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Murry VM, Nyanamba JM, Hanebutt R, Debreaux M, Gastineau KAB, Goodwin AKB, Narisetti L. Critical examination of resilience and resistance in African American families: Adaptive capacities to navigate toxic oppressive upstream waters. Dev Psychopathol 2023; 35:2113-2131. [PMID: 37665095 DOI: 10.1017/s0954579423001037] [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] [Indexed: 09/05/2023]
Abstract
African American families navigate not only everyday stressors and adversities but also unique sociocultural stressors (e.g., "toxic upstream waters" like oppression). These adverse conditions are consequences of the historical vestiges of slavery and Jim Crow laws, often manifested as inequities in wealth, housing, wages, employment, access to healthcare, and quality education. Despite these challenges, African American families have developed resilience using strength-based adaptive coping strategies, to some extent, to filter these waters. To advance the field of resilience research, we focused on the following questions: (1) what constitutes positive responses to adversity?; (2) how is resilience defined conceptually and measured operationally?; (3) how has the field of resilience evolved?; (4) who defines what, when, and how responses are manifestations of resilience, instead of, for example, resistance? How can resistance, which at times leads to positive adaptations, be incorporated into the study of resilience?; and (5) are there case examples that demonstrate ways to address structural oppression and the pernicious effects of racism through system-level interventions, thereby changing environmental situations that sustain toxic waters requiring acts of resilience to survive and thrive? We end by exploring how a re-conceptualization of resilience requires a paradigm shift and new methodological approaches to understand ways in which preventive interventions move beyond focusing on families' capacity to navigate oppression and target systems and structures that maintain these toxic waters.
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Affiliation(s)
- Velma McBride Murry
- Department of Human and Organizational Development, Vanderbilt University, Nashville, TN, USA
- Department of Health Policy, Vanderbilt University, Nashville, TN, USA
| | - Juliet M Nyanamba
- Department of Human and Organizational Development, Vanderbilt University, Nashville, TN, USA
| | - Rachel Hanebutt
- Department of Human and Organizational Development, Vanderbilt University, Nashville, TN, USA
| | - Marlena Debreaux
- Department of Human and Organizational Development, Vanderbilt University, Nashville, TN, USA
| | - Kelsey A B Gastineau
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Aijah K B Goodwin
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Lipika Narisetti
- Center for Medicine Health & Society, Vanderbilt University, Nashville, TN, USA
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2
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DiBari JN, Rouse L. Parent Perspectives: Part 1-Considerations for Changing the NICU Culture. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1735. [PMID: 38002826 PMCID: PMC10670714 DOI: 10.3390/children10111735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/10/2023] [Accepted: 10/19/2023] [Indexed: 11/26/2023]
Abstract
While publications that aim to reflect the parent perspective are increasingly common in the medical literature, few are authored by parents in their own words. As mothers with lived and professional experience in the Neonatal Intensive Care Unit (NICU), we believe this perspective is vital to improving health outcomes. We are writing from a life course health development framework that regards health as an active process that develops over time with the integration of physical, social, emotional, and relational components. Health development trajectories are shaped by the family and community ecosystems that surround each child. This means that the child's ability to thrive is strongly linked to the family's health and well-being. These links are not being given sufficient attention in clinical practice. Psychological distress, trauma, and grief are common family experiences in the NICU. Left unaddressed, they can negatively impact parent-child bonding. Drawing on life course principles, we make a series of recommendations for changes to practice to enable NICUs to better serve children and families, and better prepare families for the post-NICU experience. These include setting a positive tone in the NICU, creating a nurturing, personalized environment; addressing the social determinants of health; supporting families to develop a 'growth' mindset; and communicating in an optimistic, positive manner. Building trust is key to ensuring families feel supported and can be promoted through establishing equitable collaborative models of care. Peer support, doulas, and community health worker engagement can facilitate early interactions crucial to the child's developmental progress and family healing.
