Clusters of Behavioral Health and Psychosocial Risk for Childbearing Women in Four Virginia Communities.

Introduction Four Virginia communities participated in a community services enhancement pilot to centralize intake and referral for childbearing women eligible for home visiting support through the Maternal, Infant and Early Childhood Home Visiting (MIECHV) program. Methods As an aspect of the study, project-trained intake workers administered behavioral health and psychosocial risk screening (including emotional health, substance use, interpersonal violence, and smoking) during intake eligibility assessment. Participants identified as at-risk were referred for community intervention concurrently with referral to MIECHV services. Results In the study sample (N = 1515), emotional health was identified as the most common single risk factor (n = 326, 21.5%) and clusters of 2 or more behavioral health risks were identified for 223 (14.7%) of women. Among those with two or more behavioral health risks, smoking was significantly related to all other areas of behavioral health risk. Conclusion Findings from this multi-site pilot emphasize concomitant behavioral health and psychosocial risks in childbearing women and reinforce the importance of embedding comprehensive public health interventions in community systems of care.

Prevalence and Predictors of Depressive Symptoms in Pregnant African American Women.

African American women may be especially vulnerable to antepartum depression, a major health concern during pregnancy. This study investigated the prevalence and predictors of depressive symptoms in a sample of African American women who were between 14-17 weeks pregnant, a timeframe that is typically thought to be a time of general well-being. Two-thirds reported a CES-D score ≥ 16 indicative of depressive symptomatology. Age, perceived stress (as measured by the Perceived Stress Scale [PSS]), and anxiety (as measured by the State Trait Anxiety Inventory [STAI]) predicted depressive symptoms; the interaction between PSS and STAI scores was also a significant predictor. Our study findings suggest that early identification of stress and anxiety, in addition to depressive symptoms, is vital for intervention with this group.

What does it mean when we screen? A closer examination of perinatal depression and psychosocial risk screening within one MCH home visiting program.

Perinatal depression screening has become an imperative for maternal and child health (MCH) home visitation programs. However, contextual life experiences and situational life stress may be equally important in determining program response. As one component of a larger research study with an urban MCH home visitation program, we examined the results from multiple measures of depression and anxiety symptoms, social support and stressful life events in a sample of 30 newly enrolled program participants. We compared commonly used tools in identifying women who were "at risk" for perinatal depression. The analysis used published and agency practice cut-off scores, examined correlations between measures, and reflected on the role of stressful life events in this assessment. In this low-income, predominantly African-American sample, the assessed tools were inconsistent in identifying "at risk" women for perinatal depression, ranging from 22 % (Edinburgh Perinatal Depression Scale) to 75 % (Center for Epidemiological Studies, Depression Scale) depending on the instrument. Depression and anxiety were correlated across most measures, although provider-collected data did not correlate as anticipated with other measures. The combination of screening for perinatal depression and stressful life events offered an additional perspective on possible symptom alleviation and psychosocial intervention that could occur within the home visiting program. Our experience suggests that introducing a brief inventory of stressful life events accompanying perinatal depression screening allowed for a more comprehensive understanding of women's experiences than perinatal depression screening alone. We encourage psychosocial risk screening which integrates assessment of social support, stressful life events and perinatal depression symptoms.

Psychopharmacology decision-making among pregnant and postpartum women and health providers: informing compassionate and collaborative care women's health.

Psychopharmaceutical use by pregnant and postpartum women is complicated by the complexity of prescribing as well as the sociocultural context in which medication-related decisions are made. This study sought to advance understanding of decision-making processes and communication experiences regarding use of psychopharmaceuticals during pregnancy by considering both provider and consumer perspectives. An electronic survey was conducted with health care providers (N = 88) and women consumers (N = 83) from July 2010 through October 2011 regarding the perceived costs and benefits of taking mental health medication during and around the time of pregnancy. Descriptive analysis compared and contrasted experiences between the two groups regarding consumer-provider communication, critical incidents and triggers in decision-making, and response to case scenarios crafted around hypothetical client experiences. Both similarities and differences were evident among health care provider and women consumer responses regarding costs, benefits, communication experiences, and case scenario responses. Both quantitative and qualitative survey results indicated the need for more accurate, unbiased, and complete information exchange around mental health and medication. Study results suggested the centrality of the client-provider milieu to guide decision-making and emphasized the expressed need within both groups to create a shared decision-making practice environment characterized by authenticity, non-judgmental decision-making, compassion, humaneness, and reciprocity.

