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Hash JB, Walker AJ, Ward TM, Oxford ML, Spieker SJ. Trying to Do What's Best: Maternal Perspectives About Toddler Sleep Health Among an Underresourced Sample of Mothers With Diverse Racial and Ethnic Identities. J Pediatr Health Care 2024; 38:160-171. [PMID: 38429028 PMCID: PMC10987074 DOI: 10.1016/j.pedhc.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 11/29/2023] [Accepted: 12/03/2023] [Indexed: 03/03/2024]
Abstract
INTRODUCTION This study describes mothers' knowledge, attitudes, beliefs, and practices about their toddler's sleep health among an underresourced sample of mothers with diverse racial and ethnic identities. METHOD This was a descriptive qualitative study with 16 mothers and their 12- to 36-month-old child. Mothers completed a semistructured, audio-recorded interview about their toddler's sleep health. Data were analyzed using inductive content analysis on the basis of established methods. RESULTS Mothers self-identified as 18.8% Black, 43.8% White, 12.5% multiracial, 25.0% other race, and 37.5% Hispanic. Of the mothers, 80.0% reported a past year household income of ≤ $40,000. A core construct, "Trying to do What's Best," emerged from the interview data, and this construct included three domains: Getting Good Sleep, Getting Thrown Off, and Rolling With It. DISCUSSION Findings support future strengths-based and multilevel sleep health-promoting interventions.
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Bishop AS, Nurius PS, Walker SC, Oxford ML. Sexual health variation among gang-involved youth in Washington state: Social ecological implications for research and practice. Perspect Sex Reprod Health 2024; 56:16-29. [PMID: 38391121 PMCID: PMC11026090 DOI: 10.1111/psrh.12251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
INTRODUCTION Gang-involved youth experience greater disparities in sexual health compared to non-gang-involved youth. Yet, little is known about how and why sexual behaviors vary within the youth gang population. Developing relevant and effective service approaches requires an understanding of this variation and the environmental factors that influence patterns of sexual health risk. METHODOLOGY AND RESULTS Using latent class analysis, we identified four sexual behavior classes within a school-based sample of gang-involved youth in Washington State (N = 2060): Non-Sexually Active (54%), Limited Partners with Condom Use (14%), Multiple Partner with Sexting (19%), and High Sexual Vulnerability (13%). These classes were distinguished by age at sexual debut, number of sexual partners, condom use, and sexting. Interpersonal and macrosocial factors differentiated the classes, including multiform violence exposures, limited social support, and socioeconomic instability. We also found differences according to sexual identity and substance use. DISCUSSION Findings highlight the need for service approaches that are responsive to both the individual needs of gang-involved youth and the factors that shape their living environments. We discuss the implications for research and practice, including the potential utility of a harm reduction framework to promote sexual health and reduce disparities in the youth gang population.
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Affiliation(s)
- Asia S Bishop
- School of Social Work and Criminal Justice, University of Washington Tacoma, Tacoma, Washington, USA
- School of Social Work, University of Washington Seattle, Seattle, Washington, USA
| | - Paula S Nurius
- School of Social Work, University of Washington Seattle, Seattle, Washington, USA
| | - Sarah C Walker
- CoLab for Community and Behavioral Health Policy, Department of Psychiatry and Behavioral Health Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Monica L Oxford
- Barnard Center for Infant Mental Health and Development, School of Nursing, University of Washington, Seattle, Washington, USA
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Almulla HA, Lewis FM, Oxford ML. Development and Psychometric Evaluation of the Children's Illness-Related Concerns Scale. Nurs Res 2023; 72:E172-E179. [PMID: 37625187 PMCID: PMC10463208 DOI: 10.1097/nnr.0000000000000670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2023]
Abstract
BACKGROUND Despite the effect of maternal breast cancer on many children, there is no valid or reliable quantitative measure of the concern that children attribute to their mothers' disease, which constrains both science and clinical practice. OBJECTIVES This study aimed to develop and psychometrically evaluate the initial measures of child-reported, illness-related concerns associated with maternal cancer. METHODS The study was conducted in three phases: scoping review, item extraction from a battery of items obtained from school-aged children about general issues related to their mothers' breast cancer, and testing of the three proposed structural models of these extracted items using confirmatory factor analysis. The scoping review yielded five categories of illness-related concerns: altered family routines, uncertainty, concerns about illness contagion, maternal death, and maternal well-being. To reflect these five categories, 18 items were extracted from a 93-item questionnaire completed by 202 school-aged children regarding their mothers' breast cancer. Next, three structural models were hypothesized to assess the construct validity of illness-related concerns: five-, three-, and one-factor models. Confirmatory factor analysis was used to test and compare the models. RESULTS The five-factor model best fit the data, and each factor showed adequate internal consistency reliability. These findings align with the a priori five-factor model informed by the scoping review. CONCLUSION The results provide initial evidence of the construct validity of the 18-item Children's Illness-Related Concerns Scale, which can be used to assess children's concerns and inform future intervention studies.
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Affiliation(s)
- Hebah A. Almulla
- Imam Abdulrahman Bin Faisal University, College of Nursing, Dammam, Saudi Arabia
| | - Frances Marcus Lewis
- University of Washington, School of Nursing, Seattle, WA
- Fred Hutchinson Cancer Research, Public Health Sciences and Clinical Research Divisions, Seattle, WA
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Oxford ML, Hash JB, Lohr MJ, Fleming CB, Dow-Smith C, Spieker SJ. What works for whom? Mother's psychological distress as a moderator of the effectiveness of a home visiting intervention. Infant Ment Health J 2023; 44:301-318. [PMID: 36917197 DOI: 10.1002/imhj.22050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 02/21/2023] [Accepted: 02/21/2023] [Indexed: 03/16/2023]
Abstract
Attachment-based home visiting programs that serve new mothers experiencing psychological distress may advance health equity by helping families systemically exposed to adversity. This study examined whether one such program (Promoting First Relationships/PFR) had particularly beneficial effects on maternal and child relationship outcomes for mothers reporting the greatest psychological distress. A randomized controlled trial of the PFR program included a low-income sample of 252 Spanish- and English-speaking mother-child dyads referred prenatally for mental health concerns. The sample of mothers was 65.5% White, 17.5% Black, and 17.1% multiracial or other racial groups; 47.2% reported Hispanic ethnicity. The moderating variable of psychological distress was measured using maternal-reported screening tools for symptoms of depression, anxiety, anger, post-traumatic stress, and interpersonal sensitivity. Outcomes included observed parenting sensitivity and self-reported understanding of infants/toddlers, caregiving confidence, and child externalizing behavior. Results showed a significant treatment condition by baseline psychological distress interaction for observed parenting sensitivity such that differences in outcomes favoring the PFR condition were greatest among those with high baseline psychological distress (baseline child age 6-12 weeks). In a low-income sample of new mothers, those with the greatest need, as indicated by high psychological distress, showed greater improvements in their sensitive and responsive caregiving if they were randomized to the PFR treatment condition.
