What to Look for in Relationships: Development, inter-rater reliability, and initial validity estimates for a young child-caregiver relationship assessment

Introduction

Observational assessments are important for understanding a range of behaviors and emotions in the young child-caregiver relationship. This paper provides initial data on a multidimensional assessment for professionals who work with young children and their caregivers, the What to Look for in Relationships (WLR). The WLR was designed to assist providers in evaluating strengths and areas for improvement in five areas of young child-caregiver relationship dimensions. This paper reports on the development, interrater reliability, initial convergent and discriminant validity, and incremental utility of the scales.

Methods

Data were collected from caregiver-child dyads, who participated in a semi-structured observational caregiver-child interaction session as part of a clinic evaluation for relationship-based therapeutic services for young children in child protection. Recorded interactions were coded using the WLR scales with 146 interactions coded by at least two independent observers for interrater reliability analyses.

Results

The scales showed adequate internal consistency, good inter-rater reliability, strong convergent associations with a single dimension measure (i.e., the Parent-Infant Relationship Global Assessment Scale; PIR-GAS) and discriminated those in the clinical range from those with adaptive functioning on the PIR-GAS.

Discussion

This study provides initial support for the usefulness of the WLR scales for assessing dimensions of caregiver-child relationships during early childhood that may be useful targets of intervention.

The importance of adverse childhood experiences during the perinatal period

The Adverse Childhood Experiences (ACEs) study (Felitti et al., 1998) has led to an understanding of how exposure to abuse, neglect, and family dysfunction in childhood are related to subsequent physical and mental health problems. These issues are important to consider during the perinatal period, with studies indicating that pregnant women who report adverse experiences in childhood may be at risk of experiencing mental health and substance use problems. This study examined the association of pregnant women's ACEs with symptoms of depression, anxiety, posttraumatic stress, and substance use, and examined the potential buffering effect of women's resilience against the deleterious effects of ACES on mental health and substance use. Women reported on ACES, mental health symptoms, substance use, and resilience when they were screened for participation in a perinatal psychosocial support intervention, which was integrated into obstetrical clinics in a Southern academic medical center. Almost a quarter of the 303 women in this sample reported four or more ACEs, indicating significant risk. Those reporting more overall ACEs also reported more symptoms of depression, posttraumatic stress, and increased risk of tobacco use. Unique effects of specific ACEs subtypes were also found. Women exposed to child maltreatment reported more anxiety, depression, and posttraumatic stress symptoms, and were at risk for tobacco, cannabis, or opioid use during pregnancy. Women exposed to household dysfunction reported more posttraumatic stress symptoms and were at increased risk of tobacco and alcohol use during pregnancy. Women's resilience attenuated effects of household dysfunction on posttraumatic stress symptoms. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Hurricane Katrina and the Gulf Oil Spill: Lessons learned about short-term and long-term effects

The impact and lessons learned from Hurricane Katrina and the Gulf Oil Spill are described as an example of work done reflecting best practices and theory to gain a better understanding of risk and resilience for children and families. Hurricane Katrina, described as the worst natural disaster in the US history, resulted in traumatic separations of children and families and devastation of communities and schools. The impact was greater on families with fewer resources before the hurricane who were provided limited support to return and rebuild. Insufficient community support and economic resources contributed to prolonged traumatiaation and slow recovery. Many were still recovering from Hurricane Katrina when impacted by the Gulf Oil Spill. For families with multigenerational ties to the fishing and oil industries, the Gulf Oil Spill resulted in both cumulative trauma and increased risk. In implementing the behavioural health response, much was learned about promotive and protective factors for individual and community resilience. Services provided following the disasters were based on precepts of individual, family, and community resilience. To enhance recovery and support resilience, the development of regional coalitions across at risk areas provides important coordination before disasters occur for better preparation and response.

