Caregiving can be costly : a qualitative study of barriers and facilitators to conducting kangaroo mother care in a US tertiary hospital neonatal intensive care unit

Preterm birth is a leading cause of morbidity and mortality in children under five and often requires a newborn to have an extended stay in a neonatal intensive care unit (NICU). Maternal engagement, such as visiting the NICU to provide kangaroo mother care (KMC), can improve outcomes for preterm infants but requires significant investment of time and resources. This study sought to understand barriers and facilitators to provision of KMC in the NICU.; We conducted semi-structured in-depth interviews with mothers of preterm infants (N = 20) at a large academic medical center in Massachusetts. A series of open-ended interview questions were designed to elicit all aspects of mothers' experiences and to understand how these experiences influence provision of KMC. All interviews were recorded and transcribed verbatim. We conducted an inductive thematic analysis to identify themes in the data with a focus on the barriers and facilitators of KMC provision in the NICU.; Findings show that engaging in KMC is heavily influenced by the mental, emotional, and physical effects of preterm birth on the birth mother, such as stress around preterm birth and difficulty recovering from birth. These challenges are compounded by structural barriers such as costly accommodations, unreliable transportation, lack of child care, and inadequate maternity leave policies that limit the frequency and duration of KMC and parental ability to provide care.; A complex array of mental, emotional, physical, and structural factors determine a mother's ability to visit the NICU and provide kangaroo mother care. Providing social supports, such as improved maternity leave policies and reliable hospital access through child care, accommodation, and transportation services, may address the structural barriers that inhibit KMC, reduce burdensome costs, and improve the health of mothers and their preterm infants

Benefits of Prenatal Enrollment in Early Head Start on Successful Smoking Cessation

Despite known negative health effects, many women continue smoke during pregnancy, and many do not access available cessations supports. In a population of low-income mothers with children enrolled in Early Head Start (EHS) we explored which demographic, smoking behavior, and treatment access characteristics were associated with being referred for smoking cessation services. Findings highlighted equity among referrals, consistent with EHS’s anti-racist foundation. We found mothers only reporting smoking history were missed compared to mothers who reported current smoking behaviors, which presents an important opportunity for prevention work, given relapse rates. Finally, we found when EHS knows about a pregnancy, either from early referral to EHS or from other children receiving services, the referral mechanism is most successful. Implications for EHS include an emphasis on recruiting earlier in gestation

Understanding Context-Dependent Attentional Bias to Threat in Posttraumatic Stress Symptoms

Attentional bias to threat (AB) is a transdiagnostic deficit for many internalizing disorders including posttraumatic stress disorder (PTSD). The relationship between AB and PTS symptoms (PTSS) is robust and consistent throughout the literature, but it is unclear which specific AB is associated with PTSS. It is also possible that this relationship could be different when assessing AB during an aversive context and if the threatening stimuli that draw the attention is masked. This study used a masked dot-probe task to measure AB to angry faces in two independent samples—50 treatment-seeking participants, and a second independent sample of 98 trauma-exposed participants. Linear mixed effects models yielded an increased orienting AB in an aversive (relative to safe) context in both samples; however, PTSS did not moderate these effects in either sample. These results highlight the importance of assessing AB in varying contexts and in multiple samples of differing severity. Given prior research, these null results suggest that AB deficits in PTSD are likely due to later threat processing rather than early threat detection

Falling Through the Cracks of Early Intervention and Prevention: Missed Smoking Cessation Referrals for Mothers in Early Head Start

