Category: All Publications

Family treatment courts and the COVID-19 pandemic: Barriers and facilitators to program implementation, client engagement, and recovery

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Romain Dagenhardt, D., Richards, J.,* Liu, X.,* & Mersky, J. P. (2023). Family treatment courts and the COVID-19 pandemic: Barriers and facilitators to program implementation, client engagement, and recovery. Journal of Substance Abuse Treatment. Advance online publication. https://www.sciencedirect.com/science/article/pii/S2949875923003302

Abstract

Introduction

Family Treatment Courts (FTCs) serve child welfare-involved parents with substance use issues who are working toward recovery and reunification with their children. Research has linked FTCs to successful outcomes such as treatment access and completion and family reunification, but there has been less attention to factors that hinder and facilitate program implementation and client engagement. Moreover, little is known about how the shift to virtual services during the COVID-19 pandemic impacted FTC programs and the families they serve.

Methods

This study examined interview data gathered from staff in six FTCs located in different regions of the country to investigate the impact of the pandemic on programs and the clients they serve. Interviews conducted with clients from one FTC in the Midwest reinforce the data.

Results

FTC programs and professionals adjusted to the pandemic by attempting to replicate face-to-face services in an online environment. Virtual services were vital for sustaining FTCs and mitigating barriers to client engagement during the pandemic. At the same time, FTCs were compelled to navigate new barriers to online program implementation as well as acute challenges that clients faced such as greater isolation and reduced treatment access.

Conclusions

We discuss implications from these findings with an eye toward maximizing FTC implementation and impact through the intentional use of both in-person programming and online technology after the pandemic.

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Impact of a family treatment court on child permanency and safety

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Mersky, J., Lee, C. P., Liu, X., & Janczewski, C. (2023). Impact of a family treatment court on child permanency and safety. Child Abuse & Neglect, 146, 106512.

Abstract

Background

Family Treatment Courts have been linked to promising effects on key child welfare outcomes, though few rigorous program evaluations have been conducted.

Objective

This study employs a robust quasi-experimental design to evaluate effects associated with Family Treatment Court participation on child permanency and safety.

Participants and setting

The sample included 648 eligible adults who were referred to a Family Treatment Court in a Midwest metropolitan area, including 266 program participants and 382 non-participants.

Methods

Propensity score weighting was applied to match program and comparison groups on demographic and case characteristics. Child welfare records yielded safety and permanency outcomes. Participants and non-participants were compared following an intent-to-treat principle, with logistic regressions used to test the odds of reunification and maltreatment recurrence, and Kaplan-Meier analyses used to explore time to reunification and permanency. Moderation tests were performed to analyze differences in program impact across racial/ethnic groups and substance use types.

Results

Compared to non-participants, program participants were 81 % more likely to reunify. Group differences in time to reunification and permanency were mixed, and there was no evidence of program impact on maltreatment recurrence. Substance use type and race/ethnicity did not moderate associations between program participation and study outcomes.

Conclusions

Mounting evidence suggests that Family Treatment Courts are more effective than usual services in promoting family reunification, though it is unclear if these interventions hasten reunification or increase safety post-reunification. Rigorous evaluations are needed to explore moderating and mediating processes and identify implementation drivers and local conditions that contribute to heterogeneous results.

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Adverse Childhood Experiences and Sexual Orientation: An Intersectional Analysis of Nationally Representative Data

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Mersky, J., Lee, C. P. & Hami, D. (2023). Adverse Childhood Experiences and Sexual Orientation: An Intersectional Analysis of Nationally Representative Data. American Journal of Preventive Medicine, 10.

Introduction

This study compared the prevalence of adverse childhood experiences across intersections of sexual orientation, gender, race/ethnicity, and economic status.

Methods

Data collected between 1994 and 2018 from 12,519 participants in the National Longitudinal Study of Adolescent to Adult Health were analyzed in 2023 to generate adverse childhood experience prevalence estimates. Unadjusted 1-way ANOVAs and multivariate regressions were performed to compare differences in independent and cumulative adversity measures by sexual orientation, gender, race/ethnicity, and poverty status. A multilevel analysis of individual heterogeneity and discriminatory accuracy was conducted to estimate adversity scores across 24 groups that were stratified by sexual orientation, gender, race/ethnicity, and poverty status.

Results

Adolescents with same-sex attractions and adults who identified with a sexual minority group reported more adverse childhood experiences overall than straight participants, although associations varied by type of adversity. Strikingly, adversity scores were higher among White youth with same-sex attractions than among Black youth with same-sex attractions, among more economically advantaged bisexual adults than among poorer ones, and among poor White participants than among poor Black and Hispanic participants, suggesting that the combination of disadvantaged and marginalized statuses does not necessarily correspond with greater childhood adversity. A multilevel analysis of individual heterogeneity and discriminatory accuracy interaction model showed that sexual orientation and poverty status contributed significant variance to cumulative adversity scores, whereas gender and race/ethnicity did not.

Conclusions

The results show that disparities in adverse experiences can be more fully and accurately represented when sexual orientation and other social identities are modeled as intersectional configurations. Given that adverse childhood experiences are linked to morbidity and mortality, the findings have salient implications for understanding health disparities that affect population subgroups.

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Predicting mental and behavioral health service utilization among child welfare-involved caregivers: A machine learning approach

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Janczewski, C. E., & Nitkowski, J. (2023). Predicting mental and behavioral health service utilization among child welfare-involved caregivers: A machine learning approach. Children and Youth Services Review, 155, 107150.

Abstract

Caregiver substance misuse (SM) and mental illness (MI) are risk factors for child abuse and neglect and are associated with more intensive CPS involvement including increased risk of foster care placement and multiple re-reports. This study examines the prevalence of SM and MI among 929 CPS-involved caregivers during the early phases of CPS involvement and explores the extent to which family and CPS-case characteristics predict referral and service receipt. We used a machine learning approach to identify the strongest predictors of SM and MI service receipt by comparing the predictive strength of random forest and logistic regression models. Results indicate a high prevalence of self-reported need for SM (13%) and MI (34%) services among caregivers. Nearly one-quarter (23.5%) of caregivers with SM needs and 34% of caregivers with MI needs did not receive needed services. Frequent contact with CPS workers, adverse experiences in adulthood, and court involvement were strong predictors of both SM and MI service uptake. Findings suggest the need for consistent screening for SM and MI among primary caregivers at the early stages of CPS-involvement, as well as enhanced referral practices. Machine learning applications for applied social science researchers are also discussed.

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Intergenerational transmission of child protective services involvement

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Janczewski, C., Mersky, J., & Lee, C. P. (2023). Intergenerational transmission of child protective services involvement: Exploring the role of ACEs and domestic violence among families who receive home visiting services. Child Abuse & Neglect, 144, 106384.

Abstract

Background
Adverse childhood experiences (ACEs) are associated with negative outcomes over the life course and across generations, including domestic violence (DV) and child maltreatment. However, no studies have examined the connection between parents’ ACEs and their child’s risk of child protective services (CPS) involvement or possible mechanisms of transmission.

Objective
In addition to describing the prevalence and correlates of CPS involvement, our primary aims are to test whether parental adversity in childhood is associated with CPS involvement and whether DV victimization mediates the ACE-CPS association.

Participants and setting
The sample included 3039 primary caregivers and 3343 children served by home visiting programs in Wisconsin between 2014 and 2019.

