SUPPORTING POSITIVE PARENTING IN COMMUNITY HEALTH CENTERS: THE ACT RAISING SAFE KIDS PROGRAM

The present study involves an evaluation of the effect of the American Psychological Association's ACT Raising Safe Kids (RSK) program on parenting outcomes for families served by Community Health Centers. The ACT‐RSK program is a primary family violence and child physical abuse prevention program for parents of young children. Parents were trained in effective parenting including nonviolent discipline, child development, anger management, social problem‐solving skills, effects of violent media on children, and methods to protect children from exposure to violence. Results indicate improved nurturing and positive parenting behaviors and lower rates of psychologically and physically aggressive behavior toward children. These improvements occurred independent of children's age and prior levels of aggression. Use of this model within healthcare settings has the potential to more effectively address parents’ needs for parenting guidance while reducing the likelihood of child maltreatment.     

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.     

Caregiver issues and AIDS orphans: perspectives from a social worker focus group.

This study examines social workers'' perceptions of the needs of families coping with acquired immunodeficiency syndrome (AIDS). This research investigates the problems of family caregivers of children orphaned by human immunodeficiency virus (HIV)-related death of their parents. A qualitative semistructured interview format was used in a focus group of 18 social workers. Four questions were designed to assess family needs and resources, as well as to evaluate the social workers'' perspectives of governmental policies affecting these families. A list of four problems and two recommendations for change evolved from the focus group. Inadequate finances to house and care for the children was the primary cause for distress in these families. The major governmental policy that hindered the social workers'' ability to assist families pertained to the low financial entitlement for caregivers who are related to the orphaned child. It was noted that unrelated caregivers receive substantially more money for the care of these children than family caregivers receive. Recommendations were made to change this policy and to develop guardianship laws that facilitate families'' abilities to provide care to AIDS orphans. Family caregivers of AIDS orphans are bombarded with great demands and limited resources. This analysis of their situation from the social workers'' perspective is a positive step toward the improvement of support services for these families. Further research should include individual qualitative interviews assessing the needs of the caregivers and AIDS orphans.     

Family processes among Latino Early Head Start families: Understanding the role of caregiver acculturation

The Family Stress Model (FSM) provides a framework for how economic pressure can impact family processes and outcomes, including parent's mental health, parenting, and child problem behaviors. Although the FSM has been widely replicated, samples disproportionately impacted by poverty, including early childhood samples and in particular Latino families with young children, have been largely excluded from FSM research. Therefore, among a sample of Latino Early Head Start children (N = 127), the current study evaluated a modified FSM to understand the direct and indirect pathways among economic pressure, parental depression, parenting self‐efficacy, the parent–child relationship, child problem behaviors, and parental acculturation. Results showed that the majority of the direct FSM pathways were well‐replicated among Latino caregivers of young children. Further analyses illuminated how some pathways were replicated among more but not among less‐acculturated Latino parents. Implications for future FSM research with Latino families as well as for parent‐focused interventions are discussed.     

Linking urban families to community resources in the context of pediatric primary care

Introduction

Pediatric guidelines emphasize the importance for healthcare providers to view children in the context of family and community, and promote community resources at visits. In 2006, a Family Help Desk (FHD) was established in an urban academic-based clinic in Baltimore, MD to assist healthcare providers in educating families about available community-based resources.

Methods

A longitudinal cohort pilot study was conducted during a 6-week period in 2007 to evaluate the impact of the FHD in connecting at-risk families to community resources.

Results

Overall, 6% of parents (n = 59) who brought their child for a scheduled clinic visit accessed the FHD. Parents had a mean of 1.7 social needs, including after-school programs and childcare (29%), employment (13%), housing (12%), and food (11%). Most parents who utilized the FHD (64%) contacted a community resource or service within 6 months of their clinic visit. Nineteen parents (32%) who utilized the FHD enrolled in community programs.

Conclusion

A clinic-based multi-disciplinary model can empower families to connect with community-based resources for basic social needs.

Practice implications

The Family Help Desk model has great potential for addressing family psychosocial needs, and educating families about community resources within the context of pediatric primary care.     

