Trauma-informed care with women diagnosed with postpartum depression: a conceptual framework.

Postpartum depression (PPD) is a mental health disorder that affects approximately 20% of all new mothers. PPD frequently co-occurs with and is exacerbated by trauma, particularly for women from vulnerable populations. Trauma-informed care (TIC) is a best practice that recognizes the importance of, and takes steps to promote recovery from, trauma while preventing retraumatization. Despite its potential utility, there is limited research published on TIC, including how TIC is operationalized across practice settings. Further, despite the prevalence and negative effects of untreated PPD, to date there have been limited articles published on TIC and PPD. The purpose of this article is to provide a TIC framework for service delivery for women diagnosed with PPD including explicit strategies for how TIC should be structured across roles, settings, and systems. Implications for health practice, policy, and future research are provided.

Public Health Social Work as a Unifying Framework for Social Work's Grand Challenges.

Introduced in 2013 by the American Academy of Social Work and Social Welfare, the Grand Challenges for Social Work (GCSW) implicitly embrace a public health perspective. However, the lack of a specific overarching conceptual framework creates a challenge for moving the GCSW from concept to practice. In this article, authors propose that public health social work (PHSW) provides a unifying framework for moving the GCSW from concept to practice. Authors undertook a review of the literature, including a review of published literature and all Web sites and other Web materials focused on the GCSW. Three GCSW were selected to illustrate the utility of PHSW and the social work health impact model (SWHIM): (1) stopping family violence, (2) eradicating social isolation, and (3) achieving opportunity and justice. Using a wide-lens PHSW approach, the illustrations focus on actions that can influence populations through strengthened environments and multilevel interventions. The public health field reflects the rigorous science behind the theoretical models, community-based approaches, and attention to effects of social determinants of health at the population level. Because health and inequalities are the focus of many of the GCSW, incorporating both public and population health, together with the SWHIM, can help provide structure to achieve collective goals.

Community Gun Violence as a Social Determinant of Elementary School Achievement.

The association of indirect exposure to firearm-related violence and standardized test scores among third grade elementary school children were analyzed using geospatial mapping of police department data for all gunshots in Syracuse, NY (n = 2, 127) and state standardized test scores from 2009-2015. Confirmed gunshots were geocoded and mapped across the city and neighborhood school catchment areas. Third grade standardized New York State test scores for English Language Arts (ELA) and math were coded as dichotomous variables of proficient and below proficient scores. State standardized test scores for ELA and math were found to be 50% lower in the elementary schools located within higher concentration gunshot areas, than in elementary schools in lower gunshot areas. Higher levels of gun violence within school catchment areas were significantly associated with higher rates of ELA and math failure (p ≤ .05). These findings suggest that community violence may be an important, though under recognized, social determinant of poor school performance.

Integrating the social determinants of health into two interprofessional courses: Findings from a pilot study.

Five colleges and universities in Upstate New York, United States, created the 'Route-90 Collaborative' to support faculty implementing the Institute of Medicine's (IOM) Framework for Educating Health Professionals to Address the Social Determinants of Health. The two courses described herein used a flipped classroom approach in which students from 14 different nations were responsible for facilitating individual classes. This descriptive study used an educational intervention in two interprofessional courses - reproductive health and global health - based on the IOM Framework into two courses. The evaluation used quantitative and open-ended text response data from students. Course evaluations indicated the students found the courses helped them to learn more about health issues and service delivery in various countries, expand their knowledge base on sociocultural and ecological influences on health care, and broaden their perspectives on various health topics so they will be able to provide higher quality healthcare. Although this is the first effort of our Collaborative to implement the Framework, given the student feedback, we believe implementing the Framework in various courses has the potential to enhance healthcare service delivery and reduce the negative impact of social determinants of health.

Advancing Social Work Education for Health Impact.

Social work education plays a critical role in preparing social workers to lead efforts that improve health. Because of the dynamic health care landscape, schools of social work must educate students to facilitate health care system improvements, enhance population health, and reduce medical costs. We reviewed the existing contributions of social work education and provided recommendations for improving the education of social workers in 6 key areas: aging, behavioral health, community health, global health, health reform, and health policy. We argue for systemic improvement in the curriculum at every level of education, including substantive increases in content in health, health care, health care ethics, and evaluating practice outcomes in health settings. Schools of social work can further increase the impact of the profession by enhancing the curricular focus on broad content areas such as prevention, health equity, population and community health, and health advocacy.

Filling out the forms: Health literacy among the uninsured.

This study addresses health literacy among patients at a free clinic in Syracuse, NY. Researchers conducted chart reviews of 600 patients and qualitative interviews with 22 patients and 7 providers. Most clinic patients had a high school, or higher, level education and no difficulty with reading comprehension. Nevertheless, a majority had at least some difficulty with comprehending and following through on health information. For many interviewees, the greatest difficulty was completing the required forms for entitlement programs. The findings demonstrate that low health literacy may occur even among well-educated patients and recommend that health literacy be assessed for all patients.

