When Parents Refuse: Resolving Entrenched Disagreements Between Parents and Clinicians in Situations of Uncertainty and Complexity

When shared decision making breaks down and parents and medical providers have developed entrenched and conflicting views, ethical frameworks are needed to find a way forward. This article reviews the evolution of thought about the best interest standard and then discusses the advantages of the harm principle (HP) and the zone of parental discretion (ZPD). Applying these frameworks to parental refusals in situations of complexity and uncertainty presents challenges that necessitate concrete substeps to analyze the big picture and identify key questions. I outline and defend a new decision-making tool that includes three parts: identifying the nature of the disagreement, checklists for key elements of the HP and ZPD, and a “think list” of specific questions designed to enhance use of the HP and ZPD in clinical decision making. These tools together will assist those embroiled in complex disagreements to disentangle the issues to find a path to resolution.     

Coping with Disasters While Living in Poverty: A Systematic Review

ABSTRACT

This review synthesizes the literature on how Asia-Pacific children and families living in poverty cope with disasters. A systematic search yielded 26 studies from six low- and middle-income countries (LMIC) in the region. Findings emphasized the role of socioeconomic factors, sociocultural factors, and indigenous knowledge. Coping strategies related to finances were most prominently described in the studies, in contrast to health and psychosocial strategies. Substantial gender issues were identified. The review highlights gaps regarding child involvement in research and coping strategies used by children living in poverty.     

Moving Forward with Systems of Care: Needs and New Directions

The articles in this Special Issue on system change within systems of care (SOCs) provide guidance regarding strategies for modifying SOCs to address the needs of different populations, and ways for changing systems to support more positive child and family outcomes. This paper frames central needs, unanswered questions, and issues that remain for those working to implement SOCs. Specific needs and new directions considered include: (1) rigorous implementation-focused research to identify the necessary and sufficient elements of SOCs and the primary practice approach currently used in SOCs, wraparound; (2) applied research to assess SOCs and document their effectiveness in non-standard or non-traditional settings (i.e., non-mental health settings, including child welfare, juvenile justice, local housing authorities); (3) controlled outcome studies for school-based wraparound initiatives; (4) research to document the effectiveness of the family support efforts that are part of most SOCs; and (5) attention to context, for families, service providers, and collaborative implementation efforts, by researchers and providers alike. Progress in these areas can inform well-targeted system change efforts in the context of SOCs, a critical need given changes in federal funding for these initiatives.     

The influence of family routines on the resilience of low-income preschoolers

Using data from the Birth to Three Phase (1996–2001) of the Early Head Start Research and Evaluation Project, we investigated whether family routines at 14, 24, and 36 months play a role in the development of children's self-regulation and cognitive ability at 36 months. The moderating effects of child sex and race/ethnicity were also examined. Analyses revealed that routines do matter for child outcomes; concurrent routines appear to be critical for fostering self-regulation at 36 months, whereas early routines may be important for children's later cognitive ability. Second, the effects differed by child sex, with early routines having a stronger association for girls and concurrent routines having a stronger association for boys. Associations also varied by race/ethnicity such that routines appear to matter slightly more for African–American children than European–American and Hispanic children. Implications of these findings with respect to strength-based interventions for low-income preschoolers and their families are discussed.     

Modifying Children's Responses to Unsecured Firearms and Modifying the Keeping and Storage of Firearms in Families of Elementary School Children: A Possible Role for Child Behavior Therapy

ABSTRACT

This paper reviews the literature on young children (children under 13) at-risk of firearms injuries, and outlines potential strategies for reducing the disproportionate rate of firearms accidents among low-income children. The available evidence suggests that this problem stems from risky gun storage practices common in low-income homes keeping guns for protection, and these practices, in turn, are a response to high rates of crime victimization and fears of crime. The role that child behavior therapy could assume to reduce the risk of firearm injury to young children and other persons due to these unsafe storage practices is the primary focus of this paper.     

