BackgroundEvidence-based interventions (EBIs) are often seen as the gold standard but it is uncle... more BackgroundEvidence-based interventions (EBIs) are often seen as the gold standard but it is unclear if they are effective in different settings or populations. We developed a model to adapt and test the implementation of a postpartum depression prevention intervention (Reach Out and Stay Strong, Essentials for new Mothers -- ROSE) in shelter. Our model entailed: (1) Intervention Adaptation and Planning (2) Feasibility Testing, (3) Monitoring Outcomes. The adapted intervention was called Strong in Shelter (SIS).MethodsIntervention adaptation and planning entailed provider engagement, shelter resident input, and responsive adaptations. Feasibility testing began in pilot sites, and we made modifications based on feedback. Fidelity to the model was tracked through session checklists, audio recordings and weekly consultations. Additional modifications were made due to COVID-19. Outcome measures were collected pre- and post-intervention, and included measures of depression (PHQ-9), percei...
Child and Adolescent Psychiatric Clinics of North America, 2013
the history of psychotherapy is, in large part, the story of encounters between existent therapeu... more the history of psychotherapy is, in large part, the story of encounters between existent therapeutic approaches and new clinical populations for whom the existing concepts and techniques were not designed. The specific psychopathology that is clinically addressed is of crucial importance to an understanding of the therapeutic approach that develops. Theories arise with specific clinical phenomena in mind.
This study found that within a non-referred community pediatrics clinic sample, the severity of m... more This study found that within a non-referred community pediatrics clinic sample, the severity of moth-ers' trauma-related psychopathology, in particular, their interpersonal violence-related (IPV) posttraumatic stress, dissociative, and depressive symptoms predicted the degree of negativity of mothers' attributions towards their preschool age children, themselves, and their own primary attachment figure. Results also showed that mothers with IPV-related posttraumatic stress disorder (PTSD) as compared to non-PTSD controls showed a significantly greater degree of negativity of their attributions toward their child, themselves and their primary attachment figure during childhood. The study finally found a significant reduction in the degree of negativity of mothers' attributions only towards their child following a three-session evaluation-protocol that included a form of experimental intervention entitled the ''Clinician Assisted Videofeedback Exposure Session(s)'' (CAVES), for mothers with IPV-PTSD as compared to control-subjects. Keywords Maternal PTSD Á Interpersonal violence Á Maternal attributions Á Videofeedback intervention Á Infant and early childhood mental health Á Intergenerational transmission of violence and trauma
Journal of the American Academy of Child and Adolescent Psychiatry, Mar 1, 2009
There is no such thing as a baby... A baby cannot exist alone, but is essentially part of a relat... more There is no such thing as a baby... A baby cannot exist alone, but is essentially part of a relationship.
CHAPTER 12 The Effects of Violent Experiences on Infants and Young Children Daniel S. Schechter E... more CHAPTER 12 The Effects of Violent Experiences on Infants and Young Children Daniel S. Schechter Erica Willheim I n reviewing ... in young children similarly appear to be mediated or buffered by maternal psychological functioning (Bai-ley, Hannigan, Delaney-Black, Covington ...
This study tested whether mothers with interpersonal violence-related posttraumatic stress disord... more This study tested whether mothers with interpersonal violence-related posttraumatic stress disorder (IPV-PTSD) vs healthy controls (HC) would show greater limbic and less frontocortical activity when viewing young children during separation compared to quiet play. Mothers of 20 children (12–42 months) participated: 11 IPV-PTSD mothers and 9 HC with no PTSD. During fMRI, mothers watched epochs of play and separation from their own and unfamiliar children. The study focused on comparison of PTSD mothers vs HC viewing children in separation vs play, and viewing own vs unfamiliar children in separation. Both groups showed distinct patterns of brain activation in response to viewing children in separation vs play. PTSD mothers showed greater limbic and less frontocortical activity (BA10) than HC. PTSD mothers also reported feeling more stressed than HC when watching own and unfamiliar children during separation. Their self-reported stress was associated with greater limbic and less frontocortical activity. Both groups also showed distinct patterns of brain activation in response to viewing their own vs unfamiliar children during separation. PTSD mothers may not have access to frontocortical regulation of limbic response upon seeing own and unfamiliar children in separation. This converges with previously reported associations of maternal IPV-PTSD and atypical care-giving behavior following separation.
