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Guyon-Harris KL, Krans EE, Gill A, Karnosh C, Shaw DS. Supporting positive parenting among pregnant people in recovery from opioid use disorder: Introducing family check‐up–prenatal. Infant Ment Health J 2024. [PMID: 39118311 DOI: 10.1002/imhj.22132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 06/14/2024] [Accepted: 06/25/2024] [Indexed: 08/10/2024]
Abstract
Opioid use disorder (OUD) among pregnant people has increased dramatically during the opioid epidemic, affecting a significant number of families with young children. Parents with OUD commonly face significant challenges as they are often balancing the stress of caring for young children with maintaining recovery and co-occurring psychosocial challenges (e.g., mental health, low social support). Toward designing interventions to address parenting needs among parents with OUD, we conducted a mixed-methods study to understand the acceptability of receiving parenting support prenatally among pregnant people with OUD residing in the United States. Semi-structured interviews were conducted among 18 pregnant and early postpartum people recruited from a substance use treatment program specializing in the care of pregnant and parenting populations. Among all participants, a prenatal parenting program that comprehensively addresses recovery, parenting, and wellbeing was found to be widely acceptable. Regarding content most desirable within a parenting intervention, participants indicated an interest in breastfeeding, caring for newborns with in-utero opioid exposure, parent-infant bonding, infant soothing techniques, their own wellbeing/mental health, and parenting skills. We introduce a prenatal adaptation of the well-established Family Check-up parenting intervention as a novel, prenatal intervention to prevent negative outcomes for caregivers in recovery and their children.
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Affiliation(s)
- Katherine L Guyon-Harris
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Elizabeth E Krans
- Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Research Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Anne Gill
- Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Caroline Karnosh
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Daniel S Shaw
- Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Regmi S, Kedia SK, Ahuja NA, Lee G, Entwistle C, Dillon PJ. Association Between Adverse Childhood Experiences and Opioid Use-Related Behaviors: A Systematic Review. TRAUMA, VIOLENCE & ABUSE 2024; 25:2046-2064. [PMID: 37920999 DOI: 10.1177/15248380231205821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
As opioid use-related behaviors continue at epidemic proportions, identifying the root causes of these behaviors is critical. Adverse childhood experiences (ACEs) are shown to be an important predictor of opioid initiation, opioid dependence, and lifetime opioid overdose. The purpose of this systematic review is to examine the association between ACEs and opioid use-related behaviors later in life and to discuss implications for policy, practice, and research regarding ACEs and opioids. Five databases (PubMed, PsycINFO, CINAHL, Medline, and Scopus) were used to identify studies investigating the association between ACEs and opioid use-related behaviors. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, 20 studies out of the initial 428 met the inclusion criteria for this review. Among the included 20 studies, 15 focused on the relationship between ACEs and lifetime opioid use-related behaviors, and five focused on current opioid use-related behaviors. All studies found statistical associations between ACEs and lifetime or current opioid use-related behaviors. Five studies found a significant gradient effect; that is, as the number of ACEs increased, the risk of opioid use-related behaviors also increased. A significant dose-response relationship exists between ACEs and opioid use-related behaviors. Hence, it is essential for clinicians to screen for ACEs before prescribing opioid medications, for opioid treatment to incorporate trauma-informed methods, and for messaging around opioid use interventions to include information about ACEs. The current review points to a critical need to implement standardized ACE screening instruments in clinical and research settings.
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Huynh T, Kerr ML, Kim CN, Fourianalistyawati E, Chang VYR, Duncan LG. Parental Reflective Capacities: A Scoping Review of Mindful Parenting and Parental Reflective Functioning. Mindfulness (N Y) 2024; 15:1531-1602. [PMID: 39328292 PMCID: PMC11426413 DOI: 10.1007/s12671-024-02379-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/07/2024] [Indexed: 09/28/2024]
Abstract
Objectives Two key parental reflective capacities-mindful parenting (MP) and parental reflective functioning (PRF) - have been shown to promote healthy parent-child relationships through parents' increased sensitivity and responsiveness to their children's needs in spite of parenting stressors. Despite the theoretical overlap between these two constructs, researchers have continued to examine them independently. Therefore, the purpose of this scoping review was to review the overlapping and distinctive outcomes and correlates in the empirical MP and PRF literatures. Method A comprehensive literature search across the MP and PRF literature for studies published from 2005 through early 2020 (pre-COVID-19 pandemic) was conducted. Results A review of 301 articles (n = 180 MP and n = 121 PRF) revealed overlapping study outcomes and correlates, including improvement in parent and child well-being, parenting behaviors, and attachment. Both MP and PRF literatures suggest MP and PRF are amenable to intervention-induced changes, although mostly documented in White mothers, which results may not be generalizable to diverse populations. Conclusions Researchers should consider the impact MP and PRF have on positive family relationships. Results suggest that scholars should consider investigating and intervening on MP and PRF simultaneously. Specifically, results identified MP and PRF convergent associations and perhaps synergistic impacts on positive parenting behaviors. Limitations and future directions are discussed. Preregistration This review was not preregistered.
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Affiliation(s)
- Tuyen Huynh
- Department of Psychology, University of South Carolina, Barnwell College Room 517, 1512 Pendleton Street, Columbia, SC 29208, USA
| | - Margaret L Kerr
- Human Development and Family Studies, University of Wisconsin-Madison, 4109 Nancy Nicholas Hall, 1300 Linden Drive, Madison, Wisconsin 53706, USA
| | - Christina N Kim
- Department of Population Health, NYU Grossman School of Medicine, New York, USA
| | - Endang Fourianalistyawati
- Faculty of Psychology, Universitas YARSI, Menara YARSI, Kav. 13, Jl. Letjend. Suprapto. Cempaka Putih, Jakarta Pusat, DKI, Jakarta 10510, Indonesia
| | | | - Larissa G Duncan
- Human Development and Family Studies, University of Wisconsin-Madison, 1300 Linden Drive, Madison, Wisconsin 53706, USA
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Rohde JF, Chaiyachati BH, Demharter NS, Dorrian C, Gregory EF, Hossain J, McAllister JM, Ratner JA, Schiff DM, Shedlock AR, Sibinga EMS, Goyal NK. Pediatric Primary Care of Children With Intrauterine Opioid Exposure: Survey of Academic Teaching Practices. Acad Pediatr 2024:S1876-2859(24)00217-1. [PMID: 38880392 DOI: 10.1016/j.acap.2024.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 06/03/2024] [Accepted: 06/06/2024] [Indexed: 06/18/2024]
Abstract
OBJECTIVE Intrauterine opioid exposure (IOE) has increased over the last 2 decades and is associated with additional needs after birth. To date, no clinical guidelines address the primary care of children with IOE. We aimed to characterize clinician-reported screening and referral practices, barriers to effective primary care for children with IOE, and clinician- and practice-level characteristics associated with perceived barriers. METHODS We conducted a cross-sectional survey of pediatric residents, pediatricians, and advanced practitioners at 28 primary care clinics affiliated with 7 pediatric residency programs (April-June 2022). We assessed screening and other clinical practices related to IOE and perceived barriers to addressing parental opioid use disorder (OUD). We used descriptive statistics to analyze survey responses, assessed the distribution of reported barriers, and applied a 2-stage cluster analysis to assess response patterns. RESULTS Of 1004 invited clinicians, 329 (32.8%) responses were returned, and 325 pediatric residents and pediatricians were included in the final analytic sample. Almost all (99.3%) reported parental substance use screening as important, but only 11.6% screened routinely. Half of the respondents routinely refer children with IOE to early intervention services and social work. Lack of standard screening for substance use was the most frequently selected barrier to addressing parental OUD. Participants reporting fewer barriers to addressing parental OUD identified having greater access to OUD treatment programs and home visiting programs. CONCLUSIONS Pediatricians report variations in primary care screenings and referrals for children with IOE. Access to parental OUD treatment programs may mitigate perceived barriers to addressing parental OUD in the pediatric office.
