1
|
Rinne GR, Podosin M, Mahrer NE, Shalowitz MU, Ramey SL, Dunkel Schetter C. Prospective associations of prenatal stress with child behavior: Moderation by the early childhood caregiving environment. Dev Psychopathol 2024:1-12. [PMID: 38738363 DOI: 10.1017/s0954579424000920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2024]
Abstract
Fetal exposure to prenatal stress can increase risk for psychopathology but postnatal caregiving may offset risk. This study tests whether maternal sensitivity and the home environment during early childhood modify associations of prenatal stress with offspring behavior in a sample of 127 mother-child pairs (n = 127). Mothers reported on perceived stress during pregnancy. Maternal sensitivity was rated by coders during a parent-child free play task when children were 4 years old. One year later, mothers reported on the home environment, child internalizing and externalizing behaviors, and children completed an assessment of inhibitory control. As hypothesized, the early childhood caregiving environment modified associations of prenatal stress with child behavior. Specifically, prenatal stress was associated with more internalizing behaviors at lower levels of maternal sensitivity and in home environments that were lower in emotional support and cognitive stimulation, but not at mean or higher levels. Furthermore, prenatal stress was associated with lower inhibitory control only at lower levels of maternal sensitivity, but not at higher levels. Maternal sensitivity and an emotionally supportive and cognitively stimulating home environment in early childhood may be important factors that mitigate risk for mental health problems among children exposed to prenatal stress.
Collapse
|
2
|
Sullivan ADW, Roubinov D, Noroña-Zhou AN, Bush NR. Do dyadic interventions impact biomarkers of child health? A state-of-the-science narrative review. Psychoneuroendocrinology 2024; 162:106949. [PMID: 38295654 DOI: 10.1016/j.psyneuen.2023.106949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 11/22/2023] [Accepted: 12/23/2023] [Indexed: 03/04/2024]
Abstract
BACKGROUND Early life adversity is related to numerous poor health outcomes in childhood; however, dyadic interventions that promote sensitive and responsive caregiving may protect children from the negative consequences of such exposures. To date, quasi-experimental and randomized controlled trials (RCTs) have examined the impact of dyadic interventions on a range of individual biomarkers in children, which may elucidate the relation between early stress exposure and transdiagnostic risk factors for prospective poor health. However, the content of interventions, analytic strategies, and findings vary widely across studies, obscuring key themes in the science and hindering policy and research efforts. METHODS We use a narrative approach to review findings from methodologically rigorous (predominantly RCT) studies of dyadic interventions' impacts on different biomarkers in children, including indicators of the hypothalamic-pituitary-adrenal (HPA) axis, parasympathetic (PNS) and sympathetic nervous systems (SNS), brain development, inflammation, and intracellular DNA processes. We contribute to this important area of inquiry through integrating findings across biological systems and identifying contextual and mechanistic factors to depict the current state of the field. RESULTS Evidence suggests dyadic interventions improved PNS functioning and advanced brain maturation. Some studies indicated interventions reduced hair cortisol concentrations, systemic inflammation, and resulted in differences in DNA methylation patterns. Findings did not support main effect-level change in salivary measures of HPA axis activity, SNS activity, or telomere length. Importantly, reviewed studies indicated significant heterogeneity in effects across biological systems, underscoring the importance of contextual factors (e.g., adversity subtype and severity) as potential moderators of effects. Further, findings suggested enhanced parenting behaviors may be a mechanism through which dyadic interventions operate on biomarkers. CONCLUSIONS We close with future policy and research directions, emphasizing the promise of biologically-informed dyadic interventions for understanding and ameliorating the effects of early adversity on transdiagnostic biomarkers of health.
