Psychological Consultation on a Pediatric Infant Division

A newly developed program of psychological services for infantsin a pediatric hospital is described. In I year, 56 infantsand toddlers were referred for evaluation and treatment-planningfor problems such as delayed cognitive development, child abuseand neglect, chronic illness and prolonged hospitalization,and physical symptoms with a psychosocial basis, including environmentallybased failure to thrive. An active visible presence and caseconferences featuring live demonstration of developmental assessmentfacilitated treatment planning concerning such problems. Althoughpsychological services for infants were well accepted by familiesand pediatric staff, the inconsistent coordination between hospitaland community-based services limited the quality of servicesto infants following hospitalization. Moreover, the lack ofservices for infant psychosocial problems emerged as an importantgap in community mental health services. The development ofhospital and community-based treatment programs for infantsat emotional risk is a priority for the growing field of infantmental health. Developmentally trained psychologists can playa leadership role in the implementation of mental health servicesfor infants in pediatric hospitals.     

Addressing the Needs: Guidelines for Training Psychologists to Work with Children,Youth, and Families

A need exists for criteria for training psychologists who work with children, youth, and families. Recognizing that the provision of competent services is directly related to training for those services, a set of recommendations was adopted by the Executive Committee of the Division on Child, Youth, and Family Services. This paper outlines these recommended experiences and coursework with their rationale for child development and lifespan developmental psychology, child and adult psychopathology, mental retardation and developmental disabilities; specialized child assessment techniques; child psychotherapy and behavior change; parent, family, and school intervention techniques; specialized clinical practice in child, parent, and family therapy; research methods in child psychology; ethics and legal issues related to children, youth, and families; and subspecialties within psychology for children, youth, and families. Examples of training programs meeting these recommended training criteria are discussed.     

Normalizing the development of cortisol regulation in maltreated infants through preventive interventions

Longitudinal effects of child maltreatment on cortisol regulation in infants from age 1 to 3 years were investigated in the context of a randomized preventive intervention trial. Thirteen-month-old infants from maltreating families (N = 91) and their mothers were randomly assigned to one of three intervention conditions: child-parent psychotherapy, psychoeducational parenting intervention, and a control group involving standard community services (CS). A fourth group of infants from nonmaltreating families (N = 52) and their mothers comprised a nonmaltreated comparison (NC) group. The two active interventions were combined into one maltreated intervention (MI) group for statistical analyses. Saliva samples were obtained from children at 10:00 a.m. before beginning a laboratory observation session with their mothers when the children were 13 months of age (preintervention), 19 months (midintervention), 26 months (postintervention), and 38 months (1-year postintervention follow-up). At the initial assessment, no significant differences among groups in morning cortisol were observed. Latent growth curve analyses examined trajectories of cortisol regulation over time. Beginning at midintervention, divergence was found among the groups. Whereas the MI group remained indistinguishable from the NC group across time, the CS group progressively evinced lower levels of morning cortisol, statistically differing from the MI and NC groups. Results highlight the value of psychosocial interventions for early child maltreatment in normalizing biological regulatory processes.     

Developing pathways to assist parents to exit the child protection system in Australia

The prevalence of child abuse and neglect is an international concern that justifies the existence of child protection systems. An important first principle for all such statutory child protection systems is to ensure that the system itself does no further harm. It can be argued that there are specific circumstances within which well‐meaning services have the potential to do harm: specifically, processes and actions that disempower parents by reducing their autonomy and capacity for positive action. Exploring the circumstances in which reduced parental autonomy impacts negatively on families is an important first step in developing procedures for working with families that not only avoid harm but are orientated to produce meaningful change. Two evidence‐based programs are described that together have the potential to assist child protection practitioners to develop a collaborative helping partnership with families, clarify goals for change and support parents to achieve meaningful improvement in their family functioning. The programs described are both manualised and have empirical support for their effectiveness. The potential benefits for both families and practitioners working within child protection agencies in the two programs are described.     

