Pediatric pedestrian injury is a major public health concern. Children’s perceived abilities correlate with behavior across many pediatric behavioral health contexts, but this association is untested regarding pedestrian safety. If children’s perceptions relate to behavior in pedestrian settings, there are implications for targeted intervention. We evaluated associations between parent and child perceptions of children’s street-crossing ability with actual abilities within a virtual reality (VR) pedestrian platform. As part of a larger clinical trial, 497 children aged 7–8 years participated in baseline pedestrian skill assessments and subsequent virtual reality training sessions. Training terminated when children achieved adult competency. Outcomes included baseline unsafe crossings and number of visits to reach adult competency. Baseline perceptions of children’s ability were assessed via parent and child self-report. Linear regression models were completed for each outcome, with parent perception, child perception, child age, and child sex as predictors. The first linear regression demonstrated significant associations between baseline unsafe crossings and both parent perception of real-world crossings (β=-0.10771, p<.05) and child age (β=-0.18288, p<.01). A second linear regression examining the number of training visits required to achieve adult competency also identified significant associations between parent perception of real-world crossings (β=-0.13499, p<.01) and child age (β=-0.13927, p<.01). Parents’ perceptions of children’s abilities are significantly associated with children’s pedestrian skills, whereas children’s own perceptions show less consistent and non‑significant associations. Prioritizing youth voices alongside educating parents about pedestrian safety risks may offer complementary and effective strategies to support children to become safe, active pedestrians. The trial was registered at ClinicalTrials.gov, Identifier NCT02948400.
Evidence-based early parenting programs delivered in early childhood can improve children’s social-emotional and mental health outcomes, yet achieving population-level impact requires effective delivery at scale. Despite growing interest in scaling such interventions, no comprehensive review has synthesized lessons from past efforts. This systematic review aimed to synthesize available peer-reviewed literature on scaled ‘early’ parenting programs (defined as programs delivered during pregnancy and up to child age 5 years). Specifically, the review examined (1) which programs have been scaled, (2) frameworks guiding scaling efforts, (3) reported outcomes, and (4) barriers and enablers to successful scaling. Guided by PRISMA-SR, four databases (PsychInfo, EMBASE, SCOPUS, PubMed) were searched for studies published between 2004 and March 2026. Eligible studies reported data on scaling early parenting programs beyond a single site. Data were synthesized narratively, and qualitative thematic analysis was applied to barriers and enablers. Sixty-two papers describing 39 distinct scaling efforts were included, spanning 15 unique programs. Scaled programs included attachment-based interventions and behavioral programs. While some initiatives employed implementation frameworks, most did not. Data suggested positive impacts for families in some relevant areas, however most evidence came from descriptive or non-randomized study designs, and there was significant variation in how outcomes were measured. Reported outcomes relating to scaling reach, fidelity, and sustainability were limited. Six key enablers/barriers were identified: implementation approach; local contexts; collaboration; institutionalizing within systems; leadership; and funding and resources. In the last two decades, efforts have been made to scale early parenting programs to support child social-emotional and mental health outcomes. To support future scaling, ongoing research is required.
School bullying is a major risk factor for adolescent mental health difficulties. Psychiatric treatment and recovery may also require a temporary interruption of schooling. Returning to school after bullying-related psychiatric treatment is therefore an important but complex stage of recovery that remains insufficiently understood. This study explored how Chinese high school students make sense of the challenges they encounter when returning to school after bullying-related psychiatric treatment. Guided by an interpretivist perspective, this qualitative study used Interpretative Phenomenological Analysis (IPA) to explore how adolescents made sense of their lived experiences of returning to school. Twelve Chinese high school students aged 16–18 who had experienced school bullying, received formal psychiatric diagnoses and treatment, undergone an interruption to their schooling, and subsequently returned to school participated in semi-structured interviews. Interviews were audio-recorded, transcribed, and analysed through iterative IPA procedures. Five group experiential themes were identified: Living Beneath the Label, Returning to the Site of Harm, A Body That Tells the Story, Falling Behind, and Alone in the Classroom. Participants described reintegration as a psychologically vulnerable transition shaped by stigma, fear of former perpetrators and bullying-related spaces, treatment-related physical and cognitive changes, learning gaps, and diminished social belonging. School reintegration after bullying-related psychiatric treatment should not be understood as a simple resumption of education. Coordinated support across schools, families, and healthcare services is needed to address psychological safety, stigma, academic adjustment, treatment-related challenges, and peer belonging.