Family well‐being and disabled children: A psychosocial model of disability‐related child behaviour problems

Background: When parents receive a diagnosis that their child is disabled, many families adjust to this healthily and cope well, but others do not. Feelings of hopelessness, social isolation of the family within the community and child behaviour problems have all been reported. While utilization of social support systems is well documented in the literature as being a significant factor in family coping and adjustment to the child's disability, less attention has been focused on the role of psychological factors. Objective: This theoretical study aims to address this inbalance by integrating perspectives from a social model of disability with psychological research on the role of cognitive change in families' coping and adjustment to having a disabled child, and thus to produce a new psychosocial model of disability‐related child behaviour problems. Method: Negative societal attitudes to disability identified by a social model of disability are interpreted with respect to how they might translate to parent views of their disabled child within the family. Resultant parenting beliefs and their possible implications for family interaction, child behaviour and family health and well‐being are explored within this new framework. Conclusions: The psychosocial model of disability‐related child behaviour problems provides a useful conceptual framework that has both clinical and research implications for professionals working with families with disabled children.     

Assessment of parenting practices in families of elementary school-age children

Tested multimethod and multi-informant assessment of parenting practices in families of clinic-referred children between the ages of 6 and 13 (n = 124) and in families of community volunteer children (n = 36) who were comparable to the clinic group on age and sex of child, family ethnicity, and parental marital status. In general, children's report was no1 useful for assessing the parenting constructs using either a global report format or multiple telephone interviews. This was especially true for younger children (below age 9) and for child report on the telephone interviews, whereby children tended to respond using a consistent response set. In contrast, both assessment formats for obtaining parental report showed good utility. Reports from parents (in most cases the child's mother) generally were not strongly associated with measures of socially desirable responding, and parental report showed expected age trends and expected associations with socioeconomic status. Most important, both parental report formats were useful for differentiating families of children with disruptive behavior disorders (defined by teacher report alone) from families of normal volunteer children screened for disruptive behavior disorders.     

Primary care supports for children with chronic health conditions: identifying and predicting unmet family needs

Objective To examine unmet needs among families of childrenwith chronic health conditions treated in primary care settingsand to identify predictors of these needs. Method Primarycare physicians referred 83 caregivers of children with chronichealth conditions. Mothers completed the Family Needs Survey,as well as other measures of child and family functioning. Results Mothersreported a high prevalence and broad range of unmet family needs.The most frequent area of need was for information about servicesand ways to promote child health and development. Predictorsof total number of family needs included demographic characteristics,ratings of social support, and appraisals of family burden.Predictors of specific types of family needs varied accordingto category of need. Conclusions Innovative psychosocialintervention programs are needed in primary care settings toreduce family needs and promote child health. More intensivefamily supports may be indicated for those with minority-groupor low socioeconomic status, limited social support, or highperceived burden.     

Event-Related Household Discussions Following the Boston Marathon Bombing and Associated Posttraumatic Stress Among Area Youth

Despite research documenting the scope of disaster-related posttraumatic stress (PTS) in youth, less is known about how family processes immediately postdisaster might associate with child outcomes. The 2013 Boston Marathon bombing affords a unique opportunity to assess links between immediate family discussions about community trauma and child mental health outcomes. The present study examined associations between attack-related household discussions and child PTS among Boston-area youth ages 4 to 19 following the Marathon bombing (N = 460). Caregivers completed surveys 2 to 6 months postattack about immediate household discussions about the events, child exposure to potentially traumatic attack-related experiences, and child PTS. During the Marathon bombing and manhunt, there was considerable heterogeneity in household discussions across area families, and several discussion items were differentially predictive of variability in children’s PTS. Specifically, after controlling for children’s direct exposure to the potentially traumatic attack/manhunt events, children showed lower PTS when it was their caregivers who informed them about the attack and manhunt, and when their caregivers expressed confidence in their safety and discussed their own feelings about the manhunt with their child. Children showed higher PTS when their caregivers did not discuss the events in front of them, asked others to avoid discussing the events in front of them, and expressed concern at the time that their child might not be safe. Child age and traumatic attack/manhunt exposure moderated several links between household discussions and child PTS. Findings underscore the importance of family communication and caregiver modeling during times of community threat and uncertainty.     

Family resources and stress: a comparison of families of children with cystic fibrosis, diabetes, and mental retardation.