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Affiliation(s)
- Monica L Oxford
- Child, Family, and Population Health Nursing at the University of Washington, Seattle, Washington, USA
| | - Jonika B Hash
- Child, Family, and Population Health Nursing at the University of Washington, Seattle, Washington, USA
| | - Mary Jane Lohr
- Child, Family, and Population Health Nursing at the University of Washington, Seattle, Washington, USA
| | - Charles B Fleming
- Department of Psychiatry and Behavioral Sciences at the University of Washington, Seattle, Washington, USA
| | - Carrie Dow-Smith
- WakeMed Children's Hospital, Pediatric Primary Care, Raleigh, North Carolina, USA
| | - Susan J Spieker
- Child, Family, and Population Health Nursing at the University of Washington, Seattle, Washington, USA
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Booth-LaForce C, Oxford ML, O’Leary R, Rees J, Petras A, Buchwald DS. Implementation fidelity of the Promoting First Relationships intervention program in a Native community. Transl Behav Med 2023; 13:34-41. [PMID: 36227860 PMCID: PMC9853091 DOI: 10.1093/tbm/ibac060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Promoting First Relationship (PFR) is an evidence-based intervention designed to promote positive, supportive relationships between primary caregivers and their young children. Implementing and testing the efficacy of PFR in a remote Native community is especially challenging and requires methods and tools for ensuring implementation fidelity. Tribal members of a Native community were successfully trained and certified to deliver PFR by university-based personnel. During PFR delivery, they achieved very high scores on adherence to intervention content (M = 0.99, SD = 0.02), and their quality of delivery uniformly exceeded established criteria. High attrition occurred before PFR was delivered. However, participants who remained in the study completed all 10 sessions of PFR content. Participants' satisfaction with the program was very high (M = 3.90 [of 4 points], SD = 0.19). High implementation fidelity was attained in the face of many inherent challenges. The suite of methods and tools used for training, monitoring, and evaluating implementation fidelity in this study provides an example that may be useful in the evaluation of evidence-based programs more generally.
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Affiliation(s)
- Cathryn Booth-LaForce
- Department of Child, Family, and Population Health Nursing, University of Washington, Barnard Center for Infant Mental Health and Development, Box 357231, Seattle, WA 98195-7231, USA
| | - Monica L Oxford
- Department of Child, Family, and Population Health Nursing, University of Washington, Barnard Center for Infant Mental Health and Development, Box 357231, Seattle, WA 98195-7231, USA
| | - Rae O’Leary
- Missouri Breaks Industries Research Inc., Eagle Butte, SD 57625, USA
| | - Jennifer Rees
- Department of Child, Family, and Population Health Nursing, University of Washington, Barnard Center for Infant Mental Health and Development, Box 357231, Seattle, WA 98195-7231, USA
| | - Anthippy Petras
- Elson S. Floyd College of Medicine, Institute for Research and Education to Advance Community Health, Washington State University, 1100 Olive Way, Ste 1200, Seattle, WA 98101, USA
| | - Dedra S Buchwald
- Elson S. Floyd College of Medicine, Institute for Research and Education to Advance Community Health, Washington State University, 1100 Olive Way, Ste 1200, Seattle, WA 98101, USA
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O'Leary R, Oxford ML, Booth-LaForce C, London S, Buchwald DS. Experiences of Native Participants in the Promoting First Relationships® Intervention: Focus Group Findings. Matern Child Health J 2022; 26:2263-2270. [PMID: 36109420 PMCID: PMC10693919 DOI: 10.1007/s10995-022-03533-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2022] [Indexed: 10/14/2022]
Abstract
OBJECTIVES We tested Promoting First Relationships® (PFR), an evidence-based preventive intervention program for caregivers promoting attachment and social and emotional development of infants and toddlers, in a randomized controlled trial in a Native community. Quantitative results yielded evidence of efficacy; but in this report, our objective was to assess the participants' real-life experiences, challenges, and suggested enhancements to further adapt the program. METHODS At the end of the study we conducted three focus groups (N = 17)-two groups for participants who completed the 10-week intervention and one group for those who did not. Focus groups were structured to generate discussion about (1) elements or activities of PFR they enjoyed and others that were challenging, (2) suggested solutions to participant challenges, (3) experiences with video recordings and handouts, and (4) aspects of the program that could be changed to make it more culturally-relevant. RESULTS Qualitative analysis of the focus group transcripts revealed five themes: (1) appreciation for PFR providers and program, (2) personal growth, (3) improved caregiver-child relationships, (4) participant challenges, and (5) participant suggestions to improve the program. CONCLUSIONS These qualitative results complement our quantitative assessment of the positive impact of the PFR program. Additionally, they provide importance guidance for future implementation of PFR in this, and other Native communities, as well as insight into broader issues to consider when adapting intervention programs for Native families.
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Affiliation(s)
- Rae O'Leary
- Missouri Breaks Industries Research, Inc., 118 S. Willow Street, PO Box 1824, Eagle Butte, SD, 57625, USA.
| | - Monica L Oxford
- Child, Family, and Population Health Nursing, University of Washington, Seattle, USA
| | - Cathryn Booth-LaForce
- Child, Family, and Population Health Nursing, University of Washington, Seattle, USA
| | - Sara London
- College of Education, University of Washington, Seattle, USA
| | - Dedra S Buchwald
- Institute for Research and Education to Advance Community Health, Washington State University, Seattle and Spokane, USA
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Lee RY, Oxford ML, Sonney J, Enquobahrie DA, Cato KD. The mediating role of anxiety/depression symptoms between adverse childhood experiences (ACEs) and somatic symptoms in adolescents. J Adolesc 2022; 94:133-147. [PMID: 35353421 PMCID: PMC9511877 DOI: 10.1002/jad.12012] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 01/12/2022] [Indexed: 11/09/2022]
Abstract
INTRODUCTION This study examines the relationships among recent adverse childhood experiences (ACEs), somatic symptoms, and anxiety/depression symptoms during adolescence and whether anxiety/depression symptoms mediate the relationship between ACEs and somatic symptoms. METHODS Longitudinal prospective data from the Longitudinal Studies of Child Abuse and Neglect study of 1354 children and their primary caregivers in the United States was used in this study. A longitudinal cross-lagged path analysis among recent ACEs, anxiety/depression symptoms, and somatic symptoms at three points during adolescence (ages 12, 14, and 16 years) was conducted. RESULTS The sample was 51% female and 53% African American. The results indicated significant concurrent associations between recent ACEs and increased anxiety/depression symptoms at ages 12, 14, and 16 (β = .27, p < .001; β = .15, p < .001; β = .07, p < .05) and between anxiety/depression symptoms and increased somatic symptoms at ages 12, 14, and 16 years (β = .44, p < .001; β = .39, p < .001; β = .49, p < .001). Moreover, anxiety/depression symptoms significantly mediated the relationship between recent ACEs and concurrent somatic symptoms at ages 12, 14, and 16 years (β = .12, p < .001; β = .06, p < .001; β = .04, p < .05). However, there was no significant relationship between recent ACEs and somatic symptoms. CONCLUSION The findings suggest that anxiety/depression symptoms mediate the concurrent relationships between recent ACEs and somatic symptoms at ages 12, 14, and 16. Clinicians should consider assessing anxiety/depression symptoms and possible concurrent exposure to ACEs when caring for adolescents who present with somatic symptoms.
