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Open Access Publications from the University of California

Scholarly Works (12 results)

  • Thesis
  • Peer Reviewed
UC Davis Electronic Theses and Dissertations (2022)

AbstractComplex contexts of adversity such as family poverty and homelessness have been linked to multiple adverse, yet heterogenous risk profiles. Traditionally, high-risk environments have been examined through the framework of cumulative risk, which has been useful in exploring associations between risk factors and child and family outcomes. Methodologically, however, this approach lacks sensitivity to disentangle nuanced relationships between proximal experiences of various aspects of adversity and distal developmental and functional outcomes. These limitations underscore insufficiencies in currently existing typologies and risk assessment tools, translating to practical barriers to serving these underprivileged communities. The current dissertation seeks to explore alternative theoretical frameworks concerned with dimensional conceptualization of adversity. More specifically, Studies I and II draw on the Fragile Families and Child Wellbeing Study (FFCW) longitudinal data to test empirically a) the feasibility of dimensional decomposition of high-risk contexts of adversity; b) the effects of early life dimensional adversity on subsequent child development; and c) comparison of the ecological fit and predictive performance of cumulative risk and dimensional adversity models. Study I presents a case for integration of the two well-established dimensional frameworks into a three-dimensional parsimonious model of threat, deprivation, and unpredictability, modeled on the total sample of FFCW (N = 3253). Study I findings were consistent with theory, as children exposed to threat at three years of age showed more aggressive behaviors at age five; whereas exposure to deprivation at age three related to physical health problems and cognitive deficits at age five, and exposure to unpredictability at age three predicted risky behaviors and sexual risk-taking at age 15. Study II expands on Study I by applying the three-dimensional framework to a subset of FFCW multigenerational and doubled-up families (N = 2422), based on the literature review, which identified this precariously housed population as the most heterogenous subgroup in terms of child and family outcomes and participation in services. Furthermore, dimensional modeling of adversity based on indicators of precarious housing was compared to the cumulative risk modeling, with the focus on the ecological fit and predictive performance the competing models. Results indicated that the three-dimensional model yielded a considerably better fit to the data than did the cumulative-risk model. In terms of developmental predictions, the two competing models showed similar effects magnitude and directionality, whereas dimensional approach also showed promise in terms of predictive specificity. In line with Study I findings, Study II demonstrated robust associations between early exposure to threat and prospective aggressive behavior; early experiences of deprivation and unpredictability and downstream cognitive deficits, and to some degree, a link between exposure to unpredictability in early childhood and risky behavior and sexual risk-taking in adolescence. Taken together, these findings lend credibility to the utility of the three-dimensional integrative framework of adversity in application to complex developmental contexts, such as family poverty and precarious housing, with implications relevant to the field of developmental science and public health.

    Cover page: Empirical Inquiry into the Multidimensional Adversity: Implications for Families Affected by Housing Instability
    • Article
    • Peer Reviewed
    UC Davis Previously Published Works (2018)
    Although many parenting interventions have been shown efficacious in reducing externalizing behavior problems in young children, they often take months to implement and tend to target children with moderate to severe behavior problems. Parent–Child Care (PC-CARE) was designed to be an engaging, brief (six-session) dyadic intervention to reduce mental health symptoms even for children with few behavior problems and/or parents who are unable to commit to lengthy treatments. We present an evidence-based case study of a 5-year-old child with mild externalizing problems and his biological parents, who participated in PC-CARE. Standardized measures were collected, and the child’s and parents’ emotional availability were assessed at pre- and posttreatment. Weekly codings of parent–child interactions and parent-reported measures of child behaviors were also collected. This child’s behavioral symptoms improved from pre- to posttreatment (per parents’ reports and observation), and he maintained this improved behavior 1 month after treatment. The parents similarly demonstrated improvement in their use of parenting skills and emotional availability. Aspects of treatment that may affect effectiveness are discussed.
      Cover page: Parent–Child Care as a Brief Dyadic Intervention for Children With Mild to Moderate Externalizing Problems: A Case StudyCreative Commons 'BY' version 4.0 license
      • Thesis
      • Peer Reviewed
      UC Davis Electronic Theses and Dissertations (2023)

      Parenting programs can serve as effective interventions for improving child behavioral problems, strengthening parent-child relationships and promoting healthy development. However, family engagement remains a significant challenge and there is a need for practical and cost-effective solutions. This study was a randomized controlled trial to evaluate the effectiveness of an original, evidence-informed video which leverages communication science best practices to enhance engagement. Parents of children aged 2-8 years were recruited through Prolific (N = 250) and randomized to the engagement video or a standard-of-care informational video condition. After viewing the video, parents completed a battery of questionnaires about their expectancies for program helpfulness, program-related attitudes, parenting self-efficacy, anticipated commitment, and emotional and cognitive engagement in the video. Participants' engagement in the video (i.e., transportation) was tested as a potential mediator. Results showed that participants who viewed the engagement video reported greater expectancies for program effectiveness, higher parenting self-efficacy, stronger levels of anticipated commitment and more transportation into the video, compared to participants who viewed the informational video. Results further showed that transportation mediated all persuasive outcomes (i.e., expectancies, program-related attitudes, parenting self-efficacy and anticipated commitment), providing insights into why the engagement video was effective. Findings suggest that evidence-informed tools that absorb and engage people in the content can effectively shape parents' perceptions of parenting programs, help them feel capable to positively impact their child, and bolster their commitment to parenting change. Findings have implications for the development of future materials, and reveal the value of video-based tools that leverage visuals, storytelling, and modeling to engage families in treatment.

