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During pregnancy, low-income women are at high risk for depression and posttraumatic stress disorder (PTSD), but they are unlikely to receive mental health services. As a follow-up to Narayan et al. (2017), we provide a detailed picture of pregnant women's mental health service (MHS) need versus utilization. Results suggested that the majority of women with very elevated depression and PTSD symptoms received MHSs during pregnancy. However, few women with lower-grade depression received MHSs, despite meeting prenatal depression criteria recommended by the American Academy of Pediatrics. Pregnant women of color were also especially unlikely to receive MHSs. Inefficient transportation and lack of child care were primary issues interfering with service utilization. Detailed recommendations for how to improve MHS access are discussed.

This article describes the impact on young children of sudden and extended separation from a primary attachment figure. It recommends clinical intervention when the child's development and family functioning are negatively affected by the severity of the child's symptoms, and it highlights key treatment modalities derived from Child-Parent Psychotherapy, including the importance of "speaking the unspeakable," defined as affirming reality by giving words to the separation and its sequelae and the importance of offering a safe space for the child's expression of sadness, anger, and fear in the supportive presence of the caregiver. Two clinical examples illustrate treatment while the separation is ongoing and after reunion takes place.

The prenatal period represents an opportunity to buffer the intergenerational transmission of adversity through integrated, comprehensive perinatal health services for women experiencing high levels of adversity and clinical symptoms. This article presents preliminary descriptive data, drawn from an ongoing clinical research study, on prenatal clinical symptomatology and service usage and needs in 101 pregnant women who have experienced lifetime adversity. The women gave birth at a university-affiliated county hospital that serves low-income, ethnically diverse, medically uninsured families. Results highlight the need for improved identification of unmet mental health service needs during pregnancy. The authors provide recommendations for strategies to more comprehensively understand how to support low-income pregnant women via tailored, trauma-informed services for maternal health and infant well-being.

This article describes the Attachment Vitamins program, a trauma-informed parent group intervention for families with young children. Attachment Vitamins is a relational psychoeducational intervention based on the principles of Child-Parent Psychotherapy (CPP). Its goal is to repair the impact of chronic stress and trauma through strengthening the child-parent relationship. The authors discuss the history, development, and implementation of the intervention, made possible through a collaborative research and development platform. Two vignettes are presented to highlight unique aspects of the program. Attachment Vitamins is a promising new intervention with the potential to improve outcomes for vulnerable young children and their families on a large scale.

Childhood experiences of interpersonal trauma often leave a legacy of painful emotions and memories that can be especially destructive when adults transition to parenthood. In this article, the authors present a promising treatment approach, Perinatal Child-Parental Psychotherapy (P-CPP), adapted from evidence-based Child-Parent Psychotherapy (CPP) for trauma-exposed parents and young children. Like CPP, P-CPP addresses traumatic experiences and improves mother-child emotional attunement, but it brings this work to the prenatal period. A clinical case illustrates the core modalities of P-CPP and emphasizes how uncovering, making meaning of, and healing from childhood trauma has enduring benefits on prenatal and postnatal maternal and child well-being.

Including fathers is the next frontier for infant mental health. In this article, the authors describe the inclusion of fathers as equal partners in Child-Parent Psychotherapy (CPP), an evidence-based treatment for young children experiencing or at risk for mental health problems following exposure to violence and other adversities. The authors present two vignettes in which the father's participation in treatment was pivotal to successful outcomes for the child, and they illustrate some of the considerations, complexities, concerns, and rewards of engaging and working with fathers. They discuss the benefit of using a "triadic lens" (McHale, 2011) for formulation and treatment planning with all families involved with CPP.

Originally published in 1994 by ZERO TO THREE as the "Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood" ("DC:0-3") and revised in 2005 by ZERO TO THREE as the "Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood, Revised Edition" ("DC:0-3R"), ZERO TO THREE is now updating and revising the "DC:0-3R." This article provides background on the creation of the classification system and describes the need and process for the current revision.