IMPLEMENTATION OF A COMMUNITY‐BASED FAMILY‐CENTERED PROGRAM IN PORTUGAL: A MULTIPLE CASE STUDY EVALUATION

Family‐centered, community‐based programs are particularly suited to support families with at‐risk children or maltreated children and achieve family preservation or reunification. In these child protection and child welfare cases, assessment is of great importance to inform decision making. But the implementation of services to support the families change and its evaluation in real settings is not without challenges. The Integrated Family Assessment and Intervention Model (IFAIM) was designed to conduct assessment and intervention with multichallenged families with at‐risk or maltreated children and support the activities of the child protection system. In this article, we describe a pragmatic, focused on improvement, action research multicase study of the process and outcome of IFAIM's first implementation. Multiple factors affected implementation, namely, factors related with the teams, the organizations, and the communities. An improved model of implementation based on the evaluation results is proposed.     

Introduction to the Special Section: Disadvantaged Children and Families

Provides an overview of some of the outstanding issues confronting psychologists and other health service providers involved in the treatment of disadvantaged children and families. The diverse ways in which clinical child psychology can contribute to enhanced care for underserved families are briefly outlined and exemplified by reference to articles included in this section. A call is issued for an intensified effort by clinical child psychologists to ensure that services to such children and families constitute a priority for future research, advocacy, and service system change efforts.     

Application of a community needs assessment survey to decategorization of child welfare services

Decategorization is a process of restructuring funding sources and services to encourage interagency collaboration, out-of-home placement prevention, and innovative programming driven by needs of families as opposed to bureaucratic contingencies. In this study a community needs assessment survey was used as one of the first steps in decategorization program planning. The survey assessed the most serious problems, the priorities for tax dollar support, and the service needs in a county beginning decategorization of child welfare services. Methods, results, and implications are discussed and compared to other types of data available about needs of the residents of the county as a model for other communities that may be undertaking decategorization projects or other large-scale planning efforts.     

Hospital-based case management for medically fragile infants: results of a randomized trial.

A recent federal law has expanded the eligibility for multidisciplinary evaluation and assessment of infants suspected of developmental delay. At the same time, modern neonatal care has increased infant survival. These two developments have created a need for family education regarding the need for health and developmental intervention, as well as counseling to maintain family participation in these services. This study compares the education and counseling services of a hospital-based case management team with the traditional discharge and follow-up services of a neonatal intensive care unit (NICU). Subjects were the 10% most medically severe infants discharged from a neonatal intensive care unit over a 16-month period. Preliminary data suggests a significantly greater number of families accessed community-based, coordinated, comprehensive health and developmental services when they received case management services. The data suggest that hospital professionals generally refer the most medically severe 3% of this group for services under a traditional model. However, the additional 7% referred under the transition model showed greater developmental benefits from the services during the first 6 months of life. These data support current federal initiatives for early intervention services which are family-centered, community-based and coordinated.     

Marital Adjustment,Marital Discord Over Childrearing,and Child Behavior Problems: Moderating Effects of Child Age

Examined whether marital discord over childrearing contributes to child behavior problems after taking into account general marital adjustment, and if child age moderates associations between child behavior problems and either general marital adjustment or marital discord over childrearing. Participants were 146 two-parent families seeking services for their child's (4 to 9 years of age) conduct problems. Data on marital functioning and child behavior problems were collected from both parents. Mothers' and fathers' reports of marital discord over childrearing related positively to child externalizing problems after accounting for general marital adjustment. Child age moderated associations between fathers' reports of general marital adjustment and both internalizing and externalizing child problems, with associations being stronger in families with younger children. The discussion highlights the role that developmental factors may play in understanding the link between marital and child behavior problems in clinic-referred families.     

Treatment effectiveness of Parent Management Training in Norway: a randomized controlled trial of children with conduct problems

This study was a randomized control trial (RCT) of Parent Management Training--The Oregon Model (PMTO) in Norway. A sample representing all health regions of Norway and consisting of 112 children with conduct problems and their families participated in the study. Families were randomly assigned to either PMTO or a regular services comparison group. PMTO was delivered via existing children's services, and families were recruited using the agencies' regular referral procedures, making this the first effectiveness study of PMTO and the first RCT of PMTO conducted outside of the United States. Using a multiagent-multimethod approach, results showed that PMTO was effective in reducing parent-reported child externalizing problems, improving teacher-reported social competence, and enhancing parental discipline. Age level and gender modified the effects of PMTO treatment on other outcomes. In a path model, participation in PMTO was associated with improved parental discipline, and effective discipline predicted greater child compliance, fewer child-initiated negative chains, and lower levels of child externalizing problems. Findings are presented along with a discussion of the implications for practice and research and the challenges accompanying effectiveness trials.     

