Quality of the Parent-Child Relationship as a Moderator of Witnessing Violence and Youth Trauma Symptoms.

Traumatic event exposure affects two in every three adolescents in the United States and there is the potential for numerous deleterious effects including higher levels of youth depression, anxiety, posttraumatic stress symptoms, and emotional and behavioral problems. Witnessing violence is one of the more common experiences associated with trauma exposure. Despite the ample research on mental health outcomes associated with witnessing violence, less is known about the extent to which parent-child relationships play a role in youth mental health outcomes when youth are exposed to violence. With a clinically relevant, diverse sample of 806 youth ages 12 years old who experienced maltreatment or were at risk of being maltreated, we tested hypotheses that the parent-child relationship quality would moderate the associations between witnessing violence and youth mental health outcomes. Results supported hypotheses for youths' symptoms of anxiety, depression, dissociation, and posttraumatic stress. The study contributes to the trauma literature by determining that the quality of the parent-child relationship moderated the effects of witnessing violence on trauma outcomes.

A test of the dyadic associations between ineffective arguing, emotional distress, and violence perpetration and victimization among couples seeking therapy.

Researchers have tested associations between ineffective arguing and emotional distress among couples without relationship violence. Moreover, studies have demonstrated associations between physical violence perpetration and victimization in the aftermath of emotional distress. However, there is a paucity of research examining linkages between ineffective arguing, emotional distress, and physical violence perpetration or victimization. Dyadic data from 231 married, heterosexual couples seeking therapy were used to test a model examining pathways between ineffective arguing and physical violence perpetration and victimization through emotional distress. The hypothesized model was compared to two plausible alternative models. Results revealed higher levels of men's ineffective arguing were positively associated with men's physical violence perpetration, both directly and indirectly, through higher levels of emotional distress. Higher levels of men's ineffective arguing were associated with lower men's physical violence perpetration through higher levels of women's emotional distress. Results can inform the clinical treatment of interpersonal violence by targeting ineffective arguing and emotional distress.

Current Caregiver Involvement and Contact with Biological Parents are Associated with Lower Externalizing Symptoms of Youth in Out-of-Home Child Welfare Placements.

Positive family relationships are important for child well-being. However, family relationships are unique for youth in out-of-home child welfare placements because they involve both biological and foster parents. The aim of this study was to test the interactive association between current caregiver involvement and contact with biological parents on youths' externalizing symptoms using a sample representative of youth in out-of-home child welfare placements in the United States. Findings supported a significant interaction between current caregiver involvement and the amount of biological parent contact on youths' externalizing symptoms, such that there was a more pronounced buffering effect of high caregiver involvement on youth externalizing symptoms when there was more frequent youth contact with biological parents. Results can be used to support education initiatives about the importance of visitation for caseworkers and parents, and interventions aimed at promoting positive biological family and foster parent relationships focused on the best interests of the child.

Which therapist perceptions best predict client outcomes? A naturalistic examination.

Examining associations between therapists' perceptions of therapy sessions and client-reported outcomes in naturalistic settings (real-life therapy settings) can provide valuable guidance for the assessment, treatment, and monitoring of clients. This study included data of 1334 sessions from 127 clients (86 individual and 41 couple cases) and 15 therapists, collected at a therapy training center. Clients reported their personal functioning and individual symptoms before each session. Therapists rated clients' participation, receptivity, session progress, goal progress, and therapeutic alliance at the end of each therapy session. Multilevel Structural Equation Modeling analyses revealed that therapist-rated client participation and goal progress predicted better personal functioning, beyond clients' previous personal functioning scores. In contrast, none of therapist-rated session variables predicted clients' individual symptoms, beyond previous symptom scores. Power analyses suggested sufficient statistical power to detect small effect sizes. Findings of the current study have clinical implications for treatment planning and progress monitoring.

Thought Problems and Aggression Over Time Among Youth in Foster Care.

