The feasibility and utility of trauma screening for children involved in the juvenile justice system.

Childhood exposure to potentially traumatic events and adversity is highly prevalent and linked to adverse outcomes. Many children suffering from symptoms related to traumatic stress are not identified or do not receive appropriate trauma-focused treatment, including evidence-based treatments. Trauma screening is a promising strategy to improve identification, but many child-serving staff members have concerns about asking youth and caregivers about trauma. This study aimed to describe staff perceptions about the feasibility, utility, and potential for distress associated with trauma screening. Between 2014 and 2019, the Child Trauma Screen was used in 1,272 trauma screenings completed by juvenile probation officers or mental health clinicians as part of routine practice with youth in the juvenile justice system. Further, 1,190 caregiver reports about youth trauma were completed for youth in the juvenile justice system. Staff completed a brief postscreening survey about the feasibility and utility of the screening and the perceived level of child or caregiver distress. Across staff roles, trauma screening was deemed to be feasible and worthwhile to practice, with very few staff members reporting that children or caregivers appeared very uncomfortable as a result of screening, although some differences in feasibility and utility by staff role did occur. Trauma screening measures appear to be useful and practical in juvenile justice settings when appropriate support is provided, including when administered by nonclinical staff. Nonclinical staff may benefit from additional training, consultation, or support with trauma screening.

A Systematic Review of Organizational Assessments Related to Racism and Equity.

This systematic review aimed to assess the following questions: (1) what organizational assessments exist for measuring racism and equity? (2) How are these assessments meant to be completed? (3) What constructs are typically assessed for in these measures? (4) What are the psychometric properties of these measures? Assessments were located by searching PubMed/MEDLINE (including non-MEDLINE and pre-MEDLINE), Scopus, CINAHL Plus with Full Text, PsycInfo, SocIndex, Dissertations & Theses Global, and the Trip Database through June 27, 2022. Cited and citing references of included assessments were also screened. In total, 21 organizational assessments assessing equity, racial equity, health equity, racism, and cultural competency were located. The setting for completion, who was meant to complete the assessment, and whether re-evaluation was needed were frequently not described in assessments. The ten question types most commonly assessed for in organizational assessments, in order of frequency, were community partnership, engagement, and accountability; cultural competency and norms; education and training; values and mission; communication; hiring, retention, and promotion; resources and funding; service provision; leadership and shared decision-making; and policies. Just one assessment assessed any form of reliability and validity. Although there has been substantial growth over the last decade in assessments that measure racism and equity, results indicate a need for more empirically developed and tested assessments to ensure reliability and validity and a more prescriptive structure and process for the administration of the assessment.

Adaptations of evidence-based trauma-focused interventions for children and adolescents: a systematic review.

BACKGROUND: Rates of potentially traumatic events (PTEs) and other forms of adversity among children are high globally, resulting in the development of a number of evidence-based interventions (EBIs) to address the adverse outcomes stemming from these experiences. Though EBIs are intended to be delivered according to set parameters, these EBIs are frequently adapted. However, little is known about existing adaptations of EBIs for children who experienced PTEs or other adversities. As such, this review aimed to determine: (1) why existing EBIs designed to address PTEs and other adversities experienced by children are adapted, (2) what processes are used to determine what elements should be adapted, and (3) what components of the intervention are adapted. METHODS: Nine academic databases and publicly available search engines were used to identify academic and grey literature. Initial screening, full-text review, data extraction, and quality determinations were completed by two members of the research team. Data were synthesized narratively for each adapted EBI by research question. RESULTS: Forty-two studies examining the adaptations of nine different EBIs were located, with Trauma-Focused Cognitive Behavioral Therapy and Cognitive Behavioral Intervention for Trauma in Schools being the most commonly adapted EBIs. Most frequently, EBIs were adapted to improve fit with a new population and to address cultural factors. Most commonly, researchers in combination with others made decisions about adapting interventions, though frequently who was involved in these decisions was not described. Common content adaptations included the addition of intervention elements and the tailoring/tweaking/refining of intervention materials. Common contextual adaptations included changes to the intended population, changes to the channel of treatment delivery, and changes to who administered the intervention. CONCLUSIONS: Most published studies of EBI adaptions have been developed to improve fit and address cultural factors, but little research is available about adaptations made by clinicians in day-to-day practice. Efforts should be made to evaluate the various types of adaptations and especially whether adaptations improve access to services or improve child outcomes in order to ensure that all children exposed to trauma can access effective treatment. TRIAL REGISTRATION: The protocol for this systematic review was published with PROSPERO (CRD42020149536).

