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Objective: This study involves a reanalysis of data from a randomized controlled trial to examine whether child-parent psychotherapy (CPP), an empirically based treatment focusing on the parent-child relationship as the vehicle for child improvement, is efficacious for children who experienced multiple traumatic and stressful life events (TSEs)., Methods: Participants comprised 75 preschool-aged children and their mothers referred to treatment following the child's exposure to domestic violence. Dyads were randomly assigned to CPP or to a comparison group that received monthly case management plus referrals to community services and were assessed at intake, posttest, and 6-month follow-up. Treatment effectiveness was examined by level of child TSE risk exposure (<4 risks versus 4+ TSEs)., Results: For children in the 4+ risk group, those who received CPP showed significantly greater improvements in PTSD and depression symptoms, PTSD diagnosis, number of co-occurring diagnoses, and behavior problems compared to those in the comparison group. CPP children with <4 risks showed greater improvements in symptoms of PTSD than those in the comparison group. Mothers of children with 4+ TSEs in the CPP group showed greater reductions in symptoms of PTSD and depression than those randomized to the comparison condition. Analyses of 6-month follow-up data suggest improvements were maintained for the high risk group., Conclusions: The data provide evidence that CPP is effective in improving outcomes for children who experienced four or more TSEs and had positive effects for their mothers as well., Practice Implications: Numerous studies show that exposure to childhood trauma and adversity has negative consequences for later physical and mental health, but few interventions have been specifically evaluated to determine their effectiveness for children who experienced multiple TSEs. The findings suggest that including the parent as an integral participant in the child's treatment may be particularly effective in the treatment of young children exposed to multiple risks., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

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.

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.

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.

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.

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.

There is an urgent imperative to scale up access to effective, family‐focused mental health services for trauma‐exposed infants, toddlers, and preschoolers, who represent the most vulnerable and most underserved sector of the clinical child population. This article describes the process of scaling child–parent psychotherapy, an evidence‐based treatment currently used in 39 U.S. states and six countries, as an example of the promise and challenge of large‐scale implementation of relationship‐based treatments [ABSTRACT FROM AUTHOR]

Caregivers' ability to identify infant cues plays a crucial role in child development, enabling attuned and responsive caregiving that serves as the basis for secure attachment. At the same time, exposure to interpersonal violence (IPV) could alter mothers' interpretations of social stimuli and interfere with normative parent-child interactional processes. The current study examined four interrelated hypotheses. The first two hypotheses test whether IPV-exposed mothers show bias toward fear or anger in interpreting infants' facial expressions, and whether this bias is related to child symptoms. Our second set of hypotheses examines whether bias can be changed by Child-Parent Psychotherapy (CPP) and whether this change mediates treatment gains. 113 IPV-exposed mothers of 2 to 6 year old children completed the I FEEL picture task at baseline and again twelve months later. In the interim, 33 mothers were randomized into a treatment comparison group and the remainder received CPP. Analyses revealed that IPV-exposed mothers exhibit a perceptual bias toward fear, but not anger. Bias toward fear was linked to greater child internalizing symptoms while bias toward anger was linked to greater child externalizing symptoms. Participation in CPP resulted in decreased bias toward fearful faces. The treatment-related changes in mothers' perceptions of children's facial expression did not emerge as the mechanism by which CPP reduces children's symptoms. These results suggest that exposure to IPV alters mothers' ability to interpret infant facial expressions and that CPP is effective in reducing such biases., Author(s): Rosemary E. Bernstein [sup.1] , Adela C. Timmons [sup.1] [sup.2] , Alicia F. Lieberman [sup.1] Author Affiliations: (Aff1) 0000 0001 2297 6811, grid.266102.1, Department of Psychiatry, Child Trauma Research [...]

