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Extracts from the Journals relating to Children, Youth and Families - in the fields of health, substance abuse, education, psychology, science ...

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Care and connections: Bridging relational gaps for foster youths

In the United States, more than 20,000 youths “age out” of foster care each year. But leaving foster care presents its own challenges. Only 55 percent of former foster youths report having a high school diploma or GED by the time they’re 19, compared with 87 percent of their peers in the population sample.

Significant efforts are made by policymakers at all levels to improve educational, social and economic outcomes for this at-risk group, with mixed results.

One way to help improve the outcomes of foster youths may be to focus on relationship-building skills. Research suggests that healthy and supportive relationships improve life chances for foster youth. But so far there have been relatively few attempts to build insights into these programs and practice.

In “Care and connections: Bridging relational gaps for foster youths”, Ramona Denby-Brinson, Efren Gomez, and Richard V. Reeves explore the steep challenges of implementing and evaluating relationship-based interventions in child welfare.

The authors examine the experience of recent programs that aimed to increase relationship-building skills for youths transitioning out of foster care. They find four important lessons for policymakers and researchers moving forward.

1. Child welfare agencies should measure youths’ relational capacities to help reinforce the importance of foster youths’ relational needs for front-line workers.
2. Given the transient nature of the living conditions of foster youths, increasing the number of service providers may be counterproductive and overwhelming for foster youths. Instead, it is important to design relationship-based interventions with care.
3. Relationship-based interventions should seek to tailor services to the unique needs of each youth.
4. The support of all pertinent parties involved in a youth’s case, even nontraditional partners, is important to help foster youths reinforce and practice their relationship skills in different environments.

The authors conclude that “Helping foster youths develop relational skills necessary for strong and positive interactions with others underpins efforts to improve outcomes across a range of areas, including in education, employment, and family formation.”

Read the full paper here.

14 September 2017



New study looks to improve emergency health care for youth and young adults in Alberta

Calgary mom Shirley Bates describes the experience as “awful.” Her 17-year-old daughter was in crisis, experiencing symptoms related to post-traumatic stress, but when they sought help at a Calgary emergency department, they were told all the psychiatry beds were full.

“Because there was no beds available, my daughter had to be left in the emergency unit over 24 hours,” Bates said. “Having to go home in the middle of the night and leave her in an emergency unit that wasn’t a secure facility gave me great concern.”

According to the Centre for Mental Health and Addictions five per cent of all emergency department visits in 2012 for children and youth in Canada were for a mental disorder.

“Emergency departments are being accessed more and more for these issues as the years go on because people are becoming better at identifying these situations and then figuring out that they need to seek help,” said Dr. Frank MacMaster, the senior director of the Addictions and Mental Health Strategic Clinical Network for the Alberta Children’s Hospital Research Institute.

MacMaster said this is why his team is currently studying how emergency mental health care is provided and looking at where improvements can be made.

The research team will be collecting survey responses from either Alberta youth and young adults aged 15 – 24 or their caregivers until Friday, Sept. 29. MacMaster said he hopes the information collected will help improve care not only within Alberta, but across the country.

“In a survey, we’re asking [young people] about their experiences – what lead them to go to the ER, what care are they hoping for, what care did they receive and what happened afterward.”

“This will end up providing a lot of vital information, not just to Alberta Health Services but also to other jurisdictions around the world.”

The surveys can be accessed online at and

By Heather Yourex-West

22 September 2017 



How you manage conflict has an impact on your kids

Few parents want their children to hear them arguing, but since conflict is a normal part of any relationship, it can be hard to shield little ones from every spat.

That's OK, as long as parents handle disagreements in a constructive way, says University of Arizona researcher Olena Kopystynska.

Kopystynska, a graduate student in the UA's Norton School of Family and Consumer Sciences in the College of Agriculture and Life Sciences, studies conflict and conflict resolution. In a new paper, forthcoming in the Journal of Family Psychology, she looks at how the way parents handle conflict with each other affects their parenting styles and how emotionally secure their children feel after being exposed to conflict between their parents.

Kopystynska's study focuses on constructive versus destructive styles of conflict management. In constructive conflict management, there is calmness and respect, despite a difference in opinion; the conflict stays focused on one topic; and progress is made toward a resolution. When conflict is handled destructively, there is anger and resentment, and the argument often strays off topic to things that may have happened in the past.

Kopystynska and her colleagues found that when even one parent handles conflict with a partner destructively, it can leave children feeling more emotionally insecure about their home life.

"Children are very good at picking up on little nuances of how parents interact with each other, so it really matters how parents express and manage their daily life challenges because that determines children's confidence in the stability and safety of their family," Kopystynska said. "If parents are hostile toward each other, even children as young as 3 years old may be threatened that their family may be headed toward dissolution. They may not necessarily be able to express their insecurities verbally, but they can feel it."

