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The emergence and rapid spread of COVID-19 led to unprecedented changes for families and systems of care. This study sought to understand the needs of families participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) before and during the pandemic and considers the impact remote service delivery has on access to an integrated behavioral health intervention to support the psychosocial needs of children and caregivers. Needs for referral varied significantly pre- and post-pandemic onset. Analyses revealed that significantly more referrals were made regarding social determinants of health after the onset of COVID-19 (13.8%) compared with prior to the COVID-19 pandemic (4.1%, p < .05). Providers’ transition to telehealth services sufficiently served WIC families.

Low-income women experience disproportionately high rates of adverse maternal mental health outcomes, such as pregnancy-related depression, and have less access to behavioral health support. Adverse maternal mental health affects children through compromising bonding, impeding early childhood development, and increasing risks of child maltreatment. Integrated behavioral health approaches can improve access to behavioral health services by locating services in community-based settings routinely accessed by low-income families. Warm Connections is an innovative integrated behavioral health program delivered in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and rooted in an infant and early childhood mental health (IECMH) framework. This exploratory study describes Warm Connections and provides evaluation results from its pilot implementation. Findings suggest Warm Connections may reduce distress and increase parenting efficacy among low-income mothers and support further research of this program's feasibility.

The current review summarizes the management of early-childhood externalizing behavior problems (ages 2–5) within the primary care setting. The review highlights factors pediatricians should consider when addressing externalizing behavior problems and summarizes general principles, opportunities for prevention and health promotion, parent-training interventions, integrated models, and therapies to consider when referring families to a specialty mental health provider. Pediatricians have an important role in addressing early-childhood externalizing behavior problems in the primary care setting, and practices can take a range of meaningful steps to address these issues both universally and for children with higher levels of impairment. In particular, integrated approaches offer the opportunity to increase access to behavioral health services while also providing the chance to build medical providers’ skills in managing early-childhood externalizing behavior problems in the primary care setting. Pediatricians have a range of options to consider and can use the literature regarding evidence-based programs to guide their decisions on the best interventions to implement in their settings. Further dissemination work is needed to better understand which programs are most effective when implemented in community settings.

Very young children can experience a wide range of mental health disorders including posttraumatic stress disorder, anxiety disorders, depression, and parent-child relationship disorders, among others. These disorders cause young children true psychological suffering and family stress and often do not resolve without treatment. Pediatricians have a pivotal role in routinely screening all young children for mental health concerns and referring to specialized early childhood mental health providers when concerns are present. A “watchful waiting” approach is strongly discouraged. There are a number of highly effective evidence-based practices that exist to treat most mental health problems in young children. We strongly espouse dyadic mental health services that focus clinical interventions on the parent-child relationship, which is seen as the vehicle of change at these developmental stages. The conservative use of psychiatric medications should be reserved for preschoolers ages 3 and over, should occur only after a course of psychotherapy has been unsuccessful in ameliorating severe symptoms, and should be managed under the supervision of a child and adolescent psychiatrist.

PURPOSE OF REVIEW: This paper reviews literature on perinatal depression prevalence, consequences, and screening among low-income women and women of color. We introduce the Warm Connections program’s innovative perinatal depression screening protocol and explore perinatal depression patterns among WIC participants. RECENT FINDINGS: Perinatal depression negatively impacts maternal and child outcomes. Research shows mixed findings of perinatal depression prevalence rates among low-income women and women of color. The Warm Connections program supports the ability of WIC staff to administer the EPDS to WIC participants. Perinatal depression rates appeared lower in the Warm Connections program than in studies using less specific perinatal depression screening instruments with similar samples. SUMMARY: Future research should continue to explore perinatal depression patterns among low-income women and women of color. Partnering with community-based settings such as WIC provides innovative opportunities to provide screening, referral, and treatment for low income women and women of color.

In this chapter, the authors describe a clinical case formulation, identify approaches to case formulations, including cultural considerations and a Five P’s approach, and finally describe applications therein when evaluating preschool age children. In particular, this chapter highlights the importance of constructing a joint case formulation and techniques which can be utilized, such as the “soft start up,” to invite the caregivers into the process of creating a joint understanding of the nature of child’s difficulties. Caregiver resistance, defensiveness, grief and/or denial as well as provider countertransference are identified as crucial elements to achieving consensus and caregiver “buy-in.” Approaches to creating a joint treatment plan with the child’s caregivers are discussed, including a SMART goals approach, and a comprehensive list of current, evidence-based interventions is reviewed. Finally, a case example is presented and formulated to demonstrate the key concepts discussed in the chapter.