Combat exposure,psychological symptoms,and marital satisfaction in National Guard soldiers who served in Operation Iraqi Freedom from 2005 to 2006

Abstract

In current military operations in Iraq and Afghanistan, US National Guard (NG) troops are serving longer deployments than ever before. Little is known, however, about how such deployments affect this population of individuals, relative to active component (AC) troops. This study investigated the extent of combat exposure, severity of post-deployment psychological symptoms, and general interpersonal functioning, as well as the interrelationships of these variables, in 50 NG soldiers who served a 12-month deployment in Iraq from 2005 to 2006. The results indicate that combat exposure and post-deployment post-traumatic stress symptoms in this sample are greater than those in NG veterans of past military operations, and similar to those of full-time soldiers in current operations. Furthermore, the patterns of interrelationships between combat exposure, psychological symptoms, and interpersonal variables were similar to those detected in prior research on AC troops. These results suggest that NG veterans of current military operations may require similar services as active duty veterans. Given that NG troops are less integrated into the military structure, specific outreach efforts may be needed to help NG veterans to receive such services.     

Preparing for Deployment: Examining Family- and Individual-Level Factors

Deployment can be a significant source of stress for military families. Understanding how families prepare in the face of such stress, and which families are more versus less likely to prepare, is a priority of the Department of Defense. However, there has been scant research on how families prepare for deployments and the factors associated with engagement in preparation activities. The current study is a cross-sectional examination of the proportion of households engaging in deployment preparation activities and family-level and individual-level factors that are associated with these activities in a large and representative sample of married, deployable service members and their families from all military services and components (n = 1,621). Overall, results showed that families reported high rates of engaging in preparation activities, with particularly strong engagement in financial and legal preparation tasks. Talking about deployment to prepare a spouse or child was also relatively highly endorsed but not as frequently cited compared to other logistical preparation activities. Older spouses, officers, active component families, and those with higher marital satisfaction reported greater participation in preparation activities. Families with greater socioemotional difficulties, as indexed by child emotional problems or greater depressive symptoms in the service member or spouse, as well as those with lower spouse-reported marital satisfaction, were more likely to seek professional help. Evaluating the effectiveness of programs in reaching the families that may be least likely to prepare, as well as examining the longitudinal association between deployment preparation and postdeployment family adjustment, is an important area for further inquiry.     

“Dream More,Learn More,Care More,and Be More”: The Imagination Library Influencing Storybook Reading and Early Literacy

Abstract

This study examined the free book giving program of Dolly Parton's Imagination Library and its influence upon storybook reading and early literacy within one county-wide setting in the United States. Family literacy and early literacy experiences are known to be critical to young children's literacy development. The study found that childre who received the Imagination Library books were statistically different from those children who did not participate in the free book giving program. This study has implications for the early literacy outcomes for young children and their families, as well as other communities who utilize Dolly Parton's Imagination Library.     

Homelessness Among Families, Children, and Adolescents: An Ecological–Developmental Perspective

This paper reviews and evaluates the literatures on children in families that are homeless and on adolescents who are homeless on their own. After presenting several emerging theoretical approaches, we propose a broad ecological-developmental perspective that recognizes that, although persons in these groups often lack resources and experience negative events that can amplify the risk for poor outcomes, they also have resources and adaptive potential. The perspective also recognizes that homelessness may have different meanings and outcomes at different points in development and that we need to consider interactions between individual development and multiple levels of social organization in order to foster new solutions to homelessness. On the basis of this perspective, we discuss directions for treatment and preventive interventions as well as social policy.     

Family Therapy with East Indian Immigrant Parents Rearing Children in the United States: PARENTAL CONCERNS,THERAPEUTIC ISSUES,AND RECOMMENDATIONS

The paper focuses on East Indian immigrant parents and some of the post-immigration difficulties they experience in their attempts to rear culturally East Indian children within the United States cultural context. Concerns specific to parenting children in the US, and therapeutic issues East Indian immigrant parents bring to therapy are presented and discussed. Effective therapy with East Indian immigrant families requires that therapists be flexible in their therapeutic approaches with these families, and become more knowledgeable about the varieties of East Indian families, their cultural beliefs, values, and norms. Recommendations for culturally effective therapy are offered.David A. Baptiste, PhD, is Senior Psychologist, New Mexico Corrections Department, and in the private practice of Marital and Family Therapy, 2709 Sim Ave. Las Cruces, NM 88005 (DAB2709@aol.com).*The author is an immigrant from Guyana, South America, an Indian diaspora country. The experiences and observations discussed here are culled from 30 years of clinical practice in several US locations with a variety of East Indian Families from the Indian subcontinent and other diaspora countries.