Tiffani S. Kisler

Teaching Accountability: Using Client Feedback to Train Effective Family Therapists

The AAMFT Task Force on Core Competencies (Nelson et al., 2007) proposed that marriage and family therapy (MFT) educators teach and provide evidence of trainee competence beyond coursework and accrued clinical hours. This article describes the integration of a systematic client feedback protocol into an MFT-accredited programs curricula to address the call for outcome-based learning. Outcome management (OM) provides a framework for teaching and assessing trainee effectiveness. Continuous incorporation of client feedback embodies collaborative, strengths-based, integrative, and diversity-centered program values. Students learn a system for being accountable to clients, the profession, and service communities.

Associations between family food behaviors, maternal depression, and child weight among low-income children☆

Although low-income children are at greater risk for overweight and obesity than their higher income counterparts, the majority of poor children are not overweight. The current study examined why such variation exists among diverse young children in poor families. Cross-sectional data were collected on 164 low-income, preschool aged children and their mothers living in two Rhode Island cities. Over half of the sample was Hispanic (55%). Mothers completed measures of family food behaviors and depression while trained assistants collected anthropometric data from children at seven day care centers and a Supplemental Nutrition Assistance Program outreach project. Multivariate analysis of covariance revealed that higher maternal depression scores were associated with lower scores on maternal presence when child eats (P < .05), maternal control of childs eating routines (P < .03), and food resource management skills (P < .01), and with higher scores on child control of snacking (P < .03) and negative mealtime practices (P < .05). Multiple regression results revealed that greater maternal presence whenever the child ate was significantly associated with lower child BMI z scores (β = .166, P < .05). Logistic regression analyses indicated that higher scores on food resource management skills reduced the odds of child overweight (odds ratios = .72-.95, P < .01). Maternal depression did not modify the relationship between family food behaviors and child weight. Overall, caregiver presence whenever a child eats, not just at meals, and better parental food resource management skills may promote healthier weights in low-income preschoolers. Further research is needed to identify the mechanisms that connect caregiver presence and food resource management skills to healthier weights for this age group.

Food- and Health-Related Correlates of Self-Reported Body Mass Index Among Low-Income Mothers of Young Children

OBJECTIVE To examine how income-related challenges regarding food and health are associated with variation in self-reported maternal body weight among low-income mothers. DESIGN Cross-sectional design. SETTING Two Northeastern cities. Seven day care centers and a Supplemental Nutrition Assistance Program outreach project. PARTICIPANTS Sample of 166 mothers; 67% were overweight or obese, 55% were Hispanic, and 42% reported household food insecurity (HFI). MAIN OUTCOME MEASURES Maternal self-reported height and weight to calculate body mass index (BMI). Independent variables were food program participation, supermarket use, 8-item food shopping practices scale, HFI, maternal depressive symptoms, and self-rated health. ANALYSIS Hierarchical multiple regression analysis tested relationships between maternal BMI with the independent variables of interest, adjusting for demographic confounds. RESULTS Shopping practices to stretch food dollars (P = .04), using community food assistance programs (P < .05), and HFI (P < .04) correlated with heavier maternal BMIs; higher self-rated health corresponded to lower BMIs (P = .004). CONCLUSIONS AND IMPLICATIONS Some strategies low-income mothers use to manage food resources are associated with heavier BMIs. Nutrition educators, public health practitioners, and researchers need to collaboratively address the associations between these strategies, food insecurity, poor health, and unhealthy weight.

College Women's Experiences of Intimate Partner Violence: Exploring Mental Health Issues.

College women’s experiences with sexual and physical violence are so common that campus interventions are needed. To help guide these, we surveyed 339 college women and asked: (a) are college women’s experiences with different types of relational violence interrelated; and (b) are there patterns of association between types of violence and mental health symptoms? Analyses showed that experiences with verbal aggression, and minor and major physical violence overlapped. Experiences of sexual assault and minor physical violence also co-occurred. Moreover, women who encountered verbal and physical, but not sexual violence, suffered from symptoms of hostility, anxiety, and depression; those who encountered sexual coercion displayed signs of depression. We explore the implications of these findings for those who work with college women.

A Pilot Examination of Self-Esteem, Depression, and Sleep in College Women.

While sleep deficits in adulthood are common and worsening, college women experience significantly more sleep problems and depression than their male counterparts. In recent years, sleep has been investigated as one of the primary contributors to college functioning and GPA. No known study, however, has investigated the connection between self-esteem, depression and sleep. Questionnaire assessments were given to 43 female college juniors and seniors, including: demographic information, Rosenberg Self-esteem Scale, Beck Depression Inventory, and Pittsburg Quality Sleep Index. This pilot study investigates the relationship between college self-esteem and sleep quality, as mediated by depression. The results of the study indicate that self-esteem predicts both depression and sleep quality, such that decreased levels of self-esteem are associated with higher levels of depression and decreased sleep quality. Moreover, depression also predicts sleep quality and serves to mediate the relation between self-esteem and sleep quality. The results suggest that students’ self-esteem plays a significant role in the experience of depression, and that depression is the primary mechanism through which self-esteem influences sleep.

Maternal Strategies to Access Food Differ by Food Security Status

BACKGROUND Household food insecurity is associated with health and behavior risk. Much less is known about how food insecurity is related to strategies that adults use in accessing food: how and where they shop, use of alternative food sources, and their ability to manage resources. OBJECTIVE To examine how maternal behaviors, including shopping, accessing alternative sources of food, and managing resources, are related to household food security status (HHFSS). DESIGN Cross-sectional study collecting survey data on HHFSS, shopping behaviors, use of alternative food sources, and managing resources obtained from low-income mothers of preschool-aged children. PARTICIPANTS One hundred sixty-four low-income mothers of young children (55% Hispanic) from two communities in Rhode Island. MEASURES HHFSS was measured using 10 items from the 18-item Core Food Security Module to assess adult food security. Mothers were surveyed about where, when, and how often they shopped; the strategies they use when shopping; their use of alternative sources of food, including federal, state, and local assistance; and their ability to manage their resources. STATISTICAL ANALYSIS Analysis of variance and χ2 analyses assessed the associations between demographic variables, shopping, accessing alternative food sources, and managing resources, and HHFSS. Multivariate logistic regression assessed the associations between HHFSS and maternal demographic variables, food shopping, strategies, alternative sources of food, and ability to manage resources. RESULTS Maternal age and language spoken at home were significantly associated with HHFSS; food insecurity was 10% more likely among older mothers (adjusted odds ratio [aOR] 1.10, 95% CI 1.03 to 1.17) and 2.5 times more likely among Spanish-speaking households (compared with non-Spanish speaking [aOR 3.57, 95% CI 1.25 to 10.18]). Food insecurity was more likely among mothers reporting more informal strategies (aOR 1.98, 95% CI 1.28 to 3.01; P<0.05) and perceiving greater inability to manage resources (aOR 1.60, 95% CI 1.30 to 1.98; P<0.05). CONCLUSIONS The results suggest that low-income mothers use a variety of strategies to feed their families and that the strategies they use vary by HHFSS. Community nutrition programs and providers will need to consider these strategies when counseling families at risk for food insecurity and provide guidance to minimize the influence on healthy food choices.