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Affiliation(s)
- Jessica N. DiBari
- U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau, Rockville, MD 20857, USA
| | - LaToshia Rouse
- Certified Doula at Birth Sisters Doula Services and Patient Engagement Consultant, Knightdale, NC 27545, USA;
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3
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West NS, Kussaga F, Rittenhouse A, Duroseau B, Knight D, Mbwambo J, Likindikoki S, Saleem HT. From trauma to transmission: exploring the intersection of adversity, substance use, and HIV risk in women's life histories. Int J Equity Health 2023; 22:174. [PMID: 37658358 PMCID: PMC10474777 DOI: 10.1186/s12939-023-01994-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 08/21/2023] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND At increased risk for poor health outcomes, physical and/or sexual violence, and onward transmission of HIV, women who use drugs and are living with HIV (WWUDHIV) are vulnerable and in need of services. Understanding the role of trauma across their life history may offer insights into HIV and drug use prevention and opportunities for intervention. We explored trauma and drug use among WWUDHIV in Dar es Salaam, Tanzania. METHODS We conducted in-depth interviews with 30 WWUDHIV from January-March 2019. Interviewers used semi-structured interview guides and asked questions about the life history as related to drug use. Interviews were audio recorded, transcribed, translated, coded, and life histories charted. We utilized content analysis. RESULTS Participants described death of family members as traumatic catalysts for drug use. Sexual partners early in their life history were often the point of introduction to drugs and source of HIV acquisition. Death of partners was present across many life histories and was a traumatic event negatively influencing life trajectories, including start of sex work for survival or to support drug use. Sex work in-turn often led to traumatic events including sexual and/or physical violence. HIV diagnosis for many participants followed the start of drug use, frequently occurred during pregnancy or severe illness and was described by most participants as a trauma. Despite this, particularly during pregnancy, HIV diagnosis was a turning point for some participant's desire to engage in drug use treatment. Traumatic events were often cumulative and regularly described as catalysts for poor mental health that could lead to new or increased drug use for coping. CONCLUSIONS These findings suggest trauma is common in the life history of WWUDHIV and has negative impacts on drug use and HIV vulnerability. Our life history charting highlights the cumulative and cyclical nature of trauma and drug use in this population. This study allows for better understanding of trauma, drug use, and HIV prevention, which offers opportunities for intervention among a group with limited access to services: during adolescence for orphaned youth, following the death of a child or partner, and when vulnerable women engage with the health system (HIV diagnosis, pregnancy, illness).
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Affiliation(s)
- Nora S West
- Division of Pulmonary and Critical Care Medicine, University of California San Francisco, San Francisco, CA, USA.
| | - Frank Kussaga
- Internal/Preventive Medicine, Griffin Hospital, Derby, CT, USA
| | - Alex Rittenhouse
- Department of Environmental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- Johns Hopkins University School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | | | - Deja Knight
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Jessie Mbwambo
- Department of Psychiatry and Mental Health, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Samuel Likindikoki
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Haneefa T Saleem
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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4
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Lesnick J, Abrams LS, Angel K, Barnert ES. Credible messenger mentoring to promote the health of youth involved in the juvenile legal system: A narrative review. Curr Probl Pediatr Adolesc Health Care 2023; 53:101435. [PMID: 37914551 PMCID: PMC10823586 DOI: 10.1016/j.cppeds.2023.101435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
This narrative review examines the literature on credible messenger mentoring (CMM) as an intervention to promote the health and well-being of youth involved in the juvenile legal system. In the CMM model, individuals with shared life experiences (e.g., from the same neighborhoods or marginalized communities, with former gang or incarceration history) serve as mentors, leveraging their own history of transformation to engage youth involved in the juvenile legal system and promote individual and community change. CMM is an increasingly popular approach for working with youth involved in the juvenile legal system, yet the state of the research on this intervention is unclear. This article provides a narrative review of existing research on CMM to understand what is known, and unknown, about the intervention. Results find an emerging, but incomplete body of evidence supporting the impact of CMM for youth involved in the juvenile legal system, and for adult mentors. Qualitative and observational findings provide stronger support for the model, while quantitative findings provide more mixed evidence, indicating that CMM may be a promising life course health intervention, yet needs more empirical study. Findings from this review underscore the value of integrating community-informed evidence in the evaluation of health interventions. Future research can inform contemporary interest in the CMM approach and guide implementation and measurement standards for optimizing intervention delivery with youth involved in the juvenile legal system.
