The Comparative Effectiveness of Group Prenatal Care on Women\u27s Psychosocial Health

Background: High rates of adverse birth outcomes persist in the United States despite increased access to individual prenatal care (IPNC). Psychosocial factors influence birth outcomes and affect infant and child development and maternal functioning. Group prenatal care (GPNC) combines individual physical assessments and facilitated group education and support. Studies of GPNC show promising results, including lowered preterm birth rates, but the GPNC psychosocial mechanisms influencing birth outcomes are unclear. Methods: Surveys at study enrollment (N=248), late pregnancy, and six weeks postpartum assessed psychosocial effects of each PNC model. Multiple regression models and planned moderator analyses tested whether GPNC participants had better outcomes compared to IPNC, as main effects and for at-risk subgroups. Frequent, brief semi-structured interviews with 29 women during pregnancy through six weeks postpartum were conducted and analyzed to describe important PNC functions and how experiences and benefits differed according to the PNC model women selected. Results: GPNC participants did not demonstrate overall greater improvements in psychosocial outcomes compared to IPNC participants. Among women with low survey 1 social support, GPNC vs. IPNC participants demonstrated greater improvements in late-pregnancy prenatal distress and postpartum negative affect. Among women with high initial prenatal distress, GPNC vs. IPNC participants demonstrated greater improvements in planning-preparation coping in late pregnancy and postpartum depressive symptoms. In the qualitative interviews, women described four PNC functions: confirming baby and mother\u27s health, preventing and monitoring complications, educating and preparing, and building supportive relationships. Benefits included stress reduction, increased confidence, preparation, and motivation to change health behaviors, and informed decision making. While individual experiences varied, GPNC participants described greater educational and psychosocial benefits compared to IPNC participants. Implications: This study contributes to the existing PNC literature by explicating functions of PNC for women and showing that GPNC confers additional educational and psychosocial benefits compared to IPNC, particularly among women with greater psychosocial risk. Efforts to increase availability of high-quality GPNC can provide women with choices in PNC. The qualitative results indicate functions and benefits important to include in future PNC research. Large randomized studies are needed to establish conclusively the biological and psychosocial benefits of GPNC for women

The Effects of CenteringPregnancy Group Prenatal Care on Postpartum Visit Attendance and Contraception Use

We examined whether Medicaid-enrolled women in CenteringPregnancy group prenatal care had 23 higher rates of postpartum visit attendance and postpartum uptake of contraceptives, compared to women in individual prenatal care

An Enhanced Mentoring Model’s Impact on Youth in Boys and Girls Clubs

Although federal funding has been provided to add mentoring to youth development programs for decades, we still lack knowledge about the impacts of mentoring on youth outcomes. This research seeks to fill a gap by documenting youth outcomes from an enhanced mentoring approach for urban Boys and Girls Clubs (BGC) in the Southeastern United States delivered by paid staff who serve as mentors through group activities and 1:1 interactions with youth. We perform logistic regressions of secondary data from a cohort of BGCs to understand the relationships between enhanced mentoring and youth outcomes related to program retention, behaviors, and academics. We find the presented approach has a significant relationship with retention with those mentored being 1.92 times more likely to return the following program year. Mentored youth also experienced higher expectations from staff and were less likely to be involved in a physical fight with peers

Older Adults and Substance-Related Disorders: Trends and Associated Costs

Purpose. The aim of this study is to examine the changing service profile of older adults receiving substance abuse services over the past decade and the increased costs of treating this population. Design and Methods. Medicaid claims for mental health and substance abuse services data from a medium sized county in an eastern state were analyzed for individuals aged 50 years and older in calendar year 2000 or 2009. Univariate statistics are presented to describe the substance abuse and mental health services used by older adults in these two years. Results. The number of low-income older adults who accessed services for treatment and who had a substance-related diagnosis grew from 545 individuals in 2000 to 1,653 individuals in 2009. Costs for services utilized by older adults with a substance-related diagnosis rose by 358% from $2.1 million in 2000 to$9.5 million in 2009. Implications. The increase in the number of low-income older adults with a substance-related disorder and the concomitant rise in total spending for Medicaid reimbursed services indicate that local and state social service providers need to prepare for an older adult population who will need appropriate substance abuse prevention and treatment programs

Centering and Racial Disparities (CRADLE study): rationale and design of a randomized controlled trial of centeringpregnancy and birth outcomes

Abstract Background In the United States, preterm birth (PTB) before 37 weeks gestational age occurs at an unacceptably high rate, and large racial disparities persist. To date, medical and public health interventions have achieved limited success in reducing rates of PTB. Innovative changes in healthcare delivery are needed to improve pregnancy outcomes. One such model is CenteringPregnancy group prenatal care (GPNC), in which individual physical assessments are combined with facilitated group education and social support. Most existing studies in the literature on GPNC are observational. Although the results are promising, they are not powered to detect differences in PTB, do not address the racial disparity in PTB, and do not include measures of hypothesized mediators that are theoretically based and validated. The aims of this randomized controlled trial (RCT) are to compare birth outcomes as well as maternal behavioral and psychosocial outcomes by race among pregnant women who participate in GPNC to their counterparts in individual prenatal care (IPNC) and to investigate whether improving women’s behavioral and psychosocial outcomes will explain the potential benefits of GPNC on birth outcomes and racial disparities. Methods/design This is a single site RCT study at Greenville Health System in South Carolina. Women are eligible if they are between 14–45 years old and enter prenatal care before 20 6/7 weeks of gestational age. Eligible, consenting women will be randomized 1:1 into GPNC group or IPNC group, stratified by race. Women allocated to GPNC will attend 2-h group prenatal care sessions according to the standard curriculum provided by the Centering Healthcare Institute, with other women due to deliver in the same month. Women allocated to IPNC will attend standard, traditional individual prenatal care according to standard clinical guidelines. Patients in both groups will be followed up until 12 weeks postpartum. Discussion Findings from this project will provide rigorous scientific evidence on the role of GPNC in reducing the rate of PTB, and specifically in reducing racial disparities in PTB. Establishing the improved effect of GPNC on pregnancy and birth outcomes can change the way healthcare is delivered, particularly with populations with higher rates of PTB. Trial registration NCT02640638 Date Registered: 12/20/2015

Assessing Adverse Childhood Experiences during Pregnancy: Evidence toward a Best Practice

Abstract Objective To quantify the prevalence of adverse childhood experiences (ACEs) among a diverse urban cohort of pregnant women. Study Design The ACE survey was self-administered to 600 women categorized evenly between the waiting room, private examination rooms, and CenteringPregnancy group spaces. The percentage of women willing to complete the survey per location was compared using chi-square tests, and the mean ACE score per arm was compared using Wilcoxon's rank–sum test. Results Of the 660 women approached for participation, 5% declined; 67% reported ≥ 1 ACE exposure and 19% reported an ACE score of ≥ 4. By domain, 59% experienced household dysfunction, 25% abuse, and 25% neglect. Women in the waiting room were more likely to decline participation (p < 0.01), and those participating in the postpartum inpatient arm had a significantly lower proportion affirming 8 of 10 ACE questions, were less likely to report ≥1 ACE, and had a lower mean ACE score when compared with the outpatient arm (p < 0.01). Conclusion The prevalence of ACEs in this diverse pregnant cohort was high. The ideal locations to distribute the survey are the outpatient examination rooms