Psychiatry: Interpersonal and Biological Processes, 2010
The literature suggests an adverse impact of maternal stress related to interpersonal violence on... more The literature suggests an adverse impact of maternal stress related to interpersonal violence on parent-child interaction. The current study investigated associations between a mother's self-reported parent-child relationship dysfunction and what she does in response to her child's cues. It also examined whether maternal perception of parent-child dysfunctional interaction and child behavior when stressed by separation, along with maternal behavior in response to child distress, predicted impaired joint attention (JA) during play. Participant mothers (n -74) and their children ages 12-48 months were recruited from community pediatrics clinics and completed two videotaped visits. After correlations, multiple linear regression was applied to find the best model fit that would predict outcomes of interest. We found that both maternal subjective report of self-reported parentchild relationship dysfunction and observed child separation distress together predicted atypical maternal behavior. Self-reported parent-child relationship dysfunction, observed atypical maternal behavior, and child separation distress combined significantly predicted less time spent in joint attention during play. Maternal posttraumatic stress predicted less maternal availability after separation stress. Clinicians should thus carefully assess and listen to parents' communication of disturbances in their relationship with their young child. Left untreated, parent-child relationship dysfunction may well lead to impairment in learning and social-emotional development.
This study examined media viewing by mothers with violence-related posttraumatic stress disorder ... more This study examined media viewing by mothers with violence-related posttraumatic stress disorder (PTSD) and related media exposure of their preschool-age children. Mothers (N = 67) recruited from community pediatric clinics participated in a protocol involving a media-preference survey. Severity of maternal PTSD and dissociation were significantly associated with child exposure to violent media. Family poverty and maternal viewing behavior were also associated. Maternal viewing behavior mediated the effects specifically of maternal PTSD severity on child exposure. Clinicians should assess maternal and child media viewing practices in families with histories of violent trauma exposure and related psychopathology.
This study aims to understand if greater severity of maternal posttraumatic stress symptoms (PTSS... more This study aims to understand if greater severity of maternal posttraumatic stress symptoms (PTSS), related to maternal report of interpersonal violence, mediates the effects of such violence on (a) child PTSS as well as on (b) child externalizing and internalizing symptoms. Study participants were mothers (N = 77) and children 18 to 48 months recruited from community pediatric clinics. Data were analyzed continuously via bivariate correlations and then multiple linear regression. Post hoc Sobel tests were performed to confirm mediation. Paternal violence accounted for 15% of the variance of child PTSS on the PCIP-OR (β = .39, p ≤ .001). While the child's father being violent significantly predicts child PTSS related to domestic violence, as mentioned, when maternal PTSS is included in the multiple regression model, father's being violent becomes less significant, while maternal PTSS remains strongly predictive. Sobel tests confirmed that maternal PTSS severity mediated effects of paternal violence on clinician-assessed child PTSS as well as on maternal report of child externalizing and internalizing symptoms. When presented with a preschool-aged child who is brought to consultation for behavioral difficulties, dysregulated aggression, and/or unexplained fears, clinicians should evaluate maternal psychological functioning as well as assess and treat the effects of interpersonal violence, which otherwise may be avoided during the consultation.
Child and Adolescent Psychiatric Clinics of North America, 2009
The study of ''attachment'' now spans 4 decades and multiple domains; theory, research, psychobio... more The study of ''attachment'' now spans 4 decades and multiple domains; theory, research, psychobiology, and clinical application. This ever-expanding field of study owes its inception to Bowlby. Synthesizing object-relational and ethological perspectives, Bowlby theorized that the evolutionary interests of the species are best served by a biobehavioral caregiver-infant system that ensures the safety of the vulnerable human infant. 1,2 To that end, the human infant is biologically predisposed to engage in proximity seeking behaviors toward the caregiver in times of distress. In this conceptualization, Bowlby radically departed from the Freudian paradigm of primary
There is no such thing as a baby... A baby cannot exist alone, but is essentially part of a relat... more There is no such thing as a baby... A baby cannot exist alone, but is essentially part of a relationship.
This study found that within a non-referred community pediatrics clinic sample, the severity of m... more This study found that within a non-referred community pediatrics clinic sample, the severity of mothers' trauma-related psychopathology, in particular, their interpersonal violence-related (IPV) posttraumatic stress, dissociative, and depressive symptoms predicted the degree of negativity of mothers' attributions towards their preschool age children, themselves, and their own primary attachment figure. Results also showed that mothers with IPV-related posttraumatic stress disorder (PTSD) as compared to non-PTSD controls showed a significantly greater degree of negativity of their attributions toward their child, themselves and their primary attachment figure during childhood. The study finally found a significant reduction in the degree of negativity of mothers' attributions only towards their child following a three-session evaluationprotocol that included a form of experimental intervention entitled the ''Clinician Assisted Videofeedback Exposure Session(s)'' (CAVES), for mothers with IPV-PTSD as compared to control-subjects.