Methods
Using matched home visiting and CPS records, we generated prevalence estimates of screened-in CPS reports and assessed bivariate associations between CPS involvement and ACEs, DV, and household demographics. We then conducted a two-stage path analysis to test the association between ACEs and CPS involvement and whether DV mediated the ACE-CPS association.

Results
Overall, 22.8 % of caregivers had a screened-in report. Prevalence rates were higher among women who endured ACEs and DV, and they varied by demographic characteristics. ACEs were directly linked to DV and CPS involvement, and there was an indirect pathway linking ACEs to CPS involvement through DV exposure.

Conclusions
Home visiting programs serve families that frequently interact with the child welfare system. By enhancing the trauma-responsive potential of these interventions, it may be possible to interrupt intergenerational mechanisms that contribute to child abuse and neglect and CPS involvement.

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Adverse adult experiences and health outcomes: Racial and ethnic differences in a low-income sample

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Mersky, J. P., Plummer Lee, C., & Janczewski, C. E. (2023). Adverse adult experiences and health outcomes: Racial and ethnic differences in a low-income sample. Stress & Health. Advance online publication. https://doi.org/10.1002/smi.3212

Extending research on adverse childhood experiences (ACEs), this study aimed to investigate whether the prevalence of and outcomes associated with adverse adult experiences vary among racial and ethnic subgroups. Survey data were collected from 1566 low-income women in Wisconsin using the Adult Experiences Survey (AES). Ten major adult adversities were assessed, including items that reference an intimate partner or household member (e.g., physical or emotional abuse, substance use) along with other social and economic stressors such as homelessness and discrimination. Adverse adult experiences were highly prevalent overall, but even more so among non-Hispanic Whites than their Black and Hispanic counterparts. The results reinforce prior research on ACEs in low-income populations. Lending further credence to these findings, tests of measurement invariance indicated that the AES demonstrated acceptable configural and scalar invariance across racial and ethnic groups. As expected, greater exposure to adult adversity was significantly related to poorer physical and mental health. These associations manifested cross-sectionally and longitudinally for observed and latent measures of adult adversity—even after controlling for ACEs. Associations between adult adversity and health were not moderated by race/ethnicity. In sum, adverse adult experiences were unequally distributed across racial/ethnic groups, but the consequences associated with adversity appeared to be evenly dispersed.

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Life course adversity and sleep disturbance among low-income women with young children

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Mersky, J. P., Plummer Lee, C., & Jackson, D. B. (2023). Life course adversity and sleep disturbance among low-income women with young children. Sleep Health. Advance online publication. https://doi.org/10.1016/j.sleh.2023.02.007

Objectives: This study explored whether patterns of lifetime adversity are associated with sleep disturbance and tested whether adult adversity mediates the relationship between childhood adversity and sleep.

Methods: A sample of 1510 postpartum women in Wisconsin who received home visiting services completed assessments of childhood adversity, adult adversity, and sleep disturbance; 989 women completed another sleep assessment about one year later. Latent class analysis was used to identify classes of lifetime adversity, which were then used to predict later sleep ratings while controlling for earlier sleep ratings and demographic variables. A path analysis was conducted to explore whether adult adversity mediated the association between childhood adversity and sleep.

Results: Adverse childhood and adult experiences were highly prevalent, and greater life-course adversity was associated with sleep disturbance. The association between childhood adversity and sleep was significantly mediated by adult adversity.

Conclusions: Sleep quality appears to correspond with life-course adversity, pointing to ongoing opportunities for prevention and intervention.

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The long arm of maternal incarceration

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Gómez, A. Mersky, J. P., Plummer Lee, C., Zhang, L., Shlafer, R. J., & Jackson, D. B. (2023). The long arm of maternal incarceration: Indirect associations with children’s social-emotional development. Child and Adolescent Social Work Journal. Advance online publication. https://doi.org/10.1007/s10560-023-00924-1

A growing body of research reveals a connection between maternal incarceration and various child development outcomes. Even so, little is known about how the timing of maternal incarceration may shape the social–emotional development of young children and the role of maternal mental health in mediating this association. Using a sample of 1097 mothers (18–52 years old, 47.6% white) and children (aged 12–48 months) receiving home visiting services in Wisconsin, this study examined the intergenerational effect of incarceration before a child’s birth on child social–emotional development, and whether this association was mediated by maternal mental health. While incarceration prior to a child’s birth was not directly associated with child social–emotional outcomes, path analysis revealed an indirect association between mother’s incarceration prior to a child’s birth and child social–emotional problems through maternal mental health problems. Findings suggest that formerly incarcerated mothers may experience long-lasting mental health concerns that can undermine child social–emotional development. To optimize outcomes, practitioners may consider services that address the mental health, social support, and instrumental needs of mothers and children who have been impacted by mass incarceration.

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Linking adverse experiences to pregnancy and birth outcomes

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Mersky, J. P., Jeffers, N. K., Plummer Lee, C., Shlafer, R. A., Jackson, D. B, & Gómez, A. (2023). Linking adverse experiences to pregnancy and birth outcomes: A life course analysis of racial and ethnic disparities among low-income women. Journal of Racial and Ethnic Health Disparities. Advance online publication. https://doi.org/10.1007/s40615-023-01647-w 

Racial and ethnic disparities in birth outcomes have persisted in the United States for decades, though the causes remain poorly understood. The life course perspective posits that poorer outcomes of Black birthing people stem from heightened exposure to stressors early in life and cumulative exposure to stressors over time. Despite its prominence, this perspective has seldom been investigated empirically. We analyzed longitudinal data gathered from 1319 women in low-income households in Wisconsin who received perinatal home visiting services. Variable- and person-centered analyses were performed to assess whether 15 adverse childhood experiences (ACEs) and 10 adverse adult experiences (AAEs) were associated, alone and in combination, with pregnancy loss, preterm birth, and low birth weight among Hispanic (i.e., Latinx) and non-Hispanic Black and White participants. As expected, there were disparities in preterm birth and low birth weight, and both ACEs and AAEs were linked to poorer pregnancy and birth outcomes. Unexpectedly, bivariate and multivariate analyses showed that the associated effects of ACEs and AAEs were most robust for non-Hispanic White women. A latent class analysis produced four patterns of life course adversity, and multigroup latent class analyses confirmed that, compared to White women, higher-adversity class assignments were associated with less robust effects for Hispanic women, and even less robust effects for Black women. We discuss interpretations of the paradoxical findings, including the possibility that alternative sources of stress such as interpersonal and structural racism may better account for the reproductive disparities that disproportionately affect Black birthing people.

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Trauma-Responsive Vocational Rehabilitation Services

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Chopp, S., Topitzes, J., & Mersky, J. P. (2023). Trauma-responsive vocational rehabilitation services. Behavioral Sciences, 13(6), 511.  https://www.mdpi.com/2076-328X/13/6/511

Research on the effectiveness of Vocational Rehabilitation (VR) Programs has revealed that VR services are less effective for trauma-affected and Black consumers. For instance, consumers with trauma exposure disengage from services earlier than their non-traumatized counterparts, and Black consumers benefit less from each phase of VR services compared to others. One midwestern state’s VR program sought to address these disparities by offering trauma-informed and trauma-responsive services that emphasize cultural responsiveness, racial equity, and strengths-based practices. To begin this work, the state’s VR program collaborated with an applied research unit in a public university to establish two work groups: a communications group and a training group. The purpose of the communications group was to build a robust referral network within the VR Division and with other community-based agencies and providers, particularly for low-income, Black consumers. The purpose of the training group was to develop and deliver a training program to support VR professionals in providing trauma-informed and trauma-responsive services. Results from an evaluation of the training indicated that each training module generated for staff both reminders and new insights into ways to effectively work with consumers. Staff expressed that they wanted opportunities to further explore and apply the training content and needed additional, ongoing support to implement what they were learning. In response to staff needs, the state’s VR program is continuing to invest in this community–university partnership by establishing communities of practice for staff and evaluating the effectiveness of the training program.