Collapse
Affiliation(s)
- Alexandra D W Sullivan
- Department of Psychiatry and Behavioral Sciences, Center for Health and Community, Weill Institute for Neurosciences, University of California, San Francisco, USA.
| | - Danielle Roubinov
- Department of Psychiatry and Behavioral Sciences, Center for Health and Community, Weill Institute for Neurosciences, University of California, San Francisco, USA; Department of Psychiatry, University of North Carolina, Chapel Hill, USA
| | - Amanda N Noroña-Zhou
- Department of Psychiatry and Behavioral Sciences, Center for Health and Community, Weill Institute for Neurosciences, University of California, San Francisco, USA; Department of Pediatrics, Division of Developmental Medicine, UCSF, USA
| | - Nicole R Bush
- Department of Psychiatry and Behavioral Sciences, Center for Health and Community, Weill Institute for Neurosciences, University of California, San Francisco, USA; Department of Pediatrics, Division of Developmental Medicine, UCSF, USA.
| |
Collapse
|
3
|
Dinzinger A, Ismair S, Brisch KH, Sperl W, Deneault AA, Nolte T, Hitzl W, Priewasser B. Mentalizing in first-time fathers: reflective functioning as a mediator between attachment representation and sensitivity. Attach Hum Dev 2023; 25:544-565. [PMID: 37815537 DOI: 10.1080/14616734.2023.2258354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 09/09/2023] [Indexed: 10/11/2023]
Abstract
Sensitivity in parent-child interaction is essential for child development. Since fathers are increasingly involved in childrearing, identifying factors leading to paternal sensitivity is crucial. We examined the relation between attachment representation and reflective functioning (RF) as factors influencing paternal sensitivity in a longitudinal study including N = 40 first-time fathers (Mage = 33) and their 6-month-old children. We used the Adult Attachment Interview during pregnancy to assess paternal attachment representation and general RF, the Parental Development Interview to assess fathers' parental RF, and the Emotional Availability Scale to measure sensitivity at child's age of 6 month. Data show that secure paternal attachment representation, high general and parental RF are associated with higher levels of paternal sensitivity. Further, parental RF mediates the association between attachment representation and paternal sensitivity. These findings contribute to the identification of a causal interplay in that they suggest an explanatory effect of RF on the association between fathers' attachment representation, and sensitivity.
Collapse
Affiliation(s)
- Antonia Dinzinger
- Institute for Early Life Care, Paracelsus Medical University, Salzburg, Austria
- Department of Pediatrics, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Selina Ismair
- Institute for Early Life Care, Paracelsus Medical University, Salzburg, Austria
- Department of Pediatrics, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Karl Heinz Brisch
- Institute for Early Life Care, Paracelsus Medical University, Salzburg, Austria
- Dr. von Hauner Children's Hospital Ludwig Maximilians University, Munich, Germany
| | - Wolfang Sperl
- Department of Pediatrics, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | | | - Tobias Nolte
- Research Department for Clinical, Educational and Health Psychology, University College London, UK
| | - Wolfgang Hitzl
- Research and Innovation Management, Biostatistics, Paracelsus Medical University, Salzburg, Austria
| | - Beate Priewasser
- Institute for Early Life Care, Paracelsus Medical University, Salzburg, Austria
- Department of Pediatrics, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| |
Collapse
|
4
|
Cerqueira A, Almeida TC. Adverse Childhood Experiences: Relationship with Empathy and Alexithymia. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2023; 16:559-568. [PMID: 37593064 PMCID: PMC10427576 DOI: 10.1007/s40653-023-00520-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/01/2023] [Indexed: 08/19/2023]
Abstract
Several studies showed that adults who have experienced childhood adversity are more likely to develop alexithymia and low empathy. Therefore, this research aims to analyze the relationship between childhood adversity and alexithymia and empathy in adulthood and verify a predictive explanatory model of alexithymia. The sample comprised 92 adults who responded to the sociodemographic questionnaire, the Childhood History Questionnaire, the Interpersonal Reactivity Index, and the Alexithymia Scale of Toronto. Childhood adversity showed a positive relationship with alexithymia and a negative relationship with empathy. Predictive validity showed that marital status, adverse childhood experiences (ACEs), and empathic concern predicted higher alexithymia scores. These results show the impact of these childhood experiences on adult life, underlining the importance of developing intervention programs in this field.
