Abstract
These data include clinically and theoretically grounded, cross-domain cumulative risk and protection measures. These measures were established for use with three sibling groups at Mothercraft's Breaking the Cycle (BTC), a child maltreatment prevention and early intervention program for substance using mothers and their children. These measures were established using archival data obtained from clients’ charts. The cumulative risk factor measure encompasses: 1) items from a cumulative risk measure utilized in prior BTC research, 2) clinical measures assessing maternal mental health, addiction, and parenting capacity, 3) a measure utilized in studies on adverse childhood experiences, and 4) the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (Axis IV: Psychosocial Stressors) [1–3]. The cumulative protection factor measure encompasses: 1) existing early intervention components of services at BTC, 2) clinical measures assessing maternal mental health, addiction, and parenting capacity, and 3) known protective factors outlined in the literature. Both measures were theoretically grounded using the Developmental Model of Transgenerational Transmission of Psychopathology [4], which enabled salient domains of risk and protection to be delineated for children exposed prenatally to substances and accessing child maltreatment prevention and early intervention services. For a description of the process of establishing these measures, the total and cross-domain cumulative risk and protection percentages for the sample, as well as a qualitative interpretation of the balance between domains of risk and protection, see [5]. These measures can contribute to improved future understanding around cumulative risk and cumulative protection in vulnerable populations, salient domains of risk and protection, and the unique interaction that occurs between risk and protective processes in the context of child maltreatment prevention and early intervention.
Keywords: Cumulative risk, Cumulative protection, Cross-Domain, Theoretically Grounded, Child maltreatment, Prenatal substance exposure
Specifications table
| Subject | Psychology: Clinical Psychology |
| Specific subject area | Cumulative Risk and Protection |
| Type of data | Cumulative Risk Measure (table) Cumulative Protection Measure (table) |
| How data were acquired | Clinical measures, clinical factors, early intervention services, relevant literature |
| Data format | Raw |
| Parameters for data collection | Relevant cumulative risk and protection items for children exposed prenatally to substances across theoretically grounded perinatal domains (i.e., mother, other parental figure, family, pre-natal/pregnancy, birth/post-natal, child, parent-child interaction, social network/professional services). |
| Description of data collection | The cumulative risk measure encompasses prior measures of risk and diagnostic classifications. The cumulative protection measure encompasses components of early intervention, clinical measures, and factors outlined in the literature. |
| Data source location | Mothercraft's Breaking the Cycle Toronto Canada |
| Data accessibility | With the article |
| Related research article | B.C. Bondi, D.J. Pepler, M. Motz, and N.C.Z. Andrews, Establishing Clinically and Theoretically Grounded Cross-Domain Cumulative Risk and Protection Scores in Sibling Groups Exposed Prenatally to Substances, Child Abuse & Neglect.108, 2020 https://doi.org/10.1016/j.chiabu.2020.104631. |
Value of the data
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These data are cumulative risk and protection measures that were clinically grounded in a child maltreatment prevention and early intervention program. Their theoretical foundation enabled a domain-specific conceptualization of risk and protection, which facilitates the consideration of intra- and inter-domain risk and protection. Further, these data enable consideration of cumulative protection in addition to risk.
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Researchers and clinicians interested in understanding cumulative risk and protection across clinically salient perinatal domains in vulnerable children can benefit from these data. The measures take a strength-based approach, highlighting the importance of protection alongside risk. Researchers interested in examining the balance between risk and protection can make use of both measures concurrently.
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These measures can be employed in future validation research in larger samples of vulnerable children. Together, the measures of cumulative risk and protection can contribute to future understanding around how risk and protective processes interact, and highlight salient domains of risk and protection in vulnerable populations.
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Given that these measures were established for use in a highly vulnerable sample of children at Mothercraft's Breaking the Cycle, they are comprehensive measures applicable for use with populations exposed to variable levels of risk.
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These measures can contribute to future research on evidence-based child maltreatment prevention and early interventions that: 1) serve children identified as having high-risk profiles, 2) address the full range of risk factors impacting development, 3) provide individualized interventions specific to vulnerable risk domains, and 4) incorporate the most effective protective factors into practice.
1. Data description
Table 1. Cumulative Risk Factor Measure. Dichotomously coded risk factors for substance-exposed children undergoing early intervention organized by perinatal domains (i.e., mother, other parental figure, family, pre-natal/pregnancy, birth/post-natal, child, parent-child interaction, social network/professional services).