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Increasing equitable access to home visiting: An independent implementation study of Family Connects

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Mersky, J. P., Choi, C., Langlieb, J., Plummer Lee, C., & Chang, P. (2022). Increasing equitable access to home visiting: An independent implementation study of Family Connects. Journal of the Society for Social Work and Research.

Objectives: Home visiting programs often provide long-term services to at-risk populations, though briefer, universal interventions like Family Connects are increasingly being disseminated to bring home visiting to scale. Extending research by the model’s developers in North Carolina, this paper presents findings from the first independent implementation study of Family Connects.

Method: Observational data were drawn from program records entered between August 2017 and February 2020 at a new Family Connects site in [location blinded]. Indicators of program acceptance, participation, and fidelity were examined. Data collected during home visits were used to describe family needs and demographics. An analysis of data gathered after program completion examined consumer satisfaction and referral connections.

Results: Of 2,304 families who were offered the program, 1,778 (77.2%) accepted services and 1,107 (48.0%) received services. Replicating prior findings, the program was implemented with high fidelity. Most participants had some need for education (99.4%), and over half (50.6%) had a need that warranted a referral. Family needs varied by race/ethnicity, educational attainment, and health insurance status. Post-program data gathered from 648 participants revealed high levels of program satisfaction and high rates of referral connections.

Conclusion: Interpretations of the findings and implications for health equity are discussed.

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Trauma Screening, Brief Intervention, and Referral to Treatment (T-SBIRT) Implemented within TANF Employment Services: An Outcome Study

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Topitzes, J., Bacalso, E., Plummer-Lee, C. T., Jonas-Gordon, S., & Mersky, J. P. (2022). Trauma Screening, Brief Intervention, and Referral to Treatment (T-SBIRT) Implemented within TANF Employment Services: An Outcome Study. Journal of Social Service Research, 48(6), 753-767.

Abstract

The current study tested a trauma screening, brief intervention, and referral to treatment (T-SBIRT) interview protocol as implemented within Temporary Assistance to Needy Families programming. Using a non-experimental process evaluation and quasi-experimental outcome evaluation (N = 88), the study assessed four research questions. First, do T-SBIRT providers reach model adherence rates above 90%? Second, do over 90% of T-SBIRT completers experience the intervention as tolerable? Third, is T-SBIRT completion associated with decreases in mental health symptoms? Fourth, is T-SBIRT completion linked to reductions in positive mental health screenings? Process data emerged from provider-completed integrity checklists. Participant-completed baseline and follow-up surveys furnished outcome data, i.e., mental health indicators from validated scales of depression, anxiety, and post-traumatic stress disorder (PTSD). Descriptive statistics answered questions one and two; multivariate analyses addressed questions three and four. Results revealed that providers realized adherence rates at 98.5%; 91.3% of completers found the protocol tolerable; and completers reported significant reductions in depression symptoms, PTSD symptoms, and positive PTSD screenings relative to a comparison group. Findings recommend integrating T-SBIRT into social services to promote participant mental health and potentially enhance program outcomes. Future T-SBIRT research should include a randomized controlled trial assessing long-term mental health, employment, and income outcomes.

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Adverse adult experiences and health outcomes: Racial and ethnic differences in a low-income sample

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Mersky, J. P., Plummer Lee, C., & Janczewski, C. E. (2022). Adverse adult experiences and health outcomes: Racial and ethnic differences in a low-income sample. Stress & Health.

Abstract

Extending research on adverse childhood experiences (ACEs), this study aimed to investigate whether the prevalence of and outcomes associated with adverse adult experiences vary among racial and ethnic subgroups. Survey data were collected from 1566 low-income women in Wisconsin using the Adult Experiences Survey (AES). Ten major adult adversities were assessed, including items that reference an intimate partner or household member (e.g., physical or emotional abuse, substance use) along with other social and economic stressors such as homelessness and discrimination. Adverse adult experiences were highly prevalent overall, but even more so among non-Hispanic Whites than their Black and Hispanic counterparts. The results reinforce prior research on ACEs in low-income populations. Lending further credence to these findings, tests of measurement invariance indicated that the AES demonstrated acceptable configural and scalar invariance across racial and ethnic groups. As expected, greater exposure to adult adversity was significantly related to poorer physical and mental health. These associations manifested cross-sectionally and longitudinally for observed and latent measures of adult adversity—even after controlling for ACEs. Associations between adult adversity and health were not moderated by race/ethnicity. In sum, adverse adult experiences were unequally distributed across racial/ethnic groups, but the consequences associated with adversity appeared to be evenly dispersed.

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The Association between Family Physical Environment and Child Maltreatment

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Zhang, L., & Topitzes, J. (2022). The Association between Family Physical Environment and Child Maltreatment. Children and Youth Services Review, 106551.

Abstract

Background

A body of emerging research has indicated that adverse family physical environment is related to parenting problems such as parent-child conflict, decreased caregiver sensitivity, and less parental emotional availability. Yet, no study has examined if family physical environment is also associated with child abuse and neglect.

Objective

This study aimed to examine the relationships between family physical environment and different types of child maltreatment.

Participants and Setting

The study sample includes 1,624 mothers who participated in both year 3 and year 5 surveys of the U.S. Fragile Family and Child Well-Being Study (FFCWS).

Methods

Family physical environment was measured by the Infant-Toddler Child Care Home Observation of Environment (HOME). Child maltreatment was assessed by the Conflict Tactics Scale: Parent-Child Version (CTS-PC), and mother’s self-report if child protective services had a concern about the family’s child maltreatment. Multivariate logistic regression models were run to test if family interior (i.e., inside house conditions) or exterior (i.e., immediate outside house conditions) environment would predict child abuse and neglect, while controlling for a series of covariates.

Results

Results indicated that family exterior environment was not related to any type of child abuse and neglect. However, family interior environment was significantly associated with child neglect (OR = 1.10; 95% CI = 1.02–1.20), but not with physical abuse, emotional abuse, and sexual abuse.

Conclusions

Study findings suggest that family interior environment is significantly associated with initial or ongoing child neglect. Implications for future research and practice are discussed.

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Mental health among university employees during the COVID-19 pandemic: The role of previous life trauma and current posttraumatic stress symptoms

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Goldstein, E., Topitzes, J., Brown, R. L., & Jussel, A. B. (2022). Mental health among university employees during the COVID-19 pandemic: The role of previous life trauma and current posttraumatic stress symptoms. Psychological Trauma: Theory, Research, Practice, and Policy.