Practical guidelines for educating policymakers: the family impact seminar as an approach to advancing the interests of children and families in the policy arena.

Psychologists are well positioned to contribute to policymaking on issues affecting the well-being of children, youth, and families. A good deal of psychological research is relevant to policy issues such as child mental health services, child care, adoption and foster care, and children's media. In this article we offer an alternative to direct policy advocacy as a means for psychologists' involvement in the policy arena. Policy education, a nonpartisan and nonadversarial approach to working with policymakers, is described and differentiated from child advocacy. We then present an example of 1 approach to policy education, the Family Impact Seminar. The article closes with a discussion of lessons we have learned regarding effectively communicating research to policymakers.     

Practical Guidelines for Educating Policymakers: The Family Impact Seminar as an Approach to Advancing the Interests of Children and Families in the Policy Arena

Psychologists are well positioned to contribute to policymaking on issues affecting the well-being of children, youth, and families. A good deal of psychological research is relevant to policy issues such as child mental health services, child care, adoption and foster care, and children's media. In this article we offer an alternative to direct policy advocacy as a means for psychologists' involvement in the policy arena. Policy education, a nonpartisan and nonadversarial approach to working with policymakers, is described and differentiated from child advocacy. We then present an example of 1 approach to policy education, the Family Impact Seminar. The article closes with a discussion of lessons we have learned regarding effectively communicating research to policymakers.     

PREDICTORS OF STUDY RETENTION FROM A MULTISITE STUDY OF INTERVENTIONS FOR CHILDREN AND FAMILIES EXPOSED TO VIOLENCE

Evaluation of interventions for children exposed to violence is critical for informing dissemination of effective services nationally, but retention rates in such studies are typically low, jeopardizing intent‐to‐treat analytic approaches. We examine predictors of retention (demographics, violence exposure, child mental health, caregiver demographics, and engagement in intervention) in a large multisite national study of interventions for children exposed to violence. Our analyses found that families were more likely to be retained in the study at 6 months if caregivers rated their own physical health as poor or fair, the child experienced higher levels of maltreatment, or the family was assigned to the intervention group within the study. In models limited to those families in the study's intervention group, only receipt of services was significantly related to study retention. Methods with which to increase retention in family therapy programs for at‐risk families are discussed.     

Reducing conduct problems among children of battered women.

This study was an experimental evaluation of an intervention designed to reduce conduct problems among children of battered women. Participants were 36 families (mothers and children) in which the mother had sought shelter because of relationship violence and had at least 1 child (4-9 years old) with clinical levels of conduct problems. The intervention consisted of 2 primary components: (a) providing instrumental and emotional support and (b) teaching child management skills to mothers. Families were randomly assigned to either the intervention condition or the existing services comparison condition and were assessed on 5 occasions over 16 months after shelter departure. Compared with families receiving existing services, children in the intervention condition improved at a faster rate, the proportion of children displaying clinical levels of conduct problems was greatly diminished, and mothers displayed greater improvements in child management skills.     

Meeting between experts: evaluation of the first UK forum for lay and professional experts in intersex

At present the clinical management of intersex is in turmoil. The policy of non-disclosure of diagnosis is widespread and cosmetic genital surgery is routinely performed on infants throughout the world. Some clinicians feel such practices are in the interest of the intersex child and the family, but some intersex adults are calling for a moratorium on sex assignment genital surgery. These widely opposing views have led to distrust between groups. One way to begin to address these critical issues is to facilitate dialogue with equal input from clinicians and intersex people and families. Clinicians are experts by training, but patients and families are experts through lived experiences. Our paper reports the rationale, process and outcome of the first UK forum bringing together these different experts to address some of the most complex issues in clinical services. In communicating our experiences, we hope that it will provide a useful reference point for those seeking similar service-user/provider collaboration in other areas of medicine.     