Collapse
Affiliation(s)
- Andreia Cerqueira
- Egas Moniz School of Health and Science, Instituto Universitário Egas Moniz (IUEM), LabPSI – Laboratório de Psicologia Egas Moniz, IUEM, Caparica, Portugal
| | - Telma Catarina Almeida
- Egas Moniz School of Health and Science, Instituto Universitário Egas Moniz (IUEM); CiiEM – Centro de Investigação Interdisciplinar Egas Moniz, IUEM; LabPSI – Laboratório de Psicologia Egas Moniz, IUEM, Campus Universitário, Quinta da Granja, Monte de Caparica, 2829-511 Caparica, Portugal
| |
Collapse
|
5
|
Letourneau N, Anis L, Novick J, Pohl C, Ntanda H, Hart M. Impacts of the Attachment and Child Health (ATTACH TM) Parenting Program on Mothers and Their Children at Risk of Maltreatment: Phase 2 Results. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3078. [PMID: 36833770 PMCID: PMC9961631 DOI: 10.3390/ijerph20043078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 02/01/2023] [Accepted: 02/01/2023] [Indexed: 06/18/2023]
Abstract
Early adversity (e.g., family violence, parental depression, low income) places children at risk for maltreatment and negatively impacts developmental outcomes. Optimal parental reflective function (RF), defined as the parent's ability to think about and identify thoughts, feelings, and mental states in themselves and in their children, is linked to secure attachment and may protect against suboptimal outcomes. We present the results of Phase 2 randomized control trials (RCTs) and quasi-experimental studies (QES) of the Attachment and Child Health (ATTACHTM) parental RF intervention for families with children at risk for maltreatment. Phase 2 parents experiencing adversity, along with their children aged 0-5 years (n = 45), received the 10-12-week ATTACHTM intervention. Building on completed Phase 1 pilot data, Phase 2 examined outcomes of long-standing interest, including parental RF and child development, as well as new outcomes, including parental perceived social support and executive function, and children's behavior, sleep, and executive function. RCTs and QES revealed significant improvements in parents' RF, perception of social support, and executive function, children's development (i.e., communication, problem-solving, personal-social, and fine motor skills), and a decrease in children's sleep and behavioral problems (i.e., anxiety/depression, attention problems, aggressive behavior, and externalizing problems), post-intervention. ATTACH™ positively impacts parental RF to prevent negative impacts on children at risk of maltreatment.
Collapse
Affiliation(s)
- Nicole Letourneau
- Owerko Centre for Children’s Neurodevelopment and Mental Health, Alberta Children’s Hospital Research Institute, Faculty of Nursing, and Cumming School of Medicine, Departments of Pediatrics, Psychiatry and Community Health Sciences, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Lubna Anis
- Owerko Centre for Children’s Neurodevelopment and Mental Health, Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Jason Novick
- Owerko Centre for Children’s Neurodevelopment and Mental Health, Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Carrie Pohl
- Owerko Centre for Children’s Neurodevelopment and Mental Health, Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Henry Ntanda
- Owerko Centre for Children’s Neurodevelopment and Mental Health, Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Martha Hart
- Owerko Centre for Children’s Neurodevelopment and Mental Health, Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB T2N 1N4, Canada
| |
Collapse
|
6
|
Komanchuk J, Dewey D, Giesbrecht GF, Hart M, Anis L, Ntanda H, Cameron JL, Letourneau N. Association between maternal reflective function and preschool children’s cognitive abilities. Front Psychol 2022; 13:995426. [DOI: 10.3389/fpsyg.2022.995426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 10/24/2022] [Indexed: 11/17/2022] Open
Abstract
Children’s cognitive abilities (e.g., working memory) are associated with mental health, adaptive behaviors, and academic achievement, and may be enhanced by parental reflective function (i.e., capacity to reflect on mental states, feelings, thoughts, and intentions in one’s child and oneself). We evaluated associations between maternal reflective function and children’s cognitive abilities alone and while controlling for parent-child attachment and interaction quality, and psychosocial (i.e., maternal depressive symptoms, adverse childhood experiences) and sociodemographic (e.g., socioeconomic status) factors. Our sample, recruited in Canada, was primarily white and included 73 mothers and their 4–5 year old preschool children. Maternal reflective function was