Background: Youth in foster care may demonstrate high levels of aggression and thought problems. There is a growing trend to consider mental health symptoms of youth involved with the foster care system from a developmental trauma perspective. Objective: The aim of this study was to test if trauma, race, age, and gender predicted variability in thought problems and aggression for youth in foster care. Method: The sample (n = 303) included youth in out-of-home placements with a mean age of 14 years, a diverse racial demographic, and almost an equal percentage of males and females. Participants were assessed over three waves using a series of multilevel growth curve models. Results: Results indicated significant decreases in thought problems and aggression and youth with higher levels of trauma reported higher initial levels and swifter decreases of both thought problems and aggression over time. Conclusions: While trauma was associated with aggression and thought problems, results found that youth demonstrated significant decreases in aggression and thought problems over time. A better understanding of the long-term effects of trauma on thought problems and aggression of youth in foster care is needed. While our findings suggest foster care may be protective in fostering resilience, additional research on the nature of potential positive effects of foster care on aggression and thought problems is suggested.

Systemic interventions for traumatic event exposure: A 2010-2019 decade review.

Trauma exposure is a pervasive issue worldwide. People exposed to traumatic events may develop PTSD, depression, anxiety, and other mental health symptoms. Family and intimate partner relationship problems also are frequently associated with trauma exposure. The purpose of this study was to conduct a systematic research synthesis of the empirical evidence on systemic interventions for traumatic event exposure from 2010 to 2019. A search of peer-reviewed research resulted in 31 articles that met inclusion criteria and were included in this review. Systemic interventions were grouped by modality (e.g., parent-child, couple, group). The collective evidence was strongest for systemic youth-caregiver interventions, group, and couple treatment categories for traumatic event exposure. Youth-centered interventions that included various combinations of family member participation can be considered probably efficacious. Overall, results indicated that systemic interventions for traumatic event exposure were successful in reducing posttraumatic stress symptoms including PTSD, depression, and anxiety, and improving relational outcomes.

Individual's pretreatment psychological symptoms and progress in couples therapy: A person-centered analysis.

This study examined how individual pretreatment symptoms (depression and anxiety) predicted longitudinal, relational processes in couples therapy (the therapeutic alliance and couple satisfaction). This study included 99 heterosexual couples receiving systemic couples therapy. Partners reported their individual pretreatment symptoms of depression and anxiety before intake. Each member reported their therapeutic alliance with the therapist at the end of sessions 2-8, as well as their couple satisfaction before intake and at the end of sessions 4 and 8. A Latent Profile Analysis revealed four profiles characterizing couples on their pretreatment psychological symptoms, namely both higher (where both members of the couple had higher depressive and anxiety symptoms), female higher, male higher, and both lower profiles. Furthermore, longitudinal, dyadic multilevel models revealed that men in male higher, female higher, and both higher profiles had higher initial alliance levels, compared to men in the both lower profile. In contrast, only female partners in the both higher profile had a higher initial therapeutic alliance than those in the both lower profile. Men in the both higher profile had faster reductions in their alliance, whereas other profiles did not predict changes in male or female alliance. Additionally, the male higher and both higher profiles predicted a lower initial level of couple satisfaction in males but not females. The profiles did not predict changes in couple satisfaction, which may be a result of lowered power due to missing data. Findings were discussed in the context of systemic family theory, with clinical implications for distressed couples.