Table 1.
Cumulative risk factor measure.
| DOMAIN | SCORING | ||
|---|---|---|---|
| PARENT - MOTHER | |||
| Presence of a diagnosed DSM-IV-TRa/DSM-5b mental illness | (0) no | unknown | (+1) yes |
| Family history of mental illness | (0) no | unknown | (+1) yes |
| Chronic medical illness | (0) no | unknown | (+1) yes |
| Maternal level of education: has not completed high school | (0) no | unknown | (+1) yes |
| Conviction history | (0) no | unknown | (+1) yes |
| Mother has history of child abuse/neglect | (0) no | unknown | (+1) yes |
| Mother has history of interpersonal violence/trauma | (0) no | unknown | (+1) yes |
| Maternal anxiety symptoms (clinical level – BAIc) | (0) no | unknown | (+1) yes |
| Mother endorses depressive symptoms (clinical level – CESD-Dd) | (0) no | unknown | (+1) yes |
| Teenage parent | (0) no | unknown | (+1) yes |
| More than 3 births | (0) no | unknown | (+1) yes |
| Has tried to quit substance use ever | (0) no | unknown | (+1) yes |
| Reports having had withdrawal symptoms when trying to stop substance use | (0) no | unknown | (+1) yes |
| Low perceived social support – Family (PSSe) | (0) no | unknown | (+1) yes |
| Low perceived social support – Friends (PSSe) | (0) no | unknown | (+1) yes |
| Is not comfortable with closeness and intimacy (RAASf) | (0) no | unknown | (+1) yes |
| Does not feel she can depend on others (RAASf) | (0) no | unknown | (+1) yes |
| Worries about being rejected or unloved (RAASf) | (0) no | unknown | (+1) yes |
| Low confidence regarding ability to cope with relapse crisis situations (DTCQg) | (0) no | unknown | (+1) yes |
| History of self-harm behaviours or suicide attempt | (0) no | unknown | (+1) yes |
| PARENT - OTHER | |||
| Secondary parent is absent from child's life | (0) no | unknown | (+1) yes |
| Presence of a diagnosed DSM-IV-TRa/DSM-5b mental illness | (0) no | unknown | (+1) yes |
| Substance use | (0) no | unknown | (+1) yes |
| Has tried to quit substance use ever | (0) no | unknown | (+1) yes |
| Conviction history | (0) no | unknown | (+1) yes |
| Difficult/dysfunctional or abusive relationship with mother of child | (0) no | unknown | (+1) yes |
| FAMILY | |||
| Maternal pregnancy/Birth of a sibling | (0) no | unknown | (+1) yes |
| New child adopted | (0) no | unknown | (+1) yes |
| More than one child in the home | (0) no | unknown | (+1) yes |
| Medical illness of parent or caregiver | (0) no | unknown | (+1) yes |
| Death of parent or important person | (0) no | unknown | (+1) yes |
| Other trauma to significant person in the child's life | (0) no | unknown | (+1) yes |
| Mother is engaged in a domestically violent relationship/Domestic violence | (0) no | unknown | (+1) yes |
| Has a primary relationship with substance user | (0) no | unknown | (+1) yes |
| Parent or caregiver traumatic divorce or separation | (0) no | unknown | (+1) yes |
| Custody dispute | (0) no | unknown | (+1) yes |
| New romantic relationship | (0) no | unknown | (+1) yes |
| New adult in household (e.g., romantic partner) | (0) no | unknown | (+1) yes |
| Parent or caregiver remarriage | (0) no | unknown | (+1) yes |
| Substance use by household member (non-parental) | (0) no | unknown | (+1) yes |
| Parental substance use relapse | (0) no | unknown | (+1) yes |
| Child protective services involvement | (0) no | unknown | (+1) yes |
| Removal of non-index child from home | (0) no | unknown | (+1) yes |
| Child put up for adoption | (0) no | unknown | (+1) yes |
| Parental unemployment or job instability | (0) no | unknown | (+1) yes |
| Poverty or near poverty (less than $10,000) | (0) no | unknown | (+1) yes |
| Head of household has no more than a semiskilled occupation | (0) no | unknown | (+1) yes |
| Inadequate, unsafe or overcrowded housing or homelessness | (0) no | unknown | (+1) yes |
