The Impact of Doula-Supported Care on Stress Levels of Women Receiving Opioid Addiction Treatment

Introduction: Mothers suffering from opioid addiction are at high risk for experiencing extreme stress levels which prevents them from providing a healthy and nurturing environment for their family. The aim of this project is to explore if a doula-supported care team alleviates the parenting stress of new mothers participating in opioid addiction rehabilitation. Methods: A total of 35-40 women in treatment at the Montair program for substance use disorder rehabilitation were recruited to participate in the City of Philadelphia’s Community Doula project. The Parenting Stress Index Score (PSI) was recorded and compared to a control group composed of women in the same rehabilitation program who did not utilize the doula services. Additional qualitative interviews were recorded through phone interviews. Results: Parenting women with opioid use disorders experience high levels of stress. We hypothesize that women who utilize the doula program will have significantly lower PSIs than those who do not. Major results of this study show (placeholder). This project originally aimed to explore the effect of the doula program on attachment styles on women participating in substance abuse rehabilitation through a comparison using the Keys to Interactive Parenting Scale (KIPS). However due to limitations imposed by the COVID-19 pandemic this original goal could not be accomplished. Conclusions: We hypothesize that the implementation of doula-supported services will alleviate parenting stress to a significant degree. If our hypothesis is correct the results of this program would support future funding for the continuation and expansion of the City of Philadelphia’s Community Doula program

Impact of Long-Term Doula Services on Maternal and Fetal Health Outcomes in Women in Treatment for Opioid Use Disorder

This study analyzed the impact of doula services on maternal and fetal health outcomes in pregnant women seeking treatment for opioid use disorder. Understanding the impact of doula services is critical in reducing inequities in health outcomes experienced by this vulnerable population. Retrospective and prospective data was collected from surveys, focus groups, and maternal and infant birth data from 100 women in treatment for opioid use disorder, with fifty utilizing doulas and fifty not utilizing doulas. Standardized data abstraction of quantitative and qualitative measures were collected into an SPSS database and Nvivo, respectively, and analyzed using SPSS. Measures of importance included number of birth complications (maternal or infant), psychosocial outcomes, breastfeeding initiation, and parenting behaviors. The preliminary study is ongoing. While data is limited, preliminary results show no difference amongst control vs. doula group in PSI (PSI Mean = 67.53) (STD=11.81) or PSS (PSS Mean =14.87) (STD=5.18) scores, reflecting no change in psychosocial outcomes. Qualitative analyses of preliminary data reflect working with a doula as a generally positive experience that has assisted with family reunification, health advocacy, resource assistance, and recovery support, all of which showed the lasting positive impact of doula support on parenting behaviors. Further data collection and analyses need to be conducted to determine the impact on birth complications and health outcomes. Doula services should be included in Medicaid coverage, due to its potential to reduce complications and inequities in health outcomes, improve psychosocial support, and its cost-effectiveness

Exploring Political Awareness and Civic Engagement Among Women Utilizing MATER Services

Introduction: High levels of civic engagement by United States citizens sustains the integrity of the democratic system. Health organizations, such as The Maternal Addiction Treatment Education and Research (MATER) program, are in a position to help marginalized voting-eligible individuals overcome barriers to voting. Methods: The target population was women utilizing MATER services. The study design consisted of a survey collecting data including demographic information, political engagement, perceived barriers, and interest in future advocacy. Following the survey, participants were offered more voting resources. Results: One hundred percent of participants reported utilizing public assistance. Forty-eight percent reported a social network as their source of voting information and 28% reported social media. Seventy-seven percent reported no interest in future advocacy, 13% reported interest, and 10% were unsure. Forty-one percent of participants reported not being registered as their reason for not voting (the most common reason) and 29% reported not being interested in the election (second most common). Not knowing where to go was the most prevalent barrier to voting, with 36% of participants reporting this as the case. Conclusion: It is crucial for women at MATER to be civically engaged. Information was obtained regarding their degree of civic engagement and their barriers to engagement and voting. These results are instrumental in increasing civic engagement among the target population and related populations, as well as potentially promoting better health outcomes, more effective healthcare and drug treatment services, improved relations with political entities, sociopolitical empowerment, and more effective democracy

Assessing the Role of Virtual Social Networks in the Treatment Progress of Mothers Recovering from Opiate Addiction

