Integrating psychiatry and primary care, Aug 25, 2017
Childhood maltreatment trauma is a key determinant in intergenerational patterns of maltreatment ... more Childhood maltreatment trauma is a key determinant in intergenerational patterns of maltreatment and psychiatric vulnerability in the U.S. and globally. These cycles of maltreatment and vulnerability intersect during the childbearing year, when unresolved maternal trauma from maltreatment adversely affects a woman’s perinatal mental health and offspring development. We can recognize unresolved maternal trauma in the form of posttraumatic stress disorder (PTSD) and symptomatology, and its complex forms or comorbidities. The childbearing year presents unique clinical realities in addressing the traumatic-stress related mental health needs of women, principally among them is the lack of available trauma-informed and PTSD-specific interventions. Consequently, we must develop and implement approaches that circumvent barriers to access and address these clinical realities. Ideal characteristics of such approaches for expanding mental health service delivery have been defined and include reach, scalability, and affordability. Approaches that have the promise of addressing the needs of survivors of childhood maltreatment and sexual trauma will also need to be positioned in trauma-informed environments, and be trauma-specific in nature. One targeted approach that is trauma-specific and which has the characteristics of being a promising novel approach to delivering perinatal mental health care is the Survivor Moms’ Companion (SMC). The SMC is a fully manualized, self-study, and structured-listening psychoeducational program for women who are survivors of childhood maltreatment and who are pregnant (“survivor moms”). The goal of the SMC program is to improve women’s obstetric, postpartum, and early parenting experiences, and enhance psychological functioning.
Purpose: A trauma-informed educational support group pilot addressed traumatic stress, substance ... more Purpose: A trauma-informed educational support group pilot addressed traumatic stress, substance use disorders (SUDs), and child-rearing for clients who were pregnant and/or parenting young children. Methods: Seeking Safety was adapted with parenting content and delivered at two intensive residential rehabilitation facilities. An explanatory sequential mixed methods approach was used to evaluate the pilot. Forty-eight participants completed starting assessments (intention-to-treat) and 31 graduates completed postgroup surveys (per protocol). Focus group sessions were completed with 19 graduates. Results: Paired samples t tests of intention-to-treat data showed a statistically significant decrease in self-reported symptoms of stress and substance cravings and increases in positive behaviors and parenting self-efficacy. There were no statistically significant differences on lifestyle behaviors, parenting skill, and parenting confidence. Most participants found the intervention accepta...
Black individuals are at high risk for intimate partner violence (IPV) but are less likely to uti... more Black individuals are at high risk for intimate partner violence (IPV) but are less likely to utilize existing IPV services and supports. In an effort toward developing more culturally responsive IPV solutions for the Black community, researchers set out to understand how residents of high-risk IPV communities explained the high rates of IPV in their community, and what they thought possible solutions would entail. A purposive sample of 22 Black nursing students (20 female, 2 male) from a high-IPV risk predominately Black community in Western New York who were students enrolled in a Licensed Practitioner Nursing (LPN) program attended four focus groups that utilized a semi-structured interview format. Their verbatim responses were analyzed using qualitative inductive thematic analysis. Participants identified five major causes of IPV in Black communities: (a) weakened family structure, (b) IPV is normalized (c) community lacks IPV knowledge, (d) mistrust of formal resources, and (e)...
Public policy debate about guns continues in the United States, with many professional organizati... more Public policy debate about guns continues in the United States, with many professional organizations taking strong stands in policy statements. Moreover, many clinical organizations have provided recommendations for practitioners to use with clients to encourage gun safety in the home, particularly for vulnerable populations such as families with young children and those at risk of suicide. Social workers are in an excellent position to encourage gun safety with some of the most at-risk populations; however, clinical guidelines and research on preventing gun violence has lagged in social work compared to other disciplines. In this article we examine the importance of gun safety for social work clients (with special attention to families with children, families experiencing violence, and individuals at risk of suicide), consider the recommendations made by other professional organizations, and provide some initial thoughts about how social workers might engage with the families they ...