Effectiveness of cash-plus programmes on early childhood outcomes compared to cash transfers alone: A systematic review and meta-analysis in low- and middle-income countries.

BACKGROUND: To strengthen the impact of cash transfers, these interventions have begun to be packaged as cash-plus programmes, combining cash with additional transfers, interventions, or services. The intervention's complementary ("plus") components aim to improve cash transfer effectiveness by targeting mediating outcomes or the availability of supplies or services. This study examined whether cash-plus interventions for infants and children <5 are more effective than cash alone in improving health and well-being. METHODS AND FINDINGS: Forty-two databases, donor agencies, grey literature sources, and trial registries were systematically searched, yielding 5,097 unique articles (as of 06 April 2021). Randomised and quasi-experimental studies were eligible for inclusion if the intervention package aimed to improve outcomes for children <5 in low- and middle-income countries (LMICs) and combined a cash transfer with an intervention targeted to Sustainable Development Goal (SDG) 2 (No Hunger), SDG3 (Good Health and Well-being), SDG4 (Education), or SDG16 (Violence Prevention), had at least one group receiving cash-only, examined outcomes related to child-focused SDGs, and was published in English. Risk of bias was appraised using Cochrane Risk of Bias and ROBINS-I Tools. Random effects meta-analyses were conducted for a cash-plus intervention category when there were at least 3 trials with the same outcome. The review was preregistered with PROSPERO (CRD42018108017). Seventeen studies were included in the review and 11 meta-analysed. Most interventions operated during the first 1,000 days of the child's life and were conducted in communities facing high rates of poverty and often, food insecurity. Evidence was found for 10 LMICs, where most researchers used randomised, longitudinal study designs (n = 14). Five intervention categories were identified, combining cash with nutrition behaviour change communication (BCC, n = 7), food transfers (n = 3), primary healthcare (n = 2), psychosocial stimulation (n = 7), and child protection (n = 4) interventions. Comparing cash-plus to cash alone, meta-analysis results suggest Cash + Food Transfers are more effective in improving height-for-age (d = 0.08 SD (0.03, 0.14), p = 0.02) with significantly reduced odds of stunting (OR = 0.82 (0.74, 0.92), p = 0.01), but had no added impact in improving weight-for-height (d = -0.13 (-0.42, 0.16), p = 0.24) or weight-for-age z-scores (d = -0.06 (-0.28, 0.15), p = 0.43). There was no added impact above cash alone from Cash + Nutrition BCC on anthropometrics; Cash + Psychosocial Stimulation on cognitive development; or Cash + Child Protection on parental use of violent discipline or exclusive positive parenting. Narrative synthesis evidence suggests that compared to cash alone, Cash + Primary Healthcare may have greater impacts in reducing mortality and Cash + Food Transfers in preventing acute malnutrition in crisis contexts. The main limitations of this review are the few numbers of studies that compared cash-plus interventions against cash alone and the potentially high heterogeneity between study findings. CONCLUSIONS: In this study, we observed that few cash-plus combinations were more effective than cash transfers alone. Cash combined with food transfers and primary healthcare show the greatest signs of added effectiveness. More research is needed on when and how cash-plus combinations are more effective than cash alone, and work in this field must ensure that these interventions improve outcomes among the most vulnerable children.

Effects of Laws Expanding Civilian Rights to Use Deadly Force in Self-Defense on Violence and Crime: A Systematic Review.