Stressors can feed strife

Kopystynska's study is based on national data collected for the Building Strong Families Project, which targeted low-income families -- a population that could be at high risk for conflict, given the many stressors associated with financial strife. Parents in the study were mostly unmarried and had just conceived their first child at the start of data collection, which was done in three waves.

Kopystynska focused on the third wave of data, collected when the children in the study were 3 years old. Mothers and fathers were surveyed at that point about their perceptions of their conflict management behaviors with each other, and how their children react emotionally when they witness conflict between their parents. While similar studies have relied only on data from mothers, the inclusion of fathers helps provide a more complete picture of what's going on, Kopystynska said.

Kopystynska and her co-authors identified four different profiles of the couples surveyed: couples in which both partners handled conflict constructively; couples in which both partners handled conflict destructively; couples in which the mother was more constructive and the father more destructive; and couples in which the father was more constructive and the mother more destructive.

The researchers further looked at supportive and harsh parenting behaviors, as measured through direct observations of each parent separately interacting with his or her child. Supportive behaviors might include making positive statements, being sensitive to the child's needs and engaging the child in cognitively stimulating ways. Harsh parenting might include forceful or intrusive behaviors or expressions of anger and dissatisfaction toward the child.

Researchers found that fathers' parenting styles did not seem to be affected by how they managed conflict with their partners. In other words, fathers interacted with their children similarly in all profiles. Yet, mothers in the profile in which fathers handled conflict constructively and mothers handled conflict destructively tended to be harsher with their children than mothers in the profile in which both parents handled conflict constructively.

As far as the impact on children's emotional insecurity, researchers found that when one parent handled conflict destructively and the other constructively, children's emotional insecurity was higher than what was reported for children whose parents both handled conflict constructively.

"What we found is that when parents are using constructive conflict management, the children feel less insecure about their family climate, and when at least one parent argues destructively, there are some levels of insecurity about the family relationships," Kopystynska said.

'Arguing constructively'

Worth noting, Kopystynska said, is that despite a common misconception that most low-income families are at risk for dysfunctional behaviors, very few couples in the study were entirely destructive in their conflict management styles. In fact, only 3 percent of couples in the sample included two partners who handled conflict destructively, suggesting that most couples in the sample participated in healthy and positive conflict patterns.

"There is often a belief out there that if you are a low-income family, you probably have a lot of dysfunction, but over 50 percent of the couples we looked at were arguing constructively," Kopystynska said. "Considering all the stressors they're dealing with, the majority of them still have a good, functional relationship, at least when it comes to conflict."

The fact that the group in which both parents were arguing in destructive ways was so small might help explain one surprising finding of Kopystynska's study -- that emotional insecurity levels were lowest for children of these parents. Also contributing to that finding could be the fact that those couples may have broken up and physically separated from each other by the time the data was collected, meaning that children may not have been as directly exposed to their parents' interactions, Kopystynska said.

"Parents who were in the concordant destructive group were less likely to stay together, so they were probably not in the same home, so children were probably not exposed to that interparental conflict," said Kopystynska, whose co-authors on the paper were UA faculty memebers Melissa Barnett and Melissa Curran, along with Katherine Paschall of the University of Texas, Austin.

In general, Kopystynska said, it's important for parents to be aware of how they interact with each other, and remember that conflict shouldn't necessarily be avoided but handled in a way that makes a child feel less threatened.

"Not all conflict is bad -- it's about how you manage it," Kopystynska said. "Given that children are going to encounter conflict out there in the real world, exposure to some conflict can be beneficial. However, it's really how parents handle that conflict that sets the tone for how safe children feel, and may further promote similar conflict management behaviors for when children are confronted with conflict of their own."

20 September 2017



Kids are actually growing up slower than decades past, report says

It's a widely-held belief that kids keep growing up faster and faster. But a new study shows it's actually the opposite.

It turns out that kids today (in the 2010s) are pursuing traditional rites of adulthood – i.e. drinking alcohol, having sex, working or driving – less so than teens of decades past, according to a study published this week in Child Development. What's more: These changes didn't happen in a vacuum. They were found across gender, race/ethnicity and socioeconomic status, among other demographic groups.

"In terms of adult activities, 18-year-olds now look like 15-year-olds once did," lead study author Jean M. Twenge, a professor of psychology at San Diego State University, said in a statement.

Researchers took into account seven surveys of 8.3 million people for their analysis. All the people studied, from 1976 to 2016, were between the ages of 13 to 19 years old. The surveys correlated with the U.S. teen population when it came to factors like gender, socioeconomic status and race/ethnicity.

A more granular look at the data found 86 percent of high school seniors had been on a date between 1976 and 1979, but that declined to 63 percent between 2010 and 2015, reports The Washington Post. This matched up with Centers for Disease Control and Prevention data, which found high school students who had sex dipped to 41 percent in 2015, a 13 percentage point decline from 1991.

