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Empirical evidence suggests young children who have experienced trauma are at risk of developing sleep problems and behavior difficulties, but it is unclear of the specific relation between these behavioral health concerns. The primary purpose of the study is to determine whether sleep problems moderate the relation between traumatic stress and behavior problems in a sample of young children referred for treatment. A secondary purpose is to explore if sleep problems also moderate the relation between specific domains of traumatic stress (i.e., intrusion, avoidance, arousal) and behavior problems. Data from 170 preschoolers ages 3 through 5 referred for treatment were gathered at intake and utilized in this study. Results indicate sleep problems moderate the effect of overall traumatic stress on behavior problems. This statistical finding also was found with intrusive symptoms, and the moderation analyses approached significance with avoidance and arousal. Our findings highlight the importance for clinicians to assess for sleep problems when young children who have experienced trauma are referred to them for treatment, particularly if a low level of overall traumatic stress is present.

Developing strategies to improve retention in home visiting programs is critical to their success. The purpose of the study is to examine how the content provided during home visits moderates the association between family risks (economic, household functioning, and conflict) and retention in services. Parents (n = 1,322) voluntarily enrolled in Healthy Families America (n = 618) and Parents as Teachers (n = 704). Family characteristics were collected using the Family Map Inventories. Multilevel analyses showed a moderating impact of the time home visitors spent supporting parent-child interaction for all family risks examined. Moderating effects demonstrated a stronger positive association between focusing on the parent-child relationship and retention at 6 and 12 months for parents demonstrating greater needs. There were no moderating effects of child development content or case management activities with retention at 6 and 12 months. Together, families were more likely to stay in services when home visitors focused on parent-child interaction and child development, but less likely retained with more case management. Parents with greater risks were more likely to remain in services with more time focused on supporting parent-child interactions. Findings suggest the need to support our home visiting workforce in their work to promote healthy parent-child relationships.

Researchers have documented the ways in which children’s parenting and home environments impact their social, emotional, and cognitive skills. There is scientific consensus that certain adverse childhood experiences (ACEs), particularly in the absence of a nurturing caregiver, decrease the likelihood that children will develop optimally. Many ACEs co-occur, thereby increasing the number of adversities children experience. This study examined the interrelatedness of ACEs for 14-month-old children from the Early Head Start Research and Evaluation Project (N = 2361). Using latent class analysis, three classes were identified: ACEs-low (N = 1431, 60.6%), ACEs-parent maltreatment (N = 636, 26.9%), and ACEs-household dysfunction (N = 294, 12.5%). Class membership was significantly associated with related parenting constructs. Children in families with greater household dysfunction (ACEs-household dysfunction) had parents with the highest levels of parenting stress and the lowest levels of self-efficacy, but who were knowledgeable of infant development and were observed to be moderately supportive in play with their child. Parents at risk for child maltreatment (ACEs-parent maltreatment) had moderate levels of stress and self-efficacy, but the least knowledge of development and were observed to be the least supportiveness in play. Our study suggests that infants experience constellations of ACEs, which are differentially associated with parenting characteristics and behaviors. Results lend credibility to ACE screening in infancy and could be used to inform intervention efforts and the development of more efficient, sensitive screening methods.

Background: The Adverse Childhood Experiences (ACEs) study articulated the negative effects of childhood trauma on adult weight and health. The purpose of the current study is to examine the associations between ACEs in infancy and toddlerhood and obesity and related health indicators in middle childhood. Methods: We used data collected from a sample of low-income families enrolled in the national evaluation of Early Head Start (EHS). Data come from 1335 demographically diverse families collected at or near children's ages 1, 2, 3, and 11. An EHS-ACE index was created based on interview and observation items from data collected at ages 1, 2, and 3, which were averaged to represent exposure across infancy and toddlerhood. At age 11, children's height and weight were measured and parents were asked about their child's health. Results: Children were exposed at rates of 30%, 28%, 15%, and 8% to one, two, three, and four or more EHS-ACEs, respectively. Logistic regressions revealed significant associations between EHS-ACEs in infancy/toddlerhood and obesity, respiratory problems, taking regular nonattention-related prescriptions, and the parent's global rating of children's health at age 11. Across all outcomes examined, children with four or more ACEs had the poorest health. Compared with children with no ACE exposure, the odds of each of the examined health outcomes were over twice as high for children who experienced four or more ACEs. Conclusions: Findings highlight that ACEs experienced very early in development are associated with children whose health is at risk later in childhood.

BACKGROUND AND OBJECTIVESThe Following Baby Back Home (FBBH) home visiting program supports families of high-risk low birth weight preterm infants after discharge from a hospital NICU. This study compares the health care use, immunization, and infant mortality rate of low birth weight preterm infants enrolled in FBBH with similar infants not in the program.METHODSFrom January 2013 to December 2017, 498 children enrolled in FBBH were identified in Arkansas vital statistics records and the Arkansas All-Payer Claims Database. Infants in FBBH were matched with children in a control group on the basis of demographics and medical conditions of the infant. Generalized linear mixed models with double propensity-score adjustment were used to estimate program effects.RESULTSIn the first year after discharge and compared with a propensity-score matched cohort of control infants, those enrolled in FBBH were significantly more likely to have higher numbers of medical appointments and more compliant immunization history. The odds of dying in the first year of life for control infants was 4.4 times (95% confidence interval: 1.2–20.7) higher than those managed in the program.CONCLUSIONSA goal of the FBBH home visiting program is to work with parents to educate and support them as they care for their medically fragile infants. We conclude that education and support was instrumental in the infant health care use and outcome differences we observed during the first year of life.

This article describes the development, initial implementation, and formative evaluation of Arkansas’s plan to reduce suspensions and expulsion from early care and education (ECE) settings. We describe how Arkansas used multifaceted implementation strategies to facilitate change in six areas: policy, workforce development, specialized supports, family partnerships, child screening, and data tracking. We also highlight key findings from the formative evaluation. For example, needs assessment data revealed that 40.8% of ECE providers suspended at least one child in the past year, and 9% expelled one or more children. We evaluated efforts to educate ECE providers on new nonexpulsion policies and new supports, and results indicate that 89.5% of directors agreed that they understand why young children should not be suspended or expelled, though the majority reported concern about implementing a nonexpulsion policy. Initial utilization data from a new ECE provider support system indicate that in the first quarter, 53 requests were submitted for help with challenging classroom behavior. Most requests involved male children over the age of 3, and one-third of the requests referenced traumatic events experienced by the children.

