Journey to Parenthood: How New Fathers and Mothers Make Sense of Perinatal Emotional Distress

This dissertation study drew on in-depth interviews with a class diverse sample of 30 mothers and 17 fathers who experienced emotional distress as a new parent. The definitional boundaries of perinatal mental health conditions, such as postpartum depression, are debated and these diagnoses have been criticized for individualizing social problems. Nonetheless, the postpartum depression diagnosis is being extended to fathers and additional conditions are coming to be recognized as perinatal mental health disorders (e.g., anxiety, PTSD). In light of the contested nature of these conditions, I drew on social constructionist theories on health and illness to examine how lay parents made sense of and acted on their perinatal mental health symptoms. I found that distressed new parents provided nuanced, complex accounts of perinatal mental health and largely did not individualize their troubles. Further, parents exercised a great deal of agency in addressing their mental health conditions, whether in seeking professional help or implementing non-medical solutions. Their illness narratives were shaped, but not determined, by medicalized discourse. I also drew on feminist theories to explore the social and cultural factors that contributed to their perinatal mental health symptoms, in light of changing gender roles. I found that mothers and fathers largely spoke to the same stressors and concerns as they adjusted to parenthood, including the overwhelming demands of caring for an infant, the difficult-family work balance, and changes to the marital relationship. This speaks to the convergence of gender roles in modern families, as well as growing super-parent pressures. However, nuanced gender differences were also found. Mothers were disappointed by the high expectations of motherhood, whereas fathers were frustrated by the ambiguous nature of modern fatherhood. There was a tendency to fall back on traditional gender roles when parents felt overwhelmed or in the face of structural barriers. Class-based differences were starker than gender differences, with low-income parents citing everyday hardships and problematic relationships over idealized expectations of parenthood. This difference is best understood within the larger contexts of low-income and middle class lives, in which the former may not have expected as much control over parenthood and further that parenthood was relatively more rewarding than their other social roles. The difficulty balancing the demands placed on new mothers and fathers calls for improved family supports and policies

Self-Directed Care in Home-Based Long-Term Care During the Pandemic: Policy and Practice Implications

The COVID-19 pandemic highlighted strengths and challenges of the self-directed care model for home-based long-term care. We discuss policy and practice implications drawing on interviews with over 50 home-and-community-based-services consumers, caregivers, workers, and providers in Kansas. Low-pay, lack of benefits, rising wages in competing sectors, enhanced unemployment and COVID-19 concerns exacerbated workforce shortages that compromised consumer safety and well-being. The lack of budget authority for self-directed consumers in Kansas limited their ability to address these issues. Furthermore, the self-directed model was excluded from emergency funding sources that would have enhanced pay and benefits for workers, including sick pay for quarantine, pointing to the need for targeted funding. Emergency flexibility allowing paid family caregivers addressed care needs for some but is temporary and should be expanded. In the managed care model, MCOs still kept their capitated payment despite significant unfilled care hours, and thus pay-for-performance incentives need to be revisited

Successful Strategies for Discharging Medicaid Nursing Home Residents with Mental Health Diagnoses to the Community

The state and federal push to transition Medicaid residents from nursing homes to the community calls for effective discharge strategies targeted to residents’ diverse needs. This exploratory, mixed-methods study utilized the Minimum Data Set to describe demographics, health characteristics, and transition patterns of Kansas Medicaid residents with mental health diagnoses who were discharged from nursing homes from 2005 to 2008. Discharged residents (n = 720) had multiple comorbidities, and more than half remained in the community following their first nursing home event. In-depth interviews with nursing home staff (n = 11) explored successful discharge strategies. Successful strategies support an ecological approach to meeting individual, family, organizational, and community needs. This includes creating/sustaining a culture of discharge, encompassing informal and formal community supports in the discharge process, proactively addressing physical environment needs, and assisting individuals and their family members in managing physical and mental health conditions. Findings suggest that policies in the areas of preadmission screening, caregiver support, and revised Medicaid reimbursement are needed to better support continuity of care and promote discharge for nursing home residents with complex care needs. Future research could examine individual and family perspectives on the discharge process and track outcomes when transitioning between settings

