The Interdisciplinary Doula Project: Innovations in Nursing Clinical Education.

ABSTRACT: People giving birth report overwhelmingly positive experiences with nursing students acting as doulas. However, no programs report on improving diversity among students, pregnant people, and curricula. This article describes the Interdisciplinary Doula Project, a program to enhance diverse perspectives and clinical skills of university students. Nursing (n = 21, 77.8%) and other health students (n = 6, 22.2%) completed doula training, diversity seminars, and 36 hours of intrapartum care. Seven nursing students were hired to work on labor and delivery upon graduation. This innovative program may increase registered nurses trained to provide culturally congruent labor support for vulnerable pregnant populations.

Strengthening the System Supporting Perinatal People with Substance Use Disorder in the Midwest Using Group Model Building.

INTRODUCTION: Providing comprehensive, evidence-based care to perinatal people with substance use disorders (SUD) requires multi-stakeholder collaboration and alignment. The National Maternal and Child Health Workforce Development Center facilitated a system-strengthening process with the Midwest substance use in pregnancy (SUPper) club, a regional collaborative of health care providers, state public health agencies, and community-rooted organizations. METHODS: Facilitators led a 2 day group model building (GMB) workshop with 20 participants and two semi-structured interviews. Workshop participants were invited to complete an evaluation. RESULTS: Two primary trends were identified as priorities for change: (1) Birthing people's perception/experience of stigma and (2) The Midwest SUPper Club's reach and influence. Three causal loop diagrams (CLDs) were created to capture the interconnected dynamics of the Midwest perinatal SUD system: (1) the influence of stigma on maternal and infant health outcomes, (2) the role of clinic, organizational, and state policies, and (3) the impact of workforce education and evidence-based practices on care. From the CLDs, four priorities for action emerged: (1) align and promote shared mental models across stakeholders, (2) expand education and training opportunities for the perinatal SUD workforce, (3) strengthen systems infrastructure to support care navigation for patients and providers, and (4) collaboratively identify evidence-based practices that meet regional needs. All evaluation respondents reported that the workshop supported the development of a shared mental model. DISCUSSION: The GMB process strengthened collaboration and advanced strategic planning for the SUPper Club. GMB can be further utilized among diverse stakeholders across MCH systems to create shared mental models and accelerate collaborative planning efforts.

Differences in Sexual Health Outcomes Between Adolescents in Public Schools and Juvenile Correctional Facilities.

Data from a statewide, anonymous survey were used to test for differences between adolescents' sexual health behaviors and their outcomes across settings. Youth in juvenile correctional facilities (JCFs) were disproportionally male and Black compared to their peers in public schools. Youth in JCFs were significantly more likely than their peers to report that they had ever had sex, used substances prior to last sex, or been involved in a pregnancy. They were less likely to have used condoms or contraception at last sex, or to report having talked with their partners about sexually transmitted infections or birth control. The results highlight the importance of comprehensive sexual health education and access to a reproductive health provider for students in JCFs.

Adaptation of the event history calendar for Ugandan adolescents.

Adolescent and emerging adult risk behavior is a concern globally. Discussing health promotive and risk behaviors with adolescents and young adults can be challenging regardless of the country of data collection and dominant culture. In the United States, event history calendars have been used in both research and clinical settings to identify healthy and risky behaviors among adolescents and emerging adults, and contextual factors that may influence their behavior. After an unsuccessful attempt to employ a particular event history calendar on family life, negative and positive events, sexual behavior and substance use in data collection in rural fishing villages in Western Uganda, the current study aimed to modify the United States validated event history calendar for use with adolescents in Uganda, as a first step to cultural adaptation. Focus groups with 24 college students provided information about ways to modify the event history calendar for Ugandan youth. This paper discusses the modifications of the event history calendar for Ugandan young people.

A case study of childhood disintegrative disorder using systematic analysis of family home movies.

Childhood disintegrative disorder (CDD) is a rare pervasive developmental disorder that involves regression after a period of at least 2 years of typical development. This case study presents data from family home movies, coded by reliable raters using an objective coding system, to examine the trajectory of development in one child with a reported regression at 48 months of age. Coding substantiated parent reports of mostly typical early development, followed by later catastrophic loss of skills across many developmental domains. Differential diagnosis of CDD and autism with regression is discussed.

Atypical object exploration at 12 months of age is associated with autism in a prospective sample.

This prospective study examined object exploration behavior in 66 12-month-old infants, of whom nine were subsequently diagnosed with an autism spectrum disorder. Previous investigations differ on when the repetitive behaviors characteristic of autism are first present in early development. A task was developed that afforded specific opportunities for a range of repetitive uses of objects and was coded blind to outcome status. The autism/ASD outcome group displayed significantly more spinning, rotating, and unusual visual exploration of objects than two comparison groups. The average unusual visual exploration score of the autism/ASD group was over four standard deviations above the mean of the group with no concerns at outcome. Repetitive behaviors at 12 months were significantly related to cognitive and symptomatic status at 36 month outcome. These results suggest that repetitive or stereotyped behaviors may be present earlier than initially thought in very young children developing the autism phenotype.

Onset patterns in autism: correspondence between home video and parent report.

OBJECTIVE: The onset of autism is usually conceptualized as occurring in one of two patterns, early onset or regressive. This study examined the number and shape of trajectories of symptom onset evident in coded home movies of children with autism and examined their correspondence with parent report of onset. METHOD: Four social-communicative behaviors were coded from the home video of children with autism (n = 52) or typical development (n = 23). All home videos from 6 through 24 months of age were coded (3199 segments). Latent class modeling was used to characterize trajectories and determine the optimal number needed to describe the coded home video. These trajectories were then compared with parent reports of onset patterns, as defined by the Autism Diagnostic Interview-Revised. RESULTS: A three-trajectory model best fit the data from the participants with autism. One trajectory displayed low levels of social-communication across time. A second trajectory displayed high levels of social-communication early in life, followed by a significant decrease over time. A third trajectory displayed initial levels of behavior that were similar to the typically developing group but little progress in social-communication with age. There was poor correspondence between home video-based trajectories and parent report of onset. CONCLUSIONS: More than two onset categories may be needed to describe the ways in which symptoms emerge in children with autism. There is low agreement between parent report and home video, suggesting that methods for improving parent report of early development must be developed.