Findings from the Adverse Childhood Experiences (ACE) study articulated the negative effects of childhood trauma on long-term well-being. The purpose of the current study is to examine the associations between ACEs experienced in infancy and toddlerhood and adaptive behavior and academic status in middle childhood. We used data collected from a sample of low-income families during the impacts study of Early Head Start (EHS). Data were collected by trained interviewers demonstrating at least 85% reliability with protocols. Data come from 1469 socio-demographically diverse mothers and children collected at or near ages 1, 2, 3, and 11. At ages 1, 2, and 3, an EHS-ACEs index was created based on interview and observation items. The EHS-ACEs indices were averaged to represent exposure across infancy and toddlerhood. At age 11, parents were asked about school outcomes and completed the Child Behavior Checklist. Across development, children were exposed to zero (19%), one (31%), two (27%), and three or more ACEs (23%). Logistic regression analyses, controlling for EHS program assignment, and parent, school, and child characteristics, showed ACEs were significantly associated with parental report of the child: having an individualized educational program since starting school and in the current school year, having been retained a grade in school, and problems with externalizing and internalizing behavior, as well as attention. Findings suggest that ACEs influence children's behavioral and academic outcomes early in development.

Excessive television (TV) viewing by children can lead to negative health and developmental outcomes. Using structural equation modeling, this study tests a conceptual model to understand social and familial factors associated with TV exposure among a sample of 767 Head Start families with children between the ages of 3 and 5 years. Fit statistics suggested that the overall model provided an acceptable fit to the observed data. Specifically, significant structural paths suggest that parents’ social support affects child TV exposure. Additionally, lower levels of social support were associated with significantly greater parental stress, which also predicted child TV exposure. Findings suggest that physicians and other team members of the patient-centered medical home may benefit from broad-based interventions that address familial factors to combat excess TV exposure among children. Urging parents to turn off the TV could fail to address the underlying causes of child TV exposure.

Empirical evidence suggests maternal behavioral health problems are significant predictors of child behavioral health difficulties, but it is unclear of the specific relation of maternal alcohol use problems and depression symptoms with child internalizing and externalizing behavior problems. The purpose of the study is to examine the impact of maternal depression symptoms and alcohol use problems on children’s internalizing and externalizing behavior problems over a period of 5 years. Implications for intervention may differ depending on which type of maternal behavioral health concerns predicts which child behavior problem. A total of 1874 families eligible for Early Head Start participated. Maternal depression symptoms and alcohol use problems were assessed when children were in preschool, and internalizing and externalizing behavior problems were assessed when children were in fifth grade. Clinical internalizing behavior problems was best predicted by maternal depression symptoms, whereas clinical externalizing behavior problems was best predicted by maternal alcohol use problems. Children were almost twice as likely to have clinical internalizing behavior problems when mothers exhibited very elevated depression symptoms compared to when mothers displayed minimal symptoms. A similar relation was found with maternal alcohol use problems and clinical externalizing behavior problems. Our findings highlight the importance of understanding and treating various kinds of behavioral health concerns in mothers of young children.

Background and Objectives: Untreated maternal depression negatively impacts both the mother and her children’s health and development. We sought to assess family medicine program directors’ (PDs) knowledge and attitudes regarding maternal depression management as well as resident training and clinical experience with this disorder. Methods: Data were gathered through the Council of Academic Family Medicine’s (CAFM) Educational Research Alliance (CERA) national survey of family medicine PDs in US and Canadian programs, from January through February, 2018. Results: Surveys were completed by 298 PDs (57.1% response rate) who were majority male (58.9%) and white (83.8%). Nearly all (90.2%) PDs agreed that family physicians should lead efforts to minimize the impact of maternal depression on child well-being. According to PD report, in the family medicine clinics where residents train, most (77.3%) have a clinic process that ensures that routine screening for depression occurs, and 54.4% do some screening of mothers during pediatric visits. Only 18.2% report routinely taking steps to minimize the impact of the mothers’ depression on child well-being. Finally, 41.3% of PDs reported being familiar with the literature on the impact of maternal depression on children; self-reported familiarity was significantly associated with more comprehensive resident training on this topic. Conclusions: Family medicine residency program directors are supportive of training in maternal depression, though their current knowledge is variable and there are opportunities to enhance care of mothers and children impacted by this common and serious disorder.

Adverse childhood experiences (ACEs) have long-term health consequences. Young children in the southern part of the United States (US) are at greater risk than children in other parts of the US. This study assessed preschool children ACEs using a family-friendly tool, the Family Map (FMI), and compared children living in rural/urban areas while examining the potential moderation of race. The FMI&ndash, ACE score was examined as a total and two sub-scores. We found that race did not moderate the FMI&ndash, ACE score but that Black children (Cohen&rsquo, s d = 0.52) and children in urban and large rural areas were at highest risk (Cohen&rsquo, s d = 0.38). However, the subscale FMI&ndash, ACEs parenting risk was moderated by race such as that Black children were less at risk in rural areas than urban (Cohen&rsquo, s d = 0.62). For FMI&ndash, ACEs environmental risk, race moderated risk such that Black children were most at risk in large rural areas but less so in small rural areas (Cohen&rsquo, s d = 0.21). Hispanic children were most at risk in small rural areas and least in large rural environments. Findings from this study suggest that targeting the most at-risk children for interventions should consider the context including race and location.

This paper describes the development, implementation and preliminary evaluation of the Reaching Educators and Children (REACH) program, a training and coaching intervention designed to increase the capacity of early childhood teachers to support children’s social and emotional development. We evaluated REACH with 139 teachers of toddler and preschool classrooms. Teacher attendance and survey results suggest that teachers were highly satisfied with the training and materials. Data from classroom observation scales conducted pre- and post-REACH implementation suggest significant improvements in the sensitivity of teachers’ interactions with children in the classroom, and increased teacher use of targeted social and emotional supports (such as teaching children to resolve conflicts). Further, data from observations of children’s classroom behavior suggest increases in children’s prosocial behaviors and small but significant decreases in verbal aggression. These findings provide preliminary evidence that the REACH program may be effective in building teachers’ capacity to support social–emotional development of young children, and point to the need for additional research.