Introduction: Social engagement is a significant contributor to the treatment success of individuals with prior substance use. This project aims to determine if social engagement improves the progression through and experience of treatment of mothers with prior opioid use at an inpatient recovery facility. We hypothesize that increased social engagement will improve treatment progress and experience. Methods: The project is centered on mothers seeking treatment for opioid use at an urban inpatient treatment facility. The study obtains qualitative and quantitative data through interviews and therapy sessions. The data informs the extent and quality of social engagement and individual perspectives of the facility residents on their current social engagement. The data was evaluated for major themes and analyzed using basic statistics (mean and mode). Results: 92.35% of social engagement discussions in therapy sessions were neutral or positive, and 45% of interviewees were interested in family therapy. The average number of support persons mentioned during each therapy session was 1.44, and the most often mentioned type of social support was the resident’s partner or father of her baby. The most common time duration spent engaging with support persons was up to 1.5 hours per week. Conclusion: The preliminary data is insufficient to conclude if the data supports that increased social engagement leads to improved treatment progress. This current data requires the integration of interview data with data reported from therapy sessions to better assess treatment experience. Long-term observation is necessary obtain a broader perspective on the development of social engagement and its impact on treatment progress

Race and Disordered Eating: A Narrative Review of Current Literature

Research Problem: Eating disorder literature has well-established a correlation between childhood trauma and development of eating disorder symptomology. One type of trauma that is often overlooked in eating disorder research is that of racial stress faced by ethnic minorities. The literature on racism and eating disorders tends to focus on the transdiagnostic construct of disordered eating behavior rather than specific DSM-5 diagnoses. As such, the current literature review examined the findings regarding associations between racial stressors and disordered eating behavior. Methods: The current literature review between Nov 2007 and August 2020 searched 3 databases, PubMed, CINAHL, and PsycInfo for English-language publications pertaining to conflict in racial identity (e.g., racism and acculturative stress) and disordered eating (keywords provided below). As there is limited primary research examining the association between racial stress and clinical diagnoses of eating disorders, this literature review expanded the search term of “eating disorder” (and its associated subcategories) to include other types of disordered eating, a behavior that often precedes the development of clinically diagnosable eating disorders. The literature search yielded 42 results, 81% (N=34) of which were included in the review; the included articles examined the relationship between disordered eating and various racial identity conflicts, including racism, ethnic identity exploration, perceived discrimination, and acculturative stress. 32 articles were cross-sectional design, 1 article was a theoretical analysis, and 1 article was a review. Results: The included literature looked at multiple minority populations, including Asian Americans, African Americans, Hispanic Americans, and Native Americans, and overwhelmingly found that perceived racism is consistently associated with disordered eating, especially for minority women. Current research suggests that across minority groups, the mediating factor in this association is self-reported stress. Other studies (N=7) produced mixed findings (i.e., positive correlations or null results) regarding the relationship between acculturative stress and disordered eating behavior. The magnitude of the relationship often differed based on the ethnicity and gender of the population being studied. Finally, racial teasing and discrimination were associated with disordered eating, disturbed body image, and depressive symptoms primarily among females across multiple races. Conclusion: While there is a body of research examining racial stress and disordered eating behavior, samples were primarily drawn from college students, and this body of research relies almost entirely on cross-sectional methodology. Moreover, the current review did not identify any studies that examined clinically-diagnosed eating disorder populations or any studies that utilized a longitudinal design. As such, the current review indicates a need for prospective longitudinal studies examining relevant risk factors and their relationship to the development of disordered eating behaviors over time in minority populations. Additionally, it is important for physicians to assess for racial stress as a potential factor contributing to the physical and mental health outcomes of minority patients, especially among minority women

Strategic Design Development for Malawian Public Health Center Labor & Delivery Suites

