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O'Keefe VM, Grubin F, Vaidya N, Maudrie TL, Conrad M, Neuner S, Jridi S, Cook MA, Carson KA, Barlow A, Haroz EE. Pilot evaluation of a Psychological First Aid online training for COVID-19 frontline workers in American Indian/Alaska Native communities. Front Public Health 2024; 12:1346682. [PMID: 39005986 PMCID: PMC11240286 DOI: 10.3389/fpubh.2024.1346682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 06/11/2024] [Indexed: 07/16/2024] Open
Abstract
Introduction The COVID-19 pandemic exacerbated mental health concerns and stress among American Indians and Alaska Natives (AI/ANs) in the United States, as well as among frontline workers responding to the pandemic. Psychological First Aid (PFA) is a promising intervention to support mental wellbeing and coping skills during and after traumatic events, such as the COVID-19 pandemic. Since PFA is often implemented rapidly in the wake of a disaster or traumatic event, evidence evaluating its impact is lacking. This paper reports pilot evaluation results from a culturally adapted PFA training designed to support COVID-19 frontline workers and the AI/AN communities they serve during the pandemic. Methods This study was designed and implemented in partnership with a collaborative work group of public health experts and frontline workers in AI/AN communities. We conducted a pre-post, online pilot evaluation of a culturally adapted online PFA training with COVID-19 frontline workers serving AI/AN communities. Participants completed a baseline survey and two follow-up surveys 1 week and 3 months after completing the PFA training. Surveys included demographic questions and measures of anxiety, burnout, stress, positive mental health, communal mastery, coping skills, PFA knowledge, confidence in PFA skills, and satisfaction with the PFA training. Results Participants included N = 56 COVID-19 frontline workers in AI/AN communities, 75% were AI/AN, 87% were female, and most (82%) were between the ages of 30-59. Participants reported high satisfaction with the training and knowledge of PFA skills. Pilot results showed significant increases in positive mental health and social wellbeing and reductions in burnout from baseline to 3 months after completing the PFA training among frontline workers. There were no changes in communal mastery, coping skills, stress, or anxiety symptoms during the study period. Discussion To our knowledge, this is the first pilot evaluation of a PFA training designed and culturally adapted with and for AI/AN communities. Given that many AI/AN communities were disproportionately impacted by COVID-19 and prior mental health inequities, addressing acute and chronic stress is of crucial importance. Addressing traumatic stress through culturally adapted interventions, including Indigenous PFA, is crucial to advancing holistic wellbeing for AI/AN communities.
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Affiliation(s)
- Victoria M O'Keefe
- Department of International Health, Social and Behavioral Interventions, Center for Indigenous Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Fiona Grubin
- Department of International Health, Social and Behavioral Interventions, Center for Indigenous Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Nainika Vaidya
- Department of International Health, Social and Behavioral Interventions, Center for Indigenous Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Tara L Maudrie
- Department of International Health, Social and Behavioral Interventions, Center for Indigenous Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Maisie Conrad
- Department of International Health, Social and Behavioral Interventions, Center for Indigenous Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Sophie Neuner
- Department of International Health, Social and Behavioral Interventions, Center for Indigenous Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Shardai Jridi
- Department of International Health, Social and Behavioral Interventions, Center for Indigenous Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Mary Ann Cook
- Department of Nursing, Red Lake Indian Health Service Hospital, Red Lake, MN, United States
| | - Kathryn A Carson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Allison Barlow
- Department of International Health, Social and Behavioral Interventions, Center for Indigenous Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Emily E Haroz
- Department of International Health, Social and Behavioral Interventions, Center for Indigenous Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
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Hare MM, Landis TD, Hernandez ML, Graziano PA. A Systematic Review of Infant Mental Health Prevention and Treatment Programs. EVIDENCE-BASED PRACTICE IN CHILD AND ADOLESCENT MENTAL HEALTH 2023; 9:138-161. [PMID: 38680216 PMCID: PMC11052540 DOI: 10.1080/23794925.2022.2140458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
Although many prevention and treatment programs exist for children and families, there have been no reviews specifically examining their impact on infant mental health at the program level. Therefore, the purpose of the current review was to a) systematically examine prevention and treatment programs targeting infant mental health outcomes (i.e., internalizing problems, externalizing problems, social-emotional development, trauma) or the parent-infant relationship/ attachment in children from pregnancy to 2 years; b) classify each program by level of empirical support; and c) highlight strengths and identify gaps in the existing literature to inform future mental health intervention science. From over 121,341 publications initially identified, 60 prevention and treatment programs met inclusion criteria for this review. Each program was reviewed for level of scientific evidence. Of the 60 programs reviewed, 29 (48.33%) were classified as promising, while only six (10.0%) were classified as effective. Lastly, only two programs (3.33%; Attachment and Biobehavioral Catch-Up and Video-feedback Intervention Parenting Program) were classified as evidence-based specific to infant mental health and/or parent-infant relationship/attachment outcomes. Implications related to disseminating evidence-based prevention/treatment programs are discussed.
