Archive for December, 2016


    Prenatal Exposure to Drugs: Is still shocking and unacceptable!

    Early Childhood Interventions December 30, 2016

    Children who are prenatally exposed to drugs are at risk for developing a series of health conditions, or physical or intellectual disabilities. Although the use of drugs by women who are pregnant is decreasing, the amount of use is still shocking and unacceptable. Research indicates that more than 5 percent of women use illicit drugs while pregnant; 15 percent of pregnant women ages 15 to 17 use or abuse illicit drugs. (Levine, Liu, Das, Lester, Lagasse, Shankaran, et al., 2008) Women of color and women from low income families are disproportionately more likely to use drugs than their white, upper class counterparts. Prevention outreach and awareness campaigns can help inform mothers that using substances during pregnancy can lead to a variety of issues, including maternal anxiety and depression, child development delays or disabilities, domestic violence, and suboptimal support for the children in a family. (Marques, Pokorni,   Long, & Teti 2007). The developmental delays experienced by the children can include problems with motor skills, learning disabilities, and behavior problems.

    Though drugs have clear negative effects on children and families, there is little research being done to identify promising practices implemented to prevent the use of drugs like cocaine, heroin, or prescription pills (http://www.drugabuse.gov/sites/default/files/prenatal.pdf).

    during pregnancy. Researchers have focused more on alcohol use and tobacco as causes of Fetal Alcohol Spectrum Disorder (FASD), low birthweight, and other developmental issues. Slowly, researchers and policy-makers are prioritizing early intervention programs that support and empower women, especially young, low-income, women of color, to not use drugs, preventing their deleterious effects on the children. Recent studies have indicated that certain programs decrease the rate of substance abuse and strengthen indicators of academic success in children.

    Several intervention projects are being implemented in our country’s most underserved and disadvantaged communities. These come in the form of community partnerships with private companies, medical services associated with hospitals and universities, state- and federally- funded programs through schools, and grassroots awareness campaigns from non-profit organizations. Each of these programs targets certain demographics of women and the specific issues that they face. These can greatly influence how a mother experiences her pregnancy and whether a child is exposed to drugs.

    The Johns Hopkins School of Public Health


    http://www.jhsph.edu/news/news-releases/2014/in-home-visits-reduce-drug-use-depression-in- pregnant-teens.html) released a report that highlighted an intervention framework that was implemented in an underserved American Indian community, and showed great promise. The Native American population is at high risk for substance abuse, especially alcohol abuse and the community has a high incidence of fetal alcohol syndrome. (http://www.drugabuse.gov/sites/default/files/prenatal.pdf) The program, “Family Spirit”, reaches out to young mothers-to-be, offering resources and services necessary to maintain a healthy pregnancy and raise healthy children. The program includes home-visiting by nurses and paraprofessionals using a curriculum designed specifically for the Native American population. Findings from a study of 322 expectant Native American teens indicated that many of the teens had experienced substance abuse, depressive symptoms, residential instability, and did not complete high school, all factors that can have a negative impact on a child. The nurses in the program worked very closely with the Family Spirit participants, sharing best practices for dieting and avoiding substances during pregnancy, as well as tips for breastfeeding, reading at night, and coping with stressful situations after the child is born. The nurses and paraprofessionals were also members of the American Indian community, making the initial trust-building a much smoother process. At the end of the three year study period, researchers concluded that the program decreased maternal depression and decreased the rate of illicit substance abuse.  Based on these positive results, Family Spirit is now eligible for federal funding, and other communities are looking to replicate this program.

    The Family Spirit program is just one example of what states can do to address substance abuse during pregnancy. Other institutions are coming together to brainstorm ways to sensitively confront mothers who are potentially engaging in dangerous behavior. A report presented at  the National Abandoned Infants Assistance (AIA) Resource Center conference in California (2014) described how, four unique, federally-funded programs collaborated to identify common issues across states, share best strategies for policy implementation and service dissemination, and devise new ways to address issues of prenatal substance exposure in children. The conference presented approaches used to engage mothers in discussions on sensitive subjects like drug use and underlying problems.  A referral flowchart was developed for primary care physicians to discuss with mothers the need for specialists or entering programs to decrease drug use and to access resources and information necessary for a healthy pregnancy and to avoid prenatal drug exposure in children.

    The society, government, civil society, and communities should do more to encourage, incentivize, and reward programs that prioritize substance abuse during pregnancy. Ensuring that every mother can live in a drug-free and safe space is crucial to ensure that every child, regardless of ability or disability, can thrive.

    References

    Levine, T. P., Liu, J., Das, A., Lester, B., Lagasse, L., Shankaran, S., et al. (2008). Effects of prenatal cocaine exposure on special education in school-aged children. Pediatrics,122(1), e83-e91.

    Marques, P. R., Pokorni, J. L., Long, T., & Teti, L. O. (2007). Maternal depression and cognitive features of 9-year-old children prenatally-exposed to cocaine. American Journal of Drug and Alcohol Abuse, 33(1), 45-61.

