Objective: To assess the effect of maternal prenatal and past-year cocaine use on mother-child interactions across preschool years. Methods: The sample is drawn from the Miami Prenatal Cocaine Study, a longitudinal follow-up of prenatal cocaine exposure (PCE) in a large cohort of African-American infants prospectively enrolled at birth. Analyses are based on the 366 children (168 PCE and 198 non-cocaine-exposed) in the care of their biological mothers and with completed mother-child interaction measures at the 3- and/or 5-year assessments. Videotaped interactions were coded using a modified Egeland Teaching Task scheme. Generalized linear models with a generalized estimating equations approach were used to evaluate the effect of PCE on the overall quality of maternal-child interaction, measured by the Egeland total score at both study visits, and on the individual Egeland subscales at the 5-year visit, while adjusting for other suspected influences on interactions. Results: PCE dyads demonstrated less optimal overall mother-child interactions compared with non-cocaine-exposed dyads. The estimated PCE-associated difference did not shift appreciably with statistical adjustment for child sex, child age at examination, or other birth covariates. PCE dyads with past-year maternal cocaine use had significantly lower Egeland summary scores compared with children with neither exposure. In subscale analyses, PCE was most strongly associated with greater maternal intrusiveness and boundary dissolution at the 5-year visit. Conclusions: Prenatal and past-year maternal cocaine use seems to be associated with poorer quality in mother-child interaction during early childhood. These dynamics should be considered when examining the association between PCE and child cognitive, behavioral, and academic outcomes.

Behavior problems in young children, especially among families from disadvantaged backgrounds (e.g., facing greater risk of poverty, social exclusion, discrimination, and violence), often result in referrals to mental health clinics. However, low‐income families from historically marginalized racial and ethnic backgrounds disproportionately experience barriers to accessing, engaging, and completing treatment. This study examined the recruitment and referral network of a parenting program providing Parent‐Child Interaction Therapy (PCIT) in a large urban academic medical center and affiliated community‐embedded clinics, as well as the impact of recruitment/referral sources on screening paperwork completion, intake attendance, and treatment completion. Data from 2510 families referred between 2018 and 2022 were analyzed, considering demographic factors and recruitment adaptations during COVID‐19. Referral sources included but were not limited to community agencies, social media, and healthcare providers. Logistic regression analyses determined the likelihood of completing the screening paperwork, attending intake, and completing treatment based on recruitment/referral sources. Every recruitment/referral source increased the likelihood of screening paperwork completion (except community outreach). Every source increased the likelihood of attending intake (except previously enrolled families). Treatment completion was significantly more likely for those referred from pediatricians, friends, behavioral health, and Google. After COVID‐19 (post March 2020), families were more likely to complete the screening paperwork, attend intake, and complete treatment compared to families screened before COVID‐19. Effective recruitment and retention strategies are crucial for engaging families in mental health services. Findings emphasize the role of community and healthcare providers, word‐of‐mouth, and Google and the benefits of telehealth (indicated by post‐COVID‐19 results), in improving treatment access and retention, highlighting the need for flexible service delivery methods.

Background Objectives: Parental anxiety and depression demonstrate bidirectional connections with child developmental outcomes (e.g., disruptive behavior). Directly targeting child development through behavioral parent training (BPT) has potential for reversing this cycle. Parent–Child Interaction Therapy (PCIT), a BPT with robust research evidence for decreasing child disruptive behaviors, has demonstrated promise in also decreasing caregiver anxiety and depression. However, the mechanisms that explain this relationship are less understood. Methods: The current study examined whether caregivers (N = 840) completing time-limited PCIT experienced significant reductions in depression and anxiety symptoms and improvements in child disruptive behaviors at each time point. Generalized estimate equation analyses assessed whether caregiver anxiety and depression moderated changes in child disruptive behavior. Mediation analyses explored the extent that changes in caregiver–child interactions over time explained changes in family outcomes. Results: Child disruptive behavior and caregiver depression and anxiety symptoms improved significantly at each time point of PCIT. Change in child behavioral outcomes was significantly moderated by caregiver race. Caregivers with higher anxiety reported fewer improvements in child disruptive behavior compared to other caregivers. Changes in caregiver anxiety and depression over the course of treatment were partially mediated by improvement in caregiver–child interaction skills. Changes in child disruptive behavior were not mediated by improvement in caregiver–child interaction skills. Conclusions: Results demonstrate that time-limited PCIT could significantly improve caregiver anxiety and depression, and some PCIT-taught parenting skills are direct drivers of this process. Further research is needed to understand other mechanisms underlying the relationship between PCIT and improved family outcomes.