Background. Since 2005, most US states have expanded civilian rights to use deadly force in self-defense outside the home. In most cases, legislation has included removing the duty to retreat anywhere one may legally be, commonly known as stand-your-ground laws. The extent to which these laws affect public health and safety is widely debated in public and policy discourse.Objectives. To synthesize the available evidence on the impacts and social inequities associated with changing civilian rights to use deadly force in self-defense on violence, injury, crime, and firearm-related outcomes.Search Methods. We searched MEDLINE, Embase, PsycINFO, Scopus, Web of Science, Sociological Abstracts, National Criminal Justice Reference Service Abstracts, Education Resources Information Center, International Bibliography of the Social Sciences, ProQuest Dissertations and Theses, Google Scholar, National Bureau of Economic Research working papers, and SocArXiv; harvested references of included studies; and consulted with experts to identify studies until April 2020.Selection Criteria. Eligible studies quantitatively estimated the association between laws that expanded or restricted the right to use deadly force in self-defense and population or subgroup outcomes among civilians with a comparator.Data Collection and Analysis. Two reviewers extracted study data using a common form. We assessed study quality using the Risk of Bias in Nonrandomized Studies of Interventions tools adapted for (controlled) before-after studies. To account for data dependencies, we conducted graphical syntheses (forest plots and harvest plots) to summarize the evidence on impacts and inequities associated with changing self-defense laws.Main Results. We identified 25 studies that estimated population-level impacts of laws expanding civilian rights to use deadly force in self-defense, all of which focused on stand-your-ground or other expansions to self-defense laws in the United States. Studies were scored as having serious or critical risk of bias attributable to confounding. Risk of bias was low across most other domains (i.e., selection, missing data, outcome, and reporting biases). Stand-your-ground laws were associated with no change to small increases in violent crime (total and firearm homicide, aggravated assault, robbery) on average across states. Florida-based studies showed robust increases (24% to 45%) in firearm and total homicide while self-defense claims under stand-your-ground law were more often denied when victims were White, especially when claimants were racial minorities.Author's Conclusions. The existing evidence contradicts claims that expanding self-defense laws deters violent crime across the United States. In at least some contexts, including Florida, stand-your-ground laws are associated with increases in violence, and there are racial inequities in the application of these laws.Public Health Implications. In some US states, most notably Florida, stand-your-ground laws may have harmed public health and safety and exacerbated social inequities. Our findings highlight the need for scientific evidence on both population and equity impacts of self-defense laws to guide legislative action that promotes public health and safety for all.Trial Registration. Open Science Framework (https://osf.io/uz68e).

Caregiver satisfaction with their child's trauma-focused cognitive behavioral therapy.

Background: Despite the value trauma-focused cognitive-behavioral therapy (TF-CBT) places on caregivers being included in treatment, limited qualitative research has examined their experience with treatment. Thus, this research aimed to assess (a) overall caregiver satisfaction; (b) aspects of TF-CBT caregivers found most and least useful or thought could be improved; and (c) if satisfaction differed between caregivers of completers and noncompleters. Methods: In total, 1,778 caregiver/child dyads were included. Caregivers of children receiving TF-CBT completed the Caregiver Satisfaction Questionnaire. To assess overall satisfaction, descriptive statistics were compiled. To assess what aspects of TF-CBT were most/least helpful or could be improved, thematic analysis was conducted. Finally, a t test was conducted to determine whether overall satisfaction with TF-CBT differed between caregivers who had children who did and did not complete treatment. Results: Overall satisfaction with TF-CBT was high. Qualitatively, caregivers reported PRACTICE components, communication between parties in treatment, the child learning coping skills, and the child experiencing positive outcomes as most helpful. Least helpful aspects included scheduling, not seeing positive outcomes, and the child and outside factors impeding treatment. When making suggestions for improvement, caregivers suggested changes in scheduling and session length/frequency, and an increase in their involvement. Quantitatively, caregivers of children who completed treatment experienced significantly higher total mean satisfaction scores than caregivers of noncompleters. Conclusions: Caregiver satisfaction should be assessed during TF-CBT, with efforts made to identify and address key areas of concern caregivers may be experiencing. Focusing on caregiver satisfaction may prevent treatment attrition, allowing children to increasingly receive evidence-based care. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

A systematic review of the effectiveness of interventions designed for mothers who experienced child sexual abuse.