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Affiliation(s)
- Rachel Y. Lee
- School of Nursing, Columbia University, New York City, New York, USA
| | - Monica L. Oxford
- Department of Child, Family, and Population Health Nursing, University of Washington, Seattle, Washington, USA
| | - Jennifer Sonney
- Department of Child, Family, and Population Health Nursing, University of Washington, Seattle, Washington, USA
| | | | - Kenrick D. Cato
- School of Nursing, Columbia University, New York City, New York, USA
- Department of Emergency Medicine, Columbia University College of Physicians & Surgeons, New York City, New York, USA
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Oxford ML, Hash JB, Lohr MJ, Bleil ME, Fleming CB, Unützer J, Spieker SJ. Randomized trial of promoting first relationships for new mothers who received community mental health services in pregnancy. Dev Psychol 2021; 57:1228-1241. [PMID: 34591567 DOI: 10.1037/dev0001219] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The effectiveness of Promoting First Relationships (PFR), a 10-week home visiting program with video feedback, was tested in a randomized controlled trial involving 252 mothers and their 8- to 12-week-old infants. Mothers were eligible if they initiated treatment after mental health screening (depression, anxiety, posttraumatic stress disorder [PTSD]) at a community or public health primary care center in pregnancy. At baseline, 51% had mild to severe depression symptoms, 54% had mild to severe anxiety, and 35% had PTSD. Their ages ranged from 18 to 42 years. Mothers were 66% White, 18% Black, and 16% other races. Forty-seven percent identified as Hispanic, and 33% preferred to read and speak in Spanish. The median family annual income was less than $20,000. The PFR program or receipt of a resource packet (control condition) followed the baseline assessment and randomization; we assessed outcomes when infants were age 6 and 12 months. Compared to mothers in the control condition, mothers in the PFR condition had significantly (ps < .05) higher observed sensitivity scores at both follow-up time points (d = .25, d = .26), had improved understanding of infant-toddler social-emotional needs at both time points (d = .21, d = .45), and reported less infant externalizing behavior at age 12 months (d = .28). This study is the fourth completed randomized controlled trial of the PFR program, all involving populations experiencing adversity. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- Monica L Oxford
- Department of Child, Family, and Population Health Nursing, University of Washington
| | - Jonika B Hash
- Department of Child, Family, and Population Health Nursing, University of Washington
| | - Mary J Lohr
- Department of Child, Family, and Population Health Nursing, University of Washington
| | - Maria E Bleil
- Department of Child, Family, and Population Health Nursing, University of Washington
| | - Charlie B Fleming
- Department of Child, Family, and Population Health Nursing, University of Washington
| | - Jurgen Unützer
- Department of Psychiatry and Behavioral Sciences, University of Washington
| | - Susan J Spieker
- Department of Child, Family, and Population Health Nursing, University of Washington
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Booth-LaForce C, Oxford ML, Barbosa-Leiker C, Burduli E, Buchwald DS. Randomized Controlled Trial of the Promoting First Relationships® Preventive Intervention for Primary Caregivers and Toddlers in an American Indian Community. Prev Sci 2020; 21:98-108. [PMID: 31754964 DOI: 10.1007/s11121-019-01053-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Preventive intervention programs that address parenting practices and children's developmental needs early in life have led to positive changes in caregiving behavior and children's developmental outcomes. However, little is known about the efficacy of such programs among American Indian families. This study tested the efficacy of the strengths-based Promoting First Relationships® (PFR) program in American Indian families living on a rural reservation. Participants were 34 toddlers (10-30 months old) and their primary caregivers. Families were randomized to an Immediate (n = 17) or Waitlist (n = 17) group after a home visit for baseline data collection, which included assessment of observed caregiver-child interactions, caregiver perceptions, and child behavior. After randomization, we delivered the PFR intervention in 10 visits to the Immediate group, with some adaptations based on focus groups with community members and staff input. We analyzed follow-up assessments by implementing multiple regression analyses, controlling for baseline scores and using multiple imputation to handle missing data. Results supported our primary hypotheses: the Immediate group, compared with Waitlist, had significantly higher scores on the quality (p = .011, d = 1.02) and contingent responsiveness (p = .013, d = 1.21) of caregiver-child interactions, as well as on caregiver knowledge of toddlers' social and emotional needs and level of developmentally appropriate expectations (p = .000, d = 0.58). Caregiver stress and caregivers' reports of child behavior did not differ significantly. Our results hold promise for additional PFR research in other Native communities.
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Affiliation(s)
- Cathryn Booth-LaForce
- Department of Child, Family, & Population Health Nursing, University of Washington, CHDD 106 South Building, Box 357920, Seattle, WA, 98195-7920, USA.
| | - Monica L Oxford
- Department of Child, Family, & Population Health Nursing, University of Washington, CHDD 106 South Building, Box 357920, Seattle, WA, 98195-7920, USA
| | | | - Ekaterina Burduli
- College of Nursing, Washington State University, Spokane, WA, 99210-1495, USA
| | - Dedra S Buchwald
- Elson S. Floyd College of Medicine, Institute for Research and Education to Advance Community Health, Washington State University, 1100 Olive Way, Ste 1200, Seattle, WA, 98101, USA
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Kuklinski MR, Oxford ML, Spieker SJ, Lohr MJ, Fleming CB. Benefit-cost analysis of Promoting First Relationships®: Implications of victim benefits assumptions for return on investment. Child Abuse Negl 2020; 106:104515. [PMID: 32454356 PMCID: PMC7359609 DOI: 10.1016/j.chiabu.2020.104515] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 04/11/2020] [Accepted: 04/22/2020] [Indexed: 05/08/2023]
Abstract
BACKGROUND Child abuse and neglect (CAN) cost United States society $136 billion to $428 billion annually. Preventive interventions that reduce CAN may improve people's lives and generate economic benefits to society, but their magnitude is likely to vary greatly with assumptions about victim costs avoided through intervention. OBJECTIVE We examined the implications of different assumptions about avoided victim costs in a benefit-cost analysis of Promoting First Relationships® (PFR), a 10-session attachment and strengths-based home visiting intervention. PARTICIPANTS AND SETTING Participants were 247 child protection-involved but intact families in Washington State randomized to receive PFR (n = 124) or resource and referral (n = 123). METHODS We monetized intervention effects on out-of-home placements and implicit effects on CAN and calculated net present values under three scenarios: (1) benefits from avoided system costs, (2) additional benefits from avoided tangible victim costs, and (3) additional benefits from avoided tangible and intangible quality-of-life victim costs. For scenarios 2 and 3, we varied the CAN effect size and estimated the effect size at which PFR was reliably cost beneficial. RESULTS PFR's societal net benefit ranged from $1 (scenario 1) to $5514 - $25,562 (scenario 2) and $7004 - $32,072 (scenario 3) (2014 USD). In scenarios 2 and 3, PFR was reliably cost beneficial at a CAN effect size of approximately -0.25. CONCLUSIONS PFR is cost beneficial assuming tangible victim costs are avoided by PFR. Research into the long-term health and economic consequences of reducing CAN in at-risk populations would contribute to comprehensive, accurate benefits models.
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Affiliation(s)
- Margaret R Kuklinski
- Social Development Research Group, School of Social Work, University of Washington, 9725 Third Ave. NE, Suite 401, Seattle, WA 98115, United States.
| | - Monica L Oxford
- Department of Child, Family, and Population Health Nursing, School of Nursing, University of Washington, United States.
| | - Susan J Spieker
- Department of Child, Family, and Population Health Nursing, School of Nursing, University of Washington, United States.
| | - Mary Jane Lohr
- Department of Child, Family, and Population Health Nursing, School of Nursing, University of Washington, United States.
| | - Charles B Fleming
- Center for The Study of Health and Risk Behavior, Department of Psychiatry, University of Washington, United States.
