereport or substantiated recurrence.

A scoping review of mental health prevention and intervention initiatives for infants and preschoolers at risk for socio-emotional difficulties.

BACKGROUND: Infant mental health has emerged as a unique area of practice and research distinguished from child and youth sub-specialties by its advocacy for a relational practice framework with an emphasis on parents/caregivers being integral to assessment, treatment, and prevention initiatives. A diverse array of initiatives offered across a broad spectrum of delivery methods is available to clinicians. However, to date, a large-scale mapping of the research evidence regarding these interventions has yet to be completed to help inform clinician's decisions regarding the best approaches for their clients. To address this knowledge gap, this study aimed to report on the landscape of research pertaining to mental health interventions for infants and preschoolers (0-5 years), and their families at risk for socio-emotional difficulties and negative developmental outcomes. METHOD: A scoping review methodology was used to conduct a large-scale mapping of the intervention research pertaining to infants and preschoolers (0-5) at risk for socio-emotional difficulties. We searched MEDLINE, PsycINFO, EMBASE, Web of Science, The Cochrane Library, CINAHL, LILACS, ProQuest Nursing & Allied Health Source, World Cat, and ClinicalTrials.gov , from inception to December 31, 2012. We extracted information regarding publication date, geographical location, study design, level of risk, population, key intervention mechanism, and outcome measures. RESULTS: We identified 533 potential studies from 1233 title and abstracts after the first round of screening. Full text article review in the second round of screening resulted in a total of 162 included articles for the final analysis. Results indicated that over 50% of interventions evaluated were randomized controlled trials conducted in Westernized countries. Most studies could be subdivided by level of risk within a preventative public health framework including universal, selected, indicated, and direct treatment for children formally diagnosed with a mental disorder. Risk factors experienced by children and their families were heterogeneously defined and numerous outcome measures across included studies. The results of this study are limited to the last search date of 2012. CONCLUSIONS: Key intervention mechanisms spanned a range of approaches including parenting groups, dyadic, in-home, cognitive-behavioral therapy, and day care-based interventions. The findings are discussed in terms of implications for broad trends and gaps in research and policy for this population.

Family-based treatment for transition age youth: the role of expressed emotion and general family functioning.

The aim of this study was to investigate changes in family functioning and parental expressed emotion (EE) in parents and transition age youth (18 to 25 years old) with Anorexia Nervosa participating in Family-Based Treatment for Transition Age Youth (FBT-TAY). Further, we examined whether perceived family functioning and EE were associated with changes in eating disorder behaviour and weight in participants at end-of-treatment and three months post-treatment. Generalized estimating equations revealed that changes in family functioning significantly improved from baseline to end-of-treatment (p = .0001), and baseline to three months post-treatment (p = .0001) in parents; and from baseline to end-of-treatment (p = .011), and baseline to three months post-treatment (p = .0001) in transition age youth. The level of parental EE did not differ significantly from baseline to end-of-treatment (p = .379), or baseline to three months post-treatment (p = .185). A series of Ordinary Least Square regression models demonstrated that changes in perceived family functioning and EE were not significantly associated with changes in eating disorder behaviour and weight restoration of transition age youth at end-of-treatment and three months post-treatment. Overall, perceptions of family functioning improved during the course of FBT-TAY, but EE did not.

Family-based treatment for transition age youth: parental self-efficacy and caregiver accommodation.