Abstract

Objective: Previous studies indicated that the coronavirus disease 2019 (COVID-19) pandemic has harmed the mental health of diverse samples. Adopting a trauma lens with a sample of university faculty and staff, this study examined risk conferred by previous exposure to traumatic life events (TLE) on pandemic-related mental health harm (MHH) and stress and the mediating influence of posttraumatic stress disorder (PTSD) symptoms. Method: In Spring 2021, employees (N = 641) of a public university in the United States completed an online cross-sectional survey, including validated scales of TLE and PTSD and single-item measures of MHH and stress taken from published COVID-19 studies. A structural probit model was used to estimate: (a) direct effects of cumulative TLE on PTSD, MHH, and stress; and (b) indirect effects of cumulative TLE via PTSD adjusting for age. Gender was tested as a moderating influence. Results: Nearly 36% of the sample reported positive PTSD screens along with high levels of MHH (22.5%) and stress (42.3%). Cumulative TLE was significantly and positively associated with MHH and stress. Both genders experienced a negative impact on mental health and stress either fully or partially through PTSD symptoms; however, the gender by trauma interaction term was not significant. As age decreased, PTSD and MHH increased. Conclusion: Results suggest that PTSD symptoms play a crucial role in the experience of MHH and stress during the pandemic for those who endured previous trauma. Implications for employer policies, public health messaging, and mental health services are explored.

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Quasinatural experiment of postnatal home visiting: An independent impact study of Family Connects

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Mersky, J. P., Choi, C., & Plummer Lee, C. (2022). Quasinatural experiment of postnatal home visiting: An independent impact study of Family Connects. American Journal of Preventive Medicine, 63(5), 783-789.

Family Connects (FC) is a postnatal nurse home visiting program that has scale-up potential because it is brief, inexpensive, and universal. Three investigations have linked Family Connects to improved maternal and family outcomes, but no independent impact studies have been conducted to date. This study investigates a FC program in Racine County, WI that was implemented by a multimunicipal health department in partnership with a local hospital.

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Impact of home visiting programs on parenting stress in low-income women: Findings from a community-based trial at an urban health department

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Mersky, J. P., Janczewski, C. E., Plummer Lee, C., & Yasin, T. (2022). Impact of home visiting programs on parenting stress in low-income women: Findings from a community-based trial at an urban health department. Children and Youth Services Review, 142, 106638.

Four decades of home visiting research has yet to reveal clear implications regarding the amount and type of services required to produce intended outcomes like reduced parenting stress. This study compared the effects of two home visiting programs on parenting stress and examined whether depressive symptoms and social support were associated with stress levels and differential program effects. Data were collected during an impact study at an urban health department in the Midwest United States from 237 low-income pregnant women who were referred for services between April 2014 and March 2017. Referrals were randomly assigned to a Healthy Families America program or a briefer prenatal care coordination program. A third quasi-experimental study group included women who were referred to but did not receive services. Data on demographics, depressive symptoms, and social support were collected at baseline near the time of program enrollment; 210 participants completed post-baseline parenting stress assessments at up to three time points during the child’s first year. Results from mixed model repeated measures analysis of covariance showed that receiving prenatal care coordination was associated with lower parental distress at 14–60 days postpartum. Neither intervention was linked to reduced stress at 6 or 12 months postpartum. Higher depressive symptoms and lower social support predicted greater stress. Depressive symptoms moderated the effects of prenatal care coordination, with benefits concentrated among participants with higher depression scores. Joining recent calls for greater precision in home visiting, the findings highlight the need to optimize limited resources by effectively tailoring services to address specific outcomes in different populations and contexts.

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Intergenerational transmission of parental adverse childhood experiences and children’s outcomes: A scoping review

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Zhang, L., Mersky, J. P., Gruber, A. M., & Kim, J. Y. (2022). Intergenerational transmission of parental adverse childhood experiences and children’s outcomes: A scoping review. Trauma, Violence & Abuse. 

Adverse childhood experiences (ACEs) are among the leading environmental causes of morbidity and mortality. Extending research on within-generation effects, more recent scholarship has explored between-generation consequences of ACEs. Despite growing interest in the intergenerational effects of parents’ ACEs on children’s outcomes, this line of scholarship has yet to be coalesced into a comprehensive review. The current study is a scoping review on the intergenerational transmission of parental ACEs and children’s outcomes. Ten databases such as PubMed, APA PsycArticles, and Social Work Abstracts were searched. To be included, empirical studies must have been published in English and analyzed associations between a cumulative measure of at least four parental ACEs and children’s outcomes. Sixty-eight studies qualified for the review and, among these, 60 were published in the most recent 5 years (2018–2022). Fifty-one studies had sample sizes smaller than 500, and 55 focused on the effect of maternal ACEs. Nearly all studies demonstrated that parental ACEs could affect children’s outcomes directly or indirectly via mechanisms like maternal mental health problems or parenting-related factors. By scoping the extant literature, this review advances the knowledge base regarding the intergenerational impacts of parental childhood trauma and children’s outcomes. It also reveals methodological limitations that should be addressed in future research to strengthen causal inferences along with practical implications for interventions that aim to interrupt the intergenerational transmission of trauma.

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Helping nurses identify and report sentinel injuries of child abuse in infants

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Cleek, E. A., Totka, J. P., Sheets, L. K., Mersky, J. P., Haglund, K. L. (2022). Helping nurses identify and report sentinel injuries of child abuse in infants. Pediatric Nursing Journal, 48(3), 123-128. 

Abstract

Sentinel injuries (SIs) are some of the earliest and most readily identifiable red flags of child abuse. SIs are unexpected bruising or intra-oral injuries in premobile infants and highly correlated with child abuse. However, SIs are not always recognized and reported as red flags of child abuse. Infants are left at risk for continued harm when SIs are not identified and reported. Although increasing nurses’ knowledge of SIs is important, child abuse researchers and behavioral theorists have identified that knowledge alone does not predict nurses’ behaviors when identifying and reporting suspected child abuse. Other predictors may include implicit biases, interpersonal and interprofessional relationships, and nurses’ understanding of mandatory reporting laws. Nurses may improve their recognition and comfort of reporting SIs and all suspected child abuse by being alert for SIs, being aware of potential implicit biases, communicating in non-technical language with families, understanding the clinical evaluation of suspected child abuse, and understanding the processes of Child Protective Services (CPS). Using these steps, nurses can fulfill their legal and ethical responsibilities to protect and advocate for victimized children.

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Secondary traumatic stress among home visiting professionals

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Janczewski, C. E. & Mersky, J. P. (2022). Secondary traumatic stress among home visiting professionals. Psychological trauma : theory, research, practice and policy. 

Abstract

Objective: This study examined the reliability and factor structure of the Secondary Traumatic Stress Scale (STSS) and the prevalence and correlates of secondary traumatic stress (STS) among home visitors.

Method: Survey data were collected between 2015 and 2020 from 301 home visitors with caseloads. Participants completed the 17-item STSS, which assesses intrusion, avoidance, and arousal symptoms using the DSM-IV-TR diagnostic criteria. Internal reliabilities of the scale and subscales were measured and confirmatory factor analyses were performed to validate hypothesized model solutions. Symptom prevalence among the sample was calculated and linear regressions were conducted to examine whether personal and workplace factors were associated with STS.

Results: Analyses confirmed that the STSS had sound internal consistency and that both 3- and single-factor measurement models fit the data. Approximately 10% of home visitors met the clinical criteria for PTSD, though prevalence decreased to 8% after omitting an intrusion item that was endorsed by most respondents. Increased exposure to adverse childhood experiences and poorer work environment ratings were associated with increased STS. Non-Hispanic White race was associated with elevated arousal symptoms. No other personal or workplace factors were associated with scores on the STSS full scale or subscales.