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Hash JB, Oxford ML, Ward TM, Fleming CB, Spieker SJ. Sleep Patterns, Problems and Ecology among Toddlers in Families with a Child Protective Services Maltreatment Referral. J Pediatr Nurs 2020; 51:85-91. [PMID: 31945664 PMCID: PMC7276301 DOI: 10.1016/j.pedn.2019.12.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 10/20/2019] [Accepted: 12/22/2019] [Indexed: 12/12/2022]
Abstract
PURPOSE To describe sleep patterns, problems, and ecology among toddlers (13 to 36 months) from families referred to Child Protective Services (CPS) for maltreatment and to compare sleep duration among a subgroup (24- to 36-month-olds) to previously published population-based data. DESIGN AND METHODS A secondary analysis of a larger longitudinal study was conducted. Participants included 113 parent-toddler dyads recruited out of CPS offices based on having a recent maltreatment referral. Parents reported about their toddler's sleep at two time points (approximately six months apart). RESULTS At the earlier and later time points, respectively, mean sleep duration was 11.03 and 10.90 h (nighttime), 1.36 and 1.36 h (daytime), and 12.47 and 12.28 h (total 24-h). Of the toddlers, 24% and 17% had two or more nighttime awakenings, 34% and 33% had at least a somewhat hard time falling asleep, and 25% and 26% had difficulty sleeping alone. Mean bedtimes were 8:50 pm and 8:58 pm. Nighttime sleeping arrangement/location, nap arrangement/location, and method of falling asleep at night varied. Compared to the population-based data, nighttime sleep duration was 43 min longer and nap duration was 46 min shorter in the CPS sample. CONCLUSIONS Symptoms of behavioral sleep problems were common in this sample of toddlers from families referred to CPS for maltreatment. Distribution of sleep, but not total 24-hour sleep, differed significantly between the CPS sample and the population-based data. PRACTICE IMPLICATIONS Nurses caring for toddlers from families involved with CPS can play an integral role promoting sleep health and addressing behavioral sleep problems.
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Affiliation(s)
- Jonika B Hash
- Department of Biobehavioral Nursing & Health Informatics, University of Washington, Seattle, WA, United States of America.
| | - Monica L Oxford
- Department of Family & Child Nursing, University of Washington, Seattle, WA, United States of America
| | - Teresa M Ward
- Psychosocial & Community Health, University of Washington, Seattle, WA, United States of America
| | - Charles B Fleming
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA, United States of America
| | - Susan J Spieker
- Department of Family & Child Nursing, University of Washington, Seattle, WA, United States of America
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Hash JB, Oxford ML, Fleming CB, Ward TM, Spieker SJ. Sleep Problems, Daily Napping Behavior, and Social-Emotional Functioning among Young Children from Families Referred to Child Protective Services. Behav Sleep Med 2020; 18:447-459. [PMID: 31084215 PMCID: PMC6851456 DOI: 10.1080/15402002.2019.1611579] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE/BACKGROUND Insufficient and/or poor-quality sleep may contribute to poor social-emotional well-being, and vice versa, among young children who have experienced maltreatment. This study examined longitudinal associations between sleep and social-emotional functioning among a sample of infants and toddlers from families involved with Child Protective Services (CPS) for maltreatment. PARTICIPANTS Participants were 123 parents and their infant or toddler (baseline age 10 to 24 months) from families referred to CPS for maltreatment. METHODS Data were collected at baseline and at 3, 6 and 9 months post-baseline. At all time points, parents completed a questionnaire about their child's social-emotional functioning including internalizing behavior, externalizing behavior, and competence in social-emotional skills and social relatedness. At 3 months post-baseline, parents reported about their child's sleep problems and daily napping behavior. RESULTS Higher baseline externalizing behavior was associated with a greater propensity for sleep problems at 3 months post-baseline. Sleep problems at 3 months post-baseline were associated with higher internalizing and higher externalizing behavior at 9 months post-baseline. Daily napping at 3 months post-baseline was associated with lower internalizing behavior, lower externalizing behavior, and higher competence at 9 months post-baseline. CONCLUSIONS Among this sample of young children from families involved with CPS for maltreatment, parents' concerns about their child having a sleep problem longitudinally associated with children's internalizing and externalizing behavior. Children's daily napping behavior longitudinally associated with later internalizing behavior, externalizing behavior, and competence.
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Affiliation(s)
- Jonika B. Hash
- Department of Biobehavioral Nursing & Health Informatics, University of Washington
| | | | - Charles B. Fleming
- Department of Psychiatry & Behavioral Sciences, University of Washington
| | - Teresa M. Ward
- Department of Psychosocial & Community Health, University of Washington
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Hash JB, Oxford ML, Fleming CB, Ward TM, Spieker SJ, Lohr MJ. Impact of a home visiting program on sleep problems among young children experiencing adversity. Child Abuse Negl 2019; 89:143-154. [PMID: 30665020 PMCID: PMC6526956 DOI: 10.1016/j.chiabu.2018.12.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 12/14/2018] [Accepted: 12/20/2018] [Indexed: 05/10/2023]
Abstract
BACKGROUND Adversity may negatively impact young children's sleep but receiving home visitation services could buffer children from this potential consequence of adversity. OBJECTIVE This study examined whether young children's adverse experiences increased their risk for sleep problems and if Promoting First Relationships® (PFR), a home visitation program, reduced children's risk for sleep problems both directly and indirectly through increased parenting sensitivity. PARTICIPANTS AND SETTING Participants were 247 parents and their 10- to 24-month-old child recruited from Child Protective Services offices. METHODS A secondary analysis of a randomized controlled trial comparing PFR to a resource and referral control condition was conducted. Four time points of data were collected from baseline to 6 months post-intervention. Parenting sensitivity was measured at all time points using a parent-child interaction tool. Children's adversities were measured at various time points using caregiver report tools and official state records. Children's sleep problems were reported by parents at 6 months post-intervention. RESULTS The likelihood of having a sleep problem increased as children's adversities increased (β = .23, SE = .08, p = .005). There was no effect (direct or indirect) of treatment assignment on children's sleep problems (ps > .05). Post hoc analyses showed a treatment assignment by adversity interaction such that children's odds of having a sleep problem increased as their adversities increased, but only among children in the control condition (b = -0.37, SE = 0.17, p = .030). CONCLUSIONS Experiencing more adversities associated with a greater risk for sleep problems, but PFR buffered children from this risk.
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Affiliation(s)
- Jonika B Hash
- Department of Biobehavioral Nursing & Health Informatics, University of Washington, Seattle, WA, 98195, USA.
| | - Monica L Oxford
- Department of Family & Child Nursing, University of Washington, Seattle, WA, 98195, USA
| | - Charles B Fleming
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA, 98195, USA
| | - Teresa M Ward
- Department of Psychosocial & Community Health, University of Washington, Seattle, WA, 98195, USA
| | - Susan J Spieker
- Department of Family & Child Nursing, University of Washington, Seattle, WA, 98195, USA
| | - Mary Jane Lohr
- Department of Family & Child Nursing, University of Washington, Seattle, WA, 98195, USA
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Pasalich DS, Fleming CB, Spieker SJ, Lohr MJ, Oxford ML. Does Parents' Own History of Child Abuse Moderate the Effectiveness of the Promoting First Relationships® Intervention in Child Welfare? Child Maltreat 2019; 24:56-65. [PMID: 30428707 DOI: 10.1177/1077559518809217] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
To better understand how and for whom parenting intervention may improve family outcomes in child welfare services, we examined whether parents' own history of child abuse moderated the indirect effects of the Promoting First Relationships® (PFR) intervention on toddlers' secure base behavior via parental sensitivity. Parents ( N = 247) and their toddlers (10-24 months) involved with child protective services were randomized to PFR or a control intervention. Results showed that the PFR group demonstrated greater parental sensitivity at postintervention than the control group, which in turn led to higher levels of toddler secure base behavior at 6-month follow-up. Findings from a moderated mediation model indicated that these intervention effects were only evident for parents who experienced physical abuse in their childhood. Parents' history of sexual or emotional abuse did not significantly moderate outcomes. These results provide evidence for a key mechanism of change in PFR informed by attachment theory and suggest that PFR intervention effects may be stronger in parents at higher risk of the intergenerational transmission of abuse.
