What Do Community Doulas Think About the Future of the Doula Workforce?

INTRODUCTION: Expanding access to doula care is a key strategy for improving the perinatal experiences and health outcomes of birthing people of color in the U.S. This study investigates the future of maternal healthcare in the U.S. from the perspective of doulas and highlights emerging technology and other opportunities related to strengthening the doula workforce. METHODS: The study recruited community doulas from 12 unique U.S. states, ensuring at least half of the doulas predominantly served communities of color. Doulas (N = 26) participated in semi-structured, futures-oriented interviews that explored their experiences providing care during the COVID-19 pandemic and utilization of technology. A subset of doulas (n = 8) were engaged in interactive workshops where they envisioned alternative futures for doula care and childbirth. Interviews and workshops were analyzed using the Framework Method. RESULTS: The COVID-19 pandemic heightened technology use among doulas and increased client accessibility. Social media serves as a unique space for critical community building and client outreach. Doulas reported opportunities to strengthen and mobilize the future workforce: recognizing doula care as a reimbursable service by health insurers, utilizing doula collectives for community practice to decrease burnout, increasing emotional support for doulas, and instilling a chain of learning through mentorship. DISCUSSION: Futures thinking served as a valuable approach for doulas to illuminate the implications of present-day challenges and empowered doulas to design roadmaps toward better futures for doulas and maternal health. Doulas should be engaged as partners to hold a meaningful decision-making role when discussing policies, employment structures, emerging technology, and other aspects of doulas' positioning within the healthcare system.

Integration of a clinical pharmacist practitioner-led pharmacogenomics service in a Veterans Affairs hematology/oncology clinic.

PURPOSE: This article describes the implementation and evaluation of pharmacogenomic testing within the hematology/oncology ambulatory care clinic at the William S. Middleton Memorial Veterans Hospital in Madison, WI. SUMMARY: The Pharmacogenomic Testing for Veterans (PHASER) program provides preemptive pharmacogenomic testing for veterans nationally. Program implementation at the Madison Veterans Affairs site began in the hematology/oncology clinic with the goal of integrating the offer for pharmacogenomic testing, testing completion, and review of the results by the hematology/oncology clinical pharmacist practitioner (CPP) into current workflows to create a sustainable process for PHASER. The hematology/oncology CPP designed workflows outlining how testing would be offered to patients, how results would be reported and to whom, and how documentation would occur in the electronic medical record. Veterans are offered preemptive PHASER testing, before needing therapy requiring pharmacogenomic results. Exceptions to pharmacogenomic testing were patients with a history of liver or allogeneic hematopoietic stem cell transplantation. CONCLUSION: This article provides a summary of the role of the hematology/oncology CPP in the implementation of a pharmacogenomics service and the impact on medication management in a hematology/oncology clinic.

Mental Health Distress and Delayed Contraception Among Older Adolescents and Young Adults.

Background: Symptoms of mental distress increased sharply during the COVID-19 pandemic, especially among older adolescents and young adults. Mental health distress may make it more challenging for young people to seek other needed health care, including contraception. This study explored the association of symptoms of depression, anxiety, and stress with delays in getting a contraceptive method or prescription. Materials and Methods: Data from a supplementary study (May 15, 2020-March 20, 2023) to a cluster randomized trial in 29 sites in Texas and California were used. The diverse study sample included community college students assigned female at birth of ages 18-29 years (n = 1,665 with 7,023 observations over time). We measured the association of depression (CES-D [Center for Epidemiologic Studies Depression Scale]) or anxiety and stress (DASS-21 [Depression Anxiety Stress Scales]) symptoms with delayed contraceptive care-seeking with mixed-effects multivariable regression with random effects for individual and site. We controlled for age and sociodemographic factors important for access to care. Results: Over one-third of participants (35%) reported they delayed getting the contraceptive method they needed. Multivariable regression results showed increased odds of delayed contraceptive care among participants with symptoms of depression (adjusted odds ratio [aOR] 1.58, 95% confidence interval [CI] 1.27-1.96). Likewise, delays were associated with anxiety and stress symptoms (aOR 1.46, 95% CI 1.17-1.82). Adolescents were more likely to delay seeking contraception than young adults (aOR 1.32, 95% CI 1.07-1.63). Conclusions: Results showed a strong association between mental distress and delayed contraception. Interventions are needed to increase contraceptive access for young people delaying care, along with supportive mental health care services, including for adolescents who face elevated odds of delay. ClinicalTrials.gov Identifier: NCT03519685.

Quality of prenatal and postpartum telehealth visits during COVID-19 and preferences for future care.