The purpose of this study was to examine the feasibility and usefulness of a universal screening tool, the Family Map Inventory (F MI), to assess family strengths and needs in a home visiting program. The FMI has been used successfully by center-based early childcare programs to tailor services to family need and build on existing strengths. Home visiting coordinators (N = 39) indicated the FMI would provide useful information, and they had the capacity to implement. In total, 70 families who enrolled in a Home Instruction for Parents of Preschool Youngsters (HIPPY) program were screened by the coordinator. The results of the FMI provided meaningful information about the home and parenting environment. Overall, most caregivers provided high levels of school readiness and parental warmth and low levels of family conflict and parenting stress. On the other hand, many families did not provide adequate food quality, exhibited chaotic home environments, and practiced negative discipline. This study demonstrated that the FMI is a feasible and useful option to assess comprehensive family needs in home visiting programs. It also demonstrated that the FMI provided home visiting coordinators a system to measure family strengths and needs. This could provide an assessment of program effectiveness and changes in the family’s environment.

Objectives Improving family retention and engagement is crucial to the success of home visiting programs. Little is known about retaining and engaging depressed parents in services. The purpose of the study is to examine how home visit content moderates the association between depression and retention and engagement. Methods The sample (N = 1322) was served by Healthy Families America (n = 618) and Parents as Teachers (n = 704) between April 1, 2012 and June 30, 2016. Parents averaged 23 years (SD = 6). Nearly half of the parents were White (48%) and the majority was single (71%). Depression was screened with the Patient Health Questionnaire-2. Home visitors reported the percent of time focused on particular content and parent engagement at every home visit. Results Multilevel regression analyses showed the amount of time that home visitors spent supporting parent–child interaction moderated the association between depression and retention at 6 (B = .08, SE = .03, p = .003) and 12 (B = .1, SE = .03, p

Introduction Adverse childhood experiences (ACEs) have lifetime consequences for health and development. This study examined whether there is evidence to support a screening approach that assesses children's current exposures to risks that act as proxies for ACEs, measured in a way that falls below a threshold of explicit abuse, neglect, or illegal behavior. Method We used data collected during routine home visitations of at-risk children aged 0-5. Home visitors used the Family Map Inventories (FMI; Whiteside-Mansell et al., 2007) to screen ACEs and measure health outcomes, and the Ages and Stages Questionnaire (3rd ed.; ASQ-3; Squires, Twombly, Bricker, & Potter, 2009) to screen child development. Parents (N = 2,004) were 28 years of age on average and most were White (60%). Children were 32 months of age on average and equally divided on gender (51% male). Results Children were exposed at rates of 27%, 17%, 11%, and 11% to 1, 2, 3, and 4 or more FMI-ACEs, respectively. Logistic regressions revealed significant associations between FMI-ACE scores and health environments and outcomes for children, including health risks in the home (e.g., safety and secondhand smoke exposure), underuse of preventive health care, and overuse of emergency medical treatment. In terms of development, having four or more FMI-ACEs was associated with the child having a chronic health condition and screening at risk for delay in at least one area of development. Discussion Findings highlight the potential use of questionnaires and in-home observations to measure and intervene in potentially developing ACEs. Further, our screening was associated with children whose health was at risk very early in development. (PsycINFO Database Record

Our objective was to examine how mothers' warmth can protect children from the negative effects of maternal alcohol problems on children's externalizing behavior and, alternately, how harsh parenting can exacerbate the problem. We used data from 1,563 families eligible for Early Head Start and assessed when children were age 5 and again at age 11. We examined whether mothers' warmth or harsh parenting at age 5 moderated the effect of maternal alcohol problems on children's behavior problems at age 11. Results indicated that mothers' symptoms of alcohol problems when children were age 5 predicted greater externalizing behavior problems (aggression and rule breaking) when children were age 11. Aggression and rule-breaking behaviors, externalizing behaviors commonly associated with maternal alcohol problems, were lessened when mothers were warm and did not engage in harsh parenting techniques. Our findings highlight the importance of positive parenting techniques in high-risk families.

Infant Mental Health based interventions aim to promote the healthy development of infants and toddlers through promoting healthy family functioning to foster supportive relationships between the young child and his or her important caregivers. This study examined impacts of an Infant Mental Health home-based Early Head Start (IMH-HB EHS) program on family functioning. The sample includes 152 low-income families in the Midwestern United States, expectant or parenting a child younger than 1 year of age, who were randomly assigned to receive IMH-HB EHS services (n = 75) or to a comparison condition (n = 77). Mothers who received IMH-HB EHS services reported healthier psychological and family functioning, outcomes that are consistent with the IMH focus, when their children were between the ages of 3 and 7 years of age. Specifically, mothers in the IMH-HB EHS group reported healthier family functioning and relationships, better coping skills needed to advocate for their families, and less stress in the parenting role versus those in the comparison condition. The study also examined support seeking coping, some of which changed differently over time based on program group assignment. Overall, findings suggest that the gains families achieve from participating in IMH-HB EHS services are maintained after services cease.

Research Findings: The purpose of this study was to examine the relationship between low-level depressive symptoms in mothers and teacher-reported child behavioral outcomes. Participants included 442 low-income mothers of preschool-age children who were screened for maternal depression by their child's preschool teacher. Teacher reports of child behavior problems were collected on a random sample of the children (n = 264). Of mothers screened for depression, 16.7% reported low-level depressive symptoms (below the cutoff on the screener indicating clinically elevated symptoms). Analyses revealed that children of mothers with low-level depressive symptoms had significantly greater problems with externalizing behavior compared to children of mothers with no depressive symptoms. Practice or Policy: Results suggest that children whose mothers experience even low-level depressive symptoms are at risk for problems with behavior, pointing to the need for screening and interventions to address maternal depression ...

