Siblings' Perspectives of the Impact of Child Sexual Abuse Disclosure on Sibling and Family Relationships.

Child sexual abuse (CSA) may have significant consequences for siblings; however, limited research has been conducted on the impact of the abuse on sibling and family relationships following the disclosure of CSA. This study sought to investigate sibling responses to disclosures of CSA among a group of adult siblings in Ireland, and the impact on sibling and family relationships through an online survey. A thematic analysis was conducted on a sub-set of participants who responded to open-ended questions (n = 45). Three main themes were identified as follows: (a) intense emotional reactions, (b) relationship support and strain, and (c) managing family dynamics. CSA disclosure may have a substantial impact on sibling and family relationships. Supporting siblings in the aftermath of CSA disclosure is essential, both for the well-being of the individual who was sexually abused and for the wider family.

El abuso sexual infantil puede tener consecuencias importantes para los hermanos, sin embargo, se han realizado pocas investigaciones sobre el efecto del abuso en las relaciones familiares y fraternales después de la revelación de abuso infantil. El presente estudio tuvo como finalidad investigar las respuestas de los hermanos a las revelaciones de abuso sexual infantil entre un grupo de hermanos adultos en Irlanda, y el efecto en las relaciones familiares y fraternales mediante una encuesta en línea. Se realizó un análisis temático en un subconjunto de participantes que respondieron preguntas de interpretación abierta (n=45). Se identificaron tres temas principales: (a) reacciones emocionales intensas, (b) apoyo y tensión en la relación, y (c) manejo de la dinámica familiar. La revelación del abuso sexual infantil puede tener un efecto considerable en las relaciones fraternales y familiares. Es fundamental apoyar a los hermanos después de la revelación de abuso sexual infantil, tanto por el bienestar de la persona que fue abusada sexualmente como para el resto de la familia.

Parent-to-child aggression, intimate partner aggression, conflict resolution, and children's social-emotional competence in early childhood.

Early childhood is critical to the development of children's social-emotional competence, which predicts peer relations and school adjustment in later periods of childhood. The effects of experiencing or witnessing aggression on children's social-emotional development are well known, yet the role of conflict resolution within the family has not been sufficiently studied. Social information processing models suggests that children who experience positive forms of conflict resolution within the family are likely to generalize these experiences and related skills outside the family, and thus develop greater social-emotional competence. In this longitudinal study, 128 parents (representing 79 families) participated in four quarterly telephone interviews in which they described aggressive conflicts that occurred in their family for which their children were present, including the degree to which each conflict was resolved. They also reported on the frequency of intimate partner aggression (IPA) and parent-to-child aggression (PCA) that occurred while the child was in toddlerhood and preschool as well as children's social-emotional competence at the end of the study. Multi-level models reveal that parents' reports of positive conflict resolution mitigated the concurrent and longitudinal negative effects of children's exposure to both IPA and PCA on their social-emotional competence. These findings reinforce prevention scientists' emphasis on conflict resolution skills as an essential component of parent education programs.

La primera infancia es fundamental para el desarrollo de la competencia socioemocional de los niños, la cual predice las relaciones entre pares y la adaptación escolar en periodos posteriores de la niñez. Se conocen muy bien los efectos que producen el sufrir o ser testigos de agresión en el desarrollo socioemocional de los niños, sin embargo, aún no se ha estudiado de manera suficiente el papel que desempeña la resolución de conflictos dentro de la familia. Los modelos de procesamiento de la información social sugieren que los niños que viven formas positivas de resolución de conflictos dentro de la familia son propensos a generalizar estas experiencias y las habilidades afines fuera de la familia y, por lo tanto, a desarrollar una mayor competencia socioemocional. En este estudio longitudinal, 128 padres (que representaban 79 familias) participaron en cuatro entrevistas telefónicas cada tres meses en las cuales describieron conflictos agresivos que hubo en su familia en los cuales sus hijos estuvieron presentes, incluido el grado en el cual se resolvió cada conflicto. También informaron la frecuencia de agresión en la pareja y de agresión de padres a hijos que tuvo lugar durante sus primeros años de vida y en la etapa del preescolar, así como la competencia socioemocional de los niños al final del estudio. Los modelos multinivel indican que los informes de los padres sobre la resolución positiva de los conflictos mitigaron los efectos negativos longitudinales y simultáneos de la exposición de los niños a la agresión en la pareja y a la agresión de padres a hijos en su competencia socioemocional. Estos resultados refuerzan el énfasis en las habilidades de resolución de conflictos de los científicos de la prevención como componente esencial de los programas de educación para padres.

Co-infections, comorbidities, and alcohol or other substances abuses in chronic hepatitis C-related hospitalisations in Spain.