| Multiple housing moves (2+) | (0) no | unknown | (+1) yes |
| Parental arrest | (0) no | unknown | (+1) yes |
| Parental incarceration (or return from incarceration) | (0) no | unknown | (+1) yes |
| PRE-NATAL/PREGNANCY | |||
| Domestic violence | (0) no | unknown | (+1) yes |
| Alcohol use | (0) no | unknown | (+1) yes |
| Cannabis use | (0) no | unknown | (+1) yes |
| Crack/cocaine use | (0) no | unknown | (+1) yes |
| Heroin use | (0) no | unknown | (+1) yes |
| Methadone use | (0) no | unknown | (+1) yes |
| Other opiates use | (0) no | unknown | (+1) yes |
| Nicotine use | (0) no | unknown | (+1) yes |
| Prescription drug use | (0) no | unknown | (+1) yes |
| Other drug use (eg., amphetamines, hallucinogens, barbiturates/sleeping pills, sedatives/hyponotics/tranquilizers, inhalants | (0) no | unknown | (+1) yes |
| Poly-substance exposure versus single substance exposure during pregnancy | (0) no | unknown | (+1) yes |
| Continuous exposure over all three trimesters during pregnancy | (0) no | unknown | (+1) yes |
| Transiency | (0) no | unknown | (+1) yes |
| Low maternal weight gain | (0) no | unknown | (+1) yes |
| High blood pressure/ pre-eclampsia | (0) no | unknown | (+1) yes |
| Mother overweight pre-pregnancy | (0) no | unknown | (+1) yes |
| Poor pre-natal nutrition | (0) no | unknown | (+1) yes |
| Mom >35 years | (0) no | unknown | (+1) yes |
| Teenage pregnancy | (0) no | unknown | (+1) yes |
| Minimal prenatal care | (0) no | unknown | (+1) yes |
| History of miscarriages or terminations | (0) no | unknown | (+1) yes |
| Diabetes during pregnancy | (0) no | unknown | (+1) yes |
| Infections/Sexually Transmitted Disease | (0) no | unknown | (+1) yes |
| Anemia | (0) no | unknown | (+1) yes |
| Placenta Previa | (0) no | unknown | (+1) yes |
| Multiple fetuses | (0) no | unknown | (+1) yes |
| Vaginal bleeding (2nd or 3rd trimester) | (0) no | unknown | (+1) yes |
| BIRTH/POST-NATAL | |||
| Mom >35 years | (0) no | unknown | (+1) yes |
| Teenage pregnancy | (0) no | unknown | (+1) yes |
| Caesarean delivery | (0) no | unknown | (+1) yes |
| Premature delivery | (0) no | unknown | (+1) yes |
| Birth complications | (0) no | unknown | (+1) yes |
| Post-partum depression | (0) no | unknown | (+1) yes |
| Apprehension at birth | (0) no | unknown | (+1) yes |
| Post-natal Medical Diagnoses: | |||
| Fetal Alcohol Spectrum Disorder | (0) no | unknown | (+1) yes |
| Drug withdrawal | (0) no | unknown | (+1) yes |
| Genetic disorder | (0) no | unknown | (+1) yes |
| Seizure/tremors | (0) no | unknown | (+1) yes |
| Heart complications | (0) no | unknown | (+1) yes |
| Birth injuries | (0) no | unknown | (+1) yes |
| Birth defects | (0) no | unknown | (+1) yes |
| Breathing difficulty | (0) no | unknown | (+1) yes |
| Low birth weight | (0) no | unknown | (+1) yes |
| Meconium in placenta | (0) no | unknown | (+1) yes |
| Post-natal Interventions: | |||
| Incubator | (0) no | unknown | (+1) yes |
| Tube feeding | (0) no | unknown | (+1) yes |
| Apnea monitor | (0) no | unknown | (+1) yes |
| Respirator (required ventilation) | (0) no | unknown | (+1) yes |
| Medication requires | (0) no | unknown | (+1) yes |
| CHILD | |||
| Hospitalization of child | (0) no | unknown | (+1) yes |
| Child medical illness | (0) no | unknown | (+1) yes |
| Presence of a diagnosed DSM-IV-Ra/DSM-5b mental illness | (0) no | unknown | (+1) yes |
| Presence of Fetal Alcohol Spectrum Disorder diagnosis | (0) no | unknown | (+1) yes |
| Child in foster care or kin care/Change in primary caregiver | (0) no | unknown | (+1) yes |
| Child neglect (physical, emotional) | (0) no | unknown | (+1) yes |
| Child abuse (physical, sexual, emotional) | (0) no | unknown | (+1) yes |
| Child reunification with parent after separation | (0) no | unknown | (+1) yes |
