Vibrant and Healthy Kids Aligning Science, Practice, and Policy to Advance Health Equity (2019) / Chapter Skim
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4 Fostering Caregiver Well-Being Toward Healthy Child Development
4 Fostering Caregiver Well-Being Toward Healthy Child Development
Pages 233-300
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From page 233... ...
The primary focus is on fostering caregiver well-being and support, family cohesion, and social connections to promote healthy child development. This is reflected in the 233
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. After discussions on these universals, the chapter continues with a consideration of some context-specific pathways to healthy child development: influences that are potent in and unique to particular subgroups of the population.
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For example, for all children, the single most important factor in promoting positive psychosocial, emotional, and behavioral well-being is having a strong, secure attachment to their primary caregivers; in most instances, this is their biological mother. This chapter also examines the evidence on interventions that support strong relationships and highlights promising examples.
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From page 236... ...
As noted above, there are important considerations for the context within which a child exists and how that environment affects resilience. As is true for all children -- facing adversities or not -- the developing child's lived experience is shaped by the family, caregivers, community, and systems that the child interacts with on a daily basis.
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Considerations around men and fathers as primary caregivers are discussed separately later in this chapter, as the literature clearly indicates that there are distinct needs and issues that warrant specific, careful attention in interventions for men. The critical importance of the parent–child relationship, specifically, is underscored in a 2017 special section published in Child Development, which highlights evidence-based interventions to maximize resilience in children and families.
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. Sections that follow begin with a synthesis of this literature providing the basis for what are considered the universal principles of human child development, that is, principles that are largely generalizable to most children and families in the United States.
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SOURCE: McLeod, 2018. core principle that prenatal through early childhood development is both experience dependent and experience expectant.1 Thus, the adaptability of the organism to future challenges is influenced substantially by genetic and epigenetic factors that contribute to homeostatic boundaries within which the brain and other organ systems operate over the life course and the experiences that occur during development that the organism anticipates as the "future" contexts in which it will need to operate to survive and thrive.
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See Box 4-3 for a list of the nine universal principles of human development. The first principle, deriving from more than eight decades of research on resilience, is the following, mentioned earlier: For all children, the single most important factor in promoting positive psychosocial, emotional, and behavioral well-being is having a strong, secure attachment to their primary caregivers; in most instances, this is their biological mother.
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From page 241... ...
Following this first universal -- that a strong attachment to primary caregivers is critical for the child's well-being -- the second major universal is that this strong attachment presupposes effective parenting behaviors in everyday life, and "effective parenting" changes in nature and complexity and with development over time. In infancy, parenting is extremely demanding
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. To that end, differences between mothers and fathers render it critical to better understand the unique factors that shape fatherhood and child development to inform interventions.
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There are multiple studies showing that when mothers struggle with mental illness, this can significantly affect all of their parenting behaviors (Knitzer, 2000; Luthar and Sexton, 2007; Rahman et al., 2013)
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In the same way, the first order of business in ensuring optimal child development is to ensure that all primary caregivers have the necessary supports on an ongoing basis if they are to sustain optimal parenting. Providing supports (e.g., in the form of services)
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This again implies attentiveness when primary caregivers are stretched too thin, because they are at the most risk for maltreatment. As noted earlier, living with chronically high stress or mental illnesses, such as untreated depression, can lead the most well-meaning and loving parent to become angry and slip into neglectful or harsh parenting behaviors.
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Sixth, developmental research has clearly shown that relationships in the early childhood years are critical in shaping subsequent child development -- but at the same time, there remains much room to change course and impact these trajectories in a positive fashion, with those starting out as negative changing to be more positive as well as the reverse. Without question, early attachments form the lens through which subsequent relationships are viewed (Lieberman et al., 2005; Sroufe et al., 2005; Yates et al., 2003; Zeanah and Zeanah, 1989)
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At the same time, intergenerational transmission of disorders is far from inevitable. As noted earlier, the notion of resilience encompasses the phenomenon wherein children who are at risk for psychopathology -- or mothers who are at risk for negative parenting behaviors -- can show healthy outcomes if they have the appropriate corrective or buffering influences in their lives.
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because across cultures and socioeconomic settings, they are typically the primary caregivers of young children (e.g., Hrdy, 2011; Luthar and Eisenberg, 2017) ; however, there are many instances where fathers are primarily responsible for raising children.
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. Involving Fathers in Preventive Interventions As noted earlier in this chapter, developmental scientists have increasingly emphasized that it cannot be presumed that what helps fathers do well as parents is the same as what most benefits mothers (e.g., Grusec and Davidov, 2010)
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Relationship-based strategies that are highly effective, such as those in home visiting programs for new mothers, will not
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As researchers and practitioners think of how best to promote the wellbeing of young children via effective support for their primary caregivers, it would be prudent to avoid presuming that we can simply transfer program strategies and procedures from mothers to fathers. Although instances where a father is solely responsible for the child are not as common, this in no way obviates the need for understanding the most effective paths to reach and benefit these fathers.
