Providing Continuity in Infant Mental Health Services for Medically Fragile Infants and Their Families

Having a baby who is prenatally or postnatally diagnosed with a medical condition places considerable stress on the parents, infants, and their developing relationship. Infant mental health (IMH) services offer an opportunity to address the challenges and support the parent-infant relationship. The present study outlined a continuum of care IMH program embedded within various medical settings of a large metropolitan children's hospital. Applications of IMH principles within the fetal care center, neonatal intensive care unit, high risk infant follow-up clinic, and the patient's home are described. Descriptive data about families served across settings and a case study are provided in order to illustrate the implementation of this unique IMH intervention model.

Early childhood predictors of global competence in adolescence for youth with typical development or intellectual disability

BACKGROUND AND AIMS

We aimed to determine whether a second-order global competence latent factor could be identified as underlying relations between adolescent mental health, social skills, and academic functioning. A secondary aim was to test whether early childhood characteristics predict adolescent global competence. A final aim was to test differences in these models across youth with typical cognitive development (TD) or intellectual disability (ID).

METHODS AND PROCEDURES

Participants were 246 youth with TD (n = 148) or ID (n = 98), with assessments from early childhood (3, 4, 5 years) and adolescence (13, 15). These youths' parents and teachers provided measures. A Multiple Indicator, Multiple Causes (MIMIC) model was tested using structural equation modeling, in which parenting, maternal depression, and emotional dysregulation in early childhood were entered as predictors of adolescent global competence.

OUTCOMES AND RESULTS

A second-order global competence factor emerged, and was predicted by early childhood variables. The final MIMIC model demonstrated excellent fit. Negative parenting in early childhood predicted lower adolescent global competence for both TD and ID youth. Maternal depression predicted adolescent global competence only for youth with ID, while emotion dysregulation predicted only for youth with TD.

CONCLUSIONS AND IMPLICATIONS

Results have implications for longitudinal mechanisms of influence and early intervention targets for specific populations.

Emergent Life Events: An In-Depth Investigation of Characteristics and Provider Responses during Youth Evidence-Based Treatment

Emergent life events (ELEs), or acute client stressors disclosed within psychotherapy sessions, are not addressed by many evidence-based psychosocial treatments (EBTs). Preliminary provider-report studies suggest that ELEs may interfere with effective EBT implementation. The present study offers a detailed, observational examination of ELEs and their impact on EBT within therapy sessions. Data were observationally coded from 274 sessions with 55 primarily low-income, Latino youth clients (58% male, ages 5-15) in the modular EBT condition (Modular Approach to Therapy for Children [MATCH]) of the Child STEPs California trial. The ELE Coding System-Revised was used to measure ELEs, their characteristics, and provider responses to ELEs, including provider adherence to MATCH. Interrater reliability was generally high. At least one ELE was identified in 13% of randomly selected sessions. ELEs ranged widely in content, and their characteristics did not cluster together. Providers responded more frequently to ELEs with non-EBT content (e.g., information gathering, empathy) than EBT content; use of the ELE as a "teaching moment" for EBT content was the least common response (40% of ELEs). Multilevel regression analyses revealed that compared to sessions without an ELE, ELE sessions were significantly associated with reduced provider adherence to MATCH. Within ELE sessions, higher client distress when discussing the ELE was associated with reduced provider adherence to MATCH, but only when ELE severity was high. Beyond provider report, observational measures indicate that ELEs are prevalent and unpredictable in community settings and disrupt EBT delivery. Findings can inform the development of structured ELE management procedures to enhance existing EBTs.

Emotion socialization and internalizing behavior problems in diverse youth: A bidirectional relationship across childhood

Mothers' and fathers' emotion socialization (ES) practices have been widely associated with child socioemotional outcomes. To extend this research, we examined the bidirectional relationship between parent ES practices (supportive and non-supportive parenting) and internalizing behavior problems in children of Anglo and Latino parents. Participants were 182 mothers and 162 fathers and their children with or without intellectual disability (ID). We compared the stability of mother and father ES practices across child ages 4-8. We utilized cross-lagged panel modeling to examine the bidirectional relationship between parents' ES and child internalizing behavior problems. Emotion socialization practices differed across time by parent gender, with mothers displaying higher levels of supportive parenting and lower levels of non-supportive parenting than fathers. Cross-lagged panel models revealed differential relationships between child internalizing behaviors and emotion socialization practices by parent gender and by ethnicity. Implications for intervening with culturally diverse families of children with ID are discussed.

Unsupportive parenting and internalising behaviour problems in children with or without intellectual disability

BACKGROUND

Children with intellectual disability (ID) are at heightened risk for developing other psychological disorders, including internalising disorders. Anxiety and depression have been shown to be familial, and parenting is a contributing factor to the development of these disorders. To extend this research, we examined the extent to which mother and father depression and negative, unsupportive parenting related to child internalising behaviour problems, in children with ID or with typical development (TD).

METHOD

Participants were 156 mother and father dyads and their children, assessed at ages 4 and 5 years. We examined parent (mother and father) and child delay status (ID and TD) in relation to measures of both observed and self-reported unsupportive, negative parenting. Utilising moderation models, we examined the relationship between parental depression, unsupportive/negative parenting and child internalising behaviour problems.

RESULTS

Unsupportive, negative parenting differed based on parent gender and child delay status. In addition, father depression was a significant moderator of the relationship between unsupportive parenting and child internalising behaviour problems.

CONCLUSIONS

Children with ID were found to be at higher risk of experiencing unsupportive, negative parenting than children with TD. Children of depressed fathers were especially vulnerable to developing internalising behaviour problems in an unsupportive parenting context.

Fathers of children with or without ID: understanding long-term psychological symptoms

BACKGROUND

Researchers have primarily relied on mother report to understand the parenting contexts of rearing children with intellectual disabilities. Fathers are increasingly being considered as equally important reporters of their child's behaviours, as they have unique and independent relationships with their children. The purpose of this study was to understand how one source of stress - reports of child behaviour problems - along with spousal support related to parenting tasks, associated with fathers' reports of psychological symptoms over time.

METHOD

One hundred eighty-two father participants completed measures of child behaviour problems, spousal support and psychological symptoms. Growth curve modelling was employed to examine paternal psychological symptoms over the child's developmental trajectory.

RESULTS

Fathers' reports of child behaviour problems predicted initial levels of paternal psychological symptoms but did not predict change in paternal psychological symptoms over time. Spousal support further reduced initial levels of paternal psychological symptoms.

CONCLUSIONS

Child behaviour problems are more important than disability status in predicting father's psychological symptoms. Spousal support predicts paternal psychological symptoms and can be viewed as an additional resource for fathers. Implications for research and practice are discussed.