Faculty Bibliography

Children's mental health problems are pressing social, economic, and public health concerns in the U.S. While pediatric primary care offers important venues to integrate mental health services for children and their families, new challenges, including widening educational, economic, and health disparities in the context of structural racism and COVID-related social isolation, underscore the need for innovative approaches. The authors reviewed 6 innovative methods in pediatric care that have helped address these issues and amplify intervention efforts focused on children's mental health. Limitations and future directions for research and clinical practice in pediatric mental health services are also discussed.

Based on theoretical premises of ecological systems theory and the compensatory hypothesis, a subset of data from the Family Life Project (N = 773), a population-based study of rural families with low incomes, were used to test for associations between maternal literacy in infancy and children's academic outcomes and teacher-reported problem behaviors in kindergarten. A second aim tested whether increased time in child care averaged from 6-36 months moderated such relations. Results indicated that maternal literacy was significantly positively related to academic outcomes (ES = .17-.23) and significantly negatively related to children's problem behaviors (ES = -.15) in kindergarten. Child care hours were not significantly related to any outcome. Significant interactions were found between maternal literacy and hours in child care on both children's academic skills and problem behaviors. Specifically, for mothers with lower literacy levels, significant dose-response relationships were detected between increased time in child care and children's higher academic scores and reduced problem behaviors (ES = .07-.09). Implications for maternal literacy and child care access among rural families are discussed.

OBJECTIVE:To test the feasibility of implementing The Pittsburgh Study's (TPS) Early Childhood Collaborative, a population-level, community-partnered initiative to promote relational health by offering accessible preventive parenting program options for families with young children. STUDY DESIGN/METHODS:TPS partnered with healthcare and community agencies serving families in Allegheny County, Pennsylvania, to enroll and screen 878 parents of 1,040 children 4-years-old and under. Participants were assigned to one of four tiered groups based on identified needs: (1) universal, (2) targeted/universal, (3) secondary/tertiary, or (4) tertiary programs. Parents were offered choices in empirically supported parenting programs within group ranging from texting programs to intensive home visiting. Program selection was optional. Chi-square tests were conducted to examine the likelihood of selecting a program by group. RESULTS:About 25% of participants were assigned to each tiered group; 78% of parents chose to enroll in a parenting program. In general, parents with higher levels of adversity were more likely to select a parenting program compared with those reporting less adversity, including secondary/tertiary versus targeted/universal groups (81.4% vs. 72.8%), and tertiary versus universal and targeted/universal groups (83% vs. 74.1% and 72.8%, respectively; p < .001). CONCLUSION/CONCLUSIONS:Our high program enrollment rate supports the feasibility of TPS. TPS successfully engaged families in the study by offering choices in, and optimizing accessibility to, parenting programs. TPS is highly aligned with recent recommendations by the American Academy of Pediatrics for tiered approaches as part of a broad public health strategy for supporting early relational health.