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Affiliation(s)
- Jessica F Rohde
- Division of General Academic Pediatrics (JF Rohde and C Dorrian), Nemours Children's Health, Wilmington, Del; Sidney Kimmel Medical College (JF Rohde, C Dorrian, and NK Goyal), Thomas Jefferson University, Philadelphia, Pa; Value-Based Service Organization (NK Goyal, JF Rohde and C Dorrian), Nemours Children's Health, Philadelphia, Pa.
| | - Barbara H Chaiyachati
- Policy Lab (BH Chaiyachati and EF Gregory), Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, Pa; Department of Pediatrics (BH Chaiyachati and EF Gregory), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa
| | - Neera Shah Demharter
- Penn State Health Children's Hospital (NS Demharter and AR Shedlock), Penn State College of Medicine, Hershey, Pa
| | - Christina Dorrian
- Division of General Academic Pediatrics (JF Rohde and C Dorrian), Nemours Children's Health, Wilmington, Del; Sidney Kimmel Medical College (JF Rohde, C Dorrian, and NK Goyal), Thomas Jefferson University, Philadelphia, Pa; Value-Based Service Organization (NK Goyal, JF Rohde and C Dorrian), Nemours Children's Health, Philadelphia, Pa
| | - Emily F Gregory
- Policy Lab (BH Chaiyachati and EF Gregory), Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, Pa; Department of Pediatrics (BH Chaiyachati and EF Gregory), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa
| | - Jobayer Hossain
- Biostatistics Core (J Hossain), Biomedical Research, Nemours Children's Health, Wilmington, Del
| | - Jennifer M McAllister
- Cincinnati Children's Hospital Perinatal Institute (JM McAllister), University of Cincinnati Department of Pediatrics, Cincinnati, Ohio
| | - Jessica A Ratner
- Division of Addiction Medicine (JA Ratner), Johns Hopkins School of Medicine, Baltimore, Md
| | - Davida M Schiff
- Division of General Academic Pediatrics and Newborn Medicine (DM Schiff), MassGeneral for Children, Boston, Mass
| | - Aaron R Shedlock
- Penn State Health Children's Hospital (NS Demharter and AR Shedlock), Penn State College of Medicine, Hershey, Pa
| | - Erica M S Sibinga
- Department of Pediatrics (EMS Sibinga), Johns Hopkins School of Medicine, Baltimore, Md
| | - Neera K Goyal
- Sidney Kimmel Medical College (JF Rohde, C Dorrian, and NK Goyal), Thomas Jefferson University, Philadelphia, Pa; Value-Based Service Organization (NK Goyal, JF Rohde and C Dorrian), Nemours Children's Health, Philadelphia, Pa
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Goyal N, Gannon M, Sood E, Harris G, Franko E, Abatemarco DJ, Hand DJ, Leib S, Short VL. Group Well Child Care for Mothers with Opioid Use Disorder: Framework for Implementation. Matern Child Health J 2023; 27:75-86. [PMID: 37515747 PMCID: PMC10692244 DOI: 10.1007/s10995-023-03762-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2023] [Indexed: 07/31/2023]
Abstract
OBJECTIVE For parents with opioid use disorder (OUD) and their children, group well child care (WCC) is an under-studied intervention that may reduce stigma, increase quality of care, and improve clinical outcomes. We explored barriers and facilitators to this intervention using an implementation science framework. METHODS A qualitative study was conducted from October 2020-March 2021 as part of the planning phase of a cluster-randomized trial of group WCC. Parent participants were recruited from one urban, university-affiliated OUD treatment center to participate in semi-structured telephone interviews. Eligible parents had a child under two years old and were English speaking. Clinician participants were recruited from a nearby pediatric primary care practice. Inductive thematic analysis of interview responses was led by two investigators using open coding procedures. RESULTS Thirty-one parents and thirteen pediatric clinicians participated in the interviews. Most parents (68%) reported that they would be likely or very likely to bring their child to the OUD treatment center for WCC. Six themes emerged describing perceived implementation barriers, including intervention difficulty, complexity, and potential negative outcomes such as loss of privacy. Six themes emerged as implementation facilitators: (1) focus on parental OUD and recovery, (2) peer support, (3) accessibility and coordination of care, (4) clinician skill and expertise in parental OUD, (5) increased time for patient care, and (6) continuity of care. CONCLUSIONS FOR PRACTICE Parents and clinicians expressed multiple perceived benefits of this intervention. Identified barriers and facilitators will inform implementation and evaluation of group WCC within one OUD treatment program.
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Affiliation(s)
- Neera Goyal
- Nemours Children's Health, Wilmington, DE, USA.
- Sidney Kimmel Medical College of Medicine, Thomas Jefferson University, Philadelphia, PA, USA.
- Nemours Children's Health Philadelphia, 833 Chestnut St, Ste. 300, Philadelphia, PA, 19107, USA.
| | - Meghan Gannon
- Sidney Kimmel Medical College of Nursing, Philadelphia, PA, USA
| | - Erica Sood
- Nemours Children's Health, Wilmington, DE, USA
- Sidney Kimmel Medical College of Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Grace Harris
- Sidney Kimmel Medical College of Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Elizabeth Franko
- Sidney Kimmel Medical College of Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Dennis J Hand
- Sidney Kimmel Medical College of Nursing, Philadelphia, PA, USA
| | - Susan Leib
- Department of Pediatric and Adolescent Medicine, Einstein Medical Center Philadelphia, Philadelphia, PA, USA
| | - Vanessa L Short
- Sidney Kimmel Medical College of Nursing, Philadelphia, PA, USA
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Short VL, Abatemarco DJ, Sood E, Hand DJ, Gannon M, Hossain J, Goyal NK. The Child Healthcare at MATER Pediatric Study (CHAMPS): a 2-arm cluster randomized control trial of group well child care for mothers in treatment for opioid use disorder and their children. Trials 2023; 24:333. [PMID: 37194074 PMCID: PMC10189945 DOI: 10.1186/s13063-023-07357-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 05/05/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND Studies suggest that group-based well child care-a shared medical appointment where families come together as a group to receive pediatric primary care-increases patient-reported satisfaction and adherence to recommended care. Evidence supporting the use of group well child care for mothers with opioid use disorder, however, is lacking. The overall objective of the Child Healthcare at MATER Pediatric Study (CHAMPS) trial is to evaluate a group model of well child care for mothers with opioid use disorder and their children. METHODS CHAMPS is a single-site 2-arm cluster randomized controlled trial. A total of 108 mother-child dyads will be enrolled into the study. Twenty-six clusters of approximately 4 mother-infant dyads each will be randomized 1:1 to one of two study arms (intervention or control). Clustering will be based on child's month of birth. In the intervention arm, group well child care will be provided on-site at a maternal substance use disorder treatment program. Mother-child dyads in the control arm will receive individual well child care from one nearby pediatric primary care clinic. Dyads in both study arms will be followed prospectively for 18 months, and data will be compared between the two study arms. Primary outcomes include well child care quality and utilization, child health knowledge, and parenting quality. DISCUSSION The CHAMPS trial will provide evidence to determine if a group well child care offered on-site at an opioid treatment program for pregnant and parenting women is beneficial over individual well child care for families impacted by maternal opioid use disorder. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT05488379. Registered on Aug. 04, 2022.