Children's exposure to violence is a national crisis. The high prevalence of exposure to violence in infancy and early childhood has implications for lifelong health and development because early experiences are most influential in shaping the structure and functioning of the brain, the quality of attachments and other relationships, and the child's readiness to explore and learn. The authors highlight the urgency of creating effective approaches to identification and treatment as well as public policy initiatives that protect both children and society.

The impacts of violence for young children and their caregivers are multidimensional. The story of 2-year-old Tyronne, his mother, Josephine, and his father, James, illustrates the use of a relationship-focused treatment, child-parent psychotherapy (CPP), in addressing the traumatic consequences of exposure to violence. This family's story exemplifies the complexity of domestic violence by unraveling the source of intergenerational transmission of attachment patterns and unresolved psychological conflict that become internalized, impacting sense of self, safety, and emotional well-being.

A system of care for abused and neglected infants and young children should adopt a comprehensive perspective, with mental health considerations systematically incorporated into policies and decisions affecting children and their families. Children age birth to 5 years have disproportionately high rates of maltreatment, with long-term consequences for their mental and physical health. Research on normal development and developmental psychopathology has shown that early development unfolds in an ecology of transactional influences among biological, interpersonal, and environmental domains. Psychologists should collaborate with other early intervention disciplines to create systems of care based on an ecological-transactional model of development that includes early mental health principles in order to serve the needs of these young children. Didactic courses, practicums, and internships in infant and early childhood mental health should become integral components of undergraduate and graduate curricula in psychology in order to build capacity to achieve this goal. Recommendations are offered for systemic change by integrating infant and early childhood mental health principles into existing systems of care for young children and their families.

This article is excerpted and reprinted by permission of the publisher, Wiley-Blackwell, from the book "Nurturing Children and Families: Building on the Legacy of T. Berry Brazelton", edited by Barry M. Lester and Joshua D. Sparrow. In the first excerpt, Alicia F. Lieberman and William W. Harris explore the impact of violence and describe a treatment approach to the trauma of domestic abuse. In the second excerpt, Joy D. Osofsky and Howard J. Osofsky discuss traumatic exposure to natural disasters and share their work with young children and their families in New Orleans, Louisiana, following Hurricane Katrina.

Young children growing up in poverty face chronic risk factors, including abuse and neglect, severe maternal depression, parental substance abuse, harsh parenting, and family and community violence as well as greater exposure to physical risks, including substandard housing, lack of access to resources, and environmental toxins. The authors offer suggestions for raising awareness, providing education and training across systems that serve young children and their families, and developing increased capacity for those professionals in the field of infant and early childhood mental health to respond effectively.

Pregnancy is a time of heightened risk for domestic violence and of increased vulnerability to traumatic events. In this article, the authors explain how the experience of domestic violence during pregnancy threatens the newborn's healthy development as well as the parent-child relationship. San Francisco General Hospital's Perinatal Child-Parent Psychotherapy (Perinatal CPP) is an intervention designed to promote physical and emotional safety during gestation and the first year of life.

This article is an excerpt from the opening plenary address at "ZERO TO THREE's" National Training Institute in Orlando, Florida, on November 29, 2007. Dr. Lieberman uses the example of a 2-year-old and her mother whom she treated more than 20 years ago to illustrate what has changed in our understanding and treatment of infancy and early childhood trauma in the past decades.

For thousands of years military children have been faced with many challenges that result from the combat deployment of their parents. These challenges are likely to be particularly burdensome to infants, toddlers, and preschoolers because of their emotional and cognitive immaturity, their reliance on magical thinking, and their dependence upon their parents for healthy development. This article outlines the challenges that modern young military children face, focusing on parental combat deployment, parental combat injury, parental postcombat health consequences, and parental death. Readers are reminded of the unique needs of young military children and the culturally informed services that are necessary for them to overcome these challenges.

