Participation in Pediatric Primary Care Innovation, DULCE, Increases Caregiver Agency and Resilience and Decreases Impact of Stress.

The purpose of the present study was to explore outcomes and heterogeneous effects of an evidence-based, cross-sector pediatric healthcare intervention for families with infants, Developmental Understanding and Legal Collaboration for Everyone (DULCE). DULCE is tailored to allow families' needs and desires to drive DULCE intensity. This is a longitudinal study following families involved with pediatric primary care clinics from infant's birth to 15 months. Multi-level longitudinal modeling was used to compare the program's influence on resilience, parent agency, and the impact of stress on parent functioning among program recipients (n = 172) and non-recipients (n = 170). Study participants were recruited from four health care clinics in California and Florida, and participants completed in-person survey interviews at baseline (infant age 0-6 months) and final (infant age 12-15 months) timepoints, with a minimum of 6 months between baseline and final interview required. Assignment of families to intervention (participated in DULCE) or comparison group (received clinic care as usual) varied by clinic. The cross-sector pediatric primary care intervention screened families at high rates (70-90%), along with referring and connecting families to resources. DULCE participation was associated with increases in parents' agency and resilience. DULCE's positive influence on parent agency and impact of stress was observed with low dosage, and higher-risk families saw additional improvements in resilience at high dosage (high and low risk defined with Latent Profile Analysis). Findings reinforce the importance of examining heterogeneous effects of evidence-based interventions. DULCE's influence on parent agency and impact of stress was observed with low dosage; strengthened resilience among higher-risk families was found at high dosage. These findings document the value of a universal approach to prevention services in pediatric settings with tailoring that allows families to drive their engagement with the intervention.

Pre-Pandemic Adversity Buffers the Role of Social Loneliness in Caregiver Mental Health During the COVID-19 Pandemic.

Objectives: This study investigates how family profiles of risk and resilience established prior to COVID-19 are associated with changes in caregiver depression and stress 1 year after the pandemic onset, and how these associations are moderated by experiences of social loneliness. Methods: A sample of 243 caregivers in four risk and resilience profiles interviewed pre-COVID-19 were interviewed virtually in December 2020-February 2021 (during pandemic). Multi-level models were used to examine changes in mental health. Results: All caregivers reported increases in extreme stress during the pandemic. Caregivers with less relative adversity pre-pandemic showed significantly greater depression and loneliness in the pandemic compared to caregivers with higher pre-pandemic adversity. Social loneliness was a moderator of the association between pre-pandemic adversity and mental health. Conclusion: The study suggests families with more pre-pandemic adversity demonstrate coping that buffers the negative impact of social loneliness on mental health, emphasizing the strengths of these families that are assets to build upon in crisis. Families with more relative advantage pre-pandemic likely need assistance to reduce feelings of stress and depression in the face of increased social loneliness.

Improving Child Health and Healthcare Use Outcomes: How Risk and Resilience Intersect in Pediatric Care.

More nuanced and comprehensive approaches are needed in preventive healthcare to have a larger impact on the social determinants of health that influence health and well-being over the life course. Using data from a nine-site study of pediatric health care innovations focused on screening, referring, and linking families of infants to services for social needs, we examined the clustering of risk and resilience reported by 888 parents at infant age birth to 6 months using latent profile analysis (LPA). We then examined how risk and resilience profiles were associated with children's health status and family unmet need for social supports 1 year later. The study was conducted in three states in 2018-2020 with recruitment in pediatric clinics serving low-income families. Results found four distinct family profiles of risk and resilience, and families in one profile (high household/relational risk and lower strengths) reported worse health outcomes compared to the low-risk, high strengths profile. Public benefits need-income assistance, health insurance, housing, and food assistance-at 1 year continued to be heightened among all groups compared with the low risk, high-strength group, highlighting the importance of screening for social needs early in life as risk and resilience profiles are predictive of future need. Study findings point to the need to include risk and resilience screening in the strategies used by pediatric healthcare to predict health outcomes and design preventive approaches.

Latinx Family Perspectives on Social Needs Screening and Referral during Well-Child Visits.

OBJECTIVE: To understand Latinx parent perspectives on screening and referral approaches to identify social determinants of health and address social and material needs during well-child visits and to identify techniques that promote their engagement with these approaches. STUDY DESIGN: We investigated parent perspectives and engagement with social needs screening and referral practices during well-child visits using focus group methodology. RESULTS: We conducted 17 focus groups (n = 134 parents and other primary caregivers) with families receiving care at sites operated by eight pediatric primary care clinics. Adding social needs screening and referral shifted the social context of well-child visits for Latinx parents. Participants reported greater engagement with the practices where they perceived an emotional connection with nurses and other clinicians and cultural brokering to ensure their screening responses accurately reflected family needs and priorities. Participants highlighted the importance of having a personal patient-provider relationship as many preferred to discuss social needs outside of the exam room. CLINICAL IMPLICATIONS: Nurses and other clinicians play a critical role in establishing systems needed to systematically screen and refer families for social needs. Future policy development should consider implications for nursing practice and leadership in adopting these approaches.

Sexual minority status and child maltreatment: How do health outcomes among sexual minority young adults differ due to child maltreatment exposure?

BACKGROUND: Although prior studies indicate heightened health and well-being concerns for sexual minority (SM) youth, as well as for youth exposed to child maltreatment in the general population, it is unclear whether there are differences in these outcomes among SM youth that have and have not experienced maltreatment. OBJECTIVE: Our aim was to investigate the unique associations between child maltreatment and emerging health outcomes beyond the impact of SM status. Data was drawn from a nationally representative sample of 648 SM youth in the U.S. in grades 7-12 during the 1994-1995 school year. METHODS: Using data from the National Longitudinal Study of Adolescent to Adult Health, descriptive statistics and ordinary least squares regression models were used to investigate differences in SM young adult outcomes by experiences of child maltreatment. RESULTS: Maltreatment among SM individuals showed strong associations with poor adult mental health outcomes (e.g. depression, anxiety, isolation, and suicidal ideation) and fairly strong negative associations with general health outcomes (e.g., heart and lung problems) when compared to their non-maltreated peers. Associations with maltreatment and behavioral health and socioeconomic outcomes were not as strong for this population, which suggests the effects of maltreatment for SM youth are most salient in regards to mental and physical health. CONCLUSIONS: Findings provide insight into what areas of health and well-being should be focused on when working with SM youth that have been maltreated, and offer evidence to encourage further exploration of the outcomes of SM maltreated individuals in young adulthood.