Conclusion: This study reaffirms that the STSS has sound psychometric properties, but it also raises questions about the prevalence and etiology of STS. Given the likely costs of PTSD to personal well-being and professional efficacy, further research is needed to advance the measurement and prediction of secondary traumatic stress.

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Advancing research on perinatal depression trajectories

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Choi, C., Mersky, J. P., Janczewski, C. E., & Goyal, D. (2022). Advancing research on perinatal depression trajectories: Evidence from a longitudinal study of low-income women. Journal of Affective Disorders, 301, 44-51.

Abstract

Objectives: The current study aimed to describe and predict perinatal depression trajectories in a sample of low-income women from the first trimester of pregnancy to six months postpartum.

Methods: The study sample consisted of 899 women in Wisconsin who received home visiting services. Eligible participants were screened for depressive symptoms by home visitors using the Edinburgh Postnatal Depression Scale at least three times across four time periods from the first trimester of pregnancy to six months postpartum. Growth Mixture Modeling was applied to identify distinct trajectory classes, and multinomial logistic regressions were performed to analyze predictors of class membership.

Results: Mean depressive symptom scores in this racially/ethnically diverse sample of low-income women decreased significantly over time from a high of 8.1 at time1 to a low of 6.8 at time4. Four classes were identified, including a low-stable group (78.2% of sample), a high-stable group (10.6%) along with decreasing (7.1%) and increasing (4.1%) trajectories. Women with a history of abuse and mental health difficulties were more likely to be classified in the high-stable and decreasing depression groups than the low-stable group. Low social support was linked to an increasing trajectory that resulted in high levels of postpartum depression.

Conclusions and implications: Although most women exhibited stable and positive trajectories, more than one out of five presented with either persistently or intermittently high depression scores. Taken together, the findings underscore the importance of depression screening throughout the perinatal period and identifying factors that may be used to target resources to at-risk populations.

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Intergenerational effects of mothers’ adverse childhood experiences on children’s social-emotional development

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Zhang, L., Mersky, J. P., & Plummer Lee, C. (2022). Intergenerational Pathways Linking Mothers’ Adverse Childhood Experiences and Children’s Social-Emotional Problems. Child Abuse & Neglect. 

Abstract

Despite the persistent hypothesis that adverse childhood experiences (ACE) have intergenerational implications, empirical research documenting the effects and the mechanisms of transmission remains underdeveloped. This study examined the intergenerational effects of mothers’ adverse childhood experiences on their offspring’s social-emotional development and whether the association was mediated by mothers’ mental health, adult adversity, and perceptions of paternal involvement. The study sample included 831 mothers (19–49 years old, 47.5% White) with children aged 12–48 months who participated in a longitudinal investigation of low-income families in Wisconsin. ACEs were assessed by home visitors, and two waves of survey data were collected by researchers to assess demographics, mediators, and social-emotional outcomes. A path analysis showed that the association between maternal ACEs and children’s social-emotional problems was fully mediated, with postpartum mental health acting as a primary mechanism. Implications for intervention and future research directions are discussed.

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Effects of COVID-19 on Home Visiting Services for Vulnerable Families

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Mersky, J. P., McKelvey, L. M., Janczewski, C. E., & Fitzgerald, S. (2021). Effects of COVID-19 on home visiting services for vulnerable families: A multi-state analysis of enrollment, engagement, and attrition patterns. Families, Systems, & Health.

Abstract

Introduction: COVID-19 has resulted in massive health and economic consequences, with effects felt most acutely by populations that were disadvantaged prior to the pandemic. For families with young children, the effects have been compounded by service interruptions, though there is a lack of empirical evidence that demonstrates how COVID-19 has affected home visiting programs. This cross-state study is the first to examine the effects of the pandemic on home visiting enrollment, engagement, and retention patterns.

Method: Program implementation records gathered from 2017–2020 in Arkansas and Wisconsin were analyzed. Both states operate a large network of home visiting programs that serve predominantly low-income families and that are supported by the federal Maternal, Infant, and Early Childhood Home Visiting program. Trends prior to COVID were compared to post-COVID trends (March 12 to December 31, 2020) in program enrollments, service capacity, visitation frequency, service modalities, attrition rates, and service duration.

Results: Compared to average pre-pandemic enrollments from 2017–2019, post-COVID enrollments decreased by 33–36%. Total visits fell by 15–24%; the percentage of completed visits relative to expected visits declined more modestly. However, the average duration of services increased post-COVID while rates of early program dropout decreased.

Discussion: The findings suggest that enrollment and engagement in home visiting decreased during the COVID-19 pandemic, which is unfortunate given the large number of vulnerable families served nationwide. Further research is needed to examine how COVID affected both consumer and program behaviors.

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Increasing mental health treatment access and equity through trauma-responsive care

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Mersky, J. P., Topitzes, J., Langlieb, J., & Dodge, K. A. (2021). Increasing mental health treatment access and equity through trauma-responsive care. American Journal of Orthopsychiatry.

Abstract

Adverse childhood experiences and other potentially traumatic events have lasting implications for mental health. Evidence-based treatments are available to address trauma-related symptoms, but their impact is hindered because access is limited and unequal. In the U.S., adverse experiences and mental disorders disproportionately affect socioeconomically disadvantaged groups that face treatment access barriers—disparities that are compounded by passive systems of care that wait for clients to seek treatment. This article presents a conceptual argument, backed by empirical evidence, that population health can be improved by implementing trauma-responsive practices, and that greater mental health equity can be achieved if these strategies are used to engage underserved clients. A description is provided of the Trauma Screening, Brief Intervention, and Referral to Treatment (T-SBIRT), a promising protocol that can be used by nonclinical providers to detect trauma-related mental health concerns in adults and help them access therapeutic services. The T-SBIRT protocol has been successfully implemented in diverse settings, and it is currently being piloted in a universal postpartum home visiting program called Family Connects. Prior results from three trials of Family Connects are summarized, including evidence of program impact on maternal mental health. New results are also presented indicating that T-SBIRT is feasible to implement within Family Connects, as denoted by indicators of suitability, tolerability, provider adherence, and referral acceptance. Closing recommendations are offered for reducing mental health disparities by testing and disseminating T-SBIRT through Family Connects and other large-scale programs and systems of care.

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Assessing polyvictimization in a family justice center: Lessons learned from a demonstration project

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Romain Dagenhardt, D., Mersky, J.P., Topitzes, J., Schubert, E., & Krushas, A. (2021). Assessing polyvictimization in a family justice center: Lessons learned from a demonstration project. Journal of Interpersonal Violence.

Abstract

There is a growing interest in developing comprehensive assessments that measure intimate partner violence (IPV) alongside other adverse events that correlate with IPV and compound its effects. One promising line of research in this area has focused on the impact of exposure to multiple types of victimization, i.e., polyvictimization. The purpose of this study is to examine the experience of administration of a polyvictimization tool from staff and client perspectives in order to inform future tool developments and assessment procedures. Qualitative interviews and focus groups with clients and staff from a family justice center who had experience with the assessment tool were used to identify strengths and challenges of the assessment too and inform future tool development. Findings demonstrate that an assessment tool provides the space for clients to talk about trauma and facilitate empowerment, while providing the opportunity for psychoeducation and service referrals. Concerns about the assessment tool included adverse reactions without proper framing and language, as well as shifting the emphasis from screening for adversities toward strengths, coping skills, and resilience. Implications for future measurement development and establishing best practices in polyvictimization assessment are discussed, with an emphasis on the benefits of social service agencies utilizing assessment tools.