This study applies non-inferiority testing to assess the relationship between child weight and food security status in a sample of 808 children between 3 and 5 years old who were attending an urban, state-funded preschool program. Most families were African American (72.3%). Analyses were conducted using non-inferiority testing to evaluate the overweight-food security association. Odds of being overweight in the Food Insecure (FI) group were .643 (95% CI .525 to .788) while odds from the Food Secure (FS) group were .570 (95% CI .464 to .697), OR=1.127 (P=.004). These findings held across sub-groups of gender, race, and family conflict. Children whose parent indicated education beyond high school showed a reversal with FI odds of overweight less than FS odds (OR=.663). As illustrated in this study, non-inferiority testing provides an alternative analytic approach to examining the association between FI and weight in children.

The aim of the current study was to examine the effects of early childhood mental health consultation (ECMHC) on teacher-level and child-level outcomes in the context of a partnership between community mental health centers in three regions of Arkansas and publically funded early education programs (14 intervention sites and 4 comparison sites). From 2005 to 2008, 193 teachers participated in the study, along with 1,448 children. Data-collection activities included structured classroom observations, teacher ratings of children's strengths and behavior, and teacher surveys to assess satisfaction with ECMHC services. Results suggest that teachers were highly satisfied with the consultation services and that teachers receiving the intervention had lower levels of permissiveness and detachment, with a trend toward higher levels of sensitivity in interactions with children in their classroom. In terms of child outcomes, we found that by the third year of the project, children at intervention sites were rated by their teachers as having fewer behavior problems and more protective factors.

Adverse childhood experiences (ACEs) have lifetime consequences for health and development. Identification of ACEs early in childhood provides the potential to intervene before health and development are impaired. This study examined the timing and duration of exposure to ACEs experienced by children from low-income families from ages one to three years to identify whether there were patterns of exposure when infants and toddlers were most vulnerable. We were able to confirm the early negative consequences on cognitive, health, and behavior outcomes previously reported in young children using a national, longitudinal data set of parents and children from low-income households (N=2250). Using Finite Mixture Models, five classes of exposure were identified for children, Consistently Low (63.8%), Decreasing (10.3%), High at Age 2 (11.4%), Increasing (10.4%), and Consistently High (4%). The Consistently Low and Consistently High classes had the most and least optimal development across all domains, respectively. When examining child development outcomes among children with variable exposures to adversities, we found that for cognitive, language, and physical development, the most proximal ACEs were more robust for predicting child outcomes. For socioemotional health, exposure at any time from one to three to ACEs had negative consequences. As a whole, findings from this study highlight the need to consider ACEs screening tools that are both time-sensitive and permit a lifetime report.

The interdisciplinary field of infant mental health focuses on factors that influence the early organization of social and emotional development, self-regulation and adaptive functioning. The quality of the maternal-infant relationship provides an important context for the development of self and self-other relationships, whereas, paternal influences appear to be more focused on organization of self-regulation. In the absence of quality rearing environments, risk factors cumulate and shift very young children onto risk aversive developmental pathways. We review approaches to prevent the early development of psychopathology as well as interventions designed to shift very young children away from risk-aversive environments.

Children of substance abusers face myriad risks, including child maltreatment, residential instability, and exposure to violence, crime, and disorganization in their homes and neighborhoods. Using data from a substance abuse treatment program for women and their children, this study sought to examine the changes in children's living situations before and after their mother's treatment experience. First, we examined pre- and post-treatment changes in the legal and physical custody status of children, as well as neighborhood and household factors that can impact children's physical or emotional health and safety. Mothers who had at least one child living with them reported a significant decrease in problems in the home and neighborhood environments. Independent observations by research assistants also indicated few visible problems with the appropriateness of the post-treatment home and neighborhood environments for children. Second, we examined whether treatment completion predicted healthier living situations for children. Results indicated that treatment graduates were 2.5 times more likely to have at least one child living with them after treatment. In addition, non-graduates experienced more unwanted moves compared to graduates. These findings suggest that the homes and neighborhoods families return to post-treatment are, on the whole, relatively safe.

The use of trauma-informed practices in the child welfare system is critically important to prevent system-induced trauma and encourage timely assessment, triage and referral for care when indicated. Ultimately, such measures have the potential over time to decrease the risk for mental health problems in children exposed to a trauma. This study evaluates an initiative in Arkansas to train child welfare front-line staff members in trauma-informed care practices. We evaluated the impact of the training on knowledge and use of trauma-informed care practices among three types of child welfare staff (Caseworkers, Program Assistants and Other front-line staff). Results suggest that this training process was highly successful in improving knowledge of trauma-informed care practices, especially among staff with the least formal education and training. We also found a significant increase in staff use of trauma-informed care practices at the three-month follow-up with little difference observed across staff groups. Barriers that may prevent staff from full implementation of training concepts are described and strategies to address barriers are proposed.