Assessed patterns of stress in families of children with pediatric conditions that varied on 2 dimensions: (a) fatal vs. nonfatal outcome and (b) presence vs. absence of cognitive impairment. Families of children with cystic fibrosis (n = 23), diabetes (n = 24), and moderate mental retardation (n = 24) were compared to families of well children (n = 24) in 3 age groups. Maternal responses to a multidimensional measure of family stress, the Questionnaire on Resources and Stress--Short Form (QRS-S), indicated that families of children with chronic conditions did not differ from families of well children on scales assessing generic aspects of family stress, such as family conflict. However, diagnostic groups differed on QRS-S scales assessing stressors specific to the child's disability (e.g., families of children with mental retardation were characterized by concerns about caring for the child as an adult). There was no evidence of higher levels of stress for families of older children. Data on the internal consistency of QRS-S scales and their relation to measures of maternal and child adjustment are presented.     

Community attitudes toward childhood suicide and attempted suicide

To assess whether people's reactions to family members of child suicide attemptors were similar to reactions to family members of (a) actual suicides and (b) actual suicides that were preceded by a failed suicide attempt, 120 shoppers (60 men and 60 women) read and responded to one of five short newspaper articles about an incident of a 10-year-old child who either (a) attempted suicide, (b) committed suicide, (c) committed suicide after a previous suicide attempt, (d) died accidentally, or (e) died of a viral illness. Opinions about the psychological health of the victim and reactions to the surviving family varied depending on the nature of the incident. However, in many instances reactions to families of suicide attemptors could not be differentiated from reactions to families of actual suicides. Therefore, it is likely that the number of people affected by negative community reactions to suicidal behavior has been previously underestimated.     

Examining the service‐related experiences and outcomes of caregivers involved in a system of care who experienced everyday discrimination

Individuals who report everyday experiences of discrimination are at heightened risk for adverse health outcomes and tend to report underutilization of health services. Systems of care (SOCs) have the potential to engage members of minority groups and to reduce health disparities. We examined the service‐related experiences of predominantly Latinx caregivers enrolled in a SOC for their children with severe psychological health needs. We used independent samples t‐tests and regression analyses to compare relations among service access, perceived service characteristics, and caregiver stress according to whether caregivers reported frequent or infrequent discrimination. The frequent discrimination group scored significantly higher on dimensions of stress and had greater dosage than the infrequent group. There were no differences in relations between service characteristics and outcomes by group. Findings indicated important differences in the service‐related experiences and outcomes of caregivers who reported frequent and infrequent discrimination. We discuss limitations and implications.     

Family environment patterns in families with bipolar children

BACKGROUND: We studied the characteristics of family functioning in bipolar children and healthy comparison children. We hypothesized that the family environment of bipolar children would show greater levels of dysfunction as measured by the Family Environment Scale (FES). METHODS: We compared the family functioning of 36 families that included a child with DSM-IV bipolar disorder versus 29 comparison families that included only healthy children. All subjects and their parents were assessed with the K-SADS-PL interview. The parents completed the FES to assess their current family functioning. Multivariate analysis of variance was used to compare the family environment of families with and without offspring with bipolar disorder. RESULTS: Parents of bipolar children reported lower levels of family cohesion (p<0.001), expressiveness (p=0.005), active-recreational orientation (p<0.001), intellectual-cultural orientation (p=0.04) and higher levels of conflict (p<0.001) compared to parents with no bipolar children. Secondary analyses within the bipolar group revealed lower levels of organization (p=0.031) and cohesion (p=0.014) in families where a parent had a history of mood disorders compared to families where parents had no history of mood disorders. Length of illness in the affected child was inversely associated with family cohesion (r=-0.47, p=0.004). LIMITATIONS: Due to the case-control design of the study, we cannot comment on the development of these family problems or attribute their cause specifically to child bipolar disorder. CONCLUSION: Families with bipolar children show dysfunctional patterns related to interpersonal interactions and personal growth. A distressed family environment should be addressed when treating children with bipolar disorder.     

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.     

Pathways between profiles of family functioning, child security in the interparental subsystem, and child psychological problems

This study was designed to delineate pathways between systems profiles of family functioning, children's emotional insecurity in the interparental relationship, and their psychological adjustment in a sample of 221 children and their parents. Consistent with family systems theory, cluster analyses conducted with assessments of marital, coparental, and parent-child functioning indicated that families fit into one of four profiles: (a) cohesive families, characterized by warmth, affection, and flexible well-defined boundaries in family relationships; (b) disengaged families, reflected in high levels of adversity and low levels of support across family subsystems; (c) enmeshed families, evidenced by high levels of discord and weak maintenance of relationship boundaries in the family unit; and (d) adequate families, defined by elevated parental psychological control within a larger family context of low discord and high warmth. In comparison to children in cohesive families, children in enmeshed and disengaged families exhibited greater signs of insecurity in the interparental relationship concurrently and internalizing and externalizing symptoms both concurrently and 1 year later. Structural equation models revealed that a latent, multimethod measure of insecurity in the interparental relationship partially mediated associations between family enmeshment and disengagement and children's psychological symptoms 1 year later. Results are discussed in relation to how they inform and refine a family-wide model of the emotional security hypothesis.     