BACKGROUND: The Strategic Plan for Tackling Hepatitis C launched in 2015 in Spain has led to an important nationwide decrease in hepatitis C related hospitalisation rates. However, patients' infection progression during decades could increase their health status complexity and challenge patient's prognosis after hepatitis C eradication. METHODS: We carried out an observational retrospective study evaluating the prevalence of the main co-infections, comorbidities (risk factors and extrahepatic manifestations), and alcohol or other substances abuses in chronic hepatitis C related hospitalised patients in Spain. Data were obtained from the National Hospitalisation Registry discharges from January 1st of 2012 to December 31st of 2019. RESULTS: Between 2012 and 2019 there were 356,197 chronic hepatitis C-related hospitalisations. In-hospital deaths occurred in 11,558 (4.6%) non-advanced liver disease and in 10,873 (10.4%) advanced liver disease-related hospitalisations. Compared to 2012-2015, in 2016-2019 the proportion of hospitalisations related to non-advanced liver disease increased from 69.4% to 72.4%, while the advanced disease-related hospitalisations decreased from 30.6% to 27.6% (P<.001). In spite of the decrease in severe cases among hospitalisations, all comorbidities evaluated, and alcohol abuse increased in 2016-2019 compared to 2012-2015, while co-infections and other substances abuses decreased in the same period. In the latest period (2016-2019): 28,679 (18.3%) of the hospitalised patients had a HIV, 6928 (4.4%) a hepatitis B, and 972 (.6%) a tuberculosis co-infection. Most frequent comorbidities were diabetes (N=33,622; 21.5%); moderate to severe renal disease (N=28,042; 17.9%), chronic obstructive pulmonary disease and asthma (N=25,559; 16.3%), and malignant neoplasms (excluding hepatocellular carcinoma) (N=19,873; 12.7%). Alcohol or substances abuse was reported in 48,506 (31.0%) hospitalisations: 30,782 (19.7%) with alcohol; 29,388 (18.8%) with other substances; and 11,664 (7.5%) with both, alcohol and other substances, abuses. CONCLUSIONS: Despite the reduction in advanced liver disease hepatitis C-related hospitalisations due to prioritisation of treatment to the more severe cases, high and increasing prevalence of comorbidities and risks factors among hepatitis C-related hospitalisations have been found.

My Brother's Keeper? The Sibling Subsystem in the Context of Physical and Sexual Child Abuse.

The sibling subsystem is of central importance and a possible protective factor for children. Nevertheless, it remains surprisingly understudied and lacks any theoretical or conceptual framework. The current study explored the sibling subsystem in the context of child abuse (CA). Thorough thematic analysis was conducted on the narratives of 30 children referred to forensic interviews following suspected physical or sexual abuse by a parent. Aged 4-14, all had at least one sibling each and referred to this sibling during their interviews in the specific context of the CA they had experienced. Their narratives shed light on two dynamics that can characterize the sibling subsystem in the context of CA: compensation and spillover of the trauma into the sibling subsystem. They stress the centrality of the sibling subsystem in the children's lives and the siblings' role in the children's survival of CA. The current study's findings emphasize the urgency of continuing to develop studies in this area, as they will likely contribute to both prevention and intervention efforts.

El subsistema de hermanos es de fundamental importancia y un posible factor protector para los niños. Sin embargo, sorprendentemente, se sigue estudiando poco y carece de todo marco teórico o conceptual. El presente estudio analizó el subsistema de hermanos en el contexto del abuso de menores. Se realizó un análisis temático completo sobre las historias de 30 niños derivados a entrevistas forenses después del presunto abuso sexual o físico por parte de un padre. Los niños de entre 4 y 14 años tenían todos al menos un hermano cada uno y mencionaron a este hermano durante sus entrevistas en el contexto específico del abuso de menores que habían sufrido. Sus historias aclararon dos dinámicas que pueden caracterizar el subsistema de hermanos en el contexto del abuso de menores: la compensación y la transferencia del trauma en el subsistema de hermanos. Además, acentúan la importancia del subsistema de hermanos en las vidas de los niños y el papel de los hermanos en la supervivencia al abuso de esos niños. Los resultados del presente estudio enfatizan la urgencia de continuar desarrollando estudios en esta área, ya que probablemente contribuyan tanto a esfuerzos de prevención como de intervención.

Bidirectional Spillover in the Family across the Transition to Parenthood.

Although family systems theory posits reciprocal causality between subsystems of the family, such as intimate partner violence exacerbating harsh parenting and vice versa, longitudinal studies with cross-lagged models have been used infrequently to test these principles. As guided by the spillover model, this study examined bidirectional associations between couple dysfunction, parent-child aggression risk, and child functioning across the transition to parenthood to determine whether and how disruptions in one subsystem relate to problems in other family subsystems. Participants were 201 first-time mothers and 151 fathers from a diverse community sample, evaluated during pregnancy, and reassessed two more times through their child's first 18 months of life. Individual and dyadic path model results indicate bidirectional spillover effects between parent-child aggression risk and child functioning for both mothers and fathers, and spillover from parent-child aggression risk to couple dysfunction for mothers but not fathers. However, limited spillover effects were identified between couple functioning and child adjustment, in contrast to previous work. Findings suggest that spillover can happen reciprocally and early in the family, supporting transactional models of behavior and highlighting the need for early family level intervention.