Forced displacement may accelerate adolescent roles through parentification under adultist expectations (Jurkovic, 1997; Titzmann, 2012), yet longitudinal links with peer networks and belonging in shared refugee–host classrooms remain underexamined. To test whether early role acceleration is associated with peer network position and whether classroom social ties prospectively relate to school belonging and internalizing symptoms among refugee and host adolescents. Adolescents completed three waves of measures of instrumental and emotional parentification, perceived adultism, school belonging, and internalizing symptoms; roster-based peer nominations mapped within-class networks. Multilevel and longitudinal models accounted for classroom clustering; RSiena models estimated within-class selection and influence processes. Focus groups at T3 contextualized quantitative patterns. Refugee-background adolescents reported higher role acceleration and lower belonging. Higher T1 emotional parentification predicted lower T2 network centrality (indegree; β = −0.14, p = .017) and worsening internalizing trajectories, especially when perceived adultism was higher. Network position and cross-group ties prospectively predicted later belonging, and belonging predicted lower subsequent internalizing symptoms. Multi-group analyses suggested that structural paths did not differ by refugee status (Δχ²(4) = 5.82, p = .213). Emotional parentification under adultist conditions and peripheral peer network position each carry prospective mental health costs in shared refugee–host classrooms. School belonging may represent a school-level indicator through which peer ecologies translate into differential internalizing outcomes over time. Reducing role-acceleration burdens and strengthening relational inclusion may be complementary targets for supporting adolescent mental health in displacement contexts.
Involvement with bullying intersects with the dimensions of social inclusion as bullying is associated with a sense of non-belonging, weakened prerequisites for agency, and a sense of meaninglessness. However, the associations between involvement in bullying and the subjective experience of social inclusion remain underexplored. This study first examines how different forms of involvement in bullying—victimization, perpetration, and victim-perpetration—are related to sociodemographic background. Second, it analyzes the associations between bullying involvement and the experience of very weak social inclusion. Data were gathered from the 2021 Finnish School Health Promotion survey, which was completed by 91,560 adolescents aged 14–16 years. Cross‑tabulation analyses were used to determine the associations between sociodemographic background and bullying involvement, and logistic regression models were applied to analyze the associations between bullying involvement and the experience of very weak social inclusion. All analyses were gender-stratified. Adolescents involved in weekly bullying were more likely to come from disadvantaged sociodemographic backgrounds than those not involved in bullying. In addition, bullying involvement was associated with higher odds of experiencing very weak social inclusion. Odds ratios varied by form of bullying involvement and gender and were statistically significant, except for perpetration among girls. The findings extend the existing research by demonstrating links between involvement in bullying and the experience of weakened social inclusion. Weekly bullying is related to sociodemographic vulnerabilities, suggesting that anti-bullying efforts should better address these vulnerabilities.
The Positive Youth Development–Very Short Form (PYD-VSF) is a brief measure of the Five Cs of positive youth development; however, its measurement properties have not been evaluated among Persian-speaking adolescents. This cross-sectional psychometric study examined the structural validity, reliability, measurement invariance, and external construct validity of the Persian PYD-VSF in a school-based adolescent sample. Participants were 740 Iranian adolescents aged 13–18 years (M = 15.01, SD = 1.57). The PYD-VSF was translated using forward–backward translation, expert review, and cognitive pretesting. Structural validity was evaluated using confirmatory factor analysis and bifactor modeling with the weighted least squares mean- and variance-adjusted estimator. Reliability was examined using Cronbach’s alpha, McDonald’s omega (ω), composite reliability, omega hierarchical, and test–retest intraclass correlation coefficients. Measurement invariance across gender and developmental stage was tested using multi-group confirmatory factor analysis. The bifactor model showed slightly better fit than the correlated five-factor model (CFI = 0.99, TLI = 0.99, RMSEA = 0.03, SRMR = 0.02). Items loaded substantially on the general PYD factor (λ = 0.49–0.63). Omega hierarchical (ωh = 0.78) supported the interpretability of the total score, whereas explained common variance (ECV = 0.46) and omega hierarchical subscale coefficients (ωhs = 0.36–0.51) indicated meaningful but comparatively attenuated domain-specific variance. Internal consistency (α = 0.91, ω = 0.89), test–retest reliability (ICC(2,1) = 0.78, 95