BackgroundEvidence-based interventions (EBIs) are often seen as the gold standard but it is uncle... more BackgroundEvidence-based interventions (EBIs) are often seen as the gold standard but it is unclear if they are effective in different settings or populations. We developed a model to adapt and test the implementation of a postpartum depression prevention intervention (Reach Out and Stay Strong, Essentials for new Mothers -- ROSE) in shelter. Our model entailed: (1) Intervention Adaptation and Planning (2) Feasibility Testing, (3) Monitoring Outcomes. The adapted intervention was called Strong in Shelter (SIS).MethodsIntervention adaptation and planning entailed provider engagement, shelter resident input, and responsive adaptations. Feasibility testing began in pilot sites, and we made modifications based on feedback. Fidelity to the model was tracked through session checklists, audio recordings and weekly consultations. Additional modifications were made due to COVID-19. Outcome measures were collected pre- and post-intervention, and included measures of depression (PHQ-9), percei...
Child and Adolescent Psychiatric Clinics of North America, 2013
the history of psychotherapy is, in large part, the story of encounters between existent therapeu... more the history of psychotherapy is, in large part, the story of encounters between existent therapeutic approaches and new clinical populations for whom the existing concepts and techniques were not designed. The specific psychopathology that is clinically addressed is of crucial importance to an understanding of the therapeutic approach that develops. Theories arise with specific clinical phenomena in mind.
This study found that within a non-referred community pediatrics clinic sample, the severity of m... more This study found that within a non-referred community pediatrics clinic sample, the severity of moth-ers' trauma-related psychopathology, in particular, their interpersonal violence-related (IPV) posttraumatic stress, dissociative, and depressive symptoms predicted the degree of negativity of mothers' attributions towards their preschool age children, themselves, and their own primary attachment figure. Results also showed that mothers with IPV-related posttraumatic stress disorder (PTSD) as compared to non-PTSD controls showed a significantly greater degree of negativity of their attributions toward their child, themselves and their primary attachment figure during childhood. The study finally found a significant reduction in the degree of negativity of mothers' attributions only towards their child following a three-session evaluation-protocol that included a form of experimental intervention entitled the ''Clinician Assisted Videofeedback Exposure Session(s)'' (CAVES), for mothers with IPV-PTSD as compared to control-subjects. Keywords Maternal PTSD Á Interpersonal violence Á Maternal attributions Á Videofeedback intervention Á Infant and early childhood mental health Á Intergenerational transmission of violence and trauma
Journal of the American Academy of Child and Adolescent Psychiatry, Mar 1, 2009
There is no such thing as a baby... A baby cannot exist alone, but is essentially part of a relat... more There is no such thing as a baby... A baby cannot exist alone, but is essentially part of a relationship.
CHAPTER 12 The Effects of Violent Experiences on Infants and Young Children Daniel S. Schechter E... more CHAPTER 12 The Effects of Violent Experiences on Infants and Young Children Daniel S. Schechter Erica Willheim I n reviewing ... in young children similarly appear to be mediated or buffered by maternal psychological functioning (Bai-ley, Hannigan, Delaney-Black, Covington ...
This study tested whether mothers with interpersonal violence-related posttraumatic stress disord... more This study tested whether mothers with interpersonal violence-related posttraumatic stress disorder (IPV-PTSD) vs healthy controls (HC) would show greater limbic and less frontocortical activity when viewing young children during separation compared to quiet play. Mothers of 20 children (12–42 months) participated: 11 IPV-PTSD mothers and 9 HC with no PTSD. During fMRI, mothers watched epochs of play and separation from their own and unfamiliar children. The study focused on comparison of PTSD mothers vs HC viewing children in separation vs play, and viewing own vs unfamiliar children in separation. Both groups showed distinct patterns of brain activation in response to viewing children in separation vs play. PTSD mothers showed greater limbic and less frontocortical activity (BA10) than HC. PTSD mothers also reported feeling more stressed than HC when watching own and unfamiliar children during separation. Their self-reported stress was associated with greater limbic and less frontocortical activity. Both groups also showed distinct patterns of brain activation in response to viewing their own vs unfamiliar children during separation. PTSD mothers may not have access to frontocortical regulation of limbic response upon seeing own and unfamiliar children in separation. This converges with previously reported associations of maternal IPV-PTSD and atypical care-giving behavior following separation.