Psychological and social impact of COVID-19

The high numbers of COVID-19 infections and deaths, economic difficulties, uncertainty about the future, as well as the approaches needed to contain the spread of the virus are all playing critical roles in the short and long-term social and psychological impact of the COVID-19 pandemic. Inequities based on race and socioeconomic status influence the rates of infection and deaths and steps that are needed to achieve recovery. This commentary focuses on similarities and differences after other disasters and efforts being initiated to provide support and recovery. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Commentary: Understanding the impact of domestic violence on children, recognizing strengths, and promoting resilience: reflections on Harold and Sellers (2018)

Violence and abuse in families occurs frequently with significant impact on children of all ages. However, this type of interpersonal violence is often the least disclosed or discussed. Therefore, the Harold and Sellers paper is important to bring attention to the broad range of both behavioral and neuroscience research in this area and the clinical implications for children and adolescents including risk for later psychopathology. The commentary also expands an understanding of the impact and outcomes for very young children exposed to domestic violence. The authors provide a thorough description of the many prevention and intervention programs and approaches to help children exposed to domestic violence. In conclusion, it is essential to recognize that even at times of adversity for children and families, such as when domestic violence occurs, it is important to recognize strengths and support resilience.

Factors Contributing to Mental and Physical Health Care in a Disaster-Prone Environment

Environment as a contextual factor plays an important role in southeastern Louisiana, as this area represents a major economic hub for the United States port, petroleum, and fishing industries. The location also exposes the population to both natural and technological disasters, including Hurricane Katrina and the Gulf oil spill. This study explored associations among hurricane loss, oil spill disruption, and environmental quality of life on mental and physical health on over 1,000 residents (N = 1,225) using structural equation modeling techniques. Results showed that oil spill distress was associated with increased symptoms of mental and physical health; Hurricane Katrina loss; and decreased environmental quality of life. Findings also indicate that mental health symptoms explain the association among oil spill distress and physical health symptoms-specifically, those that overlap with somatic complaints. These findings provide important support of the need for mental health assessment and service availability for disaster recovery.

Trajectories of post-traumatic stress disorder symptoms among youth exposed to both natural and technological disasters

BACKGROUND

Theorists and researchers have demonstrated multiple trajectories of symptoms following disasters (Ecology and Society, 13, 2008, 9), highlighting the importance of obtaining more knowledge about exposed youth who demonstrate resilience as well as those who suffer chronic difficulties. This paper examines trajectories of post-traumatic stress disorder (PTSD) symptoms following exposure to hurricanes and the Deepwater Horizon Oil Spill to increase understanding of resilience and chronic reactions to both natural and technological disasters.

METHODS

A multiwave longitudinal design was used to follow N = 4,619 youth who were evaluated for PTSD symptoms, hurricane exposure, and oil spill exposure/stress at four time points over a period of 4 years. Trajectories were identified with cluster analyses and multilevel modeling.

RESULTS

Individual trajectories were statistically identified consistent with theory. The largest group exhibited stable-low symptoms (52%), a second group showed steep declines following initial symptoms (21%), a third group exhibited increasing symptoms (18%), and a fourth group showed stable-high symptoms (9%). Both hurricane exposure and oil spill stress predicted trajectories and overall levels of PTSD symptoms.

CONCLUSIONS

Results identified an effect of oil spill stress and hurricane exposure on symptom levels and trajectories of exposed youth. Results provide prospective data to support theories of multiple symptom trajectories following disasters and reinforce the importance of research that utilizes a developmental perspective to consider the long-term effects of disasters in youth. Findings highlight the importance of identifying symptoms and predictors of resilience as well as factors that contribute to resilience.

Innovations in Practice: Dissemination and implementation of child-parent psychotherapy in rural public health agencies

BACKGROUND

Early trauma exposure can have long-term negative health effects. Few young children receive evidence-based trauma treatment. This article explores the feasibility of implementing Child-Parent Psychotherapy (CPP), an evidence-based intervention, in rural public health agencies.

METHOD

Twenty-three clinicians across four agencies were trained. Training outcomes and implementation barriers and facilitators were assessed.

RESULTS

One hundred twelve client-caregiver dyads began the year-long treatment; 50% are currently enrolled or have completed treatment. Barriers and facilitators to implementation were identified.

CONCLUSIONS

CPP is feasible to implement in rural community mental health agencies. Important lessons were learned related to planning, implementation, and sustainability.