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Affiliation(s)
- Megan M Hare
- Center for Children and Families, Department of Psychology, Florida International University
| | - Taylor D Landis
- Center for Children and Families, Department of Psychology, Florida International University
| | - Melissa L Hernandez
- Center for Children and Families, Department of Psychology, Florida International University
| | - Paulo A Graziano
- Center for Children and Families, Department of Psychology, Florida International University
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Ingalls A, Rebman P, Martin L, Kushman E, Leonard A, Cisler A, Gschwind I, Brayak A, Amsler AM, Haroz EE. Towards precision home visiting: results at six months postpartum from a randomized pilot implementation trial to assess the feasibility of a precision approach to Family Spirit. BMC Pregnancy Childbirth 2022; 22:725. [PMID: 36151535 PMCID: PMC9502904 DOI: 10.1186/s12884-022-05057-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 09/12/2022] [Indexed: 11/25/2022] Open
Abstract
Background Shared implementation challenges at scale in early childhood home visiting have led researchers to explore precision home visiting as a promising service delivery mechanism to better address families’ unique needs and build greater program efficiencies. This randomized controlled pilot study aimed to assess the acceptability of a precision approach to one home visiting model, Family Spirit® and explore potential differences between Precision Family Spirit (PFS) and Standard Family Spirit (Standard FS) on participant-home visitor relationship and maternal outcomes. Methods Participants (N = 60) were at least 14 years old, pregnant or within 2 months postpartum, and enrolled in Family Spirit. Four sites in Michigan were randomized 1:1 to deliver PFS (up to 17 core lessons plus up to 13 additional lessons as needed) or Standard FS (home visiting services as usual). Primary (program acceptability, participant satisfaction, home visitor-participant relationship quality, retention, adherence) and secondary (knowledge, quality of life, difficulty with parenting problems, substance use, depression, stress) outcomes at 6 months postpartum are presented. PFS participants also self-reported on quality of life, difficulty with parenting problems, stress, substance use, and concerns with sexual and reproductive health and self and child’s nutrition status at each home visit. This informed which lessons they should receive. Results Mothers in both groups reported positive program acceptability, satisfaction, and home visitor-participant relationships at 6 months postpartum. However, open-ended feedback from Standard FS participants indicates that some lesson content may not be applicable to all participants. At 6 months, retention was 82.3% for PFS and 66.7% for Standard FS, and adherence was 30.1% for PFS and 20.6% for Standard FS. Conclusions Preliminary findings indicate that precision home visiting may be acceptable and feasible. A definitive trial is needed to build on this pilot data, assess outcomes for mothers and children participating in a precision approach to home visiting as compared to standard home visiting, and ready this approach for scale. Trial registration ClinicalTrials.govNCT03975530 (first posted on 05/06/2019).
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Affiliation(s)
- Allison Ingalls
- Johns Hopkins University, Bloomberg School of Public Health, International Health Department, Center for American Indian Health, Allison Ingalls, 415 N. Washington St., 4th Floor Room 439, Baltimore, MD, 21231, USA.
| | - Paul Rebman
- Johns Hopkins University, Bloomberg School of Public Health, International Health Department, Center for American Indian Health, Allison Ingalls, 415 N. Washington St., 4th Floor Room 439, Baltimore, MD, 21231, USA
| | - Lisa Martin
- Inter-Tribal Council of Michigan, Inc, Sault Ste. Marie, MI, USA
| | | | - Amanda Leonard
- Inter-Tribal Council of Michigan, Inc, Sault Ste. Marie, MI, USA
| | - Aimee Cisler
- American Indian Health and Family Services, Detroit, MI, USA
| | | | | | | | - Emily E Haroz
- Johns Hopkins University, Bloomberg School of Public Health, International Health Department, Center for American Indian Health, Allison Ingalls, 415 N. Washington St., 4th Floor Room 439, Baltimore, MD, 21231, USA
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Russette HC, Grubin F, Ingalls A, Martin L, Leonard A, Kushman E, Cisler A, Leffler E, Herman A, Haroz EE. Home visitor perspectives on implementing a precision approach to home visiting in communities serving Native American families. Infant Ment Health J 2022; 43:744-755. [PMID: 35921432 DOI: 10.1002/imhj.22012] [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: 11/24/2021] [Accepted: 05/10/2022] [Indexed: 12/15/2022]
Abstract
Family Spirit (FS) is a federally endorsed evidence-based home visiting programs serving as a key prevention strategy for expectant families and families with young children. Like other home-visiting programs, it shares client challenges in retention and engagement during implementation. We assessed (1) the feasibility and acceptability of implementing a precision approach to FS; and (2) differences in approaches to FS delivery. Home visitors, serving primarily Native American families, that delivered a standard (N = 6) or a precision approach (N = 6) to FS across four study sites each participated in up to four virtual focus group discussions (FGDs) (N = 16). Facilitators and barriers to implementation were identified across the curriculum approach, relational and contextual levels. Facilitators: Relevant and culturally sensitive lessons, lesson structure, client-home visitor relationship, client buy-in, home visitor autonomy, leadership support, flexible funding, and training. Barriers: Irrelevant lessons, substance use content, missing topics, families experiencing crises, client and home visitor availability, client feedback, nonsupportive leadership, inadequate funding, and organizational policies and practices. The precision approach offers (1) tailoring of lessons that supports relevance of content to clients; and (2) a target timeframe that supports flexibility in lesson delivery. This model structure may improve client participation and retention.