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A brief measure of workplace environment for health and human service professionals

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Janczewski, C. E., Mersky, J. P., & Plummer Lee, C. (2021). A brief measure of workplace environment for health and human service professionals. Human Service Organizations: Management, Leadership & Governance.

Abstract 

Organizational characteristics are important predictors of workplace outcomes, but the length and complexity of validated instruments restrict their use in research and practice. This study tested a brief Measure of Work Environment (MWE) using data from 718 child welfare and 349 home visiting professionals. Results confirmed a three-factor structure: group cohesion, leadership support, and organizational justice. The MWE demonstrated acceptable internal consistency (α = .87) and was significantly associated with job satisfaction, burnout, and intent to leave. The MWE is a promising, pragmatic measure of organizational environment for implementation research and program improvement.

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Tool available here

Disparities in adverse childhood experiences by race/ethnicity, gender, and economic status

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Mersky, J. P., Choi, C., Plummer Lee, C, & Janczewski, C. E. (2021). Disparities in adverse childhood experiences by race/ethnicity, gender, and economic status: Intersectional analysis of a nationally representative sample. Child Abuse & Neglect.

Abstract

Background
Adverse childhood experiences (ACEs) are disturbingly common and consequential. Priority should be given to identifying populations that bear a disproportionate share of the burden of ACEs, but such disparities have received limited attention to date.

Objective
This study analyzes data from the National Longitudinal Study of Adolescent to Adult Health, a nationally representative sample in the U.S., to explore variation in ACEs by race/ethnicity, economic status, and gender.

Methods
In addition to using conventional statistical methods to generate unadjusted and adjusted estimates, we conduct an intercategorical intersectional analysis of variation in ACEs using multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA).

Results
Descriptively, we find that ACEs are more prevalent overall among the poor than the non-poor, among most racial/ethnic minority groups than non-Hispanic Whites, and among females than males. However, multivariate regression results indicate that gender is not a robust correlate of cumulative adversity and that economic status moderates racial/ethnic differences. MAIHDA models further expose heterogeneity in aggregate ACE scores between intersectional strata representing unique combinations of gender, race/ethnicity, and economic status.

Conclusions
The MAIHDA results confirm that conclusions based on unadjusted group differences may be spurious. While most variance in ACE scores is explained by additive main effects, accounting for intersections among social categories generates a more complex portrait of inequality. We compare our work to prior studies and discuss potential explanations for and implications of these findings for research on disparities.

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A mutual process of healing self and healing the community

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Mueller, D., Bacalso, E., Ortega‐Williams, A., Pate Jr, D. J., & Topitzes, J. (2021). A mutual process of healing self and healing the community: A qualitative study of coping with and healing from stress, adversity, and trauma among diverse residents of a midwestern city. Journal of Community Psychology.

Abstract

Residents of urban American neighborhoods facing economic hardship often experience individual and collective adversities at high levels. This study explores how racially diverse adults experience stress, adversity, and trauma, and how they cope and heal in the context of their environment. Following a critical realist grounded theory methodology, four focus groups were conducted with African American, White and Latinx participants (N = 21) within an employment service program. Participants identified key stressors ranging from financial and job challenges, violence, and trauma. To cope with and heal from adversity, they practiced positivity, named trauma and its effects, sought social connection, envisioned community‐based resources, and addressed structural and systemic barriers. The data generated a theory of “a mutual process of healing self and healing the community” through intrapersonal, interpersonal, and structural change. The results of this study indicate a need for peer‐led, community‐engaged initiatives and holistic, trauma‐informed, healing‐centered practices.

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Prevalence and correlates of vaccine hesitancy in a sample of low-income mothers

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Gilbert, R., Mersky, J. P., & Plummer Lee, C. (2021). Prevalence and correlates of vaccine hesitancy in a sample of low-income mothers. Preventive Medicine Reports, 21, 101292. 

Abstract

The US is facing a rise in vaccine hesitancy, delay, and refusal, though little is known about these outcomes in socio-economically disadvantaged populations. This study examines the prevalence and correlates of vaccine attitudes and behaviors in a diverse cohort of low-income mothers receiving home visiting services. Survey data were collected from 813 recipients of evidence-based home visiting services in Wisconsin from 2013 to 2018. Analyses were performed to describe outcome measures of vaccine attitudes and self-reported completion, and multivariate regressions were used to test associations between vaccine-related outcomes and hypothesized correlates. Most women (94%) reported their children were up to date on vaccines; 14.3% reported having ever delayed vaccination. A small minority disagreed that vaccines are important (5.0%), effective (5.4%), and safe (6.2%), though a larger proportion responded ambivalently (10.9%–21.9%). Participants with greater trust in health care providers reported more positive overall vaccine attitudes (B = 0.24; 95% CI = 0.17, 0.31), a lower likelihood of vaccine delay (OR = 0.57; 95% CI = 0.46, 0.73), and a greater likelihood of being up to date on vaccines (OR = 1.79, 95% CI = 1.30, 2.44). Women with greater trust in a home visitor also rated vaccines more positively (B = 0.09; 95% CI = 0.02, 0.15), and women who reported better mental health were more likely to report their children were up to date (OR = 1.05; 95% CI = 1.02, 1.09). Compared to non-Hispanic whites, American Indians and non-Hispanic blacks had poorer vaccine-related outcomes. More research on vaccine attitudes and behaviors among higher-risk populations is needed to develop tailored strategies aimed at addressing vaccine hesitancy and underimmunization.

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Toward the Assessment of Adverse Adult Experiences: An Initial Validation Study of the Adult Experiences Survey

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Mersky, J. P., Plummer Lee, C., & Janczewski, C. E. (2020). Toward the Assessment of Adverse Adult Experiences: An Initial Validation Study of the Adult Experiences Survey. Psychological Trauma: Theory, Research, Practice, and Policy.

Objective: The current investigation is a validation study of the Adult Experiences Survey, a seminal assessment of adverse adult experiences.

Method: Data were collected between July 2015 and June 2019 from a sample of 1,747 low-income women as part of a longitudinal study in Wisconsin, United States. Analyses of 10 adversities were conducted to assess item prevalence and internal consistency in the full sample and test-retest reliability in a subsample of 90 participants. Exploratory and confirmatory factor analyses were performed to examine the factor structure of the measure, and multivariate regressions were conducted to estimate the effects of adult adversity on 3 health-related outcomes: poor physical health, depression, and posttraumatic stress disorder.

Results: Most participants (86%) endorsed at least 1 adversity. Each item demonstrated good test-retest reliability except crime victimization, and the full measure had sound internal consistency. Each adversity was associated with all health-related outcomes at the bivariate level, and most were linked to 1 or more outcomes in multivariate analyses. Exploratory and confirmatory factor analyses validated 1- and 2-factor solutions with good fit. A cumulative adult adversity score was associated with all study outcomes controlling for adverse childhood experiences, and effects associated with a latent adversity score were even larger in magnitude.

