Preventing Adverse Childhood Experiences in a Sample of Largely Indigenous Children

OBJECTIVES

The purpose of this study was to develop, pilot, and evaluate a culturally grounded, family-based program to prevent adverse childhood experiences (ACEs) among low-income and Indigenous children aged 10 to 14. The Tiwahe Wicagwicayapi program (TWP) is a 7-session program that teaches skills to prevent ACEs and is rooted in Lakota culture, language, and history.

METHODS

A total of 124 families (124 caregivers [96% Indigenous; 90% reported yearly income <$40 000] with 194 children aged 10 to 14 [93% Indigenous]) were randomly assigned to treatment (N = 66 families and 173 individuals) or waitlist (N = 58 families and 145 individuals) control groups. Caregivers and children completed a baseline, immediate posttest, and 6-month follow-up survey.

RESULTS

Treatment effects were detected, indicating, compared with control participants, reductions in the incidence of child ACEs (incidence rate ratio [IRR] = 0.64), bullying victimization (odds ratio = 0.53), depression (d = -0.20), and externalizing behaviors (d = -0.23) and increased parent-child communication (g = 0.27) and child help-seeking behaviors (d = 0.28). For caregivers, the effects indicated that the program prevented intimate partner violence victimization (IRR = 0.36) and perpetration (IRR = 0.45), harsh parenting (g = -0.35), and depression (d = -0.24) and increased emotion regulation (d = 0.37), social support (d = 0.33), and cultural connection (d = 0.34).

CONCLUSIONS

The TWP holds great promise in preventing ACEs among low-income, Indigenous children, showing potential promise for widespread public health impact. Future rigorous research on the TWP is warranted.

Using Wearable Digital Devices to Screen Children for Mental Health Conditions: Ethical Promises and Challenges

In response to a burgeoning pediatric mental health epidemic, recent guidelines have instructed pediatricians to regularly screen their patients for mental health disorders with consistency and standardization. Yet, gold-standard screening surveys to evaluate mental health problems in children typically rely solely on reports given by caregivers, who tend to unintentionally under-report, and in some cases over-report, child symptomology. Digital phenotype screening tools (DPSTs), currently being developed in research settings, may help overcome reporting bias by providing objective measures of physiology and behavior to supplement child mental health screening. Prior to their implementation in pediatric practice, however, the ethical dimensions of DPSTs should be explored. Herein, we consider some promises and challenges of DPSTs under three broad categories: accuracy and bias, privacy, and accessibility and implementation. We find that DPSTs have demonstrated accuracy, may eliminate concerns regarding under- and over-reporting, and may be more accessible than gold-standard surveys. However, we also find that if DPSTs are not responsibly developed and deployed, they may be biased, raise privacy concerns, and be cost-prohibitive. To counteract these potential shortcomings, we identify ways to support the responsible and ethical development of DPSTs for clinical practice to improve mental health screening in children.

Validating the Pediatric Symptoms Checklist–17 in the Preschool Environment

In the Response to Intervention framework, a psychometrically sound screening tool is essential for identification of children with emotional and behavioral risk. The purpose of this study was to examine the validity of the Pediatric Symptom Checklist–17 (PSC-17) screener in school-based settings. Forty-four teachers rated 738 preschoolers using the PSC-17; children were later assessed using long forms of the Behavior Assessment System for Children (BASC-2) Preschool form or the Achenbach System of Empirically Based Assessment (ASEBA) Caregiver–Teacher Report Form to identify emotional and behavioral disorder. Validity evidence including examinations of a multilevel factor structure, internal consistency, and criterion-related validity supported the conclusion that the PSC-17 is a high-quality universal screening tool in school-based settings. Finally, to identify emotional and behavioral risk with young children, receiver operating characteristic curve analyses with the PSC-17 yielded a lower cutoff score (i.e., 7) than the original cutoff score (i.e., 15) based on a clinical sample.