Changes in Families’ Caregiving Experiences through Involvement as Participants then Facilitators in a Family Peer‐Education Program for Mental Disorders in Japan

A family peer‐education program for mental disorders was developed in Japan, similar to existing programs in the United States and Hong Kong. Families that serve as facilitators in such programs may enhance their caregiving processes and, thereby, their well‐being. This study's aim was to describe how families’ caregiving experiences change, beginning with the onset of a family member's mental illness, through their involvement in a family group or peer‐education program as participants then facilitators. Thus, this study was conducted in a family peer‐education program for mental disorders in Japan. Group interviews were conducted with 27 facilitators from seven program sites about their experiences before, during, and after becoming facilitators. Interview data were coded and categorized into five stages of caregiving processes: (1) withdrawing and suppressing negative experiences with difficulty and regret; (2) finding comfort through being listened to about negative experiences; (3) supporting participants’ sharing as facilitators; (4) understanding and affirming oneself through repeated sharing of experiences; and (5) finding value and social roles in one's experiences. The third, fourth, and fifth stages were experienced by the facilitators. The value that the facilitators placed on their caregiving experiences changed from negative to positive, which participants regarded as helpful and supportive. We conclude that serving as facilitators may improve families’ caregiving processes.     

MATERNAL TRAUMA AFFECTS PRENATAL MENTAL HEALTH AND INFANT STRESS REGULATION AMONG PALESTINIAN DYADS

We examined how diverse and cumulated traumatic experiences predicted maternal prenatal mental health and infant stress regulation in war conditions and whether maternal mental health mediated the association between trauma and infant stress regulation. Participants were 511 Palestinian mothers from the Gaza Strip who reported exposure to current war trauma (WT), past childhood emotional (CEA) and physical abuse, socioeconomic status (SES), prenatal mental health problems (posttraumatic stress disorder and depression symptoms), and perceived stress during their secondtrimester of pregnancy as well as infant stress regulation at 4 months. While all trauma types were associated with high levels of prenatal symptoms, CEA had the most wide‐ranging effects and was uniquely associated with depression symptoms. Concerning infant stress regulation, mothers’ CEA predicted negative affectivity, but only among mothers with low WT. Against hypothesis, the effects of maternal trauma on infant stress regulation were not mediated by mental health symptoms. Mothers’ higher SES was associated with better infant stress regulation whereas infant prematurity and male sex predisposed for difficulties. Our findings suggest that maternal childhood abuse, especially CEA, should be a central treatment target among war‐exposed families. Cumulated psychosocial stressors might increase the risk for transgenerational problems.     

EARLY HEAD START FAMILIES’ EXPERIENCES WITH STRESS: UNDERSTANDING VARIATIONS WITHIN A HIGH‐RISK,LOW‐INCOME SAMPLE

The federal Early Head Start program provides a relevant context to examine families’ experiences with stress since participants qualify on the basis of poverty and risk. Building on previous research that has shown variations in demographic and economic risks even among qualifying families, we examined possible variations in families’ perceptions of stress. Family, parent, and child data were collected to measure stressors and risk across a variety of domains in families’ everyday lives, primarily from self‐report measures, but also including assay results from child cortisol samples. A cluster analysis was employed to examine potential differences among groups of Early Head Start families. Results showed that there were three distinct subgroups of families, with some families perceiving that they experienced very high levels of stress while others perceived much lower levels of stress despite also experiencing poverty and heightened risk. These findings have important implications in that they provide an initial step toward distinguishing differences in low‐income families’ experiences with stress, thereby informing interventions focused on promoting responsive caregiving as a possible mechanism to buffer the effects of family and social stressors on young children.     