The goal of the current study was to examine the impact of the frequency of two types of early childhood mental health consultation (ECMHC) activities (time spent in the class and time spent meeting with teachers) on teacher–child interactions, use of positive classroom-management techniques, and the intent to quit the childcare profession. We addressed these questions with a sample of 115 teachers from private childcare settings participating in a midlength (6–8 months) consultation partnership, using pre- and posttest data collected from structured classroom observations and teacher surveys. Results suggest that ECMHC time spent in the classroom was associated with less teacher punitiveness, permissiveness, and detachment, and more use of positive classroom-management strategies at the posttest assessment (controlling for baseline teacher behaviors). The frequency of meetings with teachers did not impact teacher–child interactions; however, in an exploratory analysis, the frequency of meetings with the teacher was associated with a reduction in teachers’ intent to leave the profession of childcare. La meta del presente estudio fue examinar el impacto de la frecuencia de dos tipos de actividades (el tiempo dedicado a la clase y el tiempo dedicado a reuniones con educadores) de la Consulta de Salud Mental en la Temprana Ninez (ECMHC) sobre las interacciones entre educador y nino, el uso de tecnicas positivas de manejo del aula de clases y el intento de abandonar la profesion de prestacion de cuidado al nino. Respondimos a estas preguntas con una muestra de 115 educadores en el sector privado de las prestaciones de cuidado al nino, quienes participaron en un proyecto de consulta bilateral de termino medio (6–8 meses), usando informacion anterior y posterior al examen la cual fue obtenida de observaciones en un aula estructurada y por medio de encuestas a los educadores. Los resultados sugieren que el tiempo dedicado a la clase segun ECMHC fue asociado con un menor sentido del castigo, lo permisible y la separacion por parte del educador, y mas uso de estrategias positivas de manejo del aula en la evaluacion posterior al examen (verificando la conducta de base de los educadores). La frecuencia de las reuniones con los educadores no tuvo impacto sobre las interacciones entre educador y nino. Sin embargo, en un analisis exploratorio, la frecuencia de las reuniones con el educador se asocio con una baja en el intento de los educadores por abandonar la profesion de prestacion de cuidado al nino. Le but de cette etude etait d’examiner l’impact de la frequence de deux types d’activites de Consultaion consultation de sante mentale pour la petite enfance, abrege (ECMHC) sur les interactions enseignant-enfant, l’utilisation de techniques positives de gestion de la classe et l’intention de quitter la profession de puericulterice ou puericulteur. Nous nous sommes penches sur ces questions avec un echantillon de 115 enseignants de contextes de services de garde prives participant a un partenariat de consultation de moyenne duree (6–8 mois), et en utilisant des donnees avant et apres tests rassemblees d’observations structurees de la classe et de sondages aupres des enseignants. Les resultats suggerent que le temps ECHMC passe en classe etait lie a un comportement punitif moindre, a moins de laisser-aller et de detachement et a plus de strategies positives de gestion de la classe au post-test d’evaluation (controlant les comportements de base de l’enseignant). La frequence des reunions avec les enseignants n’a pas eu d’impact sur les interactions enseignant-enfant. Cependant, dans une analyse exploratoire, la frequence des meetings avec l’enseignant etait liee a la reduction de l’intention qu’avaient les enseignants de quitter la profession de puericulteur/puericultrice. Das Ziel der vorliegenden Studie war es, die Auswirkungen der Haufigkeit von zwei Aktivitaten (Zeit in der Klasse und aufgewendete Zeit fur Treffen mit den Lehrern) von Beratungen zur mentalen Gesundheit in der fruhen Kindheit (Early Childhood Mental Health Consultation; ECMHC) auf Lehrer-Kind-Interaktionen, die Nutzung positiver Unterrichts-Management-Strategien und die Absicht, die Kinderbetreuungsaufgabe zu beenden, zu erforschen. Wir untersuchten diese Sachverhalte anhand einer Stichprobe von 115 Lehrern aus privaten Kinderbetreeungseinrichtungen, welche an einer mittelfristigen (6–8 Monate) Beratung teilnahmen. Fur die Beantwortung der Untersuchungsfragen wurden Daten mithilfe von strukturierten Unterrichtsbeobachtungen und Lehrerfragebogen vor und nach der Intervention erhoben. Die Ergebnisse legen nahe, dass die ECMHC-Aktivitat “Zeit im Klassenzimmer verbringen” mit weniger Bestrafung, Freizugigkeit und Loslosung seitens der Lehrer und mehr Einsatz von positiven Unterrichts-Management-Strategien nach der Intervention einherging (kontrolliert fur anfangliche Lehrerverhaltensweisen). Die Haufigkeit der Treffen mit den Lehrern hatte keinen Einfluss auf die Lehrer-Kind-Interaktion. Allerdings wurde in einer explorativen Analyse die Haufigkeit der Treffen mit dem Lehrer mit einer reduzierten Absicht, die Aufgabe der Kinderbetreuung zu beenden, assoziiert. 抄録：この研究の目的は、二つのタイプの早期小児精神保健コンサルテーションEarly Childhood Mental Health Consultation (ECMHC)活動の頻度（教室で使われる時間と教師とのミーティングに使われる時間）が、教師－子どもの相互交流、ポジティブな教室管理技法の使用、および保育の仕事を辞めようとする意図に与える影響を、調査することだった。私たちはこれらの質問を、中等度の期間（6–8か月）のコンサルテーションパートナーシップに参加した私立保育施設の115名の教師に聞いた。それには構造化された教室の観察と教師への調査から、テスト前とテスト後に集めたデータを用いた。結果から、教室で使われたECMHC時間は、教師の処罰、寛容さ、そして無関心の減少、およびテスト後の評価時において（基準値となる教師の行動をコントロールして）ポジティブな教室管理をより多く用いることと、関連したことが示された。教師とのミーティングの頻度は、教師－子ども相互交流には影響しなかった。しかし、予備分析において、教師とのミーティングの頻度は、教師が保育という職業を離れようとする意図の減少と関連していた。

Maternal supportiveness and children’s emotion regulation are considered crucial for the development of school readiness, and enhancing both is particularly important for children from low-income families who are at higher risk for reduced school readiness. This study uses latent growth curve analysis to examine longitudinal connections between maternal supportiveness and toddler emotion regulation as predictors of children’s cognitive school readiness at age 5 and as mediators of the relation between family demographic risk and cognitive school readiness. The sample includes 1,258 mother–child dyads enrolled in the Early Head Start Research Evaluation project. Results support the hypothesized connections between initial and subsequent growth in maternal supportiveness and children’s emotion regulation with later cognitive school readiness. Children’s initial emotion regulation and growth in emotion regulation partially mediate the relation between initial maternal supportiveness and school readiness. Mat...

While maternal substance use problems increase the likelihood of behavior problems in children, child outcomes are varied, leading to interest in understanding additional family factors that contribute to the development of behavior problems in children impacted by maternal substance abuse. The purpose of this study is to examine harsh parenting and family conflict as potential moderators of the relationship between symptoms of maternal substance use problems and child externalizing behavior problems. The non-clinical sample for this study included 250 low-income parents whose preschool age children were enrolled in Head Start programs in a Southern state. This study utilized data collected during two home visits, an average of 10 months apart, with data on family functioning and maternal symptoms of substance use problems collected at the first time point and child externalizing behavior collected at the second time point. Over one-third of the children (38.1 %) had clinically elevated externalizing behavior scores. We used regression analysis to examine whether harsh parenting or family conflict moderated the relationship between maternal substance use symptoms and child externalizing behavior. In this community sample, we found that in the absence of family risks related to harsh parenting and family conflict, maternal symptoms of substance use problems did not have a significant impact on child externalizing behavior in preschool children. However, when high levels of family conflict or harsh parenting were present, symptoms of maternal substance use problems increased the risk of externalizing behavior problems in children.