Community health agency administrators' access to public health data for program planning, evaluation, and grant preparation.

The Affordable Care Act mandates that public health data be made available for community agency use. Having access to such data allows community agencies to tailor interventions, evaluations, and funding requests more effectively. This study, jointly undertaken by Syracuse University faculty and students with the New York State Perinatal Association, sought to understand community agencies' access to requests for governmental data, as well as to identify areas for improving data access. Results from this survey of administrators from 43 agencies in New York State found that only one-half of their requests for data were successful. Difficulties in obtaining access to needed data included fiscal and staffing constraints of the state-level agencies that house the data, as well as possible overinterpretation of confidentiality policies. In addition, some of community agency respondents reported that their staff lacked skills in data analysis and would benefit from training in epidemiology and quantitative evaluation.

Prenatal Depression: Screening and Referral for Women Who Are Low Income during Antenatal Care.

This study uses prenatal clinical chart reviews of 245 women who were screened for depression while receiving antenatal care services at an urban hospital-based clinic in Syracuse, New York. The results indicate that more than one half of the mothers who screened positive are not being adequately referred and followed-up on to ensure they are receiving proper treatment. Among the mothers who are not being successfully referred are women who are non-English speaking, facing multiple life stressors, and inadequately insured. Recommendations for colocating services that may ease the ongoing burdens of new motherhood are addressed.

Addressing access barriers to services for mothers at risk for perinatal mood disorders: A social work perspective.

This article identifies variables at the micro/individual, mezzo/partner/spouse and family, and macro/health care-system levels that inhibit mothers at risk for perinatal mood disorders from accessing health and mental health care services. Specific recommendations are made for conducting thorough biopsychosocial assessments that address the mothers' micro-, mezzo-, and macro-level contexts. Finally, the authors provide suggestions for how to intervene at the various levels to remove access barriers for mothers living with perinatal mood disorders as well as their families.

Building Mobile Apps for Underrepresented Mental Health care Consumers: A Grounded Theory Approach.

Cell phone mobile application ("app") use has risen dramatically within the past several years. Many individuals access apps to address mental health issues. Unlike individuals from privileged backgrounds, individuals from oppressed backgrounds may rely on apps rather than costly mental health treatment. To date, very little research has been published evaluating mental health apps' effectiveness. This paper focuses on three methods through which grounded theory can facilitate app development and evaluation for people underrepresented in mental health care. Recommendations are made to advance mobile app technology that will help clinicians provide effective treatment, and consumers to realize positive treatment outcomes.

Use of electronic technologies to promote community and personal health for individuals unconnected to health care systems.

Ensuring health care services for populations outside the mainstream health care system is challenging for all providers. But developing the health care infrastructure to better serve such unconnected individuals is critical to their health care status, to third-party payers, to overall cost savings in public health, and to reducing health disparities. Our increasingly sophisticated electronic technologies offer promising ways to more effectively engage this difficult to reach group and increase its access to health care resources. This process requires developing not only newer technologies but also collaboration between community leaders and health care providers to bring unconnected individuals into formal health care systems. We present three strategies to reach vulnerable groups, outline benefits and challenges, and provide examples of successful programs.

Health disparities: a primer for public health social workers.

In 2001, the U.S. Department of Health and Human Services published Healthy People 2010, which identified objectives to guide health promotion and to eliminate health disparities. Since 2001, much research has been published documenting racial and ethnic disparities in healthcare. Although progress has been made in eliminating the disparities, ongoing work by public health social workers, researchers, and policy analysts is needed. This paper focuses on racial and ethnic health disparities, why they exist, where they can be found, and some of the key health/medical conditions identified by the U.S. Department of Health and Human Services to receive attention. Finally, there is a discussion of what policy, professional and community education, and research can to do to eliminate racial and ethnic disparities in healthcare.

Barriers to healthcare among Asian Americans.

The myth of the well-adjusted Asian American resulted from sample-biased research studies that concluded that Asian Americans are physically healthier and financially better off than Caucasians. The myth has been perpetuated by researchers who have often categorized Asian Americans as a single, undifferentiated group rather than as distinct ethnic groups. Consequently, data analysis techniques do not reveal distinctions that may exist had the researchers controlled for ethnic group variation. The authors discussed four major barriers-language and culture, health literacy, health insurance, and immigrant status-to healthcare that may influence within-group disparities among Asian Americans that may go unreported. The authors argue that healthcare policy makers and researchers should consider Asian Americans as members of discrete ethnic groups with unique healthcare needs. Recommendations for health policies and future research are provided.

Examining health-related factors among an ethnically diverse group of Asian-American mental health clients.