Something else that came out of the study: Growing up in a world with longer life expectancies and where women gave birth later, teens weren't as likely to take part in these adult activities.

"Adult activities were less common when median income, life expectancy, college enrollment, and age at first birth were higher and family size and pathogen prevalence [communicable diseases] were lower, consistent with life history theory," according to the study abstract.

Survey questions included how teens spent their time, allowing researchers the ability to crosscheck responses from teens in the 2010s to the 2000s, 1990s and so on.

Of course, the ultimate question – why is this happening? – is less clear than the definitive data. Authors point out this dip in development speed could be associated with how much time teens are online, as that exposure ticked up notably. But the researchers say the drop in adult activities can't be explained by time spent on homework or extracurricular activities, because time on those activities dropped among eighth and tenth graders and was steady for twelfth graders and college students.

And according to an adolescent psychiatrist, it tracks that teens brains would change along with cultural shifts.

"In a culture that says, 'Okay, you're going to go to high school, go to college, go to graduate school, and then get an internship, and you're not going to really be responsible till your late 20s,' well then the brain will respond accordingly," Dr. Daniel Siegel told The Washington Post.

19 September 2017




Care leavers missing out on mental health support, study finds

Around two-thirds of care leavers with mental health problems are not receiving specialist support, a study by Barnardo's has found.

A study by the charity of 274 of its care leaver services cases found that 125 young people had mental health needs but 81 (65 per cent) were not receiving specialist support from a mental health service. The study also found that one in four (69) care leavers had experienced a mental health crisis since leaving care.

Barnardo's chief executive Javed Khan is calling on the government to ensure that some of the £1.4bn in additional funding pledged to improve children's mental health, is used to support care leavers.

"Our research shows a shocking picture of care leavers in need with no access to suitable mental health support," Khan said. "Young people who have been in care often experience poor mental health ranging from anxiety to serious problems following abuse or neglect. The government must ensure these vulnerable young people receive the support they so desperately need when it honours its pledge to improve children's mental health."

The charity is specifically calling for a mental health worker to be embedded within leaving care teams.

It also wants to see improved mental health training among those working in care leaver services. The study found that many care leaver professionals do not have a good understanding of how to support young people's mental health needs.

The Local Government Association said government must ensure extra money is made available to improve access to support for all young people with mental health problems.

"Children come into care in the most difficult circumstances, and giving them the best opportunities to overcome these and get a good start in life is a major focus for councils. This is particularly true as they move from care into adulthood," said LGA children and young people board chairman Richard Watts.

"Whilst this research rightly highlights that care leavers are more likely to experience poorer mental health than the general population, we must do more to ensure that all children and young people are able to access emotional health and wellbeing support whenever they need it," he added.

In July the government published its mental health workforce plan that included a pledge to improve access by recruiting an additional 2,000 child and adolescent mental health services staff within the next three years. But the British Association of Social Workers is concerned that social workers are being frozen out of the plans.

The Department of Health has been contacted for comment.

By Joe Lepper

14 September 2017



New book about the history of American foster care to come out in October

University of Missouri associate history professor Catherine Rymph’s new book, “Raising Government Children: A History of Foster Care and the American Welfare State,” details the history of the 20th century foster care system in America and will be released this October.

Introduced to the subject through having family members connected to the system, Rymph’s second book is the first to document one of the country’s more hidden fractions of the welfare state.

“I wanted to know something about what it was like in the past because I knew a little about what it was like in the present,” Rymph said. “I tried to find a history of the system, but there was no history.”

A nine-year project, Rymph’s research follows foster care’s evolution beginning with its formation in the 1930s through the end of the 1970s. Two archival collections make up most of the primary sources that shaped the book, one of which includes the standard practices of foster families documented by the Child Welfare League of America.

The second collection is from the records of the Children's Bureau and includes letters sent by mainly women involved with the system. Written by both mothers and foster mothers, the letters often asked for help in various situations.

“I got a lot of really gripping, really personal firsthand accounts of this subject, which I didn’t expect to find,” Rymph said. “Case files are all closed to the public.”

Rymph said these letters made it possible for her to tell a more “human” story.

“I think currently there are a lot of negative feelings about foster children and foster parents,” Rymph said. “One of the things I tried to do in this book is help people try to understand what this system is like for them.”

Her work explores the functional problems of having a social welfare provision subsidized through private families and how lack of funds along with overworked caseworkers have always added to inherent flaws.

“There was never some period in the past when people thought [foster care] was working well,” Rymph said. “It’s always been a system that no one thought really served the children it was supposed to serve.”