Conclusions: Extending research on adverse childhood experiences, the findings indicate that adverse adult experiences can be measured reliably and validly using a brief assessment. Implications are discussed, including opportunities to advance the study of trauma and resilience over the life course.

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Validity of an expanded assessment of adverse childhood experiences: A replication study

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Choi, C., Mersky, J. P., Janczewski, C. E., Plummer Lee, C., Davies, W. H., & Lang, A. C. (2020). The Childhood Experiences Survey: Replication study of an expanded assessment of adverse childhood experiences. Children and Youth Services Review.  

Research has shown unequivocally that adverse childhood experiences (ACEs) are prevalent and consequential, but the field lacks consensus around how they should be measured. This replication study reexamined the construct and concurrent validity of the Childhood Experiences Survey (CES), an expanded assessment of 10 conventional ACEs and seven novel childhood adversities. The CES was administered to three samples of adults with children in a Midwest state: (1) caregivers whose children were the subject of a screened-in child protective services report (n = 1,087), (2) low-income women who voluntarily enrolled in a home visiting program (n = 659), and (3) a convenience sample from general population (n = 667). The prevalence of childhood adversities and their intercorrelations were assessed. Extending a previous exploratory analysis, a confirmatory factor analysis was conducted to examine the underlying structure of the CES, and tests of association were performed between the factors and adult mental health outcomes. Results confirmed that all 17 adversities were common and interrelated. For each sample, the 10 conventional ACEs fit a two-factor structure: child maltreatment and household dysfunction. The expanded assessment of 17 adversities fit a four-factor solution: direct victimization/household dysfunction, neglect, poverty, and family separation/loss. All factors were significantly associated (p < .05) with depressive symptoms and anxiety symptoms in all three samples. Implications for further measurement development aimed at advancing ACE research are discussed.

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Adverse childhood experiences and psychological well-being in a rural sample of Chinese young adults

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Zhang, L., Mersky, J. P., & Topitzes, J. (2020). Adverse childhood experiences and psychological well-being in a rural sample of Chinese young adults. Child Abuse & Neglect. 

Background

International interest in adverse childhood experiences (ACE) is on the rise. In China, recent research has explored the effects of ACEs on health-related outcomes, but little is known about how ACEs impact the psychological functioning of rural Chinese youth as they make transition to adulthood.

Objective

This study is aimed to assess the prevalence and psychological consequences of ACEs among a group of rural Chinese young adults.

Participants and settings

1019 rural high school graduates from three different provinces of China participated in this study.

Methods

A web-based survey was used to assess ten conventional ACEs and seven other novel ACEs using the Childhood Experiences Survey. Using validated brief measures, six indicators of psychological functioning were assessed: anxiety, depression, perceived stress, posttraumatic stress, loneliness, and suicidality. Descriptive and correlational analyses of all ACEs were performed, and multivariate regressions were conducted to test associations between ACEs and study outcomes.

Results

Three-fourths of Chinese youth endorsed at least one of ten conventional ACEs. The most prevalent ACEs were physical abuse (52.3 %) and domestic violence (43.2 %). Among seven new adversities, prolonged parental absence (37.4 %) and parental gambling problems (19.7 %) were most prevalent. Higher conventional ACEs scores were significantly associated with poorer psychological functioning, and each type of new adversity was associated with one or more psychological problems.

Conclusion

ACEs were prevalent among rural Chinese young adults and had deleterious effects on their psychological well-being. Further work is needed to address ACEs by developing culturally appropriate assessment practices, interventions, and policy responses.

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Bidirectional Relations between Adverse Childhood Experiences and Children’s Behavioral Problems

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Zhang, L., & Mersky, J. P. Bidirectional relations between adverse childhood experiences and children’s behavioral problems. (2020). Child and Adolescent Social Work Journal.

Research has shown that adverse childhood experiences (ACEs) increase the risk of poor health and well-being, yet less is known about the pathways through which these life outcomes emerge. For instance, prospective, longitudinal research into the link between ACEs and the trajectories of children’s behavioral problems is limited. Moreover, no longitudinal study has investigated whether children’s behavioral problems also increase their risk of adverse experiences over time. Therefore, the main purpose of this study is to explore bidirectional relations between adverse childhood experiences (ACEs) and children’s behavioral problems in a sample of low-income children. This study uses the Fragile Families and Child Wellbeing Study, a birth cohort study of 4898 children followed from birth through 15 years of age. A random intercept cross-lagged panel model was fit to examine the bidirectional relations between ACEs and child behavioral problems. Study findings indicated that age 5 ACEs score significantly predicted age 9 anxious or depressed problems and age 9 aggressive problems. Age 5 anxious or depressed problems also significantly predicted age 9 ACEs exposure. From age 3 to age 9, ACEs also played a dominant role in the bidirectional relations with behavioral problems. There were certain bidirectional relations between ACEs and child behavioral problems. The findings have implications for understanding the etiology and consequences of adversities as well as the design of prevention and intervention strategies.

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Childhood polyvictimization and marijuana use trajectories

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Plummer Lee, C., Mersky, J. P., Marsee, I., & Fuemmeler, B. (2020). Child maltreatment and marijuana use trajectories. Development and Psychopathology.

Despite public sentiment to the contrary, recreational marijuana use is deleterious to adolescent health and development. Prospective studies of marijuana use trajectories and their predictors are needed to differentiate risk profiles and inform intervention strategies. Using data on 15,960 participants in the National Longitudinal Study of Adolescent to Adult Health, variable-centered approaches were used to examine the impact of childhood polyvictimization on marijuana onset, marijuana use from age 15 to 24 years, and marijuana dependence symptoms. Zero-Inflated Poisson latent class growth analysis (ZIP-LCGA) was used to identify marijuana use subgroups, and their associations with childhood polyvictimization were tested via multinomial logit regression within ZIP-LCGA. Results showed that the overall probability and frequency of marijuana use increased throughout adolescence, peaked in early adulthood, and diminished gradually thereafter. Polyvictimization was associated with earlier onset and greater overall use, frequency of use, and dependence symptoms. ZIP-LCGA uncovered four subgroups, including non-users and three classes of users: adolescence-limited users, escalators, and chronic users. Polyvictimization distinguished non-users from all classes of marijuana users. The findings underscore the lasting developmental implications of significant childhood trauma. Children who experience polyvictimization represent a group that may benefit from selective interventions aimed at preventing early, frequent, chronic, and dependent marijuana use.

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Home Visiting Effects on Breastfeeding and Bedsharing in a Low-Income Sample

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Mersky, J. P., Janczewski, C.E., Plummer Lee, C., Gilbert, R.M., McAtee, C., and Yasin, T. (2020). Home Visiting Effects on Breastfeeding and Bedsharing in a Low-Income Sample. Health Education & Behavior. 1-8.

Background
Research suggests that home visiting interventions can promote breastfeeding initiation, though their effects on breastfeeding continuation are unclear. No known studies have assessed the impact of home visiting on bedsharing.

Aims
To test the effects of home visiting on breastfeeding and bedsharing in a low-income, urban sample in the United States.

Methods
During a field trial conducted in Milwaukee, Wisconsin, from April 2014 to March 2017, referrals to a public health department were randomized to a Healthy Families America (HFA) program or a prenatal care and coordination (PNCC) program. Of the 204 women who accepted services, 139 consented to the study and were allocated to the two treatment groups, which were compared with each other and a third quasi-experimental group of 100 women who did not accept services. Data were collected at four time points up to 12 months postpartum.

