Fostering Informed and Responsive Systems for Trauma in Early Care and Education (FIRST:ECE): A Preliminary Evaluation.

Children with histories of trauma exposure experience a wide-range of developmental, social, emotional, and behavioral symptoms. The effects of traumatic life experiences can impact children's ability to learn and function within the school environment. Trauma-informed (TI) schools seek to create environments in which children with experiences of trauma can build resilience and be successful and must begin as early as possible in the child's educational experience. The current paper summarizes preliminary evaluation results from a two-year initiative focused on implementing TI organizational change in two school district pre-kindergarten (pre-k) systems in a Southern state. Site 1 (urban) had 7 pre-k locations with 31 classrooms, while site 2 (micropolitan) had 5 locations with 12 classrooms (43 classrooms total). In surveys across two years, participating teachers (N = 91) reported gains in trauma-related knowledge and implementation of TI teaching strategies. Surveys of a subset of staff who were involved in district-level teams focused on implementation of broader TI organizational changes (e.g. adapting policies and procedures) revealed that most staff felt they developed an effective and sustainable process for facilitating organizational change. Theoretical implications and future directions are discussed.

Sleep as a Moderator of Young Children's Traumatic Stress and Behavior Problems: a Treatment-Referred Sample.

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.

Evaluation of a statewide initiative to reduce expulsion of young children.

This program evaluation study describes 3 years of implementation of Arkansas's BehaviorHelp (BH) system, a statewide expulsion prevention support system for early care and education (ECE). BH coordinates three tiers of supports to ECE professionals, including phone support, on-site technical assistance (TA), and infant and early childhood mental health consultation (IECMHC). We examine differences in characteristics of those served across BH service tiers, describe short-term case outcomes, and explore factors associated with expulsions. BH accepted referrals for 1,195 children in 488 ECE programs. The majority of referrals involved male children over the age of three, and most cases were assigned to the TA tier (68.5%). Cases assigned to receive IECMHC (28.4%) were more likely to involve children in foster care, receiving developmental therapies, and with higher rates of exposure to potentially traumatic events. The expulsion rate among referred children was 2.9%, and reported teacher engagement with the support process was high. Teachers receiving IECMHC services reported significant improvements in children's symptoms of emotional and behavioral problems. Exploratory analyses revealed that risk factors for expulsion included being a male, in foster care, in a lower quality ECE environment, and having a teacher with less training in social-emotional development.

Este estudio de evaluación de programa describe tres años de implementación de (BH), un sistema de todo el estado de apoyo de prevención a la expulsión en el caso del cuidado temprano y la educación (ECE). BH coordina tres niveles de apoyo a los profesionales ECE, incluyendo apoyo por teléfono, asistencia técnica en el lugar de trabajo, (TA) y consulta de salud mental del infante y en la temprana niñez (IECMHC). Examinamos las diferencias en cuanto a características de aquellos que recibieron servicios a lo largo de los niveles de BH, describimos los resultados de un caso a corto plazo y exploramos los factores asociados con las expulsiones. BH aceptó referencias en el caso de 1195 niños en 488 programas ECE. La mayoría de las referencias tenían que ver con niños varones de más de tres años, y la mayoría de los casos fueron asignados al nivel TA (68.5%). Los casos asignados para recibir IECMHC (28.4%) estaban más propensos a tratarse de niños bajo cuidados adoptivos temporales, que recibían terapias de desarrollo, y con altos puntajes de haber estado expuestos potencialmente a eventos traumáticos. El porcentaje de expulsión entre niños referidos fue de 2.9% y la participación del maestro, tal como fue reportada, en el proceso de apoyo, fue alta. Los maestros que reciben servicios IECMHC reportaron mejoras significativas en los síntomas de problemas emocionales y de conducta de los niños. Análisis exploratorios revelan que los factores de riesgo de expulsión incluían un varón, bajo cuidado adoptivo temporal, dentro de un ambiente ECE de baja calidad y con un maestro con menos entrenamiento en el desarrollo socio-emocional.