Psychiatry: Interpersonal and Biological Processes, 2010
The literature suggests an adverse impact of maternal stress related to interpersonal violence on... more The literature suggests an adverse impact of maternal stress related to interpersonal violence on parent-child interaction. The current study investigated associations between a mother's self-reported parent-child relationship dysfunction and what she does in response to her child's cues. It also examined whether maternal perception of parent-child dysfunctional interaction and child behavior when stressed by separation, along with maternal behavior in response to child distress, predicted impaired joint attention (JA) during play. Participant mothers (n -74) and their children ages 12-48 months were recruited from community pediatrics clinics and completed two videotaped visits. After correlations, multiple linear regression was applied to find the best model fit that would predict outcomes of interest. We found that both maternal subjective report of self-reported parentchild relationship dysfunction and observed child separation distress together predicted atypical maternal behavior. Self-reported parent-child relationship dysfunction, observed atypical maternal behavior, and child separation distress combined significantly predicted less time spent in joint attention during play. Maternal posttraumatic stress predicted less maternal availability after separation stress. Clinicians should thus carefully assess and listen to parents' communication of disturbances in their relationship with their young child. Left untreated, parent-child relationship dysfunction may well lead to impairment in learning and social-emotional development.
This study examined media viewing by mothers with violence-related posttraumatic stress disorder ... more This study examined media viewing by mothers with violence-related posttraumatic stress disorder (PTSD) and related media exposure of their preschool-age children. Mothers (N = 67) recruited from community pediatric clinics participated in a protocol involving a media-preference survey. Severity of maternal PTSD and dissociation were significantly associated with child exposure to violent media. Family poverty and maternal viewing behavior were also associated. Maternal viewing behavior mediated the effects specifically of maternal PTSD severity on child exposure. Clinicians should assess maternal and child media viewing practices in families with histories of violent trauma exposure and related psychopathology.
This study aims to understand if greater severity of maternal posttraumatic stress symptoms (PTSS... more This study aims to understand if greater severity of maternal posttraumatic stress symptoms (PTSS), related to maternal report of interpersonal violence, mediates the effects of such violence on (a) child PTSS as well as on (b) child externalizing and internalizing symptoms. Study participants were mothers (N = 77) and children 18 to 48 months recruited from community pediatric clinics. Data were analyzed continuously via bivariate correlations and then multiple linear regression. Post hoc Sobel tests were performed to confirm mediation. Paternal violence accounted for 15% of the variance of child PTSS on the PCIP-OR (β = .39, p ≤ .001). While the child's father being violent significantly predicts child PTSS related to domestic violence, as mentioned, when maternal PTSS is included in the multiple regression model, father's being violent becomes less significant, while maternal PTSS remains strongly predictive. Sobel tests confirmed that maternal PTSS severity mediated effects of paternal violence on clinician-assessed child PTSS as well as on maternal report of child externalizing and internalizing symptoms. When presented with a preschool-aged child who is brought to consultation for behavioral difficulties, dysregulated aggression, and/or unexplained fears, clinicians should evaluate maternal psychological functioning as well as assess and treat the effects of interpersonal violence, which otherwise may be avoided during the consultation.
Child and Adolescent Psychiatric Clinics of North America, 2009
The study of ''attachment'' now spans 4 decades and multiple domains; theory, research, psychobio... more The study of ''attachment'' now spans 4 decades and multiple domains; theory, research, psychobiology, and clinical application. This ever-expanding field of study owes its inception to Bowlby. Synthesizing object-relational and ethological perspectives, Bowlby theorized that the evolutionary interests of the species are best served by a biobehavioral caregiver-infant system that ensures the safety of the vulnerable human infant. 1,2 To that end, the human infant is biologically predisposed to engage in proximity seeking behaviors toward the caregiver in times of distress. In this conceptualization, Bowlby radically departed from the Freudian paradigm of primary
There is no such thing as a baby... A baby cannot exist alone, but is essentially part of a relat... more There is no such thing as a baby... A baby cannot exist alone, but is essentially part of a relationship.
This study found that within a non-referred community pediatrics clinic sample, the severity of m... more This study found that within a non-referred community pediatrics clinic sample, the severity of mothers' trauma-related psychopathology, in particular, their interpersonal violence-related (IPV) posttraumatic stress, dissociative, and depressive symptoms predicted the degree of negativity of mothers' attributions towards their preschool age children, themselves, and their own primary attachment figure. Results also showed that mothers with IPV-related posttraumatic stress disorder (PTSD) as compared to non-PTSD controls showed a significantly greater degree of negativity of their attributions toward their child, themselves and their primary attachment figure during childhood. The study finally found a significant reduction in the degree of negativity of mothers' attributions only towards their child following a three-session evaluationprotocol that included a form of experimental intervention entitled the ''Clinician Assisted Videofeedback Exposure Session(s)'' (CAVES), for mothers with IPV-PTSD as compared to control-subjects.
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