Integrated care: meeting mental health needs after the Gulf oil spill

This column describes an integrated behavioral health initiative in primary care clinics in Louisiana parishes affected by the Deepwater Horizon oil spill. The Louisiana Mental and Behavioral Health Capacity Project is an integral part of the Gulf Region Health Outreach Program and is funded from the Deepwater Horizon Medical Benefits Class Action Settlement. Using a public health approach, the Department of Psychiatry of the Louisiana State University Health Sciences Center developed an interprofessional collaboration model of care to provide culturally tailored and time-sensitive on-site and telemedicine services to adults and children affected by the disaster. Results indicate a high level of acceptance of the services and reductions in both mental health symptoms and general medical symptoms. Primary care clinic staff also report increased confidence and resilience to meet future disasters. The approach could be used by communities at risk of disasters and by rural communities with limited mental health resources.

The effect of long-term relocation on child and adolescent survivors of Hurricane Katrina

The current study is designed to increase knowledge of the effects of relocation and its association with longer-term psychological symptoms following disaster. Following clinical observations and in discussions held with school officials expressing concerns about relocated students, it was hypothesized that students who relocated to a different city following Hurricane Katrina in 2005 would have more symptoms of posttraumatic stress compared to students who returned to New Orleans. The effect of Hurricane Katrina relocation was assessed on a sample of child and adolescent survivors in 5th through 12th grades (N = 795). Students with Orleans Parish zip codes prior to Hurricane Katrina were categorized into relocation groupings: (a) relocated to Baton Rouge, (b) returned to prior zip code, and (c) moved to a different zip code within Orleans Parish. Overall results revealed more trauma symptoms for relocated students. Results also revealed that younger relocated students had fewer symptoms compared to older students. The opposite was found for students who returned to their same zip code, with older students having fewer symptoms. This study supports the need for school-based services not only in disaster areas, but also in schools where survivors tend to migrate.

Hurricane Katrina and the Gulf oil spill: lessons learned

Education and training about immediate responses are important for all mental health providers of immediate and continuing services to assist children, adolescents, adults, and families in the aftermath of disasters. To sensitively help with evacuations and return to normalcy, responders must also be trained to understand the culture and traditions of affected communities. It is important to provide knowledge about available resources and to emphasize the need for routines and self-care for both victims and responders in an environment that, with recovery, will reflect a new normal.

Hurricane Katrina's First Responders: The Struggle to Protect and Serve in the Aftermath of the Disaster

Objective: Hurricane Katrina highlighted both the crucial role of first responders in times of disaster and the resultant stress on them and their families. The primary objective of this study was to describe the mental health status and symptoms of first responders in the New Orleans area. We further hypothesized that given the extent of the disaster and slowness of recovery, symptoms of posttraumatic stress and depression would not decrease after the first-year anniversary of Hurricane Katrina.

Methods: A total of 1382 first responders, including respondents from police, fire, emergency medical services, and city workers, participated in this longitudinal study. The first screening was conducted between 6 and 9 months after Hurricane Katrina and the second round of data collection was conducted 13 to 18 months after the hurricane. A subsample of the respondents (n = 87) were matched at both time points, which allowed for paired sample comparisons. We measured all of the respondents' levels of traumatic experiences, alcohol use, partner conflict, requests for services, posttraumatic stress, and depression.

Results: More than one-quarter of the first responders reported the following traumatic experiences: witnessed injury or death (70%); damage to home (93%); injury to a friend (25%); and previous loss or trauma (30%). Data also revealed that at least 10% of the respondents had significant levels of posttraumatic stress symptoms; 25% of the participants reported significant levels of depression; and more than 40% reported increased alcohol use and conflict with partner (41%). A statistically significant decrease in the symptoms of posttraumatic stress or depression was not found within 18 months of Hurricane Katrina.

Conclusions: Results suggest that the severity of the traumas experienced from both the impact of Hurricane Katrina and the subsequent recovery has important mental health implications for first responders. Reports of symptoms of anxiety or depression should be attended to so as to prevent increasing symptoms that could negatively affect the first responder and his or her family. These findings highlight the importance of not only providing mental health services for first responders but also having adequate plans in place before natural or technological disasters strike.

