Warm Connections: An Integrated Behavioral Health Intervention Development Study

Research demonstrates the presence of maternal mental health disparities as well as barriers to quality behavioral health care among women with low socioeconomic status. Warm Connections represents an innovative, interdisciplinary intervention designed to improve access to timely behavioral health support for women with low socioeconomic status. Based on an infant mental health framework and drawing from integrated behavioral health and brief intervention approaches, Warm Connections addresses the psychosocial needs of participants in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). The primary mission of WIC is to provide nutrition education, access to healthy nutrition, and health care referrals for pregnant, breastfeeding and non-breastfeeding postpartum women, infants, and children under the age of five with low socioeconomic status. Co-located within WIC clinic settings, Warm Connections aims to reduce caregiver distress and increase caregiver confidence. This dissertation manuscript describes an intervention development study of Warm Connections. It includes a quantitative comparison of psychosocial needs assessments from the perspectives of WIC participants and WIC staff. It also includes the development and analysis of two versions of pre-post intervention surveys to identify which version measures intervention aims with the most sensitivity. Results show that WIC participants and WIC staff for the most part share their perceptions of what WIC families need most, but they rate the urgency of those concerns differently. Results also show that while both pre-post intervention survey versions detect statistically significant changes in the desired direction for most individual items, version 2 appears to detect change more reliably and somewhat more sensitively than version 1. Findings suggest Warm Connections may meet multiple urgent concerns among WIC families and affirm the value of intervention development studies for innovative projects. Through examining the development of Warm Connections, this study demonstrates how social workers may engage in interdisciplinary research partnerships in health contexts to advocate for health equity for women and children

An Examination of Power in a Triadic Model of parent–child–pediatrician relationships related to early childhood gender development

In this paper, the authors introduce the Triadic Model of Pediatric Care, an innovative conceptual framework for pediatric practice with transgender and gender diverse children. The Triadic Model of Pediatric Care consists of three experts—pediatricians, primary caregiver(s), and children—who each possess unique insights, knowledge, and decision-making power. This model guides pediatricians to provide gender-affirming care that acknowledges children as experts of their own experience and worthy of bodily autonomy, while also working to ensure primary caregiver(s) have the information and support necessary to provide a safe and nurturing developmental environment for their child. The authors provide a recommendation for how the Triadic Model of Pediatric Care might be applied in a pediatric healthcare setting and conclude with a summary of the model\u27s implications, limitations, and future directions

MSW Students’ Understanding of Social Location: The Development of a Positionality Measure

The current study presents findings from a pilot study of a positionality measure, developed to assess MSW students’ understanding of positionality encountered in field practice settings. Positionality refers to one’s social location and worldview, which influences how one responds to power differentials in various contexts. This construct is important for social work, as one’s own positionality impacts one’s approach when working with clients, during community engagement, and policy-making. As such, this study examined the utility of developing a positionality measure to assess how MSW students understand and respond to issues related to power, privilege, and oppression in field practice settings. The current study highlights the process of developing and piloting the positionality measure, and preliminary findings from the dissemination of the measure to a sample of MSW students (N = 103) engaged in field placements. Future opportunities for item refinement, including the further establishment of reliability and validity for the measure are discussed

Social Determinants of Health and Parenting Self-Efficacy Among Mothers of Preterm Infants

Objective: To explore the relationships between social and environmental factors and parenting self-efficacy (PSE) among mothers of preterm infants hospitalized in neonatal intensive care units (NICUs) using a social determinants of health (SDoH) framework. Method: We analyzed data from a prospective cohort study that included 187 mother-infant dyads admitted to four NICUs in the Mountain West region between June 2017 and December 2019. We used multivariable linear regression models to assess the independent associations between maternal and infant characteristics and PSE. Results: Our final multiple linear regression model predicting the efficacy score including maternal race/ethnicity, age, insurance, employment status before giving birth, gestational age, depression, and having other children was significant (F(12,160) = 3.17, p = .0004, adjusted R¬2 = .131). Significant predictors of PSE were race/ethnicity (β= 3.3, p = .022), having another child/children (β= 4.2, p = .005), and depression (β= -4.2, p = .004). Conclusions: Findings suggest that social workers and medical practitioners should consider SDoH, such as insurance type, household income, and employment, along with traditional clinical indicators when assessing families’ infant care needs. Social workers, medical practitioners, and researchers should be mindful of how implicit bias may influence the allocation of care and parental supports

Conceptualizing Social Determinants of Maternal and Infant Health Disparities

Research demonstrates that women and children within marginalized ethnic and racial groups and those living in poverty experience disparate health outcomes. These disparities have immediate and long-term consequences. Exploring two theories used to examine social determinants of health— life course perspective and historical trauma response, this article will explain the major premises of each, provide application examples, compare and examine utility for practice, and highlight areas for future research. A theoretical critique will be included, as well as insight into how these theories together might address gaps as an approach to maternal and infant health research and practice