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Affiliation(s)
- Vanessa L. Short
- Thomas Jefferson University, 1233 Locust Street Suite 401, Philadelphia, PA USA
| | - Diane J. Abatemarco
- Thomas Jefferson University, 1233 Locust Street Suite 401, Philadelphia, PA USA
| | - Erica Sood
- Nemours Children’s Health, 1600 Rockland Rd, Wilmington, DE USA
| | - Dennis J. Hand
- Thomas Jefferson University, 1233 Locust Street Suite 401, Philadelphia, PA USA
| | - Meghan Gannon
- Thomas Jefferson University, 1233 Locust Street Suite 401, Philadelphia, PA USA
| | - Jobayer Hossain
- Nemours Children’s Health, 1600 Rockland Rd, Wilmington, DE USA
| | - Neera K. Goyal
- Nemours Children’s Health, 1600 Rockland Rd, Wilmington, DE USA
- Department of Pediatrics, Thomas Jefferson University, 833 Chestnut Street, Philadelphia, PA USA
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Jones KA, Freijah I, Brennan SE, McKenzie JE, Bright TM, Fiolet R, Kamitsis I, Reid C, Davis E, Andrews S, Muzik M, Segal L, Herrman H, Chamberlain C. Interventions from pregnancy to two years after birth for parents experiencing complex post-traumatic stress disorder and/or with childhood experience of maltreatment. Cochrane Database Syst Rev 2023; 5:CD014874. [PMID: 37146219 PMCID: PMC10162699 DOI: 10.1002/14651858.cd014874.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
BACKGROUND Acceptable, effective and feasible support strategies (interventions) for parents experiencing complex post-traumatic stress disorder (CPTSD) symptoms or with a history of childhood maltreatment may offer an opportunity to support parental recovery, reduce the risk of intergenerational transmission of trauma and improve life-course trajectories for children and future generations. However, evidence relating to the effect of interventions has not been synthesised to provide a comprehensive review of available support strategies. This evidence synthesis is critical to inform further research, practice and policy approaches in this emerging area. OBJECTIVES To assess the effects of interventions provided to support parents who were experiencing CPTSD symptoms or who had experienced childhood maltreatment (or both), on parenting capacity and parental psychological or socio-emotional wellbeing. SEARCH METHODS In October 2021 we searched CENTRAL, MEDLINE, Embase, six other databases and two trials registers, together with checking references and contacting experts to identify additional studies. SELECTION CRITERIA All variants of randomised controlled trials (RCTs) comparing any intervention delivered in the perinatal period designed to support parents experiencing CPTSD symptoms or with a history of childhood maltreatment (or both), to any active or inactive control. Primary outcomes were parental psychological or socio-emotional wellbeing and parenting capacity between pregnancy and up to two years postpartum. DATA COLLECTION AND ANALYSIS Two review authors independently assessed the eligibility of trials for inclusion, extracted data using a pre-designed data extraction form, and assessed risk of bias and certainty of evidence. We contacted study authors for additional information as required. We analysed continuous data using mean difference (MD) for outcomes using a single measure, and standardised mean difference (SMD) for outcomes using multiple measures, and risk ratios (RR) for dichotomous data. All data are presented with 95% confidence intervals (CIs). We undertook meta-analyses using random-effects models. MAIN RESULTS We included evidence from 1925 participants in 15 RCTs that investigated the effect of 17 interventions. All included studies were published after 2005. Interventions included seven parenting interventions, eight psychological interventions and two service system approaches. The studies were funded by major research councils, government departments and philanthropic/charitable organisations. All evidence was of low or very low certainty. Parenting interventions Evidence was very uncertain from a study (33 participants) assessing the effects of a parenting intervention compared to attention control on trauma-related symptoms, and psychological wellbeing symptoms (postpartum depression), in mothers who had experienced childhood maltreatment and were experiencing current parenting risk factors. Evidence suggested that parenting interventions may improve parent-child relationships slightly compared to usual service provision (SMD 0.45, 95% CI -0.06 to 0.96; I2 = 60%; 2 studies, 153 participants; low-certainty evidence). There may be little or no difference between parenting interventions and usual perinatal service in parenting skills including nurturance, supportive presence and reciprocity (SMD 0.25, 95% CI -0.07 to 0.58; I2 = 0%; 4 studies, 149 participants; low-certainty evidence). No studies assessed the effects of parenting interventions on parents' substance use, relationship quality or self-harm. Psychological interventions Psychological interventions may result in little or no difference in trauma-related symptoms compared to usual care (SMD -0.05, 95% CI -0.40 to 0.31; I2 = 39%; 4 studies, 247 participants; low-certainty evidence). Psychological interventions may make little or no difference compared to usual care to depression symptom severity (8 studies, 507 participants, low-certainty evidence, SMD -0.34, 95% CI -0.66 to -0.03; I2 = 63%). An interpersonally focused cognitive behavioural analysis system of psychotherapy may slightly increase the number of pregnant women who quit smoking compared to usual smoking cessation therapy and prenatal care (189 participants, low-certainty evidence). A psychological intervention may slightly improve parents' relationship quality compared to usual care (1 study, 67 participants, low-certainty evidence). Benefits for parent-child relationships were very uncertain (26 participants, very low-certainty evidence), while there may be a slight improvement in parenting skills compared to usual care (66 participants, low-certainty evidence). No studies assessed the effects of psychological interventions on parents' self-harm. Service system approaches One service system approach assessed the effect of a financial empowerment education programme, with and without trauma-informed peer support, compared to usual care for parents with low incomes. The interventions increased depression slightly (52 participants, low-certainty evidence). No studies assessed the effects of service system interventions on parents' trauma-related symptoms, substance use, relationship quality, self-harm, parent-child relationships or parenting skills. AUTHORS' CONCLUSIONS There is currently a lack of high-quality evidence regarding the effectiveness of interventions to improve parenting capacity or parental psychological or socio-emotional wellbeing in parents experiencing CPTSD symptoms or who have experienced childhood maltreatment (or both). This lack of methodological rigour and high risk of bias made it difficult to interpret the findings of this review. Overall, results suggest that parenting interventions may slightly improve parent-child relationships but have a small, unimportant effect on parenting skills. Psychological interventions may help some women stop smoking in pregnancy, and may have small benefits on parents' relationships and parenting skills. A financial empowerment programme may slightly worsen depression symptoms. While potential beneficial effects were small, the importance of a positive effect in a small number of parents must be considered when making treatment and care decisions. There is a need for further high-quality research into effective strategies for this population.
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Affiliation(s)
- Kimberley A Jones
- Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Isabella Freijah
- Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Sue E Brennan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Joanne E McKenzie
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Tess M Bright
- Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Renee Fiolet
- Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Ilias Kamitsis
- Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Carol Reid
- Judith Lumley Centre, La Trobe University, Bundoora, Australia
| | - Elise Davis
- Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Shawana Andrews
- Poche Centre for Indigenous Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Carlton, Australia
| | - Maria Muzik
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Leonie Segal
- Health Economics and Social Policy, Australian Centre for Precision Health, University of South Australia, North Terrace, Australia
| | - Helen Herrman
- Orygen, National Centre of Excellenece in Youth Mental Health, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Catherine Chamberlain
- Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
- Judith Lumley Centre, La Trobe University, Bundoora, Australia
- NGANGK YIRA Murdoch University Research Centre for Aboriginal Health and Social Equity, Murdoch University, Perth, Australia
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Short VL, Gannon M, Sood E, Harris G, Kale A, Abatemarco DJ, Hand DJ, Goyal N. Opportunities to Increase Well-Child Care Engagement for Families Affected by Maternal Opioid Use Disorder: Perceptions of Mothers and Clinicians. Acad Pediatr 2023; 23:425-433. [PMID: 35878748 PMCID: PMC9867779 DOI: 10.1016/j.acap.2022.07.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 07/15/2022] [Accepted: 07/16/2022] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Previous research suggests gaps in well-child care (WCC) adherence, quality, and effectiveness for children impacted by parental opioid use disorder (OUD). The objective of this study was to gather in-depth information regarding maternal and clinician-reported factors that enhance ("facilitators") or hinder ("barriers") WCC engagement as well as mothers' experiences during WCC visits. METHODS Thirty mothers who were in treatment for OUD and 13 clinicians working at a pediatric primary care clinic participated in this qualitative study. All participants completed one data collection telephone session which involved a brief questionnaire followed by a semi-structured interview. Thematic analyses of the interview transcripts were conducted using an inductive approach. RESULTS Three broad themes were identified as facilitators of WCC by mothers and clinicians, including: 1) continuity in care, 2) addressing material needs, and 3) clinician OUD training and knowledge. Themes identified as barriers to WCC included: 1) stigma toward mothers with OUD, 2) gaps in basic parenting knowledge, 3) competing specialized health care needs, and 4) insufficient time to address all concerns. CONCLUSION WCC programs or clinical pathways designed for families affected by maternal OUD should consider these barriers and facilitators of WCC engagement and affect experiences of WCC for mothers and clinicians.