        Cover page: Unpacking the Persuasive Power of an Evidence-Based Engagement Video for Parenting Programs
        • Article
        • Peer Reviewed
        UC Davis Previously Published Works (2022)
        Recent dimensional models of adversity informed by a neurobiological deficit framework highlights threat and deprivation as core dimensions, whereas models informed by an evolutionary, adaptational and functional framework calls attention to harshness and unpredictability. This report seeks to evaluate an integrative model of threat, deprivation, and unpredictability, drawing on the Fragile Families Study. Confirmatory factor analysis of presumed multiple indicators of each construct reveals an adequate three-factor structure of adversity. Theory-based targeted predictions of the developmental sequelae of each dimension also received empirical support, with deprivation linked to health problems and cognitive ability; threat linked to aggression; and unpredictability to substance use and sexual risk-taking. These findings lend credibility to utility of the three-dimensional integrative framework of adversity. It could thus inform development of dimensional measures of risk assessment and exploration of multidimensional adversity profiles, sensitive to individual differences in lived experiences, supporting patient-centered, strength-based approaches to services.
          Cover page: Testing the empirical integration of threat-deprivation and harshness-unpredictability dimensional models of adversity.
          • Article
          • Peer Reviewed
          UC Davis Previously Published Works (2020)
          Young children in the foster system, who have experienced various traumas, are at risk for mental health problems, particularly externalizing and trauma-related behaviors. Such problems are related to placement instability and future difficulties. Many interventions for foster children take months to implement and tend to target only children with moderate to severe behavior problems. This study presents preliminary findings from a county-wide implementation of Parent-Child Care (PC-CARE), a 7-session dyadic intervention, as a secondary prevention service for all children aged 1–5 years in new foster placements, with the goal of improving children's behavioral adjustment and placement stability. Method: Participants included 153 children aged 1–5 years (50% male) who participated in at least one PC-CARE session with their foster caregivers in the first 90 days of placement. Results: Children who completed PC-CARE showed significant decreases in trauma and behavior symptoms and increases in positive behaviors (i.e., initiative, self-regulation), and caregiver-child relationships from pre- to post-intervention. Children who completed PC-CARE showed more placement stability and fewer placements disruptions to another foster home at one- and six-months post-intervention than children who did not complete PC-CARE. Conclusion: PC-CARE appears to be a promising secondary prevention service within child welfare associated with improvements in children's adjustment to new foster placements and increased placement stability.
            Cover page: Improving behaviors and placement stability for young foster children: An open trial of Parent-Child Care (PC-CARE) in the child welfare systemCreative Commons 'BY' version 4.0 license
            • Article
            • Peer Reviewed
            UC Davis Previously Published Works (2023)
            Research shows that parenting interventions struggle with keeping clients in treatment. The purpose of this study was to compare attrition and rates of improvement in caregiver-child dyads participating in either Parent-Child Care (PC-CARE), a brief, 7-session parenting intervention or Parent-Child Interaction Therapy (PCIT) over a 7-week period. Participants were 204 caregiver-child dyads referred to either PC-CARE (N = 69) or PCIT (N = 135) between 2016 and 2019. Children were aged 2-7 years, referred for treatment by county Behavioral Health Services, and Medicaid funded. Findings showed that PC-CARE participants were 2.5 times more likely than PCIT participants to complete 7 sessions, all other things being equal, and showed significantly greater rates of improvement during this timeframe in reported child behavior problems and parenting stress. In conclusion, compared with PCIT, PC-CARE showed greater retention and rate of improvement in child and parent outcomes over a comparable time period.
              Cover page: The Long and the Short of It: A Comparison of the Effectiveness of Parent–Child Care (PC–CARE) and Parent–Child Interaction Therapy (PCIT)Creative Commons 'BY' version 4.0 license
              • Article
              • Peer Reviewed
              UC Davis Previously Published Works (2021)

              Background

              Recent advancements in pediatric mental health (MH) increased accessibility of evidence-based interventions. Yet, accessibility alone does not explain the rise in MH services use (MHSU). Maltreatment-related adversity, symptom severity, and access to early interventions have been linked to ongoing need for services, yet their joint contributions to continuities in MHSU remain unclear.

              Objective

              The study examines the role of maltreatment, externalizing symptom severity, and referral for early intervention in pediatric MHSU across five years. To evaluate engagement in treatment, we accounted for treatment progress and referral type, comparing MHSU in court-mandated and voluntary participants.

              Participants and setting

              Participants were 321 children (M = 4.3 years; 58.9 % boys) referred to parent-child interaction therapy (PCIT), an evidence-based intervention for families struggling with child disruptive behaviors and maltreating families involved with child welfare. Services were provided at a university-affiliated clinic in a metropolitan county.