En este estudio se analizó como los síntomas individuales previos al tratamiento (depresión y ansiedad) predijeron procesos longitudinales y relacionales en la terapia de pareja (la alianza terapéutica y la satisfacción con la pareja). En este estudio participaron 99 parejas heterosexuales que recibían terapia sistémica de pareja. Antes de la admisión, las parejas informaron sus síntomas individuales de depresión y ansiedad previos al tratamiento. Cada miembro informó su alianza terapéutica con el terapeuta al final de las sesiones 2-8, así como su satisfacción con la pareja antes de la admisión y al final de las sesiones 4 y 8. Un análisis de perfiles latentes indicó cuatro perfiles que caracterizaron a las parejas en sus síntomas psicológicos previos al tratamiento, por ejemplo, los perfiles ambos más altos (donde ambos miembros de la pareja tenían síntomas más altos de depresión y ansiedad), mujeres más altos, hombres más altos y ambos más bajos. Además, los modelos multinivel longitudinales y diádicos revelaron que los hombres de los perfiles hombres más altos, mujeres más altas y ambos más altos tuvieron niveles iniciales de alianza más altos en comparación con los hombres del perfil ambos más bajos. Por el contrario, solo las mujeres del perfil ambos más altos tuvieron una alianza terapéutica inicial más alta que los del perfil ambos más bajos. Los hombres del perfil ambos más altos tuvieron reducciones más rápidas en su alianza, mientras que otros perfiles no predijeron cambios en la alianza masculina o femenina. Además, los perfiles hombres más altos y ambos más altos predijeron un nivel inicial más bajo de satisfacción con la pareja en los hombres, pero no en las mujeres. Los perfiles no predijeron cambios en la satisfacción con la pareja, lo cual puede ser un resultado de la reducción del poder debido a datos faltantes. Se comentaron los resultados en el contexto de la teoría sistémica familiar, con consecuencias clínicas para las parejas con distrés.

Parent and Caregiver Relationships and Mental Health Symptom Profiles of Youth in Foster Care.

Adolescents in foster care can be quite resilient, yet they also are at risk for developing internalizing and externalizing mental health concerns. Positive family relationships are central to adolescent mental health, and these relationships can be complex for youth in foster care placements. Accordingly, there can be significant heterogeneity in the mental health symptoms of youth in foster care. The aims of this study were to identify distinct subgroups of youth patterns of internalizing and externalizing symptoms and determine the extent to which positive biological and foster parent relationships predicted profiles of low youth mental health symptoms. Using data from the National Survey of Child and Adolescent Well-being II (N = 343) and a person-centered analytic approach, results revealed four distinct profiles of youths' mental health symptoms, those with: high internalizing and high externalizing symptoms, high internalizing and moderate externalizing symptoms, moderate internalizing and moderate externalizing symptoms, and low internalizing and low externalizing symptoms. Additionally, youth with better relationships with biological parents were less likely to be in the high symptoms group compared to the low symptoms group. These findings can be used to inform targeted intervention efforts aimed to lessen the mental health symptoms of youth in foster care.

More Contact with Biological Parents Predicts Shorter Length of Time in Out of Home Care and Mental Health of Youth in the Child Welfare System.

Foster care is intended to be a temporary placement option. Viewing permanency as central to child well-being, current U.S. policies aim to limit the length of time a child spends in out-of-home foster placements. There is little recent research, however, on predictors of length of time in out-of-home care. The purposes of this study were to test if more frequent contact with biological parents predicted less time in out-of-home care, and determine if more frequent contact with biological parents was associated with better mental health outcomes using three waves of data from the National Survey on Child and Adolescent Well-Being II, a U.S. nationally representative dataset of youth involved with the child welfare system. Findings revealed that more frequent contact with biological mothers was associated with fewer cumulative days in out-of-home care. Among covariates, older child age was related to longer stays in out-of-home care, and Black youth experienced more cumulative days in out-of-home care compared to White youth. Links between frequency of contact and youth mental health outcomes also were tested, and more frequent contact with both mothers and fathers was associated with lower mental health symptoms. Being separated from siblings also was associated with more mental health problems, and compared with foster care, being in kinship care was negatively associated with mental health problems. A discussion of the findings in light of U.S. polices and best-practices is included.

Couple Satisfaction, Depressive Symptoms, and the Therapeutic Alliance: A Systemic Perspective.