Immigrant adolescents frequently engage in language brokering, in which adolescents serve as linguistic and cultural mediators for their families, to support parents with limited English proficiency, yet little is known about how this process shapes parent–child relationships within Korean immigrant families. Existing research has largely focused on Latino families, leaving a gap in understanding culturally specific dynamics among Asian immigrant groups. This study explored (1) what role language brokering plays in parent–child relationships in Korean immigrant families, (2) which child and family characteristics shape brokering experiences, and (3) similarities and differences across families. Using a qualitative design, six Korean immigrant parent–adolescent dyads participated in semi-structured, individual interviews. Purposeful and snowball sampling identified families with adolescents aged 12–17 who regularly engaged in language brokering. Interviews were conducted in Korean, transcribed verbatim, and analyzed using Braun and Clarke’s six-step thematic analysis. Researcher reflexivity and peer debriefing enhanced trustworthiness. Two overarching themes were constructed. First, language brokering helped foster closeness and communication in many dyads, while also generating stress and conflict in others. Adolescents with stronger relationships described experiencing less stress and more effective brokering. Second, brokering patterns reflected cultural and familial characteristics: first-born adolescents, particularly daughters, served as primary brokers; first-generation adolescents accepted the role more readily than second-generation peers; and parents’ English proficiency shaped adolescents’ sense of burden. Language brokering is a culturally embedded, relational process in Korean immigrant families. Its role in parent-child relationships depends on cultural expectations, birth order, and parental language skills. Findings underscore the need for family-based and culturally informed support for adolescent language brokers.
BackgroundSocial anxiety is prevalent among adolescents, however there is limited research examining how adolescents with social anxiety can be supported in coping adaptively with stressors. In particular, close relationships with dogs may provide regulation and support in this context.ObjectiveThe objective of this study is to use an idiographic, mixed methods approach to explore adolescent-dog relationships in real-life contexts.MethodsWe present four illustrative cases of adolescents with high levels of social anxiety who represent a range of levels of pet-dog relationship quality, integrating quantitative and qualitative data sources: (1) continuous electrodermal activity using ambulatory psychophysiological sensors to measure arousal, (2) ecological momentary assessment of real-time of emotion and behavior, (3) quantitative survey data from both adolescents and parents/guardians, and (4) in-depth qualitative interviews (conducted separately with both parents and youth).ResultsFindings indicate individual variability in how and when adolescents seek proximity to their dogs and in the coherence between physiological arousal, loneliness, and positive/negative affect. This variability was often linked to the strength of the adolescent's relationship with their dog. There were differential patterns in the quality of adolescent-dog relationships and how this relationship may be linked to anxiety reduction, with some youth reporting a pathway between their dog relationship and outcomes and others showing no clear associations.ConclusionsThis study demonstrates the value of combining digital phenotyping with qualitative narratives to explore lived experiences of adolescent anxiety. Findings highlight the potential for more personalized, ecologically valid interventions that leverage existing family and pet relationships.
Empathy is widely promoted in educational settings, yet its associations with adolescent well-being remain complex, with evidence suggesting both beneficial and adverse outcomes. Drawing on the stress-buffering model, social support may shape how individual vulnerabilities, such as affective empathy, relate to well-being, highlighting its potential moderating role. This study examined the associations between affective empathy and adolescent well-being and tested whether perceived social support moderates these relationships. Participants were 834 Vietnamese adolescents (427 females; M age = 14.63). Self-report measures assessed affective empathy, empathy deficits, perceived stress, emotional and behavioral problems, life satisfaction, and social support. Moderation analyses were conducted using the PROCESS macro. Affective empathy was positively associated with life satisfaction but also with higher perceived stress and emotional and behavioral difficulties. Social support significantly moderated these associations: it strengthened the positive association between affective empathy and life satisfaction and attenuated its positive associations with psychological distress. No significant moderation effects were found for empathy deficits. Findings highlight the dual role of affective empathy in adolescent well-being and underscore the importance of social support as a contextual factor that shapes when empathy is associated with more adaptive versus maladaptive outcomes. Interventions should consider both fostering empathic sensitivity and strengthening supportive environments.