| Multiple changes in childcare provider | (0) no | unknown | (+1) yes |
| Stress surrounding child starting daycare/entered school system | (0) no | unknown | (+1) yes |
| Challenging temperament style | (0) no | unknown | (+1) yes |
| Psychosocial & Health Concerns at Intake: | |||
| Chronic colds | (0) no | unknown | (+1) yes |
| Chronic respiratory problems | (0) no | unknown | (+1) yes |
| Chronic ear infections | (0) no | unknown | (+1) yes |
| Heart problems | (0) no | unknown | (+1) yes |
| Gastroenteritis | (0) no | unknown | (+1) yes |
| Limitation in mobility | (0) no | unknown | (+1) yes |
| Seizures | (0) no | unknown | (+1) yes |
| Psychological/emotional problem | (0) no | unknown | (+1) yes |
| Developmental delays/delays to meet developmental milestones | (0) no | unknown | (+1) yes |
| Injuries | (0) no | unknown | (+1) yes |
| Eating problems | (0) no | unknown | (+1) yes |
| Slow weight gain | (0) no | unknown | (+1) yes |
| Behind in immunization | (0) no | unknown | (+1) yes |
| Visual impairment | (0) no | unknown | (+1) yes |
| Hearing impairment | (0) no | unknown | (+1) yes |
| Speech impairment | (0) no | unknown | (+1) yes |
| Cognitive impairment | (0) no | unknown | (+1) yes |
| Frequent injuries | (0) no | unknown | (+1) yes |
| Behavioural problems | (0) no | unknown | (+1) yes |
| Asthma | (0) no | unknown | (+1) yes |
| PARENT-CHILD INTERACTION | |||
| Low parental efficacy (BaPh) | (0) no | unknown | (+1) yes |
| Low parental satisfaction (BaPh) | (0) no | unknown | (+1) yes |
| High defensive responding (PSIi) | (0) no | unknown | (+1) yes |
| High parental distress (PSIi) | (0) no | unknown | (+1) yes |
| High parent-child dysfunctional interactions (PSIi) | (0) no | unknown | (+1) yes |
| Mother's perception of having a difficult child (PSIi) | (0) no | unknown | (+1) yes |
| Clinical level of stress in parenting role (PSIi) | (0) no | unknown | (+1) yes |
| High parental expectations (AAPIj) | (0) no | unknown | (+1) yes |
| Low parental empathy (AAPIj) | (0) no | unknown | (+1) yes |
| Reversed familial/parent-child roles (AAPIj) | (0) no | unknown | (+1) yes |
| High hostile ineffective parenting (NLSCYk) | (0) no | unknown | (+1) yes |
| High inconsistent parenting (NLSCYk) | (0) no | unknown | (+1) yes |
| Low positive parenting (NLSCYk) | (0) no | unknown | (+1) yes |
| Reporting challenging relationship with child | (0) no | unknown | (+1) yes |
| Child apprehension within first three years of life | (0) no | unknown | (+1) yes |
| SOCIAL NETWORK | |||
| Disadvantaged minority ethnic background | (0) no | unknown | (+1) yes |
| Immigrant status | (0) no | unknown | (+1) yes |
| Acculturation or language conflicts | (0) no | unknown | (+1) yes |
Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision; American Psychiatric Association, 2000
Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition; American Psychiatric Association, 2013
Beck Anxiety Inventory; Beck, Epstein, Brown, & Steer, 1988
Center for Epidemiologic Studies Depression Scale; Radloff, 1977
Perceived Social Support from Friends and Family; Procidano & Heller, 1983
Revised Adult Attachment Scale; Collins, 1996
Drug-Taking Confidence Questionnaire; Annis & Martin, 1985
Being a Parent Scale; Johnston & Mash, 1989
Parenting Stress Index; Abidin, 1986
Adult Adolescent Parenting Inventory; Bavolek, 1984
National Longitudinal Survey of Children and Youth; Statistics Canada, 1994
Table 2. Cumulative Protection Factor Measure. Dichotomously coded protective factors for substance-exposed children undergoing early intervention organized by perinatal domains (i.e., mother, other parental figure, family, pre-natal/pregnancy, birth/post-natal, child, parent-child interaction, social network/professional services).