Aunque la teoría de sistemas familiares plantea una causalidad recíproca entre los subsistemas de la familia, como la violencia de pareja que exacerba la crianza hostil y viceversa, se han utilizado ocasionalmente estudios longitudinales con modelos de referencias cruzadas para evaluar estos principios. Guiado por el modelo de transferencia, este estudio analizó las asociaciones bidireccionales entre la disfunción de la pareja, el riesgo de agresión entre padres e hijos y el funcionamiento de los niños durante la transición a la paternidad a fin de determinar si y cómo las alteraciones de un subsistema se relacionan con los problemas en otros subsistemas familiares. Los participantes fueron 201 madres primerizas y 151 padres de una muestra comunitaria diversa evaluada durante el embarazo y reevaluada dos veces más a lo largo de los primeros 18 meses de vida de su hijo. Los resultados del modelo de ruta individual y diádico indican efectos de transferencia bidireccional entre el riesgo de agresión entre padres e hijos y el funcionamiento de los niños tanto para las madres como para los padres, y transferencia del riesgo de agresión entre padres e hijos a la disfunción de la pareja para las madres pero no para los padres. Sin embargo, se identificaron efectos escasos de transferencia entre el funcionamiento de la pareja y la adaptación de los niños en comparación con trabajos anteriores. Los resultados sugieren que la transferencia puede ocurrir recíprocamente y pronto en la familia, lo cual respalda modelos transaccionales de comportamiento y destaca la necesidad de una intervención temprana a nivel familiar.

Breaking the cycle of intergenerational abuse: A qualitative interview study of men participating in a perinatal program to reduce violence.

Domestic violence and abuse in the perinatal period leads to long-term adverse outcomes for infants, including a greater risk of becoming victims or perpetrators of violence in adulthood. Examining men's beliefs about fatherhood and violence, and their motivations for engaging in programs to reduce violence, is essential to understand how interventions can impact on behavior and break intergenerational cycles of abuse. The aim of this study was to explore the experience of becoming a father in a sample of men who are taking part in a whole-family perinatal program to reduce violence-For Baby's Sake. Ten men who had engaged with For Baby's Sake were interviewed about their experiences and beliefs around fatherhood. Interviews were audio-recorded, transcribed verbatim, and analyzed using thematic analysis. Four themes were identified: making sense of violent behavior, conceptions of fatherhood, an emotional transition, and breaking the cycle. The data provide a unique insight into men's beliefs and behaviors at this transition point in their lives. This can aid the development of interventions aimed at breaking the cycle of abuse, indicating ways to harness the motivation for a new start and support men to overcome unhelpful behavior patterns.

La violencia y el abuso domésticos en el período perinatal conduce a resultados adversos a largo plazo para los infantes, incluyendo un alto riesgo de convertirse en víctimas o maltratadores violentos en su edad adulta. Examinar las creencias de los hombres acerca de la paternidad y la violencia, y sus motivaciones para participar en programas para reducir la violencia, es esencial para comprender cómo las intervenciones pueden tener un impacto en la conducta y romper los ciclos intergeneracionales de abuso. El propósito de este estudio fue explorar la experiencia de convertirse en papá en un grupo muestra de hombres que están participando en un programa perinatal para toda la familia para reducir la violencia - [ENMASCARDO]. Diez hombres que se han involucrado con [ENMSACARADO] fueron entrevistados acerca de sus experiencias y creencias en cuanto a la paternidad. Se grabaron en audio las entrevistas, las cuales fueron transcritas palabra por palabra, y analizadas usando un análisis temático. Se identificaron cuatro temas: dándole sentido a la conducta violenta; concepciones de la paternidad; una transición emocional; y el rompimiento del ciclo. Los datos proveen una perspectiva única en cuanto a las creencias y conductas de los hombres en este punto de transición en sus vidas. Esto puede ayudar al desarrollo de intervenciones con el propósito de romper el ciclo de abuso, lo que indica maneras de aprovechar la motivación para un nuevo comienzo y apoyar a los hombres a superar patrones de conducta no beneficiosos.

La violence et la maltraitance conjugales durant la période périnatale mène à des résultats adverses à long terme pour les nourrissons, y compris un risque plus grand de devenir des victimes ou des auteurs de violences à l'âge adulte. Le fait d'examiner les croyances des hommes pour ce qui concerne la paternité et la violence, ainsi que leurs motivations quand il s'agit de s'engager dans des programmes afin de réduire la violence, est essentiel pour comprendre comment les interventions peuvent avoir un impact sur le comportement et briser les cycles intergénérationnels de maltraitance. Le but de cette étude était d'explorer l'expérience du fait de devenir père chez un échantillon d'hommes participant à un programme périnatal au niveau de la famille entière pour réduire cette violence. Dix hommes participant au programme ont été interviewés sur leurs expériences et leurs croyances liées à la paternité. Les entretiens ont été enregistrés, transcrits mot pour mot, et analysés en utilisant une analyse thématique. Quatre thèmes ont été identifiés: donner du sens au comportement violent; les conceptions de la paternité; une transition émotionnelle; et briser le cycle. Les données offrent un regard unique sur les croyances et les comportements des hommes à ce point de transition dans leurs vies. Cela peut aider le développement d'interventions destinées à briser le cycle de la maltraitance, indiquant ainsi des manières d'exploiter la motivation pour un nouveau commencement et de soutenir les hommes afin qu'ils surmontent des patterns de comportements inutiles.

Parents' Experiences of Their Child's Disclosure of Child Sexual Abuse.

