Conversation coaching in dementia: a feasibility study.

PURPOSE: Conversation abilities of people with dementia are impacted by cognitive-communication deficits. Communication interventions can improve quality of life by increasing positive interactions and well-being. This study evaluates the feasibility of a conversation coaching intervention for people with dementia and their communication partners. METHOD: A mixed-method design was used. Thirty-four people were recruited over 12 months; 17 people with dementia and 17 communication partners. Participants with dementia were aged between 62 and 79 years (8 females, 9 males) and the communication partners were aged 33-77 years (5 males, 12 females). This conversation coaching intervention involved two assessment sessions (pre and post intervention) and 6 weekly sessions, alternating between individual and group-based sessions. These were facilitated by two experienced speech and language therapists with a three-month follow-up period. Participants were assessed initially and three months following intervention using Profiling Communication Ability in Dementia (P-CAD), Goal Attainment Scaling, and Capability Index for Older people (ICECAP-O). RESULTS: Twenty-eight participants completed the conversation coaching intervention. P-CAD scores for people with dementia were maintained at three months for 71% (n = 10) showing no decline in function and 29% (n = 4) showed improvement. Using the Goal Attainment Scaling, all people with dementia and their communication partners reported that this conversation coaching intervention helped them achieve their individual communication goals. Ten (71%) people with dementia rated their well-being as higher on the ICE-CAP-O following intervention with 29% (n = 4) rating no change in well-being from initial assessment. Over three-quarters of communication partners, (79%: n = 11), reported an increased sense of well-being following intervention and 21% (n = 3) had no change in well-being. CONCLUSIONS: Preliminary outcomes including participant feedback indicate that this conversation coaching intervention is feasible for people with dementia. The communication function and well-being of people with dementia were either maintained or improved. Conversation coaching intervention is collaborative and enhances the retained communication abilities of people living with dementia.

Assessing cognitive communication skills in dementia: a scoping review.

BACKGROUND: Cognitive communication difficulties are a characteristic feature of dementia. These deficits have negative effects on all aspects of daily life. Yet, there are few options for standardized assessment of cognitive communication skills in people with dementia. AIMS: To review published cognitive-communication assessments to determine what psychometrically sound assessments exist that are applicable to all people with dementia. METHODS & PROCEDURES: A scoping review of the literature was conducted using an established scoping review model. Cognitive-communication assessments validated in English with people with dementia were sought. A comprehensive search of eight relevant electronic databases was undertaken. Two reviewers independently analysed and assessed the psychometric quality of instruments that met inclusion criteria. OUTCOMES & RESULTS: Four cognitive-communication assessments were included in the review. Although psychometrically sound, none was suitable for administration at all stages of dementia. Only one was validated for different dementia types. None included subtests for evaluation of conversation ability, and none involved the evaluation of communication partners' communication. CONCLUSIONS & IMPLICATIONS: There are limited options for standardized communication assessment for individuals with dementia and their communication partners. Directions for the development of new measures are provided to facilitate research and improve clinical practice.

Use of competency-based self-assessments and the MCH navigator for MCH workforce development: three states' experiences.

Workforce development is a priority across many state Maternal and Child Health (MCH) Title V programs. Three case studies were conducted to explore varied state implementations of MCH workforce development initiatives. Three states utilized the online MCH Navigator resource to support orientation and ongoing professional development for staff and other partners. Key informant interviews and surveys were utilized to gather staff feedback on practical aspects of the project and to ascertain lessons learned by state MCH leadership during project implementation. Staff impressions of the MCH Navigator were generally positive. Staff reported that Navigator modules were useful to their current work and that completion of the modules resulted in expanded knowledge in key MCH competency areas and contributed to their professional development. Many indicated that they would recommend use of the Navigator to colleagues. State leaders found that utilization of introductory training sessions or the Navigator's online orientation modules were helpful in acclimating staff to the Navigator, although some staff still experienced minor technical challenges. State leaders across all three sites reported the value of pre-existing tools on the Navigator site, including core competency self-assessments and orientation bundles; the leaders also noted that the Navigator represents a useful and thorough resource that can be integrated into state efforts to enhance professional development for MCH staff. The significant variation between the three states' implementations demonstrates the flexibility of the Navigator, highlighting its utility to meet state-specific needs.

Developing a statewide public health initiative to reduce infant mortality in Oklahoma.

The Preparing for a Lifetime, It's Everyone's Responsibility initiative was developed to improve the health and well- being of Oklahoma's mothers and infants. The development phase included systematic data collection, extensive data analysis, and multi-disciplinary partnership development. In total, seven issues (preconception/interconception health, tobacco use, postpartum depression, breastfeeding, infant safe sleep, preterm birth, and infant injury prevention) were identified as crucial to addressing infant mortality in Oklahoma. Workgroups were created to focus on each issue. Data and media communications workgroups were added to further partner commitment and support for policy and programmatic changes across multiple agencies and programs. Leadership support, partnership, evaluation, and celebrating small successes were important factors that lead to large scale adoption and support for the state-wide initiative to reduce infant mortality.

Oklahoma's fetal and infant mortality review projects.

In Oklahoma, the infant mortality rate is higher than the national rate. Fetal Infant Mortality Review (FIMR) is an effective perinatal systems intervention. FIMR gathers information from medical, social, and community sources taking a comprehensive look at how well these systems are serving women and infants. It is important to understand that FIMR is a method to develop community-based plans to reduce fetal and infant mortality. It is not a quick-fix solution to a complex problem, a research study, an institutional review, or a system for assigning blame or responsibility for a death. FIMR has been instrumental in identifying what health care providers, community leaders, and citizens can do to improve the health and lives of babies in Oklahoma. Key steps include: (1.) Data abstraction (2.) A home interview (3.) A review of individual case summaries (4.) Development of community-based solutions and interventions designed to improve service systems and resources

Findings from an assessment of state Title V workforce development needs.