Embodied storytelling and meaning-making at the end of life: VoicingHan avatar life-review for palliative care in cancer patients.

This article presents VoicingHan project as a new form of life-review mediated by digital avatars promoting the reconstruction of self and identity through performativity. Whereas traditional life-review uses interview as primary means of the therapeutic process, VoicingHan is mediated by virtual bodies with self-guided participation in one's own life stories through embodied storytelling performance. VoicingHan enrolled 12-patients receiving outpatient palliative care at VCU Massey cancer center. The storytelling performances were recorded via avatar video format and distributed to participants for review and/or sharing. The present study considered the avatar videos as qualitative data emerging from these individually constructed life review narratives. In this article, the benefits of VoicngHan life-review were demonstrated by analyzing the avatar video narratives, based on theoretical and developmental frameworks. Through the lens of Social Constructivism, this qualitative study deepens our understanding of human-avatar interactions to engage life review process, within the liminal space of life-threatening illnesses.

Integrating Behavioral Health Risk Assessment into Centralized Intake for Maternal and Child Health Services.

Effectively promoting women's health during and around the time of pregnancy requires early, nonstigmatizing identification and assessment of behavioral health risks (such as depression, substance use, smoking, and interpersonal violence) combined with timely linkage to community support and specialized interventions. This article describes an integrated approach to behavioral health risk screening woven into a point of first contact with the health care delivery system: centralized intake for maternal and child health home visiting programs. Behavioral Health Integrated Centralized Intake is a social work-informed, community-designed approach to screening, brief intervention, and service linkage targeting communities at high risk for fetal and infant mortality. Women enrolled in this study were receptive to holistic risk screening as well as guided referral for both home visiting support and specialized mental health interventions. Results from this multi-community study form the foundation for strengths-based, social work-informed enhancements to community health promotion programs.

A psychiatric medication decision support guide for social work practice with pregnant and postpartum women.

In their work in human services organizations and community agencies across service sectors, social workers encounter pregnant and postpartum women experiencing mental health challenges. This article offers an evidence-informed Decision Support Guide designed for use by social workers working with pregnant and postpartum women who are struggling with complicated decisions about psychiatric medication use. The guide is built on contemporary notions of health literacy and shared decision making and is informed by three areas: (1) research into the lived experiences of pregnant and postpartum women and health care providers around psychiatric medication decision making, (2) a critical review of existing decision aids, and (3) feedback on the strategy from social work practitioners who work with pregnant and postpartum women. Emphasizing the relational nature of social work in supporting effective health-related decision making, the guide relies on maintaining a collaborative practice milieu and using a decision aid that engages clients in discussions about mental health during and around the time of pregnancy. The guide offers social workers a practice tool to support responsive and compassionate care by embracing their roles in problem solving and decision making, providing emotional and psychosocial support, and making appropriate referrals to prescribers.

Daily life or diagnosis? Dual perspectives on perinatal depression within maternal and child health home visiting.

This study describes a qualitative inquiry-informing program development in a maternal and child home visiting program. Low-income women's perceptions of the meaning and experiences of depression were ascertained through focus groups and interviews. Simultaneously, the study examines staff member perceptions and roles related to depression. Specific findings from clients and staff reveal culturally situated beliefs about depression and stressful life events; comparing and contrasting these beliefs offers a novel perspective on identification and intervention for maternal depression. This study offers a foundation for a translational research agenda that will be used for program and policy development to enhance mental health services situated within maternal and child health home visiting programs.

