Caroline C. Piotrowski

Healthy Steps: a systematic review of a preventive practice-based model of pediatric care.

The preventive role of anticipatory guidance in pediatric practice has gained increasing importance over the last two decades, resulting in the development of competing models of practice-based care. Our goal was to systematically evaluate and summarize the literature pertaining to the Healthy Steps Program for Young Children, a widely cited and utilized preventive model of care and anticipatory guidance, Medline and the bibliographies of review articles for relevant studies were searched using the keywords: Healthy Steps, preventive care, pediatric practice and others. Other sources included references of retrieved publications, review articles, and books; government documents; and Internet sources. Relevant sources were selected on the basis of their empirical evaluation of some component of care (e.g., child outcomes, parent outcomes, quality of care). From 21 identified articles, 13 met the inclusion criteria of empirical evaluation. These evaluations were summarized and compared. Results indicated that the Healthy Steps program has been rigorously evaluated and shown to be effective in preventing negative child and parent outcomes and enhancing positive outcomes. Despite limited information concerning cost effectiveness, the Healthy Steps Program provides clear benefit through early screening, family-centered care, and evidence-based anticipatory guidance. It is recommended that the Healthy Steps program be more widely disseminated to relevant stakeholders, and further enhanced by improved linguistic and cultural sensitivity and long term evaluation of cost effectiveness.

Patterns of adjustment among siblings exposed to intimate partner violence.

This research explored and compared patterns of adjustment in siblings exposed to intimate partner violence. The quality of family relationships were investigated as potential mechanisms that accounted for heterogeneity in these patterns. Participants included 47 sibling pairs and their mothers recruited from the community. Mothers and children reported on child adjustment measures and the quality of family relationships. Five cluster patterns were identified for both younger and older siblings, replicating three identified in previous research: primarily internalizing symptoms, a combination of internalizing and externalizing symptoms, and an asymptomatic cluster. There was little overlap in cluster membership within families; most siblings differed in terms of their pattern of adjustment. The quality of family relationships varied significantly across clusters. Overall, asymptomatic siblings reported the most positive family relationships. Maternal warmth differed across clusters for both older and younger siblings, while maternal hostility varied across clusters for older but not younger siblings. The quality of sibling relationships also differed across clusters for older but not younger siblings. These findings underscore the importance of examining differential sibling experiences within violent families, and demonstrate the significance of family relationships as a mediating mechanism influencing heterogeneous child adjustment.

Siblings exposed to intimate partner violence: linking sibling relationship quality & child adjustment problems.

Although the majority of families that experience intimate partner violence (IPV) have more than one child, most research to date has focused upon a single child within these families. A significant body of research has indicated siblings play an important role in childrens adjustment and well-being. To address this gap, the three main goals of the present study were to compare the adjustment of older and younger siblings exposed to IPV, to describe and compare the quality of these sibling relationships from multiple perspectives, and to investigate how sibling adjustment and relationship quality influence childrens adjustment. Forty-seven sibling pairs and their mothers were recruited from the community. Mothers self-reported on their violent experiences using the Conflict Tactics Scale, and also estimated the length of time their children were exposed to IPV. Mothers and children completed assessments of child adjustment and the quality of sibling relationships. Observers also assessed the quality of sibling interaction. Results indicated that adjustment between siblings was highly inter-related. On average, mothers reported sibling relationships as less positive but also as less hostile than did siblings themselves. Higher levels of sibling hostility, lower levels of sibling warmth and higher levels of disengagement each significantly predicted child adjustment; however, these effects were predicated upon the adjustment of the other sibling. The sibling relationships of children exposed to IPV made a difference in their individual adjustment, and their adjustment issues influenced how they feel about and interacted with their sibling. Sibling hostility played a stronger role in adjustment issues than sibling warmth. The nature of sibling influences and the direction of future research were discussed.

Modeling improvements in booster seat use: a discrete choice conjoint experiment.

Automobile crashes are the leading cause of death in children aged 1-14 years. Many children, however, are not properly restrained in safety seats that reduce serious injury and death. This study used a discrete choice conjoint experiment to study factors influencing the decision to use booster seats. Parents of 1714 children aged 4-9 years from nine Canadian provinces completed choice tasks presenting experimentally varied combinations of 15 4-level booster seat promotion attributes. Latent class analysis yielded three segments of parents. The choices of the Benefit Sensitive segment (50%) were most sensitive to the injury prevention benefits of booster seats. The choices of parents in the Context Sensitive segment (33.5%) were more likely to be influenced by installation complexity, oppositional behavior, and the prospect that their child may be teased for riding in booster seats. Parents in the High Risk segment (16.5%) were younger, less educated, and less knowledgeable about vehicle safety legislation. They anticipated fewer benefits, expected more barriers and were less likely to use booster seats. Simulations suggest that consistent enforcement coupled with advertising focusing on injury prevention and the use of booster seats by other parents would increase adoption.