Food insecurity impacts children in over 10 % of US homes with negative effects for health, cognitive, and behavioral development. Experiences of food insecurity in childhood also carry negative consequences across the lifespan. Families cannot be connected with needed services when needs are unidentified. However, early detection is essential if the harmful effects of food insecurity are to be limited for children. An efficient and valid screen of food insecurity is needed for use by practitioners such as childcare providers, home visitors, or other intervention program staff working with low-income families. The present study provides evidence of validity for a 2-item screen for food insecurity as conducted by childcare providers. Concurrence with a wide range of convergent validity indicators suggests that 2 items can sufficiently identify families with food insecurity. Convergent indicators included other basic needs, physical health, environmental safety, caregiver mental health, parenting practices, and parenting stress. Sensitivity and specificity analyses also support the use of this screen. This study is the first to document the utility of a brief screen for food insecurity by childcare providers. With an efficient screen, these front-line service providers can be a valuable resource to identify and combat FI and its deleterious effects on children.

Children of alcoholics are at risk for a wide range of negative social–emotional outcomes, including externalizing behaviors. These negative outcomes are evident as early as infancy and early childhood. The current study examined whether fathers' supportiveness can protect children from the negative effects of maternal alcohol problems on children's externalizing behavior. We used data from 514 families eligible for Early Head Start at enrollment and near the child's age 5. Mothers' symptoms of alcohol problems were associated with more externalizing problems in their young children. Likewise, father supportiveness in play was associated with fewer externalizing problems. Aggression and hyperactivity, externalizing behaviors commonly associated with maternal alcohol problems, were lessened when children's fathers were sensitive and supportive in play. Our findings highlight the importance of engaging fathers when mothers are identified as having an alcohol problem.

The current study was designed to investigate how the quality of stimulation and support available to children in the home interacts with participation in Early Head Start to determine children's development. Data were obtained as part of the national evaluation of Early Head Start (EHSRE), a randomized trial involving 3,001 children and families from 17 program sites. Hierarchical linear regression analyses were used to examine the interaction of EHS with (a) early maternal emotional warmth and (b) provision of a stimulating home environment on children's development at ages 3 and 5. Findings showed EHS sometimes differentially benefited children who came from households where the levels of warmth and stimulation were lowest. However, there was evidence of other forms of moderation as well.

Fathers play an important role in child development, particularly with respect to children's academic skills. Yet relatively little is known about the nature of fathers' teaching interactions with their young children that would produce such effects. The purpose of the current study was to understand the contribution that fathers' teaching interactions make to their children's academic skills over time. Interactions between 109 fathers and their children in low-income families were observed in the home during a novel teaching situation at ages 2 and 3. Controlling for family and child characteristics and maternal behaviors, father behaviors at age 2, but not age 3, were significantly associated with children's: receptive vocabularies at ages 5, 7, and 10; math skills at ages 5 and 7; and reading skills at age 5. Fathers' support of their children's emotion and behavior regulation may contribute to long-term influences on children's academic skills.

Research Findings: The purpose of this study was to examine the relationship between preschool children's social outcomes in the classroom (including hyperactivity, aggression, and social skills) and their media viewing habits (including the amount of television they watch and whether they watch videos/movies that are rated as inappropriate for young children). The participants were 92 low-income pre-kindergarten-age children for whom we obtained parent reports of media viewing habits and teacher reports of classroom behavior. The results suggested that viewing of inappropriate content was associated with higher hyperactivity and aggression scores and a lower social skills rating, whereas the amount of viewing was not related to these classroom outcomes. Policy: There has been a great deal of focus on how both the amount and content of television viewed affects social development in middle and later childhood. These studies have helped influence the development of guidelines for parents of young children ...

The article “Keeping Our Eyes on the Prize: Focusing on Parenting Supports Depressed Parents’ Involvement in Home Visiting Services”, written by Lorraine M. McKelvey, Shalese Fitzgerald, Nicola A. Conners Edge and Leanne Whiteside‑Mansell, was originally published electronically on the publisher’s internet portal (currently SpringerLink) on 28 May 2018 without open access

This study examines the usefulness of a screening process implemented in the context of a Head Start home visit and compares families who screened positive for substance abuse with those who did not on an array of child and family indicators important for healthy child development. The sample included 1,105 low-income families with preschool-age children enrolled in Head Start programs. Families were interviewed using the Family Map, an interview tool used to screen on a wide range of areas important for healthy child development. Children identified as having a positive screen for family problems with alcohol and other drugs (9.1%) were more likely to be at risk on 10 of 11 additional areas assessed.

This article reviews the findings from our assessments of children and their families in two Head Start programs using the Family Map. Specifically, we used the Family Map assessment tool to identify risks to children associated with alcohol and drug use in families with young children. Practical suggestions are offered to administrators about the importance of identifying such risks to children. Understanding specific risks and knowing how to address them are keys to providing the best outcomes for the children in such families.

Much is known about how to provide safe environments for preschool children (3–5 years-of-age); however, many preschool children still experience preventable injuries—particularly children living in poverty. This study examined the use of an assessment tool used to identify children at risk for unintended injury in two large, federally funded Head Start programs during home visits. Families of preschool children in two multi-center Head Start programs (N = 499 and N = 228) were screened by teachers for risks related to safety in their home and parenting environment during mandatory Head Start home visits in the fall and spring. The safety screening tool was part of an established, broader interview assessment called the Family Map, which was designed to help Head Start programs meet mandatory performance standards related to the identification of risk and strengths in the family. Study results indicated that a large number of preschool children from low-income backgrounds were at risk for a variety of risks related to unintentional injury. Further, in some areas Head Start families increased their safety related parenting behaviors by the second assessment with different areas noted in the two programs. This study demonstrated that, beyond the use of the tool to identify families in need of intervention services, it can be used by childcare providers to effectively monitor family need and for program self-assessment.

Research Findings: Family conflict is known to be associated with poor development for young children, but many children appear resilient. This study examined the extent to which high-quality center care during early childhood protects children from these negative consequences. Children participating in center-based sites of the Early Head Start (EHS) Research and Evaluation study were grouped based on their treatment status: 305 children receiving EHS services, and 305 children not receiving EHS services. Family conflict was positively associated with aggressive behavior as reported by parents for children at 3 and 5 years of age for comparison children but not for children in EHS center-based programs. However, moderation impacts were not observed for objective ratings of child negativity to parent in semistructured interactions. Practice or Policy: These findings may suggest that attending lesser quality child care and living in a family characterized by conflict is associated with heightened aggressiv...