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Affiliation(s)
- Helen C Russette
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Fiona Grubin
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Allison Ingalls
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Lisa Martin
- Maternal, Infant and Early Childhood Services, Inter-Tribal Council of Michigan, Inc., Sault Sainte Marie, Michigan, USA
| | - Amanda Leonard
- Maternal, Infant and Early Childhood Services, Inter-Tribal Council of Michigan, Inc., Sault Sainte Marie, Michigan, USA
| | - Elizabeth Kushman
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Aimee Cisler
- American Indian Health and Family Services, Detroit, Michigan, USA
| | | | | | - Emily E Haroz
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Barboza M, Marttila A, Burström B, Kulane A. Towards health equity: core components of an extended home visiting intervention in disadvantaged areas of Sweden. BMC Public Health 2022; 22:1091. [PMID: 35650586 PMCID: PMC9158140 DOI: 10.1186/s12889-022-13492-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 05/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Understanding the mechanisms of implementation of public health interventions in community settings is a key aspect of programme assessments. To determine core components and establish a programme theory are important tools to improve functioning and support dissemination of programme models to new locations. An extended early childhood home visiting intervention has been developed on-site in a socioeconomically disadvantaged area of Sweden since 2013 with the aim of reducing persisting health inequities in the population. This study aimed at investigating the core programme components and how the intervention was perceived to contribute towards health equity from early childhood. METHODS Qualitative framework method was applied in a document analysis and subsequent semi-structured interviews with 15 key actors involved in the programme. RESULTS The intervention was found to be constituted of five core components centred around the situation-based, parental strengthening work method delivered by a qualified team of child health care nurse and social worker. The programme theory foresaw positive effects on child and parental health, responsive parenting practices, families' use of welfare services according to need and increased integration and participation in society. The principles of Proportionate Universalism were recognised in the programme theory and the intervention was perceived as an important contribution to creating conditions for improved health equity for the families. Still, barriers to health equity were identified on the structural level which limit the potential impact of the programme. CONCLUSIONS The core components of the Extended home visiting programme in Rinkeby correspond well to those of similar evidence-based home visiting interventions. Combining focus on early childhood development and responsive parenting with promoting access to the universal welfare services and integration into society are considered important steppingstones towards health equity. However, a favourable macro-political environment is required in the endeavour to balance the structural determinants' influence on health inequities. Improved availability and accessibility to welfare services that respond to the needs of the families regarding housing, education and employment are priorities. TRIAL REGISTRATION The study was retrospectively registered on 11/08/2016 in the ISRCTN registry ( ISRCTN11832097 ).
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Affiliation(s)
- Madelene Barboza
- Department of Global Public Health, Equity and Health Policy Research Group, Karolinska Institutet, 17177, Stockholm, Sweden.
| | - Anneli Marttila
- Department of Global Public Health, Equity and Health Policy Research Group, Karolinska Institutet, 17177, Stockholm, Sweden.,Department of Public Health and Sports Science, Faculty of Occupational and Health Sciences, University of Gävle, Kungsbacksvägen 47, 80176, Gävle, Sweden
| | - Bo Burström
- Department of Global Public Health, Equity and Health Policy Research Group, Karolinska Institutet, 17177, Stockholm, Sweden.,Region Stockholm, Centre for Epidemiology and Community Medicine, Box 45436, 104 31, Stockholm, Sweden
| | - Asli Kulane
- Department of Global Public Health, Equity and Health Policy Research Group, Karolinska Institutet, 17177, Stockholm, Sweden
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