The development of a reliable change index and cutoff score for the SCORE-15

The Systemic Clinical Outcome and Routine Evaluation version 15 (SCORE-15) is a measure used to assess family-level change in family therapy. The SCORE-15 has been demonstrated to be a reliable and valid measure, with high clinical utility; however, the SCORE-15 lacks the ability to determine whether the change in family functioning during the course of therapy is clinically significant. This study aimed to establish a reliable change index (RCI) and clinical cutoff score so that researchers and clinicians can determine clinically significant change in family therapy. US samples of 71 clinical participants and 244 community participants completed the SCORE-15. Results indicated a cutoff score of 40.37 and an RCI of 9.52. Consequently, family members who improve their SCORE-15 score during the course of therapy by at least 9 points and who cross the threshold of 40 during the course of therapy are considered to have experienced clinically significant change.     

Maternal substance abuse and disrupted parenting: Distinguishing mothers who keep their children from those who do not

Women with substance abuse disorders typically have psychosocial characteristics that put them at risk for disrupted parenting. Prior research indicates that comprehensive, accessible services tailored to the mothers' needs can contribute to family stability. This study further explores the complicated interplay of how maternal risk and protective characteristics and service elements are associated with reunification. The study contributes to existing literature by following mothers for three years; examining service needs as identified by the mother herself; using a summary proportion score to reflect the totality of services received to matched service needs identified; and using logistic regression to examine interactions of services received with critical maternal characteristics. The sample is comprised of 458 substance-abusing mothers enrolled during pregnancy or postpartum in the Washington State Parent-Child Assistance Program (PCAP), an evidence-based case management intervention. Participants' custody status was well distributed among four categories based on continuity of parenting. Findings indicate that at program exit 60% of the mothers were caring for their index child. These mothers had more treatment and mental health service needs met, had more time abstinent from alcohol and drugs, secure housing, higher income, and support for staying clean and sober. Among women with multiple psychiatric diagnoses, the odds of regaining custody were increased when they completed substance abuse treatment and also had a supportive partner. Mothers who lost and did not regain custody had more serious psychiatric problems and had fewer service needs met. We discuss implications of our findings for child welfare policy and practices.     

Parenting Mediates the Effects of Income and Cumulative Risk on the Development of Effortful Control

This study tested the hypothesis that the effects of income and cumulative risk on the development of effortful control during preschool would be mediated by parenting. The study utilized a community sample of 306 children (36–40 months) representing the full range of family income, with 29 percent at or near poverty and 28 percent lower income. Two dimensions of effortful control (executive control and delay ability) were assessed at four time points, each separated by nine months, and growth trajectories were examined. Maternal warmth, negativity, limit setting, scaffolding, and responsiveness were observed. Above the effects of child cognitive ability, income, and cumulative risk, scaffolding predicted higher initial levels of executive control that remained higher across the study, and limit setting predicted greater gains in executive control. Parenting did not predict changes in delay ability. Significant indirect effects indicated that scaffolding mediated the effects of income and cumulative risk on growth in executive control. The findings suggest that parenting behaviors can promote effortful control in young children and could be targets of prevention programs in low‐income families.     

Oral Poliovirus Vaccine Evolution and Insights Relevant to Modeling the Risks of Circulating Vaccine‐Derived Polioviruses (cVDPVs)

The live, attenuated oral poliovirus vaccine (OPV) provides a powerful tool for controlling and stopping the transmission of wild polioviruses (WPVs), although the risks of vaccine‐associated paralytic polio (VAPP) and circulating vaccine‐derived poliovirus (cVDPV) outbreaks exist as long as OPV remains in use. Understanding the dynamics of cVDPV emergence and outbreaks as a function of population immunity and other risk factors may help to improve risk management and the development of strategies to respond to possible outbreaks. We performed a comprehensive review of the literature related to the process of OPV evolution and information available from actual experiences with cVDPV outbreaks. Only a relatively small fraction of poliovirus infections cause symptoms, which makes direct observation of the trajectory of OPV evolution within a population impractical and leads to significant uncertainty. Despite a large global surveillance system, the existing genetic sequence data largely provide information about transmitted virulent polioviruses that caused acute flaccid paralysis, and essentially no data track the changes that occur in OPV sequences as the viruses transmit largely asymptomatically through real populations with suboptimal immunity. We updated estimates of cVDPV risks based on actual experiences and identified the many limitations in the existing data on poliovirus transmission and immunity and OPV virus evolution that complicate modeling. Modelers should explore the space of potential model formulations and inputs consistent with the available evidence and future studies should seek to improve our understanding of the OPV virus evolution process to provide better information for policymakers working to manage cVDPV risks.     

Gendered policies and practices that increase older men's risk of elder mistreatment

We aim to detail some of the ways that social policy and gendered practices put older men at risk of elder mistreatment. Research on the abuse and neglect that older adults experience has often focused on the characteristics of the victims and the dynamics within families, emphasizing factors such as the likelihood of an intergenerational cycle of violence, substance abuse and dependency, and older men's financial status as key risks in elder abuse. The effect on men from this type of analysis is that elder mistreatment remains an individual or family problem rather than being viewed as a larger societal concern. This article challenges the individualistic focus by outlining the importance of societal forces affecting older men's risk of mistreatment.     

“They Kill People Over Nothing”: An Exploratory Study of Latina Immigrant Trauma

Abstract

This article presents findings from an exploratory, mixed methods study to: (1) Ascertain whether Latina immigrant clients of a healthcare clinic for uninsured patients suffer a higher rate of PTSD compared to the citizen population at large and (2) Explore whether factors unique to immigrants, such as surviving human smuggling, would predict PTSD. Two validated instruments were deployed with clients who agreed to be screened (n?=?62). Ten percent of U.S. women are expected to develop PTSD in a lifetime, a total tripled by immigrant women in this study. Women who scored high on the PTSD CheckList for Civilians (PCL-C) reported victimization from sexual assault, robberies and loss of friend/family member to violence, though no single assault predicted PTSD. Qualitative data, however, revealed that violence in countries of origin influenced decisions to immigrate. Among the avenues for future research identified by this study are (1) exploration of methods for linking Latina immigrants to mental health services, (2) determining the effects of smuggling violence on immigrants, and (3) Evaluate additive effects of multiple traumas.