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Affiliation(s)
- Julia Lesnick
- Department of Social Welfare, Luskin School of Public Affairs, University of California, Los Angeles, California, US.
| | - Laura S Abrams
- Department of Social Welfare, Luskin School of Public Affairs, University of California, Los Angeles, California, US
| | - Kassandra Angel
- Department of Social Welfare, Luskin School of Public Affairs, University of California, Los Angeles, California, US
| | - Elizabeth S Barnert
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, California, US
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5
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Laurenzi CA, Mamutse S, Marlow M, Mawoyo T, Stansert Katzen L, Carvajal-Velez L, Lai J, Luitel N, Servili C, Sinha M, Skeen S. Critical life course interventions for children and adolescents to promote mental health. Glob Ment Health (Camb) 2022; 10:e4. [PMID: 36843881 PMCID: PMC9947636 DOI: 10.1017/gmh.2022.58] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 10/08/2022] [Accepted: 10/31/2022] [Indexed: 12/13/2022] Open
Abstract
Childhood and adolescence are key developmental periods in the life course for addressing mental health, and there is ample evidence to support significant, increased investment in mental health promotion for this group. However, there are gaps in evidence to inform how best to implement mental health promotion interventions at scale. In this review, we examined psychosocial interventions implemented with children (aged 5–10 years) and adolescents (aged 10–19 years), drawing on evidence from WHO guidelines. Most psychosocial interventions promoting mental health have been implemented in school settings, with some in family and community settings, by a range of delivery personnel. Mental health promotion interventions for younger ages have prioritised key social and emotional skills development, including self-regulation and coping; for older ages, additional skills include problem-solving and interpersonal skills. Overall, fewer interventions have been implemented in low- and middle-income countries. We identify cross-cutting areas affecting child and adolescent mental health promotion: understanding the problem scope; understanding which components work; understanding how and for whom interventions work in practice; and ensuring supportive infrastructure and political will. Additional evidence, including from participatory approaches, is required to tailor mental health promotive interventions to diverse groups’ needs and support healthy life course trajectories for children and adolescents everywhere.
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Affiliation(s)
- Christina A. Laurenzi
- Institute for Life Course Health Research, Stellenbosch University, Cape Town, South Africa
| | - Sihle Mamutse
- Institute for Life Course Health Research, Stellenbosch University, Cape Town, South Africa
| | - Marguerite Marlow
- Institute for Life Course Health Research, Stellenbosch University, Cape Town, South Africa
| | - Tatenda Mawoyo
- Institute for Life Course Health Research, Stellenbosch University, Cape Town, South Africa
| | - Linnea Stansert Katzen
- Institute for Life Course Health Research, Stellenbosch University, Cape Town, South Africa
| | - Liliana Carvajal-Velez
- Division of Data, Analytics, Planning and Monitoring, Data and Analytics Section, UNICEF, New York, NY, USA
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Joanna Lai
- Programme Group, Health Section, UNICEF, New York, NY, USA
| | - Nagendra Luitel
- Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
| | - Chiara Servili
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | | | - Sarah Skeen
- Institute for Life Course Health Research, Stellenbosch University, Cape Town, South Africa
- Amsterdam Institute for Social Science Research, Faculty of Social and Behavioural Sciences, University of Amsterdam, Amsterdam, Netherlands
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6
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Affiliation(s)
- Arnold Chandler
- Address correspondence to Arnold Chandler, MS, P.O. Box 7775 #19629, San Francisco, CA 94120-7775. E-mail:
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7
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Ozer EJ, Sprague Martinez L, Abraczinskas M, Villa B, Prata N. Toward Integration of Life Course Intervention and Youth Participatory Action Research. Pediatrics 2022; 149:186920. [PMID: 35503322 PMCID: PMC9847417 DOI: 10.1542/peds.2021-053509h] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/27/2021] [Indexed: 01/21/2023] Open
Abstract
We provide an overview of diverse forms of youth participation, with a focus on youth participatory action research (YPAR) and its synergies with life course intervention research to promote healthier development for young people and across the life span. We analyze why YPAR matters for research, practice, and policies related to the systems and settings in which young people develop. We also illustrate how young people perform YPAR work to improve the developmental responsiveness and equity of school and health systems, including descriptions of an innovative youth-led health center in Rwanda and a long-standing and evolving integration of YPAR into public high schools in the United States. We then briefly consider the adult capacities needed to do this work well, given that YPAR challenges typical youth-adult power relationships and broader assumptions about who can generate expert knowledge. We consider the alignment and potential challenges for integration of life course intervention research as well as YPAR and next steps for research and practice at this intersection.