BACKGROUND: Family-Based Treatment (FBT) is the first line of care in paediatric treatment while adult programs focus on individualized models of care. Transition age youth (TAY) with Anorexia Nervosa (AN) are in a unique life stage and between systems of care. As such, they and their caregivers may benefit from specialized, developmentally tailored models of treatment. METHODS: The primary purpose of this study was to assess if parental self-efficacy and caregiver accommodation changed in caregivers during the course of FBT-TAY for AN. The secondary aim was to determine if changes in parental self-efficacy and caregiver accommodation contributed to improvements in eating disorder behaviour and weight restoration in the transition age youth with AN. Twenty-six participants (ages 16-22) and 39 caregivers were recruited. Caregivers completed the Parents versus Anorexia Scale and Accommodation and Enabling Scale for Eating Disorders at baseline, end-of-treatment (EOT), and 3 months follow-up. RESULTS: Unbalanced repeated measures designs for parental self-efficacy and caregiver accommodation towards illness behaviours were conducted using generalized estimation equations. Parental self-efficacy increased from baseline to EOT, although not significantly (p = .398). Parental self-efficacy significantly increased from baseline to 3 months post-treatment (p = .002). Caregiver accommodation towards the illness significantly decreased from baseline to EOT (p = 0.0001), but not from baseline to 3 months post-treatment (p = 1.000). Stepwise ordinary least squares regression estimates of eating disorder behaviour and weight restoration did not show that changes in parental-self efficacy and caregiver accommodation predict eating disorder behaviour or weight restoration at EOT or 3 months post-treatment. CONCLUSIONS: Our findings demonstrate, albeit preliminary at this stage, that FBT-TAY promotes positive increases in parental self-efficacy and assists caregivers in decreasing their accommodation to illness behaviours for transition age youth with AN. However, changes in the parental factors did not influence changes in eating and weight in the transition age youth.

Open Trial of Family-Based Treatment of Anorexia Nervosa for Transition Age Youth.

OBJECTIVE: This pilot study conducted an open trial of a manualized adaptation to Family-Based Treatment for Transition Age Youth (FBT-TAY) for Anorexia Nervosa (AN). The aims were: (1) determine the acceptability of FBT for TAY; and, (2) establish preliminary effect sizes for the impact of FBT-TAY on eating disorder behaviour and weight restoration. METHOD: Twenty-six participants across two paediatric and one adult hospital site were recruited to participate. Participants completed the Eating Disorder Examination Questionnaire (EDE-Q) at the start of treatment, the end-of-treatment, and three-month follow-up. RESULTS: FBT-TAY is an acceptable and feasible treatment to all study therapists as evidenced by their fidelity to the model. FBT-TAY is a feasible and acceptable intervention to transition age youth, given only 27.27% chose treatment as usual over FBT-TAY. Participants presented significant improvement at end-of-treatment and three-months post-treatment (p < .001; ES = 0.34) from baseline on the EDE-Q Global Score. Participants also achieved and maintained weight restoration at the end-of-treatment and three-months post-treatment when compared to baseline (p < .0001, ES = 0.54). CONCLUSIONS: FBT-TAY, the first manualized AN treatment for TAY, demonstrated feasibility and acceptability with therapists and participants as well as improvement for participants in EDE-Q global score and weight. Given the current dearth of effective treatments for TAY with AN, FBT-TAY is a promising adaptation of FBT. A larger clinical trial with a 12-month follow-up is recommended.

OBJECTIF: Cette étude pilote a mené un essai ouvert de l'adaptation dans un manuel du traitement familial pour jeunes en âge de transition (TF-JAT) pour l'anorexie mentale (AM). Les objectifs étaient: (1) déterminer l'acceptabilité du TF pour les JAT; et (2) établir des tailles de l'effet (TE) préliminaires pour l'effet du TF-JAT sur le comportement du trouble alimentaire et la reprise de poids. MÉTHODE: Vingt-six participants dans deux centres pédiatriques et un hôpital pour adultes ont été recrutés pour participer. Les participants ont répondu au questionnaire d'examen sur les troubles alimentaires (EDE-Q) au début du traitement, à la fin du traitement, et au suivi de 3 mois. RÉSULTATS: Le TF-JAT est un traitement acceptable et faisable pour tous les thérapeutes de l'étude comme en atteste leur fidélité au modèle. Le TF-JAT est une intervention faisable et acceptable pour les jeunes en âge de transition, étant donné que seulement 27,27% ont choisi le traitement habituel plutôt que le TF-JAT. Les participants ont présenté une amélioration significative au score global du EDE-Q à la fin du traitement et au suivi de trois mois (p < 0,001; TE = 0,34) comparé au début. Les participants ont également réussi à reprendre du poids et à le maintenir à la fin du traitement et au suivi de 3 mois comparé au début (p < 0,0001, TE = 0,54). CONCLUSIONS: Le TF-JAT, le premier traitement de l'AM dans un manuel pour les JAT, a démontré faisabilité et acceptabilité chez les thérapeutes et les participants ainsi qu'une amélioration pour les participants au score global de l'EDE-Q et de leur poids. Étant donné la rareté actuelle de traitements efficaces pour les JAT souffrant d'AM, le TF-JAT est une adaptation prometteuse du TF. Un essai clinique plus vaste avec suivi de 12 mois est recommandé.