There is a well-established bidirectional, negative association between couple satisfaction and depressive symptoms. Yet, a family systems perspective emphasizes the role of the therapist in interrupting this recursive cycle between couple satisfaction and depressive symptoms. The current study utilized longitudinal data to explore the bidirectional associations between depressive symptoms and couple satisfaction, moderated by the therapeutic alliance over the course of therapy. The study included 108 couples participating in couple therapy at a university training clinic. Couples rated their depressive symptoms and couple satisfaction separately before the intake session and at the end of the fourth session, and they also reported their individual therapeutic alliance with the therapist at the end of the second and third sessions. Actor-partner interdependence moderation model analysis revealed several moderation effects. In general, with low therapeutic alliance, couples with higher initial symptoms (such as depressive symptoms and low couple satisfaction) reported more severe symptoms at the fourth session, compared to those who had fewer initial symptoms. The moderating effect of alliance on a couple's symptoms was found both among individuals, and between partners. Systemic clinical implications and suggestions for future research are discussed.

Hay una asociación bidireccional y negativa firmemente establecida entre la satisfacción en la pareja y los síntomas depresivos. Sin embargo, la perspectiva de sistemas familiares enfatiza el papel que desempeña el terapeuta en la interrupción de este ciclo recurrente entre la satisfacción en la pareja y los síntomas depresivos. El presente estudio utilizó datos longitudinales para analizar las asociaciones bidireccionales entre los síntomas depresivos y la satisfacción en la pareja, moderadas por la alianza terapéutica durante el transcurso de la terapia. El estudio incluyó 108 parejas que participaron en terapia de pareja en una clínica universitaria de formación. Las parejas calificaron sus síntomas depresivos y la satisfacción en la pareja por separado antes de la sesión de ingreso y al final de la cuarta sesión, y también informaron su alianza terapéutica individual con el terapeuta al final de la segunda y la tercera sesión. El análisis del modelo de moderación de la interdependencia entre el actor y la pareja reveló varios efectos de la moderación. En general, con una alianza terapéutica baja, las parejas con síntomas iniciales más altos (como síntomas depresivos y baja satisfacción en la pareja) informaron síntomas más intensos en la cuarta sesión en comparación con aquellos que tenían menos síntomas iniciales. El efecto moderador de la alianza en los síntomas de la pareja se halló tanto entre las personas como entre las parejas. Se debaten las consecuencias clínicas sistémicas y las sugerencias para futuras investigaciones.

Clients' Attributions of the Presenting Problem and the Therapeutic Alliance in Couple Therapy: Systemic Versus Intrapersonal Perspectives.

The therapeutic alliance is central to couples' therapy success. The current study examined associations between couples' initial agreement and causal attributions of the presenting problem and changes in the therapeutic alliance. To test study hypotheses, 85 couples were recruited from a university training clinic focused on couple and family therapy. Couples completed an intake questionnaire concerning their attribution of the presenting problem, either as systemic or individual, and therapeutic alliance was assessed at the end of sessions 2-8. A dyadic multilevel model revealed that a disagreement in the couple's attributions of the problem (with one viewing it as systemic, the other as individual) was associated with a larger initial discrepancy in the couple's therapeutic alliance, as well as a decline in the discrepancy over time. Findings were discussed in the context of systemic family theory, with implications for improving assessment, treatment, and psychoeducation aimed toward couples in distress.

Informal Networks of Low-Income Mothers: Support, Burden, and Change.

OBJECTIVE: The authors examined the support and burden of low-income, urban mothers' informal networks. BACKGROUND: Living or growing up in poverty strongly predicts barriers and instability across several life domains for mothers and their children. Informal networks can play a critical role in promoting maternal and child well-being particularly in the midst of poverty. Understanding informal support and the reciprocal burden it may create is especially relevant for low-income families living with a reduced public safety net in the post-welfare reform era. Therefore, study aims were to measure support and burden among low-income mothers and determine if support and burden change over time. METHOD: Data were from the Welfare, Children, Families (WCF) project, a longitudinal study of 2,400 low-income, caregivers of children and adolescents living in Boston, Chicago, or San Antonio (http://web.jhu.edu/threecitystudy/index.html)). We applied latent class analyses to support and burden indicators in four domains-emotional, favor, child care, and financial. RESULTS: Results supported four profiles of informal networks - healthy, unhealthy, burden only, and support only. Although most mothers had healthy informal networks, approximately one-third experienced no support or support imbalance which related to network changes at later time points. Demographic characteristics largely were not predictive of support profile or profile change. CONCLUSION: Although many mothers had healthy support and burden, the most vulnerable did not have consistently healthy informal networks. The identification of a sizable minority of low-income mothers who cannot consistently rely on informal support is significant in light of diminished formal supports available to children and families.