M.C. Sarche, C.D. Croy, C. Big Crow, C. Mitchell, and P. Spicer (2009) provided first-ever information relating the socioemotional development of American Indian toddlers to the immediate context of their mothers' lives. The current study sought to replicate and build on their earlier work by examining the impact of additional maternal risk factors, identified in previous research with non-American Indian populations, on the development of American Indian toddlers: maternal depression, negative social influences, and mother's feelings of isolation. At 27 months, American Indian mothers (N = 110) completed the Parent Demographic Questionnaire, which measured maternal psychosocial characteristics (e.g., depressed affect, social support, drug and alcohol use, isolation) and demographics. Mothers also completed the Infant-Toddler Social Emotional Assessment (A.S. Carter & M.J. Briggs-Gowan, 2006) and the Parent-Child Dysfunctional Interaction subscale of the Parenting Stress Index (R.R. Abidin, 1995, 1997). Some results replicated the original study, but others did not. Reports of a dysfunctional mother-child relationship related to externalizing and internalizing problems, replicating the earlier study. This study also found associations between a dysfunctional mother-child relationship and socioemotional competence as well as dysregulation. The previous finding of a relationship between American Indian identity and socioemotional competence was supported. Adding the effects of maternal depressed affect and isolation significantly increased prediction of toddler behavior problems.

M.C. Sarche, C.D. Croy, C. Big Crow, C. Mitchell, and P. Spicer (2009) provided first-ever information relating the socioemotional development of American Indian toddlers to the immediate context of their mothers' lives. The current study sought to replicate and build on their earlier work by examining the impact of additional maternal risk factors, identified in previous research with non-American Indian populations, on the development of American Indian toddlers: maternal depression, negative social influences, and mother's feelings of isolation. At 27 months, American Indian mothers (N = 110) completed the Parent Demographic Questionnaire, which measured maternal psychosocial characteristics (e.g., depressed affect, social support, drug and alcohol use, isolation) and demographics. Mothers also completed the Infant-Toddler Social Emotional Assessment (A.S. CarterM.J. Briggs-Gowan, 2006) and the Parent-Child Dysfunctional Interaction subscale of the Parenting Stress Index (R.R. Abidin, 1995, 1997). Some results replicated the original study, but others did not. Reports of a dysfunctional mother-child relationship related to externalizing and internalizing problems, replicating the earlier study. This study also found associations between a dysfunctional mother-child relationship and socioemotional competence as well as dysregulation. The previous finding of a relationship between American Indian identity and socioemotional competence was supported. Adding the effects of maternal depressed affect and isolation significantly increased prediction of toddler behavior problems.

Objective: The Picture Completion subtest of the Wechsler Preschool and Primary Scales of Intelligence-Revised (WPPSI-R) measures visual alertness and the ability to differentiate essential from nonessential details. In children who are hypervigilant as a result of maltreatment, these skills may be over-functioning. It was hypothesized that the Picture Completion subtest scores of these children would be significantly elevated in comparison to their other nonverbal scores and their overall intellectual functioning. Method: Fourteen children from a therapeutic day treatment preschool program for maltreated children were administered the WPPSI-R. Standardized discrepancy scores between Picture Completion scores and Performance mean scores (PC-Performance Discrepancy) and the mean of all subscale scores (PC-Overall IQ Discrepancy) were formed and then analyzed. Results: The abused preschoolers scored significantly lower than the population mean on four of the five WPPSI-R Performance subscales. Only on Picture Completion did they score significantly higher. Average PC-Performance Discrepancy and PC-Overall IQ Discrepancy scores were greater than one, indicating that the mean difference of children’s Picture Completion score from either their Performance mean score or all of their mean scores was more than one standard deviation. Conclusion: Elevated Picture Completion score may serve as a marker for hypervigilance and/or PTSD in children with histories of maltreatment.

Cet article detaille le developpement du Programme Clinique et de Formation en Sante Mentale Infantile de l'Ecole de Medecine de l'Universite du Colorado, de 1976 a aujourd'hui. Nous evoquons les sites cliniques ou le programme se tient, sites qui incluent l'Unite Neonatale de Soins Intensifs, la clinique de psychiatrie infantile de consultation externe, et les programmes de traitement de jour. Les stagiaires de differentes disciplines de sante mentale participent au programme, y compris les externes etudiants en psychologie (avant le doctorat), les internes venant de l'Internat de Psychologie Clinique, les internes du Programme de Formation de Psychiatrie Infantile, et les chercheurs en psychopathologie du developpement (post-doctorat, chercheurs attaches a l'universite). Recemment, le Programme de Sante Mentale Infantile a aussi pu etre a meme d'offrir ses propres postes de formation. Les modeles philosophiques du service clinique et du service de formation sont exposes. L'article se termine avec un regard sur les directions a venir et les defis du Programme de Sante Mentale Infantile.

Children who begin kindergarten with stronger skills learn faster than did those who enter with lower skills. Minority children tend to enter kindergarten already at a disadvantage and the gap widens across time. However, little is known about cognitive development among American Indian young children. In this study, 110 American Indian infants from one Northern Plains reservation community were assessed 4 times between ages 6 months through 36 months, using the Mullen Scales of Early Learning. At 6 months of age, scores were near the national norms; a drop occurred between 6 and 15 months. Scores then tended to level off below the norms through 36 months. In each domain, we observed a crucial decline over the first year of life and relatively little change in the second and third years of life, highlighting the importance of developing culturally syntonic interventions to facilitate cognitive development during the first year of life.