A child's disclosure of sexual victimization is a difficult experience for parents and has been associated with traumatization, disbelief, denial, self-blame, and clinical difficulties. To date, most studies on parents' responses have been quantitative assessments of the psychological impact of disclosure on parents. A paucity of research has qualitatively explored mothers' experiences of their child's disclosure of child sexual abuse (CSA) and fathers' experiences have been even further neglected. The current study seeks to characterize parents' experiences of their child's disclosure of CSA and to uncover the process-oriented nature of parental responses. This qualitative study, using a grounded theory approach to analysis, involved interviews with 10 mothers and four fathers whose children (3-18 years) had experienced sexual abuse. Three themes emerged from the analysis. The first theme-making sense of the abuse in retrospect-captured the process through which parents sought to make sense of their child's disclosure, focusing on why their child had not disclosed the abuse to them earlier, and how they had noticed something was wrong but misattributed their child's behavior to other factors. The second theme-negotiating parental identity as protector-reflected how parents' identity as a protector was challenged, their perception of their world had been forever altered, and they now experienced themselves as hypervigilant and overprotective. The final theme-navigating the services-pertained to parents' struggle in navigating child protection and police services, and feelings of being isolated and alone. These findings highlight the need for empathy and parental support following child disclosure of sexual victimization.

La revelación de victimización sexual de un hijo es una experiencia difícil para los padres y se ha asociado con el trauma, la incredulidad, el rechazo, la autoculpabilización y las dificultades clínicas. Hasta la fecha, la mayoría de los estudios sobre las respuestas de los padres han sido evaluaciones cuantitativas del efecto psicológico de dicha revelación en los padres. Muy pocas investigaciones han analizado cualitativamente las experiencias de las madres con respecto a la revelación de sus hijos de abuso sexual infantil, y las experiencias de los padres se han pasado por alto aun más. El presente estudio tiene como finalidad caracterizar las experiencias de los padres con respecto a la revelación de sus hijos de abuso sexual infantil y descubrir la índole orientada a procesos de las respuestas de los padres. Este estudio cualitativo, que utilizó una metodología de muestreo teórico del análisis, consistió en entrevistas con diez madres y cuatro padres, cuyos hijos (de entre 3 y 18 años) habían sufrido abuso sexual. Del análisis surgieron tres temas. El primer tema- dar sentido al abuso retrospectivamente - captó el proceso por el cual los padres intentaron dar sentido a la revelación de su hijo, centrándose en por qué su hijo no había revelado el abuso antes, y en cómo habían notado que algo estaba mal pero atribuyeron erróneamente el comportamiento de su hijo a otros factores. El segundo tema -la negociación de la identidad parental como protectora- reflejó cómo se cuestionó la identidad de los padres como protectora; la percepción de su mundo se había modificado para siempre y ahora se sentían hipervigilantes y sobreprotectores. El último tema - cómo orientarse entre los servicios - estuvo relacionado con la dificultad de los padres para orientarse entre los servicios de protección infantil y policiales, y con el sentimiento de estar aislados y solos. Estos resultados destacan la necesidad de empatía y de apoyo a los padres después de la revelación de victimización sexual de un hijo.

Fidelity Failures in Brief Strategic Family Therapy for Adolescent Drug Abuse: A Clinical Analysis.

As evidence-based family treatments for adolescent substance use and conduct problems gain traction, cutting edge research moves beyond randomized efficacy trials to address questions such as how these treatments work and how best to disseminate them to community settings. A key factor in effective dissemination is treatment fidelity, which refers to implementing an intervention in a manner consistent with an established manual. While most fidelity research is quantitative, this study offers a qualitative clinical analysis of fidelity failures in a large, multisite effectiveness trial of Brief Strategic Family Therapy (BSFT) for adolescent drug abuse, where BSFT developers trained community therapists to administer this intervention in their own agencies. Using case notes and video recordings of therapy sessions, an independent expert panel first rated 103 cases on quantitative fidelity scales grounded in the BSFT manual and the broader structural-strategic framework that informs BSFT intervention. Because fidelity was generally low, the panel reviewed all cases qualitatively to identify emergent types or categories of fidelity failure. Ten categories of failures emerged, characterized by therapist omissions (e.g., failure to engage key family members, failure to think in threes) and commissions (e.g., off-model, nonsystemic formulations/interventions). Of these, "failure to think in threes" appeared basic and particularly problematic, reflecting the central place of this idea in structural theory and therapy. Although subject to possible bias, our observations highlight likely stumbling blocks in exporting a complex family treatment like BSFT to community settings. These findings also underscore the importance of treatment fidelity in family therapy research.

A medida que los tratamientos familiares factuales para el consumo de sustancias y los problemas de conducta en los adolescentes ganan terreno, la investigación de vanguardia trasciende los ensayos aleatorizados de eficacia teórica para abordar preguntas, por ejemplo, cómo funcionan estos tratamientos y cómo difundirlos mejor en entornos comunitarios. Un factor clave para la difusión eficaz es la fidelidad al tratamiento, que se refiere a implementar una intervención de una manera consecuente con un manual establecido. Si bien la mayor parte de la investigación de fidelidad es cuantitativa, el presente estudio ofrece un análisis clínico cualitativo de fallas de la fidelidad en un ensayo grande multicéntrico de eficacia real de Terapia Familiar Breve y Estratégica (BSFT) para el abuso de drogas en los adolescentes, donde los desarrolladores de la BSFT capacitaron a terapeutas de la comunidad para que apliquen esta intervención en sus propias agencias. Utilizando informes de casos y grabaciones de vídeo de sesiones de terapia, un panel independiente de expertos evaluó primero 103 casos con escalas de fidelidad cuantitativa basadas en el manual de BSFT y el marco estratégico estructural más amplio que respalda la intervención de la BSFT. Como la fidelidad fue generalmente baja, el panel revisó todos los casos cualitativamente para reconocer tipos o categorías emergentes de fallas de la fidelidad. Surgieron diez categorías de fallas caracterizadas por omisiones del terapeuta (p. ej.: el terapeuta no hizo participar a familiares clave, no pensó en grupos de tres) y licencias (p. ej.: desvío del modelo, formulaciones/intervenciones no sistémicas). De estas opciones, la falla en "no pensar en grupos de tres" pareció básica y particularmente problemática, lo cual refleja el lugar fundamental de esta idea en la teoría y la terapia estructural. Aunque nuestras observaciones estén sujetas a un posible sesgo, estas ponen de manifiesto posibles obstáculos a la hora de exportar un tratamiento familiar complejo como la BSFT a entornos comunitarios. Estos resultados también subrayan la importancia de la fidelidad al tratamiento en la investigación sobre terapia familiar.

