Outcomes of Therapy in High Risk Mother-Child Dyads in Which There is Active Maltreatment and Severely Disturbed Child Behaviors

Furber, Gareth; Amos, Jackie; Segal, Leonie; Kasprzak, Ann

doi:10.1080/15289168.2013.791166

Cited by 11 publications

(7 citation statements)

References 8 publications

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“…Although unmet need does not necessarily justify a service response (societal resources are scarce relative to potential needs and wants), when considered with evidence of effective and cost-effective interventions to address infant, child, and adolescent mental health concerns, a response is warranted. [32][33][34] The considerable health, social, and economic costs across the life course (and intergenerationally) of untreated child and adolescent mental health problems reinforce the logic of intervening.…”

Section: Discussionmentioning

confidence: 99%

A needs-based workforce model to deliver tertiary-level community mental health care for distressed infants, children, and adolescents in South Australia: a mixed-methods study

Segal

Guy

Leach

et al. 2018

The Lancet Public Health

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Section: Discussionmentioning

confidence: 99%

A needs-based workforce model to deliver tertiary-level community mental health care for distressed infants, children, and adolescents in South Australia: a mixed-methods study

Segal

Guy

Leach

et al. 2018

The Lancet Public Health

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“…In this mortality study, we highlight the tragic consequences of this gap. There are evidence-based interventions for healing parent and child relationships, 26,35,36 but vulnerable families typically do not have access to such programs in Australia and internationally. 37 No indicators of family socioeconomic status were associated with mortality in the multivariable model (findings consistent with the study by Jackisch et al 16 ) and, as hypothesized, the observed socioeconomic gradient in health is primarily driven by CM history.…”

Section: Policy Implicationsmentioning

confidence: 99%

Child Maltreatment and Mortality in Young Adults

et al. 2021

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BACKGROUND: Child maltreatment (CM) is a global public health issue, with reported impacts on health and social outcomes. Evidence on mortality is lacking. In this study, we aimed to estimate the impact of CM on death rates in persons 16 to 33 years. METHODS: A retrospective cohort study of all persons born in South Australia 1986 to 2003 using linked administrative data. CM exposure was based on child protection service (CPS) contact: unexposed, no CPS contact before 16 years, and 7 exposed groups. Deaths were observed until May 31, 2019 and plotted from 16 years. Adjusted hazard ratios (aHRs) by CPS category were estimated using Cox proportional hazards models, adjusting for child and maternal characteristics. Incident rate ratios (IRRs) were derived for major causes of death, with and without CPS contact. RESULTS: The cohort included 331 254 persons, 20% with CPS contact. Persons with a child protection matter notification and nonsubstantiated or substantiated investigation had more than twice the death rate compared with persons with no CPS contact: aHR = 2.09 (95% confidence interval [CI] = 1.62–2.70) to aHR = 2.61 (95% CI = 1.99–3.43). Relative to no CPS contact, persons ever placed in out-of-home care had the highest mortality if first placed in care aged ≥3 years (aHR = 4.67 [95% CI = 3.52–6.20]); aHR was 1.75(95% CI = 0.98–3.14) if first placed in care aged <3 years. The largest differential cause-specific mortality (any contact versus no CPS contact) was death from poisonings, alcohol, and/or other substances (IRR = 4.82 [95% CI = 3.31–7.01]) and from suicide (IRR = 2.82 [95% CI = 2.15–3.68]). CONCLUSIONS: CM is a major underlying cause of potentially avoidable deaths in early adulthood. Clinical and family-based support for children and families in which CM is occurring must be a priority to protect children from imminent risk of harm and early death as young adults.

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“…P-PACT ( 10 , 18 ) is now a semi-manualized dyadic psychotherapy, for which there is case study evidence that it can disrupt intergenerational cycles of maltreatment where the maltreatment is ongoing at the time of intervention ( 53 ). P-PACT requires two therapists, a playroom and an observation room connected by a one-way screen.…”

Section: Objectives Of Treatmentmentioning

confidence: 99%

Disrupting Intergenerational Maternal Maltreatment in Middle Childhood: Therapeutic Objectives and Clinical Translation

Amos

Segal

2018

Front. Psychiatry

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Background: Child Maltreatment is a concerning worldwide problem. The population of distressed mothers with their highly disturbed children, in middle-childhood, often present to child and adolescent mental health services (CAMHS). Finding effective therapies for this population has proved elusive. This led the authors to undertake a theory-driven research program to better understand intergenerational child maltreatment from a clinical perspective, in order to determine how best to treat the entrenched distressing and destructive behaviors.Methods: The model describing the mechanisms of the intergenerational transmission of maternal maltreatment is briefly described, from which the objectives of any effective treatment for these mothers and children are derived. A clinical model for achieving the therapeutic objectives is then elucidated.Findings: Core objectives of therapy are; first to support the mother and child to develop differentiated senses of self and, second to disrupt a relationship style built on a competitive dominance and submission hierarchy, replacing it with a hedonic (cooperative and compassionate relationship style). This requires a deep healing of the mother and child's trauma histories. A clinical operationalization of these objectives, through a novel dyadic psychotherapeutic protocol, Parallel Parent and Child Therapy is described, which addresses the therapeutic objectives while attending to the safety of mother and child.Interpretation: This research contributes to a better understanding of the components of effective treatment in what is a notoriously hard to treat population. It also illustrates the value of clinically informed theory development in understanding and refining treatment strategies for highly distressed and distressing populations.

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Outcomes of Therapy in High Risk Mother-Child Dyads in Which There is Active Maltreatment and Severely Disturbed Child Behaviors

Cited by 11 publications

References 8 publications

A needs-based workforce model to deliver tertiary-level community mental health care for distressed infants, children, and adolescents in South Australia: a mixed-methods study

A needs-based workforce model to deliver tertiary-level community mental health care for distressed infants, children, and adolescents in South Australia: a mixed-methods study

Child Maltreatment and Mortality in Young Adults

Disrupting Intergenerational Maternal Maltreatment in Middle Childhood: Therapeutic Objectives and Clinical Translation

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