Adverse childhood experiences have a strong negative impact on health and are a significant publi... more Adverse childhood experiences have a strong negative impact on health and are a significant public health concern. Adverse childhood experiences, including various forms of child maltreatment, together with their mental health sequelae (eg, posttraumatic stress disorder, depression, dissociation) also contribute to adverse pregnancy outcomes (eg, preterm birth, low birth weight), poor postpartum mental health, and impaired or delayed bonding. Intergenerational patterns of maltreatment and mental health disorders have been reported that could be addressed in the childbearing year. Trauma-informed care is increasingly used in health care organizations and has the potential to assist in improving maternal and infant health. This article presents an overview of traumatic stress sequelae of childhood maltreatment and adversity, the impact of traumatic stress on childbearing, and technical assistance that is available from the National Center for Trauma-Informed Care (NCTIC) before articu...
Journal of obstetric, gynecologic, and neonatal nursing : JOGNN, Jan 22, 2017
To test the hypothesis that women with posttraumatic stress disorder (PTSD) have greater salivary... more To test the hypothesis that women with posttraumatic stress disorder (PTSD) have greater salivary cortisol levels across the diurnal curve and throughout gestation, birth, and the postpartum period than women who do not have PTSD. Prospective, longitudinal, biobehavioral cohort study. Prenatal clinics at academic health centers in the Midwest region of the United States. Women expecting their first infants who fit with one of four cohorts: a nonexposed control group, a trauma-exposed control group, a group with PTSD, and a group with the dissociative subtype of PTSD. In the first half of pregnancy, 395 women provided three salivary cortisol specimens on a single day for diurnal data. A subsample of 111 women provided three salivary cortisol specimens per day, 12 times, from early pregnancy to 6 weeks postpartum for longitudinal data. Trauma history, PTSD, and dissociative symptoms were measured via standardized telephone diagnostic interviews with the use of validated epidemiologic ...
Journal of obstetric, gynecologic, and neonatal nursing : JOGNN
We propose a cycles-breaking conceptual framework to guide perinatal research, interventions, and... more We propose a cycles-breaking conceptual framework to guide perinatal research, interventions, and clinical innovations that can prevent or disrupt intergenerational cycles of childhood maltreatment and psychiatric vulnerability. The framework is grounded in literature, clinical observations, team science collaboration, and empirical research from numerous disciplines and is specific to the childbearing year. Adoption of the framework has the potential to speed the progress of research on the social problems of intergenerational childhood maltreatment and psychiatric vulnerability.
Integrating psychiatry and primary care, Aug 25, 2017
Childhood maltreatment trauma is a key determinant in intergenerational patterns of maltreatment ... more Childhood maltreatment trauma is a key determinant in intergenerational patterns of maltreatment and psychiatric vulnerability in the U.S. and globally. These cycles of maltreatment and vulnerability intersect during the childbearing year, when unresolved maternal trauma from maltreatment adversely affects a woman’s perinatal mental health and offspring development. We can recognize unresolved maternal trauma in the form of posttraumatic stress disorder (PTSD) and symptomatology, and its complex forms or comorbidities. The childbearing year presents unique clinical realities in addressing the traumatic-stress related mental health needs of women, principally among them is the lack of available trauma-informed and PTSD-specific interventions. Consequently, we must develop and implement approaches that circumvent barriers to access and address these clinical realities. Ideal characteristics of such approaches for expanding mental health service delivery have been defined and include reach, scalability, and affordability. Approaches that have the promise of addressing the needs of survivors of childhood maltreatment and sexual trauma will also need to be positioned in trauma-informed environments, and be trauma-specific in nature. One targeted approach that is trauma-specific and which has the characteristics of being a promising novel approach to delivering perinatal mental health care is the Survivor Moms’ Companion (SMC). The SMC is a fully manualized, self-study, and structured-listening psychoeducational program for women who are survivors of childhood maltreatment and who are pregnant (“survivor moms”). The goal of the SMC program is to improve women’s obstetric, postpartum, and early parenting experiences, and enhance psychological functioning.
Purpose: A trauma-informed educational support group pilot addressed traumatic stress, substance ... more Purpose: A trauma-informed educational support group pilot addressed traumatic stress, substance use disorders (SUDs), and child-rearing for clients who were pregnant and/or parenting young children. Methods: Seeking Safety was adapted with parenting content and delivered at two intensive residential rehabilitation facilities. An explanatory sequential mixed methods approach was used to evaluate the pilot. Forty-eight participants completed starting assessments (intention-to-treat) and 31 graduates completed postgroup surveys (per protocol). Focus group sessions were completed with 19 graduates. Results: Paired samples t tests of intention-to-treat data showed a statistically significant decrease in self-reported symptoms of stress and substance cravings and increases in positive behaviors and parenting self-efficacy. There were no statistically significant differences on lifestyle behaviors, parenting skill, and parenting confidence. Most participants found the intervention accepta...