Early-life risk for domestic violence perpetration: Implications for practice and policy.

Research on risks and causes of domestic violence is hampered by a policy framework that not only does not fund but in some cases suppresses inquiry into those causes. This discussion, then, will be placed in the context of those policy frameworks that hamper and distort inquiry. This includes an overview of ideological, political, and historical issues that have shaped those frameworks. Related explanatory theories and theories of practice are summarized. The article will examine known early-life risk factors for those disorders and behaviors associated with domestic violence perpetration. Particular emphasis will be placed on maltreatment and attachment/bonding processes. Framed in broad perspectives of psychosocial theory, risk factors from related literature sources (e.g. general violence and criminality) will be included where risk profiles are substantially similar.

Associations between child physical abuse potential, observed maternal parenting, and young children's emotion regulation: Is participation in Early Head Start protective?

Clinicians working with Early Head Start (EHS) families consider family well-being and positive parent-child relationships as foundational to school readiness. Understanding the links between risk factors and these dimensions of family engagement can inform clinical decision-making, as risk assessments are used to tailoring program services. The current study examined the associations between high risk, or potential, for child physical abuse and both parenting quality and children's emotion regulation (ER) during toddlerhood; EHS participation was examined as a buffer. The sample included EHS-eligible mothers of infants (N = 80) drawn from one site of the EHS Research and Evaluation Project. Associations were tested between mothers' potential for child physical abuse, measured during infancy, and observed maternal sensitivity, positive regard, harshness, and children's ER skills at child ages 1 and 2 years. Results indicated that high potential for child physical abuse was associated with lower positive regard at age 1 and lower ER skills at age 2. EHS participation operated as a buffer on each of these associations. Implications for screening for child physical abuse potential and the constructs it represents in clinical settings as well as how EHS can promote family engagement are discussed.

Los clínicos que trabajan con familias del Programa de Comienzo Temprano (Early Head Start - EHS) consideran el bienestar familiar y las positivas relaciones entre progenitor y niño como aspectos fundamentales para estar listo para la escuela (US DHHS, 2011). El poder comprender las conexiones entre los factores de riesgo y estas dimensiones de la participación familiar puede servir de base para la toma de decisiones clínicas, ya que las evaluaciones de riesgo se usan para amoldar los servicios del programa. El presente estudio examinó las asociaciones entre el alto riesgo, o riesgo potencial, del abuso físico del niño y tanto la calidad de la crianza como la regulación de la emoción por parte del niño durante la primera etapa de la niñez; se examinó la participación en EHS como mediadora. El grupo muestra incluía madres de infantes elegibles para EHS (N = 80) quienes formaban parte de un mismo Proyecto de Investigación y Evaluación del Programa de Comienzo Temprano. Se pusieron a prueba las asociaciones entre el potencial de las madres de abuso físico del niño, medidas durante la infancia, y las observaciones de sensibilidad materna, consideraciones positivas, dureza, y las habilidades de regulación de la emoción del niño a la edad de 1 y 2 años del niño. Los resultados indicaron que el alto potencial de abuso físico del niño estaba asociado con más bajas consideraciones positivas a la edad de 1 año, así como con las más bajas habilidades de regulación de la emoción a la edad de 2 años. La participación en EHS funcionó como mediadora en cada una de estas asociaciones. Se discuten las implicaciones para detectar el potencial de abuso físico del niño y la estructura que representa en escenarios clínicos, y también cómo EHS puede promover la participación familiar.

Les cliniciens travaillant avec des familles du programme américain de Early Head Start (EHS) familles considèrent le bien-être familial et des relations parent-enfants positives comme étant les fondations de la préparation au cadre scolaire (US DHHS, 2011). Le fait de comprendre les liens entre les facteurs de risque et ces dimensions de l'engagement familial peut informer la prise de décision clinique, comme les évaluations de risque sont utilisées pour adapter les services de programmes. Cette étude s'est penchée sur les liens entre le risque élevé, ou potentiel, de maltraitance physique de l'enfant et à la fois la qualité du parentage et la régulation d'émotion des enfants durant la petite enfance; la participation à l'EHS étant examinée comme tampon. L'échantillon a inclus des mères de nourrissons étant admissible à l'EHS (N = 80), tiré d'un site du Projet de Recherche et d'Evaluation du EHS. Les associations ont été testées entre le potentiel de maltraitance physique de l'enfant par les mères, mesuré durant la très petite enfance, et la sensibilité maternelle observée, l'égard positif, la dureté, et les compétences de régulation de l'émotion des enfants aux âges de 1 et 2 ans. Les résultats indiquent qu'un fort potentiel de maltraitance de l'enfant était lié à un égard positif plus bas à l'âge de 1 ans, et à des compétences de régulation de l'émotion moins élevées à l'âge de 2 ans. La participation à l'EHS a servi de tampon dans chacune de ces associations. Les implications pour le dépistage de potentiel de maltraitance physique de l'enfant et pour les constructions qu'il représente dans les contextes cliniques, ainsi que la manière dont l'EHS peut promouvoir un engagement familial sont discutées.

