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In 1982, Jane Knitzer famously reported that two-thirds of youth with serious mental health challenges were either underserved or unnecessarily institutionalized (Knitzer, 1982). In the decades since, home-based interventions for these youth and their families have emerged as viable treatment options (Stroul & Friedman, 1986;Love, Mueller, Tolman & Powell, 2014; DHHS 2005; ACA II, §2402 ( 2010)). These intensive programs occupy a critical point in the continuum of care: they represent the threshold between community retention and institutional placement. As of 1999, 35 states offered some form of intensive, home-based treatment (IHBT) for children and youth with psychiatric impairments, and research pursuant to this review found

BackgroundMothers’ stress in pregnancy is considered an environmental risk factor in child development. Multiple stressors may combine to increase risk, and maternal personal characteristics may offset the effects of stress. This study aimed to test the effect of 1) multifactorial prenatal stress, integrating objective “stressors” and subjective “distress” and 2) the moderating effects of maternal characteristics (perceived social support, self-esteem and specific personality traits) on infant birthweight.MethodHierarchical regression modeling was used to examine cross-sectional data on 403 birth mothers and their newborns from an adoption study.ResultsDistress during pregnancy showed a statistically significant association with birthweight (R2 = 0.032, F (2, 398) = 6.782, p = .001). The hierarchical regression model revealed an almost two-fold increase in variance of birthweight predicted by stressors as compared with distress measures (R2 Δ = 0.049, F (4, 394) = 5.339, p < .001). Further, maternal characteristics moderated this association (R2 Δ = 0.031, F (4, 389) = 3.413, p = .009). Specifically, the expected benefit to birthweight as a function of higher SES was observed only for mothers with lower levels of harm-avoidance and higher levels of perceived social support. Importantly, the results were not better explained by prematurity, pregnancy complications, exposure to drugs, alcohol or environmental toxins.ConclusionsThe findings support multidimensional theoretical models of prenatal stress. Although both objective stressors and subjectively measured distress predict birthweight, they should be considered distinct and cumulative components of stress. This study further highlights that jointly considering risk factors and protective factors in pregnancy improves the ability to predict birthweight.