Category: Child & Family Well-Being

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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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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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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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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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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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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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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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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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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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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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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Brief, group-based parent-child interaction therapy: Examination of treatment attrition, non-adherence, and non-response

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Blair, K., Topitzes, J., & Mersky, J. P. (2019). Brief, group-based parent-child interaction therapy: Examination of treatment attrition, non-adherence, and non-response. Children and Youth Services Review.

Abstract

Parent-Child Interaction Therapy (PCIT) has been shown to reduce challenging child behavior and improve parenting skills, yet treatment attrition, non-adherence and non-response remain matters of concern. This study analyzes rates and factors associated with attrition, non-adherence, and non-response using data from a randomized controlled trial of foster parent-child dyads who received brief, group-based PCIT. Multivariate logistic regressions demonstrated that, as compared to prior estimates of conventional outpatient PCIT, rates of treatment attrition, non-adherence and non-response from the group-based PCIT intervention were low. Compared to other racial/ethnic groups, rates of attrition were significantly higher among African American foster parents. No study variables were linked to treatment non-adherence. Foster parent ratings of child externalizing symptoms were positively associated with non-response. Implications for promoting retention and treatment effectiveness, successfully integrating PCIT into child welfare services and advancing future research are discussed.

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Adverse childhood experiences and poor birth outcomes in a diverse, low-income sample

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Mersky, J. P., & Plummer Lee, C. (2019). Adverse childhood experiences and poor birth outcomes in a diverse, low-income sample. BMC Pregnancy and Childbirth, 19(387), 1-7.

Background
Adverse childhood experiences (ACE) are associated with an array of health consequences in later life, but few studies have examined the effects of ACEs on women’s birth outcomes.

Methods
We analyzed data gathered from a sample of 1848 low-income women who received services from home visiting programs in Wisconsin. Archival program records from a public health database were used to create three birth outcomes reflecting each participant’s reproductive health history: any pregnancy loss; any preterm birth; any low birthweight. Multivariate logistic regressions were performed to test the linear and non-linear effects of ACEs on birth outcomes, controlling for age, race/ethnicity, and education.

Results
Descriptive analyses showed that 84.4% of women had at least one ACE, and that 68.2% reported multiple ACEs. Multivariate logistic regression analyses showed that cumulative ACE scores were associated with an increased likelihood of pregnancy loss (OR = 1.12; 95% CI = 1.08–1.17), preterm birth (OR = 1.07; 95% CI = 1.01–1.12), and low birthweight (OR = 1.08; 95% CI = 1.03–1.15). Additional analyses revealed that the ACE-birthweight association deviated from a linear, dose-response pattern.

Conclusions
Findings confirmed that high levels of childhood adversity are associated with poor birth outcomes. Alongside additive risk models, future ACE research should test interactive risk models and causal mechanisms through which childhood adversity compromises reproductive health.

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Client and provider discomfort with an adverse childhood experiences survey

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Mersky, J. P., Plummer Lee, C., & Gilbert, R. M. (2019). Client and provider discomfort with an adverse childhood experiences survey. American Journal of Preventive Medicine, 57(2), e51-e58.

Introduction
Many service providers report concerns that questions about adverse events may upset clients. Studies indicate that most survey respondents answer sensitive questions without experiencing distress, although little is known about the prevalence or correlates of clients’ discomfort when they are asked similar questions by direct care providers, such as home visitors.

Methods
This study used data collected between 2013 and 2018 from 1,678 clients and 161 providers in a network of home visiting programs in Wisconsin. Clients and home visitors completed an adverse childhood experience questionnaire that concludes by asking about discomfort with the questions. Analyses conducted in 2018 examined overall client discomfort and associations between discomfort and the endorsement of 10 distinct adverse childhood experiences. Multilevel regressions were performed to test whether client and provider factors were associated with client discomfort.

Results
More than 80% of clients were not at all or slightly uncomfortable with the adverse childhood experience questionnaire, and 3% reported extreme discomfort. Bivariate results showed that each adverse childhood experience, except parental divorce, was associated with greater discomfort; sexual abuse was the only adverse childhood experience associated with discomfort in a multivariate analysis. Multiple client variables were linked to increased discomfort, including higher adverse childhood experience scores (b=0.06, 95% CI=0.04, 0.08) and depression scores (b=0.01, 95% CI=0.00, 0.02). Home visitor discomfort was positively associated with client discomfort (b=0.16, 95% CI=0.01, 0.31).