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Affiliation(s)
- Vanessa L Short
- Thomas Jefferson University (VL Short, M Gannon, G Harris, A Kale, DJ Abatemarco, and DJ Hand), Philadelphia, PA.
| | - Meghan Gannon
- Thomas Jefferson University (VL Short, M Gannon, G Harris, A Kale, DJ Abatemarco, and DJ Hand), Philadelphia, PA
| | - Erica Sood
- Nemours Children's Health (E Sood and N Goyal), Wilmington, Del; Department of Pediatrics, Thomas Jefferson University (E Sood and N Goyal), Philadelphia, PA
| | - Grace Harris
- Thomas Jefferson University (VL Short, M Gannon, G Harris, A Kale, DJ Abatemarco, and DJ Hand), Philadelphia, PA
| | - Aditi Kale
- Thomas Jefferson University (VL Short, M Gannon, G Harris, A Kale, DJ Abatemarco, and DJ Hand), Philadelphia, PA
| | - Diane J Abatemarco
- Thomas Jefferson University (VL Short, M Gannon, G Harris, A Kale, DJ Abatemarco, and DJ Hand), Philadelphia, PA
| | - Dennis J Hand
- Thomas Jefferson University (VL Short, M Gannon, G Harris, A Kale, DJ Abatemarco, and DJ Hand), Philadelphia, PA
| | - Neera Goyal
- Nemours Children's Health (E Sood and N Goyal), Wilmington, Del; Department of Pediatrics, Thomas Jefferson University (E Sood and N Goyal), Philadelphia, PA
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9
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Nightingale TM, Uddin AZ, Currie C. Factors influencing female engagement, retention and completion of substance abuse treatment: a systematic review. J Public Health (Oxf) 2023. [DOI: 10.1007/s10389-022-01818-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
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10
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Shan T, Tian X. The effects of mindfulness upbringing perception on social entrepreneurship orientation: A moderated mediation model of prosocial motivation and perceived pressure from external stakeholders. Front Psychol 2022; 13:968484. [PMID: 36312148 PMCID: PMC9606459 DOI: 10.3389/fpsyg.2022.968484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 08/26/2022] [Indexed: 11/29/2022] Open
Abstract
Driven by economic and social benefits, social enterprises create new development models that combine wealth creation, social welfare provision, and environmental improvement through innovative approaches. The social entrepreneurship orientation reflects the behavioral tendency to transplant entrepreneurship orientation into the field of social value creation. It is a strategy to balance and integrate economic interests and social interests, which has a significant impact on social entrepreneurship performance. The purpose of this study is to explore the internal mechanism of the impact of social entrepreneurs’ mindfulness upbringing perception on social entrepreneur orientation. To reveal the internal mechanism, we propose a moderated and mediation model of prosocial motivation and perceived pressure from external stakeholders. In this study, random sampling was conducted among social start-ups in China. In order to improve the accuracy of the scale, a pre-survey was conducted before the formal survey. The data analysis results of the pre-survey showed that the scale in this study was suitable for the Chinese context and had good external validity. Through using survey data from social entrepreneurs in China, hierarchical regression analysis and bootstrapping model are adapted to test and verify mediation and moderation effects. The results show that mindfulness upbringing perception indeed positively influences social entrepreneurship orientation directly and partly through the mediating effect of prosocial motivation. Moreover, findings suggest the perceived pressure from external stakeholders negatively moderates not only the relationship between prosocial motivation and social entrepreneurship orientation but also the overall mediation model. This indicates that social entrepreneurs with low perceived pressure from external stakeholders will improve their social entrepreneurship orientation rapidly when their prosocial level is high. Based on these findings, we conclude that social entrepreneurship orientation may be achieved more effectively through the complex process of mindfulness upbringing perception, prosocial motivation, and perceived pressure from external stakeholders. Finally, the study proposes the theoretical and practical implications and suggestions for follow-up research.
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Khoury B, Vergara RC, Spinelli C. Interpersonal Mindfulness Questionnaire: Scale Development and Validation. Mindfulness (N Y) 2022; 13:1007-1031. [PMID: 35308644 PMCID: PMC8924575 DOI: 10.1007/s12671-022-01855-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/28/2022] [Indexed: 01/10/2023]
Abstract
Objectives Previously developed mindfulness measures focused on its intrapersonal dimensions and did not measure the interpersonal aspects of mindfulness. Furthermore, recently developed interpersonal mindfulness measures were either specific to a certain context (e.g., parenting, conjugal, teaching) or omitted/minimized the role of the body in the interpersonal dynamic. The proposed Interpersonal Mindfulness Questionnaire (IMQ) aims to operationalize the theoretical notion of embodied and embedded mindfulness by grounding it into four dimensions, each representing a set of skills that can be cultivated through training and practice: (1) Detachment from the Mind, (2) Body-Anchored Presence, (3) Attention to and Awareness of the Other Person, and (4) Mindful Responding. Methods The IMQ subscales were developed through consultations with a panel of eight graduate students and ten experts in the field. Three studies were conducted to evaluate the construct, internal consistency, reliability, convergent validity, and utility of the IMQ. Results Findings from the three studies supported the proposed four subscales of IMQ and suggested that these four subscales are independent and supported by convergent evidence. In addition, results suggested that IMQ subscales' scores are sensitive to meditation experience and are associated with better intrapersonal and interpersonal outcomes. Conclusions IMQ subscales are valid and are consistent with the proposed embodied and embedded conception of interpersonal mindfulness. IMQ subscales are associated with intrapersonal mindfulness, but not strongly enough to be conceived as the same phenomenon. Limitations, as well as theoretical and practical implications of IMQ subscales, are thoroughly discussed. Supplementary Information The online version contains supplementary material available at 10.1007/s12671-022-01855-1.
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Affiliation(s)
- Bassam Khoury
- Department of Educational and Counselling Psychology, McGill University, 3700 McTavish Street, Montreal, QC H3A 1Y2 Canada
| | - Rodrigo C. Vergara
- Centro Nacional de Inteligencia Artificial CENIA, Macul, Chile
- Departmento de Kinesiología, Facultad de Artes Y Educación Física, Universidad Metropolitana de Ciencias de La Educación, Ñuñoa Santiago, Chile
| | - Christina Spinelli
- Department of Educational and Counselling Psychology, McGill University, 3700 McTavish Street, Montreal, QC H3A 1Y2 Canada
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Gannon M, Mackenzie M, Short V, Reid L, Hand D, Abatemarco D. “You can't stop the waves, but you can learn how to surf”: Realized mindfulness in practice for parenting women in recovery. Complement Ther Clin Pract 2022; 47:101549. [DOI: 10.1016/j.ctcp.2022.101549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 02/03/2022] [Accepted: 02/04/2022] [Indexed: 11/27/2022]
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13
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Gannon M, Short V, Becker M, Parikh S, McGuigan K, Hand D, Keith S, Abatemarco D. Doula engagement and maternal opioid use disorder (OUD): Experiences of women in OUD recovery during the perinatal period. Midwifery 2021; 106:103243. [PMID: 34999514 DOI: 10.1016/j.midw.2021.103243] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 12/20/2021] [Accepted: 12/21/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Pregnant women who have substance use disorders (SUDs) are at increased risk of preterm birth, fetal mortality, and inadequate prenatal care and have higher rates of childhood trauma than their counterparts without SUDs. Doulas have been utilized with other vulnerable populations who experience trauma to increase perinatal healthcare utilization, provide emotional support, and improve birth outcomes. The objective of the current study was to examine, in women with opioid use disorder (OUD), perceptions of working with a doula in the perinatal period. METHODS Eligible participants were ≥ 18 years old, in OUD treatment, and were pregnant or recently delivered (child ≤ 3 months of age). Semi-structured interviews were used to collect tacit data on the woman's experience working with a doula during the perinatal period. All one-hour interviews were conducted over the phone and transcribed verbatim by a HIPAA compliant transcription service. Transcripts were reviewed independently by 4 coders using open coding procedures, constant comparative method of grounded theory, and inductive thematic analysis. Demographic data and history of childhood trauma information (Adverse Childhood Experiences Tool) were collected with a phone survey prior to the interview. RESULTS Participants' (N = 23) were 32.5 years of age (4.1 SD), with the majority Caucasian (71.4%), Non-Hispanic (71.4%) and Medicaid recipients (100%). Participants reported a mean of 5.61 (SD=2.93) adverse childhood experiences, indicating a significant trauma burden. Major themes uncovered in the interview transcripts revealed emotional and OUD recovery support provided by the doula and increased maternal health literacy and self-advocacy. The presence of a doula during labor/delivery reduced maternal perceptions of stigma they perceived from their healthcare providers. CONCLUSION Doula engagement was associated with perceptions of increased emotional support, health literacy and self-advocacy in maternal health among women with OUD, which is significant given this population's trauma histories. This preliminary research has significant implications for improving the health of the mother child dyad affected by maternal OUD.