Family conflict is known to have detrimental impacts on the social development of young children. An important issue in counseling parents and the development of intervention for children is the extent to which other family environmental conditions are the path through which conflict impacts children's development. This study examined two maternal parenting behaviors (harsh discipline and warmth) that may alter the impact of interpartner conflict on child social development and behavior in a large (n = 440 girls, n = 451 boys) sample of ethnically diverse, low-income families of preschool children. Interpartner conflict was associated with poorer child social development and behavior problems. This study found that interpartner conflict increased harsh discipline, which resulted in poorer child social development. This study, however, found no evidence that interpartner conflict impacted child development through its impact on maternal warmth in that mothers experiencing conflict did not alter the level of warm parenting practices. These findings suggest that, when encountering families experiencing interpartner conflict, clinicians should not only direct families to interventions to lessen family conflict but also counsel them on the mechanism (harsh discipline) by which children are impacted by the conflict.

This study examines the degree to which support from parents and teachers buffers the level of depression for four groups of children involved in bullying (victim, bully, bully-victims, or not involved children). Nine hundred and seventy-seven 5th-, 9th-, and 11th-grade students in the rural South completed questionnaires on bullying, social support, and depression. Children who were not involved in bullying reported less depression and more social support than children involved in bullying, and bully-victims were the most at-risk group. Furthermore, results indicate that in all four bully status groups, children reported fewer symptoms of depression when support from parents was high compared to when it was low. For all groups except victims, when parental support was low, support from teachers was associated with fewer symptoms of depression. When parental support was high, the impact of support from the teacher was not significant. © 2009 Wiley Periodicals, Inc.

This study used confirmatory factor analysis to examine the structure and factor loadings of an authoritarian parenting scale. The study used data from 315 married couples who had toddlers participating in the Early Head Start Research and Evaluation Project located in 14 communities across the United States. The sample was diverse and consisted largely of white, African American, and Hispanic low-income parents. The results indicate that the authoritarian parenting scale was a consistent and accurate measure of authoritarian parenting attitudes with both mothers and fathers. Social work practitioners may find this instrument a valuable assessment tool in cases in which there is a focus on parenting skills and attitudes. KEY WORDS: assessment; authoritative parenting; ethnic minority parents; parenting style ********** Parenting style is important to children's development, and when parents show a more authoritarian parenting style they tend to be more demanding and directive with their children. However, one major obstacle for researchers is the difficulty in assessing parenting style. Although Baumrind's (1971) assessment of parenting styles provided a reliable model, later researchers found it difficult to measure both economically and reliably, particularly with relatively small samples. Recently, research in this field has overcome these challenges by relying on the self-report of adolescents' perceptions of their parents' style of parenting (Dornbusch, Ritter, Leiderman, Roberts, & Fraleigh, 1987; Lamborn Mojnts, Steinberg, & Dornbusch, 1991). However, it is difficult to extend this direct survey method to younger children because self-report by young children is often problematic and likely to result in unreliable data. Therefore, most researchers of very young children have relied on parent self-report of parenting attitudes and values (Reitman, Rhode, Hupp, & Altobello, 2002). Some measures of parenting styles have been examined psychometrically; however, the trend has been for researchers to develop new survey instruments for each study rather than to use an existing instrument (Reitman et al., 2002). This trend has resulted in a major discontinuity in the area of parenting style. An assessment tool that shows promise as a brief assessment of attitudes associated with authoritarian parenting is a five-item Authoritarian Parenting Beliefs Subscale (APBS) of the Parental Modernity Scale (PMS) (Schaefer & Edgerton, 1985). Although the development and validation of the original PMS is limited by small samples, the APBS has been used in two national studies of young children; the National Institute of Child Health and Human Development study of early child care and the Early Head Start Research and Evaluation (EHSRE) project. The PMS was intended to access both progressive democratic and traditional attitudes in parents and was initially used to measure these in southern white American and African American samples (Schaefer & Edgerton, 1981, 1985). Early psychometric work on the development and validation of the original 30-item PMS was accomplished with three separate small samples of mothers. Schaefer and Edgerton's (1985) PMS measure of progressive democratic and traditional attitudes in child rearing has solid psychometric properties. It has an internal consistency reliability of .88 and a .90 split-half reliability with Spearman-Brown correction. In addition, this parenting measure has a test-retest reliability of .84. It should be noted that the reliability scores for the PMS were derived from a small sample of only African American and white American mothers with children in kindergarten in the Piedmont region of North Carolina. In addition, the earlier assessment of the reliability of the PMS failed to include fathers. An often neglected issue when cross-group examinations are conducted is the comparability of the measures across the groups. …

We examined the psychometric properties of two scales of the parenting stress index-short form (PSI-SF) in a low-income sample of fathers of toddlers. The factor structure, reliability, and validity of the parental distress and parent–child dysfunctional interaction subscales were assessed for 696 fathers in a multi-site study of Early Head Start. Confirmatory factor analyses (CFA) compared the fit of the developer recommended two-factor scales with five-factor scales theoretically derived and supported with mothers. Our results suggested that two subscales from the PSI-SF were reliable and valid for this sample of racially diverse, low-income fathers of toddlers. However, these subscales capture multiple dimensions of parenting stress and results also supported the use of more narrowly defined aspects of parenting stress that included general distress, distress specifically related to parenting demands, problematic interactions of the father–toddler dyad, perceptions of the child, and parental perceptions of self as a parent. These unidimensional scales may prove useful in research and clinical activities by allowing researchers to elucidate the mechanisms through which stress impacts parenting and permitting clinicians information to develop more targeted interventions for young children and their families.

We examined the impact of parenting behaviors on preschool children’s social development in low-income families from three cultural groups: European American (n = 286), African American (n = 399), and Hispanic American (n = 164) using Spanish as the primary language in the home. Observed parenting behaviors of stimulation, responsivity, and acceptance of the child in European American and African American families showed positive impacts on children’s social development with notable exceptions discussed. Corporal punishment had a negative impact on children’s social development. With the exception of corporal punishment, none of the parenting behaviors predicted social development outcomes for Hispanic children.