    Olds, David et al. (2004). Effects of home visits by paraprofessionals and by nurses: Age 4 follow-up results of a randomized trial, Pediatrics114(6), 1560-1568.

    Demographic and Psychosocial Characteristics of Substance-abusing Pregnant Women. National Center for Biotechnology Information. U.S. National Library of Medicine, 26

    Mar. 1999. Web. 27 Jan. 2015. <http://www.ncbi.nlm.nih.gov/pubmed/10214543>.

    Prenatal Exposure to Drugs of Abuse. National Institute on Drug Abuse, May 2011. Web. 27 Jan. 2015. <http://www.drugabuse.gov/sites/default/files/prenatal.pdf>.

    http://aia.berkeley.edu/training/online/webcasts/sen/http://www.jhsph.edu/news/news-releases/2014/in-home-visits-reduce-drug-use-depression-in- pregnant-teens.html

    Dan Silkman (GU ‘15)

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    Perinatal Depression in Latina Mothers

    Early Childhood Interventions December 20, 2016

    Mothers experiencing PD may fail to provide an enriching, developmentally supporting environment or developing a mutually beneficial relationship with their baby. A lack of toys, engaging language activities, and attention-provoking games during early stages of development may lead to poor cognitive and language development. In the long term, children of mothers with PD can show deficits in cognition, behavior, and academic performance (Bernard-Bonin, 2004). Children can demonstrate dysregulated attention, lower IQ than matched peers, and social and adaptive immaturities, and they are at higher risk for other challenges such as ADHD, anxiety, or depression) (Hay, Angold, Pawlby, Harold, & Sharp, 2003).

    Often, PD is considered a condition that should be easy to “overcome” right?  Women often hear that it is a phase that will pass or they should just “buck-up” But, for most it is much more complicated.  Research indicates that the most successful antidote to Perinatal Depression is social support, such as home visits from family, friends, and professionals (McKee, 2001). Family therapy to teach coping strategies to the new mother, increase communication within the family about the illness, and foster resilience within the child can also be extremely helpful (Pearlstein, 2008). The active involvement of the father can be a very important buffer to provide support to the baby as well as the mother (McKee, 2001). Community organizations, including religious institutions and specialized programs, can provide further assistance. However, awareness of and access to these strategies is often inadequate, restricting women and families from using them. Even when accessibility does not pose a problem, many women experiencing PD will not accept the assistance given by community programs.

    Data on prevalence of Perinatal Depression shows that certain demographics are more likely to experience PD. Due to the combination of risk factors the prevalence of PD in Latina mothers, is closer to 36%, which is significantly greater than the 12-20% national average (Baker-Ericzén, et. al., 2012). According to the US Census Bureau (2012), the majority of women giving birth are Latinas,  indicating that  there is a significant proportion of women who are at higher risk to experience PD. Additionally, Latinos in the U.S. are more likely to be low-income, have unwanted/unplanned pregnancies, and be single mothers. Latinos are also widely acknowledged to be far less likely to seek professionals regarding mental health concerns than are non-Hispanic whites (National Institute for Health Care Management, 2010). The combination of all of these factors makes the Latina mother population particularly worth considering for treatment options.

    There are, however, intervention programs developed specifically for the Latina population.  For example, the Perinatal Mental Health (PMH) Project is a culturally sensitive, short-term telemedicine intervention (Baker-Ericzén, et. al. 2012). The PMH Project involves an initial screening by a physician to determine maternal depression, followed by enrollment in the telemedicine program by a mental health assistant. The telemedicine curriculum itself contains a variety of modules that are completed by the mother with the mental health assistant. The modules are designed with specific cultural sensitivities in mind, but the primary mode of communication is in English.  The modules focus on destigmatizing mental health problems, especially PD, and providing emotional support through cognitive-behavioral therapeutic strategies as well as coping and stress management techniques. The PMH plan was piloted in Southern California, and it found that contacting low-income, often single, Latina mothers by cell phone was an effective way of both transmitting culturally sensitive information about PD and providing resources to connect them with professionals (Baker-Ericzén, et. al. 2012).

    Although its effects are still not fully understood by researchers, the PMH program was shown to be an innovative way to address problems with accessibility associated with clinics that were negatively perceived by many Latina mothers (Baker-Ericzén, et. al. 2012). Its large-scale effectiveness and long-term effects have not yet been determined, but this is certainly a program to consider furthering. Given the widespread prevalence of PD in Latina mothers, providers must find creative solutions to make treatment accessible to America’s increasingly diverse population.

    References:

    Baker-Ericzén, M. J., Connelly, C. D., Hazen, A. L., Dueñas, C., Landsverk, J. A., & Horwitz, S. M. (2012). A Collaborative Care Telemedicine Intervention to Overcome Treatment Barriers for Latina Women with Depression during the Perinatal Period. Families, Systems, & Health, 30.3, 224-40.

    Bernard-Bonin, A. (2004). Maternal depression and child development. Paediatric Child Health, 9.8, 575-83.