Table 2.
Cumulative protective factor measure.
| DOMAIN | SCORING | ||
|---|---|---|---|
| PARENT - MOTHER | |||
| Attends Basic Life Skills group at BTCa | (0) no | unknown | (+1) yes |
| Attends Emotional Awareness Life Skills group at BTCa | (0) no | unknown | (+1) yes |
| Attends Connectionsb group at BTCa | (0) no | unknown | (+1) yes |
| Attends Relapse Prevention group at BTCa | (0) no | unknown | (+1) yes |
| Attends Recovery Group at BTCa | (0) no | unknown | (+1) yes |
| Attends Mindfulness group at BTCa | (0) no | unknown | (+1) yes |
| In recovery for substance use | (0) no | unknown | (+1) yes |
| Attending substance use treatment | (0) no | unknown | (+1) yes |
| Accessing addiction support | (0) no | unknown | (+1) yes |
| Accessing urine screens | (0) no | unknown | (+1) yes |
| Accessing mental health support/therapy/trauma counselling | (0) no | unknown | (+1) yes |
| High Perceived Social Support – Family (PSSb) | (0) no | unknown | (+1) yes |
| High Perceived Social Support – Friends (PSSb) | (0) no | unknown | (+1) yes |
| Is comfortable with closeness and intimacy (RAASc) | (0) no | unknown | (+1) yes |
| Feels she can depend on others (RAASc) | (0) no | unknown | (+1) yes |
| Does not worry about being rejected or unloved (RAASc) | (0) no | unknown | (+1) yes |
| High confidence regarding ability to cope with relapse crisis situations (old DTCQd) | (0) no | unknown | (+1) yes |
| Maternal level of education: has completed post-secondary education | (0) no | unknown | (+1) yes |
| PARENT - OTHER | |||
| No substance use history | (0) no | unknown | (+1) yes |
| If substance use history, in recovery for substance use | (0) no | unknown | (+1) yes |
| Parent attending substance use treatment | (0) no | unknown | (+1) yes |
| Accessing addiction support | (0) no | unknown | (+1) yes |
| Accessing mental health support/therapy/trauma counselling | (0) no | unknown | (+1) yes |
| Presence of positive secondary parental figure to child | (0) no | unknown | (+1) yes |
| FAMILY | |||
| Partner supportive of maternal substance use treatment services | (0) no | unknown | (+1) yes |
| Family supportive of maternal substance use treatment services | (0) no | unknown | (+1) yes |
| Presence of extended familial supports | (0) no | unknown | (+1) yes |
| High socio-economic status | (0) no | unknown | (+1) yes |
| Accessing couples therapy services | (0) no | unknown | (+1) yes |
| Accessing family therapy services | (0) no | unknown | (+1) yes |
| Family cohesion | (0) no | unknown | (+1) yes |
| PRE-NATAL/PREGNANCY | |||
| Early-intervention through BTC Pregnancy Outreach Programe | (0) no | unknown | (+1) yes |
| Attends BTC Pregnancy Outreach Programe Prenatal Relapse Prevention group | (0) no | unknown | (+1) yes |
| BIRTH/POST-NATAL | |||
| Neonatal follow-up | (0) no | unknown | (+1) yes |
| CHILD | |||
| Easy temperament | (0) no | unknown | (+1) yes |
| Child was/is in daycare | (0) no | unknown | (+1) yes |
| Child involved in extra-curricular activities | (0) no | unknown | (+1) yes |
| Child has positive teacher relationships at school/daycare | (0) no | unknown | (+1) yes |
| Received occupational therapy | (0) no | unknown | (+1) yes |
| Received speech/language therapy | (0) no | unknown | (+1) yes |
| Received psychological assessment | (0) no | unknown | (+1) yes |
| Child protective services involvement | (0) no | unknown | (+1) yes |
| PARENT-CHILD INTERACTION | |||
| High parental efficacy (BaPf) | (0) no | unknown | (+1) yes |
| High parental satisfaction (BaPf) | (0) no | unknown | (+1) yes |
| Low parental distress (PSIg) | (0) no | unknown | (+1) yes |
| Low parent-child dysfunctional interactions (PSIg) | (0) no | unknown | (+1) yes |
| Mother's perception of having an easy child (PSIg) | (0) no | unknown | (+1) yes |
| Low level of stress in parenting role (PSIg) | (0) no | unknown | (+1) yes |
| Low parental expectations (AAPIh) | (0) no | unknown | (+1) yes |
| High parental empathy (AAPIh) | (0) no | unknown | (+1) yes |