Cette étude d'évaluation de programme décrit trois années de mise en place du programme ComportementAide de l'état américain de l'Arkansas (abrégé ici BH pour BehaviorHelp), un système de soutien pour prévenir l'expulsion au niveau de l'état, pour les crèches et l'éducation (abrégé ECE ici suivant l'anglais). Le BH coordonne trois niveaux de soutien aux professionnels de l'ECE, y compris du soutien avec le téléphone, une assistante technique sur place (ATG) et la consultation de santé mentale du nourrisson et de la petite enfance (IECMHC). Nous avons examiné les différences dans les caractéristiques de ceux servis par les niveaux de service du BH, nous décrivons des résultats de cas à court-terme, et nous explorons les facteurs liés aux expulsions. Le BH a accepté des recommandations pour 1195 enfants de 488 programmes ECE. La majorité des recommandations a consisté en petits garçons de plus de trois ans, et la plupart des cas ont été référés au groupe TA (68,5%). Les cas référés afin qu'ils reçoivent la IECMHC (28,4%) étaient plus à même d'impliquer des enfants placés en famille, recevant des thérapies développementales, et avec des taux d'exposition à des faits traumatiques bien plus élevés. Le taux d'expulsion au sein des enfants recommandés était de 2,9%, et l'engagement rapporté des enseignants avec le processus de soutien était élevé. Les enseignants recevant les services IECMHC ont fait état d'améliorations importantes dans les symptômes de problèmes émotionnels et comportementaux des enfants. Des analyses exploratoires ont révélé que les facteurs de risque d'expulsion incluaient être un garçon, placé en famille, dans un environnement ECE de moindre qualité, et le fait d'avoir un enseignant avec moins de formation en développement socio-émotionnel.

Nightmares in Treatment-Seeking Youth: the Role of Cumulative Trauma Exposure.

Although nightmares are frequently endorsed symptoms in children who have experienced trauma, limited research has been conducted on how nightmares vary with different forms of trauma exposure. Our goal was to assess the relationship between nightmares, trauma exposure, and symptoms of Posttraumatic Stress Disorder (PTSD) in youth. A total of 4440 trauma exposed treatment-seeking youth (ages 7 to 18) were administered the UCLA PTSD Reaction Index. Different trauma types, total traumas experienced, and PTSD symptoms were analyzed with correlations and a logistic regression in relation to nightmare frequency. Overall, 33.1% of participants reported experiencing clinically-significant nightmares. 79.1% of the sample experienced more than one trauma type, with an average of 3.06 trauma types endorsed. A binary logistic regression demonstrated the odds of reporting clinically-significant nightmares increased by 1.3 times for every additional type of trauma experienced. Lastly, nightmares were positively correlated with all PTSD criterion. The current study provides prevalence rates of trauma exposure and nightmares in a large, statewide sample of treatment-seeking youth. Each new trauma type experienced resulted in a greater likelihood of endorsing clinically-significant nightmares. This study provides useful information related to assessing and addressing nightmares in youth who have experienced trauma.

Training Residents in Maternal Depression Care to Improve Child Health: A CERA Study.

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.

Problematic Sexual Behavior in Children.

It is important for health care professionals to have a strong knowledge base of childhood sexual development, to know how to differentiate between problematic and normative sexual behaviors, and counsel parents accordingly given their assessment of the behaviors. A review of the literature suggests that sexual behaviors are a common occurrence in childhood, though some behaviors are rare regardless of age. Frequency of the behavior, developmental considerations, and the level of harm may help health care professionals assess whether the sexual behavior is typical or problematic. Research suggests that the development of problematic sexual behavior is related to a variety of child, family, developmental, and social factors. Recommendations for clinical care for this population are offered, and a case study highlights a health care professional's appropriate assessment and decision making.

Correction to: Keeping Our Eyes on the Prize: Focusing on Parenting Supports Depressed Parents' Involvement in Home Visiting Services.

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 Whiteside­Mansell, was originally published electronically on the publisher's internet portal (currently SpringerLink) on 28 May 2018 without open access.

Keeping Our Eyes on the Prize: Focusing on Parenting Supports Depressed Parents' Involvement in Home Visiting Services.

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 < .001) months, such that there was a stronger positive association for depressed parents. The main effects of child development focused content and retention at 6 (B = .07, SE = .01, p < .001) and 12 (B = .08, SE = .01, p < .001) months were positive, while effects of case management focused content at 6 (B = - .06, SE = .01, p < .001) and 12 (B = - .07, SE = .01, p < .001) months were negative. Conclusions Families were more likely to be retained when home visitors focused on child development and parent-child interaction, but less likely with more case management focus. Parents with positive depression screens were more likely to remain in services with more time spent focused on supporting parent-child interactions.

Test of a Conceptual Model to Explain Television Exposure of Head Start Children.

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.

Adverse childhood experiences: Screening and health in children from birth to age 5.

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