              Method

              Symptom severity was assessed with standardized questionnaires; maltreatment history and referral type were obtained from casefile reviews. MHSU was tracked through county behavioral health diagnostic reports. The data were analyzed using structural equation modeling.

              Results

              Results indicated that for the 44.9 % of children with onward referrals, the frequency of service use, but not progress in treatment, predicted ongoing services. Maltreatment emerged as a universal predictor, while externalizing predicted MHSU only in court-mandated participants, suggesting referral type contributes to quantifiable differences in MH needs.

              Conclusions

              Findings emphasize importance of ongoing funding for pediatric MH services, and the need to explore mechanisms underlying continuous MHSU in vulnerable children.
                Cover page: Long-term mental health services use in children referred to a clinical intervention.
                • Article
                • Peer Reviewed
                UC Davis Previously Published Works (2019)
                Research shows that parenting interventions are plagued with the problem of early treatment termination. A brief 6-week intervention, parent-child care (PC-CARE) was developed to minimize the time investment for parents while maximizing the probability of improving behavioral problems of their 1-10 year old children. The purpose of this study was to determine the feasibility of PC-CARE and examine preliminary outcomes. The data were collected as part of an open trial in a community mental health clinic and included pre- and post-treatment performance outcomes, weekly measures of treatment progress, and assessments of treatment fidelity. Participants were 64 children and their primary caregivers, referred by physicians, social workers, or self-referred for help with their children's difficult behaviors. The retention rate was 94%. Results of analyses pre- to post-intervention scores showed significant improvements in child behavioral problems as well as improvements in parenting stress and positive parenting skills. The findings suggest that PC-CARE may be a beneficial treatment for children with disruptive behaviors, encourage future research into the efficacy of this brief parenting intervention, and its effectiveness in other populations and contexts.
                  Cover page: An Open Trial of Parent–Child Care (PC-CARE)-A 6-Week Dyadic Parenting Intervention for Children with Externalizing Behavior ProblemsCreative Commons 'BY' version 4.0 license
                  • Article
                  • Peer Reviewed
                  UC Davis Previously Published Works (2022)
                  Parent-Child Care (PC-CARE) is a brief intervention for children with externalizing behaviors designed to address issues with their access to and retention in treatment. A growing evidence base of open trials and comparison studies support PC-CARE's benefits, but no randomized controlled trials (RCTs) of its effectiveness exist. The current study presents the first RCT of PC-CARE, a 7-session dyadic parenting intervention (trial number removed for blind review). Participants included a racially/ethnically diverse sample of 49 children (29% female) aged 2-10 years and their caregivers. Participants were randomly assigned to PC-CARE or waitlist control. Families participating in PC-CARE showed greater reductions in children's externalizing behaviors, improvements in children's adaptive skills, declines in parental stress, and increases in parents' positive communication skills, compared to families on the waitlist. The results of this first RCT of PC-CARE support the effectiveness of this brief intervention in improving children's behaviors.
                    Cover page: Improving Children's Behavior in Seven Sessions: A Randomized Controlled Trial of Parent-Child Care (PC-CARE) for Children Aged 2-10 Years.
                    • Article
                    • Peer Reviewed
                    UC Davis Previously Published Works (2022)

                    Background

                    Child maltreatment recidivism substantially increases the likelihood of adverse life outcomes, but there is little evidence that family preservation services are effective at reducing recidivism. Mothers in child welfare have very high rates of trauma exposure; maternal post-traumatic stress disorder (PTSD) is an intervention target that has the potential to reduce abuse and neglect. The Safe Mothers, Safe Children (SMSC) intervention program involves the delivery of an innovative combination of interventions, including Skills Training in Affective and Interpersonal Regulation (STAIR) and Parent-Child Interaction Therapy (PCIT). The combined intervention, Parenting-STAIR (P-STAIR), targets maternal PTSD and comorbid depression symptoms to reduce the adverse effects of PTSD on parenting, improve positive parenting skills, and prevent maltreatment recidivism.

                    Methods

                    This study is a two-arm randomized controlled trial: P-STAIR (23 sessions) versus supportive counseling (23 sessions). Participants are mothers receiving child welfare family preservation services (FPS), with a child in the age range of 1-8 years old and meeting diagnostic criteria for PTSD (with/without depression). Clinical assessment occurs at pre-treatment (baseline), two in-treatment assessments (mid-assessment #1 after module 9 and mid-assessment #2 after module 15), post-treatment, and at a 6-month follow-up. Recidivism will be measured using the New York State Child Welfare Registry (NYSCWR). We will enroll a total of 220 participants over 4 years: half (N = 110) randomly assigned to the P-STAIR condition and half (N = 110) to the supportive counseling condition.

                    Discussion

                    This is the first RCT to investigate the efficacy of P-STAIR. The findings for the trial have the potential to contribute to the expansion of evidence-based practices for maternal PTSD, maltreatment, and child welfare.
                      Cover page: A randomized controlled trial to assess the efficacy of Parenting-STAIR in treating maternal PTSD to reduce maltreatment recidivism: protocol for the Safe Mothers, Safe Children study
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