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Hastings PD, Kahle S, Fleming C, Lohr MJ, Katz LF, Oxford ML. An intervention that increases parental sensitivity in families referred to Child Protective Services also changes toddlers' parasympathetic regulation. Dev Sci 2019; 22:e12725. [PMID: 30156354 PMCID: PMC6294712 DOI: 10.1111/desc.12725] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 07/15/2018] [Indexed: 01/04/2023]
Abstract
Experiencing maltreatment in early childhood predicts poor parasympathetic regulation, characterized by low baseline parasympathetic activity and strong withdrawal of parasympathetic influence in response to tasks. The Promoting First Relationships® (PFR) program improves parental sensitivity toward young children in families identified as maltreating. Using a subsample from a randomized control trial, we examined whether parental participation in PFR had lasting effects on toddlers' parasympathetic regulation, as measured by respiratory sinus arrhythmia (RSA), relative to a resource and referral control condition. In addition, we examined whether parental sensitive and responsive behavior mediated or moderated associations between parent treatment group and children's RSA. More than 6 months after completing treatment, 29 families in the PFR condition and 30 families in the control condition were visited at home, and toddlers' RSA was assessed at baseline and during five moderately challenging tasks. Groups did not differ in baseline RSA, but differed in RSA reactivity to the tasks. Across tasks, toddlers of parents in the control condition manifested significantly larger RSA decreases than toddlers of parents in the PFR condition. Parental behavior showed divergent associations with RSA change for toddlers of parents in the PFR versus control condition, with PFR treatment predicting RSA change ranging from small decreases to increases in toddlers of parents who showed the most sensitive, responsive behavior in the 6 months following treatment. This preliminary study showed that the same intervention that improved parenting also improved toddlers' parasympathetic regulation in response to everyday activities, warranting further experimental investigation.
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Affiliation(s)
- Paul D. Hastings
- Center for Mind & Brain, Department of Psychology, University of California Davis
| | - Sarah Kahle
- Department of Pediatrics, School of Medicine, University of California Davis
| | - Charles Fleming
- Center for the Study of Health and Risk Behavior, Department of Psychiatry and Behavioral Sciences, University of Washington
| | - Mary Jane Lohr
- Department of Family and Child Nursing, University of Washington
| | | | - Monica L. Oxford
- Department of Family and Child Nursing, University of Washington
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Letourneau NL, Tryphonopoulos PD, Novick J, Hart JM, Giesbrecht G, Oxford ML. Nursing Child Assessment Satellite Training Parent-Child Interaction Scales: Comparing American and Canadian Normative and High-Risk Samples. J Pediatr Nurs 2018; 40:47-57. [PMID: 29776479 DOI: 10.1016/j.pedn.2018.02.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 02/06/2018] [Accepted: 02/26/2018] [Indexed: 11/19/2022]
Abstract
PURPOSE Many nurses rely on the American Nursing Child Assessment Satellite Training (NCAST) Parent-Child Interaction (PCI) Teaching and Feeding Scales to identify and target interventions for families affected by severe/chronic stressors (e.g. postpartum depression (PPD), intimate partner violence (IPV), low-income). However, the NCAST Database that provides normative data for comparisons may not apply to Canadian families. The purpose of this study was to compare NCAST PCI scores in Canadian and American samples and to assess the reliability of the NCAST PCI Scales in Canadian samples. METHODS This secondary analysis employed independent samples t-tests (p < 0.005) to compare PCI between the American NCAST Database and Canadian high-risk (families with PPD, exposure to IPV or low-income) and community samples. Cronbach's alphas were calculated for the Canadian and American samples. RESULTS In both American and Canadian samples, belonging to a high-risk population reduced parents' abilities to engage in sensitive and responsive caregiving (i.e. healthy serve and return relationships) as measured by the PCI Scales. NCAST Database mothers were more effective at executing caregiving responsibilities during PCI compared to the Canadian community sample, while infants belonging to the Canadian community sample provided clearer cues to caregivers during PCI compared to those of the NCAST Database. Internal consistency coefficients for the Canadian samples were generally acceptable. CONCLUSIONS The NCAST Database can be reliably used for assessing PCI in normative and high-risk Canadian families. PRACTICAL IMPLICATIONS Canadian nurses can be assured that the PCI Scales adequately identify risks and can help target interventions to promote optimal parent-child relationships and ultimately child development.
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Affiliation(s)
- Nicole L Letourneau
- Faculty of Nursing and Cumming School of Medicine (Pediatrics, Community Health Sciences & Psychiatry), University of Calgary, Alberta , Canada.
| | | | - Jason Novick
- Cumming School of Medicine (Pediatrics), University of Calgary, Calgary, Alberta Canada
| | - J Martha Hart
- Faculty of Nursing and Cumming School of Medicine (Pediatrics, Community Health Sciences & Psychiatry), University of Calgary, Alberta , Canada
| | - Gerald Giesbrecht
- Cumming School of Medicine (Pediatrics and Community Health Sciences), Faculty of Arts (Psychology), University of Calgary, Alberta Canada
| | - Monica L Oxford
- Center on Human Development & Disability, School of Nursing (Family & Child Nursing), Washington University, Seattle, WA United States
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Oxford ML, Spieker SJ, Lohr MJ, Fleming CB, Dillon C, Rees J. Ensuring Implementation Fidelity of a 10-Week Home Visiting Program in Two Randomized Clinical Trials. Matern Child Health J 2018; 22:376-383. [PMID: 29139056 PMCID: PMC5845475 DOI: 10.1007/s10995-017-2387-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Introduction Implementation fidelity is a challenge for the adoption of evidence-based programs within social service broadly and child welfare specifically. However, implementation fidelity is critical for maintaining the integrity of clinical trials and for ensuring successful delivery of services in public health settings. Methods Promoting First Relationships ® (PFR), a 10-week home visiting parenting intervention, was evaluated in two randomized clinical trials with populations of families in child welfare. Seven providers from community agencies participated in the trials and administered PFR. Fidelity data collected included observational measures of provider behavior, provider records, and input from clients to assess training uptake, adherence to content, quality of delivery, program dosage, and participant satisfaction. Results In mock cases to assess training uptake, providers demonstrated an increase in PFR verbalization strategies and a decrease non-PFR verbalizations from pre to post PFR training, and overall this was maintained a year later (Mann-Whitney U's = 0, p's < .01). Adherence to content in actual cases was high, with M = 97% of the program elements completed. Quality of delivery varied across providers, indicated by PFR consultation strategies (Wilks' Lambda F = 18.24, df = 15, p < .001) and global ratings (F = 13.35, df = 5, p < .001). Program dosage was high in both trials (71 and 86% receiving 10 sessions), and participant satisfaction was high (M = 3.9, SD = 0.2; 4 = greater satisfaction). Discussion This system of training and monitoring provides an example of procedures that can be used effectively to achieve implementation fidelity with evidence-based programs in social service practice.