Juggling thoughts and feelings: How do female patients with borderline symptomology and substance use disorder experience change in mentalization-based treatment?

OBJECTIVE: The aim of this study was to explore the experience of central psychological change processes for female patients with borderline symptomology and substance use disorder in mentalization-based treatment. METHOD: Semi-structured qualitative interviews on experiences from mentalization-based treatment with 13 participants were conducted. The interview material was analysed within a hermeneutical-phenomenological epistemology, with emphasis on researcher reflexivity. RESULTS: The following themes regarding central psychological change processes were found: "by feeling the feeling," "by thinking things through," "by walking in your shoes to see myself" and "by stepping outside of own bad feelings in seeing you." Two of these themes dealt with intra-psychic modes of how to relate to own mind-states. First, they had a shift from avoiding emotions into tolerating emotions. Second, they discovered the ability to think mental states through. Two themes dealt with mental stances for dealing with interpersonal situations, where one mode included a self-reflective stance in difficult encounters, and the other mode entailed an empathic reflective stance by exploring others' intentionality. CONCLUSIONS: The findings are in line with theoretical assumptions that increasing mentalizing capacity is a central change process for these patients. Furthermore, the findings demonstrate the complex interaction between different modes of mentalizing. Clinical or methodological significance of this article: The article explores change processes in manualized psychotherapy for patients with comorbid borderline personality disorder and substance use disorder, a focus which is not researched in the clinical literature. We claim that putting attention to this patient group and investigating their potential in psychotherapy is of clinical significance. Methodologically, this article utilizes thematic analyses within an epistemology following a specific procedure that is step based and transparent, thus it is of interest for qualitative researchers who also utilize thematic analyses.

COGNITIVE AND SOCIOEMOTIONAL FUNCTIONING AT 4½ YEARS IN CHILDREN BORN TO MOTHERS WHO HAVE RECEIVED TREATMENT FOR SUBSTANCE-ABUSE PROBLEMS WHILE PREGNANT.

Cognitive and socioemotional functioning at 4½ years of age were examined in children born to mothers with substance-abuse problems (n = 22) recruited from residential treatment institutions while pregnant, and then compared to children born to mothers with mental health problems (n = 18) and children from a low-risk group (n = 26). No significant group differences in cognitive functioning were found, but the children born to mothers with substance-abuse problems showed more caregiver-reported socioemotional problems than did the low-risk children, like the children born to mothers with mental health problems. Birth weight had an effect on internalizing problems at 4½ years and mediated the relation between group and socioemotional problems, although not when controlling for caregiver education, single parenthood, and anxiety and depression. At 4½ years, 7 children born to mothers with substance-abuse problems were placed in foster care. These children had lower birth weight and higher caregiver-rated internalizing problems. In addition to emphasizing the importance of the quality of the prenatal environment, this study suggests that families with previous substance abuse are in need of long-term follow-up to address socioemotional problems and enhance further positive child cognitive development. The foster-placed children may be in particular need of long-term follow-up.

[Early drop-outs and retentions in substance abuse outpatient clinics: a cross-sectional comparative study of factors that increase or decrease adherence]. / Abandono precoz y retención en servicios ambulatorios de drogodependencias: análisis transversal comparativo de factores que aumentan o disminuyen la adherencia.

AIM: The aim of this study is to define the risk factors associated with early discharge in out-patients clinics. DESIGN: Cross-sectional and observational study. SETTING: Substance abuse clinics in Girona (Catalonia, Spain). PARTICIPANTS: A total of 264 individuals were included in the sample, and 34.8% of them abandoned the process within two months of starting the therapy (n=92). PROCEDURE: Clinical and socio-demographic variables of the clinical history were compared between participants with/without adherence. MAIN MEASUREMENTS: The Student t test was used to measure the comparison, and the chi-squared test was used for the analysis of qualitative variables. A binary logistic regression model was adjusted, with adherence as the dependent variable. RESULTS: The results indicated that attending the appointments unaccompanied (OR=3.13), being female (OR=2.44), having cocaine related issues (OR=1.14), and being younger (OR=0.89) are the factors which increase the risk early abandonment. Contrarily, being referred to specialists from a Primary Health Centre reduces the risk (OR=0.28). CONCLUSIONS: It is concluded that special attention must be devoted to the patients' families, women, and young patients. Moreover, the appropriate coordination between specialist services and basic services increases adherence to treatment among drug users.

Características clínicas de mujeres con depresión mayor que sufrieron abuso sexual en la infancia.