Attachment Representation and Sensitivity: The Moderating Role of Posttraumatic Stress Disorder in a Refugee Sample

It has been hypothesized that adult attachment representations guide caregiving behavior and influence parental sensitivity, and thus affect the child's socio‐emotional development. Several studies have shown a link between posttraumatic stress disorder (PTSD) and reduced parental sensitivity, so it is possible that PTSD moderates the relationship between insecure attachment representations and insensitivity. In this study symptoms of PTSD (Harvard Trauma Questionnaire), parental sensitivity (Emotional Availability Scales), and attachment representations (Attachment Script Assessment) were assessed in 53 parents who were asylum seekers or refugees. Results showed that when parents were less able to draw on secure attachment representations, symptoms of PTSD increased the risk of insensitive parenting. These findings suggest that parental sensitivity is affected not just by attachment representations, but by a conjunction of risk factors including symptoms of PTSD and insecure attachment representations. These parents should therefore be supported to establish or confirm secure models of attachment experiences, to facilitate their ability interact sensitively and form a secure relationship with their children.     

SAFE START: AN EARLY CHILDHOOD MENTAL HEALTH PROGRAM IN A TERTIARY HEALTHCARE SETTING—A CRITICAL REVIEW

Early childhood mental health programs are vital for the current and future mental health and brain development of infants, toddlers, and preschoolers. Founded in 2014, Safe Start is the only early childhood mental health program in Beirut, Lebanon. It aims at being the prototype of such services at the national level. A retrospective analysis of the outcomes of the first year of operations has resulted in important findings about the age of the participants, their diagnoses, previous therapies that the participants have undergone, types of referrals recommended, and the number of participants who were lost to follow‐up. This first analysis pointed at the need for more in‐depth research to encompass the gaps and benefits of such services. It shows the pivotal importance of designing awareness strategies about the importance of early childhood mental health services and care; to move from a diagnostic seeking behavior to commitment to psychotherapy and follow‐up interventions.     

Disentangling the Relations Between Different Components of Family Socioeconomic Status and Chinese Preschoolers’ School Readiness

Family socioeconomic status (SES) has been frequently linked to children’s early development. Treating SES as an aggregated variable has many issues, as different components of SES may relate to child outcomes through divergent mechanisms. The purpose of the study was to examine whether parents’ engagement in home learning activities and children’s participation in extracurricular activities (EAs) would function as pathways through which individual SES components related to children’s school readiness. A total of 588 families with preschool‐aged children were recruited from Guangdong province in China. Children’s receptive vocabulary, Chinese reading, and early math skills were individually assessed at three time points, and children’s social skills were rated by parents. Parents reported their engagement in home learning activities with children and their children’s participation in EAs. The results showed that all three components of family SES were related to multiple aspects of children’s school readiness, but through different pathways. Parental income was related to children’s school readiness through EA participation only; parental education and occupational status were associated with school readiness via both parental engagement and child EA participation. The findings suggest that considering SES components separately will produce a more nuanced understanding of the divergent pathways through which family SES may relate to children’s school readiness. Chinese government may provide parent education programs focused on cognitive stimulation for low‐SES families to promote children’s school readiness. Furthermore, the government needs to ensure children’s equal access to EAs to prevent increasing the developmental gap among children from discrepant socioeconomic backgrounds.     

DOES FATHERS' PRENATAL MENTAL HEALTH BEAR A RELATIONSHIP TO PARENTING STRESS AT 6 MONTHS?

This study aimed to explore fathers’ mental health and retrospectively reported adverse childhood experiences during pregnancy, as well as various pathways predicting self‐reported stress at 6 months’ postpartum as assessed by the Parenting Stress Index (PSI; R.R. Abidin, 1990 ). A total of 835 fathers contributed data to the study. Data collection comprised five time points during pregnancy and one at 6 months’ postpartum. The main analyses were performed using linear regression and path analyses. First, linear regression analyses showed that paternal anxiety symptoms during pregnancy predicted stress scores in the PSI child domain at 6 months (coefficient = 0.36). Second, path analyses showed that depressive symptoms during pregnancy predicted parenting stress in the child domain, mediated by spousal disharmony at 6 months’ postpartum (coefficient = 0.77). Third, adverse childhood experiences scores predicted parenting stress in the child domain by two different pathways: one mediated by anxiety symptoms in pregnancy (coefficient = 0.29) and the other by depressive symptoms in pregnancy and experienced spousal disharmony at 6 months’ postpartum (coefficient = 0.77). The findings suggest that fathers’ symptoms of anxiety and depression during pregnancy as well as adverse childhood experiences predict paternal stress and a negative perception of their children's behavior at 6 months’ postpartum.     