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Affiliation(s)
- Monica L Oxford
- Department of Family and Child Nursing, University of Washington, Box 357920, Seattle, WA, 98195-7920, USA.
| | - Susan J Spieker
- Department of Family and Child Nursing, University of Washington, Box 357920, Seattle, WA, 98195-7920, USA
| | - Mary Jane Lohr
- Department of Family and Child Nursing, University of Washington, Box 357920, Seattle, WA, 98195-7920, USA
| | - Charles B Fleming
- Department of Psychiatry and Behavioral Sciences, University of Washington, Box 356560, Seattle, WA, 98195-6560, USA
| | - Colleen Dillon
- Department of Family and Child Nursing, University of Washington, Box 357920, Seattle, WA, 98195-7920, USA
| | - Jennifer Rees
- Department of Family and Child Nursing, University of Washington, Box 357920, Seattle, WA, 98195-7920, USA
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Spieker SJ, Oxford ML, Fleming CB, Lohr MJ. PARENTAL CHILDHOOD ADVERSITY, DEPRESSIVE SYMPTOMS, AND PARENTING QUALITY: EFFECTS ON TODDLER SELF-REGULATION IN CHILD WELFARE SERVICES INVOLVED FAMILIES. Infant Ment Health J 2017; 39:5-16. [PMID: 29266280 DOI: 10.1002/imhj.21685] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Parents who are involved with child welfare services (CWSI) often have a history of childhood adversity and depressive symptoms. Both affect parenting quality, which in turn influences child adaptive functioning. We tested a model of the relations between parental depression and child regulatory outcomes first proposed by K. Lyons-Ruth, R. Wolfe, A. Lyubchik, and R. Steingard (2002). We hypothesized that both parental depression and parenting quality mediate the effects of parental early adversity on offspring regulatory outcomes. Participants were 123 CWSI parents and their toddlers assessed three times over a period of 6 months. At Time 1, parents reported on their childhood adversity and current depressive symptoms. At Time 2, parents' sensitivity to their child's distress and nondistress cues was rated from a videotaped teaching task. At Time 3, observers rated children's emotional regulation, orientation/engagement, and secure base behavior. The results of a path model partly supported the hypotheses. Parent childhood adversity was associated with current depressive symptoms, which in turn related to parent sensitivity to child distress, but not nondistress. Sensitivity to distress also predicted secure base behavior. Depression directly predicted orientation/engagement, also predicted by sensitivity to nondistress. Sensitivity to distress predicted emotion regulation and orientation/engagement. Results are discussed in terms of intervention approaches for CWSI families.
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Oxford ML, Spieker SJ, Lohr MJ, Fleming CB. Promoting First Relationships ®: Randomized Trial of a 10-Week Home Visiting Program With Families Referred to Child Protective Services. Child Maltreat 2016; 21:267-277. [PMID: 27646148 PMCID: PMC5357588 DOI: 10.1177/1077559516668274] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
We conducted a community-based randomized control trial with intent-to-treat analysis on Promoting First Relationships® (PFR), a 10-week home visiting program. The study included 247 families with 10- to 24-month-old children who had a recent, open child protective services investigation of child maltreatment. Families were randomly assigned to receive either the 10-week home visiting PFR service or a telephone-based, three-call resource and referral (R&R) service. Across postintervention time points, parents in the PFR condition scored higher than families in the R&R condition in parent understanding of toddlers' social emotional needs ( d = .35) and observed parental sensitivity ( d = .20). Children in the PFR condition scored lower than children in the comparison condition on an observational measure of atypical affective communication ( d = .19) and were less likely than children in the comparison group to be placed into foster care through 1-year postintervention (6% vs. 13%, p = .042). No significant differences were found on measures of parenting stress or child social-emotional competence, behavior problems, or secure base behavior. Overall, the results show support for the promise of PFR as an intervention for enhancing parent sensitivity and preventing child removals for families in the child welfare system.
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Affiliation(s)
- Monica L Oxford
- 1 Family & Child Nursing, University of Washington, Seattle, WA, USA
| | - Susan J Spieker
- 1 Family & Child Nursing, University of Washington, Seattle, WA, USA
| | - Mary Jane Lohr
- 1 Family & Child Nursing, University of Washington, Seattle, WA, USA
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Pasalich DS, Fleming CB, Oxford ML, Zheng Y, Spieker SJ. Can Parenting Intervention Prevent Cascading Effects From Placement Instability to Insecure Attachment to Externalizing Problems in Maltreated Toddlers? Child Maltreat 2016; 21:175-85. [PMID: 27381935 PMCID: PMC5131711 DOI: 10.1177/1077559516656398] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Multiple placement changes disrupt continuity in caregiving and undermine well-being in children in child welfare. This study conducted secondary data analysis of a randomized controlled trial to examine whether a relationship-based intervention, Promoting First Relationships(©) (PFR), reduced risk for a maladaptive cascade from placement instability to less secure attachment to elevated externalizing problems. Participants included caregivers (birth or foster/kin) of toddlers (10-24 months) recently transitioned to their care because of child welfare placement decisions. Although main effects of PFR on security and externalizing problems were not previously observed, this study's results revealed that PFR attenuated the association between multiple placement changes (baseline) and less security (postintervention) and that the indirect effect of placement instability on greater externalizing problems (6-month follow-up) via less security was evident only in toddlers in the comparison condition. These findings shed light on how a history of multiple caregiver changes may influence toddlers' risk for poor adjustment in subsequent placements, and the promise of supporting caregivers through a parenting intervention to prevent such risk.
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Affiliation(s)
- Dave S Pasalich
- The Australian National University, Canberra, ACT, Australia
| | | | | | - Yao Zheng
- Simon Fraser University, Burnaby, British Columbia, Canada Child & Family Research Institute, Vancouver, British Columbia, Canada
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Russell BS, Lee JO, Spieker S, Oxford ML. Parenting and Preschool Self-Regulation as Predictors of Social Emotional Competence in 1st Grade. J Res Child Educ 2016; 30:153-169. [PMID: 27616805 PMCID: PMC5015765 DOI: 10.1080/02568543.2016.1143414] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Accepted: 09/08/2014] [Indexed: 06/06/2023]
Abstract
The current longitudinal study used data from the National Institute of Child Health and Human Development (NICHD) Study of Early Child Care and Youth Development (SECCYD) to examine a model of development that emphasizes early caregiving environments as predictors of social emotional competence (including classroom competence). This path analysis model included features of parenting, emotion regulation, preschool language skills, and attention to predict child outcomes in 1st grade. Early caregiving environments were directly predictive of peer relationship satisfaction, oppositional behavior, social skills, and classroom competence over and above significant mediated effects through preschool self regulation (language, inattention, and anger/frustration). These results suggest that the characteristics of supportive and stimulating caregiving shift in valence over time, such that qualities of the infant-child relationship that are significant in predicting early childhood outcomes are not the same as the caregiving qualities that move to the foreground in predicting primary school outcomes. Implications for school-readiness programming are discussed, including interventions in the early caregiving system to encourage sensitive and supportive parent child interactions to bolster school readiness via the development of social-emotional competence.
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Oxford ML, Marcenko M, Fleming CB, Lohr MJ, Spieker SJ. Promoting Birth Parents' Relationships with their Toddlers upon Reunification: Results from Promoting First Relationships ® Home Visiting Program. Child Youth Serv Rev 2016; 61:109-116. [PMID: 26869740 PMCID: PMC4746016 DOI: 10.1016/j.childyouth.2015.12.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Birth parents, once reunified with their child after a foster care placement, are in need of in-home support services to prevent reoccurrence of maltreatment and reentry into foster care, establish a strong relationship with their child, and enhance child well-being. Few studies have addressed the efficacy of home visiting services for reunified birth parents of toddlers. This study reports on the findings from a randomized control trial of a 10-week home visiting program, Promoting First Relationships® (Kelly, Sandoval, Zuckerman, & Buehlman, 2008), for a subsample of 43 reunified birth parents that were part of the larger trial. We describe how the elements of the intervention align with the needs of parents and children in child welfare. Although the sample size was small and most of the estimates of intervention effects were not statistically significant, the effect sizes and the pattern of results suggest that the intervention may have improved both observed parenting sensitivity and observed child behaviors as well as decreased parent report of child behavior problems. Implications are that providing in-home services soon after a reunification may be efficacious in strengthening birth parents' capacity to respond sensitively to their children as well as improving child social and emotional outcomes and well-being.