Conclusions
Results indicated that most clients in home visiting programs tolerated an adverse childhood experience questionnaire well. The findings point to clients who may be more likely to report discomfort and highlight an important association between client and provider discomfort.

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Those who disappear and those who say goodbye: Patterns of attrition in long-term home visiting

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Janczewski, C. E., Mersky, J. P., & Brondino, M. J. (2019). Those who disappear and those who say goodbye: Patterns of attrition in long-term home visiting. Prevention Science, 1-11.

Abstract

Most evidence-based home visiting models are designed to support families from pregnancy through a child’s second birthday, though programs often struggle to retain families for this long. Previous research on client and program factors that predict attrition has produced mixed results, which may be partly because attrition is typically conceptualized as a homogeneous phenomenon. The current study sampled 991 women who received home visiting services from one of 26 agencies in a statewide network of evidence-based programs. Participants who remained in services were compared to three types of early leavers: those who communicated their intent to leave (active attrition), those whose cases closed due to non-participation (passive attrition), and those who moved from the service area. Within a year of enrollment, 42% of women exited services. Cox regression results suggested no differences in the timing of service exit among the three attrition types. Multinomial analyses revealed that, when compared to participants who remained in services, active leavers were more likely to be married or cohabitating, while passive leavers were more likely to be younger, African American, unemployed, and to have a home visitor with low job satisfaction. Participants who moved were less likely to be Latina and employed. An early pattern of inconsistent attendance was the strongest predictor of active and passive withdrawal. Rates of attrition varied by home visiting model, though inconsistent attendance was a robust predictor of passive attrition across models. This study underscores the need to scrutinize service duration as a metric of success in home visiting.

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Adverse childhood experiences and postpartum depression in home visiting programs: Prevalence, association, and mediating mechanisms

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Mersky, J. P., & Janczewski, C. E. (2018). Adverse childhood experiences and postpartum depression in home visiting programs: Prevalence, association, and mediating mechanisms. Maternal and Child Health Journal.

Objectives
In this study, we examined the prevalence of postpartum depression (PPD) and its association with select demographic factors and antenatal conditions. We also investigated whether greater exposure to adverse childhood experiences (ACEs) is associated with PPD, and if antenatal conditions mediate the ACE-PPD relationship.

Methods 
Data were collected from 735 low-income women receiving home visiting services. Descriptive and bivariate analyses provided estimates of PPD and its correlates, and nested path analyses were used to test for mediation.

Results 
We found that rates of PPD were high compared to prevalence estimates in the general population. Sample rates of antenatal depression were even higher than the rates of PPD. Omnibus tests revealed that PPD did not vary significantly by maternal age or race/ethnicity, although Hispanic women consistently reported the lowest rates. American Indian women and non-Hispanic white women reported the highest rates. PPD was significantly associated with increased exposure to ACEs. Nested path models revealed that the effects of ACEs were partially mediated by three antenatal conditions: intimate partner violence (IPV), perceived stress, and antenatal depression.

Conclusions for Practice 
Supporting prior research, rates of PPD appear to be high among low-income women. ACEs may increase the risk of antenatal IPV and psychological distress, both of which may contribute to PPD. The findings have implications for screening and assessment as well as the timing and tailoring of interventions through home visiting and other community-based services.

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Rethinking the Measurement of Adversity: Moving Toward Second-Generation Research on Adverse Childhood Experiences

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Mersky, J. P., Janczewski, C. E., & Topitzes, J. (2017). Rethinking the measurement of adversity: Moving toward second-generation research on adverse childhood experiences. Child Maltreatment.

Objective
Research on adverse childhood experiences (ACEs) has unified the study of interrelated risks and generated insights into the origins of disorder and disease. Ten indicators of child maltreatment and household dysfunction are widely accepted as ACEs, but further progress requires a more systematic approach to conceptualizing and measuring ACEs.

Method
Using data from a diverse, low-income sample of women who received home visiting services in Wisconsin (N = 1,241), this study assessed the prevalence of and interrelations among 10 conventional ACEs and 7 potential ACEs: family financial problems, food insecurity, homelessness, parental absence, parent/sibling death, bullying, and violent crime. Associations between ACEs and two outcomes, perceived stress and smoking, were examined. The factor structure and test–retest reliability of ACEs was also explored.