Rymph’s colleague, postdoctoral teaching fellow in history Cassandra Yacovazzi, assisted in the completion of the book’s index and appreciates how the book illustrates the “complexity” of the foster care system. The work includes research examining how gender roles and unfulfilled expectations of how the welfare state would be today have each played their part in where the program now stands.

“Dr. Rymph’s work has really changed my perspective on the origins and development of foster care and the very hopeful and optimistic approach that those who developed [the foster care system] had,” Yacovazzi said.

Yacovazzi said the book touches many people’s lives, even those with no connection to the system directly.

“Her book raises the question of what our responsibility is to the community and the children in the community in which we live,” Yacovazzi said.

Rymph’s own personal attachment to the topic has made the research and creation of the now-finished product even more illuminating.

“It’s helped me to think a lot about how things have changed, what’s at stake really,” Rymph said.

The book is being published by the University of North Carolina Press and is available for pre-order on its website as well as on Amazon.

“I certainly hope that people who read it will think more about what foster care means and what foster parenting means,” Rymph said. “I think it’s a lot of people trying to do their best in an imperfect system.”

By Morgan Smith

11 September 2017 



Growing up with a mentally ill parent: Six core experiences

For children who grow up in the care of a mentally ill parent, life is often filled with anxiety, uncertainty and vigilance. It is not unusual for their needs to be neglected — and they may even have to “compete” with their parent’s symptoms in order to receive care themselves. It also poses risk factors for issues that can emerge later in life, including emotional and psychological disturbances, learning challenges, and poorer overall functioning. In addition, there are a host of social challenges that these children may encounter, such as social rejection, troubled relationships, marital problems, and family dissolution.

What are the core experiences for people who have been raised by a parent with mental illness? In a study led by psychologist Lynne McCormack of the University of Newcastle, she and her team interviewed adult children of an unwell parent, ranging from depression to schizoaffective disorder. They then analyzed the transcripts to see what salient themes would surface. The collaborators found an overarching theme – a fractured journey of growth to adulthood – which broke down into six core experiences. The following is a digest of their results.

Who cares about me? As children, the participants in this study were plagued by loneliness, vulnerability, and helplessness. They reflected on a childhood in which they felt unwanted, abandoned, and lost. At home they felt invisible. And the dysfunction of their home lives made them feel different and stigmatized in relation to their peers. One participant recalled, “There’s nobody in this world that loves me … I don’t have a mother’s love or a father’s love, or, family love, or… so it wouldn’t matter if I disappeared off the face of the earth.”

Trauma and betrayal. Surviving their childhood was a hard-won struggle for these participants, and many were heavily traumatized in their youth. Their familial environment was terrifying, and the chronic nature of this negativity exacerbated the effects of the neglect and abuse they endured. At the same time, they felt their other parent was helpless and unable to cope with the situation. The lack of parental care in childhood led to hypervigilance and extreme anxiety. Betrayal was also an important theme. Their parents failed to love, nurture, and protect them adequately. This, together with repeated instances of abuse and neglect, made it difficult to develop healthy self-esteem and a sense of self-worth – especially since the inaction of the other parent confused them. One participant stated, “Growing up with dad, I never felt secure…And I know that I have always been anxious, my whole life.”

Transferring the pain. Participants expressed feeling heightened guilt and sadness, accompanied by self-blame. Very often, information about their parent’s condition, including its cause and development, was withheld from them. This gave rise to confusion, shame, and the need for secrecy – further fueling their stress and anxiety. One participant recalled, “All I knew was um, my grandparents were telling me that mum’s sick and dad was telling me that mum’s sick and um, I was confused, because she didn’t look sick to me.” In addition, many participants feared passing on the illness to a future generation which played a role in the decisions they made about whether or not to have a family of their own.

Staying out of the way, and staying safe. The adults in this study had to navigate treacherous emotional shoals. Some became a “parentified child,” taking on a caregiving role that their mentally ill parent didn't assume – that they were children themselves was often overlooked. Others developed a suite of adaptive behaviors that kept them and their family members safe from harm. This often involved learning to please and fit in with others. The need for positive feedback, and modifying one’s behavior to attain it, became itself a crucible of sorts. As one participant put it: “I become very adaptable in different situations because I was always in such different environments…People always say oh you fit in so well here and it’s, it’s just something you learn because (laughs) that’s what had to happen.” While there was value in these adaptive behaviors, it also meant that the vigilant child within could not relax and give much needed focus to oneself.

Growing myself up. All of the participants reflected on the positive and negative facets of childhood experiences, and often found benefits, meaning, and opportunities for growth. Some found that it fostered empathy, compassion, and resilience. Others referred to their experience of having a mentally ill parent as “a blessing in disguise,” in which a broken self healed and became healthy. As the participants transitioned to adulthood, this phase of life allowed them to look back on their lives with their unwell parent and give new meaning to their experiences. Many described a process in which self-hatred transformed into self-acceptance. As one participant described it, “You work out why you’re doing the things you do and why you act the way you act – the penny drops and you really grow as a person. I’m just really blessed I suppose. Yeah I am, I’m really lucky.”