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Affiliation(s)
- Emily J Ozer
- Division of Community Health Sciences, University of California, Berkeley, Berkeley, California
| | | | | | - Brian Villa
- Division of Community Health Sciences, University of California, Berkeley, Berkeley, California
| | - Ndola Prata
- Division of Community Health Sciences, University of California, Berkeley, Berkeley, California
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8
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Hoover C, Ware A, Serano A, Verbiest S. Engaging Families in Life Course Intervention Research: An Essential Step in Advancing Equity. Pediatrics 2022; 149:186908. [PMID: 35503310 PMCID: PMC9847408 DOI: 10.1542/peds.2021-053509g] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/27/2021] [Indexed: 01/21/2023] Open
Abstract
Life course intervention research requires a thorough understanding of complex factors that interact to affect health over time. Partnerships with families and communities are critical to understanding these interconnections and identifying effective interventions. Here, family and community engagement are presented, aligned with the 5 phases of the life course intervention research framework: planning, design, implementation, evaluation, and translation. During planning, the researcher considers their own starting position and what they need to learn from families and the community. The design phase produces a plan for family engagement that is layered, iterative, and includes qualitative methods that will inform life course modeling and the research process. The implementation phase includes administrative actions such as creating opportunities for contributions and providing compensation to family and community partners. The evaluation phase requires measurement of the quality of partnerships with families and community and includes making adjustments as indicated to improve these partnerships. This phase also calls for reflection on the impact these partnerships had on the intervention, including if they made a difference for those being served. During translation, the researcher works with all partners, including families and communities, about follow up steps toward project continuation, replication, or completion. The researcher also works collaboratively in determining how the study results are shared. A holistic approach to health over the life course that is designed and executed in partnership with families and their community can generate research findings with broad practical applicability and strong translational potential.
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Affiliation(s)
- Clarissa Hoover
- Family Voices, Lexington, Massachusetts,Address correspondence to Clarissa Hoover, Family Voices, 110 Hartwell Ave, Lexington, MA 02421. E-mail:
| | | | | | - Sarah Verbiest
- Jordan Institute for Families, School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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9
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Liu PY, Beck AF, Lindau ST, Holguin M, Kahn RS, Fleegler E, Henize AW, Halfon N, Schickedanz A. A Framework for Cross-Sector Partnerships to Address Childhood Adversity and Improve Life Course Health. Pediatrics 2022; 149:e2021053509O. [PMID: 35503315 PMCID: PMC9549524 DOI: 10.1542/peds.2021-053509o] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/27/2021] [Indexed: 11/24/2022] Open
Abstract
Childhood adversity and its structural causes drive lifelong and intergenerational inequities in health and well-being. Health care systems increasingly understand the influence of childhood adversity on health outcomes but cannot treat these deep and complex issues alone. Cross-sector partnerships, which integrate health care, food support, legal, housing, and financial services among others, are becoming increasingly recognized as effective approaches address health inequities. What principles should guide the design of cross-sector partnerships that address childhood adversity and promote Life Course Health Development (LCHD)? The complex effects of childhood adversity on health development are explained by LCHD concepts, which serve as the foundation for a cross-sector partnership that optimizes lifelong health. We review the evolution of cross-sector partnerships in health care to inform the development of an LCHD-informed partnership framework geared to address childhood adversity and LCHD. This framework outlines guiding principles to direct partnerships toward life course-oriented action: (1) proactive, developmental, and longitudinal investment; (2) integration and codesign of care networks; (3) collective, community and systemic impact; and (4) equity in praxis and outcomes. Additionally, the framework articulates foundational structures necessary for implementation: (1) a shared cross-sector theory of change; (2) relational structures enabling shared leadership, trust, and learning; (3) linked data and communication platforms; and (4) alternative funding models for shared savings and prospective investment. The LCHD-informed cross-sector partnership framework presented here can be a guide for the design and implementation of cross-sector partnerships that effectively address childhood adversity and advance health equity through individual-, family-, community-, and system-level intervention.