Trauma exposure is strongly linked to maternal posttraumatic stress disorder (PTSD) and depressive symptoms during the perinatal period; however, childhood trauma exposure is often assessed without accounting for adult exposure. This study tested the unique impacts of childhood and adulthood trauma exposure on PTSD and depressive symptoms among pregnant women (N = 107, 82.9% Latina) enrolled in a nonrandomized intervention study. Regression analyses at baseline showed positive associations between trauma exposure and PTSD symptoms irrespective of trauma timing, childhood: B = 1.62, t(91) = 2.11, p =.038; adulthood: B = 2.92, t(91) = 3.04, p =.003. However only adulthood trauma exposure, B = 1.28, t(94) = 2.94, p =.004, was positively associated with depressive symptoms. Mixed‐effects analyses of variance revealed interaction effects of time and adulthood trauma exposure, indicating that women with high degrees of adulthood trauma exposure had higher baseline levels of PTSD, F(1, 76.4) = 6.45, p =.013, and depressive symptoms, F(1, 87.2) = 4.88, p =.030, but showed a more precipitous decrease posttreatment than women with lower levels of adulthood trauma exposure. These findings support the clinical relevance of assessing both childhood and adulthood trauma exposure during the perinatal period given their impacts on baseline symptoms and psychotherapy response. [ABSTRACT FROM AUTHOR]

Intimate partner violence (IPV) is often considered an adult problem despite profound consequences for the children who are exposed toviolent relational patterns. About a third of children and adolescents report past exposure to parental IPV, and a majority were first exposed as infants. Exposure to IPV during pregnancy through the first 5 years of a child's life has consequences ranging from adverse birth outcomes to diagnosable emotional problems and lasting physiological dysregulation. This article reviews risks and consequences of IPV in pregnancy and early childhood and discusses a relational psychotherapeutic treatment approach (Child–Parent Psychotherapy) applied to both developmental stages to mitigate the adverse consequences of family violence on parents and their children. Research evidence for the effectiveness of Child–Parent Psychotherapy (CPP) among IPV‐exposed families is reviewed as are specific treatment components which seek to restore relational safety following familial violence. Additionally, clinical considerations unique to families with histories of or ongoing exposure to IPV are discussed. Finally, recommendations are presented to improve the integration between medical and early childhood behavioral health systems for families at highest risk for chronic IPV. Key points for the family court community: Infants and children exposed to IPV are at elevated risk for later socioemotional difficulties, physiological dysregulation and child welfare involvement.IPV threatens relational safety; dyadic, relationship‐based psychotherapies are well suited to repair ruptures in family relationships caused by violence restore psychological health.Child Parent Psychotherapy and its perinatal application are interventions that can improve to child and parental psychopathology, parenting beliefs and attachment security. [ABSTRACT FROM AUTHOR]

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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. [ABSTRACT FROM AUTHOR]

Abstract: A prenatal intervention designed to prevent the onset of major depressive episodes (MDEs) during pregnancy and postpartum was pilot tested at a public sector women’s clinic. The Mamás y Bebés/Mothers and Babies Course is an intervention developed in Spanish and English that uses a cognitive-behavioral mood management framework, and incorporates social learning concepts, attachment theory, and socio-cultural issues. The four goals of this project were to develop the intervention, assess its acceptability, test the feasibility of conducting a randomized trial with public sector patients, and obtain estimates of its effect size. Forty-one pregnant women at high risk for developing MDEs were randomized to the Mothers and Babies Course (n = 21) or a comparison condition (n = 20). Assessments occurred during pregnancy and at 1, 3, 6, and 12 months postpartum. Differences in terms of depression symptom levels or incidence of MDEs between the two groups did not reach statistical significance in this pilot trial. However, the MDE incidence rates of 14% for the intervention condition versus 25% for the comparison condition represent a small effect size (h = 0.28) that will be further examined in a larger scale study. The intervention was well received by the participants and implementation of a randomized trial appeared quite feasible as indicated by our follow-up rate of 91% at 12 months. Implications for the continuing development of preventive interventions for perinatal depression are discussed. [Copyright &y& Elsevier]