| Intact familial/parent-child roles (AAPIh) | (0) no | unknown | (+1) yes |
| Low hostile ineffective parenting (NLSCYi) | (0) no | unknown | (+1) yes |
| Low inconsistent parenting (NLSCYi) | (0) no | unknown | (+1) yes |
| High positive parenting (NLSCYi) | (0) no | unknown | (+1) yes |
| Attended New Mom Support group at BTCa | (0) no | unknown | (+1) yes |
| Attends Mother Goose group at BTCa | (0) no | unknown | (+1) yes |
| Attends Learning Through Playj group at BTCa | (0) no | unknown | (+1) yes |
| SOCIAL NETWORK/PROFESSIONAL CARE/SERVICES | |||
| Non-family adult support network | (0) no | unknown | (+1) yes |
| Public health services | (0) no | unknown | (+1) yes |
| High risk nurse services | (0) no | unknown | (+1) yes |
| Physician | (0) no | unknown | (+1) yes |
| Financial Allowances (e.g., ODSPk, OCCSl, Ontario Works) | (0) no | unknown | (+1) yes |
Mothercraft's Breaking the Cycle
Perceived Social Support from Friends and Family; Procidano & Heller, 1983
Revised Adult Attachment Scale; Collins, 1996
Drug-Taking Confidence Questionnaire; Annis & Martin, 1985
Racine, Motz, Leslie, & Pepler, 2009
Being a Parent Scale; Johnston & Mash, 1989
Parenting Stress Index; Abidin, 1986
Adult Adolescent Parenting Inventory; Bavolek, 1984
National Longitudinal Survey of Children and Youth; Statistics Canada, 1994
Pepper & Weitzman, 2004
Ontario Disability Support Program
Ontario Child Care Supplement
2. Experimental design, materials and methods
The cumulative risk measure was established using items from prior measures, including: 1) items from a cumulative risk measure utilized in prior BTC research, 2) measures used clinically at BTC to assess maternal mental health, addiction, and parenting capacity, 3) a measure utilized in studies on adverse childhood experiences, and 4) the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood, specifically Axis IV on Psychosocial Stressors [1], [2], [3]. Each risk item is coded dichotomously, with exposure = 1 and no exposure = 0. Risk assignment was intended to be accomplished using statistical criteria (e.g., upper quartile of risk exposure = 1; all others = 0) or a priori theoretical and conceptual categorization (e.g., being below the poverty line, single parenthood) and clinical classifications on relevant clinical measures (e.g., clinically significant anxiety), when appropriate.
The cumulative protection measure was established based on 1) existing early intervention components of services at BTC, 2) clinical measures assessing maternal mental health, addiction, and parenting capacity, and 3) known protective factors outlined in the literature. Each protection item is coded dichotomously, with exposure = 1 and no exposure = 0. Again, assignment was intended to be accomplished using statistical criteria (e.g., lower quartile of risk exposure = 1; all others = 0) or a priori theoretical and conceptual categorization (e.g., accessing early intervention services), when appropriate.
The sum of the dichotomous elements within each domain can be calculated to yield domain-specific cumulative risk and protection scores. Total cumulative risk and protection scores can be computed by adding the scores across each domain. Total and domain-specific scores can be converted into percentages to ensure that the denominator is dependent on the number of applicable items, with unknown elements removed.
Ethics statement
Informed consent was obtained from all individual participants included in the study.
Declaration of competing interest
The authors declare that they have no known competing financial interests or personal relationships which have, or could be perceived to have, influenced the work reported in this article.
Acknowledgments
None.
Contributor Information
Bianca C. Bondi, Email: bbondi@yorku.ca.
Debra J. Pepler, Email: pepler@yorku.ca.
Mary Motz, Email: mmotz@mothercraft.org.
Naomi C.Z. Andrews, Email: nandrews@brocku.ca.
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