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Affiliation(s)
- Patrick Y. Liu
- Center for Healthier Children, Families, and Communities
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Andrew F. Beck
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Stacy Tessler Lindau
- Department of Obstetrics and Gynecology and The University of Chicago, Chicago, Illinois
- Section of Geriatrics and Palliative Medicine, Department of Medicine, The University of Chicago, Chicago, Illinois
| | - Monique Holguin
- University of Southern California Suzanne Dworak-Peck School of Social Work, Los Angeles, California
| | - Robert S. Kahn
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Eric Fleegler
- Division of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts
- Department of Pediatrics and Emergency Medicine, Harvard Medical School, Boston, Massachusetts
| | | | - Neal Halfon
- Center for Healthier Children, Families, and Communities
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Adam Schickedanz
- Center for Healthier Children, Families, and Communities
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
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10
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Russ SA, Hotez E, Berghaus M, Hoover C, Verbiest S, Schor EL, Halfon N. Building a Life Course Intervention Research Framework. Pediatrics 2022; 149:186923. [PMID: 35503325 PMCID: PMC9847427 DOI: 10.1542/peds.2021-053509e] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/27/2021] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVES To report on first steps toward building a Life Course Intervention Research Framework (LCIRF) to guide researchers studying interventions to improve lifelong health. METHODS The Life Course Intervention Research Network, a collaborative national network of >75 researchers, service providers, community representatives and thought leaders, participated in an iterative review process. Building on the revised Medical Research Council Guidance for Developing and Evaluating Complex Interventions, they identified 12 additional key models with features for inclusion in the LCIRF, then incorporated the 12 characteristics identified by the Life Course Intervention Research Network as actionable features of Life Course Interventions to produce the new LCIRF. RESULTS The LCIRF sets out a detailed step-wise approach to intervention development: (1) conceptualization and planning, (2) design, (3) implementation, (4) evaluation, and (5) spreading and scaling of interventions. Each step is infused with life course intervention characteristics including a focus on (1) collaborative codesign (2) health optimization, (3) supporting emerging health development capabilities (4) strategic timing, (5) multilevel approaches, and (6) health equity. Key features include a detailed transdisciplinary knowledge synthesis to inform intervention development; formation of strong partnerships with family, community, and youth representatives in intervention codesign; a means of testing the impact of each intervention on biobehavioral processes underlying emerging health trajectories; and close attention to intervention context. CONCLUSIONS This first iteration of the LCIRF has been largely expert driven. Next steps will involve widespread partner engagement in framework refinement and further development. Implementation will require changes to the way intervention studies are organized and funded.
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Affiliation(s)
- Shirley A. Russ
- Center for Healthier Children, Families, and Communities, University of California, Los Angeles, Los Angeles, California,Departments of Pediatrics,Address correspondence to Shirley Russ, MD, 10960 Wilshire Blvd Suite 960, Los Angeles, CA 90024. E-mail:
| | - Emily Hotez
- Center for Healthier Children, Families, and Communities, University of California, Los Angeles, Los Angeles, California,Medicine, Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Mary Berghaus
- Center for Healthier Children, Families, and Communities, University of California, Los Angeles, Los Angeles, California,Departments of Pediatrics
| | | | - Sarah Verbiest
- School of Social Work, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | - Neal Halfon
- Center for Healthier Children, Families, and Communities, University of California, Los Angeles, Los Angeles, California,Departments of Pediatrics,Department of Health Policy and Management, Fielding School of Public Health,Department of Public Policy, Luskin School of Public Affairs, University of California, Los Angeles, Los Angeles, California
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11
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Halfon N, Russ SA, Schor EL. The Emergence of Life Course Intervention Research: Optimizing Health Development and Child Well-Being. Pediatrics 2022; 149:186912. [PMID: 35503314 PMCID: PMC9847410 DOI: 10.1542/peds.2021-053509c] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/27/2021] [Indexed: 01/21/2023] Open
Abstract
Advances in life course health science, systems biology, and epigenetics suggest that health development can be represented as a trajectory affected by multiple risk and protective factors arrayed in a relational developmental ecosystem across child, family, community, and systems levels. Despite tremendous potential for early life interventions at multiple levels of this ecosystem to improve children's life course health trajectories, this potential has not been fully explored. In fact, Life Course Health Development is a low priority for both health care and research funding. Representing the work of the Life Course Intervention Research Network, this supplement to Pediatrics reports on the first steps taken to define the emerging discipline of life course intervention research. Articles cover the characteristics of life course interventions together with a research framework and core competencies for this work. Topics include family, community, and youth engagement as vital components of grounding this work in health equity, family health development and its measurement, supporting children after prematurity, and new approaches to early childhood mental health. Schools and telehealth are considered innovative platforms for life course interventions, whereas cross-sector partnerships are recognized as key components of interventions to address childhood adversity. Researchers apply a Life Course Health Development lens to juvenile justice issues, including the minimum age law, and consider potential trade-offs whereby "striving" (education and income mobility) can limit "thriving" (health mobility) for people of color and those raised in low-income families. Finally, we present the Australian experience of embedding life course interventions in longitudinal studies.