Anxiously attached 12-month-olds and their mothers as assessed in the Strange Situation were randomly assigned to an intervention and a control group to test the hypothesis that infant-parent psychotherapy can improve quality of attachment and social-emotional functioning. Securely attached dyads comprised a second control group. Intervention lasted 1 year and ended when the child was 24 months. ANOVAs were used to compare the research groups at outcome. Intervention group toddlers were significantly lower than anxious controls in avoidance, resistance, and anger. They were significantly higher than anxious controls in partnership with mother. Intervention mothers had higher scores than anxious controls in empathy and interactiveness with their children. There were no differences on the outcome measures between the intervention and the secure control groups. The groups did not differ in maternal child-rearing attitudes. Within the intervention group, level of therapeutic process was positively correlated with adaptive scores in child and mother outcome measures. [ABSTRACT FROM PUBLISHER]

As a result of the Department of Homeland Security’s zero-tolerance policy (ZTP), over 5,000 children were separated from their parents at the U.S. southern border from 2017-2021, with over 1,000 still lacking confirmed reunifications. Separations also occur daily due to immigration raids, chaotic processing, and changing immigration policies. This article addresses the most fundamental question faced by families enduring such separations; how to mend attachment bonds that have been suddenly severed, especially within a population likely already traumatized. The paper begins by updating readers about separation in the United States and offers a concise summary of the consequences of child-parent separation. The paper then introduces Child-Parent Psychotherapy (CPP) as an intervention for affected families. This paper also uniquely applies CPP to older children and provides three case examples of its use in treating separated families. Finally, the paper offers general suggestions for supporting these families. [ABSTRACT FROM AUTHOR]

Early-life adversity increases the risk of health problems. Interventions supporting protective and responsive caregiving offer a promising approach to attenuating adversity-induced changes in stress-sensitive biomarkers. This study tested whether participation in an evidence-based dyadic psychosocial intervention, child-parent psychotherapy (CPP), was related to lower epigenetic age acceleration, a trauma-sensitive biomarker of accelerated biological aging that is associated with later health impairment, in a sample of children with trauma histories. Within this quasi-experimental, repeated-measures study, we examined epigenetic age acceleration at baseline and postintervention in a low-income sample of children receiving CPP treatment (n = 45; age range = 2-6 years; 76% Latino) compared with a weighted, propensity-matched community-comparison sample (n = 110; age range = 3-6 years; 40% Latino). Baseline epigenetic age acceleration was equivalent across groups. However, posttreatment, epigenetic age acceleration in the treatment group was lower than in the matched community sample. Findings highlight the potential for a dyadic psychosocial intervention to ameliorate accelerated biological aging in trauma-exposed children. [ABSTRACT FROM AUTHOR]

Child-Parent Psychotherapy (CPP) is an evidence-based treatment for children age 0-5 who have experienced at least one traumatic event and/or are experiencing mental health, attachment, and/or behavioral problems. Harley, Williams, Zamora, & Lakatos (2014) use a case study approach to examine the utility of CPP for working with children with developmental disabilities. They share specific ways in which the model can be tailored for this population. In this commentary, we reflect on their work with James, a 14-month old Latino boy with global delays related to a stroke he suffered after surgery for a congenital heart defect, and Juan, a 6 year, 2 month old boy diagnosed as autistic who has also experienced multiple traumas. We highlight interventions that address core CPP goals and discuss the need to address four key topic areas when conducting CPP with children with disabilities: 1) the importance of addressing risks that present within the caregiver-child relationship, including caregivers' unresolved grief; 2) the potential for the caregiver or child's history of trauma to contribute to challenges in the child and caregiver's functioning; 3) the importance of working as part of an interdisciplinary team to coordinate care and better address the complex needs of families; and 4) the importance of applying a socio-cultural lens in every aspect of the work. [ABSTRACT FROM AUTHOR]