    Field, T. (2011). Prenatal depression effects on early development: A review. Infant Behavior and Development, 34, 1-14. doi: 10.1016/j.infbeh.2010.09.008

    Hay, D.F., Angold, A., Pawlby, S., Harold, G.T., & Sharp, D. (2003). Pathways to Violence in the Children of Mothers Who Were Depressed Postpartum. Developmental Psychology, 39.6, 1083-94.

    Mckee, M. (2001). Health-related Functional Status in Pregnancy: Relationship to Depression and Social Support in a Multi-ethnic Population. Obstetrics & Gynecology 97.6, 988-93.

    National Institute for Health Care Management. (2010). Identifying and treating maternal depression: Strategies & considerations for health plans. NIHCM Foundation Issue Brief, June, 1–28.

    Pearlstein, T. (2008). Perinatal depression: treatment options and dilemmas. Journal of Psychiatry & Neuroscience : JPN, 33(4), 302–318.

    Phillips, M. L. (2011). Treating post-partum depression. American Psychological Association Monitor on Psychology, 42.2, 46. Retrieved from http://www.apa.org/monitor/2011/02/postpartum.aspx.

    Teti, D. M., Gelfand, D. M., Messinger, D. S., & Isabella, R. (1995). Maternal depression and the quality of early attachment: An examination of infants, preschoolers, and their mothers. Developmental Psychology, 31(3), 364–376.

    U.S. Census Bureau. (2004). Current populations survey, annual social and economic supplement: Ethnicity and ancestry statistics branch, population division. Retrieved from http://www.census.gov

    Abby Lindsay (C’ 17)

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    Implementing the Summer Food Service Program

    Early Childhood Interventions December 09, 2016

    Many families celebrate the advent of the summer school vacation with picnics to the beach and cookouts. Students and teachers alike are excited to take a break from classrooms and mandated testing. For families with children on free or reduced price lunch, summer vacation can be devastating. No school means no lunch or breakfast for millions of school-aged children. Summer vacations present a gap in the nutritional needs of low-income children. The Summer Food Service Program (SFSP) seeks to fill that gap.  Unfortunately, only one in seven children currently registered for the free and reduced price lunch program participates in SFSP (Facts on the Summer Food Service Program, n.d.).

    Families who receive Supplemental Nutrition Assistance Program or SNAP benefits are automatically enrolled in free and reduced price lunch programs. The US Department of Agriculture (USDA) uses the federal poverty guidelines to determine eligibility for SNAP benefits. Attached are the USDA’s “Income Eligibility Guidelines” for the 2016-2017 school year (Income Eligibility Guidelines, 2016). For families not eligible for SNAP, there is a sliding scale for reduced price meals based on family income. These same families are eligible for services from SFSP (Facts on the Summer Food Service Program, n.d.).

    During the summer, The Summer Food Service Program provides free meals and snacks to low-income children The program fed 3.2 million children a day during the month of July, 2014. The Summer Food Service Program is implemented in two ways. It can operate on an enrollment basis or as an open program. In order to be eligible for funding, a site must operate in a low-income neighborhood and serve a population consisting of at least 50% on free and reduced price lunch. Individual groups such as nonprofits, YMCA camps, and local governments can run a SFSP site. Usually an SFSP site also provides some sort of academic enrichment in addition to free meals and snacks.

    There is an estimated 22 million children who receive free or reduced price lunch during the school year. Only 3.2 million of them participate in the Summer Food Service Program.  This may indicate that a significant number of children may be going hungry during the summer months, the SFSP is not operating in a satisfactory manner, or many families find it difficult to visit an SFSP site to obtain a meal because of the lack of transportation.

    In the summer of 2015, the USDA proposed a program to help meet the nutritional needs of low-income seniors and people with disabilities who are unable to access community based resources. For the first time, the USDA is proposing that agencies that deliver groceries accept SNAP benefits, allowing them to deliver groceries to people who cannot travel to a grocery store.  A program like this has the potential to also impact the lives of low-income children who are unable to visit the SFSP sites.

    The Obama administration has proposed a new program to help feed families during the summer. This program would give families eligible for free or reduced-price lunches an electronic benefit card. These cards would allow families to spend an extra $45 per child a week on groceries.  Such a program would erase the transportation difficulties associated with traveling to SFSP sites. It would also allow families to make independent choices in regards to their family diet. Unfortunately, this idea has yet to put into action due to Congressional inaction. Thus, millions of children may not be receiving nutritious meals. This is a perfect example of how Congress and the White House need to put aside differences to provide services that would benefit our country’s most vulnerable children.

    References

    Facts on the Summer Food Service Program. (n.d.). Food Research and Action Center. Retrieved from http://frac.org/pdf/sfsp_fact_sheet.pdf

    Fessler, P. (2016). President Obama Wants More Funds to Feed Low-income Kids In Summer. Kosu. Retrieved from http://kosu.org/post/president-obama-wants-more-funds-feed-low-   income-kids-summer#stream/0

    Income Eligibility Guidelines. (2016). Federal Register. Retrieved from         https://www.federalregister.gov/articles/2016/03/23/2016-06463/child-nutrition-           programs-income-eligibility-guidelines#h-8

    Emma Hamstra (C’16)

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