BACKGROUND: At the start of the COVID-19 pandemic, telehealth practices for pregnancy-related care were rapidly implemented. Telehealth for pregnancy-related care is likely to continue after the pandemic. In order for health systems and clinicians to provide person-centered pregnancy-related care via telehealth, it is critical to understand patients' telehealth experiences and their preferences regarding the use of telehealth moving forward. OBJECTIVE: This study aimed to describe perceived quality of prenatal and postpartum telehealth visits during COVID-19 and to examine the association between telehealth quality during the pandemic and future telehealth preferences. STUDY DESIGN: We used data from of an online sample of US women aged 18 to 45 years seeking reproductive health care during COVID-19. Two cross-sections of survey data were collected in July 2020 and January 2021. This analysis included those who sought prenatal (n=1496) or postpartum (n=482) care during the pandemic. Among those who had a prenatal or postpartum telehealth visit, we used multivariable logistic regression to examine the association between a measure of perceived telehealth quality and openness to future telehealth visits, adjusting for sociodemographic characteristics. RESULTS: A total of 57.5% of prenatal and 52.9% of postpartum respondents had a telehealth appointment. Respondents agreed with most statements about the quality of their telehealth appointments, with ≥80% reporting that they were convenient, easy, safe, and provided good information. Lower-ranked quality items were related to visits feeling personal and the patient feeling cared for. A total of 35.2% of prenatal (n=816) and 43.3% of postpartum (n=231) respondents expressed openness to telehealth visits in the future. Prenatal and postpartum respondents reporting higher telehealth quality had increased odds of being open to telehealth in the future (prenatal: adjusted odds ratio, 1.2; 95% confidence interval, 1.2-1.3; postpartum: adjusted odds ratio, 1.2; 95% confidence interval, 1.1-1.3). CONCLUSION: Prenatal and postpartum respondents with better telehealth experiences were more likely to express openness to telehealth in the future, although most preferred future in-person visits. As pregnancy-related telehealth continues, it is important to offer appointment options that match patient preferences, especially populations that face barriers in access to care, and to explore ways to personalize care and support positive patient-provider relationships.

Relational savoring intervention: Positive impacts for mothers and evidence of cultural compatibility for Latinas.

Parenting young children poses numerous emotion regulation challenges, and prevention programs that promote emotion regulation skills can help with this important task of parenthood. Relational savoring (RS), which entails savoring a positive experience of interpersonal connectedness, is a brief manualized intervention program, 4 weeks in length, grounded in positive psychology and attachment theory. In the current longitudinal, randomized, controlled trial, we examined the impacts of RS compared with an active control (personal savoring [PS], defined as savoring a positive individual experience) in a sample of N = 164 mothers of toddlers (Mage = 20.93 months) on outcomes that were assessed immediately postintervention (positive emotion, closeness to child) and at a 3-month follow-up visit (parenting sensitivity, reflective functioning [RF], savoring uptake, and parenting wellness). Compared with mothers assigned to the PS condition, mothers in the RS condition had greater immediate response to the intervention (greater increases in positive emotions [gratitude, pride], closeness to their child) as well as greater increase in sensitivity to toddlers' cues at the three-month follow-up. Neither RS nor PS increased overall parenting wellness at the three-month follow-up. Latina mothers (but not non-Latina mothers) in the RS condition had higher RF and greater savoring uptake than Latina mothers in the PS condition at follow-up. Findings provide preliminary evidence of the efficacy of RS in modifying therapeutic targets and suggest evidence of the cultural congruence of RS for Latina mothers. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Barreras y Soluciones: Lessons learned from integrating research-based clinical techniques into a community agency serving low-income Latinx immigrant families.

Barriers facing effective science-to-practice translation have led scholars to conduct early-stage intervention research within community organizations. We describe our experiences developing a manualized parent-youth attachment-based group therapy intervention within a community health organization dedicated to serving low-income Latinx immigrant families, Latino Health Access (LHA), in which services are rendered by trained community workers (promotores). By conducting a qualitative analysis of interviews with all members of this academic-community partnership (research [Principal Investigator, student researchers] and community agency team members [Administrators, promotores]), we discuss the challenges and opportunities that this collaboration has generated. The results led both the research and community teams to question assumptions about the basic skills, values, and attitudes that underlie the integration of science and practice. We will share the insights that have helped to promote connection and understanding among the stakeholders and the efforts made to support the progress and successes of developing community interventions.