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Affiliation(s)
- Meghan Gannon
- Department of OB/GYN, Thomas Jefferson University, 1233 Locust St, Philadelphia, PA 19107, United States.
| | - Vanessa Short
- Department of Obstetrics and Gynecology, Thomas Jefferson University, 1233 Locust St, Philadelphia, PA 19107, United States.
| | - Mariel Becker
- Thomas Jefferson University, Philadelphia, PA 19107, United States.
| | - Saloni Parikh
- Thomas Jefferson University, Philadelphia, PA 19107, United States.
| | - Kelly McGuigan
- Thomas Jefferson University, Philadelphia, PA 19107, United States.
| | - Dennis Hand
- Department of Obstetrics, Gynecology, and Psychiatry, Thomas Jefferson University, 1233 Locust St, Philadelphia, PA 19107, United States.
| | - Scott Keith
- Department of Biostatistics, Thomas Jefferson University, 1015 Chestnut St, Philadelphia, PA 19107, United States.
| | - Diane Abatemarco
- Gynecology and Pediatrics Director of Maternal Addiction Treatment, Education and Research (MATER), 1233 Locust St, Philadelphia, PA 19107, United States.
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14
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Velez ML, Jordan C, Jansson LM. Reconceptualizing non-pharmacologic approaches to Neonatal Abstinence Syndrome (NAS) and Neonatal Opioid Withdrawal Syndrome (NOWS): A theoretical and evidence-based approach. Part II: The clinical application of nonpharmacologic care for NAS/NOWS. Neurotoxicol Teratol 2021; 88:107032. [PMID: 34600100 DOI: 10.1016/j.ntt.2021.107032] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 09/22/2021] [Accepted: 09/24/2021] [Indexed: 11/20/2022]
Abstract
There has been increasing emphasis on the importance of the development of self-regulatory capacities of the individual as the cornerstone of development. The caregivers' abilities to manage their own attention, emotions, physiology and behaviors influence the development of the child's self-regulatory and interactive capacities, and thereby their overall development. Newborns prenatally exposed to psychoactive substances and/or to other prenatal stressors such as maternal poor nutrition, increased maternal stress, trauma, difficult and/or impoverished environments, in tandem with genetic predispositions, can result in alterations to their neurodevelopment that predispose them to self-regulatory problems that can be expressed at any stage of life. The care of infants with Neonatal Abstinence Syndrome (NAS)/Neonatal Opioid Withdrawal Syndrome (NOWS) and their mother/caregiver is a window of opportunity to assess the regulatory and co-regulatory capacities of both, and to provide holistic interventions with the goal of empowering the mother/caregiver in their own self-knowledge/self-regulation capacities and their crucial role in promoting the healthy development of their children. Non-pharmacologic care for the infant with NAS/NOWS is the first line of treatment and of paramount importance. Yet, current approaches are based on a limited scope of infant functioning, and the scoring systems in current use do not result in individualized and specific non-pharmacologic care of the infant, which can result in excessive or insufficient medication and a lack of caregiver appreciation for the infant's strengths, difficulties and early development. The interventions described here are based on the infant's signs of dysregulation in four neurobehavioral subsystems that can be dysregulated by NAS/NOWS, the infant's adaptive or maladaptive responses to return to a regulated functioning, and the co-regulatory behaviors of the infant and the mother/caregiver. In Part I of this two-part series on re-conceptualizing non-pharmacologic care for NAS/NOWS we laid the foundation for a new treatment approach, one grounded in developmental theory and evidence-based observations of infant and interpersonal neurobiology. Here, in Part II, we outline actionable, individually tailored evaluations and approaches to non-pharmacologic NAS/NOWS treatment based on strategies to support the regulatory capacities and development of 4 key domains: 1) autonomic; 2) motor/tone; 3) sleep/awake state control; and 4) sensory modulation subsystems.
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Affiliation(s)
- Martha L Velez
- Johns Hopkins University, School of Medicine, Baltimore, MD, USA.
| | - Chloe Jordan
- Division of Alcohol, Drugs and Addiction, Department of Psychiatry, McLean Hospital/Harvard Medical School, Belmont, MA, USA.
| | - Lauren M Jansson
- Johns Hopkins University, School of Medicine, Baltimore, MD, USA.
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15
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Reese SE, Conradt E, Riquino MR, Garland EL. An Integrated Mechanistic Model of Mindfulness-Oriented Recovery Enhancement for Opioid-Exposed Mother-Infant Dyads. Front Psychol 2021; 12:688359. [PMID: 34777086 PMCID: PMC8582323 DOI: 10.3389/fpsyg.2021.688359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 09/28/2021] [Indexed: 12/05/2022] Open
Abstract
A growing body of neurobiological and psychological research sheds light on the mechanisms underlying the development and maintenance of opioid use disorder and its relation to parenting behavior. Perinatal opioid use is associated with risks for women and children, including increased risk of child maltreatment. Drawing from extant data, here we provide an integrated mechanistic model of perinatal opioid use, parenting behavior, infant attachment, and child well-being to inform the development and adaptation of behavioral interventions for opioid-exposed mother-infant dyads. The model posits that recurrent perinatal opioid use may lead to increased stress sensitivity and reward dysregulation for some mothers, resulting in decreased perceived salience of infant cues, disengaged parenting behavior, disrupted infant attachment, and decreased child well-being. We conclude with a discussion of Mindfulness-Oriented Recovery Enhancement as a means of addressing mechanisms undergirding perinatal opioid use, parenting, and attachment, presenting evidence on the efficacy and therapeutic mechanisms of mindfulness. As perinatal opioid use increases in the United States, empirically informed models can be used to guide treatment development research and address this growing concern.
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Affiliation(s)
- Sarah E. Reese
- School of Social Work, College of Health, University of Montana, Missoula, MT, United States
| | - Elisabeth Conradt
- Child Adaptation and Neurodevelopment Lab, Department of Psychology, University of Utah, Salt Lake City, UT, United States
| | - Michael R. Riquino
- School of Social Welfare, University of Kansas, Lawrence, KS, United States
| | - Eric L. Garland
- Center on Mindfulness and Integrative Health Intervention Development, College of Social Work, University of Utah, Salt Lake City, UT, United States
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16
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Abatemarco DJ, Gannon M, Short VL, Baxter J, Metzker KM, Reid L, Catov JM. Mindfulness in Pregnancy: A Brief Intervention for Women at Risk. Matern Child Health J 2021; 25:1875-1883. [PMID: 34618309 DOI: 10.1007/s10995-021-03243-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The U.S. has the highest rate of preterm birth (PTB), of all developed countries, especially among African American women. Social determinants of health and inequalities in health outcomes are understudied areas. The intersectionality of race and socioeconomic status has been shown to contribute to chronic stress, stress has been shown to be associated with PTB, yet the mechanisms that affect pregnancy outcomes have not been explicit. Mindfulness-based Interventions that address stress reduction during pregnancy may improve quality of life during pregnancy, perhaps enhancing resilience, and be on the pathway to reducing the risk of negative pregnancy outcomes such as PTB. METHODS We over-enrolled African American women and those covered by Medicaid to reach women at higher risk for PTB and included women in substance use treatment. Participants were enrolled in a 6-week mindfulness in pregnancy (MIP) intervention at the obstetric clinic. Sociodemographic characteristics and psychosocial assessments were obtained at three time points. RESULTS We enrolled 35 women who self-identified as: non-white, Medicaid recipients, aged 25-35 years, with high school or less education. We found reductions in perceived stress, pregnancy specific stress, trait anxiety and depression and increases in mindfulness that sustained post-intervention at 2 and 7 months. DISCUSSION Social determinants and stress in particular have been associated with negative birth outcomes. This paper describes a brief intervention and results of MIP tailored to women who have significantly more stress due to race, poverty, homelessness, substance use treatment and other comorbid health risks including PTB.