BACKGROUND: Past experiences of child sexual abuse (CSA) have been shown to have a pernicious effect on the parenting behaviors of mothers. As a result, interventions have been developed to address these effects. However, a systematic synthesis of the effectiveness of such interventions has not been conducted. OBJECTIVE: To conduct a systematic review of existing literature on interventions that have been developed and evaluated for mothers who experienced CSA. METHODS: Studies were located through a sensitive search strategy in nine academic databases and search engines, and through handsearching reference lists of included studies and their subsequent citations. Two authors independently completed screening, full text review, data extraction, and quality appraisal. RESULTS: Searches revealed a paucity of literature, with four intervention studies located. All four interventions consisted of therapy, with three of these interventions using a group-based format. One of the included intervention studies used reiki as an adjunct to therapy. Decreases in negative mental health symptoms were reported through both validated measures and interviews. No validated measures to assess parenting were used in any intervention, though some qualitative results indicated changes in parenting. Qualitative results also suggested that most mothers were satisfied with the interventions. Studies were of limited quality - none used a randomized trial design, and only one a control group. CONCLUSIONS: Given the limitations of the identified intervention studies for mothers who experienced CSA, there is a clear need to develop evidence-based interventions for this population given the unique detrimental effects of CSA on parenting. Avenues for future intervention development are discussed.

A mixed methods investigation of the association between child sexual abuse and subsequent maternal parenting.

BACKGROUND: Child sexual abuse (CSA) is associated with a number of pernicious outcomes, including adverse parenting outcomes among mothers who experienced CSA (MCSA). Despite the large literature on these outcomes, gaps and uncertainties in the literature exist. Specifically, while previous literature has shown that some MCSA have their parenting negatively affected by CSA, others do not, and potential mechanisms explaining these variations, such as mental health and characteristics of the CSA experience, have not been fully explored. OBJECTIVES: To investigate (1) how MCSA believe their CSA experiences have affected their parenting, if at all; (2) what factors may be contributing to these perceived effects; and (3) what resources or intervention components MCSA believe they need to cope with their experiences. PARTICIPANTS AND SETTING: Participants were MCSA primarily from the UK and the Republic of Ireland. METHODS: MCSA were recruited through partner organizations specializing in parenting, child abuse, and mental health to complete an online survey with both qualitative and quantitative components. Qualitative data were thematically synthesized and subgroup analyses were conducted. RESULTS: MCSA reported that their CSA experiences most affected their desire to protect their child from experiencing abuse. Additionally, breastfeeding, child-rearing practices, the mother-child relationship, and perceptions of motherhood and the child were reported to be affected. CONCLUSIONS: Given that MCSA have reported their CSA experiences to negatively affect several aspects of parenting, evidence-based interventions are needed. Participant concerns regarding parenting and suggestions made by participants in this study for interventions may aid in intervention development.

Parenting Among Mothers Who Experienced Child Sexual Abuse: A Qualitative Systematic Review.

Child sexual abuse (CSA) represents a significant public health problem. While CSA is associated with several adverse outcomes, recent attention has been given to its effect on maternal parenting. Despite a growing literature on this topic, a comprehensive systematic review has not been conducted. Thus, this review aimed to fill this gap. Several search strategies were used, including searches in academic databases. Two reviewers completed screening, full-text review, data extraction, and quality determinations. Extracted qualitative data were synthesized for the 108 studies meeting inclusion criteria. The primary themes emerging from women's accounts of the effects of CSA on their current parenting included abuse of child, breastfeeding, child-rearing practices, coping related to parenting, mother-child relationship, perceptions of child, perceptions of motherhood, and protection of children from abuse. Given the current lack of interventions designed for these mothers, the results of this review may aid in the development of evidence-based interventions.

A systematic review of the association between the childhood sexual abuse experiences of mothers and the abuse status of their children: Protection strategies, intergenerational transmission, and reactions to the abuse of their children.