Each year, exposure to violent trauma takes its toll on the development of millions of children. When their trauma goes unaddressed, children are at greater risk for school failure; anxiety and depression and other post-traumatic disorders; alcohol and drug abuse, and, later in life, engaging in violence similar to that to which they were originally exposed. In spite of the serious psychiatric/developmental sequelae of violence exposure, the majority of severely and chronically traumatized children and youth are not found in mental health clinics. Instead, they typically are seen as the "trouble-children" in schools or emerge in the child protective, law enforcement, substance abuse treatment, and criminal justice systems, where the root of their problems in exposure to violence and abuse is typically not identified or addressed. Usually, providers in all of these diverse service systems have not been sufficiently trained to know and identify the traumatic origins of the children's presenting difficulties and are not sufficiently equipped to assist with their remediation. This multiplicity of traumatic manifestations outside the mental health setting leads to the inescapable conclusion that we are dealing with a supra-clinical problem that can only be resolved by going beyond the child's individual clinical needs to enlist a range of coordinated services for the child and the family. This paper will focus on domestic violence as a paradigmatic source of violent traumatization and will (a) describe the impact and consequences of exposure to violence on children's immediate and long-term development; (b) examine the opportunities for, as well as the barriers to, bridging the clinical phenomena of children's violent trauma and the existing systems of care that might best meet their needs; and (c) critique current national policies that militate against a more rational and coherent approach to addressing these needs.

Objective: To examine the durability of improvement in child and maternal symptoms 6 months after termination of child-parent psychotherapy (CPP). Method: Seventy-five multiethnic preschool-age child-mother dyads from diverse socioeconomic backgrounds were randomly assigned to (1) CPP or (2) case management plus community referral for individual treatment. Children were 3 to 5 years old. Follow-up assessments were conducted 6 months after the end of a 1-year treatment period. Mothers completed the Child Behavior Checklist and the Symptom Checklist Revised to assess child's and mother's symptoms. Results: For treatment completers, general linear model (GLM) repeated-measures analyses support the durability of CPP with significant group x time interactions for children's total behavior problems and mothers' general distress. Intent-to-treat analyses revealed similar findings for children's behavior problems but were not significant for maternal symptoms. Conclusions: The findings provide additional evidence of the efficacy and durability of CPP with this population and highlight the importance of a relationship focus in the treatment of traumatized preschoolers. (Contains 1 table and 1 figure.)

Objective: Treatment outcome for preschool-age children exposed to marital violence was assessed, comparing the efficacy of Child-Parent Psychotherapy (CPP) with case management plus treatment as usual in the community. Method: Seventy-five multiethnic preschool mother dyads from diverse socioeconomic backgrounds were randomly assigned to (1) CPP or (2) case management plus community referral for individual treatment. CPP consisted of weekly parent-child sessions for 1 year monitored for integrity with the use of a treatment manual and intensive training and supervision. Parents completed the Child Behavior Checklist and participated in the Structured Clinical Interview for DC:0-3 to assess children's emotional and behavioral problems and posttraumatic stress disorder (PTSD) symptoms. Mothers completed the Symptom Checklist-90 and the Clinician Administered PTSD Scale interview to assess their general psychiatric and PTSD symptoms. Results: Repeated-measures analysis of variance demonstrated the efficacy of CPP with significant group X time interactions on children's total behavior problems, traumatic stress symptoms, and diagnostic status, and mothers' avoidance symptoms and trends toward significant group X time interactions on mothers' PTSD symptoms and general distress. Conclusions: The findings provide evidence of the efficacy of CPP with this population and highlight the importance of a relationship focus in the treatment of traumatized preschoolers.

Infant-mother dyads classified as anxiously attached intervention and control or securely attached control were compared. Intervention toddlers were lower than anxious controls in avoidance, resistance, and anger, and higher in partnership with mother. Intervention mothers were higher in empathy and interactiveness. No differences between intervention and secure control groups were found. (BC)

Discusses the importance of cultural sensitivity in work with parents who may be dysfunctional or inappropriate in their child rearing practices. (PCB)