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Spieker SJ, Oxford ML, Fleming CB. Permanency Outcomes for Toddlers in Child Welfare Two Years After a Randomized Trial of a Parenting Intervention. Child Youth Serv Rev 2014; 44:201-206. [PMID: 25125769 PMCID: PMC4128499 DOI: 10.1016/j.childyouth.2014.06.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
This study reports on child welfare outcomes of a community based, randomized control trial of Promoting First Relationships® (PFR; Kelly, Sandoval, Zuckerman, & Buehlman, 2008), a 10-week relationship-based home visiting program, on stability of children's placements and permanency status two years after enrollment into the study. Toddlers 10 - 24 months (N = 210) with a recent placement disruption were randomized, along with their birth or foster/kin parents, to PFR (n = 105) or a comparison condition (n = 105). A stable placement had no interruptions or disruptions. A permanent placement was a stable placement ending with a legal discharge to the study caregiver. Logistic regression models predicting the dichotomous stability and permanency variables, controlling for caregiver type, child welfare variables, and caregiver commitment, were conducted. There was no difference by intervention group on stability or permanency, but there was a significant interaction between caregiver type (birth parent vs. foster/kin) and intervention group. More foster/kin caregivers who received the PFR intervention provided stable, uninterrupted care and eventually adopted or became the legal guardians of the toddlers in their care, compared to foster/kin caregivers randomized to the comparison condition.
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Oxford ML, Fleming CB, Nelson EM, Kelly JF, Spieker SJ. Randomized Trial of Promoting First Relationships: Effects on Maltreated Toddlers' Separation Distress and Sleep Regulation after Reunification. Child Youth Serv Rev 2013; 35:10.1016/j.childyouth.2013.09.021. [PMID: 24357891 PMCID: PMC3864747 DOI: 10.1016/j.childyouth.2013.09.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
This study investigates the impact of an attachment focused intervention, Promoting First Relationships (PFR), on sleep problems among toddlers in child welfare recently reunified with their birth parent. Recently reunified parent-toddler dyads (n = 43) were drawn from a larger random control trial. Toddlers (11-36 months) and their parents were assessed in two-hour research home visits at enrollment (baseline), and a 6-month post-intervention follow-up. Measures included parental report of sleep problems and research visitor observation of separation distress (using the Toddler Attachment Sort-45). The PFR intervention predicted fewer sleep problems, adjusting for a baseline measure of sleep problems and other covariates. A path model showed evidence of an indirect effect of PFR on sleep problems through declines in separation distress. An attachment focused intervention like PFR that reduces infant separation distress can lead to reductions in sleep problems.
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Affiliation(s)
| | | | | | - Jean F Kelly
- Family & Child Nursing, University of Washington
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Spieker SJ, Oxford ML, Kelly JF, Nelson EM, Fleming CB. Promoting first relationships: randomized trial of a relationship-based intervention for toddlers in child welfare. Child Maltreat 2012; 17:271-86. [PMID: 22949743 PMCID: PMC3552521 DOI: 10.1177/1077559512458176] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
We conducted a community-based, randomized control trial with intent-to-treat analyses of Promoting First Relationships (PFR) to improve parenting and toddler outcomes for toddlers in state dependency. Toddlers (10-24 months; N = 210) with a recent placement disruption were randomized to 10-week PFR or a comparison condition. Community agency providers were trained to use PFR in the intervention for caregivers. From baseline to postintervention, observational ratings of caregiver sensitivity improved more in the PFR condition than in the comparison condition, with an effect size for the difference in adjusted means postintervention of d = .41. Caregiver understanding of toddlers' social emotional needs and caregiver reports of child competence also differed by intervention condition postintervention (d = .36 and d = .42) with caregivers in the PFR condition reporting more understanding of toddlers and child competence. Models of PFR effects on within-individual change were significant for caregiver sensitivity and understanding of toddlers. At the 6-month follow-up, only 61% of original sample dyads were still intact and there were no significant differences on caregiver or child outcomes.
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Affiliation(s)
- Susan J Spieker
- Department of Family & Child Nursing, University of Washington, Seattle, WA, USA.
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Spieker SJ, Oxford ML, Kelly JF, Nelson EM, Fleming CB. Response to the Barth commentary (2012). Child Maltreat 2012. [PMID: 23180864 PMCID: PMC3544192 DOI: 10.1177/1077559512467396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Affiliation(s)
- Susan J Spieker
- Family & Child Nursing, University of Washington, Seattle, WA 98195, USA.
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Oxford ML, Lee JO. The effect of family processes on school achievement as moderated by socioeconomic context. J Sch Psychol 2011; 49:597-612. [PMID: 21930011 DOI: 10.1016/j.jsp.2011.06.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2010] [Revised: 06/16/2011] [Accepted: 06/24/2011] [Indexed: 01/01/2023]
Abstract
This longitudinal study examined a model of early school achievement in reading and math, as it varies by socioeconomic context, using data from the NICHD Study of Early Child Care and Youth Development. A conceptual model was tested that included features of family stress, early parenting, and school readiness, through both a single-group analysis and also a multiple-group analysis. Latent profile analysis was used to identify subgroups of more advantaged and less advantaged families. Family stress and parenting were shown to operate differently depending on the socioeconomic context, whereas child-based school readiness characteristics were shown to operate similarly across socieodemographic contexts. Implications for intervention are discussed.
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Affiliation(s)
- Monica L Oxford
- Department of Family and Child Nursing at the University of Washington, School of Social Work, Box 357920, Seattle, WA 98195, USA.
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Oxford ML, Lee JO, Lohr MJ. Predicting Markers of Adulthood among Adolescent Mothers. Soc Work Res 2010; 34:33-44. [PMID: 24511218 PMCID: PMC3917503 DOI: 10.1093/swr/34.1.33] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2008] [Revised: 01/06/2009] [Accepted: 01/26/2009] [Indexed: 05/27/2023]
Abstract
This prospective longitudinal study examines the antecedents of adolescent mothers' transition into adulthood and their attainment of multiple adult statuses in their early 30s in a nonclinical sample. The distribution, timing, and impact of factors in adolescence (education, employment, marriage, economic status, criminal involvement, and others) are shown relative to their impact on the transition into adulthood and attainment of typical markers of adulthood (employment, economic status, marriage, postsecondary education, and family formation). Descriptive data of demographic variables for adolescent mothers are reported from birth of child at average age 16 through 16 years postpartum at average age 32. Logistic regression results indicate that of all the factors examined in adolescence, on-time graduation from high school or receipt of a GED (by age 19) influenced the attainment of multiple markers of adulthood. Implications for intervention and policy with regard to completion of basic education are discussed.
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Affiliation(s)
- Monica L. Oxford
- Send correspondence to Monica Oxford, School of Social Work, University of Washington, 4101 15th Avenue NE, Seattle, WA 98105; e-mail:
| | | | - Mary Jane Lohr
- School of Social Work, University of Washington, Seattle
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Booth-Laforce C, Oxford ML. Trajectories of social withdrawal from grades 1 to 6: prediction from early parenting, attachment, and temperament. Dev Psychol 2008; 44:1298-313. [PMID: 18793064 DOI: 10.1037/a0012954] [Citation(s) in RCA: 144] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
From 1,092 children in the NICHD Study of Early Child Care and Youth Development, the authors identified 3 trajectory patterns of social withdrawal from teacher reports in Grades 1-6: a normative consistently low group (86%), a decreasing group (5%) with initially high withdrawal that decreased, and an increasing group (9%) with initially low withdrawal that increased. Prediction models supported the role of early dysregulated temperament, insensitive parenting, and attachment. Preschool shy temperament was a specific pathway to decreasing withdrawal, and poor inhibitory control was a specific pathway to increasing withdrawal. Children on the increasing pathway were more lonely, solitary, and were excluded by peers. Results suggest differentiated pathways to varying trajectories of social withdrawal and highlight the importance of identification of longitudinal patterns in relation to risk.
