A Cycles-Breaking Framework to Disrupt Intergenerational Patterns of Maltreatment and Vulnerability During the Childbearing Year

Healing the Past by Nurturing the Future: trauma-aware, healing-informed care to improve support for Aboriginal and Torres Strait Islander families - implementation and evaluation study protocol

INTRODUCTION

Complex trauma can have serious impacts on the health and well-being of Aboriginal and Torres Strait Islander families. The perinatal period represents a 'critical window' for recovery and transforming cycles of trauma into cycles of healing. The Healing the Past by Nurturing the Future (HPNF) project aims to implement and evaluate a programme of strategies to improve support for Aboriginal and Torres Strait islander families experiencing complex trauma.

METHOD

The HPNF programme was codesigned over 4 years to improve awareness, support, recognition and assessment of trauma. Components include (1) a trauma-aware, healing-informed training and resource package for service providers; (2) trauma-awareness resources for parents; (3) organisational readiness assessment; (4) a database for parents and service providers to identify accessible and appropriate additional support and (5) piloting safe recognition and assessment processes. The programme will be implemented in a large rural health service in Victoria, Australia, over 12 months. Evaluation using a mixed-methods approach will assess feasibility, acceptability, cost, effectiveness and sustainability. This will include service user and provider interviews; service usage and cost auditing; and an administrative linked data study of parent and infant outcomes.

ANALYSIS

Qualitative data will be analysed using reflexive thematic analysis. Quantitative and service usage outcomes will be described as counts and proportions. Evaluation of health outcomes will use interrupted time series analyses. Triangulation of data will be conducted and mapped to the Consolidated Framework for Implementation Research and Reach, Effectiveness, Adoption, Implementation and Maintenance frameworks to understand factors influencing feasibility, acceptability, effectiveness, cost and sustainability.

ETHICS AND DISSEMINATION

Approval granted from St Vincent's Melbourne Ethics Committee (approval no. 239/22). Data will be disseminated according to the strategy outlined in the codesign study protocol, in-line with the National Health and Medical Research Council Aboriginal and Torres Strait Islander Research Excellence criteria.

Resilient Infant Feeding Among Young Women With Histories of Maltreatment and Poor Support

OBJECTIVE

To explore how young women with histories of maltreatment describe their experiences and decisions around infant feeding.

DESIGN

Secondary qualitative analysis using supplementary analysis.

SETTING

Washington, DC; Baltimore, MD; and their respective suburbs.

PARTICIPANTS

Young women with histories of being abused or neglected as children or adolescents and who gave birth to one child before age 19 years (N = 9).

METHODS

We collected data through in-depth semistructured interviews and analyzed them using reflexive thematic analysis.

RESULTS

The analysis resulted in three themes: Infant Feeding Intention, Identifying Challenges and Persistence, and Pivoting to What Is Feasible. Participants felt that breastfeeding was valuable and wanted to be able to breastfeed their children. They continued to provide human milk through painful latches and a lack of support and guidance, but formula became the only viable option for many of them.

CONCLUSION

Despite wanting to breastfeed and continuing through barriers, many participants could not continue to breastfeed as long as they wanted because of a systemic lack of support. These findings indicate a need to support young women with histories of maltreatment through increased and consistent access to lactation support providers and trauma-informed care. Nurses and other clinicians are uniquely positioned to support young women with histories of maltreatment to overcome barriers related to breastfeeding.

Childhood maltreatment history and trauma-specific predictors of parenting stress in new fathers

For new fathers, parenting stress is a risk factor for impaired early parenting and child maltreatment perpetration. Predictors of parenting stress, including fathers' own experiences of trauma, could be useful intervention targets to support new fathers. We aim to examine associations between new fathers' own histories of child maltreatment, and their perinatal mental health, relationships, and parenting stress. We recruited 298 first-time fathers for a survey that measured child maltreatment history, trauma sequelae including posttraumatic stress disorder (PTSD), major depressive disorder (MDD), interpersonal reactivity, substance use, anger expression, coparenting quality, and parenting stress. On the Parenting Stress Index (PSI) (from 36 to 180), bivariate analysis demonstrated that new fathers who experienced child maltreatment (n = 94) had significantly higher parenting stress (x̅ = 85.3, σ = 18.7) than those who did not (n = 204; x̅ = 76.0, σ = 16.6; P < .000). Hierarchical linear regression modeling indicated that a child maltreatment history, PTSD, and MDD were significantly associated with parenting stress. The strongest predictors of parenting stress were coparenting quality and complex trauma sequelae-interpersonal reactivity and anger expression. Interventions to reduce fathers' parenting stress by targeting known mental health and relationship sequelae of maltreatment are promising avenues to breaking intergenerational transmission of child maltreatment and psychiatric vulnerability.

Perinatal (Re)experiencing of Post-Traumatic Stress Disorder Symptoms for Survivors of Childhood Sexual Abuse: An Integrative Review

This integrative review aimed to synthesize both qualitative and quantitative research on the (re)experiencing of post-traumatic stress disorder (PTSD) symptoms during the perinatal period for childhood sexual abuse (CSA) survivors. Whittemore and Knafl's framework, which includes problem identification, literature review, data evaluation, data analysis, and results dissemination, was used. A search in four databases (i.e., PsycINFO, MEDLINE, Scopus, and ProQuest Dissertations and Thesis Global) yielded an initial sample of 3420 articles. After screening and deduplication, 16 articles met our inclusion criteria (i.e., history of CSA, minimum 8 weeks pregnant, reported quantitative statistics or qualitative findings, discussed PTSD symptoms) and were retained in the final sample. CSA survivors (re)experienced PTSD symptoms as a result of (1) aspects of their medical care (vaginal examinations, male medical providers, lack of control, and restraint), (2) physical sensations during pregnancy, childbirth, and breastfeeding, and (3) sex of the child (worries over child becoming an abuser/abused, male genitalia). CSA survivor's PTSD symptoms of intrusion, dissociation, avoidance, and hyperarousal were significantly greater throughout the perinatal period compared with individuals without CSA or with other traumas. CSA survivors are at increased risk of (re)experiencing PTSD symptoms throughout the perinatal period, which may be due to several internal and external triggers. Further research is needed to understand external triggers outside of medical care, and how the unique context of pregnancy may differ from other life contexts for survivors of CSA. Findings point to the relevance of adopting trauma-informed practices with CSA survivors during their perinatal period.

