Safe Babies, Safe Moms: A Multifaceted, Trauma Informed Care Initiative.

PURPOSE: This report describes a multifaceted, trauma-informed initiative developed to address racial/ethnic maternal and infant health inequities in Washington, D.C. DESCRIPTION: Structural racism and systemic oppression of marginalized communities have played a critical role in maternal and infant health inequities in the United States. Black birthing individuals are exponentially more likely to experience adverse birth outcomes, including preterm birth, low birth weight and maternal mortality. In response to these statistics, the Safe Babies Safe Moms (SBSM) initiative was developed to support patients of marginalized identities and improve health outcomes. SBSM Women's and Infants' Services Specialty Care (WIS-SC) is one component of this initiative focused on perinatal services. ASSESSMENT: SBSM WIS-SC includes trauma-informed clinical services, nurse navigation, lactation, diabetes and nutrition education, social work services, medical-legal services, and behavioral health support. Services are delivered by a multidisciplinary team trained on the following domains: (1) building connection within diverse care teams; (2) recognizing systemic barriers to trauma-informed approaches; (3) learning the brain science of implicit bias, trauma, and resilience; (4) Integrating self-care practices; and (5) acknowledging progress. Since the inception of the program, SBSM WIS-SC has served over 1500 patients. CONCLUSION: The SBSM WIS-SC intervention reflects a patient-centered approach to care, offering the multidisciplinary services required for perinatal patients with complex medical, psychosocial, and legal needs. Trauma informed training and team building is foundational to successful service delivery to address these multifaceted health needs of historically marginalized perinatal populations nationwide.

Legal Needs and Health Outcomes for People with Cancer in Medical-Legal Partnership Programs: A Systematic Review.

Medical-legal partnerships (MLPs) integrate lawyers into medical teams to address patients' unmet legal needs that create barriers to good health and well-being (i.e., health-harming legal needs). This systematic review of the peer-reviewed literature focused on measuring 1) cancer patients' legal needs and 2) outcomes for cancer patients after receiving MLP services. Literature was searched according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) for the period 2006-2022. Four articles met the inclusion criteria for objective one: three articles met the criteria for objective two. While limited, the literature provides data that when screened, cancer patients regularly struggle with health-harming legal needs. Preliminary evidence suggests that while MLPs can help resolve legal needs, measuring outcomes of MLP intervention is complex. Further peer-reviewed research is needed to better understand the unmet legal needs of cancer patients and the impact of MLPs on their health.

Talking With Children About Prognosis: The Decisions and Experiences of Mothers With Metastatic Cancer.

PURPOSE: Parents with metastatic cancer report unique concerns and challenges when discussing their illness with their minor children. Greater understanding of parents' communication experiences can facilitate these discussions. This study aimed to describe the challenges, approaches, and decisions related to discussing prognosis among a sample of mothers with metastatic cancer. METHODS: We conducted a web-based cross-sectional survey assessing the psychosocial concerns of 224 women with metastatic cancer who had minor children. This analysis focused on participant responses to structured and open-ended questions addressing communication with their children. We used descriptive statistics to summarize responses to the structured questions and qualitative content analysis for responses to open-ended questions. RESULTS: Nearly 80% (n = 176) reported they had discussed their prognosis with at least one of their children; 79% identified at least one barrier to these discussions. The most common obstacles were participants' uncertainty about their illness trajectory (43%) and emotional distress associated with these conversations (41%). Qualitative analyses revealed three principles that guided mothers' communication decisions: commitment to honesty and protection; child developmental readiness; and beliefs about the right time. Approaches to discussing prognosis included total honesty, using the language of chronic illness, gradual disclosure, waiting for questions, and emphasizing hope, love, and reassurance. CONCLUSION: This study provides further evidence of the complexity and challenges of parental communication with their children about metastatic cancer. There is a need for both clinicians and researchers to identify, test, and implement evidence-based strategies to assist ill parents with their communication concerns.