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Affiliation(s)
- Diane J Abatemarco
- Maternal Addiction Treatment, Education and Research (MATER), Departments of Obstetrics, Gynecology, and Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, 1233 Locust St, Suite 401, Philadelphia, PA, 19107, USA.
| | - Meghan Gannon
- Department of Obstetrics and Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, USA
| | - Vanessa L Short
- Department of Obstetrics & Gynecology, Thomas Jefferson University, Philadelphia, USA
| | - Jason Baxter
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, USA
| | | | - Lindsay Reid
- Department of Obstetrics and Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, USA
| | - Janet M Catov
- Departments of Obstetrics, Gynecology and Reproductive Sciences and Epidemiology, University of Pittsburgh, Pittsburgh, USA
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Hand DJ, Fischer AC, Gannon ML, McLaughlin KA, Short VL, Abatemarco DJ. Comprehensive and compassionate responses for opioid use disorder among pregnant and parenting women. Int Rev Psychiatry 2021; 33:514-527. [PMID: 34176410 DOI: 10.1080/09540261.2021.1908966] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Pregnant and parenting women with opioid use disorder face multiple challenges to recovery. Trauma histories, poverty, stigma and discrimination, and lack of access to treatment intersect to marginalise this population. It is important that pregnant and parenting women with opioid use disorder receive comprehensive care to improve their health, the health of their child(ren), and prevent the intergenerational transmission of opioid and other substance use disorders. For nearly 50 years the Maternal Addiction Treatment, Education, and Research program has provided an evolving and expanding range of comprehensive services for treating opioid and other substance use disorders in this population. In this review the rationale for, and processes by which, key components of a comprehensive approach are discussed. These components include patient navigation for access to care, low-barrier medications for opioid use disorder, effective trauma-responsive therapy, prenatal and well-child healthcare, and other support services that make it possible for pregnant and parenting women to engage in treatment and improve the health of the entire family. Additionally, a method for supporting staff to build resilience and reduce fatigue and burnout is discussed. These components comprise an effective model of care for pregnant and parenting women with opioid and other substance use disorders.
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Affiliation(s)
- Dennis J Hand
- Department of Obstetrics & Gynecology, Thomas Jefferson University, Philadelphia, PA, USA.,Department of Psychiatry & Human Behavior, Thomas Jefferson University, Philadelphia, PA, USA
| | - Alice C Fischer
- Department of Obstetrics & Gynecology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Meghan L Gannon
- Department of Obstetrics & Gynecology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Kimberly A McLaughlin
- Department of Obstetrics & Gynecology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Vanessa L Short
- Department of Obstetrics & Gynecology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Diane J Abatemarco
- Department of Obstetrics & Gynecology, Thomas Jefferson University, Philadelphia, PA, USA.,Department of Pediatrics, Thomas Jefferson University, Philadelphia, PA, USA
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18
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Velez ML, Jordan CJ, Jansson LM. Reconceptualizing non-pharmacologic approaches to Neonatal Abstinence Syndrome (NAS) and Neonatal Opioid Withdrawal Syndrome (NOWS): A theoretical and evidence-based approach. Neurotoxicol Teratol 2021; 88:107020. [PMID: 34419619 DOI: 10.1016/j.ntt.2021.107020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 07/12/2021] [Accepted: 08/15/2021] [Indexed: 01/17/2023]
Abstract
Discussions about non-pharmacologic interventions for Neonatal Abstinence Syndrome and Neonatal Opioid Withdrawal Syndrome (NAS/NOWS) have been minor compared with wider attention to pharmacologic treatments. Although historically under-recognized, non-pharmacologic interventions are of paramount importance for all substance-exposed infants and remain as a first line therapy for the care of infants affected by NAS. Here we examine the role of non-pharmacologic interventions for NAS/NOWS by incorporating theoretical perspectives from different disciplines that inform the importance of individualized assessment of the mother-caregiver/infant dyad and interventions that involve both individuals. NAS/NOWS is a complex, highly individualized constellation of signs/symptoms that vary widely in onset, duration, severity, expression, responses to treatment and influence on long-term outcomes. NAS/NOWS often occurs in infants with multiple prenatal/postnatal factors that can compromise neurobiological self-regulatory functioning. We propose to rethink some of the long-held assumptions, beliefs, and paradigms about non-pharmacologic care of the infant with NAS/NOWS, which is provided as non-specific or as "bundled" in current approaches. This paper is Part I of a two-part series on re-conceptualizing non-pharmacologic care for NAS/NOWS as individualized treatment of the dyad. Here, we set the foundation for a new treatment approach grounded in developmental theory and evidence-based observations of infant neurobiology and neurodevelopment. In Part II, we provide actionable, individually tailored evaluations and approaches to non-pharmacologic NAS/NOWS treatment based on measurable domains of infant neurobehavioral functioning.
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Affiliation(s)
- Martha L Velez
- Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Chloe J Jordan
- Division of Alcohol, Drugs and Addiction, Department of Psychiatry, McLean Hospital/Harvard Medical School, Belmont, MA, USA
| | - Lauren M Jansson
- Johns Hopkins University, School of Medicine, Baltimore, MD, USA.
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Labella MH, Eiden RD, Roben CKP, Dozier M. Adapting an Evidence-Based Home Visiting Intervention for Mothers With Opioid Dependence: Modified Attachment and Biobehavioral Catch-up. Front Psychol 2021; 12:675866. [PMID: 34489793 PMCID: PMC8418066 DOI: 10.3389/fpsyg.2021.675866] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 07/13/2021] [Indexed: 01/10/2023] Open
Abstract
Infants born to mothers who are dependent on opioids often have difficulty regulating behavior and physiology at birth. Without sensitive maternal care, these infants are at risk for ongoing problems with self-regulation. Mothers who are dependent on opioids may experience challenges related to their substance use (e.g., unsupportive and/or risky environment, impulse control and reward system problems) that increase the likelihood of insensitive parenting in the absence of effective intervention. In this paper, we describe a home-visiting intervention we have adapted to enhance sensitive, responsive caregiving tailored to the specific needs of mothers with opioid dependence. The original intervention, Attachment and Biobehavioral Catch-up (ABC), was designed for mothers of infants aged 6-24 months who were exposed to early adversity. ABC has been shown to enhance sensitive parenting as well as children's behavioral and biological functioning, with positive outcomes extending into at least middle childhood. Mothers who are opioid dependent need earlier support than provided by ABC because opioid-exposed infants are often vulnerable at birth. The adapted intervention (modified ABC or mABC) includes one prenatal session and one early postnatal session, followed by 10 sessions every 2-3 weeks. In the initial two sessions in particular, mothers are helped to anticipate the challenges of caring for a baby who may be difficult to soothe while nonetheless providing sensitive care. mABC is intended to help mothers see the importance of responding sensitively so as to help infants overcome the developmental risks associated with opioid exposure. Additionally, mABC is structured to support mothers with the challenges of early parenting, especially if the mother herself was not parented sensitively. Throughout, the focus is on helping the mother nurture the distressed infant, attend to the infant's signals, and avoid behaving in overstimulating or intrusive ways. Case examples are presented that highlight both the challenges of working with this population as well as the gains made by mothers.