SYNOPSIS Objective. This study examines psychometric properties of 2 scales of the Parenting Stress Index—Short Form (PSI—SF) in a sample of preschool children from low-income families. Design. The factor structure, reliability, and validity of the Parental Distress and Parent—Child Dysfunctional Interaction subscales were assessed for 1122 Early Head Start parents of 15 (n = 959), 25 (n = 899), and 37-month-old (n = 845) children in a multisite study. Confirmatory factor analyses (CFA) compared the fit of 2-factor scales that are recommended by the developer with theoretically derived 5-factor scales. Results. CFA indicated that the 5-factor scales fit the data better than the 2-factor scales. Both 2 and 5-factor scales had high internal consistency, and the pattern of relations between the new scales and validity constructs support their usefulness. Conclusions. The PSI—SF scales can be helpful in clinical applications because the proposed scales clarify relations between parent and child outcomes and s...

The Early Head Start Research and Evaluation Project, a random-assignment evaluation, found a broad pattern of positive impacts for children and families. However, there were no program impacts on depression or use of mental health services by the time children reached age 3, at the end of the Early Head Start (EHS) program. This paper presents recent findings from the follow-up study in the spring prior to the children entering kindergarten, when a positive program impact emerged for reducing maternal depression. Results show that earlier program impacts on children and parents (when children were 2 and 3 years of age) mediated, or led to, the delayed impact on maternal depression. The combination of the most promising child factors accounted for over 57% of the later impact on depression, while the most promising parent factors accounted for over 35% of the later impact on depression. Implications for EHS programs are discussed.

Objectives Examine the association between mothers’ low- and high-level depressive symptoms in early childhood and children’s behavior problems in middle childhood. Methods We used data from 1844 families in a multi-site, longitudinal study beginning when children were 14 months and continuing to age 11 years. Children’s internalizing and externalizing behavior problems at age 11 were assessed using the child behavior checklist for ages 6–18. Mothers’ scores on the Center for Epidemiological Studies-Depression Scale when children were 14 months were used to classify them into three groups: ‘no depressive symptoms’, ‘low-level depressive symptoms (below the clinical cut-off)’ and ‘clinically significant depressive symptoms (above the clinical cut-off).’ Results Mothers were racially/ethnically diverse, including Caucasian (38.9 %), African-American (34.4 %), Hispanic (21.6 %), or other (5.1 %). More than one-third (39.2 %) were teenaged mothers, and 46.0 % did not complete high school. Of the 1844 families, 1172 had age 11 child outcome data. Logistic regression analyses controlling for family demographics revealed a significant association between early maternal depressive symptoms and later child behavioral outcomes. Both low level and clinically significant symptoms were associated with internalizing and externalizing behavior problems. For example, children whose mothers had low-level depressive symptoms were twice as likely to have clinically elevated internalizing problems compared with children whose mothers never had symptoms of depression. Conclusions Children whose mothers experience low-level depressive symptoms early in their development have increased risk for later behavioral problems, suggesting a possible need for new screening and intervention strategies for mothers with lower than clinically elevated symptoms.

The general aim of early intervention and home visiting programs is to support families to minimize Adverse Childhood Experiences (ACEs). However, assessing children's exposure to these risks is complicated because parents serve as the conduit for both measurement and intervention. The primary aims of the study were to develop an assessment of children's exposure to ACEs and to examine concurrently measured parental child abuse and neglect potential and child social-emotional functioning. Home visiting programs in a southern state implemented the Family Map Inventories (FMI) as comprehensive family assessment and child screenings (N=1,282) within one month of enrollment. Children (M=33 months of age, SD=20) were exposed at rates of 27% to one, 18% to two, 11% to three, and 12% to four or more FMI-ACEs. FMI-ACEs were associated with increased parental beliefs and behaviors associated with child abuse and neglect. FMI-ACEs also significantly predicted the likelihood of the child having at-risk social-emotional development; children with 4 or more FMI-ACEs were over 6 times more likely than those with none to have at-risk scores. The findings add to our understanding of the negative impact of trauma on children and families. Assessing these risks as they occur in a family-friendly manner provides a platform for early intervention programs to work with families to increase family strengths and reduce the impacts of adverse experiences for their children.

Infant Mental Health based interventions aim to promote the healthy development of infants and toddlers through promoting healthy family functioning to foster supportive relationships between the young child and his or her important caregivers. This study examined impacts of an Infant Mental Health home-based Early Head Start (IMH-HB EHS) program on family functioning. The sample includes 152 low-income families in the Midwestern United States, expectant or parenting a child younger than 1 year of age, who were randomly assigned to receive IMH-HB EHS services (n = 75) or to a comparison condition (n = 77). Mothers who received IMH-HB EHS services reported healthier psychological and family functioning, outcomes that are consistent with the IMH focus, when their children were between the ages of 3 and 7 years of age. Specifically, mothers in the IMH-HB EHS group reported healthier family functioning and relationships, better coping skills needed to advocate for their families, and less stress in the parenting role versus those in the comparison condition. The study also examined support seeking coping, some of which changed differently over time based on program group assignment. Overall, findings suggest that the gains families achieve from participating in IMH-HB EHS services are maintained after services cease.

Beverage intake and diet quality of toddlers from families with limited incomes were described and compared to their mother's beverage intake. At both 2 and 3 years of age, the children's average milk intake was adequate, the juice intake was twice that recommended, and the intake of sweetened beverages was high. Mothers who consumed more than 12 fl oz of soft drinks per day were nearly four times more likely to have a child with poor diet quality. Health practitioners should do focused screening of mothers' and children's beverage intakes to quickly assess those at high risk for poor diets.

Objective. We examined the relation between neighborhood violence and father antisocial behavior with a national sample of fathers from low-income families with 3-year-old children Design. Children were classified into 4 groups based on their exposure to father antisocial behavior and neighborhood violence. Results. Children who experience high levels of each performed more poorly on indicators of emotion regulation. Children in risk groups were exposed to higher levels of family conflict, father depression, and poorer internal and external physical environments than children who were in the low-risk group. Children with fathers who were not antisocial were 3 times more likely to be spanked when the father resided in a high-risk neighborhood. Conclusions. Fathers should be included in early prevention programs targeting families with very young children, and such programs simultaneously challenged to broaden into community networks.