measured with the Reflective Functioning Scale applied to the Parent Development Interview and the Parental Reflective Functioning Questionnaire. Multiple regression analyses revealed that maternal reflective function was associated with children’s cognitive abilities. The Parent Development Interview rated child-reflective function was associated with children’s higher verbal comprehension alone and while adjusting for covariates (e.g., parent-child interaction quality, socioeconomic status), and the Parental Reflective Functioning Questionnaire Interest and Curiosity with higher verbal comprehension while adjusting for parent-child interactions and attachment pattern. The Parental Reflective Functioning Questionnaire Certainty in Mental States was associated with higher working memory scores for children while adjusting for covariates. Full Scale IQ and Visual Spatial Index were not significantly associated with maternal reflective function. Associations were found between secure and disorganized attachment with higher verbal comprehension and lower working memory, respectively. These findings highlight the importance of high maternal reflective function to cognitive abilities in early childhood.
Collapse
|
7
|
Anis L, Letourneau N, Ross KM, Hart M, Graham I, Lalonde S, Varro S, Baldwin A, Soulsby A, Majnemer A, Donnelly C, Piotrowski C, Collier C, Lindeman C, Goldowitz D, Isaac D, Thomson D, Serré D, Citro E, Zimmermann G, Pliszka H, Mann J, Baumann J, Piekarski J, Dalton JA, Johnson-Green J, Wood K, Bruce M, Santana M, Mayer M, Gould M, Kobor M, Flowers M, Haywood M, Koerner M, Parker N, Muhajarine N, Fairie P, Chrishti R, Perry R, Merrill S, Pociuk S, StephanieTaylor, Cole S, Murphy T, Marchment T, Xavier V, Shajani Z, West Z. Study protocol for Attachment & Child Health (ATTACHTM) program: promoting vulnerable Children’s health at scale. BMC Pediatr 2022; 22:491. [PMID: 35986306 PMCID: PMC9388995 DOI: 10.1186/s12887-022-03439-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 06/22/2022] [Indexed: 11/11/2022] Open
Abstract
Background Children’s exposure to toxic stress (e.g., parental depression, violence, poverty) predicts developmental and physical health problems resulting in health care system burden. Supporting parents to develop parenting skills can buffer the effects of toxic stress, leading to healthier outcomes for those children. Parenting interventions that focus on promoting parental reflective function (RF), i.e., parents’ capacity for insight into their child’s and their own thoughts, feelings, and mental states, may understand help reduce societal health inequities stemming from childhood stress exposures. The Attachment and Child Health (ATTACHTM) program has been implemented and tested in seven rapid-cycling pilot studies (n = 64) and found to significantly improve parents’ RF in the domains of attachment, parenting quality, immune function, and children’s cognitive and motor development. The purpose of the study is to conduct an effectiveness-implementation hybrid (EIH) Type II study of ATTACHTM to assess its impacts in naturalistic, real-world settings delivered by community agencies rather than researchers under more controlled conditions. Methods The study is comprised of a quantitative pre/post-test quasi-experimental evaluation of the ATTACHTM program, and a qualitative examination of implementation feasibility using thematic analysis via Normalization Process Theory (NPT). We will work with 100 families and their children (birth to 36-months-old). Study outcomes include: the Parent Child Interaction Teaching Scale to assess parent-child interaction; the Parental Reflective Function and Reflective Function Questionnaires to assess RF; and the Ages and Stages Questionnaire – 3rd edition to examine child development, all administered pre-, post-, and 3-month-delayed post-assessment. Blood samples will be collected pre- and post- assessment to assess immune biomarkers. Further, we will conduct one-on-one interviews with study participants, health and social service providers, and administrators (total n = 60) from each collaborating agency, using NPT to explore perceptions and experiences of intervention uptake, the fidelity assessment tool and e-learning training as well as the benefits, barriers, and challenges to ATTACHTM implementation. Discussion The proposed study will assess effectiveness and implementation to help understand the delivery of ATTACHTM in community agencies. Trial registration Name of registry: https://clinicaltrials.gov/. Registration number: NCT04853888. Date of registration: April 22, 2021. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-022-03439-3.