Child sexual abuse (CSA) represents a significant public health concern. Research shows an association between the CSA status of mothers and the abuse status of their children, how they react to the abuse of their children, and behaviors they engage in to protect their children from abuse. However, a systematic review of this literature has yet to be conducted, and this review aimed to fill that gap. Seven databases and search engines were searched for relevant studies from inception until March 2017. Reference lists of included studies and titles of studies that cited included studies were also searched. Two authors independently completed study screening, data extraction, and quality determinations. Ninety-three studies were identified and narratively synthesized by significant, non-significant, and descriptive results. These results were further elaborated on in the context of the methods used. Though some heterogeneity existed, results showed that status as a mother with a CSA history (MCSA) was associated with having children who experienced CSA. There was no evidence that MCSA status was associated with a greater likelihood of believing their children when they disclosed abuse, although MCSA status was associated with increased emotional distress. Results were mixed regarding whether MCSA status was associated with perpetrating maltreatment broadly, perpetrating individual forms of maltreatment, such as emotional abuse or neglect, or having the potential to abuse. Most studies found no association between MCSA status and use of corporal punishment. However, when mothers and others were combined, because the main perpetrator was not listed, it was found that belonging to this combined group was associated with increased risk of engaging in maltreatment behaviors. Finally, few studies on protective behaviors of MCSA were located. Future research is needed with larger, more diverse samples using validated instruments. This information will be critical for future intervention development.

A systematic review of stakeholder perceptions of supervised injection facilities.

INTRODUCTION: Supervised injection facilities (SIFs) have been developed to address the public health burden associated with substance use. While these facilities have been associated with a number of positive outcomes, stakeholder opinion (the opinions of those potentially affected by these facilities) is likely to influence their future development. This systematic review aims to answer the question, "how do stakeholders perceive SIFs?" MATERIALS AND METHODS: Articles were located through nine academic databases, by searching for grey literature, by contacting health departments in countries where SIFs have been implemented, by searching articles that cited included articles, and by searching the reference lists of included articles. Two reviewers screened all articles. Data was double-extracted and quality appraised. All extracted perceptions were analyzed by two coders. RESULTS: Forty-seven articles were synthesized. Key themes included (1) benefits of SIFs, such as the increased safety of people who use drugs (PWUD) and the education that was provided at these facilities; (2) concerns regarding SIFs, such as the location of these facilities and existing rules and regulations; and (3) suggestions for SIFs, such as changing restrictions and regulations. Perceptions often fluctuated between stakeholders with first-hand experience of SIFs (e.g. staff and PWUD) and stakeholders not involved in the operation of SIFs (e.g. the general public). CONCLUSION: The findings of this review illustrate how perceptions vary and align across different types of SIFs. Going forward, it will be important to draw on these insights to facilitate a more informed discussion on the implementation and continuation of these facilities.

Adverse Childhood Experiences and Their Relation to Parenting Stress and Parenting Practices.

The objective of this study was to understand the relationship between the early adverse childhood experiences (ACEs) of parents and their later parenting stress and practices. At the baseline visit of an 8-week course of cognitive behavioral therapy, parenting women completed the Parenting Stress Index-Short Form (PSI-SF) and the Positive Parenting Practices (PPP) scale. Linear regression procedures were used to assess the relationship between a parent's own early experience of ACEs and current parenting stress and practices, including if there was a dose-response relationship. For the PSI-SF, significant dose-response relationships were observed between ACEs and the PSI Total Stress score (p < 0.05) and the difficult child subscale (p < 0.05). Additionally, a relationship was suggested with the parental distress subscale (p < 0.10). No significant relationships were found between ACEs and the parent-child dysfunctional interaction subscale of the PSI-SF or the PPP scale. Given the association observed between ACEs and parenting stress, it is important that future psychosocial interventions and policy initiatives preventing ACEs are developed.

Barriers and facilitators to implementing evidence-based interventions among third sector organisations: a systematic review.