Introduction. Smoking rates have decreased overall but smoking during pregnancy remains a challenge with impacts to mother, child, and family. Referrals are a critical component in accessing cessation, yet research identifies several barriers to access. Early Head Start (EHS) is one avenue for referrals, and we wanted to understand which characteristics describe those who have received prenatal smoking cessation referrals from EHS. Methods. This project utilized secondary data from the EHS Family and Child Experiences Study (N = 144). We conducted three hierarchical logistic regressions based on the following characteristics pulled from the literature—demographics (e.g., race, ethnicity, age, education, marital status, and partner at home), smoking behavior, and accessibility (e.g., language, location, siblings in EHS, length of time (LOT) in EHS, and program type)— removing non-significant variables at each stage of the hierarchy. Results. Results indicated no significant differences in referral rates across demographics (ps > .32). Results also showed smoking during pregnancy predictive of referral receipt (OR = 10.35, p < .05). Lastly, results showed longer LOTs with EHS (OR = 4.41, p < .01) and siblings in EHS (OR = 10.98, p < .05) significantly associated with referral receipt. Discussion. We found equity among referrals, consistent with EHS’s anti-racist foundation. We found mothers only reporting smoking history were missed. Finally, we found when EHS knows about a pregnancy, either from early referral to EHS or from other children receiving services, the referral mechanism is most successful. Future work should include an emphasis on recruiting earlier in gestation

Financial support to medicaid-eligible mothers increases caregiving for preterm infants

To assess the impact of financial support on maternal caregiving activities for preterm infants.; We conducted a small randomized controlled trial (RCT) in two Massachusetts Neonatal Intensive Care Units (NICUs). We enrolled 46 Medicaid-eligible mothers of preterm infants between January 2017 and June 2018 and randomly assigned them to a treatment group (up to 3 weekly financial transfers of $200 each while their infant was in the hospital) or a control group. We collected hospital-record data while the infant was admitted. The primary outcome was a binary variable indicating skin-to-skin care (STSC) was provided during a hospital day. Secondary outcomes included daily maternal visitation, daily provision of breastmilk, neonatal growth and length of stay (LOS). Multilevel generalized linear models with random effects were used to estimate treatment effects on daily maternal behaviors and ordinary least squares models were used to estimate impacts on neonatal growth and LOS.; We assigned 25 women to the intervention and 21 to the control and observed them over 703 days of their infants' hospitalization. Mothers who received financial support were more likely to provide STSC (adjusted risk ratio: 1.85; 95% confidence interval [CI] 1.31-2.62) and breastmilk (adjusted risk ratio: 1.36; 95% CI 1.06-1.75) while their infant was in the NICU. We see no statistically significant impact on neonatal growth outcomes or LOS, though estimated confidence intervals are imprecise.; Our evidence demonstrates the potential for financial support to increase mothers' engagement with caregiving behaviors for preterm infants during the NICU stay

The impact of aversive context on early threat detection in trauma exposed individuals and associations with post-traumatic stress symptoms.

IntroductionProlonged attentional bias to threat (AB) is associated with posttraumatic stress symptoms (PTSS). However, it is unclear whether this relationship extends to early threat detection (elicited by masked stimuli) and/or varies if AB is measured during an aversive context.MethodsTwo trauma-exposed samples of either intervention-seekers (N = 50) or community members (N = 98) completed a masked dot-probe task to measure early AB to angry faces in safe vs. aversive contexts (i.e., during threat of aversive noises).ResultsLinear mixed effects models showed that an aversive context increased the orienting responses in both samples; however, PTSS did not moderate these effects in either sample.LimitationsSample size and heterogeneity of trauma-type may have impacted effect of PTSS on AB.ConclusionThese results highlight the importance of assessing AB in varying contexts and examining generalizability across populations. Given prior research, the results also suggest that increased AB in PTSS may only be present for later attentional processes rather than early threat detection, at least with behavioral methods

A Systematic Review of Early Childhood Exclusionary Discipline

Young children (birth to age 5) are more likely to be expelled or suspended than school-aged children, but we know comparatively little about the precursors to and prevention of exclusion in early childhood settings. Furthermore, what research has been conducted has not been systematically synthesized to inform policy and funding decisions. The present review seeks to determine how early childhood exclusion is defined and assessed in the academic literature. Studies measuring early childhood suspension or expulsion were systematically gathered and coded for study characteristics, definitions, and measures of exclusionary discipline and disparity, and factors associated with exclusion rates. Results (n = 20) show an accelerating pace of inquiry that attends to multiple levels of the ecological system (children, teachers, and programs) across diverse settings (home-, center-, and school-based care). Additional research that draws on data spanning multiple types of early care and education settings is needed to inform legislation and intervention funding decisions