Perinatal depression screening and intervention: enhancing health provider involvement.

OBJECTIVE: The authors of this study collaborated in the analysis of public health survey data in order to inform future statewide interventions that could systematically enhance depression screening and mental health service use for women of reproductive age. The primary objective of the study was to empirically inform and test the program theory components of a motivational interviewing intervention that we anticipate will guide statewide practice and policy priorities. METHODS: Data were examined from a survey of healthcare practitioners statewide (n=1498) regarding their practices with and perceptions of perinatal depression care for women. Confirmatory factor analysis (CFA) was used to measure two latent constructs: health provider confidence in the ability to diagnose and treat and the importance placed on screening and treatment. Structural equation modeling (SEM) was used to test a program theory supporting motivational interviewing using a model implied relationship between confidence and importance on screening and treatment/referral practices. RESULTS: The data fit the model; the model provisionally supports motivational interviewing as an intervention influencing provider attitudes and practices surrounding perinatal depression screening and treatment/referral. CONCLUSIONS: Ultimately, study findings support statewide public health efforts to expand the role of health providers in recognizing and responding to perinatal depression and suggest that motivational interviewing techniques that augment importance and confidence may lead to enhanced screening and referral/treatment outcomes for pregnant and postpartum women.

A rural perspective on perinatal depression: prevalence, correlates, and implications for help-seeking among low-income women.

UNLABELLED: CONTEXT/PURPOSE: To examine a low-income sample of women in the rural Midwest (N = 1,086) who were screened for perinatal depression through the outreach and education activities within a Healthy Start Initiative project. Specifically, we describe the frequency and severity of depressive symptoms, explore social and demographic correlates of depression, and examine help-seeking through patterns of self-referral to a Healthy Start perinatal depression project in a rural, medically underserved community. METHODS: Depression screening data using the Primary Care Evaluation of Mental Disorders (PRIME-MD) as well as intake records from the project were analyzed in a retrospective analysis to identify important demographic and psychosocial characteristics associated with elevated levels of depressive symptoms and help-seeking patterns. FINDINGS: Thirty-six percent of screened women met criteria for major, minor, or subthreshold depression, with 13% meeting diagnostic criteria for major depression alone. Less than 8% were currently receiving any type of mental health services or treatment at screening. The most significant correlate of self-referral to the Healthy Start project was meeting symptom criteria for major depression, although minor depression, subthreshold depression, and status as low-income/Temporary Aid to Needy Families (TANF)-eligible were all significantly associated with self-referral. CONCLUSIONS: The findings from this study highlight the potential significance of identifying and addressing the unmet mental health needs of low-income rural women during and around pregnancy. In addition, the study illustrates that low income, in addition to depressive symptoms, impacts mental health service delivery in this rural community with a fragmented mental health service infrastructure.

Stepping back to gain perspective: pregnancy loss history, depression, and parenting capacity in the Early Childhood Longitudinal Study, Birth Cohort (ECLS-B).

Previous empirical studies of pregnancy loss have predominantly focused on complex grief response and emergent problems associated with future parenting in self-selected samples of bereaved women. This article presents findings from a retrospective secondary data analysis conducted with a racially and ethnically diverse sample of currently parenting women in the United States (N = 10,688) that examined the relationships among pregnancy loss history, current maternal depressive symptoms, and mother-infant interaction with the enrolled child. Study findings underscore a racial-ethnic disparity in pregnancy loss history for African American women, whereas current maternal depressive symptoms remain fairly constant across racial-ethnic groups. Multiple loss history is associated with a slight elevation in overall symptoms of depression, but there is no relationship between pregnancy loss history and current mother-infant interaction in the study sample. An important limitation in this study is that the Early Childhood Longitudinal Study, Birth Cohort (ECLS-B) data does not allow for inferences specific to the type of loss, gestational age of fetus, time since loss, or whether the loss was spontaneous or induced. However, study findings highlight areas of incongruity between clinical and population-based research that deserve further investigation. Ultimately, the findings from this population-based research contribute to a wider perspective regarding maternal response to reproductive loss that can inform future research and targeted bereavement support.

