Paula D. Zeanah

Intergenerational Transmission of Maltreatment: Insights from Attachment Theory and Research

The maltreated-maltreating cycle is the most striking example of the psychodynamic notion that early relationship experiences are carried forward and reenacted in subsequent relationships. Bowlbys attachment theory proposes that transmission of patterns of relating across generations, including maltreatment, is mediated by an individuals internal working models. Recent research that operationalizes working models in infants and in adults provides preliminary support for the congruence of working models across generations. Results from these investigations suggest that the maltreated-maltreating cycle should be redefined. Instead of specific types of maltreatment, an organizing theme of the parent-child relationship and an associated internal working model that provides a way of experiencing that theme are transmitted and later reenacted. In this paper, preliminary data implicating rejection, role-reversal and fear as themes organizing maltreating relationships are reviewed and directions for further research are discussed.

Nurse home visiting: Perspectives from nurses

Nurses working in the Nurse Family Partnership (NFP) program provide intensive home-visitation services for first-time, low-income mothers. The goals are to improve maternal health outcomes, child health and development outcomes, and to enhance maternal life-course development; however, many of the families face significant psychosocial and mental health issues that can impede progress achieving their goals. Because of the importance of the nurse-client relationship in achieving positive outcomes, these non-mental-health nurses must shift their approaches and techniques from a medical to a psychosocial model. In this article, we examine the role of the nurse in the NFP and present results of focus groups with experienced NFP nurses regarding their perspectives, challenges, and rewards in conducting this work.

The process and promise of mental health augmentation of nurse home-visiting programs: Data from the Louisiana Nurse–Family Partnership

The Nurse-Family Partnership (NFP) model is a well-studied and effective preventive intervention program targeting first-time, impoverished mothers and their families. Data documenting the negative impact of maternal depression and partner violence on the developing young child can be used to make a strong case for augmenting NFP programs to focus on mental health problems impacting the mother-child relationship. This article reviews the rationale for and process of augmenting an NFP program in Louisiana. Data on the prevalence of depression and partner violence in our sample are presented alongside a training protocol for nurses and mental health consultants designed to increase the focus on infant mental health. The use of a weekly case conference and telephone supervision of mental health consultants as well as reflections on the roles of the mental health consultant and the nurse supervisor are presented.

Prospective Analysis of the Transition to Sexual Experience and Changes in Sexual Self-Esteem among Adolescents Attending Therapeutic Schools.

Given increased sexual risk-taking among youth with mental health problems, this study sought to understand the developmental trajectory of sexual self-esteem (SSE) among this vulnerable population and how it is impacted by sexual experiences. Participants were 185 adolescents who attended therapeutic/alternative schools in southern New England. Changes in five domains of SSE identified by Zeanah and Schwarz (1996) were examined across adolescents who either: 1) were sexually active at baseline, 2) transitioned to activity during the study, and 3) remained inexperienced at follow-up. In support of the hypothesis that changes in SSE precede onset of experience, youth who transitioned reported higher baseline scores in the Skills domain than those who remained inexperienced. SSE was subsequently impacted by sexual activity, with differences in several domains found at baseline and follow-up across level of experience. Changes in SSE following sexual experience depended, in part, on the percentage of casual partners teens reported.

Infant Mental Health and the “Real World”- Opportunities for Interface and Impact

A growing literature highlights established and developing approaches to infant mental health assessment and treatment. Like other evidence-based and theory-based interventions, real world application of these approaches requires an understanding of the theoretical and empirical foundations of infant mental health as well as consideration of cultural, systemic, and logistical factors. In this article, the authors present models of universal and targeted interventions in infant mental health, with attention to the adaptations used to apply evidence-based practice in real world settings.

Mental Health, Infant

Infant mental health is considered synonymous with healthy social and emotional development. Important indicators of infant mental health include the young child’s capacity for emotion regulation, ability to communicate feelings to caregivers, and active exploration of the environment. These behaviors lay the groundwork for later social and emotional competence, readiness to enter school, and better academic and social performance. Assessment of infants’ mental health should involve characteristics of the infant’s caregiving relationships in the social and cultural contexts which are relevant. Treatment may be directed toward established problems or intervention efforts may be directed more broadly to prevent adverse outcomes.

Growth Parameters Help Predict Neurologic Competence in Profoundly Deprived, Institutionalized Children in Romania

Growth Parameters Help Predict Neurologic Competence in Profoundly Deprived, Institutionalized Children in Romania