The importance of adverse childhood experiences during the perinatal period.

The Adverse Childhood Experiences (ACEs) study (Felitti et al., 1998) has led to an understanding of how exposure to abuse, neglect, and family dysfunction in childhood are related to subsequent physical and mental health problems. These issues are important to consider during the perinatal period, with studies indicating that pregnant women who report adverse experiences in childhood may be at risk of experiencing mental health and substance use problems. This study examined the association of pregnant women's ACEs with symptoms of depression, anxiety, posttraumatic stress, and substance use, and examined the potential buffering effect of women's resilience against the deleterious effects of ACES on mental health and substance use. Women reported on ACES, mental health symptoms, substance use, and resilience when they were screened for participation in a perinatal psychosocial support intervention, which was integrated into obstetrical clinics in a Southern academic medical center. Almost a quarter of the 303 women in this sample reported four or more ACEs, indicating significant risk. Those reporting more overall ACEs also reported more symptoms of depression, posttraumatic stress, and increased risk of tobacco use. Unique effects of specific ACEs subtypes were also found. Women exposed to child maltreatment reported more anxiety, depression, and posttraumatic stress symptoms, and were at risk for tobacco, cannabis, or opioid use during pregnancy. Women exposed to household dysfunction reported more posttraumatic stress symptoms and were at increased risk of tobacco and alcohol use during pregnancy. Women's resilience attenuated effects of household dysfunction on posttraumatic stress symptoms. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

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.

Termination as a therapeutic intervention when treating children who have experienced multiple losses.

Children who have endured traumatizing events often have a history of prior disruptions and losses which also have been experienced as traumatic. Termination of therapy with these children, therefore, provides a unique opportunity for the clinician to provide the traumatized child and his or her caregiver with a new experience of loss; one that is controlled, predictable, and paced. Through this experience, the child and caregiver can develop a new model for loss, one that permits for losses that are a natural part of healthy growth and change. This article outlines one approach to utilizing termination as an integral component of the therapeutic process with infants, toddlers, and preschoolers and their caregivers. Using a psychodynamic model and working dyadically with the child and the caregiver, termination is approached as a primary intervention, pivotal to the successful treatment of this vulnerable population.

Fostering healthcare providers' post-traumatic growth in disaster areas: proposed additional core competencies in trauma-impact management.

Disaster planning has traditionally focused on the concrete needs of the impacted population. This article looks at the impact of direct and indirect trauma exposure as it affects healthcare providers responding to a region-wide natural disaster and discusses trauma management via the incorporation of self-care techniques. It also explores post-traumatic growth as a potential benefit arising from trauma exposure. We propose that preventative and post-traumatic interventions be added to disaster planning. We further propose that the governing bodies that oversee the training of healthcare providers add training in post-traumatic interventions, including training in and support of self-care interventions to prevent and/or mitigate the effects of secondary traumatic stress. We suggest that they also provide training in Mind-Body Medicine Skills, a promising intervention that addresses symptoms of secondary traumatic stress and promotes post-traumatic growth.