CREATING A "NEST" OF EMOTIONAL SAFETY: REFLECTIVE SUPERVISION IN A CHILD-PARENT PSYCHOTHERAPY CASE.

Reflective supervision is considered a key practice component for any infant mental health provider to work effectively with young children and their families. This article will provide a brief history and discussion of reflective supervision followed by a case study demonstrating the importance of reflective supervision in the context of child-parent psychotherapy (CPP; A.F. Lieberman, C. Ghosh Ippen, & P. Van Horn, ; A.F. Lieberman & P. Van Horn, , 2008). Given that CPP leverages the caregiver-child relationship as the mechanism for change in young children who have been impacted by stressors and traumas, primary objectives of CPP include assisting caregivers as they understand the meaning of their child's distress and improving the caregiver-child relationship to make it a safe and supportive space in which the child can heal. As this case will demonstrate, when a clinician is emotionally triggered by a family's negative intergenerational patterns of relating, reflective supervision supports a parallel process in which the psychotherapist feels understood and contained by the supervisor so that she or he is able to support the caregiver's efforts to understand and contain the child.

Hurricane Katrina's first responders: the struggle to protect and serve in the aftermath of the disaster.

OBJECTIVE: Hurricane Katrina highlighted both the crucial role of first responders in times of disaster and the resultant stress on them and their families. The primary objective of this study was to describe the mental health status and symptoms of first responders in the New Orleans area. We further hypothesized that given the extent of the disaster and slowness of recovery, symptoms of posttraumatic stress and depression would not decrease after the first-year anniversary of Hurricane Katrina. METHODS: A total of 1382 first responders, including respondents from police, fire, emergency medical services, and city workers, participated in this longitudinal study. The first screening was conducted between 6 and 9 months after Hurricane Katrina and the second round of data collection was conducted 13 to 18 months after the hurricane. A subsample of the respondents (n = 87) were matched at both time points, which allowed for paired sample comparisons. We measured all of the respondents' levels of traumatic experiences, alcohol use, partner conflict, requests for services, posttraumatic stress, and depression. RESULTS: More than one-quarter of the first responders reported the following traumatic experiences: witnessed injury or death (70%); damage to home (93%); injury to a friend (25%); and previous loss or trauma (30%). Data also revealed that at least 10% of the respondents had significant levels of posttraumatic stress symptoms; 25% of the participants reported significant levels of depression; and more than 40% reported increased alcohol use and conflict with partner (41%). A statistically significant decrease in the symptoms of posttraumatic stress or depression was not found within 18 months of Hurricane Katrina. CONCLUSIONS: Results suggest that the severity of the traumas experienced from both the impact of Hurricane Katrina and the subsequent recovery has important mental health implications for first responders. Reports of symptoms of anxiety or depression should be attended to so as to prevent increasing symptoms that could negatively affect the first responder and his or her family. These findings highlight the importance of not only providing mental health services for first responders but also having adequate plans in place before natural or technological disasters strike.

Attention to process and clinical outcomes of implementing a rural school-based trauma treatment program.

The Louisiana Rural Trauma Services Center was established to provide, improve, and enhance urgently needed assessment, treatment, crisis management, and consultation services for children and adolescents exposed to traumatic events in three rural southeastern Louisiana parishes. The purpose of this study is to describe the process of implementing the rural school-based trauma treatment program and to evaluate its effectiveness in 115 students. Through attention to process including the three-tiered approach of relationship building, trauma training, and trauma services, the school-based trauma treatment program proved effective in reducing trauma symptoms. This study is important to support the widespread implementation of school-based mental health services.

Children of Katrina: lessons learned about postdisaster symptoms and recovery patterns.

Trauma symptoms, recovery patterns, and life stressors of children between the ages of 9 and 18 (n = 387) following Hurricane Katrina were assessed using an adapted version of the National Child Traumatic Stress Network Hurricane Assessment and Referral Tool for Children and Adolescents (National Child Traumatic Stress Network, 2005). Based on assessments 2 and 3 years after the hurricane, most children showed a decrease in posttraumatic stress and depression symptoms over time. Students were also classified into outcome trajectories of stress resistant, normal response and recovery, delayed breakdown, and breakdown without recovery (A. S. Masten & J. Obradovic, 2008). Age, gender, and life stressors were related to these recovery patterns. Overall, the findings highlight the importance of building and maintaining supportive relationships following disasters.

Neurodevelopmental outcome in children born to mothers with hypertension in pregnancy: the significance of suboptimal intrauterine growth.

In this investigation of 45 children born to mothers with hypertension in pregnancy, our objective was to examine the role of a fetal risk factor (suboptimal intrauterine growth [SOIUG]) in determining developmental outcome. There were two groups of children: Group 1 (n=26; 10 males, 16 females; mean testing age 56.77 mo [SD 13.03], range 41-82 mo; mean gestational age 32.96 wks [SD 2.24], range 27-38 wks; mean birthweight 1,984.42g [SD 563], range 1,046-3,515g) without, and Group 2 (n=19; 6 males, 13 females; mean testing age 57.63 mo [SD 14.86], range 40-84 mo; mean gestational age 34.21 wks [SD 2.10], range 29-39 wks, mean birthweight 1,572g [SD 365], range 855-2,690g) with SOIUG. We found that SOIUG was associated with a significant reduction in cognitive and motor skills (p<0.05). Visuospatial (p<0.01) as well as motor skills (p<0.001) were linearly associated with the extent of intrauterine growth deficit when the latter was treated as a continuous variable. To conclude, an increase in intrauterine growth deficit is accompanied by a proportionate decline in quality of developmental outcome in children born to mothers with hypertension in pregnancy.