Evaluation of a statewide initiative to reduce expulsion of young children

This program evaluation study describes 3 years of implementation of Arkansas's BehaviorHelp (BH) system, a statewide expulsion prevention support system for early care and education (ECE). BH coordinates three tiers of supports to ECE professionals, including phone support, on‐site technical assistance (TA), and infant and early childhood mental health consultation (IECMHC). We examine differences in characteristics of those served across BH service tiers, describe short‐term case outcomes, and explore factors associated with expulsions. BH accepted referrals for 1,195 children in 488 ECE programs. The majority of referrals involved male children over the age of three, and most cases were assigned to the TA tier (68.5%). Cases assigned to receive IECMHC (28.4%) were more likely to involve children in foster care, receiving developmental therapies, and with higher rates of exposure to potentially traumatic events. The expulsion rate among referred children was 2.9%, and reported teacher engagement with the support process was high. Teachers receiving IECMHC services reported significant improvements in children's symptoms of emotional and behavioral problems. Exploratory analyses revealed that risk factors for expulsion included being a male, in foster care, in a lower quality ECE environment, and having a teacher with less training in social–emotional development.     

Relationships,Environment, and the Brain: How Emerging Research is Changing What We Know about the Impact of Families on Human Development

Recent research is providing family therapists with new information about the complex interaction between an individual's biological makeup and his/her social and physical environment. Family and social relationships, particularly during sensitive periods early in life, can affect a child's biological foundation. Additionally, stress during the early years can have a lasting effect on an individual's physical and mental health and contribute to the onset of severe mental illness. Community programs have been developed to intervene early with families who have an at‐risk child to prevent or minimize the onset of mental illness including providing partnerships with at‐risk mothers of infants to shape attachment relationships. Programs are also developing individual and family interventions to prevent the onset of psychosis. Practicing family therapists can incorporate emerging neuroscience and early intervention research and leverage the growing base of community programs to enhance the effectiveness and sustainability of mental health outcomes for clients. Additionally, family therapy education programs should broaden student training to incorporate the growing body of information about how family relationships affect individual mental health development.     

Preparing the Field for Feasibility Testing of a Parenting Intervention for War‐Affected Mothers in Northern Uganda

In this article, we discuss the successful implementation of an adapted evidence‐based parenting intervention for families affected by two decades of war in Northern Uganda. The adaptation and adoption of such interventions to support mental health and family functioning is widely endorsed by prevention scientists and considered a priority in global mental health. The preparation and early adoption phases of engaging with a highly vulnerable community affected by war trauma are documented in this paper along with a discussion of the steps taken to adapt a parenting intervention for cultural and contextual fit. This study is a component of an overall program of research aimed at reducing the long‐term negative effects of war on parenting practices and childhood outcomes, which have considerable implications for preventing mental, neurological, and substance‐use disorders. The processes described here cover a 4‐year period culminating in the implementation of the nine‐session Enhancing Family Connection intervention piloted with a group of 14 mothers. The lessons in cultural adaptation have been valuable and the feasibility results promising for further testing the intervention.     

Discrimination,Internalized Homonegativity,and Attitudes Toward Children of Same‐Sex Parents: Can Secure Attachment Buffer Against Stigma Internalization?