Results
As expected, prevalence rates were high compared to studies of more representative samples. Except for parent/sibling death, all ACEs were intercorrelated and associated at the bivariate level with perceived stress and smoking. Exploratory factor analysis confirmed that conventional ACEs loaded on two factors, child maltreatment and household dysfunction, though a more complex four-factor solution emerged once new ACEs were introduced. All ACEs demonstrated acceptable test–retest reliability.

Conclusion
Implications and future directions toward a second generation of ACE research are discussed.

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Impacts of Adverse Childhood Experiences on Health, Mental Health, and Substance Use in Early Adulthood: A Cohort Study of an Urban, Minority Sample in the U.S.

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Mersky, J.P., Topitzes, J., Reynolds, A. (2013). Impacts of adverse childhood experiences on health, mental health, and substance use in early adulthood: A cohort study of an urban, minority sample in the U.S. Child Abuse and Neglect.

Objective
Research has shown that adverse childhood experiences (ACEs) increase the risk of poor health-related outcomes in later life. Less is known about the consequences of ACEs in early adulthood or among diverse samples. Therefore, we investigated the impacts of differential exposure to ACEs on an urban, minority sample of young adults.

Method
Health, mental health, and substance use outcomes were examined alone and in aggregate. Potential moderating effects of sex were also explored. Data were derived from the Chicago Longitudinal Study, a panel investigation of individuals who were born in 1979 or 1980. Main-effect analyses were conducted with multivariate logistic and OLS regression. Sex differences were explored with stratified analysis, followed by tests of interaction effects with the full sample.

Results
Results confirmed that there was a robust association between ACEs and poor outcomes in early adulthood. Greater levels of adversity were associated with poorer self-rated health and life satisfaction, as well as more frequent depressive symptoms, anxiety, tobacco use, alcohol use, and marijuana use. Cumulative adversity also was associated with cumulative effects across domains. For instance, compared to individuals without an ACE, individuals exposed to multiple ACEs were more likely to have three or more poor outcomes (OR range = 2.75–10.15) and four or more poor outcomes (OR range = 3.93–15.18). No significant differences between males and females were detected.

Conclusion
Given that the consequences of ACEs in early adulthood may lead to later morbidity and mortality, increased investment in programs and policies that prevent ACEs and ameliorate their impacts is warranted.

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Unsafe at Any Age: Linking Childhood and Adolescent Maltreatment to Delinquency and Crime

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Mersky, J.P., Topitzes, J., Reynolds, A. (2011). Unsafe at any age: linking childhood and adolescent maltreatment to delinquency and crime. Journal of Research in Crime and Delinquency.

Objective
This study compares the effects of childhood maltreatment and adolescent maltreatment on delinquency and crime, including violent and nonviolent offending.

Method
Data were derived from the Chicago Longitudinal Study, a prospective investigation of 1,539 underprivileged, minority subjects.

Results
Results confirmed that rates of overall delinquency, along with violent, drug, and property offending specifically, were elevated among childhood and adolescent maltreatment victims compared to their nonmaltreated peers. Childhood maltreatment was associated with delinquency independent of adolescent maltreatment, and strong connections between adolescent maltreatment and delinquency were present independent of prior victimization. Childhood maltreatment was also significantly related to a panel of adult crime measures, while the effects of adolescent maltreatment on adult crime were less robust.

Conclusion
The study findings suggest that maltreatment at any age increases the risk of future offending, implying that investments in prevention and intervention strategies throughout childhood and adolescence may reduce delinquency and crime.

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Maltreatment Prevention Through Early Childhood Intervention: A Confirmatory Evaluation of the Chicago Child-Parent Center Preschool Program

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Mersky, J.P., Topitzes, J., Reynolds, A. (2011). Maltreatment prevention through early childhood intervention: A confirmatory evaluation of the Chicago child-parent center preschool program. Children and Youth Services Review.

Objective
Increased recognition of the consequences associated with child maltreatment has led to greater emphasis on its prevention. Promising maltreatment prevention strategies have been identified, but research continues to suffer from methodological limitations and a narrow focus on select prevention models. This investigation uses data from the Chicago Longitudinal Study to examine mediating mechanisms that link the Chicago Child-Parent Center preschool program to a reduction in overall child maltreatment and, more specifically, child neglect.

Method
We use structural equation modeling to test child, family, and school measures hypothesized to mediate the effects of CPC participation on maltreatment and neglect.