BACKGROUND: The third sector is becoming a growing provider of public, social, and health services. However, there is little evidence on the effectiveness of third sector organisations (TSOs), and their capacity to implement evidence-based interventions (EBIs). Understanding implementation aspects of service delivery remains an important issue in clinical practice, but is poorly understood in the context of TSOs. This is problematic, since implementation issues are known to be critical for effective intervention outcomes. OBJECTIVES: To identify and synthesise existing research on what barriers and facilitators influence the implementation process of TSOs delivering EBIs. METHODS: This review is reported according to PRISMA guidelines and was pre-registered in PROSPERO. Key databases were searched using relevant terms, experts in the field were contacted, and websites were reviewed. All identified studies were double-screened, and data were extracted independently by two authors. Included studies were synthesised using thematic analysis and were quality appraised. RESULTS: Thirty-one studies were included, most of which were conducted in North America. The thematic synthesis identified resource limitations, in particular staff and finance, to be the most reported barrier to TSOs implementing EBIs. Organisational culture, including factors such as alignment between the mission of the TSO and EBI, and support/prioritisation of the implementation process were the most reported facilitators. These findings generalise across the included studies and are robust to study quality assessment. CONCLUSIONS: While it is often assumed that good outcomes follow when implementing interventions that have been developed and tested according to best practice, little attention has been paid to how EBIs are best transported, contextualised, and implemented by third sector providers. This systematic review found that TSOs faced considerable challenges in implementing EBIs, which were primarily a lack of support and expertise, and unclear/insufficient guidelines on how to adapt EBIs to different populations. To address these challenges, it is important to engage with central stakeholders, such as funders, researchers, policymakers, and practitioners, to discuss how these needs can be met. TRIAL REGISTRATION: PROSPERO: CRD42017073090 .

Contributing Risk Factors for Substance Use Among Youth in Postconflict Liberia.

Substance use is prevalent among youth in postconflict African countries and is associated with a number of public health problems such as poverty, child homelessness, and school truancy. This qualitative study explores the risk factors associated with substance use among Liberian youth from the perspective of public-school students. Nine focus groups were conducted with 72 Liberian public-school students (35 female, 37 male). Multiple risk factors for substance use among Liberian youth were identified through qualitative analysis, including emotional instability, gender, fear of academic failure, accessibility to substances within the school and community, poverty, and unintentional drug use. These findings are important to public health campaigns and postconflict recovery in Liberia, and may also inform prevention programs for substance use among Liberian youth.

Closing the Mental Health Treatment Gap through the Collaboration of Traditional and Western Medicine in Liberia.

Liberians have experienced significant psychological trauma following fourteen years of violent civil war and the 2014-2015 Ebola epidemic, but there are only two psychiatrists for the entire population. However, many traditional healers commonly treat mental health-related illnesses throughout the country. This paper examines the potential for collaboration between traditional and Western medicine to close the mental health treatment gap in Liberia. We conducted 35 semi-structured qualitative interviews with Liberian traditional healers and utilizers of traditional medicine asking questions about common health problems, treatments, beliefs, and personal preferences. Participants discussed cultural attitudes, beliefs, and structural factors that may influence collaboration between traditional and Western medicine. Healers expressed willingness to collaborate in order to strengthen their skills, though realized Western physicians were hesitant to collaborate. Additionally, Liberians believed in both medical traditions, though preferred Western medicine. Finally, structural factors such as geographic distance and financial barriers made traditional medicine more accessible than Western medicine. Traditional healers and utilizers support collaboration as evidenced by their perceptions of cultural attitudes, beliefs, and structural factors within the Liberian context. With Liberia's overwhelming mental illness burden, collaboration between traditional healers and Western medicine physicians offers a solution to the treatment gap in Liberian mental health care.

Detection of elder abuse: Exploring the potential use of the Elder Abuse Suspicion Index© by law enforcement in the field.

There are no known instruments to aid law enforcement officers in the assessment of elder abuse (EA), despite officers' contact with older adults. This study aimed to identify: 1) officers' perceptions and knowledge of EA, 2) barriers in detecting EA in the field, 3) characteristics officers value in a detection tool, and to explore 4) the potential for officers to use the Elder Abuse Suspicion Index (EASI)©. Data was collected from 69 Connecticut officers who confirmed that barriers to effectively detecting EA included a lack of EA detection instruments, as well as a lack of training on warning signs and risk factors. Officers indicated that the important elements of a desirable tool for helping to detect EA included ease of use, clear instructions, and information on follow-up resources. Approximately 80% of respondents could see themselves using the EASI

A qualitative analysis of parental loss and family separation among youth in post-conflict Liberia.