As currently developed, health policies and practices consider Asian Americans as one homogenous group, ignoring the unique differences of each group regarding its own healthcare needs. In fact, the healthcare needs of mental health clients have received little attention in the professional literature. The purpose of this article is to investigate the diverse healthcare needs of Asian Americans seeking mental health services. The authors reviewed the literature on healthcare for ethnic minority groups while focusing primarily on Asian Americans and analyzing these needs as they relate to mental health-seeking clients. The results indicate that Korean Americans are faring less well than either Japanese or Chinese Americans. The authors discuss the implications for health policy, practice, and education.

Structural violence, urban retail food markets, and low birth weight.

This paper investigates urban retail food markets and health in Syracuse, New York. A structured observational analysis found that a majority of corner markets do not sell fresh produce or low fat dairy products, but conduct a lively business selling lottery tickets, cigarettes, and liquor. A comparison of census tracts with and without access to supermarkets that sell fresh produce and other healthy food found that pregnant women living in proximity to a supermarket had significantly fewer low birth weight births than other pregnant women regardless of income level.

Environmental injustice: childhood lead poisoning, teen pregnancy, and tobacco.

PURPOSE: This study investigates the persistent relationships between childhood lead exposure, repeat teen pregnancy, and tobacco use in a sample of teenage females in Syracuse, NY. METHODS: We analyzed the association of childhood lead poisoning with repeat pregnancy and tobacco use among 536 teens (aged 15-19 years) in Syracuse, NY, who received services at Syracuse Healthy Start between 1998 and 2002. RESULTS: The mothers' childhood lead exposure, controlling for race, age, and Medicaid status, was associated with repeat teen pregnancy and tobacco use. CONCLUSION: Long-term negative health outcomes associated with childhood lead exposure should not be underestimated. This study helps to shore up prior research that found lead poisoning to have a long-lasting impact on children's functioning and healthy development. Policy efforts focused on neighborhood development and health education continue to be sorely needed.

From the bottom up: tracing the impact of four health-based social movements on health and social policies.

Although health-based social movements organized by grassroots activists have a rich history in impacting health and social policy, few systematic studies have addressed their policy change efforts or effectiveness. In this article, the authors trace how four health-based social movements-the women's health movement, ACT UP, breast cancer, and needle exchange-influenced health and social policy legislation. The activists' efforts wrested control of "authoritative knowledge" that had once been the sole domain of "experts" with advanced medical training. They used this knowledge to empower "average" people with medical information, promote self help and engage in civil disobedience, which led to changes in healthcare delivery, drug testing and approval, and increased research funds for HIV/AIDS, breast cancer, and needle exchange. The activists' efforts led to other health-based social movements that are currently, or will become, issues for health and social policy analysts in the future.

Marriage promotion and missing men: African American women in a demographic double bind.

Since 1996, state legislators, members of the U.S. Congress, and more recently President George W. Bush, have called for the protection of monogamous, heterosexual marriage and the promotion of marriage among poor women. The thrust of this policy making is directed at African American families, among which female headship doubled between 1965 and 1990. This doubling is temporally associated with enacting the legislation directed toward the War on Drugs, which resulted in a tripling of the African American prison population. In Syracuse, New York, the swelling African American population behind bars has resulted in a skewed sex ratio, in which women significantly outnumber men. The authors use national, state, and local epidemiological, environmental, and ethnographic data to argue that the proliferation of marriage-promotion policies is heterosexist and blames African American women for demographic realities over which they have little control.

Structural violence and racial disparity in HIV transmission.

Among women of color in the United States, infection with the human immunodeficiency virus (HIV) is rising. Most of the research on this topic, however, has focused on individual-level risk factors, which do not fully explain racial or ethnic differences in infection rates. This article uses structural violence as a conceptual framework to examine ecological-level risk factors leading to disparate rates of heterosexually transmitted HIV among women of color in Syracuse, New York. Three ecological pathways to disproportionate infection are discussed: community rates of infection, concurrent partnerships, and increased vulnerability. The discussion of the pathways considers the following macro-level risk factors: disproportionate incarceration rates of African American men, residential segregation, gang turf, constraints on access to sexually transmitted disease services, an African American sex ratio in which women outnumber men, social norms stigmatizing homosexuality, and commercial sales of douching products. The authors argue that health care providers and policy analysts must address ecological-level risk factors for HIV transmission in underserved communities.

Medicaid managed care meets developmental disabilities: proceed with caution.

This article examines Medicaid managed care's potential impact on people with developmental disabilities. The authors discuss how the philosophy behind the skills/functional model of service provision for people with developmental disabilities is incongruent with the medical model of managed care. They discuss the policy issues that various states have had to face concerning Medicaid managed care's administration of health benefits for people with developmental disabilities. They extrapolate from the research on managed care to formulate potential models that states might use to administer the health benefits for people with developmental disabilities. Finally, the authors propose policy and research agendas to begin investigating Medicaid managed care's potential impact on people with developmental disabilities.