Los obstáculos que enfrenta el traslado eficaz de la ciencia a la práctica han conducido a los investigadores a realizar investigaciones en etapas iniciales de las intervenciones dentro de las organizaciones comunitarias. Describimos nuestras experiencias con el desarrollo de una intervención estandarizada de terapia grupal basada en el apego entre padres y jóvenes dentro de una organización de salud comunitaria dedicada a asistir a familias inmigrantes latinas de bajos recursos, Latino Health Access (LHA), en la cual prestan servicios trabajadores comunitarios capacitados (promotores). Al realizar un análisis cualitativo de las entrevistas con todos los miembros de esta asociación académico-comunitaria (investigación [investigador principal, investigadores estudiantes] y los miembros del equipo de la organización comunitaria [administradores, promotores], comentamos las dificultades y las oportunidades que ha generado esta colaboración. Los resultados llevaron a los equipos comunitarios y de investigación a cuestionar las suposiciones acerca de las habilidades básicas, los valores y las actitudes que forman la base de la integración de la ciencia y la práctica. Compartiremos los conocimientos que han contribuido a promover la conexión y la comprensión entre las partes interesadas y los esfuerzos realizados para fomentar el avance y los logros de desarrollar intervenciones comunitarias.

Más Fuertes Juntos: Attachment relationship quality, but not demographic risk, predicts psychopathology in Latinx mother-youth dyads.

Latinx families are increasing in the population in the United States and have documented mental health concerns. Much remains to be understood about mental health predictors within this population. The present study aimed to help fill this gap and offer an in-depth assessment of psychopathology within a large (N = 330) sample of Latinx mothers and youth by exploring associations between sociodemographic risk, attachment relationship quality, and mental health. Demographic risk was not associated with youth or maternal psychopathology, but attachment relationship quality was associated with all indices of psychopathology in youth and mothers. The interaction between demographic risk and psychopathology only added to the prediction of maternal depression, revealing a pattern wherein maternal closeness was associated with lower depression at low and mean but not high levels of demographic risk. We discuss these findings in terms of the importance of supporting parent-child relationships in this population.

Higher maternal reflective functioning is associated with toddlers' adaptive emotion regulation.

Parental reflective functioning (RF), the ability to consider the child's behavior as a function of mental states (cognitions, emotions), is theorized to promote emotion regulation in children via its positive impact on parenting sensitivity. Using a sample of mothers and toddlers (N = 151 dyads; 41% Latinx; 54% girls; MAge  = 21 months; SDAge  =  2.5 months), we measured mothers' self-reported RF (high RF = low certainty/high interest-curiosity/low prementalizing), toddlers' distress during a standardized challenging behavioral task (toy removal), and three methods of children's coping with distress. Then, we tested whether RF moderated the association between children's observed distress and coping during the task (mother-directed adaptive coping, task-directed adaptive coping, maladaptive aggression) as an index of emotion regulation. Although RF was not associated with toddlers' distress, indices of RF moderated the associations between distress and coping. As maternal RF increased, the positive association between toddler distress and mother-oriented behavior increased, whereas the association between toddler distress and child aggression decreased. Findings were present only for certainty of mental states, whereas no effects were present for prementalizing or interest/curiosity. We discuss these findings in terms of their contributions to theory regarding parent-child relationships, maternal RF, and child emotion regulation.

La función de reflexión de los padres (RF), la habilidad de considerar el comportamiento del niño como una función de los estados mentales, promueve, según la teoría, la regulación de la emoción en los niños por medio de su impacto en la sensibilidad de los progenitores. Con un grupo muestra de madres y niños pequeñitos (N = 151 díadas; 41% Latinx; 54% niñas; Edad M = 21 meses; Edad SD = 2.5 meses), medimos la auto-reportada RF de las madres (RF alta = baja certeza/alto interés-curiosidad/baja pre-mentalización), la angustia de los niños pequeñitos durante una tarea estándar de reto de comportamiento (apartar un juguete) y tres métodos de cómo los niños se las arreglan con la angustia. Entonces, pusimos a prueba si la RF moderaba la asociación entre la observada angustia de los niños pequeñitos y el arreglárselas con la tarea (el arreglárselas con adaptarse a la directriz de la madre, el arreglárselas con adaptarse a la directriz de la tarea, agresión mal adaptada) como índice de regulación de la emoción. A pesar de que no se asoció la RF con la angustia de los niños pequeñitos, los índices de RF moderaron las asociaciones entre la angustia y el proceso de arreglárselas. A medida que la RF aumentó, también aumentó la positiva asociación entre la angustia del niño pequeñito con ambas, orientado hacia la madre, mientras que la asociación entre la angustia del niño pequeñito y la agresividad del niño disminuyó. Los resultados estuvieron presentes sólo en cuanto a la certeza de los estados mentales, mientras que ningún efecto se presentó en el caso de la pre-mentalización o el interés/curiosidad. Discutimos estos resultados en términos de sus contribuciones a la teoría acerca de las relaciones progenitor-niño, RF materna y la regulación de la emoción del niño.