Collapse
|
8
|
Peck A, Provost S, East L, Hutchinson M. Process mining the trajectories for adolescent-to-mother violence from longitudinal police and health service data. J Adv Nurs 2022; 79:1540-1552. [PMID: 35864079 DOI: 10.1111/jan.15377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 06/30/2022] [Accepted: 07/05/2022] [Indexed: 11/30/2022]
Abstract
AIM The aim was to discover longitudinal trajectories and patterns of events preceding adolescent-to-mother family violence in a geographic locale in Australia. DESIGN This was a retrospective case series. METHODS Routinely collected administrative data were sourced and linked from police and health service electronic records for adolescents born between 1994 and 2006 who had been issued a legal action for a family violence-related offence (n = 775). A time-stamped log of events from birth (where available) was created. Process mining was employed to discover dominant events and trajectories in the log from birth until adolescents' first recorded offence against their mother. RESULTS/FINDINGS Most adolescents in the case series offended against mothers (63%, n = 486). Trajectory analysis confirmed dominant early childhood events were repeated exposure to parental intimate partner violence (P-IPV), parental drug and/or alcohol use and neglect. During early adolescence, pathways towards adolescent-to-mother violence involved other offending, drug and/or alcohol use and mental health service contact. CONCLUSION The trajectories evidenced provide a complex picture of the emergence of adolescent-to-mother violence. From an early intervention perspective, it was found that many children and mothers were identifiable from police records in early childhood, at an average age of 35 months. Responses to adolescent family violence need to acknowledge the impact of childhood trauma and emerging mental health problems, along with strategies to mitigate the effect of P-IPV on mother-to-child relationships. IMPACT This is the first large-scale study to specifically examine trajectories from birth for adolescents who engage in violence towards mothers. The findings have important implications for the design and delivery of early intervention childhood services and interagency collaboration in nursing and midwifery services. In early adolescence, contact with mental health services represents an opportunity for screening and support interventions. This is an important preventive timepoint for family violence, adolescent drug and alcohol use and other offences.
Collapse
Affiliation(s)
- Allison Peck
- Faculty of Health, Southern Cross University, Coffs Harbour, New South Wales, Australia
| | - Steve Provost
- Faculty of Health, Southern Cross University, Coffs Harbour, New South Wales, Australia
| | - Leah East
- Faculty of Medicine and Health, School of Health, University of New England/Hunter New England Health, Armidale, New South Wales, Australia
| | - Marie Hutchinson
- Faculty of Health, Southern Cross University, Coffs Harbour, New South Wales, Australia
| |
Collapse
|
9
|
Anis L, Ross K, Ntanda H, Hart M, Letourneau N. Effect of Attachment and Child Health (ATTACH TM) Parenting Program on Parent-Infant Attachment, Parental Reflective Function, and Parental Depression. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148425. [PMID: 35886276 PMCID: PMC9324434 DOI: 10.3390/ijerph19148425] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 07/02/2022] [Accepted: 07/05/2022] [Indexed: 02/01/2023]
Abstract
High-risk families exposed to toxic stressors such as family violence, depression, addiction, and poverty, have shown greater difficulty in parenting young children. In this study, we examined the effectiveness of ATTACHTM, a 10−12 session manualized one-on-one parental Reflective Function (RF)-based parenting program designed for high-risk families. Outcomes of parent-child attachment and parental RF were assessed via the Strange Situation Procedure (SSP) and Reflective Function Scale (RFS), respectively. The protective role of ATTACHTM on parental depression was also assessed. Data were available from caregivers and their children < 6 years of age who participated in five pilot randomized control trials (RCTs) and quasi-experimental studies (QES; n = 40). Compared with the control group, caregivers who received the ATTACHTM-program demonstrated a greater likelihood of secure attachment with their children (p = 0.004) and higher parental RF [self (p = 0.004), child (p = 0.001), overall (p = 0.002)] in RCTs. A significant improvement in parental RF (p = 0.000) was also observed in the QES within ATTACHTM group analysis. As attachment security increased, receiving the ATTACHTM program may be protective for depressed caregivers. Results demonstrated the promise of ATTACHTM for high-risk parents and their young children.