With increasing numbers of same‐sex couples raising children in the United States, discriminatory attitudes toward children of same‐sex parents (ACSSP) are of increasing concern. As with other forms of stigma and discrimination, lesbian, gay, and bisexual (LGB) individuals are at risk for internalizing these societal attitudes, which can negatively affect parenting‐related decisions and behaviors and the mental and physical health of their children. Secure attachment is characterized by positive views of the self as loveable and worthy of care that are understood to develop in early relationships with caregivers. Secure attachment has been associated with positive mental and physical health, including among LGB individuals and couples. This study aimed to test the potential buffering role of secure attachment against stigma internalization by examining associations among secure attachment, discrimination, internalized homonegativity (IH), and ACSSP in an online survey study of 209 U.S. adults in same‐sex relationships. Bootstrap analyses supported our hypothesized moderated mediation model, with secure attachment being a buffer. Greater discrimination was indirectly associated with more negative ACSSP through greater IH for individuals with mean or lower levels, but not for individuals with higher than average levels of secure attachment, specifically because among those with higher levels of secure attachment, discrimination was not associated with IH. These findings build on and extend past research, with important implications for future research and clinical work with LGB individuals, same‐sex couples, and their families, including potential implementation of interventions targeting attachment security.     

Applying a Family Resilience Framework in Training,Practice, and Research: Mastering the Art of the Possible

With growing interest in systemic views of human resilience, this article updates and clarifies our understanding of the concept of resilience as involving multilevel dynamic processes over time. Family resilience refers to the functioning of the family system in dealing with adversity: Assessment and intervention focus on the family impact of stressful life challenges and the family processes that foster positive adaptation for the family unit and all members. The application of a family resilience framework is discussed and illustrated in clinical and community‐based training and practice. Use of the author's research‐informed map of core processes in family resilience is briefly noted, highlighting the recursive and synergistic influences of transactional processes within families and with their social environment. Given the inherently contextual nature of the construct of resilience, varied process elements may be more or less useful, depending on different adverse situations over time, with a major crisis; disruptive transitions; or chronic multistress conditions. This perspective is attuned to the diversity of family cultures and structures, their resources and constraints, socio‐cultural and developmental influences, and the viability of varied pathways in resilience.     

Voices of Dialogue and Directivity in Family Therapy With Refugees: Evolving Ideas About Dialogical Refugee Care

In this article, we reflect on our evolving ideas regarding a dialogical approach to refugee care. Broadening the predominant phased trauma care model and its engaging of directive expertise in symptom reduction, meaning making, and rebuilding connectedness, these developing dialogical notions involve the negotiation of silencing and disclosure, meaning and absurdity, hope and hopelessness in a therapeutic dialogue that accepts its encounter of cultural and social difference. In locating therapeutic practice within these divergent approaches, we argue an orientation on collaborative dialogue may operate together with notions from the phased trauma care model as heuristic background in engaging a polyphonic understanding of coping with individual and family sequelae of forced displacement. This locating of therapeutic practice, as informed by each perspective, invites us to remain present to fragments of therapeutic positioning that resonate power imbalance or appropriation in a therapeutic encounter imbued with a social context that silences refugees’ suffering. In a clinical case analysis, we further explore these relational complexities of negotiating directive expertise and collaborative dialogue in the therapeutic encounter with refugee clients.     

Recruitment and Retention of Low‐SES Ethnic Minority Couples in Intervention Research at the Transition to Parenthood

Low‐SES couples have limited resources to manage the chronic and acute stressors with which they are disproportionately faced. Although these couples are at greater risk for negative individual and relationship outcomes, evaluations of the impact of couple relationship education (CRE) in low‐SES couples have been plagued by methodological problems, most notably challenges associated with recruitment and retention. We review the literature on challenges couples face associated with low‐SES, as well as on recruitment, retention, and CRE in low‐SES, ethnic minority populations. We illustrate some of these challenges in a case study of CRE for low‐SES couples transitioning to parenthood. In this pilot study, 21 couples were recruited from a community health clinic and randomized to either an experimental treatment condition (EXP; N = 11) or a treatment‐as‐usual control condition (TAU; N = 10). This study sought to mitigate documented challenges with recruitment and retention: We leveraged community partnerships, attempted to build and maintain strong relationships with study participants, provided incentives for assessments as well as intervention meetings, and attempted to reduce potential barriers to enrollment and retention. Nonetheless, we had low rates of recruitment and retention. We integrate these findings and experiences with our review of previous work in this area. We make recommendations for future CRE research and practice that have potential implications for public policy in this area.     

