Two-generation psychiatric intervention in the prevention of early childhood maltreatment recidivism

Year: 2015
Bibliography: Constantino, J., Ben-David, V., Navsaria, N., Spiegel, E., Glowinski, A., Rogers, C., Jonson-Reid, M. Two-generation psychiatric intervention in the prevention of early childhood maltreatment recidivism. The American Journal of Psychiatry, 2015. In Press.
Author: Constantino, et al



Objective: This article describes experience and early outcomes of a two-generation approach to preventive psychiatric care in the common setting of foster care, in which young children in particular are at extreme high-risk for child maltreatment and its long-term consequences. Currently there exist few reimbursable mechanisms by which to implement what has been shown to offset risk for maltreatment recidivism among families in the child welfare system.  This represents a missed opportunity for the prevention of psychopathology in childhood.  Methods: The manuscript briefly reviews the current literature on child maltreatment as a preventable cause of psychopathology, discusses current best practices for its prevention in the setting of foster care, and describes the experience and early outcomes of a two-generation clinical psychiatric service, the SYNCHRONY Project, developed at Washington University and based on the Tulane model described by Zeanah et al. (2001).  Results: In comparison to an historic cohort of 247 young children in foster care in St. Louis County whose cases were closed prior to the launch of the SYNCHRONY Project, we observed among program participants significant reductions in time in foster care, despite the fact that the referred cases were at substantially higher risk than an average historic case.  Serial standardized observations of the children and families in the program revealed improved adaptive functioning of the children, improvement in parenting practices of the parents as a function of evidence-based parenting education (provided as a component of intervention), and extremely low rates of maltreatment recidivism. Conclusion: Two-generation psychiatric care, including evidence-based parenting education, can be successfully implemented among infants and young children at extreme high risk, was associated with steady improvement in adaptive and relational functioning of parent-child dyads, and represents a promising intervention for the prevention of child maltreatment recidivism in public health practice.

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