Transforming the broken childhood. Looking back on their struggle from childhood to adulthood, participants identified factors that helped them transcend their circumstances. For some, having exposure, however limited, to families without mental illness helped them to see a life beyond it. It gave them hope and optimism for a future that could be different. They also looked to education and employment as a road to independence and freedom from their families. Sometimes the pursuit of reaching impossibly high standards led to profound dissatisfaction with oneself in the – but school largely provided an escape from the distress at home. As one participant remarked, “One of my mottos is success is the best revenge. I just love learning and bettering myself and being independent.”

By Vinita Mehta

5 September 2017



South Africa: Therapist develops child emotional intelligence solution

Research within the field of psychology suggests that fewer children are able to cope with the complex range of emotions that they are confronted with these days.

Globally, experts have reported a decline in emotional intelligence (EQ) amongst children, which is detrimental to their capacity to work harder, resolve conflict, explore new activities and achieve more in life. The inability to express their feelings result in a general lack of communication, poor discipline and frustration that manifests low self-esteem within both children and parents.

Cape Town-based child therapist and social worker, Shontell Fiet, applied her extensive knowledge and experience of child play therapy to develop a support tool for parents and therapists in need of a practical solution. Introducing iFeel, Fiet developed a unique card game that enables parents and therapists to facilitate an environment in which children are encouraged to identify, express and regulate their feelings more effectively.

Comments Fiet: “We live in a fast-paced, technology-driven, hyper-connected society, yet our children struggle to express their thoughts and feelings. Globally, there is a growing concern that children are not able to effectively understand and manage their own feelings – let alone identify and sympathise with the feelings of others.”

The game includes a deck of 14 animal-themed cards that promotes a fun and non-threatening context in which children – aged three and older – can safely explore and express their feelings. Through the power of projection, the game teaches children to identify and express their emotions. The facial expressions and visual clues within the cards are intended to encourage the child to project their own interpretations, which means that there are no right or wrong answers. This enables parents, teachers and therapists to gain an in-depth understanding of their experiences – both positive and negative – to address problem areas, improve their social skills, memory, cognitive skills and vocabulary.

Commenting further, Fiet says: “Our ability to develop and maintain emotional intelligence is paramount to the early childhood development stages. An emotionally intelligent individual is more likely to achieve confidence and success than a person who simply has a high IQ, supporting the argument that we need to teach our children to identify, acknowledge and regulate their feelings from a young age.”

Fiet developed this game to provide an easy-to-use, affordable tool for parents, teachers and anyone actively involved with childhood development. Commenting on the ultimate benefits to parents, she adds: “I believe that – when our children are confident that their feelings will be heard within a safe, stimulating environment – they will learn to communicate them effectively.”

7 September 2017 




Innovative work on attachment between parents and children showcased by international expert

The work of an innovative team which provides targeted mental health support and specialist therapy to help families on the edge of care to stay together has been showcased in a new book.

Norfolk and Suffolk NHS Foundation Trust’s PIMHAT (Parent Infant Mental Health Attachment Team) has been included in Transforming Infant Wellbeing – Research, Policy and Practice for the first 1,001 Critical Days, which was published on August 24.

The book has been edited by Penelope Leach, who is a research psychologist and one of the world’s leading experts in child development. It includes 25 articles by experts in different aspects of infant development which highlight the importance of the first 1,001 days of life, and focuses on theory and research as well as practice currently taking place across the country.

PIMHAT was launched in 2015 and offers specialist therapy and targeted mental health support to the parents of babies up the age of two who live in Norfolk and are at risk of being taken into care.

A partnership between NSFT and Norfolk County Council, the service sees health and social services work together to support parents who are finding it difficult to attach to their child, with the ultimate aim of reducing the number going through court proceedings and being taken into care. The team works from children’s services locality bases and children’s centres in Norwich, King’s Lynn and Great Yarmouth.

Since its launch, it has helped around 80 families, with babies remaining with their parents in around 86 percent of the cases where therapeutic interventions were offered. Calculations show that if it helps just 15 children to remain at home each year it will have paid for itself, as the average annual cost of placing a child in care is very high.

It has also received good feedback from families.

One mother who worked with PIMHAT and whose children no longer require social services involvement said: “Prior to the work I did with PIMHAT, I didn’t even understand how important it was to strengthen their emotional wellbeing, and the impact we were all having on each other.”

Dr Richard Pratt, clinical psychologist and clinical lead with PIMHAT, said: “We are delighted that our team is being used as an exemplar to illustrate the benefits which early intervention can bring to the whole family. It shows that the work which is taking place in Norfolk is innovative, effective, and an example of best practice.