Between 1989 and 2003, the Republic of Liberia experienced a brutal civil war. In 2008, the population was approximately 3.5 million people, and there were an estimated 340,000 orphans. Nearly 6000 more children were orphaned by the Ebola epidemic from 2014-2015. The goal of this research was to explore the impact of parental loss, identify moderating factors, and consider interventions that could help vulnerable youth in post-conflict societies following the loss of a parent. Seventy-five young people (age 13-18 years) in Monrovia, the capital city of Liberia, were recruited in 2012. Semi-structured interviews were conducted, and demographic data were collected. Interviews were then transcribed and coded thematically. The loss of a parent or other primary caregiver had a significant impact on psychosocial and emotional health. The timing of the loss, strength of connection with the deceased parent, and relationship with surviving parent or substitute caregiver were all relevant factors. Children separated from living parents were functioning better than those whose parents were deceased. The case of Liberian children underscores the importance of early caregiver relationships and the difficulties children face when such relationships are disrupted. Children who did not experience stable early relationships suffered disconnection from their families and communities.

A Mixed Methods Investigation of the Experience of Poverty Among a Population of Low-Income Parenting Women.

This study sought to operationalize poverty in the context of parenting specific to a sample of low-income mothers; to examine how mothers describe sources of stress related to poverty; and to explore how these experiences affect mothers' parenting practices. Mothers trained in research methods administered surveys to other mothers in community settings assessing parenting stressors, mental wellbeing, basic needs, and goals. Women reported difficulty obtaining basic needs. Qualitatively, women described financial hardship, housing, employment status, and transportation as sources of stress, which influenced their parenting practices. These findings connect a mother's inability to meet her basic needs with parenting quality, and suggest that programs promoting early childhood development through building the capacity of parents must focus on basic needs and strategies to alleviate poverty. Healthcare providers may be able to glean specific terminology utilized by women when they inquire about basic needs and form partnerships with basic needs providers.

The impact of transactional sex with teachers on public school students in Monrovia, Liberia - a brief report.

Access to education has been shown to strongly influence adolescent health across the world, and strong relationships with teachers has been found to lead to better academic and psychosocial outcomes for students. In many low-income countries where adolescents have less access to education and are more likely to experience poor health outcomes, risky sexual behaviors can exacerbate these challenges by increasing the risk of unintended pregnancy and sexually transmitted infections. This study sought to examine risky behaviors, such as substance use and risky sexual practices, of in-school youth in Liberia, a country in West Africa. Nine focus groups were conducted with public school students in Monrovia, Liberia in April 2012 using a semi-structured guide. The sessions took place in three public schools with n = 72 participants aged 12-20 years old. Following thematic content analysis, a pattern emerged of transactional sex between female students and male teachers, which often led to contrived and coercive relationships for the students. Conversely, participants reported that educators were not disciplined for having sex with students. Interventions to reduce the prevalence of transactional sex within the academic environment would likely protect the well being of school-going youth, particularly female youth, and support students' academic pursuits in Liberia.

A qualitative analysis of factors impacting resilience among youth in post-conflict Liberia.

BACKGROUND: In 2008, 5 years after the Liberian civil war ended, there were an estimated 340,000 orphans in Liberia, 18 % of the total child population of the country. Given that children make up half the population and that these children experienced significant trauma and loss both through direct exposure to the war and then to the Ebola epidemic, and indirectly as a result of the trauma experienced by their parents, the recovery of these children is essential to the recovery of the nation as a whole. The goal of this research was to identify factors contributing to resilience among youth in post-conflict Liberia. Resilience was defined as evidence of adaptive functioning and psychological health. METHODS: Seventy-five young people (age 13-18) in the capital city of Monrovia, Liberia were recruited in 2012. Semi-structured interviews were conducted, and demographic data were collected. Interviews were then transcribed and coded thematically. RESULTS: Forty-six of the participants were attending school, and 29 were not enrolled in school. Youth enrolled in school demonstrated greater adaptive functioning. This was particularly true for boys in any school setting and girls attending private school. Youth not attending school were more likely to have lost family members or become estranged from them, and many were also engaging in substance use. Emotion regulation, cognitive flexibility, agency, social intelligence and, in some cases, meaning-making were found in participants who showed resilient outcomes. CONCLUSIONS: Caregiver relationships mediate the development of psychological capacities that impact resilience. These findings suggest that youth who have lost a caregiver, many of whom are not attending school, are experiencing a significant ongoing burden in terms of their daily functioning and psychological health in the post-war period and should be the focus of further study and intervention targeting substance use and community reintegration. Trial registration Partners Healthcare IRB Protocol# 2012P000367.