Rules of Everyday Family Life: The Development of Social Rules in Mother-Child and Sibling Relationships

The aims of this study were: (1) to characterise changes in the frequency and kind of social rules used in mother-child and sibling relationships over a 14-month period; (2) to assess the degree to which conflict functioned as a forum for social rules; and (3) to describe the nature of the association between references to social rules and the quality of family relationships. Naturalistic home observations of 47 families were conducted when focal younger siblings were 33 and 47 months of age. Family conversations were coded for a variety of rules. Over time, mothers referred to rules less frequently per hour, whereas elder siblings referred to rules more frequently per hour. Proportionately, mothers employed rules relatively more often than children; however, conventional rules were utilised by mothers more than moral rules. As hypothesised, moral rules were more symmetrical in sibling relationships and more complementary in mother-child dyads. Mothers mentioned social rules more often during conflicts, whereas siblings did not. Finally, moral rules mentioned by both younger and elder siblings were associated with less harmonious sibling relationships. Results were discussed with regard to theories of moral socialisation and the nature of family relationships.

Children exposed to intimate partner violence: influences of parenting, family distress, and siblings.

The aim of this study was to investigate associations between maternal stress, parenting behavior, and sibling adjustment in relation to child trauma symptoms in families with and without a history of intimate partner violence (IPV). Maternal report was used to measure maternal stress and child trauma symptoms, whereas parenting behavior was assessed through an observational measure. Participants consisted of mothers with 2 school-age siblings recruited from the community. Results indicated that violent families reported higher levels of maternal stress and sibling trauma symptoms than nonviolent families, although no differences were found in parenting behavior. Sibling trauma symptoms and negative maternal behavior toward a sibling were strong predictors of trauma symptoms in younger siblings exposed to IPV but only modest predictors for older siblings. Moderator analyses showed that in IPV-affected families, the trauma symptoms of older siblings were related to the trauma symptoms of younger siblings when maternal stress was high.

My Brother's Teacher? Siblings and Literacy Development in the Home

Frequency of sibling literacy interactions were examined in 134 families with at least two children, where at least one of the children attended school in grade one to grade four. Parents in the majority of families reported that their children read together on a regular basis without a parent present. This held across various demographic constellations including gender of the older child. However, children from families with three or more children were less likely to read with their siblings. Implications for parents and teachers are discussed.

Aggression by Children Exposed to IPV: Exploring the Role of Child Depressive Symptoms, Trauma-Related Symptoms, & Warmth in Family Relationships

Multi-informant reports of aggression by siblings in families with and without a history of IPV were compared. Associations between aggressive behavior and child depressive and trauma-related symptoms, as well as maternal and sibling warmth were also explored. Mothers, observers and the siblings themselves reported on aggressive behaviour. Mothers reported on child trauma-related symptoms while children provided self-report on depressive symptoms and mother–child and sibling warmth. The frequency of observed aggression did not differ across groups on average, although more sibling dyads exposed to IPV engaged in aggression than those not exposed. Child reports of sibling aggression did not differ across groups but mothers reported significantly less aggressive behavior by children exposed to IPV than those not exposed. Regression results indicated that depressive and trauma-related symptoms were significant risk factors for aggression, while the role of mother–child and sibling warmth was more complex. Results were discussed within a developmental psychopathology framework.

Child Sexual Abuse and Adult Religious Life: Challenges of Theory and Method

The religious consequences of child sexual abuse in adulthood remain relatively unexamined in the research literature, especially where abusers are not clergy. Some studies suggest child sexual abuse survivors may rely on religion as a source of support, though the majority document a decrease in religiosity. Given the propensity for psychological challenges among adult survivors with diminished spiritual coping, we are calling for increased research attention to religion in the context of child sexual abuse. The objectives of this article were to review the literature on intersections between child sexual abuse (perpetrated by nonclergy) and religiosity in adults and set forth relevant research approaches for future investigation. Findings revealed a comprehensive, multidisciplinary, and theoretically informed approach to research may be needed.

Understanding the Elevated Prevalence of Intimate Partner Violence in Interracial Relationships

Research from the United States and Canada suggest that interracial relationships tend to have an elevated prevalence of intimate partner violence (IPV). Among seven extant studies, only one empirically examined speculations in the literature for this relationship. Based on analyses of data from Statistics Canadas 2009 General Social Survey (GSS), Brownridge was not able to fully account for the elevated odds of IPV in interracial relationships. The current study used data on 16,706 Canadians (731 in interracial relationships and 15,975 in noninterracial relationships) from the 2014 iteration of Statistics Canadas GSS to determine whether the risk of IPV in interracial relationships had changed since 2009 and to explore risk factors that may account for the elevated odds of IPV in interracial relationships. Results showed that individuals in interracial relationships faced elevated odds of IPV victimization relative to monoracial relationships in the 5-year reporting period prior to the study (odds ratio [OR] = 2.37; 95% confidence interval [CI] = [1.40, 4.02]; p < .001). This was similar to what Brownridge found in the 2009 GSS data, indicating that the elevated risk of IPV in interracial relationships had remained stable in Canada over a 10-year reporting period. Risk factors from three levels of an ecological model were explored, and logistic multiple regression analyses showed that characteristics of the partner (young age, drug use, and jealous behavior) fully accounted for the significantly elevated odds of IPV victimization in interracial unions. Although the leading speculation for this relationship implicates stressors that are unique to these relationships, the current study suggested that this phenomenon is mostly due to characteristics of individuals with whom those in interracial relationships are more likely to be coupled.