Adolescence is a developmental period in which peer relationships, emotion regulation, and responses to interpersonal tension become increasingly consequential in school and social life. Within this context, humour styles may be relevant to how young people manage conflict, yet their association with tendency toward violence remains underexamined. This study examined the associations between adolescents’ humour styles and their tendency toward violence. Using a cross-sectional correlational design, data were collected from 445 high school students attending public high schools in the city centre of Balıkesir, Türkiye, during the 2015–2016 academic year. Participants completed a Personal Information Form, the Humour Styles Questionnaire, and the Tendency Toward Violence Scale. Data were analysed using SPSS 20.0. Affiliative and self-enhancing humour were negatively associated with tendency toward violence, whereas aggressive and self-defeating humour were positively associated with it. These associations were small in magnitude. Male students reported higher tendency toward violence than female students. Students who participated in social and cultural activities outside school reported higher affiliative and self-enhancing humour. The findings suggest that humour styles are associated with adolescents’ tendency toward violence. Adaptive humour styles were associated with lower tendency toward violence, whereas maladaptive humour styles were associated with higher tendency toward violence. These findings highlight the potential relevance of humour styles for understanding adolescents’ social-emotional adjustment and conflict-related orientations in school contexts.
The development of social-emotional competencies (SEC) constitutes a significant challenge for educators working with children and young people (CY) in residential care (RC) under state protection. Despite recognition of the importance of SEC, there is limited guidance on standardized practices and protocols to support their development. This study explored professionals’ perspectives on facilitators and barriers influencing SEC in CY residing in RC. A qualitative, exploratory design was used, involving semi-structured interviews with 17 professionals (technical directors and members of technical teams with an average of 15 years of experience) in Portuguese institutions. Data were analyzed thematically following Braun and Clarke’s (2006) six-step procedure within an ecological framework. The findings identified facilitators and barriers across five interrelated contextual dimensions shaping SEC development: professionals’ qualifications and training; intervention characteristics; social climate; team management and professionals’ emotional well-being; and external support and activities. Relationship quality, time availability, team stability, and working conditions emerged as transversal factors influencing all dimensions. While strong relational practices, professional commitment, internal supervision, and interinstitutional collaboration were perceived as key facilitators, the absence of structured intervention protocols, shortages of qualified staff, limited specialized training, and high workload were identified as major barriers. Overall, the study highlights the central role of contextual and relational conditions in promoting SEC in RC and underscores the need for structured, sustainable, and relationship-centered intervention models. The findings also provide a foundation for the future development of assessment tools and practice-oriented guidelines to strengthen SEC promotion in RC settings.
Patterns of association among key processes in child trauma-focused treatments for posttraumatic stress are not well understood. There is evidence of between-session habituation and distress tolerance as mechanism of exposure-based therapy with adults with posttraumatic stress disorder, but limited research exists among children. This study examined patterns of association during treatment for between-session habituation and distress tolerance in a parent-led/therapist-assisted treatment, Stepping Together for Children after Trauma (Stepping Together-CT) versus Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) with children (ages 4–12). Measures included child/parent self-reports of subjective distress, distress tolerance, and heart rate and skin conductance level to a trauma reminder, collected three times during treatment and primary measures of posttraumatic stress symptoms and impairment collected at post-treatment (Stepping Together-CT: n = 43; TF-CBT: n = 71). We used linear mixed-effect models with repeated measures, mediation, moderated mediation, and linear regression to estimate effects. In Stepping Together-CT, parent-reported child distress and child distress change rates followed a concave pattern. In TF-CBT, parent-reported distress change rate was convex and child distress did not significantly change. In both conditions, child distress tolerance change rate increased over time and heart rate reactivity decreased prior to increasing over time, but not skin conductance level reactivity. Change in parent perception of child peak distress during trauma retelling in Stepping Together-CT was associated with later change in trauma symptom improvement. Parent perception of child distress during trauma processing may play a role in symptom reduction, with implications for parent-led trauma treatments.
The widespread use of digital technology has contributed to the growing prevalence of parental phubbing, raising concerns about its potential influence on children’s development. This review synthesizes research from the past decade to evaluate empirical evidence on the effects of parental phubbing, identify the developmental domains most affected, explore potential mediating and moderating mechanisms, and clarify the developmental stages that have received research attention. Following the PRISMA guidelines, a systematic search was conducted across Web of Science, Scopus, PubMed, ERIC, APA PsycArticles/APA PsycInfo, ProQuest, and Medline (EBSCOhost), resulting in the identification of a total of 895 articles. After applying inclusion criteria (English-language, research articles, Jan 2015–Feb 2026), 151 studies with over 100,000 participants were retained. The quality assessment of the identified studies was conducted using a relevance-based evaluation methodology. Findings indicate that parental phubbing is predominantly associated with negative outcomes in children’s behavioral, social-emotional, cognitive, and physical development, with only a small number of studies reporting positive or non-significant associations. Most studies focused on adolescents, with fewer addressing younger children. Research was predominantly cross-sectional and concentrated in Asian contexts. This systematic review highlights the significant effects of parental phubbing on multiple domains of child development and summarizes the age distribution of study populations. Findings provide insight into potential mediating mechanisms and practical implications for contemporary parenting practices. The review also identifies gaps in the literature and suggests directions for future research.