Women and reproductive loss: client-worker dialogues designed to break the silence.

An estimated one in four women experiences a pregnancy loss during her lifetime. Despite the pervasiveness of fetal mortality reflected by these numbers, social workers rarely initiate dialogues regarding reproductive loss history. Reproductive loss experiences are interwoven with typical themes emerging in everyday social work practice, including mental health, self-conceptualization, social roles, and future parenting. To advance the knowledge of professional social workers regarding reproductive loss in women's lives, this article begins by synthesizing theory and empirical research related to reproductive loss and subsequent parenting. Then, four worker-initiated dialogues emerge as recommendations for integration into routine social work practice, expanding discussion of reproductive loss beyond a subset of specialized providers and into the multitude of practice settings.

Changing hospital newborn nursery practice: results from a statewide "Back to Sleep" nurses training program.

OBJECTIVE: In response to findings from a statewide survey of hospital nurses, the authors designed, conducted, and evaluated a "Back to Sleep" nursing curriculum and training program in Missouri hospitals using two distinct training formats. This article evaluates the initial and follow-up outcomes for training participants and assesses the impact of training format on participant outcomes. METHODS: Participants selected training format by hospital site. In each training format, participants responded to a pre and post test questionnaire measuring knowledge, beliefs, and current infant care behaviors as well as satisfaction with the training. Three months after completion of all statewide trainings, the authors also conducted a follow-up survey. RESULTS: Nurses who participated in the training reported statistically significant improvements in knowledge and "Back to Sleep" adherent beliefs. Over 98% of participants (N=515) intended to place infants in back-only sleep positions following the training. Knowledge, attitudes, and practice intentions were significantly improved across both training formats. Additionally, follow-up survey respondents statewide (N=295) reported lasting improvements, including 63% of nurses reportedly using supine-only sleep position for infants after the first 24 h of life, compared to 28% in the original statewide survey. CONCLUSIONS: Further research is needed to determine the long-term impact of this intervention and assess its applicability beyond this initial implementation. Ultimately, the findings from the evaluation of this pilot intervention and nursing-specific "Back to Sleep" curriculum demonstrate that it has a promising effect on risk-reduction adherence in hospital settings where parent observations of safe sleep behavior first occur.

Social work, siblings, and SIDS: conceptual and case-based guidance for family system intervention.

Sudden Infant Death Syndrome (SIDS) is a tragic loss event within the family, impacting adults as well as children. This article uses three case illustrations to discuss the role of a SIDS event on the family system with a special focus on the emergent challenges for surviving siblings of various ages. Practice application examples are woven throughout the review to illustrate the age-specific grief responses which may occur following a SIDS event. The article also presents a theoretically supported intervention matrix that integrates models of bereavement support and family system responses, taking into account children's varying developmental needs and tasks based on sibling age.

Prevalence and correlates of pregnancy loss history in a national sample of children and families.

Public health prevalence data has consistently illustrated disparities in fetal mortality prevalence on a yearly basis, yet few studies have examined the prevalence and correlates of pregnancy loss history during the reproductive life span. Using nationally representative data from the Early Childhood Longitudinal Study, Birth Cohort, approximately 25% of childbearing women in the United States were found to have experienced one or more fetal deaths prior to the current live birth. An examination of the demographic correlates of singular and multiple loss history in age-controlled models reveals that a history of multiple loss was significantly related to African-American race, lower socioeconomic status, income below poverty, and lower maternal education. Singular loss history risk was relatively consistent across social and demographic groups with some increased risk noted only for African-American women. Predictive correlates of fetal mortality varied by racial-ethnic subpopulation in multivariate analysis. Findings from this study are discussed for their contribution to existing public health knowledge and the potential for future research focused on the experience of multiple loss and demographic groups at elevated risk.