To describe results of a 2008 assessment of Title V workforce competencies and training needs at the state level, and examine preferences and barriers related to available education and training opportunities. A web-based survey was administered May through August, 2008 to Maternal and Child Health (MCH) and Children and Youth with Special Health Care Needs (CYSHCN) program leaders in all 50 states, and U.S. jurisdictions. Forty-nine MCH (96%) and 44 CYSHCN (86%) programs and four territories completed surveys. A major focus of the survey related to competencies in six core domains: Public Health/Title V Knowledge Base, Communication, Critical Thinking, Management Skills, Family Centered Care and Medical Home, and Leadership Development. The top training needs identified by state Title V programs fall into the global category of critical thinking, including skills in MCH data synthesis and translation, in program evaluation, and in systems thinking. The need to enhance personal rather than organizational leadership skills was emphasized. Blended learning approaches (graduate education), and national conferences with skills building workshops (continuing education) were identified as preferred training modalities. Barriers to training included lack of career opportunities, insufficient agency support, and inability to take leave (graduate education), and travel restrictions, release time limitations, costs, and limited geographic access (continuing education). Both the focus of training and preferred training modalities differed from previous MCH workforce survey findings. Given the changing needs expressed by state Title V leaders as well as their training preferences, it is important that current and future graduate education and continuing education approaches be better aligned to meet these needs and preferences.

Association of physical violence by an intimate partner around the time of pregnancy with inadequate gestational weight gain.

Intimate partner violence has been previously examined in relation to a variety of pregnancy, labor and delivery outcomes. We evaluated whether women who experienced physical violence by their intimate partners around the time of pregnancy were less likely to achieve weight gain according to the US Institute of Medicine (IOM) guidelines. A cross-sectional study was conducted using the 2000-2006 Oklahoma Pregnancy Risk Assessment Monitoring Survey (PRAMS) data for post-partum women, 20 years and older. Physical violence perpetrated by an intimate partner before and/or during pregnancy was prevalent in nearly 6.5% of women. Weight gain was adequate in 38.8%, deficient in 28.4% and excessive in 32.8% of these women, respectively. After adjusting for maternal age, marital status, education, pregnancy intention, stressful life events, third-trimester use of tobacco and alcohol and gestational age at delivery, physical violence by an intimate partner around the time of pregnancy was positively but non-significantly associated with excessive (but not deficient) gestational weight gain. After stratifying by age group, positive and significant associations between physical violence by an intimate partner around the time of pregnancy and inadequate gestational weight gain were observed only among women 35 years and older. With the exception of mothers ≥ 35 years of age, deficient and excessive gestational weight gains were not significantly related to experiences with physical violence by an intimate partner prior to delivery. Prospective cohort studies are needed to establish whether other forms of violence, including emotional and sexual abuse, can affect gestational weight gain and whether gestational weight gain can mediate the effect of physical, sexual and emotional abuse on pregnancy, labor and delivery outcomes.

Infant sleep position in Oklahoma: evidence from PRAMS.

BACKGROUND: The supine (back) sleep position has been found to be an important factor in the reduction of sudden infant death syndrome (SIDS). This paper will examine infant sleep position in Oklahoma and offer recommendations to increase safe sleep practices for Oklahoma infants. METHODS: Oklahoma Pregnancy Risk Assessment Monitoring System (PRAMS) data were used to estimate prevalence of sleep position among demographic maternal groups and related health behaviors. Chi-square tests were used to determine significance at p< 0.05. Logistic regression modeling was used to produce adjusted odds ratios to measure the association of selected independent variables and sleep position. RESULTS: Fifty-six percent of Oklahoma newborns were placed on their backs to sleep most of the time, far short of the Healthy People 2010 goal of 70%. Almost 1 in 5 infants were placed on their stomachs to sleep, a known risk factor for SIDS. Women between 100-184% of the federal poverty level, African American women and mothers with more than one child were those least likely to place their infants on their backs to sleep. CONCLUSION: Overall, the issue of not utilizing the recommended safe sleep position, the supine position, is pervasive among all maternal groups in Oklahoma. Significant differences were present for only a few variables (race, income, parity) indicating a strong need for a consistent message on sleep position for all Oklahoma parents and grandparents.

Maternal depression after delivery in Oklahoma.

BACKGROUND: The reduction of depression after delivery is one of the Healthy People 2010 targets. Postpartum depression (PPD) can inhibit care-giving practices and mother-child bonding and can lead some women to harm themselves. This study will examine correlates of maternal depression after delivery and associated stressors and will provide recommendations to address this issue in Oklahoma. METHODS: Oklahoma Pregnancy Risk Assessment Monitoring System (PRAMS) data were used to estimate prevalence among demographic groups and related behaviors. Logistic regression modeling was used to produce adjusted odds ratios (p < 0.05) for factors and predictors associated with depression after delivery. RESULTS: One in four new mothers reported symptoms of maternal depression within two to six months postpartum. Women 20-24 were twice as likely to indicate symptoms of depression when compared to women 35 or older; adolescents were 2.5 times as likely. Stressors found to increase the risk of depression symptoms were having an unintended pregnancy, arguing with a partner more than usual during pregnancy and having bills they could not pay. Receiving a postpartum health checkup was protective against postpartum depression symptoms. CONCLUSION: Every postpartum woman in Oklahoma should be screened for PPD using a valid and reliable scale. Providers should discuss the risks of PPD with pregnant women as a routine part of their prenatal care and encourage women to receive their postpartum health checkup within six weeks of delivery.