Personas of pregnant and parenting women with substance use and their barriers and pathways to system engagement.

BACKGROUND: Women with prenatal substance use have been identified as at-risk for the lack of engagement in perinatal services, such as medical care and home visitation programs. This issue is of particular concern in Florida (United States) where rates of fetal substance exposure have been steadily increasing. METHODS: To identify pathways of and barriers to perinatal system and service engagement, journey mapping was used to compile various personas of perinatal women with substance use. A structured guide was developed to elicit maternal personas, system and service touchpoints, and system strengths and weaknesses from focus group participants with statewide stakeholders, including perinatal service administrators and community coalition members within three Florida communities. Workshop transcripts, debriefing, and member-checking sessions were transcribed verbatim and analyzed manually. RESULTS: Six journey-mapping workshops and two member-checking meetings with mothers in-recovery were conducted with a total of 109 participants. Four personas were identified: women who (1) have substance use on a recreational basis, (2) have prescription drug use/misuse, (3) have chronic substance dependence, and (4) are in-recovery from substance dependence. Pathways that promote and barriers that prevent perinatal women with substance use from being identified, referred, or willing to accept and engage in medical care and social services were identified. CONCLUSIONS: While these personas shed light on differential pathways experienced by women with OUD, they were not intended as fixed-member groups but rather fluid descriptions of circumstances in which individuals could shift over time. These personas are beneficial to understand differences in circumstances, as well as variations in pathways and barriers to service engagement. Additionally, personas may be used to identify approaches to optimize service engagement by perinatal women with substance use and to support system improvements and integrations.

Characteristics Associated with Participant Attrition and Retention in a Perinatal Home Visiting Program.

Using data from the Florida Maternal, Infant, and Early Childhood Home Visiting (MIECHV) funded programs, we examined program- and participant-level characteristics associated with participant retention by time of enrollment. Analyses of data for 1,807 women enrolled in 11 sites across three years included descriptive statistics; Kaplan-Meier survival curve estimation and multilevel survival analyses using shared frailty model to assess participant- and program-level characteristics overall and by time of enrollment (during pregnancy or post-delivery). Median retention time for MIECHV participants was 462 days. The primary reason for attrition was loss-to-follow-up (59.4%) due to change of address/telephone. We found participant age > 25 years (compared to < 20 years), enrollment during pregnancy, and an average of 1.5-2.0 home visit/month to be protective, while current/history of substance abuse was a risk factor for attrition. To improve participant retention, the Florida MIECHV program may need to bolster efforts to support housing stability, increase outreach and engagement to younger women, address barriers to achieving two home visits per month throughout the program, and target differential predictors of participant attrition depending on time of enrollment.

A Multiple Streams Framework Approach to Access to Domestic Violence Services in an Indigenous Community.

This article focuses on access to domestic violence services within Belize. Using data from community asset mapping, interviews with key informants, and focus groups with community members, the multiple streams framework was used to identify potential areas for intervention to improve access and ameliorate the effects of family violence in Belize. Identified challenges to accessing limited domestic violence resources were mainly confidentiality concerns and mistrust. Existing laws and regulations, organizational structures, and policies and plans also influenced access. Women's groups, nongovernmental organizations, and the health department can play a crucial role in improving access to domestic violence services.

Early childhood court in Florida: Qualitative results of a statewide evaluation.

BACKGROUND: Child maltreatment, removal from the home and foster care placement are all associated with poor physical and developmental outcomes for children. Early Childhood Court (ECC) is a specialized, trauma-informed, team-based approach designed to meet the unique needs of young children and their families in the dependency court system. OBJECTIVE: The objective of the study was to evaluate the ECC program in 20 Florida circuits. PARTICIPANTS AND SETTING: Participants in the evaluation were 53 ECC professionals (e.g., judges, attorneys, mental health providers, caseworkers, etc.) and 9 parents and caregivers. Focus groups were conducted in person, and interviews were conducted either in person or on the phone. METHODS: Interviews and focus groups were transcribed verbatim and analyzed with a hybrid deductive/inductive process using MAX QDA. Two coders (trained doctoral student researchers) established inter-coder reliability with a Kappa greater than 0.80 and used an iterative process to discuss, refine, and describe each theme throughout the analysis. RESULTS: Participants described who is involved in ECC and most discussions focused on professional versus parent/caregiver team members. Participants also described how ECC is different from traditional dependency court and several themes, such as Child and Family Friendly, Judicial Leadership, and a Team-Based Approach, aligned with the national model. Emergent themes were Relationships and Success. CONCLUSIONS: Future research could explore the selection of parents into ECC.