Introduction: Maternity ward pre-, peri-, and postnatal room sharing creates concerns regarding maternal privacy (particularly confidentiality and dignity), paternal involvement in birthing process, and staff workflow efficiency. This study aimed to understand the current state of the aforementioned concerns and their impact on maternal child bonding and maternal mental health at Queen Elizabeth Central Hospital (QECH). Methods: At discharge, mothers of birth (MOBs) were surveyed on pre-, peri-, and postnatal experience with regard to privacy and paternal involvement in the birthing process, and then assessed using the Mother to Infant Bonding Scale and Edinburg Depression Scale. Father of births (FOBs) or male partners present at discharge were surveyed on quality of experience, level and duration of involvement in the birthing process, and reason for choosing such involvement. All surveys were administered until saturation was reached and then analyzed with inductive thematic analysis. Paths of clinicians and nurse/midwives were mapped using GPS-enabled pedometers for two dayshifts and two nightshifts each. Results: Common themes identified among MOBs (N = 35) included… Major themes identified among FOBs (N = 35) included… An average of ___ and ___ steps per day were taken by clinicians (N = 4) and nurse/midwives (N = 4), respectively, with most time spent … and inefficiencies identified in… Conclusion: Improvements to privacy in the QECH maternity ward are necessary to preserve MOB dignity and confidentiality and promote inclusion of FOBs and male partners in the birthing process. Architectural solutions are necessary to reduce existing inefficiencies in average staff workflow

Menstrual management in adolescent transgender males

Introduction: Gender dysphoria is associated with increased rates of anxiety, depression, and suicidal ideation in adolescents. There is anecdotal evidence that menstruation increases the occurrence of gender dysphoria in adolescent transgender males. We hypothesize that menses are distressing to transgender males and this population would benefit from menstrual management. Methods: We conducted a retrospective chart review of all transgender male patients seen in the Nemours Gender Wellness Program (GWP) and limited our population to those who have reached menarche. Data was extracted from the encounters at the GWP clinic and recorded in REDCap. We compared self-reported symptoms of gender dysphoria at 3 months, 6 months, and one year following an individual’s baseline visit to the GWP. The incidence of gender dysphoria at subsequent visits will highlight the efficacy of treatment. Results: Preliminary results show that a majority of our population reported significant gender dysphoria related to menses. Of patients reporting gender dysphoria at the initial visit, 84% chose to use menstrual suppression. Patients who chose an IUD at the initial visit had a higher incidence of breakthrough bleeding and gender dysphoria at the first follow up visit compared to patients who chose other menstrual suppression methods. Conclusion: Menstruation is associated with increased gender dysphoria in transgender male adolescents. Menstrual suppression has the potential to be a transformative treatment for this population. Further research is necessary to determine whether the potential harm that could result from prolonging the distress associated with menses justifies the benefits of using an IUD

Mindfulness and Relapse Prevention among New Mothers during Recovery for Opioid Misuse

The opioid epidemic is a growing problem in the US and continues to affect various populations, including new mothers. We examined the effect of attendance to Mindfulness-Based Parenting (MBP) on risk of relapse and determined the influence of psychosocial factors – such as Adverse Childhood Events (ACE), Perceived Stress Scale (PSS), Parental Stress Index (PSI), and Five Facet Mindfulness scores – on risk of relapse. We abstracted urine drug screens to capture relapse among participants (N = 78) who enrolled in MBP and self-selected controls from their first cohort enrollment to six months after their last MBP session/cohort participation, and then analyzed the data using bivariate Chi-squared tests and bivariate logistic regressions. Lastly, we created multivariate binary logistic regression models to predict risk of relapse with number of sessions attended and repeating the course while controlling for demographic and psychosocial measures. We found that 48.5% of MBP participants and 33.3% of controls had at least one incident of relapse of any substance within six months post-MBP/last cohort. In our multivariate models evaluating risk of relapse, lower post-MBP total PSI scores were significantly associated with a decreased risk of any substance use by 6.7% and opioid use by 8.4%. Repeating the MBP curriculum was significantly associated with a decreased risk of relapse of any substance by 97.3%. Our models also showed that higher ACE scores were associated with an increased risk of relapse of other substance use and any substance use by 52.7% and 80.4%, respectively. This study provides evidence that MBP is associated with reducing the risk of relapse and highlighted the interaction of factors that can influence relapse among new mothers undergoing treatment for opioid use disorder

Prevalence and Characterization of Adverse Childhood Experiences of Women in Substance Use Treatment

Rates of illicit drug use among women reproductive age significant national public health problem Adverse childhood experiences (ACE’s) associated with higher rates of prenatal depression and maternal childhood maltreatment Ace’s prevalent in those with Opioid Use Disorder (OUD) Aims of Study: Determine prevalence of ACE’s in a population of pregnant and parenting women in treatment for substance use disorder Characterize ACE’s Compare our sample to Behavioral Risk Factor Surveillance System (BRFSS) Pennsylvania datahttps://jdc.jefferson.edu/obgynposters/1007/thumbnail.jp