INTRODUCCIÓN: Aunque el abuso sexual en la infancia (ASI) es un factor de riesgo para desarrollar depresión mayor en la vida adulta de las mujeres, la información sobre las características clínicas asociadas con este evento es escasa. OBJETIVO: Evaluar la historia de ASI y su asociación con algunas manifestaciones clínicas en mujeres con depresión mayor. MÉTODO: Se seleccionaron 71 mujeres adultas con depresión mayor en un centro comunitario de salud mental. Fueron evaluadas con Mini Entrevista Neuropsiquiátrica Internacional, Inventario de Depresión de Beck, Escala de Autoevaluación de Adaptación Social, Índice de Maltrato Físico e Índice de Abuso Sexual en la Infancia. RESULTADOS: 53.5 % había sufrido alguna forma de ASI. No hubo diferencias significativas en edad, escolaridad, sintomatología depresiva, adaptación social o maltrato físico en la infancia entre las mujeres con y sin historia de ASI, solo mayor frecuencia de comorbilidad con el trastorno por ansiedad social (26 versus 6 %) y mayor proporción de riesgo suicida (68 versus 45.4 %) distinguió a los grupos. CONCLUSIÓN: Pocas características distinguen a las mujeres con depresión mayor con historia de ASI, sin embargo, el pronóstico y las implicaciones terapéuticas del mayor riesgo suicida subrayan la importancia de investigar sistemáticamente la historia de ASI entre las mujeres con depresión mayor. INTRODUCTION: Even when child sexual abuse (CSA) is a risk factor for the development of major depression in adult women, data on the clinical features associated with this traumatic event are scarce. OBJECTIVE: To assess the history of CSA and its association with some clinical manifestations in women with major depression. METHOD: Seventy-one adult women with major depression were selected in a community-based mental health center. They were assessed with the Mini International Neuropsychiatric Interview, the Beck Depression Inventory, the Social Adaptation Self-evaluation Scale, and childhood physical maltreatment and child sexual abuse indices. RESULTS: Some form of CSA had been suffered by 53.5%. There were no significant differences in age, level of education, depressive symptoms, social adaptation or physical maltreatment during childhood between the women with or without a history of CSA, only a higher frequency of comorbid social anxiety disorder (26% versus 6%) and a higher proportion of suicide risk (68% versus 45.4%) differentiated the groups. CONCLUSION: Few characteristics distinguish women with major depression with a history of CSA; however, the prognosis and therapeutic implications of a higher suicide risk underscore the importance of systematically investigating the history of CSA among women with major depression.

[Trauma craneal no accidental en niños: costo económico directo de la atención médica en un hospital de tercer nivel].

INTRODUCTION: Abusive head trauma (AHT) is an extreme form of physical abuse that is produced by abruptly shaking an infant or toddler. OBJECTIVE: To describe the direct economic cost of care during hospitalization of 14 children with confirmed diagnosis of AHT in a pediatric hospital. METHOD: Analysis of the cost of disease in patients with AHT attended to between 2001 and 2010. Partial direct economic cost of medical care (days of hospital stay, laboratory tests and imaging studies, surgical procedures and subspecialist consultations) was calculated adjusting for inflation, with year 2001 taken as base year. Patients were classified in three groups (moderate, severe and fatal AHT). Descriptive and sensitivity analysis was carried out. RESULTS: Patients with severe AHT generated higher medical care costs ($105,794.88 ± 33,201.91) in comparison with the group of moderate ($37,012.95, ± 7,154.87) and fatal AHT ($18,595.04 ± 6424.47) (p <0.05). Total cost was $665,467.98 Mexican pesos ($71,249.25 international dollars). CONCLUSIONS: Total cost for the 14 patients was an elevated figure, as in other parts of the world. The direct economic cost is closely related to the severity of the clinical presentation.

INTRODUCCIÓN: El trauma craneal no accidental (TCNA) es una forma extrema de abuso físico que se produce por la sacudida brusca de un lactante o preescolar. OBJETIVO: Describir el costo económico directo de la atención durante la hospitalización de 14 niños con diagnóstico confirmado de TCNA en un hospital pediátrico. MÉTODO: Análisis del costo de la enfermedad en pacientes con TCNA, atendidos entre 2001 y 2010. Se realizó análisis descriptivo y de sensibilidad. Se calculó costo económico directo parcial de la atención médica (días de estancia hospitalaria, exámenes de laboratorio y gabinete, procedimientos quirúrgicos y consultas por subespecialista), ajustado por la inflación, se tomó como año base 2001. Los pacientes se clasificaron en tres grupos: TCNA moderado, severo y fatal. RESULTADOS: Los pacientes con TCNA severo generaron mayor costo en la atención médica ($105 794.88 ± 33 201.91), en comparación con el grupo con TCNA moderado ($37 012.95 ± 7154.87) y fatal ($18 595.04 ± 6424.47) (p < 0.05). El costo total fue de 665 467.98 pesos mexicanos (71 249.25 dólares internacionales). CONCLUSIONES: El costo total de los 14 pacientes fue una cifra elevada como en otras partes del mundo. El costo económico directo se relaciona estrechamente con la gravedad del cuadro clínico.

The Cultural Adaptation of a Community-Based Child Maltreatment Prevention Initiative.