Parental reflective functioning (RF), the ability to consider the child's behavior as a function of mental states, is theorized to promote emotion regulation in children via its positive impact on parenting sensitivity. Using a sample of mothers and toddlers (N = 151 dyads; 41% Latinx; 54% girls; MAge = 21 months; SDAge = 2.5 months), we measured mothers' self-reported RF (high RF = low certainty/high interest-curiosity/low prementalizing), toddlers' distress during a standardized challenging behavioral task (toy removal), and three methods of children's coping with distress. Then, we tested whether RF moderated the association between children's observed distress and coping during the task (mother-directed adaptive coping, task-directed adaptive coping, maladaptive aggression) as an index of emotion regulation. Although RF was not associated with toddlers' distress, indices of RF moderated the associations between distress and coping. As RF increased, the positive association between toddler distress with both mother-oriented increased, whereas the association between toddler distress and child aggression decreased. Findings were present only for certainty of mental states, whereas no effects were present for prementalizing or interest/curiosity. We discuss these findings in terms of their contributions to theory regarding parent-child relationships, maternal RF, and child emotion regulation.

Confía en mí, Confío en ti: Applying developmental theory to mitigate sociocultural risk in Latinx families.

Ed Zigler was a champion for underprivileged youth, one who worked alongside communities to fight for long-lasting systemic changes that were informed by his lifespan and ecological perspective on the development of the whole child. This paper reports on the development, implementation, and preliminary outcomes of an intervention that embodied the Zigler approach by adopting a community participatory research lens to integrate complementary insights across community-based providers (promotoras), Latinx immigrant families, and developmental psychologists in the service of promoting parent-child relationship quality and preventing youth aggression and violence. Analyses from the first 112 Latinx mother-youth dyad participants (46% female children, ages 8-17) in the resultant, Confía en mí, Confío en ti, eight-week intervention revealed significant pre-post increases in purported mechanisms of change (i.e., attachment security, reflective functioning) and early intervention outcomes (i.e., depressive, anxiety, and externalizing problems). Treatment responses varied by youth age. A case analysis illustrated the lived experiences of the women and children served by this intervention. We discuss future directions for the program, as well as challenges to its sustainability. Finally, we consider Ed's legacy as we discuss the contributions of this work to developmental science and our understanding of attachment relationships among low-income immigrant Latinx families.

Relational savoring: An attachment-based approach to promoting interpersonal flourishing.

Our purpose is to introduce a novel technique for evoking emotions associated with moments of closeness with another person (relational savoring), to describe its theoretical grounding, specifics of treatment targets and outcomes, as well as to provide the preliminary evidence for its efficacy in promoting flourishing. We rely on attachment theory, the broaden-and-build theory of positive emotions, and emotion-focused therapy as foundations for our understanding of how secure relationships are built and maintained and for proposing how relational savoring can promote flourishing through strengthening relationships. To illustrate specific mechanisms of change, we provide examples from a recently completed study of mothers of young children. Finally, we discuss how the technique can be integrated into clinical practice as well as how it might be used to augment other forms of therapy. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Emotional understanding, aggression, and social functioning among preschoolers.

Evidence suggests that emotional understanding (EU) assists in the regulation of aggression, which in turn, predicts better social functioning. Although the links among EU, aggression, and social functioning have been preliminarily explored, significant gaps remain in our comprehension of the factors that could qualify these links (e.g., impact of developmental stage, type of aggression, type of social functioning, and different dimensions of EU). Here we conduct a multidimensional assessment of EU, aggression, and social functioning within a sample of aggressive preschoolers (n = 24) and a matched comparison group (n = 26; N = 50, 26 girls; Mage = 53.83 months, SDage = 3.73). We assessed EU using a behavioral assessment and social functioning via teacher-report. We conducted all analyses through the use of two measures of children's aggression-first, we compared children identified as aggressive by preschool teachers to those in the nonaggressive comparison group. Second, we used teacher-reported continuous measures of children's physical and relational aggression. Relative to the comparison group, the aggressive group demonstrated lower expressive EU, higher receptive EU, lower peer acceptance, and lower prosocial behavior. Analyses of continuous measures revealed a more complicated pattern of associations among aggression, EU, and social functioning. Higher physical aggression predicted greater peer victimization among females, and expressive EU was only associated with higher peer acceptance among the aggressive group. (PsycINFO Database Record (c) 2020 APA, all rights reserved).