Early Childhood Internalizing Problems in Mexican- and Dominican-Origin Children: The Role of Cultural Socialization and Parenting Practices

This study examined mother- and teacher-rated internalizing behaviors (i.e., anxiety, depression, and somatization symptoms) among young children using longitudinal data from a community sample of 661 Mexican and Dominican families and tested a conceptual model in which parenting (mother's socialization messages and parenting practices) predicted child internalizing problems 12 months later. Children evidenced elevated levels of mother-rated anxiety at both time points. Findings also supported the validity of the proposed parenting model for both Mexican and Dominican families. Although there were different pathways to child anxiety, depression, and somatization among Mexican and Dominican children, socialization messages and authoritarian parenting were positively associated with internalizing symptoms for both groups.     

Interactions Between Children and Abusive Versus Control Parents

Forty-five families (22 court-referred abusive families and 23 control families) participated in a laboratory play task as part of a larger study on family processes and child abuse (Reid, 1986). We led each family into a play room, asked the parents to play with the child for a 10-min period, and then asked them to have the child help clean up. We videotaped all sessions and coded the tapes using the Fagot Interactive Code, with the child's behavior categorized as passive, verbal communication, aversive, and narrative play. Although control children talked significantly more than abused children, botch abused and control children responded equally often to parent initiations of interaction. We grouped parent responses into positive and negative clusters. Abusive parents showed significantly less positive parenting than did control parents, and they responded significantly less to the child's initiations of interaction. We discuss the results in terms of lack of prosocial parenting skills of abusing parents.     

What It's Like to Be Me (Book)

Examined family moderators of the relation between everyday stressors (hassles) and behavior problems in 99 inner-city children (ages 8-12 years, M = 10.7) and their caregivers. In separate home interviews children reported on their everyday stress, perceived support from mother, and adjustment problems; mothers reported on family demographics, major life stressors, family interaction patterns, and child adjustment difficulties. Higher levels of cohesion and routines attenuated the relation between hassles and both internalizing and externalizing problem behaviors, whereas high family conflict exacerbated the risk for adjustment difficulties. For externalizing behavior, higher levels of family adaptability protected children from the impact of daily hassles. Social support from the mother did not moderate the hassle-adjustment association. Implications for interventions with families are discussed.     

Economic impact of divorce on children's development: Current findings and policy implications

Examined the economic impact of divorce on families' functioning and children's mental health. U.S. Bureau of the Census (1992b, 1993) data on rates of divorce and remarriage are reviewed, as well as data on economic aspects that both predispose to and result from marital dissolution (Hernandez, 1992). Research regarding the impact of economic stress and poverty on family functioning and child mental health problems is discussed. I make Jive recommendations for social policy that emphasize the need for attention to economic aspects of divorce and their impact on children's and parents' adjustment and well being. Particular attention is devoted to the need for continuity in families' economic standard following divorce, enforcement of child support laws, and new treatment approaches to help children cope with their parents' divorce.     

Parental beliefs and help seeking in mothers' use of a community-based family support program

This study examined mothers' help seeking from a family support program. The mothers' participation in the parenting program was examined within an attributional and social support framework as a function of four factors: (a) the mother's level of child-related stresses, (b) the mother's expressed need for social support in parenting, (c) the mother's attribution of the child's behavior problems to her own efforts, and (d) the mother's belief in her competence as a parent. Mothers participating in a community-based family support program (N = 79) were compared to mothers (N = 56) not using a family support program in a Midwestern town with a manufacturing economic base, high unemployment, and an increasing rate of confirmed child abuse. The mothers using the family support program reported significantly higher child behavior stresses than did a community sample of mothers with similar-aged children. The mothers seeking help also attributed child behavior problems to their own behavior as a parent. Though the mothers seeking help were not depressed, they believed they lacked competence and expressed more need for social support in parenting than did the comparison mothers not using the program.