Results
Results indicate that a substantial proportion of the program’s impacts can be accounted for by family support processes, including increased parent involvement in school and maternal educational attainment as well as decreased family problems. The CPC program’s association with reduced school mobility and increased attendance in higher-quality schools also significantly mediated its effects on maltreatment and neglect. Further, a decrease in troublemaking behavior contributed modestly to mediating the program’s association with maltreatment but not neglect.

Conclusion
We discuss the implications of these results for the field of maltreatment prevention.

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Child Maltreatment and Offending Behavior Gender-Specific Effects and Pathways

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Topitzes, J., Mersky, J.P., Reynolds, A. (2011). Child maltreatment and offending behavior: Gender-specific effects and pathways. Criminal Justice and Behavior.

Objective

This study assessed the association between child maltreatment (ages 0–11) and offending behavior within gender-specific models.

Method

Prospectively collected data, including official measures of maltreatment and offending, were derived from the Chicago Longitudinal Study, a panel study of 1,539 low-income minority participants.

Results

Multivariate probit analyses revealed that maltreatment significantly predicted delinquency for males but not females yet forged a significant relation to adult crime for both genders. Exploratory, confirmatory, and comparative analyses suggested that mechanisms linking maltreat-ment to adult crime primarily differed across gender. For males, childhood-era externalizing behavior and school commitment along with adolescent-era socioemotional skills, delinquency, and educational attainment explained the maltreatment-crime nexus. For females, childhood-era parent factors along with adolescent indicators of externalizing behavior, cognitive performance, mobility, and educational attainment partially mediated the maltreatment–crime relation.

Conclusion

Implications of results were explored.

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Comparing Early Adult Outcomes of Maltreated and Non-Maltreated Children: A Prospective Longitudinal Investigation

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Mersky, J.P., Topitzes, J. (2010). Comparing early adult outcomes of maltreated and non-maltreated children: A prospective longitudinal investigation. Children and Youth Services Review.

Objective
Using prospective data from the Chicago Longitudinal Study, this investigation examined associations between child maltreatment and an array of outcomes in early adulthood.

Results
Findings from bivariate and multivariate analyses indicated that verified maltreatment victims fared significantly worse than participants without an indicated maltreatment report on indicators of educational and economic attainment, criminal offending, and behavioral and mental health. Results also revealed that, while many maltreated children appeared to function well on individual outcomes, a large majority did not achieve criteria for resilience when development was assessed across domains. For example, non-maltreated participants were more than twice as likely to attain five or more positive outcomes (38.2%) on an aggregate seven-item index as the maltreated group (15.7%).

Conclusion
These findings suggest that child maltreatment is associated with extensive and enduring impacts, reinforcing the need to develop and implement effective maltreatment prevention and intervention strategies.

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Child Maltreatment and Adult Cigarette Smoking: A Long-term Developmental Model

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Topitzes, J., Mersky, J.P., Reynolds, A. (2009). Child maltreatment and adult cigarette smoking: A long-term developmental model. Journal of Pediatric Psychology.

Objective

To examine: (a) child maltreatment’s association with young adult daily cigarette smoking, (b) variations in this association by gender, and (c) mediators of this association.

Method

For all study participants (N¼1,125, 94% African American), data from multiple sources (e.g., child welfare records) were collected prospectively at child, adolescent, and young adult time points. Authors enlisted multivariate probit regression for objectives a and b versus exploratory and confirmatory mediation strategies for objective c.

Results

Maltreatment was significantly associated with daily cigarette smoking. Although not moderated by gender, this relation was fully mediated by adolescent indicators of family support/stability, social adjustment, and cognitive/school performance along with young adult indicators of educational attainment, life satisfaction, substance abuse, and criminality.

Conclusion

Maltreatment places low-income, minority children at risk for daily cigarette smoking and other deleterious young adult health outcomes. Recommended treatment targets include family support/stability, emotion regulation, social skills, and cognitive/academic functioning.

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Risk Factors for Child and Adolescent Maltreatment

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Mersky, J.P., Berger, L., Reynolds, A., Gromoske, A. (2009). Risk factors for child and adolescent maltreatment. Child Maltreatment.

Objective
This study investigates associations between individual, family, and extrafamilial factors and the likelihood of subsequent childhood and adolescent maltreatment.

Method
The authors analyzed 1,411 participants in the Chicago Longitudinal Study whose maltreatment records were verified from administrative data.