A scoping review of evidence-based interventions available to parents of maltreated children ages 0-5 involved with child welfare services.

Parents referred to child welfare services for child maltreatment often struggle against chronic risk factors including violence, substance abuse, mental health concerns, and poverty, which impinge upon their ability to be sensitive caregivers. The first line of intervention within the child welfare context is to modify parenting behavior. This scoping review comprehensively surveyed all available literature to map the extent and range of research activity around the types of interventions available within a child welfare context to parents of infants and toddlers (0-5 years of age), to identify the facilitators and/or barriers to the uptake of interventions, and to check that interventions match the risk factors faced by parents. This scoping review engaged in stringent screening of studies based upon inclusion/exclusion criteria. Sixty-five articles involving forty-two interventions met inclusion criteria. Interventions generally aimed to improve parenting practices, the relationship between parent and child, and/or attachment security, along with reducing child abuse and/or neglect. A notable finding of this scoping review is that at present, interventions for parents of children ages 0-5 involved with the child welfare system are most frequently measured via case study and quasi-experimental designs, with randomized control trials making up 26.2% of included study designs.

The Relationship Between Psychological Distress and Perception of Emotional Support in Medical Students and Residents and Implications for Educational Institutions.

OBJECTIVE: Psychological distress is pervasive among medical students and residents (MSR) and is associated with academic under-performance, decreased empathy, burnout, and suicidal ideation. To date, there has been little examination of how demographic and socioeconomic factors influence trainee's psychological distress levels, despite suggestion that financial concerns are a common source of stress. Recent Canadian studies examining the prevalence of distress, burnout, and resilience in MSR are limited. METHODS: Undergraduate and postgraduate medical trainees attending a Canadian university were surveyed. The questionnaire included standardized instruments to evaluate psychological distress, burnout, and resilience. Additional items explored MSR living and domestic circumstances, and anticipated debt upon training completion. Ordinary least squares regression models determined predictors of psychological distress, risk for burnout, and resiliency. Logistic regression of psychological distress predicted risk of MSR contemplating dropping out of their training program. RESULTS: Feeling emotionally/psychologically unsupported while attending university was a key predictor of psychological distress and burnout, while feeling supported reduces this risk. Risk for burnout increased with each year of medical training. Psychologically distressed MSR were at significantly greater odds of contemplating dropping out of their medical training program. CONCLUSIONS: Our results point to the important opportunity universities and medical schools have promoting MSR well-being by reducing institutional stressors, as well as teaching and promoting self-care and burnout avoidance techniques, instituting wellness interventions, and developing programs to identify and support at risk and distressed students.

American Indian and White Adoptees: Are There Mental Health Differences?

Adult adoptees are at increased risk for mental health problems compared to nonadoptees. However, little is known about subsets of adoptees that may be more or less vulnerable to mental health problems. The purpose of this study was to explore the presence of mental health problems of American Indian (AI) persons compared to White persons who were separated from their birth families during childhood by foster care and/or adoption. Family systems theory guided the study. AI adoptees reported higher percentages of problems than White adoptees on all mental health problems measures (e.g., substance abuse, mental health, self-injury, and suicide). Data analysis included a series of chi-square statistics and logistic regression models. AI adoptees were more likely to report mental health problems, including alcohol addiction, alcohol recovery, drug recovery, self-assessed eating disorder, eating disorder diagnosis, self-harm, and suicidal ideation than were whites.