Adolescent depression is impactful for adolescents and their parents. High parental worry and low parental self-efficacy may be rather prominent among parents with adolescents with depression, but how this is related to parenting behaviors, such as warmth and criticism, is not well known. In a sample of 58 parents (Mage = 50.10, SDage = 5.30) of 34 adolescents with depression (Mage = 15.65, SDage = 1.54) and 151 parents (Mage = 49.04, SDage = 5.87) of 80 healthy control adolescents (Mage = 15.90, SDage = 1.35), we estimated Gaussian graphical network models on adolescent-reported affect states (i.e., happy, relaxed, sad, irritated), adolescent- and parent-reported parenting behaviors (i.e., warmth, understanding, listening, criticism, dominance), and parent-reported parental worry and self-efficacy. Parents of adolescents with depression reported higher levels of worry compared to the control sample, but equal levels of self-efficacy. In both samples, parent-reported worry was positively related to adolescent-reported sadness and parent-reported parental criticism. Moreover, parent-reported self-efficacy was positively related to adolescent- and parent-reported parental warmth. Only in the depression sample, parent-reported worry was positively related to adolescent-reported parental warmth. Parental worry, self-efficacy, parenting behaviors, and adolescent affect were interrelated with considerable differences between the control and depression samples. As a next step, studies with more intensive daily assessments may yield individual family analyses, while also accounting for contextual factors, to further increase our understanding of the relation between parental worry, self-efficacy, and parenting behaviors in the context of adolescent depression.
Emotion socialization plays a crucial role in children’s emotional development, shaping how they understand, express, and regulate emotions. Little is known about how teachers respond to students’ sadness during middle-childhood, despite teachers’ role in children’s emotional experiences at school. This study examined how elementary school teachers respond to children’s experiences of sadness and whether teachers’ emotion socialization behaviors vary as a function of the type of sad event, children’s coping strategies, and children’s psychopathological symptoms. Fifty female teachers (age: 25–64, M = 46.8, SD = 10.9) completed structured interviews and questionnaires regarding sadness experienced by 346 students. A mixed-method design was employed, combining thematic analysis of interview data with multinomial mixed-effects models to examine associations among events, coping strategies, symptoms, and teacher responses, accounting for clustering within teachers. Three categories of emotion socialization behaviors emerged: emotion-focused, problem-focused, and unsupportive responses. Teachers were more likely to use emotion-focused strategies in response to personal events than to school-related events. Higher levels of children’s externalizing symptoms were associated with a greater likelihood of teachers’ emotion-focused responses. An interaction effect indicated that teachers were particularly likely to adopt emotion-focused behaviors when children responded to personal events with non-constructive coping strategies, and variability emerged across teachers. Teachers’ responses to children’s sadness are context-sensitive and related to events, children’s behavioral functioning, and individual teacher differences. Results underscore teachers’ role in the socialization of sadness during middle-childhood and highlight the importance of supporting teachers in navigating children’s emotional experiences in school.
Partnerships between families and early care and education (ECE) professionals are important for child, family, and teacher wellbeing. The Cocaring Relationship Questionnaire (CRQ) captures this partnership via four dimensions: namely support, endorsement, agreement, and undermining, validated in the U.S. context only. The lack of validation evidence from other countries hinders its applicability and prevents international comparisons, all needed to better support ECE professionals and families. This study sought to validate a short form of the Cocaring Relationship Questionnaire (S-CRQ) among Finnish parents having a child in ECE. Moreover, we examine cross-cultural differences and psychometric properties of the dimensions of S-CRQ across parents within Finnish and U.S. contexts. We utilize data from a Finnish sample of 293 parents with 3–6-year-old children in ECE classrooms, and a U.S. sample of 90 parents with children in infant and/or toddler ECE classrooms. Data were analyzed via exploratory structural equation modeling. Our analyses produced a 3-factor model including the dimensions of Endorsement, Support, and Disunity that showed strong psychometric properties and mostly similar factor structure across the samples. Also, concurrent and discriminant validity of S-CRQ in relation to parent-child relationship scale was supported. Factor means were similar between the countries. Findings validated previously identified dimensions of Endorsement and Support and suggested that a 3-factor model may provide a psychometrically stronger way to assess cocaring relationships across different cultural contexts. This has also important implications for enhancing our conceptual understanding of the essential elements within family-ECE partnerships.