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As discussed in the next section, institutionalized racism against men of color leads to higher rates of incarceration that precludes many fathers from being present in their children's lives, establishing healthy relationships, and providing the necessary support to the mother. In recognition of both the importance of fathers for child development, and the challenges fathers face, Congress has authorized and funded grants for fatherhood programs for more than a decade.
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. All four programs consisted primarily of group-based workshops covering topics such as the meaning of fatherhood, child development, co-parenting, finding and retaining employment, and even personal development topics, such as coping with stress, responding to discrimination, problem solving, selfsufficiency, and goal planning.
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The three components of the developmental niche form the cultural context of child development. (Bronfenbrenner, 1979, p.
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Subgroup Differences Although there are universal processes of development that point out the importance of the quality of intimate family relationships for early child development, there can also be powerful influences that are largely unique to particular contexts; these potent within-group processes can affect children in both positive and negative ways. Considering the former, for example, specific processes have been identified as strengths or natural coping mechanisms that foster resilience within particular racial or ethnic groups, such as familism and respect for family obligations among Latinos and other collective-oriented cultures and effective family racial/ethnic socialization.
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Parents who are preoccupied by fulfilling basic needs for themselves and their children inevitably find it challenging to attend to their children's emotional, behavioral, and educational needs. Living in poverty is stressful on parents and can compromise the quality of their parenting behaviors, the evolving parent–child relationship, and the wellbeing of their developing children.
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Research has consistently shown that poverty creates living conditions that negatively affect parenting and the mother–child relationship. The daily stresses associated with living in poverty lead to higher incidence of maternal depression, which, as noted earlier, is linked with a poorer quality of mother-infant interaction (Jackson, 2000; Taylor and Conger, 2017)
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In recent years, the increased number of parental deportations and separation of parents and children at the southern U.S. border has led to an increasing number of children of immigrant background being traumatized and pushed into developmentally inappropriate parenting roles, which will lead to increasing relationship disturbances and subsequent health disparities (Bouza et al., 2018)
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These children might be exposed to extreme stress, particularly during the prenatal period, when the in-utero child should be especially targeted at the first indication of any family relational difficulties. Children in foster care Children in foster care are overrepresented as a group in terms of health disparities (Goemans et al., 2015, 2016;
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However, children from certain racial and ethnic populations are disproportionately represented in the child welfare system. For example, AI/AN families are twice as likely to be investigated as the national population of families, and cases are twice as likely to be substantiated, with AI/AN children three times as likely to be placed in foster care as the national population of children (Hill, 2007)
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. In terms of supportive policies, the passage of the Family First Prevention Services Act in 2018 provides an opportunity to advance evidencebased child welfare policies through the investment of federal funds in children at risk for foster care, in foster family homes, or in qualified residential treatment programs or other special settings.3 Most notably, the legislation provides support for programs and practices to keep children with their families safely (e.g., allowing states to use Title IV-E funds to prevent children's entry into foster care)
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. Parental incarceration usually leads to family financial and housing instability and to more mental disorders and physical health problems in the partner (the parent who stays behind)
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These varied reactions to homophobia and discrimination can be associated with high levels of chronic stress and contribute to long-lasting health disparities (IOM, 2011)
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Extant evidence of adjustment difficulties among these children is presented here, followed by consideration of why this subgroup might merit attention in this particular report, which is focused on family-based prevention for children known to be at risk given life adversities. With regard to the existing evidence on children of well-educated, relatively affluent parents, studies using varied samples and methods have converged in indicating relatively high levels of adjustment problems, likely linked with long-standing, ubiquitous pressures to excel at academics and extracurricular activities.
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Recent research has shown that African American boys in relatively high SES communities reported significantly higher depression and substance abuse, probably as a result of greater discrimination/racism in their communities -- likely dominated by white families (Assari and Caldwell, 2018; Assari et al., 2018a,b; Lewis and Van Dyke, 2018)
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The findings showed that cohort increases in serious psychological distress were the largest in the highest income group. Among adolescents, time period increases in rates of a major depressive episode were the largest in the highest income group and smallest in the lowest income group; among adults, the cohort increase in suicidal ideation was largest and smallest in the highest and lowest income groups, respectively.
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Possibilities range from the amount of time spent on social media to spreading rumors about others, being the victim of bullying, "sexting" and accessing pornography, and constant social comparisons or feeling "less than" others. In Chapter 3, there is a section devoted to the problem of bullying even among young children; clearly, there is a lot of work that still remains to reduce this major risk process -- and, now, to also disentangle and address the new challenges introduced by the widespread use of social media from young ages onward.