(Disaster Med Public Health Preparedness. 2011;5:S214-S219)

Military children from birth to five years

Because most research on military families has focused on children who are old enough to go to school, we know the least about the youngest and perhaps most vulnerable children in these families. Some of what we do know, however, is worrisome--for example, multiple deployments, which many families have experienced during the wars in Iraq and Afghanistan, may increase the risk that young children will be maltreated. Where the research on young military children is thin, Joy Osofsky and Lieutenant Colonel Molinda Chartrand extrapolate from theories and research in other contexts--especially attachment theory and research on families who have experienced disasters. They describe the circumstances that are most likely to put young children in military families at risk, and they point to ways that families, communities, the military, and policy makers can help these children overcome such risks and thrive. They also review a number of promising programs to build resilience in young military children. Deployment, Osofsky and Chartrand write, is particularly stressful for the youngest children, who depend on their parents for nearly everything. Not only does deployment separate young children from one of the central figures in their lives, it can also take a psychological toll on the parent who remains at home, potentially weakening the parenting relationship. Thus one fundamental way to help young military children become resilient is to help their parents cope with the stress of deployment. Parents and caregivers themselves, Osofsky and Chartrand write, can be taught ways to support their young children's resilience during deployment, for example, by keeping routines consistent and predictable and by finding innovative ways to help the child connect with the absent parent. The authors conclude by presenting 10 themes, grounded in research and theory, that can guide policies and programs designed to help young military children.

Deepwater horizon oil spill: mental health effects on residents in heavily affected areas

BACKGROUND

Mental health issues are a significant concern after disasters such as the Deepwater Horizon oil spill in the Gulf of Mexico in 2010. This study was designed to assess the mental health effects on residents of areas of southeastern Louisiana affected by the oil spill.

METHODS

Telephone and face-to-face interviews were conducted with residents (N = 452) assessing concerns and direct impact.

RESULTS

The results show that the greatest effect on mental health related to the extent of disruption to participants' lives, work, family, and social engagement, with increased symptoms of anxiety, depression, and posttraumatic stress. Given the location of the oil spill affecting communities that had been devastated by Hurricane Katrina, results also revealed that losses from Hurricane Katrina were highly associated with negative mental health outcomes. Conversely, the ability to rebound after adversity and place satisfaction were highly associated with better mental health outcomes.

CONCLUSIONS

Enhanced understanding of mental health effects after the Deepwater Horizon oil spill will help in determining directions for much-needed mental health services after the disaster and in contributing to the knowledge of complex traumatization and the ability to rebound after adversity.

Attention to process and clinical outcomes of implementing a rural school-based trauma treatment program

The Louisiana Rural Trauma Services Center was established to provide, improve, and enhance urgently needed assessment, treatment, crisis management, and consultation services for children and adolescents exposed to traumatic events in three rural southeastern Louisiana parishes. The purpose of this study is to describe the process of implementing the rural school-based trauma treatment program and to evaluate its effectiveness in 115 students. Through attention to process including the three-tiered approach of relationship building, trauma training, and trauma services, the school-based trauma treatment program proved effective in reducing trauma symptoms. This study is important to support the widespread implementation of school-based mental health services.

Trends in serious emotional disturbance among youths exposed to Hurricane Katrina

OBJECTIVE

To examine patterns and predictors of trends in DSM-IV serious emotional disturbance (SED) among youths exposed to Hurricane Katrina.

METHOD

A probability sample of adult pre-hurricane residents of the areas affected by Katrina completed baseline and follow-up telephone surveys 18 to 27 months post-hurricane and 12 to 18 months later. Baseline adult respondents residing with children and adolescents (4-17 years of age) provided informant reports about the emotional functioning of these youths (n = 576) with the Strengths and Difficulties Questionnaire (SDQ). The surveys also assessed hurricane-related stressors and ongoing stressors experienced by respondent families.

