A preliminary quasi-experimental, longitudinal study was conducted to explore differences in maternal mood states, self-esteem, family functioning, maternal-infant interaction, and home environment between mothers of preterm infants who participated in a nurse-managed program of parent-to-parent support and those who served as a comparison group. Mothers who participated in the intervention scored significantly higher on the Barnard NCATS interaction measure and the HOME total scale and subscales of maternal responsiveness and organization (N = 58) at 12 months following discharge from a neonatal intensive care unit. Using repeated measures analysis for a subset of mothers (n = 32), there were significant differences between the two groups on the mood state anxiety-tension (POMS) during the first 4 months postdischarge, with the treatment group having less anxiety. There was also a group by time interaction effect on self-esteem during the first 4 months, with self-esteem of the treatment group mothers increasing and comparison mothers decreasing. Findings suggest that one-to-one veteran parent support, in a nurse-managed program, may influence maternal and maternal-infant interaction outcomes.
To determine whether a Nurse-Community Health Worker (CHW) home visiting team, in the context of a Medicaid enhanced prenatal/postnatal services (EPS), would demonstrate greater reduction of depressive symptoms and stress and improvement of psychosocial resources (mastery, self-esteem, social support) when compared with usual Community Care (CC) that includes Medicaid EPS delivered by professionals. Greatest program benefits were expected for women who reported low psychosocial resources, high stress, or both at the time of enrollment. Medicaid eligible pregnant women (N = 613) were randomly assigned to either usual CC or the Nurse-CHW team. Mixed effects regression was used to analyze up to five prenatal and postnatal psychosocial assessments. Compared to usual CC, assignment to the Nurse-CHW team resulted in significantly fewer depressive symptoms, and as hypothesized, reductions in depressive symptoms were most pronounced for women with low psychosocial resources, high stress, or both high stress and low resources. Outcomes for mastery and stress approached statistical significance, with the women in the Nurse-CHW group reporting less stress and greater mastery. Women in the Nurse-CHW group with low psychosocial resources reported significantly less perceived stress than women in usual CC. No differences between the groups were found for self-esteem and social support. A Nurse-CHW team approach to EPS demonstrated advantage for alleviating depressive symptoms in Medicaid eligible women compared to CC, especially for women at higher risk.
A community approach to the integration of health and social services for low-income pregnant women is being addressed through Community Integrated Service System (CISS) initiatives of the Maternal Child Health Bureau. This particular CISS program model was designed to enable low-income mothers to function in a Community Health Worker (CHW) role providing social support for at-risk pregnant women. Using Riessman's notion of "helper therapy," the model was also developed to enhance the potential for CHWs to gain helper benefits. The purpose of this exploratory study was to describe perceived helper benefits and stressors associated with the CHW role and to examine the usefulness of an instrument developed to assess benefits and stressors. The study findings revealed that the majority of CHWs perceived helper benefits that included positive feelings about self, a sense of belonging, valuable work experience, and access to health information and skills through training or contact with program staff. Stressors such as feeling inadequate to help, however, were associated with the helper role for some CHWs. Preliminary analysis of the Helper's Perception Measure indicated that it may be an effective measure and should be tested with a larger sample of CHWs.
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