“The article highlights the success we have had in addressing the mental health and attachment needs of the parent in order to strengthen the relationship with the baby. In the vast majority of cases, we have seen safeguarding concerns reduce following our intervention and the majority of babies able to remain with their birth families.

“Our chapter also underlines the importance of services working together and jointly considering the risks and needs of the family to find the best possible solutions.

“A strong attachment between a parent and their baby is vital as it helps the baby to feel safe and able to explore the world as they develop. Our aim is to work with our social care partners to support the parent, improve attachment and have a positive impact on the family’s emotional experiences during a crucial stage of the baby’s development, in turn helping them remain together.”

Penny Carpenter, chairman of the children’s services committee at Norfolk County Council, added: “Having a new child can be a difficult time for anyone, and parents who already have mental health problems or are going through emotional difficulties do not always find it easy to form a strong attachment to their new baby. This can lead to children becoming at risk of harm, but the good news is that we have seen families respond really well to being given intensive support at an early stage.

“This work is a wonderful example of how giving parents the right kind of help early on can enable families to stay together and build strong relationships. It is about caring for vulnerable children in Norfolk and keeping families together whenever possible, which is one of our priorities.”

By Geraldine Scott

4 September 2017



Assessment tools, relationships key to addressing child trauma

Two new studies led by researchers at the Johns Hopkins Bloomberg School of Public Health suggest that the bevy of tools available to assess and address childhood adversity and trauma, as well as the interconnected webs of relationships among families and the providers who care for children, are key to healing the effects of these potentially life-altering circumstances.

The findings, published online in a special issue of Academic Pediatrics, offer useful insights in helping children and their families recover from adverse childhood experiences, which can have myriad and serious health consequences.

Researchers have known for decades that adverse childhood experiences – which can include physical, sexual, or emotional abuse and neglect, parental incarceration, and household substance abuse, among other circumstances – are associated with a variety of other long-term health problems or high-risk behaviors, including depression, heart disease, substance abuse and sleep disorders. Only more recently have researchers understood the prevalence of these experiences among children and youth. A 2014 study found that nearly half of all US children had experienced at least one and that effects on health, school success and well-being show up early.

Despite this knowledge, public health efforts have thus far not fully addressed these issues, setting many children up for what could be lifelong health problems.

“This really is a public health opportunity, because we know children can thrive with proper support systems,” says Christina D. Bethell, PhD, professor in the Bloomberg School’s Department of Population, Family and Reproductive Health and director of the Child and Adolescent Health Measurement Initiative. “With a clear agenda, we can help create a paradigm shift. And that will help more children do well despite adverse experiences.”

To establish a research and policy agenda, Bethell and her colleagues at the Bloomberg School and elsewhere worked with more than 500 individuals across a dozen stakeholder groups to address what priorities should be for preventing and treating traumatic childhood experiences in children’s health services.

The resulting agenda, published in the same issue of Academic Pediatrics, lays out four primary goals: educating policymakers and healthcare providers; cultivating cross-sector collaboration; restoring and rewarding healthy relationships; and launching research, innovation and implementation efforts.

Critical to this agenda is understanding which assessment tools are most useful. In another paper in the special issue, Bethell and her co-authors assessed the state of tools used to evaluate adverse childhood experiences. The researchers identified and compared 14 assessment tools, each of which used parent responses to evaluate adverse childhood experiences.

The study found that each of these tools share four adverse experiences: parental incarceration, domestic violence, household mental illness/suicide, and household alcohol or substance abuse. Other experiences common to many of the 14 tools are exposure to domestic/household violence, neighborhood violence, bullying, discrimination, or a parent’s death.

Each assessment tool used cumulative scoring methodology that assessed health risks based on the number of adverse experiences that an individual had been exposed to, rather than giving more weight to different ones.

The researchers focused on a new measure included in the the National Survey of Children’s Health which looked at children’s past or current exposure to adversity. Several methods were employed to validate the tool and its scoring.

“Assessing childhood adversity is strongly linked to the health and school success of children and youth. Counting exposures rather than specific events holds up,” Bethell says.

A separate paper also recommends encouraging relationships that promote healing. In a review article in the same issue of Academic Pediatrics, Lawrence Wissow, MD, MPH, who holds joint appointments at the Johns Hopkins University School of Medicine and the Bloomberg School, and his colleagues combine conclusions from three previous systematic reviews examining relationships between pediatric patients and healthcare providers, among healthcare staff at the same practice, and among primary care providers and specialists.

This research suggests that it’s vital for patients to form healthy relationships with staff from the moment they contact a care facility, not only including those that directly provide healthcare, but also those that answer phones or check them into appointments.

“For trauma patients, knowing that you’ll be respected, that people will explain things to you, that you’ll have choices and won’t be trapped, all of this is important to achieving good outcomes,” Wissow says.

