The deinstitutionalization of children and adolescents in El Salvador's child protection system.

BACKGROUND: In 2010, El Salvador introduced legislation aimed at reforming the country's Child Protective System (CPS), with a focus on promoting deinstitutionalization. OBJECTIVE: The study aim was to explore the impact of deinstitutionalization on the Salvadoran CPS. PARTICIPANTS AND SETTING: The study was conducted in El Salvador, granting authors unique access to key informants with extensive experience in the country's CPS. Unlike the United States, which is divided into states, El Salvador is divided into departments, and CPS providers were recruited from all 14 departments. Focus groups were facilitated in the East, West, and Central zones to ensure representation from all regions. METHODS: Qualitative semi-structured interviews (n = 26) were conducted in June/July of 2019, which were then followed by focus groups (n = 4) in August 2019. The analysis of the data employed a combination of deductive and inductive thematic coding methods. RESULTS: CPS providers offered valuable insights, categorized into five main themes: (1) Strengths of El Salvador's CPS, (2) Deinstitutionalization policy encompassing socioenvironmental contextual factors, (3) Challenges in the deinstitutionalization process, including insufficient follow-up on deinstitutionalized children, (4) Recommendations from participants, highlighting the importance of enhancing stakeholder coordination/collaboration, and (5) The necessity for a paradigm shift, emphasizing the need to redefine the social contract on protecting children from child maltreatment. CONCLUSIONS: The Salvadoran CPS requires substantial systemic changes. Encouragingly, key informants have demonstrated a commitment to reform not only the deinstitutionalization process but also the broader CPS system in El Salvador including case management and quality of care in institutional settings.

Maternal Intimate Partner Violence Exposure and Autonomic Reactivity: Associations With Positive Parenting.

Intimate partner violence (IPV) can negatively impact parenting, posing a threat both to the wellbeing of mothers and their young children. Parenting may also be influenced by emotion regulation (ER), which can support parents' ability to navigate relational challenges or buffer against the influence of adverse experiences on parenting. Changes in maternal respiratory sinus arrhythmia (RSA) during parent-child interactions have been conceptualized as a psychophysiological index of ER. Competing theoretical models posit that RSA response may mediate or moderate the relation between IPV and parenting or may be independently associated with parenting, however, there is little prior evidence concerning these hypothesized associations. This study examined these associations in a sample of 125 low-income maltreating and comparison mothers and their 3- to 5-year-old children. Dyads completed a moderately challenging laboratory task, and positive parenting and maternal RSA were measured during the task. Maternal verbal IPV exposure, but not physical IPV, was associated with less positive parenting, while greater maternal RSA activation over the task was associated with more positive parenting. Maternal RSA activation did not mediate or moderate the relationship between IPV exposure and parenting, and this association did not differ by whether or not the mother had perpetrated child maltreatment. Consequently, verbal IPV exposure and greater RSA activation independently predicted positive parenting. Results suggest that interventions for IPV-exposed mothers of young children may benefit from ensuring psychological safety and improving maternal ER to promote positive parenting for at-risk children.

Perinatal Mental Health Support and Early Childhood Home Visitation During COVID-19.

COVID-19 has disrupted many of the preventive service sectors designed to serve mothers at-risk for developing postpartum depression, forcing a rapid transition to telehealth-based modes of delivery. The purpose of this study was to explore differences in early childhood home visitation service provision (enrollment and depression screening) among mothers receiving home visitation services prior to and after the onset of the COVID-19 pandemic. Additional factors related to receipt of virtual home visitation services, family risk factors, and the maternal depressive symptoms were examined. Linear and logistic regression were utilized to examine whether there were differences in family risk factors, the percentage of mothers being screened for depression and maternal depressive symptoms, and associations between risk factors and positive depression screenings, while accounting for clustering by site. Samples compared outcomes for families enrolled during the pre-pandemic period (defined as March 16th to July 27th, 2019, n = 4,743) and the post-pandemic period (defined as March 16th to July 27th, 2020, n = 2,049). Families enrolled after the onset of the pandemic were significantly less likely to be impacted by housing instability, have a child with a disability, or be involved with the military, but more likely to have a history of child abuse or neglect. Fewer mothers were screened for depression during the pandemic and maternal report of depressive symptoms decreased. Virtual home visitation is currently attracting some groups of mothers who are experiencing fewer stressors, which may place them at decreased risk for exhibiting depressive symptoms. There may be aspects of the virtual depression screening experience that make detection more difficult. As a result, many mothers at risk for maternal depression may not receive adequate prevention services.