Collapse
Affiliation(s)
- Lubna Anis
- Owerko Centre for Children’s Neurodevelopment and Mental Health, Alberta Children’s Hospital Research Institute, Faculty of Nursing, University of Calgary, Calgary, AB T2N 1N4, Canada;
| | - Kharah Ross
- Owerko Centre for Children’s Neurodevelopment and Mental Health, Alberta Children’s Hospital Research Institute, Department of Psychology, University of Calgary, Calgary, AB T2N 1N4, Canada;
- Faculty of Humanities and Social Sciences, Athabasca University, Athabasca, AB T9S 3A3, Canada
| | - Henry Ntanda
- Owerko Centre for Children’s Neurodevelopment and Mental Health, Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB T2N 1N4, Canada; (H.N.); (M.H.)
| | - Martha Hart
- Owerko Centre for Children’s Neurodevelopment and Mental Health, Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB T2N 1N4, Canada; (H.N.); (M.H.)
| | - Nicole Letourneau
- Owerko Centre for Children’s Neurodevelopment and Mental Health, Alberta Children’s Hospital Research Institute, Departments of Pediatrics, Psychiatry, and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
- Correspondence:
| |
Collapse
|
10
|
Homonchuk O, Barlow J. The commissioning of infant mental health services in the United Kingdom: A study of stakeholder views. Child Care Health Dev 2022; 48:217-224. [PMID: 34664299 DOI: 10.1111/cch.12920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 03/16/2021] [Accepted: 10/05/2021] [Indexed: 11/29/2022]
Abstract
CONTEXT Infant regulatory disturbances are common and stable over time and can compromise infant outcomes across a range of developmental domains. Many such problems have their origins within the parent-infant relationship and specialized parent-infant relationship teams provide support and intervention that is explicitly aimed at addressing such relationship difficulties. However, there are currently only around 27 such teams across the United Kingdom, and just under half of CAMHS do not accept referrals of children under 2 years of age. AIM The current research aimed to examine the views of commissioners of children's services regarding the reasons for commissioning (or not) infant mental health services. METHOD Fourteen in-depth interviews were conducted with a range of stakeholders involved in commissioning children's services across 14 areas of England, half of which were commissioning specialized infant mental health services. A thematic analysis was undertaken. RESULTS A total of five themes emerged from the data as being key factors in the commissioning of infant mental health services: pressure from local practitioners, policy transfer through policy networks, opportunity for long-term cost reduction, potential to embed the service model within existing services and perinatal mental health funding. CONCLUSION As with commissioning more widely, the commissioning of infant mental health services is a complex process, with a range of factors influencing whether such services are commissioned or not, and data to suggest that the process is currently driven by informal and contingent factors, as much as by the evidence regarding what works.