Similarly, he adds, research shows that having staff at the same healthcare practice who collaborate well despite constant exposure to patients’ crises, as well as primary care providers who have personal relationships with specialists and community organizations that also assist trauma patients, is key to getting patients the resources they need to heal.

5 September 2017

Johns Hopkins Bloomberg School of Public Health



Are 'depression naps' a harmless internet meme or a concerning sign?

If you’re under the age of 25, you've probably heard of the term “depression nap.” For those who aren’t glued to social media 24/7/365, the phrase may be new. Depression nap is a current internet meme – another term some people may need to Google. Users of Twitter, Instagram and Snapchat are fond of talking about taking a depression nap to escape whatever real life has thrown at them – whether it's work, school, nonvirtual socialization – in a mostly snarky tone. Behind the snark, though, might there be something more concerning at play?

After all, depression and sleep form a complex and intricately linked couple. As the National Sleep Foundation puts it, “depression may cause sleep problems and sleep problems may cause or contribute to depressive disorders.” In some cases, depression can lead to sleep issues like insomnia and, conversely, oversleeping. In other cases, sleep problems occur first and lead to depression: One study found that those with insomnia are 10 times more likely to develop depression and 17 times more likely to develop anxiety than those who sleep soundly. The NSF says that sleep problems and depression “may also share risk factors and biological features and the two conditions may respond to some of the same treatment strategies.”

So if sleep problems and depression are nothing to joke about, why are so many on social media doing just that?

Is depression napping really depression?

“Depression is a complex mental health issue, and while daytime sleeping can be a symptom, it hardly is, in and of itself, an indication of depression,” says Ellen Braaten, associate director of the Clay Center for Young Healthy Minds at Massachusetts General Hospital in Boston. Depression is marked by problems with mood and behavior that lead to a loss in functioning, she says. Behavioral symptoms, such as a loss of appetite or overeating, are common for people with depression, as are changes in sleeping habits. These changes may include sleeping too much or sleeping too little. They can also include early morning awakening, restless sleep and insomnia. “Thus, to say that one possible symptom of depression, such as frequent napping, is an indication of depression is misleading,” she says. “It is not a quasi-syndrome, nor is napping alone without other symptoms an indication of clinical depression.”

But depression napping is problematic, at least as a social media meme, says Rebecca Schwartz-Mette, assistant professor of psychology at the University of Maine. “In general, yes, I've heard of depression napping, but no, it's not a real thing in a psychological sense per se,” she says. It depends more on the person than the tweet. In some cases, excessive napping could be a symptom of depression, Schwartz-Mette says. “Alternately, it could be an avoidance-type behavior resulting from depression, like losing interest in things you usually enjoy, being tired, being down, withdrawing socially. Often times when we feel depressed, we may quite literally feel like pulling the covers over our head and shutting out the rest of the world for a while.”

On the other hand, taking depression napping at face value may not be the point. “The fact that this has taken a life of its own on social media is perhaps not surprising. It's sort of a tongue-in-cheek, ‘I'm shirking my responsibilities for a while,’ sort of thing that is likely to get a laugh or a like from friends who find it funny,” Schwartz-Mette says. Indeed, even if someone isn't depressed at all, just hiding out from the real world for few moments, or indulging in some other guilty pleasure, such as skipping out of work and seeing a matinee movie, “is part and parcel of our human experience,” she says. “It can be a fun, relatively harmless way of just unplugging for a second.”

When should you be concerned?

Taking a tiny vacation from the real world, be it with a nap, an ice cream sundae or not answering phone calls, can be rejuvenating from time to time. “It becomes problematic avoidance when it's habitual, which can begin to happen when someone takes these minibreaks over and over, feels better when they do, and then does it more and more to the point where they are not active participants in their own lives,” Schwartz-Mette says. “It's reinforcement in its purest sense.”

Should parents be concerned if they spot this on their child’s social media? “In a word, yes, for two reasons,” Braaten says. “First, if your child isn’t depressed, this is a good time to teach them that postings on social media have consequences. Even if it’s completely a joke, this is a teachable moment. Second, if it’s not a joke, this is a time to seek help. A child who speaks about his depression on social media is a child who is essentially asking for treatment.”

If napping and daytime sleepiness is excessive and is interfering with a person’s functioning, it should be evaluated by a medical doctor, as it could be a sign of a more serious medical problem, Braaten adds. If it is related to depression, treatment can include therapy and medication, she says, but the first step would be a thorough evaluation with a mental health professional such as a psychiatrist, psychologist or social worker. School personnel can also be helpful in determining how serious these behaviors may be, she says.