RESULTS

SED prevalence decreased significantly across survey waves from 15.1% to 11.5%, although even the latter prevalence was considerably higher than the pre-hurricane prevalence of 4.2% estimated in the US National Health Interview Survey. Trends in hurricane-related SED were predicted by both stressors experienced in the hurricane and ongoing stressors, with SED prevalence decreasing significantly only among youths with moderate stress exposure (16.8% versus 6.5%). SED prevalence did not change significantly between waves among youths with either high stress exposure (30.0% versus 41.9%) or low stress exposure (3.5% versus 3.4%). Pre-hurricane functioning did not predict SED persistence among youths with high stress exposure, but did predict SED persistence among youth with low-moderate stress exposure.

CONCLUSIONS

The prevalence of SED among youths exposed to Hurricane Katrina remains significantly elevated several years after the storm despite meaningful decrease since baseline. Youths with high stress exposure have the highest risk of long-term hurricane-related SED and consequently represent an important target for mental health intervention.

Posttraumatic stress symptoms in children after Hurricane Katrina: predicting the need for mental health services

The purpose of this study was to examine factors related to the development of posttraumatic stress symptoms in children and adolescents after Hurricane Katrina. It was hypothesized that a positive correlation would exist between trauma exposure variables and symptoms indicating need for mental health services experienced 2 years after Hurricane Katrina. Specifically, the authors hypothesized that experiences associated with natural disaster including personal loss, separation from family and/or community, and lack of community support as well as previous loss or trauma would be related to increased symptomatology in both children and adolescents. This study included 7,258 children and adolescents from heavily affected Louisiana parishes. Measures included the Hurricane Assessment and Referral Tool for Children and Adolescents developed by the National Child Traumatic Stress Network (NCTSN, 2005). Results were generally supportive of our hypotheses, and specific exposure and demographic variables were found to be strongly related to posttraumatic stress symptoms in children and adolescents.

When the bough breaks the cradle will fall: Promoting the health and well being of infants and toddlers in juvenile court

Approximately one-third of the children in the child welfare system are under the age of six. These children are almost invisible in our juvenile courts. It is now clear from the emerging science of early childhood development that during the first few years of life, children develop the foundation and capabilities on which all subsequent development builds. Living in emotional and environmental impoverishment and deprivation provides a poor foundation for healthy development. These very young and vulnerable children are exhibiting disproportionate developmental and cognitive delays, medical problems, and emotional disorders. However, there is growing evidence that early planned interventions can help. The juvenile court must take a leadership role in focusing on the very young child and learning more about risk, prevention, and early intervention in order to facilitate the healing process.

Prevalence of children's exposure to domestic violence and child maltreatment: implications for prevention and intervention

The purpose of this paper is to review research on the prevalence of children's exposure to domestic violence, to consider the available literature on the co-occurrence of domestic violence and child maltreatment, and to gain more understanding about the impact of exposure on children. There is clear evidence indicating that both severe and moderate violence occurs frequently in homes among family members and that children are exposed to this violence. However, because of differing definitions of what constitutes domestic violence and variability in research methodologies for collecting the data, there are significant discrepancies in prevalence reports across studies. Of great concern is the immediate impact on the children and the long-term consequences for their later relationships. Fewer studies have been done on the co-occurrence of domestic violence and child maltreatment. However, it is likely that children who live in homes where domestic violence occurs are more likely to be abused and neglected. On the basis of available research, there is little doubt that vast numbers of children are exposed to domestic violence and that children's responses vary widely depending on their risk and vulnerability, as well as the structure of their environments A developmental risk and protective factors framework will be used to integrate the information on children's exposure to violence.

Violent and aggressive behaviors in youth: a mental health and prevention perspective

Aggressive behavior and violence leading to disciplinary and legal difficulties have reached epidemic proportions among our youth. The severity of problems and social and economic costs to society have increased markedly. In this article, the authors review the risk factors, situational concerns, and warning signs that are important in predicting school violence and in designing effective prevention and early intervention efforts. They then describe programs with which they are involved as mental health professionals that appear to be extremely promising and applicable to other communities. The prevention and intervention programs are distinctive in that they involve collaborations with law enforcement, including the police and criminal sheriff, and the juvenile court as well as parents and schools in their efforts to promote positive development. These clinical, educational, and public policy approaches offer mental health professionals increased opportunities to be of help in this critical area.