Results
Breastfeeding initiation was higher among 72 HFA participants (88.4%; odds ratio [OR] = 2.7) and 67 PNCC participants (88.5%; OR = 2.2) than 100 comparison participants (76.5%). Similar results emerged for breastfeeding duration, though group differences were not statistically significant. Unexpectedly, bedsharing prevalence was higher among HFA participants (56.5%) than PNCC participants (31.1%; OR = 2.9) and comparison group participants (38.8%; OR = 2.0).

Discussion
Home visiting was linked to increased breastfeeding, while effects on bedsharing varied by program. Progress toward precision home visiting will be advanced by identifying program components that promote breastfeeding and safe sleep.

Conclusion
Further research is needed to examine whether home visiting reduces disparities in breastfeeding and safe sleep practices.

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Parent–Child Interaction Therapy: Findings from an exploratory qualitative study with practitioners and foster parents

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Blair, K. H., Topitzes, J., Winkler, E. N., McNeil, C. B. (2020). Parent–Child Interaction Therapy:
Findings from an exploratory qualitative study with practitioners and foster parents. Qualitative Social Work.

Abstract: This exploratory study examines practitioners’ and foster parents’ perceptions on use of Parent–Child Interaction Therapy in child welfare. Focus groups were completed with Parent–Child Interaction Therapy practitioners and foster parents. Thematic analysis was employed, and four main themes were analyzed. First, practitioners and foster parents identified implementation barriers. Second, practitioners and foster parents identified factors that facilitate implementation. While practitioners perceived benefits from on-going consultation, foster parents favored treatment flexibility and a strong therapeutic alliance with practitioners. Third, practitioners and foster parents found that the integration of trauma principles into Parent–Child Interaction Therapy helped to meet the needs of the child welfare population. Finally, the translation of Parent–Child Interaction Therapy into child welfare may be facilitated by model adaptations, such as brief treatments, and integrating Parent–Child Interaction Therapy into pre-service foster parent trainings. Findings are discussed within the context of the relevant literature, and recommendations for future areas of study are proposed.

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Prevalence and Correlates of Maternal and Infant Sleep Problems in a Low-Income US Sample

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Mersky, J. P., Lee, C. P., Gilbert, R. M., and Goyal, D. (2020). Prevalence and Correlates of Maternal and Infant Sleep Problems in a Low-Income US Sample. Matern Child Health J. 24(2):196‐203.

Objectives: This study examined the prevalence and correlates of maternal and infant sleep problems among low-income families receiving home visiting services.

Methods: The study sample includes 1142 mother-infant dyads in Wisconsin, United States. Women completed a survey when their infants were between two weeks and one year old. Outcome data were collected using the PROMIS® sleep disturbance short form-4a and the Brief Infant Sleep Questionnaire. Correlates of sleep problems were assessed in two domains: maternal health and home environment quality. Descriptive analyses produced prevalence estimates, and multivariate regressions were performed to test hypothesized correlates of maternal and infant sleep problems. Subgroup analyses were conducted to examine the prevalence and correlates of sleep problems across different infant age groups.

Results: Approximately 24.5% of women reported poor or very poor sleep in the past week; 13% reported an infant sleep problem and 11% reported more than three infant wakings per night. Reported night wakings were more prevalent among younger infants but maternal and infant sleep problems were not. Multivariate results showed that poor maternal physical and mental health and low social support were associated with maternal sleep disturbance but not infant sleep problems. Bed sharing and smoking were associated with infant sleep outcomes but not maternal sleep. There was limited evidence that the correlates of maternal and infant sleep varied by infant age.

Conclusions for practice: The findings point to alterable factors that home visiting programs and other interventions may target to enhance maternal and infant sleep.

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The transmission of violence and trauma across development and environmental contexts

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Voith, L. A., Topitzes, J., and Berg, K. A. (2020). The transmission of violence and trauma across development and environmental contexts: Intimate partner violence from the perspective of men with histories of perpetration. Child Abuse & Neglect, 99.

Background
Research has established a relation between ecological contexts and intimate partner violence (IPV), but little is known about how environmental factors affect childhood development over time and culminate in IPV perpetration from the perspective of men who perpetrated IPV.

Methods
Using grounded theory, this study employed focus groups with 32 predominately low-income, African American men in batterer intervention programs to explore factors and processes through which families, neighborhoods, and policy influence men’s development, contributing to their use of IPV. Using an inductive approach, the researchers cycled between data collection and analysis resulting in a parsimonious conceptual model validated by participants.

Results
Three core categories emerged from focused and axial coding: adverse childhood experiences (ACEs) and trauma, structural forces, and systemic forces. Theoretical coding illuminated how these core categories relate to each other, producing a collective narrative illustrating how environmental contexts contributed to men’s development. Study participants described childhood exposure to adversity and trauma within the home that diminished essential foundations of trust and safety. Positive (e.g., Old Heads, matriarchs) and negative (e.g., gangs, community violence) structural neighborhood forces influenced the social learning of violence and exposed participants to re-traumatization outside the home during their adolescence. Finally, key macro forces such as mass incarceration exacerbated violence and trauma exposure through the proliferation of high-risk neighborhoods, predisposing men toward IPV as young adults.

Conclusions
Findings reinforce the notion that environmental stress not buffered by protective adults profoundly affects development and behavior. From the perspective of male perpetrators, our results help identify those stressors and how they might contribute to male-to-female IPV.

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Translating and Implementing Evidence-Based Mental Health Services in Child Welfare

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Mersky, J.P., Topitzes, J., Janczewski, C.E., Plummer Lee, C., McGaughey, G., & McNeil, C.B. (2020). Translating and Implementing Evidence-Based Mental Health Services in Child Welfare. Adm Policy Ment Health.

Abstract

Children in the child welfare system with mental health difficulties seldom receive evidence-based treatment (EBT) despite the abundance of validated interventions that exist. This manuscript describes two projects aimed at increasing access to EBTs. The first is a completed field trial of an adapted parent–child interaction therapy intervention with foster-parent child dyads. New findings are presented from variable- and person-centered analyses of impact on diverse symptom profiles. The second is an ongoing statewide initiative that is increasing access to multiple EBTs while navigating implementation barriers. Lessons learned for bridging gaps between children’s mental health research, services, and policy are discussed.

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Trauma-responsive child welfare services: A mixed methods study assessing safety, stability and permanency

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Topitzes, J., Grove, T., Pangratz, S, Meyer, E. E., & Sprague, C. M. (2019). Trauma-responsive child welfare services: A mixed methods study assessing safety, stability and permanency. Journal of Child Custody.

Objective
Trauma-informed or trauma-responsive programming has spread across many service sectors including child welfare. However, only a few evaluations of such child welfare programs have been published.

Method
The current mixed methods study assessed a trauma-responsive child welfare program implemented within a private agency located in the Midwest region of the U.S. The intervention combined specialized training, assessment, case planning, and case consultation into a trauma-responsive case management model.

Results
Quantitative data, gathered through a quasi-experimental design (N=598), revealed that program participation was associated with improved permanency but not with enhanced child safety. Qualitative data, gathered from staff interviews (N=10), helped to contextualize quantitative results, highlighting staff experiences and impressions of the program. Implications of results are discussed.

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