Leandra Godoy

A Randomized Controlled Trial of Child FIRST: A Comprehensive Home-Based Intervention Translating Research Into Early Childhood Practice

This randomized, controlled trial was designed to document the effectiveness of Child FIRST (Child and Family Interagency, Resource, Support, and Training), a home-based, psychotherapeutic, parent-child intervention embedded in a system of care. Multirisk urban mothers and children, ages 6-36 months (N = 157) participated. At the 12-month follow-up, Child FIRST children had improved language (odds ratio [OR] = 4.4) and externalizing symptoms (OR= 4.7) compared to Usual Care children. Child FIRST mothers had less parenting stress at the 6-month follow-up (OR = 3.0), lower psychopathology symptoms at 12-month follow-up (OR = 4.0), and less protective service involvement at 3 years postbaseline (OR = 2.1) relative to Usual Care mothers. Intervention families accessed 91% of wanted services relative to 33% among Usual Care. Thus, Child FIRST is effective with multirisk families raising young children across multiple child and parent outcomes.

Patterns of anxiety symptoms in toddlers and preschool-age children: evidence of early differentiation.

The degree to which young childrens anxiety symptoms differentiate according to diagnostic groupings is under-studied, especially in children below the age of 4 years. Theoretical (confirmatory factor analysis, CFA) and statistical (exploratory factor analysis, EFA) analytical methods were employed to test the hypothesis that anxiety symptoms among 2-3-year-old children from a non-clinical, representative sample would differentiate in a manner consistent with current diagnostic nosology. Anxiety symptom items were selected from two norm-referenced parent-report scales of child behavior. CFA and EFA results suggested that anxiety symptoms aggregate in a manner consistent with generalized anxiety, obsessive-compulsive symptoms, separation anxiety, and social phobia. Multi-dimensional models achieved good model fit and fit the data significantly better than undifferentiated models. Results from EFA and CFA methods were predominantly consistent and supported the grouping of early childhood anxiety symptoms into differentiated, diagnostic-specific categories.

Internalizing Trajectories in Young Boys and Girls: The Whole Is Not a Simple Sum of Its Parts.

There is support for a differentiated model of early internalizing emotions and behaviors, yet researchers have not examined the course of multiple components of an internalizing domain across early childhood. In this paper we present growth models for the Internalizing domain of the Infant-Toddler Social and Emotional Assessment and its component scales (General Anxiety, Separation Distress, Depression/Withdrawal, and Inhibition to Novelty) in a sample of 510 one- to three-year-old children. For all children, Internalizing domain scores decreased over the study, although girls had significantly higher initial levels and boys had steeper declines. General Anxiety increased over the study period and, when modeled individually, girls evidenced higher initial levels and greater increases. For all children, Separation Distress and Inhibition to Novelty decreased significantly over time, while Depression/Withdrawal remained low without change. Findings from our parallel process model, in which all components were modeled simultaneously, revealed that initial levels of internalizing scales were closely associated while rates of change were less closely related. Sex differences in variability around initial levels and rates of change emerged on some scales. Findings suggest that, for one- to three-year-olds, examining scales of the internalizing domain separately rather than as a unitary construct reveals more meaningful developmental and gender variation.

Mental health screening and consultation in primary care: The role of child age and parental concerns [corrected].

OBJECTIVE To determine (1) how child age relates to parent concerns about child behavior and (2) how child age and parent concerns correlate with provider referrals and family attendance at mental health consultant (MHC) appointments. METHODS Data were obtained from Rhode Islands Project, Linking Actions for Unmet Needs in Childrens Health, in which universal developmental and behavioral screening and MHCs were embedded within primary care sites serving low-income diverse families. Children 9 months to 8 years of age were eligible for the study if they had a scheduled screening well-child visit in 2010 (N = 1451). Families completing screening and/or those referred for a MHC appointment were included in analyses (n = 700). Outcome measures included parent-reported concerns about child behavior, referral status following screening, and family attendance at the MHC appointment. RESULTS For every 1-month increase in child age, there was a 1.02 times increase in the likelihood of parent behavioral concern and a 1.04 times increase in the likelihood of mental health referral, even when controlling for child behavior. MHC-referred children older than 5 years were 2.61 times more likely to attend than children less than 5 years. When examining parent behavioral concerns and child age jointly, only concerns remained significant. CONCLUSIONS Infants and toddlers, who have the highest rates of unmet mental health needs, may be least likely to benefit from universal screening and on-site MHC support. Efforts to incorporate behaviorally based screening tools and increase parent concerns where appropriate appear warranted, particularly for families with very young children.Objective: To determine (1) how child age relates to parent concerns about child behavior and (2) how child age and parent concerns correlate with provider referrals and family attendance at mental health consultant (MHC) appointments. Methods: Data were obtained from Rhode Islands Project, Linking Actions for Unmet Needs in Childrens Health, in which universal developmental and behavioral screening and MHCs were embedded within primary care sites serving low-income diverse families. Children 9 months to 8 years of age were eligible for the study if they had a scheduled screening well-child visit in 2010 (N = 1451). Families completing screening and/or those referred for a MHC appointment were included in analyses (n = 700). Outcome measures included parent-reported concerns about child behavior, referral status following screening, and family attendance at the MHC appointment. Results: For every 1-month increase in child age, there was a 1.02 times increase in the likelihood of parent behavioral concern and a 1.04 times increase in the likelihood of mental health referral, even when controlling for child behavior. MHC-referred children older than 5 years were 2.61 times more likely to attend than children less than 5 years. When examining parent behavioral concerns and child age jointly, only concerns remained significant. Conclusions: Infants and toddlers, who have the highest rates of unmet mental health needs, may be least likely to benefit from universal screening and on-site MHC support. Efforts to incorporate behaviorally based screening tools and increase parent concerns where appropriate appear warranted, particularly for families with very young children.

Integrating early childhood screening in pediatrics: A longitudinal qualitative study of barriers and facilitators.

Pediatric settings are increasingly called upon to implement early childhood developmental and behavioral health screening as an early identification and health promotion strategy. Understanding the dynamic barriers and facilitators of implementation at various stages will help implementers plan for and address these factors in support of high quality implementation. Our research supported this goal by analyzing longitudinal, qualitative data. There were 128 semistructured interviews conducted with pediatric clinic and implementation providers across four years. Interviews were transcribed, coded, and synthesized using rigorous qualitative methods. Results were produced using an iterative process to summarize, analyze, and consolidate themes about screening implementation over time. Barriers and facilitators of implementation included characteristics of screening implementation as well as contextual characteristics of the pediatric primary care setting. Some implementation themes were stable over time whereas others demonstrated shifts. Results are discussed in terms of lessons learned for successfully integrating this critical preventive practice within pediatric clinics.