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Affiliation(s)
- Madelyn H. Labella
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE, United States
| | - Rina D. Eiden
- Department of Psychology, Pennsylvania State University, University Park, PA, United States
| | - Caroline K. P. Roben
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE, United States
| | - Mary Dozier
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE, United States
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Reid C, McKenzie JE, Brennan SE, Bennetts SK, Clark Y, Mensah F, Hokke S, Ralph N, Brown SJ, Gee G, Nicholson JM, Chamberlain C. Interventions during pregnancy or up to two years after birth for parents who are experiencing complex trauma or have experienced maltreatment in their childhood (or both) to improve parenting capacity or socio-emotional well-being. Hippokratia 2021. [DOI: 10.1002/14651858.cd014874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Carol Reid
- Judith Lumley Centre; La Trobe University; Bundoora Australia
| | - Joanne E McKenzie
- School of Public Health and Preventive Medicine; Monash University; Melbourne Australia
| | - Sue E Brennan
- School of Public Health and Preventive Medicine; Monash University; Melbourne Australia
| | - Shannon K Bennetts
- Judith Lumley Centre; La Trobe University; Bundoora Australia
- Murdoch Children's Research Institute; Parkville Australia
| | - Yvonne Clark
- South Australian Health and Medical Research Institute; Adelaide Australia
| | - Fiona Mensah
- Murdoch Children's Research Institute; Parkville Australia
- Department of Paediatrics; University of Melbourne; Parkville Australia
| | - Stacey Hokke
- Judith Lumley Centre; La Trobe University; Bundoora Australia
| | - Naomi Ralph
- Judith Lumley Centre; La Trobe University; Bundoora Australia
- Central Queensland University; Townsville Australia
| | - Stephanie J Brown
- Murdoch Children's Research Institute; Parkville Australia
- Department of Paediatrics; University of Melbourne; Parkville Australia
- South Australian Health and Medical Research Council; Adelaide Australia
| | - Graham Gee
- Murdoch Children's Research Institute; Parkville Australia
- Melbourne School of Psychological Sciences; University of Melbourne; Melbourne Australia
| | - Jan M Nicholson
- Judith Lumley Centre; La Trobe University; Bundoora Australia
| | - Catherine Chamberlain
- Judith Lumley Centre; La Trobe University; Bundoora Australia
- NGANGK YIRA Murdoch University Research Centre for Aboriginal Health and Social Equity; Murdoch University; Perth Australia
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21
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Prevalence of Adverse Childhood Experiences of Parenting Women in Drug Treatment for Opioid Use Disorder. Community Ment Health J 2021; 57:872-879. [PMID: 32556861 DOI: 10.1007/s10597-020-00661-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 06/11/2020] [Indexed: 10/24/2022]
Abstract
Descriptive adverse childhood experience (ACE) prevalence data on parenting women seeking treatment for opioid use disorder (OUD) is limited, despite this group being one of the fastest growing sub-populations of the opioid epidemic. The aim of this study was to: (1) determine prevalence of ACEs) in a population of parenting women in treatment for OUD, (2) characterize ACEs, and (3) compare study ACE data to Pennsylvania Behavioral Risk Factor Surveillance System (PA BRFSS) to normalize study results. Between 2014 and 2018, ACEs were collected from parenting women (N = 152) enrolled in treatment for OUDs. Results showed on average women were 30.3 years of age (SD 4.6, range 22-41 years) non-Hispanic (87.0%), white (74.0%), and held a high school education or less (76.0%). The mean total ACE score was 4.3 (SD 2.3; range 0-8). Most women reported 4 ≥ ACEs (65.0%), while only 5.0% reported 0 ACEs. The current sample had higher mean ACE score (4.3 PSMDT vs. 1.4 PA BRFSS Data) than PA BRFSS Data. The burden of ACEs in parenting women in treatment for OUD is significant. Understanding the trauma parenting women in drug treatment have experienced, may support efforts to reduce stigma of this population. Public health intervention and policy work that is trauma proactive is needed to address this growing epidemic.
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22
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Cioffi CC, DeGarmo DS. Improving Parenting Practices Among Fathers Who Misuse Opioids: Fathering Through Change Intervention. Front Psychol 2021; 12:683008. [PMID: 34234721 PMCID: PMC8255664 DOI: 10.3389/fpsyg.2021.683008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 05/27/2021] [Indexed: 11/13/2022] Open
Abstract
Fathers have been largely neglected in the parenting literature though there is a critical need to improve parenting practices among fathers who misuse opioids in the midst of the opioid epidemic. Urgency is critical to rapidly intervene in the lives of fathers and children to reduce misuse and interrupt intergenerational cycles of substance misuse. Thus, we provide an overview of solutions to adapt existing parenting interventions for fathers who misuse opioids to accelerate the pace of science for this population.
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Affiliation(s)
- Camille C Cioffi
- Prevention Science Institute, University of Oregon, Eugene, OR, United States
| | - David S DeGarmo
- Prevention Science Institute, University of Oregon, Eugene, OR, United States
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23
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Chung EK, Short VL, Hand DJ, Gubernick RS, Abatemarco DJ. Poor prenatal care does not predict well child care for children born to mothers with opioid use disorder. JOURNAL OF SUBSTANCE USE 2020. [DOI: 10.1080/14659891.2020.1736665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Esther K. Chung
- Department of Pediatrics, The Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, The A.I. duPont Hospital for Children, Wilmington, Delaware, USA
| | - Vanessa L. Short
- Department of Obstetrics and Gynecology, The Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Dennis J. Hand
- Department of Obstetrics and Gynecology, The Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Ruth S. Gubernick
- Quality Improvement Advisor, RSG Consulting, Collingswood, New Jersey, USA
| | - Diane J. Abatemarco
- Department of Obstetrics and Gynecology, The Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Khoury B, Grégoire S, Dionne F. La dimension interpersonnelle de la pleine conscience. ANNALES MEDICO-PSYCHOLOGIQUES 2020. [DOI: 10.1016/j.amp.2018.10.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Goyal NK, Rohde JF, Short V, Patrick SW, Abatemarco D, Chung EK. Well-Child Care Adherence After Intrauterine Opioid Exposure. Pediatrics 2020; 145:e20191275. [PMID: 31896548 PMCID: PMC6993495 DOI: 10.1542/peds.2019-1275] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/13/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND AND OBJECTIVES For children with intrauterine opioid exposure (IOE), well-child care (WCC) provides an important opportunity to address medical, developmental, and psychosocial needs. We evaluated WCC adherence for this population. METHODS In this retrospective cohort study, we used PEDSnet data from a pediatric primary care network spanning 3 states from 2011 to 2016. IOE was ascertained by using physician diagnosis codes. WCC adherence in the first year was defined as a postnatal or 1-month visit and completed 2-, 4-, 6-, 9-, and 12-month visits. WCC adherence in the second year was defined as completed 15- and 18-month visits. Gaps in WCC, defined as ≥2 missed consecutive WCC visits, were also evaluated. We used multivariable regression to test the independent effect of IOE status. RESULTS Among 11 334 children, 236 (2.1%) had a diagnosis of IOE. Children with IOE had a median of 6 WCC visits (interquartile range 5-7), vs 8 (interquartile range 6-8) among children who were not exposed (P < .001). IOE was associated with decreased WCC adherence over the first and second years of life (adjusted relative risk 0.54 [P < .001] and 0.74 [P < .001]). WCC gaps were more likely in this population (adjusted relative risk 1.43; P < .001). There were no significant adjusted differences in nonroutine primary care visits, immunizations by age 2, or lead screening. CONCLUSIONS Children <2 years of age with IOE are less likely to adhere to recommended WCC, despite receiving on-time immunizations and lead screening. Further research should be focused on the role of WCC visits to support the complex needs of this population.
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Affiliation(s)
| | - Jessica F Rohde
- Departments of Pediatrics and
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - Vanessa Short
- Obstetrics and Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Stephen W Patrick
- Division of Neonatology, Departments of Pediatrics and Health Policy and Vanderbilt Center for Child Health Policy, School of Medicine, Vanderbilt University, Nashville, Tennessee; and
| | - Diane Abatemarco
- Obstetrics and Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Esther K Chung
- Department of Pediatrics, School of Medicine, University of Washington and Seattle Children's Hospital, Seattle, Washington
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Keaulana S, Antonio M, Schoch H, Banna J. A Literature Review of the Role of Mindfulness Practices in Nutrition for Mothers and Their Children. Am J Lifestyle Med 2019; 13:533-536. [PMID: 31662715 DOI: 10.1177/1559827619866815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Nutrition-related problems have been increasingly prevalent among children and adults nationally and globally. Pregnant women and children are particularly susceptible to nutrition-related concerns. Mindfulness-based programs have demonstrated favorable outcomes for lifestyles and behaviors and may, therefore, assist in nutrition-related concerns. This column focuses on existing literature that focuses on the way mindfulness practices improve eating and nutrition outcomes for mothers. The synthesized findings of this review provide support for the effectiveness of mindfulness practices of mothers affecting improved nutrition for their children.
