Minimal Risk in Pediatric Research: A Philosophical Review and Reconsideration

Despite more than thirty years of debate, disagreement persists among research ethicists about the most appropriate way to interpret the U.S. regulations on pediatric research, specifically the categories of “minimal risk” and a “minor increase over minimal risk.” Focusing primarily on the definition of “minimal risk,” we argue in this article that the continued debate about the pediatric risk categories is at least partly because their conceptual status is seldom considered directly. Once this is done, it becomes clear that the most popular strategy for interpreting “minimal risk”—defining it as a specific set of risks—is indefensible and, from a pragmatic perspective, unlikely to resolve disagreement. Primarily this is because judgments about minimal risk are both normative and heavily intuitive in nature and thus cannot easily be captured by reductions to a given set of risks. We suggest instead that a more defensible approach to evaluating risk should incorporate room for reflection and deliberation. This dispositional, deliberative framework can nonetheless accommodate a number of intellectual resources for reducing reliance on sheer intuition and improving the quality of risk evaluations.     

Both Whistleblowers and the Scientists They Accuse Are Vulnerable and Deserve Protection

Whistleblowers play an important role diagnosing research misconduct, but often experience severe negative consequences. That is also true for incorrectly accused scientists. Both categories are vulnerable and deserve protection. Whistleblowers must proceed carefully and cautiously. Anonymous whistleblowing should be discouraged but cannot be ignored when the allegations are specific, serious, and plausible. When accused of a breach of research integrity it is important to be as transparent as possible. Sometimes accusations are false in the sense that the accuser knows or should know that the allegations are untrue. A mala fide whistleblower typically does not act carefully and we postulate a typology that may help in detecting them. Striking the right balance between whistleblower protection and timely unmasking false and identifying incorrect accusations is a tough dilemma leaders of research institutions have to face.     

Contact between birth parents and children in kinship care in a sample from Spain

Within the context of kinship care, the main objectives of this work are to study the characteristics of contact between foster children and their birth parents, and their relationship with key variables of fostering, the children and their kinship caregivers. The sample included 189 children from Spain and their kinship families. A semi‐structured placement interview and two scales relating to the child–caregiver relationship and child's psychological adjustment were used with the kinship families. The results revealed a significant percentage of foster children who had no family contact. Various visit types, frequencies and durations were described. Kinship care with contact, compared with placements without contact, was frequently characterized by the absence of professional supervision, and an affectionate child–caregiver relationship; moreover, children with contact were perceived to have fewer serious behaviour and socio‐emotional problems and a greater probability of family reunification. The regression analysis showed that the main predictors for how caregivers assessed contact were the children's emotional reaction during visits and the quality of the relationship between the kinship families and the birth parents. These results suggest the need for further research about contact, which will certainly have a major impact on professional intervention with these families.     

Parents at‐risk and their children: intersections of gender role attitudes and parenting practices

Existing research demonstrates that parent and child gender may influence important aspects of family relationships; however, most research in this area has been conducted with non‐clinical samples. As clinicians, it is important to consider how gender impacts family relationships, particularly among vulnerable families. This study examined the intersections of gender role attitudes and parenting practices among 34 parents involved with the child welfare system and referred for clinical intervention. Using a mixed methods design, themes regarding gender role beliefs and parenting practices were found through qualitative interviews with parents. Findings suggested that fathers felt responsible for financially providing for their families and expressed challenges in communicating with mothers, and mothers described challenges they face because of a lack of father involvement. Parents also discussed a perceived need to monitor daughters closely while fostering the independence of their sons. Results of the qualitative analyses were supported by quantitative findings indicating significant differences in harsh and inconsistent discipline practices and clear expectations for girls compared to boys. The discussion addresses implications for clinicians, including how a feminist family therapy perspective may help promote client influence over traditional gender norms by questioning gender role attitudes and exploring alternate narratives that may impact family dynamics.     