Due to the lack of short violence risk assessment instruments for youth, the Violence Risk Assessment Checklist for Youth Aged 12–18 (V-RISK-Y) was developed and tested in four acute adolescent psychiatric departments and four acute child welfare institutions in a multicenter project in Norway. Results for V-RISK-Y were good for adolescent psychiatry but insufficient for child welfare. The aims were to develop the Violence Risk Assessment Checklist – Youth Protection, Aged 12–18 (V-RISK-YP) for child welfare institutions, to explore the feasibility of V-RISK-YP, and to compare predictive properties of V-RISK-YP and V-RISK-Y in child welfare. The target group was all youths acutely placed in four child welfare institutions during a one-year period. All placements were decided by the local municipality child welfare team. Final study population consisted of 162 youths. Data for child welfare from the V-RISK-Y multicenter project was re-analysed resulting in the V-RISK-YP. V-RISK-YP and V-RISK-Y scores at admission were compared with registered violent episodes during institutional stay. The design was a prospective observational study in a naturalistic setting. Main findings were significantly better predictive results for V-RISK-YP compared to V-RISK-Y, and that V-RISK-YP significantly added predictive validity to the control variables in the study. The results indicate that V-RISK-YP can be a useful violence risk screening instrument and fill a shortage of this type of instruments in child welfare institutions, but more studies are needed in other settings or cultures with higher power to confirm validity and usability.
In educational settings where resources and time are limited, effective interventions are crucial to fostering students’ positive youth development and well-being. Two prevalent interventions in schools are psycho-educational and cultural-educational approaches, yet rigorous evaluation of their effectiveness has been lacking. The primary objective of this study was to contrast the efficacy of psycho-educational and cultural-educational approaches in promoting positive emotions and enhancing positive thinking skills among middle school students. A cluster randomized controlled trial was conducted involving 196 middle school students aged 13–15 years. Participants were assessed at three time points: baseline, immediately post-intervention, and at a 3-month follow-up. Repeated measures analysis was utilized to evaluate the outcome variables. The results showed that, compared to the cultural-educational approach, the psycho-educational intervention was associated with significantly greater improvements in positive emotions and positive thinking skills. These differential gains were maintained at the 3-month follow-up. In contrast, the gains observed in the cultural-educational group were significantly smaller than those in the psycho-educational group, and these differences were not statistically significant at post-intervention or follow-up when comparing the two approaches. Repeated measures ANOVA and post hoc analyses revealed strong main group and short - term effects on the outcome variables, favoring the psycho - educational intervention. Given that the psycho-educational approach demonstrated superior efficacy relative to the cultural-educational approach in this study, it may represent a preferable strategy for resource-constrained schools aiming to improve student well-being. However, the choice between approaches should be contingent upon the specific school context.
Children growing up in families experiencing complex and multiple problems face an increased risk of interpersonal trauma and adverse developmental outcomes. Parental trauma, emotion regulation difficulties, and strained parent-child relationships may limit the feasibility and response to outpatient trauma-focused interventions. To address these barriers, the Dutch KINGS program integrates trauma treatment for parents and children with work on family interactions and parenting in an inpatient setting that provides safety and structure. We examined outcome trajectories and change patterns before, during, and after KINGS across child and parental trauma symptoms, child emotional and behavioral problems, parental feelings and responses toward the child, and the parent-child relationship. We conducted a quasi-experimental multiple-case time-series study with non-concurrent, staggered intervention onset. The analytic sample included 15 families (n = 15 parents; n = 18 children) who completed weekly assessments across baseline (≥ 5 weeks), intervention, and 8-week follow-up. We used visual analyses, Simulation Modeling Analysis (SMA), and Nonoverlap of All Pairs (NAP) to evaluate changes and temporal patterns. For each outcome, except the parent-child relationship, at least half of the participants showed moderate-to-strong improvement during KINGS. Change patterns varied (e.g., gradual gains or brief early worsening followed by improvement), and most gains were maintained or enhanced during follow-up. Improvements were most consistent for child and parental trauma symptoms. Integrative, inpatient trauma-focused family treatment was associated with improvements in families for whom outpatient care proved insufficient. Larger comparative studies with extended follow-up are needed to strengthen causal inference and assess generalizability.