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Affiliation(s)
| | | | | | - Jinan Banna
- University of Hawai'i at Mānoa, Honolulu, Hawai'i
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Alexander K, Kronk R, Sekula K, Short V, Abatemarco D. Implementation of a Mindfulness Intervention for Women in Treatment for Opioid Use Disorder and Its Effects on Depression Symptoms. Issues Ment Health Nurs 2019; 40:690-696. [PMID: 31100036 DOI: 10.1080/01612840.2019.1585499] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Many women in treatment for opioid use disorder (OUD) also experience mental health co-morbidities. Mindfulness intervention has demonstrated effectiveness for improving mental health in the general population, but has not been tested with female populations in OUD treatment. The purpose of this study was to describe characteristics associated with participation in a mindfulness intervention provided to women in treatment for OUD, and also to evaluate the effectiveness of a mindfulness intervention on depression symptoms. Aims: To evaluate participation characteristics associated with a mindfulness intervention and to assess the impact of a mindfulness intervention on depression symptoms for women with OUD. Methods: A secondary data analysis of a mindfulness intervention with women in treatment for OUD was accomplished. Bivariate analysis was conducted to determine any sociodemographic variables associated with intervention participation. Depression scores were assessed pre and post intervention using paired samples t tests for the intervention group (n = 65) and the control group (n = 8). Results: A 45% of women in the study reported moderate to severe depression symptoms at baseline, and 63% reported high levels of childhood trauma. There was a significant decrease in depression scores (M = 3.6 [1.2,6.1]) following the mindfulness intervention for the intervention group (t(64) = 3.1, p = .003). Participants entering the intervention group with moderate to severe depression scores experienced the most significant decrease in depression symptoms (M = 6.6, SD = 13.5), (t(64) = -2.1, p < .05). Conclusions: Women in treatment for OUD experience high levels of depression symptoms and past trauma, and mindfulness is a feasible intervention for OUD populations which may improve depression symptoms.
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Affiliation(s)
- Karen Alexander
- a Jefferson College of Nursing , Thomas Jefferson University , Philadelphia , PA , USA
| | - Rebecca Kronk
- b School of Nursing , Duquesne University , Pittsburgh , PA , USA
| | - Kathleen Sekula
- b School of Nursing , Duquesne University , Pittsburgh , PA , USA
| | - Vanessa Short
- c Sidney Kimmel Medical College , Thomas Jefferson University , Philadelphia , PA , USA
| | - Diane Abatemarco
- c Sidney Kimmel Medical College , Thomas Jefferson University , Philadelphia , PA , USA
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Perceptions of Pediatric Primary Care Among Mothers in Treatment for Opioid Use Disorder. J Community Health 2019; 44:1127-1134. [DOI: 10.1007/s10900-019-00701-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Cioffi CC, Leve LD, Seeley JR. Accelerating the Pace of Science: Improving Parenting Practices in Parents with Opioid Use Disorder. PARENTING, SCIENCE AND PRACTICE 2019; 19:244-266. [PMID: 31576196 PMCID: PMC6771283 DOI: 10.1080/15295192.2019.1615801] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
A public health emergency exists in the United States as a result of rising overdose deaths related to Opioid Use Disorder (OUD). With the rise of OUD has also come an increase in the number of children exposed to parents who suffer from an OUD. There is a pressing need for parenting interventions for individuals with OUD to provide safe environments for the children being reared in the face of this epidemic. Research on parenting with an OUD is sparse, but it is impractical to move linearly from basic research to program development and implementation given the urgent need for intervention - a trajectory that prior research has established takes approximately 17 years. We have created an outline of strategies that can be used to accelerate the pace of science so that parenting practices are more immediately improved for this population. First, we summarize what is already known about OUD and parenting to characterize mechanisms that existing interventions have targeted and optimal settings for the wide dissemination of implementable interventions. Next, we identify existing interventions that either specifically target parents with OUD or mechanisms specific to parents with OUD. We describe four different approaches for accelerating the pace of science to improve the lives of parents with OUD and their children. By doing so, we hope to provide a roadmap for future researchers and practitioners to deliver more timely evidence-based interventions to address the additional burden placed on families and communities due to the rise in OUD in the United States.
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Promoting resilience in vulnerable populations: focus on opioid-exposed children, siblings of children with special healthcare needs and support for children through school-based interventions. Curr Opin Pediatr 2019; 31:157-165. [PMID: 30531404 DOI: 10.1097/mop.0000000000000722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Resilience is an important factor in withstanding the health consequences of childhood adversity. This article discusses recent literature related to promoting resilience in opioid-exposed children and siblings of children with special healthcare needs. It also addresses ways that school systems can foster childhood resilience. RECENT FINDINGS Rising rates of opioid-exposed newborns have necessitated the development of multiple strategies to address the medical and social needs of this vulnerable pediatric population. Siblings of children with special healthcare needs are a growing but sometimes overlooked group who have unique challenges that can be supported by healthcare providers. School programs that reward positive behavior and encourage self-regulation through activities like physical activity and mindfulness can foster an environment for improved youth resiliency. SUMMARY New research has led to the development of resources that help pediatric providers assess the needs of their vulnerable patient populations and foster resilience through attention to these patients' medical, emotional and social needs. Patients benefit from national policy efforts and local school programs that each promote resilience.
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Application of a RE-AIM Evaluation Framework to Test Integration of a Mindfulness Based Parenting Intervention into a Drug Treatment Program. Matern Child Health J 2019; 23:298-306. [DOI: 10.1007/s10995-018-02715-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Su J, Leerkes EM, Augustine ME. DRD4 interacts with adverse life events in predicting maternal sensitivity via emotion regulation. JOURNAL OF FAMILY PSYCHOLOGY : JFP : JOURNAL OF THE DIVISION OF FAMILY PSYCHOLOGY OF THE AMERICAN PSYCHOLOGICAL ASSOCIATION (DIVISION 43) 2018; 32:783-792. [PMID: 30035571 PMCID: PMC6126941 DOI: 10.1037/fam0000454] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
We examined whether and how the dopamine receptor D4 (DRD4) interacts with adverse life events to predict maternal sensitivity directly and indirectly via emotion regulation. The sample included 209 (106 European American, 103 African American) mothers and their children (52% female). Sensitive maternal behavior was rated and aggregated across five stress-free and stress-inducing tasks when children were about 2 years old, when mothers also retrospectively reported on their adverse life experiences and transitions throughout childhood from birth to age 20. When children were about 1 year old, mothers reported on their difficulties with emotion regulation. Results from path analysis indicated that mothers who carried the long allele of DRD4 and experienced more adverse life events were less sensitive in interactions with their children. These mothers were also more likely to have difficulties with emotion regulation, which in turn predicted lower maternal sensitivity. These effects were significant above and beyond the effects of maternal education, coherence of mind, race, or infants' DRD4 genotype, and did not vary for African American and European American mothers. Results suggest that genetic predispositions modify the effects of maternal experience of adverse life events on maternal sensitivity and that emotion regulation serves as one mechanism by which genetic factors and gene-environment interactions affect maternal behavior. (PsycINFO Database Record
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Affiliation(s)
- Jinni Su
- Department of Psychology, Virginia Commonwealth University
| | - Esther M Leerkes
- Human Development and Family Studies, University of North Carolina at Greensboro
| | - Mairin E Augustine
- Human Development and Family Studies, University of North Carolina at Greensboro
- Center for Developmental Science, University of North Carolina at Chapel-Hill
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