A unique primary prevention effort, Strong Communities for Children (Strong Communities), focuses on changing attitudes and expectations regarding communities' collective responsibilities for the safety of children. Findings from a 6-year pilot of the initiative in South Carolina have shown promise in reducing child maltreatment, but efforts to adapt the initiative to different cultural contexts have been lacking. No models exist for adapting an initiative that takes a community-level approach to ensuring children's safety. Thus, this article addresses the gap by providing an overview of the original initiative, how the initiative was adapted to the Israeli context, and lessons learned from the experience. Building on conceptualizations of cultural adaptation by Castro et al. (Prevention Science, 5, 2004, 41) and Resnicow et al. (Ethnicity and Disease, 9, 1999, 11), sources of nonfit (i.e., sociodemographic traits, political conflict, government services, and the presence and role of community organizations) were identified and deep and surface structure modifications were made to the content and delivery. Ultimately, this article describes the adaption and dissemination of a community-based child maltreatment prevention initiative in Tel Aviv, Israel, and addresses researchers' calls for more publications describing the adaptation of interventions and the procedures that need to be implemented to achieve cultural relevance.

HISTORY OF CHILDHOOD ABUSE AND MOTHER-INFANT INTERACTION: A SYSTEMATIC REVIEW OF OBSERVATIONAL STUDIES.

Literature that has examined maternal self-reported history of abuse and an observational assessment of infant-mother interaction were reviewed. Electronic databases were searched, and studies that met predefined criteria were included. Fourteen (12 independent samples) studies were included and assessed for quality using the Effective Public Health Practice Project tool (National Collaborating Centre for Methods and Tools, 2008). Ten of the 14 studies found a direct or an indirect relationship between self-reported abuse and observed caregiving. The small number of studies and variation in sample characteristics and measurement limit conclusions. Of the studies that were rated of the highest quality, there is some consistency showing that the effect of maternal abuse history on caregiving may be via a third variable (i.e., stress reactivity or depressive symptoms). The current review discusses strengths and limitations of the existing literature and offers suggestions for future research.

A PRELIMINARY EVALUATION OF THE MANAGING YOUTH TRAUMA EFFECTIVELY PROGRAM FOR SUBSTANCE-ABUSING WOMEN AND THEIR CHILDREN.

This article provides a description of the development, implementation, and preliminary evaluation of feasibility and acceptability of the Managing Youth Trauma Effectively (MYTE) program and highlights perceptions of changes in mothers' trauma-informed parenting practices. The program consists of a training and consultation program for staff of the U.S. State of Arkansas' Specialized Women's Programs (SWS), and an 8-week, group psychoeducational program designed to help mothers with substance-abuse problems learn how traumatic experiences may affect their children and how they may help support their children by creating a safe and nurturing environment. A posttraining evaluation with leadership and staff at SWS centers, feedback provided on consultation calls with MYTE facilitators, and a retrospective pre/post survey were used to examine feasibility, acceptability, and perceptions of changes in mothers' trauma-informed parenting practices. Preliminary results suggest that the MYTE program is feasible to implement and is acceptable to training participants, facilitators, and mothers participating in the program. Mothers reported significant growth in their perceptions of use of trauma-informed parenting practices. Future research is necessary to confirm these results and examine the effectiveness of the program using a randomized clinical trial.

MATERNAL TRAUMA AFFECTS PRENATAL MENTAL HEALTH AND INFANT STRESS REGULATION AMONG PALESTINIAN DYADS.

We examined how diverse and cumulated traumatic experiences predicted maternal prenatal mental health and infant stress regulation in war conditions and whether maternal mental health mediated the association between trauma and infant stress regulation. Participants were 511 Palestinian mothers from the Gaza Strip who reported exposure to current war trauma (WT), past childhood emotional (CEA) and physical abuse, socioeconomic status (SES), prenatal mental health problems (posttraumatic stress disorder and depression symptoms), and perceived stress during their secondtrimester of pregnancy as well as infant stress regulation at 4 months. While all trauma types were associated with high levels of prenatal symptoms, CEA had the most wide-ranging effects and was uniquely associated with depression symptoms. Concerning infant stress regulation, mothers' CEA predicted negative affectivity, but only among mothers with low WT. Against hypothesis, the effects of maternal trauma on infant stress regulation were not mediated by mental health symptoms. Mothers' higher SES was associated with better infant stress regulation whereas infant prematurity and male sex predisposed for difficulties. Our findings suggest that maternal childhood abuse, especially CEA, should be a central treatment target among war-exposed families. Cumulated psychosocial stressors might increase the risk for transgenerational problems.

Prevalence of intimate partner violence in Spain: A national cross-sectional survey in primary care.

OBJECTIVES: (1) To analyze the prevalence of Intimate Partner Violence by types. (2) To examine the relationship between sociodemographic characteristics and Intimate Partner Violence. DESIGN: Cross-sectional study using a self-administered questionnaire. SETTING: Primary Healthcare centers in Spain. PARTICIPANTS: 10,322 women (18-70 years) attending Primary Healthcare centers. MAIN MEASUREMENTS: A compound index was calculated based on frequency, types, and duration of Intimate Partner Violence. Multivariable adjusted logistic regression models were used to identify the sociodemographic factors, which were independently associated with each Intimate Partner Violence category. RESULTS: The prevalence of Intimate Partner Violence was 24.8%. For the physical only category, no differences were observed regarding education or employment status, and women with the highest income have less risk. For the psychological only category, no differences were observed according to the income level. The risk increases as the education level decreases, and the greatest frequency of only psychological Intimate Partner Violence was observed in women who were unemployed or students. For both the physical and psychological category of Intimate Partner Violence, a clear risk increase is observed as income and education levels decrease. Retired women showed the highest frequency of this violence category. CONCLUSION: The results show that Intimate Partner Violence affects women of all social strata, but the frequency and Intimate Partner Violence category will vary according to the socio-economic.