The Profession of Couple, Marital, and Family Therapy (CMFT): Defining Ourselves and Moving Forward.

The field of Couple, Marital, and Family Therapy (CMFT) has evolved and strengthened, but we still have work to do when it comes to identity, comprehensive scholarly resources, empirical support, and name brand recognition. We explore the reasons for these challenges and propose ways to address them: embracing the interdisciplinary nature of the field, consistently organizing treatment effectiveness by problem rather than by intervention model, continuing innovation in theory development, and utilizing more diverse and meaningful research methods. This approach provides a more accurate representation of the scope of practice of CMFTs, the range of mental and physical health problems we address, and the depth and extent of the existing research on the effectiveness of relational therapies.

Maternal depression, maltreatment history, and child outcomes: The role of harsh parenting.

The link between maternal depression and negative child outcomes has been well-established; however, less is known regarding the impact of harsh parenting on child outcomes, especially for women living with depressive symptoms and whom also experienced child maltreatment. The purpose of this study was to examine harsh parenting practices as a mediator in this known association, in order to examine factors associated with negative child outcomes and to explore a reduction in future transmission of risk. Mediation analyses were conducted with 2 samples of mother-child dyads at separate time points (child age 6: n = 325; and youth age 12: n = 213) using data collected from the Longitudinal Studies of Child Abuse and Neglect. Only women who reported a history of childhood maltreatment were included in this study. Positive, significant associations were found between maternal depressive symptoms and child internalizing and externalizing symptoms at both ages. Further, partial mediation was established among maternal depressive symptoms, child outcomes, and harsh parenting practices. Analyses demonstrated that mothers with depressive symptoms and a history of maltreatment reported use of psychological and physical aggression with their children (age 6) and youth (age 12). Findings from this study bolstered existing research on maternal depression and child outcomes and extended current knowledge of the role of harsh parenting for children age 6 and youth age 12. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Caregiver-Adolescent Disagreement on the Mental Health of Youth in Foster Care: The Moderating Role of the Caregiver Relationship.

It is not uncommon for caregivers and adolescents to provide different perspectives of adolescents' mental health symptoms; however, few studies have examined these discrepancies, especially between foster parents and adolescents in the child welfare system. The goal of this study was to investigate the levels of disagreement on adolescent mental health symptoms among caregivers and adolescents in foster care, to examine factors associated with caregiver-adolescent discrepancies, and the potential moderating role of caregiver-child closeness on the link between the length of time the youth lived with caregivers and discrepancies regarding adolescent mental health symptoms. These research questions were examined using two measures of adolescent-caregiver disagreement, intraclass correlations and discrepancy scores, using data from a nationally representative study of youth involved with the child welfare system. Analyses of 183 adolescent-caregiver dyads revealed caregiver-adolescent disagreement on adolescents' internalizing and externalizing symptoms, with caregivers reporting higher levels of adolescents' problems on average. Adolescent gender, type of maltreatment experienced, and placement type were associated with caregiver-adolescent discrepancies. Results also indicated that closeness with caregivers significantly moderated the relationship between the length of time adolescents lived with their caregivers and discrepancies on adolescent externalizing symptoms.

Adapting a parenting intervention for parents aging out of the child welfare system: A systematic approach to expand the reach of an evidence-based intervention.