Black individuals are at high risk for intimate partner violence (IPV) but are less likely to uti... more Black individuals are at high risk for intimate partner violence (IPV) but are less likely to utilize existing IPV services and supports. In an effort toward developing more culturally responsive IPV solutions for the Black community, researchers set out to understand how residents of high-risk IPV communities explained the high rates of IPV in their community, and what they thought possible solutions would entail. A purposive sample of 22 Black nursing students (20 female, 2 male) from a high-IPV risk predominately Black community in Western New York who were students enrolled in a Licensed Practitioner Nursing (LPN) program attended four focus groups that utilized a semi-structured interview format. Their verbatim responses were analyzed using qualitative inductive thematic analysis. Participants identified five major causes of IPV in Black communities: (a) weakened family structure, (b) IPV is normalized (c) community lacks IPV knowledge, (d) mistrust of formal resources, and (e)...
Public policy debate about guns continues in the United States, with many professional organizati... more Public policy debate about guns continues in the United States, with many professional organizations taking strong stands in policy statements. Moreover, many clinical organizations have provided recommendations for practitioners to use with clients to encourage gun safety in the home, particularly for vulnerable populations such as families with young children and those at risk of suicide. Social workers are in an excellent position to encourage gun safety with some of the most at-risk populations; however, clinical guidelines and research on preventing gun violence has lagged in social work compared to other disciplines. In this article we examine the importance of gun safety for social work clients (with special attention to families with children, families experiencing violence, and individuals at risk of suicide), consider the recommendations made by other professional organizations, and provide some initial thoughts about how social workers might engage with the families they ...
Adverse childhood experiences have a strong negative impact on health and are a significant publi... more Adverse childhood experiences have a strong negative impact on health and are a significant public health concern. Adverse childhood experiences, including various forms of child maltreatment, together with their mental health sequelae (eg, posttraumatic stress disorder, depression, dissociation) also contribute to adverse pregnancy outcomes (eg, preterm birth, low birth weight), poor postpartum mental health, and impaired or delayed bonding. Intergenerational patterns of maltreatment and mental health disorders have been reported that could be addressed in the childbearing year. Trauma-informed care is increasingly used in health care organizations and has the potential to assist in improving maternal and infant health. This article presents an overview of traumatic stress sequelae of childhood maltreatment and adversity, the impact of traumatic stress on childbearing, and technical assistance that is available from the National Center for Trauma-Informed Care (NCTIC) before articu...
Journal of obstetric, gynecologic, and neonatal nursing : JOGNN, Jan 22, 2017
To test the hypothesis that women with posttraumatic stress disorder (PTSD) have greater salivary... more To test the hypothesis that women with posttraumatic stress disorder (PTSD) have greater salivary cortisol levels across the diurnal curve and throughout gestation, birth, and the postpartum period than women who do not have PTSD. Prospective, longitudinal, biobehavioral cohort study. Prenatal clinics at academic health centers in the Midwest region of the United States. Women expecting their first infants who fit with one of four cohorts: a nonexposed control group, a trauma-exposed control group, a group with PTSD, and a group with the dissociative subtype of PTSD. In the first half of pregnancy, 395 women provided three salivary cortisol specimens on a single day for diurnal data. A subsample of 111 women provided three salivary cortisol specimens per day, 12 times, from early pregnancy to 6 weeks postpartum for longitudinal data. Trauma history, PTSD, and dissociative symptoms were measured via standardized telephone diagnostic interviews with the use of validated epidemiologic ...
Journal of obstetric, gynecologic, and neonatal nursing : JOGNN
We propose a cycles-breaking conceptual framework to guide perinatal research, interventions, and... more We propose a cycles-breaking conceptual framework to guide perinatal research, interventions, and clinical innovations that can prevent or disrupt intergenerational cycles of childhood maltreatment and psychiatric vulnerability. The framework is grounded in literature, clinical observations, team science collaboration, and empirical research from numerous disciplines and is specific to the childbearing year. Adoption of the framework has the potential to speed the progress of research on the social problems of intergenerational childhood maltreatment and psychiatric vulnerability.
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