This study evaluated the new online Emotional Attachment and Emotional Availability (EA2) Intervention for use with adoptive families in enhancing parent-child EA, parental perceptions of EA, child attachment behaviors, parent-child emotional attachment, and reducing parent-reported child behavioral problems and parenting-related stress. Participants in this study were adoptive parents and their adopted children ages 1.5 to 5 years old (N = 15 dyads). Participants were placed in an immediate intervention group (IG) or a delayed intervention group (DG) that would receive the 6-week EA2 Tele-Intervention after the IG. Results revealed significant differences in the IG in child behavioral problems, parent-child EA, parental perceptions of EA, and parent-child emotional attachment, improvements not seen in the DG. Analysis of effects of the DG after receiving the EA2 Tele-Intervention revealed significant differences over time also in most of these qualities.

According to data from the 1997 NICHD Study of Child Care, center-based child care can have deleterious effects on children's social-emotional development. We hypothesized that training child care professionals to develop positive relationships with children in their care would improve the quality of center-based child care. Thirty-three professional caregiver-child pairs participated in the intervention group and 24 professional caregiver-child pairs were assigned to a care as usual comparison group. The intervention consisted of an informational and a practice component with an emotional availability (EA) coach. The infants and toddlers (ages 11 to 23 months) in the classrooms were enrolled in the project only if they spent at least 20 hr per week in center-based care. The measures included were (a) the EA Scales, (b) the Attachment Q-Sort, and (c) the Classroom Interaction Scale. The intervention group professional caregiver-child relationships showed improvements on the EA Scales, Attachment Q-Sort, and the Classroom Interaction Scale from pre- to posttest, compared to the comparison group, who showed some decrements over a comparable period of time.

This study assessed relations among number of out-of-home placement changes, time in caregivers’ care, caregiver type (i.e., foster parent, adoptive parent, kinship relation, and biological parent), child gender, and caregiver-child Emotional Availability (EA) as predictive of child attachment security when children were 3 years old in a sample of 104 caregivers and children. Children entered court-ordered care by six months of age. On average, children at the age of three spent 30 months with their caregivers, and nearly half of them were adopted by that time. Child attachment was assessed using the Attachment Q-set (Waters & Deane, 1985), and caregiver-child EA was assessed using the EA Scales, 4th edition (Biringen, 2008). Sixty-six percent of children at age 3 showed secure attachments with caregivers, and EA subscale scores were also relatively high on average. The study predictor variables of EA Caregiver Sensitivity, Child Responsiveness, and Child Involvement predicted attachment security, with girls more likely to be securely attached to their substitute caregivers at age three than boys. Study limitations and directions for future research are discussed.

Although professionalism has emerged as a key competency for today’s physicians, there exists little insight into how best to teach medical students the relevant skills or instill in them the commitment required to practice according to the highest professional standards. Ten UCSF medical students were interviewed at three time points (second, third, and fourth years of school). Interviews focused on students’ learning and development regarding end-of-life care (EOLC). Students described varying steps in their professional development from their second to fourth years of school, including feeling confused about the definition of professionalism and integrating their personal and professional identities. In addition to professional development, four other themes contributed to the development of medical student understanding of how to provide EOLC as a professional: (1) curricular discordance, (2) role models, (3) the tightrope between trained versus human reactions, and (4) ethical dilemmas. These five themes represent dilemmas that students often learned how to respond to over the course of school. Professional development in EOLC required the acquisition of skills necessary to balance the tension between and navigate conflicting messages present in medical student training.

Pediatricians regularly care for children who have experienced child maltreatment. Child maltreatment is a risk factor for a broad range of mental health problems. Issues specific to child maltreatment make addressing emotional and behavioral challenges among maltreated children difficult. This clinical report focuses on 2 key issues necessary for the care of maltreated children and adolescents in pediatric settings: trauma-informed assessments and the role of pharmacotherapy in maltreated children and adolescents. Specific to assessment, current or past involvement of the child in the child welfare system can hinder obtaining necessary information or access to appropriate treatments. Furthermore, trauma-informed assessments can help identify the need for specific interventions. Finally, it is important to take both child welfare system and trauma-informed assessment approaches into account when considering the use of psychotropic agents because there are critical diagnostic and systemic issues that affect the prescribing and discontinuing of psychiatric medications among children with a history of child maltreatment.