Parents aging out of the child welfare system face a constellation of unique risk factors that threaten the well-being of themselves and their children. Although parenting interventions are an important resource for providing much-needed services to parents aging out, there is currently a lack of evidence-based parenting interventions that address the unique needs of this population. The purpose of this project was to systematically adapt an evidence-based parenting intervention for parents aging out. An established adaptation framework was used to guide this process, and acceptability and feasibility outcomes were evaluated as part of a pilot study of the adapted intervention. Preliminary intervention adaptations included modifications to program delivery and program content. Study findings indicated a high level of parent satisfaction with the adapted intervention but challenges to feasibility because of inconsistent attendance and the substantial effort required for intervention delivery. This study constitutes a critical first step toward increasing the reach of evidence-based parenting interventions among parents aging out of the child welfare system and underscores the need for continued efforts to develop sustainable and effective parenting services for this at-risk population. (PsycINFO Database Record

Reciprocal Associations Among Maternal and Child Characteristics of At-Risk Families: A Longitudinal Actor-Partner Interdependence Model.

Researchers have found linear associations among maternal and child characteristics. However, family systems theorists suggest that relationships are more complex and family members are interdependent. We used actor-partner interdependence modeling to unravel associations among maternal and child characteristics to predict outcomes in adolescence. We used data from 361 mother-child dyads from the Longitudinal Studies of Child Abuse and Neglect and found both actor and partner effects. Maternal depression and history of victimization were associated with children's later reports of lower mother-adolescent relationship quality. Children's perceptions of relationship quality were also associated with mothers' later depressive symptoms and perceptions of relationship quality. Overall, results highlighted interdependence among mothers and their children over time. We discuss implications for marriage and family therapists.

"It's a struggle but I can do it. I'm doing it for me and my kids": the psychosocial characteristics and life experiences of at-risk homeless parents in transitional housing.

Families experiencing homelessness face a number of risks to their psychosocial health and well-being, yet few studies have examined the topic of parenting among homeless families. The purpose of this multimethod, descriptive study was to acquire a better understanding of the psychosocial status and life experiences of homeless parents residing in transitional housing. Quantitative data were collected from 69 parents and primary caregivers living in a transitional housing community, with a cohort of 24 participants also contributing qualitative data. The quantitative results suggest risk associated with depression, parenting stress, and negative parenting practices. The qualitative findings highlight five themes that convey both the challenges faced by homeless parents as well as the resilience they display in spite of such adversity. These results extend current scholarship on homeless families with children and can better inform how couple and family therapists work with this at-risk population.

Child sexual abuse and the superfluous association with negative parenting outcomes: the role of symptoms as predictors.

The purpose of this study was to investigate the relationship between child sexual abuse and high-risk maternal parenting indicators and the extent to which maternal depression and self-perceived parenting competence influence that relationship. Using path analysis, results indicate maternal depression and parenting sense of competence mediate the relationship between child sexual abuse and outcome variables. Post hoc analyses indicated that child sexual abuse was significantly associated with decreased parenting sense of competence, controlling for depression. These results highlight that the pathways for increased risk in parenting outcomes for child sexual abuse survivors may be indirect and associated with beliefs of their own sense of competence and depression as opposed to a direct association with sexual abuse itself. Implications are discussed.

A biopsychosocial approach to asthma in adolescents encountering child protective services.

OBJECTIVE: To further test the validity of the Biobehavioral Family Model (BBFM), a biopsychosocial approach to explaining the effects of family processes on illness, by testing the model with adolescents with asthma involved in child protective services (CPS), a sample for whom the model's constructs are highly relevant. METHODS: Data are from the National Survey of Child and Adolescent Well-Being, CPS sample (n = 5,501). Adolescents with asthma (n = 101, ages 11-15 years) self-reported their negative family emotional climate (NFEC; caregiver psychological aggression and caregiver relationship quality), caregiver-adolescent relational security, and depressive symptoms. Caregivers rated adolescent health quality. Models were tested using path analyses and bootstrapping. RESULTS: Path analyses and bootstrapping results demonstrate support for the BBFM in explaining health quality for this sample. CONCLUSIONS: Applying the BBFM to families involved with CPS demonstrates pathways by which family processes affect health quality of adolescents with asthma, underscoring the need for biopsychosocial assessments and services.