Recurrence of perinatal lethal osteogenesis imperfecta in sibships: Parsing the risk between parental mosaicism for dominant mutations and autosomal recessive inheritance

PurposeRecurrence of lethal osteogenesis imperfecta in families results from either dominant (parental mosaicism) or recessive inheritance. The proportion of these two mechanisms is not known, and determination of the contribution of each is important to structure genetic counseling for these families.MethodsWe measured the recurrence rate of lethal osteogenesis imperfecta after the birth of an affected infant. We determined the rate of parental mosaicism in a subset of families in which we had identified dominant mutations. In 37 families in which two or more affected infants were born, we identified mutations and determined the proportion that resulted from recessive inheritance.ResultsThe recurrence rate after the first affected pregnancy was 1.3%. The rate of parental mosaicism in families in which a dominant mutation was identified in a first affected child was 16%. In 37 families with two affected infants, 26 had dominant mutations, seven had recessive mutations, and we failed to find mutations in four. The overall recurrence rate for couples after two or more affected infants was 32%; 27% for families with parental mosaicism, 31% for recessive mutations, and 50% for families with no identified mutation.ConclusionsIn most populations, recurrence of lethal osteogenesis imperfecta usually results from parental mosaicism for dominant mutations, but the carrier frequency of recessive forms of osteogenesis imperfecta will alter that proportion. Mutation identification is an important tool to assess risk and facilitate prenatal or Genet Med 2011:13(2):125–130.     

Observational assessment of family functioning at mealtime in preschool children with cystic fibrosis

OBJECTIVE: To examine functioning during a dinner meal in families of a child with a chronic illness that requires dietary treatment recommendations, as compared to families of a child without a chronic illness. METHODS: Ratings of seven dimensions of family functioning on the McMaster Mealtime Family Interaction Coding System (MICS) were obtained on 29 families of children with CF and 29 families of children with no chronic illness, ages 2 to 6 years, during a videotaped dinner meal at home. RESULTS: Ratings of families with a child with CF were significantly lower than those for families of children without a chronic illness on Overall Family Functioning and five of the six MICS dimensions: Communication, Interpersonal Involvement, Affect Management, Behavior Control, and Role Allocation and approached significance on the Task Accomplishment dimension. The ratings of families of a child with CF were in the "clinically significant" range on all subcales, including Task ACCOMPLISHMENT. CONCLUSIONS: This study suggests that family functioning at mealtimes may be different in families of children with CF in which explicit dietary guidelines exist than in families of children with no illness or dietary guidelines. These results are discussed in terms of global family functioning and treatment approaches to dietary treatment recommendations.     

Hospital-based case management for medically fragile infants: program design.

A hospital-based multidisciplinary team is demonstrating services for medically fragile infants which facilitate transition from the hospital to the community and home. The team provides education and counseling for communities and families to overcome barriers to services. With individualized case management, the team facilitates family access to the community services they need in infant health, infant development and family functioning. The team plans the infant's discharge from the hospital and collaborates on the initial Individualized Family Service Plan (IFSP) with the family and local community providers. The initial IFSP details potential outcomes in the areas of infant health, infant development and family functioning for the first year the infant is home. Systematic home visits with the team's nurse or developmental consultant, the family and the local provider continue the education and counseling process during the infant's first year of life. This describes the educational aspect of case management services for medically fragile infants.     

Families of the Developmentally Disabled (Book)

Mothers and fathers from 52 two-parent families—26 families with a normal child and 26 families with an attention-deficit-disordered/hyperactive (ADDH) child—independently completed questionnaires regarding child behavior; time for individual, couple, and family activities; extended family and community contacts; depression; and family functioning. The communication, problem solving, role allocation, behavioral control, affective responsiveness, affective involvement, and general functioning of normal and ADDH families did not differ significantly. Families of ADDH children reported fewer extended family contacts and described these as less helpful. Mothers of ADDH children reported higher depression scores than their husbands or the mothers of normal children did. Alcohol consumption was higher in families of ADDH children than in those of normal children and was higher in mothers. Mothers' depression ratings were linked both to family functioning and to child behavior, whereas fathers' depression ratings were linked only to family functioning.