Collapse
Affiliation(s)
- Olha Homonchuk
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - Jane Barlow
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| |
Collapse
|
11
|
The ATTACH™ program and immune cell gene expression profiles in mothers and children: A pilot randomized controlled trial. Brain Behav Immun Health 2021; 18:100358. [PMID: 34647106 PMCID: PMC8501501 DOI: 10.1016/j.bbih.2021.100358] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 09/25/2021] [Indexed: 11/27/2022] Open
Abstract
Background Children exposed to adversity and toxic stress are at increased risk for poor health across the lifespan, possibly through alterations to immune pathways. Parenting interventions could buffer the effect of adversity on child immune activity. The purpose of this study was to test whether mothers and children who were randomly assigned to a parenting intervention (ATTACH™) had healthier post-intervention immune cell gene expression patterns, as indexed by the Conserved Transcriptional Response to Adversity (CTRA), compared with mothers and children in a wait-list control group. Methods A sample of 20 mother-child dyads were recruited from a domestic violence shelter in Calgary, AB, Canada. The ATTACH™ program is a 10-week psycho-educational intervention that fosters maternal reflective function, i.e. how to understand and respond to mental states. Dyads were randomly assigned to an intervention or wait-list group. Dried blood spots were collected from both groups post-intervention, subjected to RNA sequencing, and assessed for CTRA gene expression using mixed effect linear model analysis. Covariates were age, child sex, maternal race/ethnicity, and maternal medication use. Results In unadjusted models, differences by treatment group were detected, F(1,1794) = 4.26, p = .039. Mothers and children who completed the ATTACH™ intervention had lower CTRA scores, indicating healthier immune cell gene expression profiles (Mn = −0.36, SE = 0.17), compared with mothers and children in the wait-list control group (Mn = 0.11, SE = 0.15). Results persisted after controlling for covariates. Discussion ATTACH™ participation predicted healthier immune cell gene expression profiles post-intervention compared with wait-list controls. Parenting interventions could decrease the impact of toxic stress on maternal-child immune health. The ATTACH™ program is a reflective function parenting intervention. The ATTACH™ program predicted healthier immune cell gene expression in children. The ATTACH™ program predicted healthier immune cell gene expression in mothers. The ATTACH™ program could protect the health of families escaping domestic violence.
Collapse
|
12
|
Anis L, Benzies KM, Ewashen C, Hart MJ, Letourneau N. Fidelity Assessment Checklist Development for Community Nursing Research in Early Childhood. Front Public Health 2021; 9:582950. [PMID: 34055705 PMCID: PMC8160096 DOI: 10.3389/fpubh.2021.582950] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 04/08/2021] [Indexed: 11/13/2022] Open
Abstract
Nurses play an important role in promoting positive childhood development via early interventions intended to support parenting. Despite recognizing the need to deliver vital parenting programs, monitoring fidelity has largely been ignored. Fidelity refers to the degree to which healthcare programs follow a well-defined set of criteria specifically designed for a particular program model. With increasing demands for early intervention programs to be delivered by non-specialists, rigorous yet pragmatic strategies for maintaining fidelity are needed. This paper describes the step-by-step development and evaluation of a program fidelity measure, using the Attachment and Child Health (ATTACH™) parenting program as an exemplar. The overall quality index for program delivery varied between "very good" to "excellent," with a mean of 4.3/5. Development of checklists like the ATTACH™ fidelity assessment checklist enables the systematic evaluation of program delivery and identification of therapeutic components that enable targeted efforts at improvement. In future, research should examine links between program fidelity and targeted outcomes to ascertain if increased fidelity scores yield more favorable effects of parenting programs.
Collapse
Affiliation(s)
- Lubna Anis
- Department of Pediatrics, Faculty of Nursing, Owerko Centre, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Karen M. Benzies
- Department of Pediatrics, Faculty of Nursing, University of Calgary, Calgary, AB, Canada
| | - Carol Ewashen
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
| | - Martha J. Hart
- Department of Pediatrics, Faculty of Nursing, Owerko Centre, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, Faculty of Nursing, Owerko Centre, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Nicole Letourneau
- Department of Pediatrics, Faculty of Nursing, Owerko Centre, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, Faculty of Nursing, Owerko Centre, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| |
Collapse
|