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Gillmore MR, Gilchrist L, Lee J, Oxford ML. Women who gave birth as unmarried adolescents: trends in substance use from adolescence to adulthood. J Adolesc Health 2006; 39:237-43. [PMID: 16857536 DOI: 10.1016/j.jadohealth.2005.12.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2005] [Revised: 11/18/2005] [Accepted: 12/09/2005] [Indexed: 10/24/2022]
Abstract
PURPOSE To determine whether adolescent childbearing mothers "mature out" of substance use as they transition into adulthood, how their substance use compares to that of typical young women of the same ages, and whether there are different patterns of substance use evident in this vulnerable population. METHODS The data come from an ongoing longitudinal study of 240 young women who were unmarried, pregnant, and under age 18 at enrollment. They have been interviewed regularly from pregnancy through 11.5 years postpartum. The data are based on self-reported substance use verified by random urinalysis for drug metabolites. RESULTS Substance use did not decline during the transition to adulthood nor into early adulthood. With the exception of alcohol, the prevalence of substance use was higher than that of a nationally representative sample of same-aged women. Three distinct patterns of substance use were identified: licit users (cigarettes and/or alcohol), marijuana users, and "hard" drug users. CONCLUSIONS Clinicians should routinely assess substance use among young mothers who bore children as teenagers, and make referrals for appropriate treatment. Cigarette smoking is especially a cause for concern, given its widespread use and harmful effects for both mothers and their children. Although only a small proportion (about 5%) of young mothers used hard drugs consistently over time, this group will likely require comprehensive interventions that address multiple issues such as mental health and contextual factors to be effective. Future research should address reasons for continued substance use in this population.
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Oxford ML, Gilchrist LD, Gillmore MR, Lohr MJ. Predicting variation in the life course of adolescent mothers as they enter adulthood. J Adolesc Health 2006; 39:20-6. [PMID: 16781957 DOI: 10.1016/j.jadohealth.2005.08.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2004] [Revised: 07/20/2005] [Accepted: 08/03/2005] [Indexed: 11/15/2022]
Abstract
PURPOSE The purpose of this article is to identify adolescent risk factors that can be used to predict life course pathways (normative, problem-prone, and psychologically vulnerable) in the transition from adolescence to young adulthood in a sample of adolescent mothers. In addition, a cumulative risk index is assessed for its ability to distinguish between the life-course pathways as a potential assessment tool for service providers. METHODS This prospective longitudinal study is based on a diverse sample of adolescent mothers in the Northwest. Data have been collected from pregnancy through adulthood. Five risk factors were used (individually and in a cumulative risk index) to predict young mothers' life course pathways from age 17 through 23 years. RESULTS A multinomial logistic regression indicated that, relative to the normative group, the problem-prone group had significantly greater odds of having a history of school problems, delinquency, and hard substance use. The psychologically vulnerable group had significantly greater odds of mental health problems, hard substance use, and marginally more delinquency. Importantly, the cumulative risk index (the sum of the five risk factors) predicted the patterns of transition into adulthood and demonstrated significant sensitivity and specificity in distinguishing those in the normative pathway from those in either the problem-prone or psychologically vulnerable pathway. CONCLUSIONS Results suggest that specific risk factors assessed at pregnancy can differentiate among adolescent mothers who experience varying levels of success in their transition into early adulthood. The cumulative risk index demonstrates applied utility as a risk assessment tool capable of distinguishing among life-course pathways.
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Affiliation(s)
- Monica L Oxford
- School of Social Work, University of Washington, Seattle, Washington 98105, USA.
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Oxford ML, Gilchrist LD, Morrison DM, Gillmore MR, Lohr MJ, Lewis SM. Alcohol use among adolescent mothers: heterogeneity in growth curves, predictors, and outcomes of alcohol use over time. Prev Sci 2003; 4:15-26. [PMID: 12611416 DOI: 10.1023/a:1021730726208] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
This paper examines patterns of alcohol use over a 10-year period in a sample of adolescent mothers and includes both predictors and outcomes of young mothers' alcohol use patterns over time. This study used mixture modeling to identify latent trajectory classes based on alcohol consumption over 10 years. Results indicate that there is significant heterogeneity in alcohol use trajectories of adolescent mothers during the transition from adolescence to adulthood as well as significant predictors and outcomes that vary by latent class trajectory. Specifically, measures of the consumption of alcohol by both quantity and frequency yielded multiple latent trajectory classes. Alcohol quantity measures yielded a two-class model with higher and lower quantity users. Age at first drink significantly differentiated between the two classes indicating that the younger the respondent was, the more likely she belonged to the higher quantity user class. In addition, members of the higher quantity class had significantly more negative outcomes in adulthood. The second measure of alcohol consumption, alcohol frequency, yielded a four-class solution consisting of low-level users, early decliners, late decliners, and increasers. As with alcohol quantity, age at first drink significantly differentiated between classes, as did age at first birth, in the expected direction. Similarly, two classes with the greatest growth and patterns of use over time, late decliners and increasers, had significantly worse outcomes in adulthood. The results suggest that identifying underlying heterogeneity in alcohol use can be informative with regard to both predictors and outcomes for young women who were adolescent mothers. Results suggest that there are possible higher order factors that can account for the results of this study.
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Affiliation(s)
- Monica L Oxford
- School of Social Work, University of Washington, Seattle, Washington 98105, USA.
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Oxford ML, Harachi TW, Catalano RF, Abbott RD. Preadolescent predictors of substance initiation: a test of both the direct and mediated effect of family social control factors on deviant peer associations and substance initiation. Am J Drug Alcohol Abuse 2001; 27:599-616. [PMID: 11727879 DOI: 10.1081/ada-100107658] [Citation(s) in RCA: 85] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
A review of the literature suggests that early substance initiation is related to a variety of negative outcomes, including substance misuse or abuse in adolescence and adulthood. This study examines potentially modifiable predictors of early substance initiation, including both family and peer factors known to influence early initiation. A theoretically derived model of substance initiation was tested using structural equation modeling. Results indicate that both family and peer factors have an impact on early substance initiation when children in this sample were 11 and 12 years old. The model explained 60% of the variance in substance initiation. Prosocial family processes (rules, monitoring, and attachment) had a significant impact on child peer association, decreasing involvement with antisocial peers. These prosocial family processes had a significant negative effect on substance initiation even while modeling the influence of antisocial peers. Implications for drug use prevention practice are discussed.
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Affiliation(s)
- M L Oxford
- Social Development Research Group, School of Social Work, University of Washington, Seattle 98105-6299, USA.
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Oxford ML, Harachi TW, Catalano RF, Haggerty KP, Abbott RD. Early elementary school-aged child attachment to parents: a test of theory and implications for intervention. Prev Sci 2000; 1:61-9. [PMID: 11521960 DOI: 10.1023/a:1010028113950] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Child attachment to parents has been shown in the literature to reduce the likelihood of problem behaviors through enhancing resiliency. Research examining attachment and its relationship to antisocial behavioral outcomes in adolescents has been shaped largely by social control theorists who have theorized that attachment to prosocial others inhibits the expression of antisocial behavioral outcomes (Hirschi, 1969). This paper seeks to expand the literature by investigating the development of child attachment to parent(s) during the early elementary school years as specified theoretically by the social development model (Catalano & Hawkins, 1996). Using structural equation modeling, the results support the theoretical model as proposed by the social development model. School-aged children's attachment to parents can be successfully predicted by constructs outlined in the social development model. Finally, implications for interventions that enhance child attachment to parent(s) are discussed.
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Affiliation(s)
- M L Oxford
- University of Washington, School of Social Work, Social Development Research Group, USA.
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