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Careful attention to potent subculture-specific processes need to be considered in working with subgroups well known to face serious inequities in relation to mental health -- including families experiencing chronic poverty; immigrants; lesbian, gay, bisexual, transgender, queer (LGBTQ) children and LGBTQ parents; and those where children are separated from parents due to incarceration or foster care.
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. This section focuses on interventions with the strongest evidence base to foster healthy child development through supporting caregivers.
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. By law, state and territory awardees have to spend the majority of their MIECHV program grants to implement evidence-based home visiting models, with up to 25 percent of funding available to implement promising approaches that will undergo rigorous evaluation.5 Tribal home visiting programs are encouraged to select evidence-based home visiting curricula, but as the research evidence is limited, this is not a program requirement.
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. Another meta-analysis examined the effect of home visiting on six outcomes: birth outcomes, parenting behavior and skills, maternal life course, child cognitive outcomes, child physical health, and child maltreatment (Filene et al., 2013)
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showing favorable impact across the greatest breadth of outcomes. Most models had favorable impacts on primary measures of child development, school readiness, and positive parenting practices; none of the models, however, showed impacts on a primary measure of reductions in juvenile delinquency, family violence, and crime (Sama-Miller et al., 2018)
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. NFP is the only home visiting program to have statistically significant positive effects over time on substantiated cases of child maltreatment.
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Parent educators provide culturally based information about prenatal health, childbirth, child development, and child rearing (Yoshimoto et al., 2014)
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States can further expand support for evidence-based home visiting services through state general funds, Medicaid financing, or braiding of different funding streams (Johnson, 2019)
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Researchers, program leaders, and policy makers should focus on expanding the concept of precision home visiting that advances which programs and activities are best for which family, in which communities, and for what outcomes. Recommendation 4-3: To strengthen and expand the impact of evidence-based home visiting programs: • Federal policy makers should expand the Maternal, Infant, and Early Childhood Home Visiting Program.
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. Further research is needed to understand how to expand home visiting programs cost effectively, and a tiered approach would provide tailored services based on family needs (see Conclusion 4-5 for more on a tiered approach)
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Compared to treatment as usual in their methadone clinics, mothers who received the 24-week intervention showed lower risk for child maltreatment -- by mothers' and children's reports -- and better personal adjustment as well as both mothers' and children's reports of child maladjustment and on mothers' drug use via urinalyses (Luthar and Suchman, 2000)
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. These examples all apply developmental science and aim to advance health equity during the preconception through early childhood periods.
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widely used, efficacious program, NFP, which provides regular home visits for low-income, single mothers by a warm, supportive nurse. These home visits begin in the prenatal months and continue through the babies' second birthdays.
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, partial eta squares correspond to the following effect sizes in the real world: 0.02 is small; 0.13 is medium; and 0.26 is large)
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Given the critical need to support caregiver well-being and to prevent child maltreatment (see Conclusions 4-1 and 4-2) , in addition to the review of high-quality interventions that are offered in community settings for families, the committee offers the following recommendation to support the development and implementation of such interventions.
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SYNTHESIZING THE EVIDENCE To summarize, major conclusions deriving from this chapter include the following. Promoting resilience in childhood rests, first, on ensuring the well-being of children's primary caregivers -- usually, their mothers -- and this requires the mothers' ongoing access to strong, supportive relationships, beyond meeting basic needs for survival.
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These include subgroups that have been extensively documented in past research to be at risk -- such as children in chronic poverty, those separated from their parents, and recent immigrants -- and those shown more recently as contending with high stress and distress, such as children and families in high-achieving communities and youth who are in the minority based on gender identification and sexual orientation. As future interventions for mothers and children are taken to large scale, it will be useful to employ a tiered approach with the intensiveness of services increasing with the level of the mother's distress.
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BOX 4-9 MOMS Partnership: A Promising Modela Based in New Haven, Connecticut, the MOMS Partnership is an evidence based, community-driven initiative that offers mental health and trauma-related services and parenting and job readiness programs to single mothers in at-risk neighborhoods (Center on the Developing Child, 2019)
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These assessments should be a routine part of prenatal, postnatal, and pediatric visits, along with other physical health indexes that are assessed and recorded. Careful, balanced consideration of all of these aspects of intervention design, delivery, and measurement -- with all of the investment of resources called for by each aspect -- is critical to move toward meaningfully increasing equity in wellbeing, considering America's most vulnerable children and families.
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Child Development 86(6)
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2016. Implementation of evidence-based home visiting programs aimed at reducing child maltreatment: A meta analytic review.
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Child Development 89(2)
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Child Development 88(2)
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Child Development 88(2)
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Child Development 65(2)
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2004. The role of the father in child development.
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Child Development 88(2)
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Child Development 88(2)
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2011. Epigenetics of early child development.
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Child Development 88(2)
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Child Development 88(2)
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Child Development 75(6)
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2009. Nurse home visitation and the preven tion of child maltreatment: Impact on the timing of official reports.
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