Home Health Agency Factors Associated With Acute Care Hospitalization and Emergency Department Use.

We linked the Medicare Provider Utilization and Payment Data for Home Health and the Home Health Compare data for the year 2016 to identify home healthcare agency (HHA) characteristics associated with acute care hospitalization (ACH) or emergency department (ED) use. The study cohort consisted of 9,800 HHAs. Beta regression was used to examine the association between average age, race/ethnic composition, number of skilled nursing visits, number of therapy visits, percentage of dual eligible patients, HHA ownership, HHA location, Medicare tenure, proportion of patients with a diagnosis of schizophrenia, stroke, diabetes, depression, chronic obstructive pulmonary disease (COPD), heart failure, cancer and Alzheimer disease, and ACH or ED use. After controlling for HHA-level characteristics, variations in HHAs' ACH and unplanned ED visits were found. For-profit HHAs were significantly less likely to have patients with ACH. (Odds ratio = -0.05, p = 0.020), HHAs in the Midwest, South, and West had lower odds of ACH. HHAs that serve more than 50% Black patients had significantly decreased odds (ß = -0.16, p < 0.001) of ACH. A 1-unit increase in the proportion of patients with a diagnosis of schizophrenia, COPD, stroke, heart failure, and Alzheimer disease was associated with increased odds of hospitalization. For each unit increase in the number of skilled nursing visits, the odds of ACH increased by 0.02 (p = 0.001). For-profit and nonprofit HHAs had a significant decrease in the odds of unplanned ED visits (p < 0.05). An increase in the proportion of patients with COPD was associated with increased odds of unplanned ED visits (p < 0.001). HHA characteristics are associated with hospitalization and ED use without hospitalization. These characteristics point to variation in quality of care measured by ACH and ED use.

Predictors of early childhood undernutrition in Nigeria: the role of maternal autonomy.

OBJECTIVE: To investigate the relationship between maternal autonomy and various indices of child undernutrition among children aged <2 years in Nigeria, considering the cultural context and sociodemographic factors. DESIGN: Population-based, cross-sectional study. Associations between various indices of maternal autonomy and child undernutrition (specifically stunting, underweight and wasting) were determined using weighted bivariate and multivariable logistic regression modelling. SETTING: 2013 Nigerian Demographic Health Survey. PARTICIPANTS: Children aged between 3 and 24 months (n 7532). RESULTS: Overall, 31·4 % (n 2270), 29·8 % (n 2060) and 25·0 % (n 1755) of children in the sample were stunted, underweight and wasted, respectively. Women with acceptance of domestic violence (low autonomy) were approximately 18 and 14 % less likely to have stunted (OR = 0·82; 95 % CI 0·71, 0·94) and underweight children (OR = 0·86; 95 % CI 0·75, 0·99), respectively. Similarly, women with low power in their couple relations were 17 % less likely to have children who were wasted (OR = 0·83; 95 % CI 0·72, 0·97). Sociodemographic predictors of all indices of undernutrition included maternal education and Hausa ethnicity. Additionally, stunting was predicted by lack of exclusive breast-feeding, low income and being of Fulani ethnicity; wasting by having mothers with low BMI; and underweight by breast-feeding initiation within 1 h hour of birth, polygamous homes, mothers with low BMI and being of Fulani ethnicity. CONCLUSIONS: Women with acceptance of domestic violence and low power in couple relations were found to be less likely to have children with indices of undernutrition. This unexpected finding calls for future exploratory research, and policies and interventions that target at-risk subgroups.

WIDENING THE SCOPE OF SOCIAL SUPPORT: THE FLORIDA MATERNAL, INFANT, AND EARLY CHILDHOOD HOME VISITING PROGRAM.

The Florida Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program is designed to support pregnant women and families in developing skills and utilizing resources necessary to promote their children's physical, social, and emotional development. Little evaluation attention has focused on large-scale, public policy driven home-visiting programs. Social support provision is a critical component of a successful home-visiting program; therefore, there is a need to better understand participants' perceptions of social support provided to them in this context. Forty-five home-visiting participants from five Florida MIECHV programs completed semistructured telephone interviews. Participants discussed their experiences with the MIECHV program, including descriptions of their interactions with home visitors. Content analysis revealed that participants experienced multilayered social support from home-visiting staff. Families needed and received substantial emotional, instrumental, informational, and appraisal support at the individual level. This support was embedded within and strengthened by the strategies and activities of the home-visiting model of service provision. Results highlight the powerful opportunity home visiting offers as a method of service delivery within the larger system of care to increase social support in families experiencing high risk for negative maternal and child health outcomes. Implications for policy and practice are discussed.