In a widely cited study, Matas, Arend, and Sroufe showed that mother-toddler interaction during problem solving at age 2 years was related to the child's prior attachment security. The current study asked (1) whether an independent laboratory could replicate this attachment finding, and (2) whether problem-solving interactions relate to mother-child interactions observed at home and to child temperament measured at 6, 13, and 24 months. Replicating Matas et al., secure dyads worked more competently, and mothers showed better quality of assistance and supportive presence. Mother-child home interaction also predicted problem solving: positive involvement at home predicted effective, unconflicted problem solving. Negative control at home did not predict problem-solving interaction. Unadaptable temperament was generally related to dependency in problem solving. Several patterns of correlations appeared to be mediated by sex of child, e.g., difficult temperament in boys predicted more effective, unconflicted problem solving, while for girls it predicted more conflict.

This research asked two questions: (a) What is the nature of social milieu perceptions (i.e., social support and stress) for middle school girls? and (b) How do girls' perceptions relate to peer-rated sociometrics? Emotional support; problem-focused support, and behavioral support dimensions were identified using the Social Milieu Scales, as were the social stress domains of general stress, discord, hurt feelings, and embarrassment. Girls differentiated between support and stress provided by their best friend versus friends in general. Individual differences in perceived support and stress were reliably detected on the Social Milieu Scales and were meaningfully related to peer popularity. Popular and neglected girls reported less stress than controversial, rejected, or average girls. Popular girls did not report feeling more supported Supportiveness was positively related to the simple number of friend nominations that a girl received Reciprocity of best friendship was positively associated with increased feelings of intimate support.

Objective To present data from a general infant psychiatry clinic, including range and frequency of presenting symptoms, relationship between symptoms and diagnoses, and comparison of two diagnostic systems, DSM-IV and Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (DC: 0–3). Method A retrospective chart review was conducted for 177 children, ages birth to 58 months, who were seen between 1982 and 1997. Presenting symptoms were identified. Subjects were given diagnoses using both DSM-IV and DC: 0–3. Presenting symptom variables were reduced using subjective and empirical determinants. Stepwise regression analyses were used to determine whether presenting symptoms and demographic variables predicted diagnoses. Results Descriptive statistics on the distribution of current presenting symptoms and assigned diagnosis were compared with previous studies. The study demonstrated interrater reliability for diagnoses using both diagnostic systems, evidence of diagnostic validity via the regression analyses, and good concordance where DSM-IV and DC: 0–3 overlap. DSM-IV disruptive behavior disorders may be better conceptualized in DC: 0–3 as regulatory disorders, leading to alternative conceptualization of the disorder and a different course of treatment. Conclusions This study clarifies a developmental progression of presenting symptoms and diagnoses and suggests the need for continued diagnostic re-evaluation in early childhood. Greater attention to relationship factors and consideration of trauma factors is encouraged.

Objective The relationship of maternal depression to self-report and observational data was investigated in a sample of depressed ( n = 30) and nondepressed women ( n = 32) and their 3-year-old children. Depression characteristics – (diagnostic subtype/remission status) were related to maternal self-report and mother—child Interactions. Method Mothers completed standardized questionnaires and the dyad was observed in the laboratory. Observations were rated for maternal behavior and child attachment. Results There were no differences between depressed and nondepressed groups on observational measures; depressed mothers' self-report was consistently more negative. Within the depressed group, women with more severe/chronic depression showed behavioral differences but were no different from less depressed women on self-report measures. Women in remission improved for self-report, but not for observational data. Conclusions The consequences of maternal depression vary depending on type of depression, severity, chronicity, current mood status, and on how the impact of depression is measured. J. Am. Acad. Child Adolssc. Psychiatry , 1996, 35(3):289–298

The central goal of the study reported here was to identify antecedent characteristics of the child and family that best predicted behavioral/ emotional problems at 3 years of age. In prior work (Bates & Bayles, 1984; Bates, Olson, Pettit, & Bayles, 1982; Lee & Bates, 1984; Lounsbury & Bates, 1982; Olson, Bates, & Bayles, 1984; Pettit & Bates, 1984) we have written extensively about mother-infant interaction, temperament, and intellectual functioning and about their interrelationships across development. What we learned from these prior findings will form the basis for interpreting patterns of relationships among our predictor and outcome variables in the present study. As a first step toward answering our central question, we considered how the important index of attachment security related to several of the mother-child relationship measures that had been included in our previous studies. As a second step, we examined relationships of attachment security to other child characteristics, such as difficult temperament and sociability. Finally, we approached our central question more directly by considering how all these variables jointly predicted behavior problems at age 3 years.