NICU discharge planning and beyond: recommendations for parent psychosocial support.

Parents will interact with a multitude of teams from various disciplines during their child's admission to the neonatal intensive care unit. Recognition of the emotional stressors experienced by these parents is a first step in working to provide the crucial support and parenting skills needed for bonding and caring for their infant from admission through discharge and beyond. Family-centered care involves time-sensitive two-way communication between parents and the multidisciplinary team members who coordinate care transition by providing emotional, educational, medical and home visitor support for these families. To do this well, a thoughtful exchange of information between team members and parents is essential to identify psychosocial stress and ameliorate family concerns. Parents will need emotional and educational support and follow-up resources. Establishing individualized, flexible but realistic, pre- and post-discharge plans with parents is needed to start their healthy transition to home and community.

Staff perceptions of sexuality-related problems and behaviors of psychiatrically hospitalized children and adolescents.

Clinical staff at two hospitals serving children and adolescents were surveyed regarding their observations and experiences regarding the sexuality-related behaviors and issues of patients. Results of this descriptive study indicate that staff frequently encounter a wide range of such problems, including the effects sexual abuse, sexually aggressive or inappropriate behavior, lack of knowledge about basic hygiene and sexual development, pregnancy and contraception, high-risk behaviors, and sexually-transmitted diseases, including AIDS. Similarities and differences of the perceptions by staff of these problems are compared across unit types (children's, adolescents, dually-diagnosed, developmentally-disabled). Implications for staff training, clinical policies, and further research are discussed.

Behavioral factors affecting HIV prevention for adolescent and young adult IDUs.

Epidemiological and sociobehavioral data regarding HIV-related risk and injection drug use among adolescents and young adults are examined to provide insight and assistance to nurses delivering preventive intervention and community and clinical care. The increase in HIV/AIDS cases among injection drug users (IDUs), adolescents, and African Americans strongly suggests that clinical care providers acquire a better understanding of the sociocultural and behavioral context within which health care is provided. Transition into injection drug use, high-risk injecting and sexual behaviors, sociodemographic differences, and the importance of social networks are discussed. Nurses are encouraged to provide health promotion, disease prevention messages, and health care to IDUs in small nontraditional clinical settings and to seek out the assistance of the IDUs' social network to increase adherence and compliance to complex prevention and therapeutic efforts.

Barriers to school-based health care programs.

Although school-based health care programs (SBHCPs) provide affordable and accessible health care to children and adolescents and are known to improve school attendance, a variety of barriers affect their development. Focus groups were conducted in three schools in Louisiana to demonstrate how barriers can affect the initiation and development of SBHCPs. Each school-based program was in a different stage of development. Identifying potential barriers and developing strategies to overcome them can enhance already existing SBHCPs and make it easier for new programs to begin. The social worker serves as an important ally in the development of SBHCPs and is a necessary part of the school-based health care team.

Community reactions to reproductive health care at three school-based clinics in Louisiana.

Despite the growing success of school-based health care during the past two decades, the issue of providing reproductive health care at school-based health centers remains controversial. In this article, focus group data from three school-based centers in Louisiana, each in different stages of development, demonstrates how the controversies about reproductive health may frame more general concerns about school-based care. In addition, community readiness to address directly problematic sexual behavior relates not only to the specific needs and priorities of the community but to recognition of the negative effect of the consequences of sexual behavior such as pregnancy, high drop out, and absenteeism rates on a community's educational, rather than social, goals and values.

PIP: Under the direction of the Louisiana Office of Public Health, focus groups at three schools were used to conduct a formal evaluation of the school-based health centers (SBHCs). Specifically, researchers aimed to determine the actual educational and health-related benefits of the SBHCs. One high school was in a politically conservative, small city in southern Louisiana. 60% of the students were African-American. More than 50% of girls became pregnant at least once during their high school years. The high pregnancy rate affected school attendance and drop-out rates. The second SBHC served elementary, junior, and senior high school students who lived in a conservative, close-knit community. Most residents were White. 90% of students enrolled for SBHC services. The third SBHC was located in a high school in the inner city of a medium-sized city. Crime, violence, drug dealing, drug use, single-parent families, and poverty were common. Most students were African Americans. Shared commonalities of the three SBHCs included: little controversy existed about provision of pregnancy and STD (sexually transmitted disease) testing or referral about contraceptive counseling, and everyone was aware of the high pregnancy rates in their communities and that adolescent pregnancy is associated with absenteeism and high drop-out rates. Yet, few people were ready to define adolescent pregnancy as a community concern or as a problem appropriately addressed by the SBHC. The willingness of a community to address reproductive health may reflect their concerns about keeping students in school. These findings suggest that SBHCs must develop and maintain strong support and commitment from students, teachers, parents, and the greater community. Once the SBHC has gained their confidence, it is free to develop services that meet the specific needs of the students. Successful launching of SBHCs depends on keeping the health care goals consistent with the community's educational goals rather than social goals.

Parents' constructions of their infants' personalities before and after birth: a descriptive study.

Thirty five middle class parents, pregnant for the first time, were recruited from childbirth classes for participation in a shortterm longitudinal study of parents' constructions of their infants' personalities during pregnancy and in early infancy. Here, we report qualitative findings about parents' descriptions of their infants' personalities before and after birth, as well as descriptions of their relationships with their infants and their first feelings of love for their infants. Descriptions of infant personalities were remarkably vivid before and after birth, but there were changes in the prominence of several attributes over time.

Intergenerational transmission of maltreatment: insights from attachment theory and research.

The maltreated-maltreating cycle is the most striking example of the psychodynamic notion that early relationship experiences are carried forward and reenacted in subsequent relationships. Bowlby's attachment theory proposes that transmission of patterns of relating across generations, including maltreatment, is mediated by an individual's internal working models. Recent research that operationalizes working models in infants and in adults provides preliminary support for the congruence of working models across generations. Results from these investigations suggest that the maltreated-maltreating cycle should be redefined. Instead of specific types of maltreatment, an organizing theme of the parent-child relationship and an associated internal working model that provides a way of experiencing that theme are transmitted and later reenacted. In this paper, preliminary data implicating rejection, role-reversal and fear as themes organizing maltreating relationships are reviewed and directions for further research are discussed.

Repeated participation in a bereaved parents group: two case studies and implications for clinicians.

Over 30,000 children die each year from catastrophic illness. Groups for the bereaved have arisen to address the needs of family members following the profound loss of a child. The authors review the commonly held notions of "normal" and "pathological" mourning and their special application to bereaved parents. The case of two women who participated in their fifth group for bereaved parents are presented with the meanings of their repeated attendance examined in the context of incomplete mourning. Implications for professionals working with bereaved parents are discussed.