Infant Mental Health: A Lens For Maternal And Child Mental Health Disparities

Maternal and child mental health disparities exist in the United States among people of color and people with low socioeconomic status. Adverse maternal and child mental health has short- and long-term consequences for both mothers and children. The persistent and intergenerational nature of maternal and child mental health disparities reflect an important social justice issue to which social workers must respond. The infant mental health framework can guide social workers in understanding and addressing these disparities. This framework provides a useful lens through which practitioners can understand and support the context and development of caregiver-infant dyads. This manuscript reviews maternal and child mental health disparities, provides an overview of the infant mental health framework, and describes implications for the social work practice. With roots in the social work profession and emphasis on human development within social context, the infant mental health provides insight to social work practitioners, scholars, and educators

Healthy Birth Initiatives: The Road Toward Reproductive Justice

This study concerns racialized experiences of reproductive oppression among Black women and the efforts of one organization - Multnomah County’s Healthy Birth Initiatives (HBI) - to combat this oppression and move towards Reproductive Justice. This study explores how Black women experience and respond to racism-related stress and its impacts on their health during and after pregnancy and subsequent parenting. The project was informed by a pilot focus group conducted in 2016 by Drs. Jenna Ramaker and Roberta Hunte in partnership with HBI, which asked HBI clients about the role of toxic stress and racism-related stress in their lives. The current study - led by Drs. Roberta Hunte and Susanne Klawetter - expands that initial focus to include the perspectives of current and former clients, as well as HBI staff. The following research questions guided the current study: How do Black women describe the experiences and impacts of racism-related stress as it relates to their pregnancy, health and parenting? How does HBI mitigate the impact of racism-related stress on clients’ pregnancy, health, and parenting, and how can program activities be enhanced? What is the shared impact of racism-related stress on Black women’s health between HBI staff and former HBI clients, as well as the lasting impact of HBI in building resiliency among Black women

Parental Leave Policy as a Strategy to Improve Outcomes among Premature Infants

Although gains have been made in premature birth rates among racial and ethnic minority and low socioeconomic status populations, tremendous disparities still exist in both prematurity rates and health outcomes for preterm infants. Parental involvement is known to improve health outcomes for preterm babies. However, a gap in evidence exists around whether parental involvement can help ameliorate the disparities in both short- and long-term outcomes for their preterm children. Families more likely to experience preterm birth are also less likely to have access to paid leave and thus experience significant systemic barriers to involvement, especially when their newborns are hospitalized. This article describes the research gap in this area and explores pathways by which social workers may ameliorate disparities in preterm birth outcomes through practice, policy, and research

“Black Nurses in the Home is Working”: Advocacy, Naming, and Processing Racism to Improve Black Maternal and Infant Health

Objectives 1) To explore how racism-related stress impacts Black women’s health, pregnancy, and parenting. 2) To explore how a culturally-specific program affects the relationship between racism-related stress and Black women’s health, pregnancy, and parenting. Methods This qualitative study uses a Black Feminist approach to center the lived experiences and perspectives of Black women. Focus groups were conducted with clients and staff of a culturally-specific program that provides perinatal care for Black families. A thematic analysis was conducted using a Reproductive Justice framework as a guide. Results Participants consisted of 23 program clients and staff who all identified as Black women. Four themes emerged from the analysis: 1) The pervasive reach of structural racism, 2) Shared identities facilitate trust and healing, 3) Racism directly impacts mental health, and 4) Advocacy on macro and micro levels is a vital service. Conclusions for Practice Results show the chronicity and toxicity of structural racism on Black women’s physical and mental health. The presence of overt and subtle forms of racism occur in multiple systems and require interventions on macro- and micro-levels. Culturally-specific perinatal care programs that prioritize racial concordance between providers and clients/ patients are well-received and effective models of care. Black perinatal care should include culturally-specific approaches, advocacy on behalf of and alongside Black people, mental health support with attention to racism-related stress, and interrogation of implicit bias. Multipronged interventions guided by Reproductive Justice principles provide a holistic framework to address interpersonal and systemic racial oppression

We Experience What They Experience : Black Nurses\u27 and Community Health Workers\u27 Reflections on Providing Culturally Specific Perinatal Health Care

Black perinatal health workers are part of a tradition of Black people fighting for the well-being of Black communities. The purpose of this article is to better understand the unique experiences of these professionals. Method: Descriptive qualitative research was used to understand Black providers’ experiences in a culturally specific perinatal public health program. A focus group was conducted with seven nurses and community health workers, and thematic analysis was used to analyze the data. Results: Three themes emerged: (a) shared lived experience and parallel process between staff and clients; (b) navigating multiple shifting gazes between clients, public health department, and medical systems; and (c) reproductive justice and community care characterize a culturally informed approach. Discussion: Findings revealed strengths and complexities facing Black nurses and community health workers in their roles. More work is needed in education, practice, and research to better prepare and support nurses and community health workers in culturally specific settings