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Affiliation(s)
- Neal Halfon
- Center for Healthier Children, Families, and Communities,Department of Pediatrics, Geffen School of Medicine,Department of Health Policy and Management, Fielding School of Public Health,Department of Public Policy, Luskin School of Public Affairs, University of California, Los Angeles, Los Angeles, California,Address correspondence to Neal Halfon, MD, MPH, Department of Pediatrics, Geffen School of Medicine, University of California, Los Angeles, 10960 Wilshire Blvd, Ste 960, Los Angeles, CA 90024. E-mail:
| | - Shirley A. Russ
- Center for Healthier Children, Families, and Communities,Department of Pediatrics, Geffen School of Medicine
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12
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Buka SL, Beers LS, Biel MG, Counts NZ, Hudziak J, Parade SH, Paris R, Seifer R, Drury SS. The Family is the Patient: Promoting Early Childhood Mental Health in Pediatric Care. Pediatrics 2022; 149:186907. [PMID: 35503309 PMCID: PMC9847420 DOI: 10.1542/peds.2021-053509l] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/27/2021] [Indexed: 01/21/2023] Open
Abstract
Advances in developmental psychology, child psychiatry, and allied disciplines have pointed to events and experiences in the early years as the origin of many adult mental health challenges. Yet, children's mental health services still largely lack a developmental or prevention-focused orientation, with most referrals to mental health professionals occurring late, once problems are well established. An early childhood mental health system rooted in the principles of life-course health development would take a very different approach to designing, testing, and implementing prevention and intervention strategies directed toward early child mental health. Priorities for such a system include supporting healthy family environments, parent-child and family relationships, parents' emotional/behavioral health, and family routines as a means of providing the best possible neurobiological foundation for mental health across the life span. The system would include proactive, trauma-informed, multidisciplinary care, with integrated mental health and social services support embedded in pediatric primary care settings. Novel intervention approaches in need of further research include 2-generational dyadic interventions designed to improve the mental health of parents and children, mental health-oriented telemedicine, and contingency management (CM) strategies. Integral to this Life Course Health Development reformulation is a commitment by all organizations supporting children to primordial and primary prevention strategies to reduce racial and socioeconomic disparities in all settings. We contend that it is the family, not the individual child, that ought to be the identified target of these redesigned approaches, delivered through a transformed pediatric system with anticipated benefits for multiple health outcomes across the life course.
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Affiliation(s)
- Stephen L. Buka
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island,Address correspondence to Stephen Buka, ScD, Department of Epidemiology, Brown University School of Public Health, 121 South Main St, Providence, RI 02912. E-mail:
| | - Lee S. Beers
- Children’s National Hospital, Washington, District of Columbia,Child Health Advocacy Institute, Washington, District of Columbia
| | - Matthew G. Biel
- Departments of Psychiatry and Pediatrics, Georgetown University School of Medicine, Georgetown University Medical Center, Washington, District of Columbia
| | - Nathaniel Z. Counts
- Mental Health America, Alexandria, Virginia,Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, The Bronx, New York
| | - James Hudziak
- Division of Child Psychiatry, Vermont Center for Children, Youth, and Families, Larner College of Medicine, University of Vermont, Burlington, Vermont
| | - Stephanie H. Parade
- Department of Psychiatry and Human Behavior, Brown University, Providence, Rhode Island,Bradley/Hasbro Children’s Research Center, Bradley Hospital, East Providence, Rhode Island
| | - Ruth Paris
- Boston University School of Social Work, Boston, Massachusetts
| | - Ronald Seifer
- Frank Porter Graham Child Development Institute, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Stacy S. Drury
- Departments of Psychiatry,Pediatrics, Tulane University, New Orleans, Louisiana,Children’s Hospital New Orleans, New Orleans, Louisiana
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