The goal of treatment, Schwartz-Mette says, is to help the individual “get that same positive reinforcement, positive feeling from being out there and having real, positive experiences in their actual, daily life.” It can be difficult to determine whether someone’s postings on social media are made in jest or are a sign of needing help, Braaten says. “So it’s always best to take these comments seriously and to ask more about whether the comments have a ring of truth – or more.”

By David Levine

1 September 2017 



Parents ought to share their challenging experiences

I admit it – I am a “Dear Abby” addict. After reading the often-difficult news every morning, I relax over my second cup of coffee with Abby’s advice. As most of you know, her readers ask questions about everything, ranging from etiquette to deep psychological problems, and I always find Abby’s advice down to earth. This morning, a reader wrote with a very difficult question. This mother had experienced sexual violence as a teenager: At a party where she admittedly had drunk too much, she was forced into unwanted sexual activity. As a result of this experience, she suffered serious psychological difficulties, including poor grades and eating disorders. Her two daughters are now teenagers and beginning to go to parties, and the mother asks Abby if she should share this very difficult story with her daughters to help them understand the dangers of teenage drinking.

As a college professor, this question also hit home because I am only too well aware of the issues surrounding drinking and sexual violence on college campuses. The statistics vary widely, but estimates are that 25 percent of college women experience unwanted sexual activity, and much of this occurs during the first semester of the freshman year during parties that include lots of alcohol and drugs. Freshman are obviously most vulnerable as they face increased freedom and autonomous decision making in the move from home to dorm. Parents send their children to college with great joy and great trepidation for exactly this reason. But how might parents help protect their children from experiencing the worst of unwanted experiences, sexual violence, heavy drinking and partying, sometimes spiraling down into enduring negative consequences?

Research from the Family Narratives Lab suggests that when parents share stories of their own teenage vulnerabilities and transgressions, it helps their adolescent and young adult children in multiple ways. Shared stories of positive experiences of achievement and pride are certainly important as models of effort and triumph, but stories of difficult, challenging experiences are also important as models of overcoming adversity and building reliance. And then there are stories of great vulnerability and horrible experiences. These are the stories that parents often struggle with whether to tell or not.

We asked adolescent and young adult students to tell us stories they know about their parents, both mothers and fathers, of times when they transgressed, when they did something wrong, or hurt someone, and/or felt guilty or regretful. Almost all of the students we asked could tell us these kinds of stories, so parents are telling them – and adolescents are listening and hearing. More important, adolescents who made links to themselves in these stories, who explicitly said they learned something about themselves, or that they learned a valuable lesson from the stories, had higher levels of self-esteem and a higher sense of autonomy, purpose and meaning in life. Most interesting, stories about parents played more of a role in building this kind of self-esteem than stories about the self. That is, adolescents and young adults are able to take stories about their parents as life lessons more so than their own experiences! This may not be all that surprising – after all, they are still processing their own experiences, whereas the stories their parents tell them are already formulated, and, of course, told by important role models.

So, should you tell your adolescent and young adult children about your own difficult, transgressive experiences? Yes, but carefully. Here are some guidelines to help you do this in ways that will help build your child’s resilience:

1. Be developmentally appropriate. Certain stories should not be told to young children. Wait until your child is facing similar developmental challenges. We have found that adolescents find the stories the parents tell them about the parents’ adolescent experiences to be the most valuable for the child; similarly, college students are most likely to tell stories they know about when their parents were in college.

2. Find the right time. Family stories are told often and mostly in casual everyday conversations. But stories about particularly difficult experiences may need a different kind of telling context, when there is enough quiet time to reflect on the experience.

3. Allow yourself to be vulnerable. In telling your child about difficult experiences the goal may not be to demonstrate how strong and brave you are – showing your vulnerabilities, your doubts, and your difficulties can allow space for your children to share their problems with you more openly and honestly.

4. Choose your stories carefully. When sharing our deepest vulnerabilities, it is important to put them in a larger life context. Choose to tell stories about events that you have been able to process and resolve. Try to focus on lessons learned, relationships strengthened. Hopefully something good came of working through this challenge. This is the kind of story that helps build resilience in children.

5. Stories may take time. Especially difficult stories. If your child cannot respond to the story when you first tell it, don't push it. Allow your child to process, come back to the story when appropriate and be open to allowing your child to revisit the story with you.

And remember, in sharing your vulnerabilities and difficult life stories with your adolescent and young adult children, you are also strengthening your relationship with them. As research by McLean and Morrison-Cohen has shown, sharing stories of vulnerability helps mothers and children to create a more nuanced and complex understanding of each other, one that will help build a healthy parent-adult child relationship. And, of course, do not forget to tell the good stories too! Building connections through telling of positive experiences with love and humor is always important.

By Robyn Fivush

26 August 2017


McLean, K. C., & Morrison-Cohen, S. (2013). Moms telling tales: maternal identity development in conversations with their adolescents about the personal past. Identity, 13(2)120-139.


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