“It's like he just goes off,BOOM!”: mothers and grandmothers make sense of child‐to‐parent violence

Child to parent violence (CPV) involves continual and cumulative abusive actions perpetrated by children and adolescents towards their parents or caregivers. This abuse produces short‐term distress and ongoing long‐term harmful consequences for parents and their families. Practitioners, researchers and policy‐makers are increasingly challenged to identify, conceptualize and respond to this form of family violence. A major challenge is that parents and caregivers under‐report this abuse so there is a lack of awareness and understanding of their psychological experiences in relation to CPV. This research adopts an interpretative phenomenological approach to explore the psychological experience of CPV. Interviews were conducted with six New Zealand mothers and two grandmothers who all experienced CPV. This abuse was experienced as an ‘emotional bloody roller coaster’ of unconditional love through to hatred; as ‘judgement’ – self‐blame and others' blame of their parenting skills; and the ‘absent father’ in their adolescents' lives was drawn on as an explanation for the abuse. Taken together, these psychological experiences identify the silencing of CPV is related to parents' conflicting emotions towards their children, their thoughts and feelings about themselves and how other people view them, and the impact of an absent father figure in their children's everyday lives.     

‘I want to be better than you:’ lived experiences of intergenerational child maltreatment prevention among teenage mothers in and beyond foster care

The growing body of research on teenage motherhood in foster care has largely focused on the risks involved for both mother and child, yet these mothers depict a much more complex picture of their own experience of becoming and being mothers. The current study employed interpretative phenomenological analysis to explore 18 in‐depth, qualitative interviews from six participants on the meaning and experience of motherhood among teenage mothers in foster care and in the years immediately after ageing out. This study focused on a particular dimension of motherhood: participants' efforts to break the cycle of child abuse and neglect with their own children. Two themes emerged as characteristic of these experiences: (i) treating children well/parenting differently and avoiding the system; and (ii) reducing isolation and enhancing support. Given the increased likelihood of the children of teen mothers – particularly those who have been maltreated – becoming involved with the child welfare system, study findings suggest possible strategies for disrupting cycles of intergenerational child welfare involvement generated by young mothers themselves. Practice implications for addressing possible substance abuse, mental health and relational and parenting needs are discussed.     

The Network Survival Method for Estimating Adult Mortality: Evidence From a Survey Experiment in Rwanda

Adult death rates are a critical indicator of population health and well-being. Wealthy countries have high-quality vital registration systems, but poor countries lack this infrastructure and must rely on estimates that are often problematic. In this article, we introduce the network survival method, a new approach for estimating adult death rates. We derive the precise conditions under which it produces consistent and unbiased estimates. Further, we develop an analytical framework for sensitivity analysis. To assess the performance of the network survival method in a realistic setting, we conducted a nationally representative survey experiment in Rwanda (n = 4,669). Network survival estimates were similar to estimates from other methods, even though the network survival estimates were made with substantially smaller samples and are based entirely on data from Rwanda, with no need for model life tables or pooling of data from other countries. Our analytic results demonstrate that the network survival method has attractive properties, and our empirical results show that this method can be used in countries where reliable estimates of adult death rates are sorely needed.     

“I Had to Go to the Streets to Get Love”: Pathways From Parental Rejection to HIV Risk Among Young Gay and Bisexual Men

Young, gay, and bisexual men (YGBM) are at increased risk of family rejection, which is related to HIV infection. What remains unknown is how family rejection leads to HIV risk. In this exploratory study, qualitative interviews were conducted with 21 HIV-positive YGBM aged 18 to 24. Most participants reported family rejection, which decreased instrumental and emotional support and resulted in participants using riskier ways to support themselves, such as engaging in survival sex. Conceptualizing the findings using a family systems framework, we present a tentative conceptual model to describe the potential relationships between family rejection and HIV risk for YGBM.     

Negative Religious Rhetoric in the Lives of Black Cisgender Queer Emerging Adult Men: A Qualitative Analysis

Given the intersection of racial, religious, and sexual identities for Black queer populations, the current study examines sexuality-related religious rhetoric. Twenty Black cisgender queer men were recruited to participate in a qualitative interview. Using thematic analysis, the research team identified four themes: negative religious rhetoric, personal consequences of negative religious rhetoric, social consequences of negative religious rhetoric, and growth from negative religious rhetoric. Participants explained the pervasiveness of negative religious rhetoric within their churches and family structures. Men also conveyed how negative religious rhetoric frames societal ideologies around same-sex behavior, often condoning violence toward queer populations. Although men had negative experiences, participants articulated the importance of using oppression as a platform for growth. Black cisgender queer men are present within religious institutions; however, such negative religious rhetoric may negatively affect their mental and physical health. Researchers, clinicians, and clergy should consider the ways negative religious rhetoric marginalizes queer populations.