UPDATING AND TESTING THE PASRR SCREEN IN KANSAS: REAL WORLD IMPLICATIONS

This work is licensed under a Creative Commons Attribution 4.0 International License.Kansas is updating the PASRR (Preadmission Screen and Resident Review) Level 1 screen per new guidance from the PASRR Technical Assistance Committee (PTAC), via a partnership between the State and university researchers. PTAC has directed states to screen for undiagnosed serious and persistent mental illness (SPMI) and also recommends screening for substance related disorders. Stakeholders were engaged through advisory workgroups and a content validity expert panel. These activities led to the creation of a revised PASRR Level-1 screen, but stakeholders also raised several concerns. PASRR law does not require Level-1 assessors to have professional training in mental health diagnoses or treatment, yet new guidelines asks them to screen for undiagnosed SPMI. Further, there are apparent discrepancies between these new guidelines and PASRR Level-2 criteria. Finally, current information management systems are not equipped to handle the higher security protocols associated substance use disorders. The draft instrument was tested with a sample of 103 nursing facility applicants by trained PASRR assessors and inter-rater reliability (IRR) was tested via a standardized vignette with 14 trained PASRR assessors. Only 3% of actual NF applicants were identified as possibly having an undiagnosed SPMI and only 43% of assessors correctly identified symptoms of a suspected SPMI in the standardized vignette, indicating poor validity and reliability in assessing for undiagnosed SPMI during the Level-1 screen. New PASRR guidelines may better ensure that nursing facility residents receive appropriate care for SPMI, however, there are many challenges to ensuring an accurate screen and supporting successful implementation

“Anything that benefits the workers should benefit the client”: Opportunities and Constraints in Self-Directed Care during the COVID-19 Pandemic

Reuse is restricted to non-commercial and no derivative uses.Self-directed care (SDC) models allow Home and Community Based Services (HCBS) consumers to direct their own care, thus supporting flexible, person-centered care. There are many benefits to the SDC model but access to resources is essential to successful outcomes. Considering the autonomy and flexibility associated with SDC, it is important to understand how SDC responded to the COVID-19 pandemic and the resources available to help manage this situation. We conducted 54 in-depth interviews with HCBS consumers, direct support workers, family caregivers, and providers to examine the impact of COVID-19 on HCBS services in Kansas. Findings illuminate how self-directed consumers carried a lot of employer responsibility, with limited resources and systemic barriers constraining self-determination and contributing to unmet care needs, stress, and burden. Policy flexibilities expanding the hiring of family members were beneficial but insufficient to address under-resourced working conditions and labor shortages that were exacerbated by the pandemic

Swings in Marijuana Use and Correspnding Media Emphases and Public Opinion

The use of marijuana in the United States has gone through shifts, with rates of use increasing throughout the sixties and seventies until its peak usage in the late seventies. Rates of use declined throughout the eighties until they reached a low point in the early nineties; at this point rates of use begin to steadily increase (Johnson, O\u27Malley, and Bachman, 2002). This research project examined 25 years of New York Times coverage of marijuana related articles to see if coverage went through any corresponding changes in claims making. Furthermore, news coverage would also document changes in public policy towards marijuana. In particular, I was investigating whether there were swings in reporting marijuana in a way that could be seen as deemphasizing its dangers versus emphasizing such dangers

Interview with Annette Lareau

Annette Lareau is the Stanley I. Sheerr Professor in the Department of Sociology at the University of Pennsylvania. She is the author of Unequal Childhoods: Class, Race, and Family Life (University of California Press). Unequal Childhoods won the best book award from three sections of the American Sociological Association: Sociology of the Family, Sociology of Children and Youth, and Sociology of Culture (co-­winner)

Supplemental Material - “Anything that Benefits the Workers Should Benefit the Client”: Opportunities and Constraints in Self-Directed Care During the COVID-19 Pandemic

Supplementary Material for “Anything that Benefits the Workers Should Benefit the Client”: Opportunities and Constraints in Self-Directed Care During the COVID-19 Pandemic by Carrie L. Wendel, Tracey A. LaPierre, Darcy L. Sullivan, Jennifer Babitzke, Lora Swartzendruber, Tobi Barta, and Danielle M. Olds in Journal of Applied Gerontology.</p