Intimate Partner Violence Among Pregnant Veterans: Prevalence, Associated Mental Health Conditions, and Health Care Utilization

BACKGROUND

Intimate partner violence (IPV) is a prevalent and serious health concern for women veterans, associated with mental and physical health symptoms. The adverse impacts of IPV are exacerbated during pregnancy, with added risks for pregnancy and postpartum outcomes.

OBJECTIVE

Identify the scope of IPV among pregnant veterans and associations with health outcomes.

DESIGN

Data were obtained from a national retrospective cohort study.

PARTICIPANTS

Study participants were 442 pregnant veterans using VHA maternity care benefits.

MAIN MEASURES

Mental health history was assessed via self-report measure and chart review; history of IPV and perinatal depression were assessed via brief validated self-report measures.

KEY RESULTS

Fourteen percent of the sample reported past-year IPV. Report of past-year IPV was associated with higher self-reported rates of lifetime mental health disorders including depression (p = 0.01), posttraumatic stress disorder (p = 0.02), anxiety disorders (p = 0.05), mood disorders (p = 0.01), bipolar disorder (p = 0.001), and eating disorders (p = 0.003); past-year IPV was also associated with the diagnosis of posttraumatic stress disorder during pregnancy (p = 0.002). Additionally, past-year IPV was associated with higher rates of military sexual trauma (MST; p = 0.03), pregnancy health risk behaviors (i.e., smoking, alcohol, and drug use; p = 0.004), greater number of VHA mental health visits during pregnancy (p = 0.04), and a lower likelihood of seeking social support from a spouse or partner (p < 0.0001).

CONCLUSIONS

Results indicate substantial rates of IPV among pregnant veterans, and high rates of mental health conditions which may be exacerbated by MST experience and lower likelihood of seeking social support. Clinicians treating pregnant veterans should screen for and address IPV and mental health treatment needs, and risks should be assessed among pregnant veterans experiencing IPV.

Struggling With Reciprocity and Compassion: Mentoring Pregnant and Parenting Mothers Experiencing Vulnerability

Transitioning from pregnancy to parenthood is particularly challenging for women living with low income and experiencing social isolation, mental illness, addiction, and/or family violence. The purpose of this qualitative study was to evaluate one component of Welcome to Parenthood, a two-generation multiple intervention program including neuroscience-based parenting education, kin and non-kin mentorship, and an engagement tool (baby kit). From late pregnancy to 2 months postpartum, mentors kept a journal regarding their experiences of mentoring mothers experiencing vulnerability. We engaged in a modified constructivist grounded theory to explore hand-written text from the journals. The core category, Struggling with Reciprocity and Compassion, influenced processes of Becoming a Mentor. Mentoring mothers experiencing vulnerability was both challenging and rewarding, requiring an inordinate amount of physical, social, emotional, and economic resources. To foster maternal mental health and infant development, pregnant and parenting women experiencing vulnerability could benefit from long-term reciprocal and compassionate mentoring.

Healing the Past by Nurturing the Future-co-designing perinatal strategies for Aboriginal and Torres Strait Islander parents experiencing complex trauma: framework and protocol for a community-based participatory action research study

INTRODUCTION

Child maltreatment and other traumatic events can have serious long-term physical, social and emotional effects, including a cluster of distress symptoms recognised as 'complex trauma'. Aboriginal and Torres Strait Islander (Aboriginal) people are also affected by legacies of historical trauma and loss. Trauma responses may be triggered during the transition to parenting in the perinatal period. Conversely, becoming a parent offers a unique life-course opportunity for healing and prevention of intergenerational transmission of trauma. This paper outlines a conceptual framework and protocol for an Aboriginal-led, community-based participatory action research (action research) project which aims to co-design safe, acceptable and feasible perinatal awareness, recognition, assessment and support strategies for Aboriginal parents experiencing complex trauma.

METHODS AND ANALYSIS

This formative research project is being conducted in three Australian jurisdictions (Northern Territory, South Australia and Victoria) with key stakeholders from all national jurisdictions. Four action research cycles incorporate mixed methods research activities including evidence reviews, parent and service provider discussion groups, development and psychometric evaluation of a recognition and assessment process and drafting proposals for pilot, implementation and evaluation. Reflection and planning stages of four action research cycles will be undertaken in four key stakeholder workshops aligned with the first four Intervention Mapping steps to prepare programme plans.

ETHICS AND DISSEMINATION

Ethics and dissemination protocols are consistent with the National Health and Medical Research Council Indigenous Research Excellence criteria of engagement, benefit, transferability and capacity-building. A conceptual framework has been developed to promote the application of core values of safety, trustworthiness, empowerment, collaboration, culture, holism, compassion and reciprocity. These include related principles and accompanying reflective questions to guide research decisions.