Results
Findings suggest that maternal age at the child’s birth was a robust predictor of maltreatment outcomes. Receipt of public assistance and single-parent family status were significantly associated with select outcomes. Among school-age indicators examined, parent participation in school was negatively associated with most maltreatment outcomes. Participation in the Chicago Child-Parent Center program was negatively associated with maltreatment, although effects varied by type and timing of maltreatment. In separate analyses, several factors were associated with neglect, but only maternal age at the child’s birth was associated with physical abuse.

Conclusion
Findings suggest that prevention programs may need to target select populations and specific mechanisms associated with different types of maltreatment to maximize effectiveness.

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Chronic Neglect: Prediction and Prevention

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Mersky, J.P., Topitzes, J., & Reynolds, A. J. (2009). Chronic neglect: Prediction and prevention. Protecting Children, 24, 67-77.

In 2006, more than 60% of verified child maltreatment victims in the United States experienced child neglect, exceeding the official rates of all other maltreatment types combined (U.S. Department of Health and Human Services [USDHHS], 2008). Despite its relatively high incidence, neglect remains one of the least studied forms of child maltreatment (Behl, Conyngham, & May, 2003; Lounds, Borkowski, & Whitman, 2006).

This disparity is disturbing because neglect often poses serious and persistent threats to child well-being. Among all types of maltreatment, neglect is associated with the largest number of child fatalities annually. In addition, neglected children are at risk for poor outcomes in multiple domains, including neurobiological development, physical and mental health, cognitive and educational performance, and social-emotional and behavioral functioning (Cicchetti & Valentino, 2006; Hildyard & Wolfe, 2002; Kendall- Tackett & Eckenrode, 1996; Kotch et al., 2008; Tyler, Allison, & Winsler, 2006).

Emerging evidence also suggests that the effects of child neglect are cumulative, meaning that the risk of unwanted consequences may rise in response to increased exposure to neglect (Bolger, Patterson, & Kupersmidt, 1998; Hildyard & Wolfe, 2002).

This is especially concerning because neglect is more likely than other types of maltreatment to manifest as a chronic pattern (DePanfilis & Zuravin, 1999; Fluke, Yuan, & Edwards, 1999). However, research into the processes that distinguish recurring and transitory forms of neglect is limited.

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Child Maltreatment and Violent Delinquency: Disentangling Main Effects and Subgroup Effects

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Mersky, J.P., Reynolds, A. (2007). Child maltreatment and violent delinquency: disentangling main effects and subgroup effects. Child Maltreatment.

Objective
This study employs data from the Chicago Longitudinal Study (CLS) to investigate the relation between child maltreatment and the incidence and frequency of violent delinquency. The authors also examine if effects vary between physically abused and neglected children and if select indicators (sex, cumulative risk, public aid receipt) moderate the connections between maltreatment and violent outcomes.

Method
The CLS follows a cohort of 1,539 low-income, minority children who attended public kindergarten programs in 1985-1986. The primary sample includes 1,404 participants for whom maltreatment and delinquency status were verified.

Results
Maltreatment is significantly associated with all violent outcomes investigated. Effects are comparable for physically abused and neglected children. Results indicate that public assistance, particularly persistent receipt, moderates the association between maltreatment and multiple outcomes.

Conclusion
Findings support the hypothesized connection between maltreatment and violent delinquency while highlighting certain subgroups that may be at elevated risk. Implications for research design and program development are discussed.

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Predictors of Early Childbearing: Evidence from the Chicago Longitudinal Study

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Mersky, J.P., Reynolds, A. (2007). Predictors of early childbearing: Evidence from the Chicago Longitudinal Study. Children and Youth Services Review.

Objective

Using prospective data from the Chicago Longitudinal Study (CLS), we investigated the effects of early childhood and school-age predictors on female childbearing, including participation in the Chicago Child-Parent Center (CPC) Program, and related family and school behaviors.

Method
The CLS follows the progress of a single cohort of 1539 low-income, minority children who attended the CPCs and other public early childhood programs in 1985–1986. Birth records were obtained for 706 females (92% of original sample) from survey data collected between ages 22–24 and supplemental public aid and school records.

Results
Results from regression and survival analyses indicated that the CPC program had a limited impact on childbearing patterns. There was no evidence that preschool participation was associated with lower rates of early childbearing. CPC school-age participation was linked to significantly lower rates of multiple births by age 20.

Conclusion
The most consistent predictor of a female’s childbearing status was her parent’s educational attainment. Parent involvement in elementary school, children’s enrollment in magnet schools, AFDC receipt, and teacher ratings of acting out behavior also were significant predictors of early childbearing. Implications for the tailoring of future interventions are discussed.

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