FATHER PLAY: IS IT SPECIAL?

Both mothers and fathers play with their children, but research on parent–child play interactions is conducted with mothers three times more often than it is with fathers. The articles in this special issue address this gap by focusing on the nature and quality of father–child play, across cultural contexts, and considering whether father play offers something unique and special for early human development, in infancy or early childhood. The studies show that fathers can be just as developmentally supportive as are mothers in terms of being playful and engaged with their children in ways that are related to greater child socioemotional competence, emotion regulation, and vocabulary, and to less aggression, anxiety, and negativity. We encourage future research to examine the cultural influences, family system dynamics, and specificity of timing and types of father–child play in relation to children's developmental competence.     

Multiple Levels of Family Factors and Oppositional Defiant Disorder Symptoms Among Chinese Children

Family factors are closely associated with child developmental outcomes. This study examined the relationship of oppositional defiant disorder (ODD) symptoms and factors at whole family, dyadic, and individual levels in Chinese children. Participants, who were recruited from 14 primary schools in north, east, and south‐west China, included 80 father‐child dyads and 169 mother‐child dyads. Children in the participating dyads were previously diagnosed with ODD. Results revealed that family cohesion/adaptability was indirectly associated with ODD symptoms via parent–child relationship and child emotion regulation. Parent–child relationship affected ODD symptoms directly and indirectly through child emotion regulation. In addition, the effects of family cohesion/adaptability on parent emotion regulation and child emotion regulation were mediated by the parent–child relationship. The tested model provides a comprehensive framework of how family factors at multiple levels are related to child ODD symptoms and highlights the importance of understanding child emotional and behavioral problems within the family context, more specifically within the multiple levels of family relationships.     

Developmental patterns of emotion regulation in toddlerhood: Examining predictors of change and long‐term resilience

Emotion regulation is critical for optimal functioning across a wide range of domains and may be even more important for individuals in high‐risk environments. While evidence suggests that childhood is generally a period of emotion regulation growth and development, research is needed to examine factors that may contribute to deviations from a typical trajectory. In a prospective study of 1,905 children, latent class growth analysis (LCGA) was used to identify trajectory groups of emotion regulation across toddlerhood (age 14–36 months), examine predictors of those trajectory groups from child temperament, parenting behaviors, and environmental risk, and explore predictions of resilience in 5th grade from the identified groups. LGCA supported a three‐class model, with a Stable Incline group, a Decline group, and a Catch‐Up group. Child negative emotionality, positive and negative parenting, and environmental risk predicted group membership. These trajectory groups in toddlerhood were predictive of child resilient functioning in the 5th grade. Our findings highlight the importance of utilizing developmental models of emotion regulation and provide implications for prevention and early intervention services to enhance emotion regulation development in early childhood.     

Beyond “Lots of Hugs and Kisses”: Expressions of Parental Love From Parents and Their Young Children in Two‐Parent,Financially Stable Families

Given that parental love is essential for children's optimal development, the current study gathered examples of how parental love was demonstrated within parent–child relationships. Fifty‐eight two‐parent, financially stable families consisting of a mother, father, and young child (3–7 years old) from the Midwest were interviewed regarding how they demonstrated or perceived parental love. Results from an inductive thematic analysis revealed considerable variability in how parental love was demonstrated, with five themes emerging that overlapped between parents and their children: playing or doing activities together, demonstrating affection, creating structure, helping or supporting, and giving gifts or treats. Some gendered patterns among these themes were found with mothers emphasizing physical and verbal affection and fathers highlighting their more prominent role as playmates. The lay examples provided by parents and children in this exploratory study extend previous conceptualizations of parental love and underscore the importance of parents being attuned and responsive to the specific needs of their children.