The impact of community health workers on the self‐determination, self‐sufficiency, and decision‐making ability of low‐income women and mothers of young children

Abstract

INTRODUCTIONThe national health objectives for the current decade make a strong commitment to the elimination of disparities in birth outcomes, yet no clear path has proven successful. In urban settings, disparities in birth outcomes may reflect differences in other variables that contribute to overall poor community health-late entry into care, substance abuse~tobacco, alcohol, and drugs!, lack of access to specialty care, fragmented health insurance coverage, poverty, poor housing, stress, and intermittent work patterns.The community health worker model approach responds to this context of women's lives. Community health worker programs for at risk pregnant and newly parenting women focus on outreach and health promotion that build on women's strengths, decrease unhealthy behaviors, provide support and foster compliance with perinatal health protocols in communities where disparities persist. Such assets-based programs may help narrow the disparities gap. Evaluating these programs requires new measures that define how improvements in women's individual capacities to mitigate contextual factors can contribute to healthier pregnancy outcomes.A multiphase study was designed to evaluate the impact of relationships formed between community health workers and their clients from the perspective of the outreach worker. Results of the focus group phase of this study are reported earlier in this issue. This article summarizes results of a community health worker directed evaluation model. BACKGROUND

When Parents With Severe Mental Illness Lose Contact With Their Children: Are Psychiatric Symptoms or Substance Use to Blame?

“…Mentoring, support groups, and education interventions have been designed to improve the parenting skills of adults with serious mental illness (e.g., Brunette & Dean, 2002; Fischer, 2002; Grella, 1996; Hoagwood, 2005; Kovach et al, 2004; Mowbray et al, 2000), and these innovative services address many of the daily hassles that beset psychiatrically disabled parents of young children, including loneliness associated with single parenthood, poverty, lack of safe housing, and poor job qualifications (Brandon & Fisher, 2001; Cairney, Boyle, & Offord, 2003; Emerson-Davis Family Development Center, 2000; Hoard & Anderson, 2004; Kost, 2001; Strug, 2003). However, few parenting programs are designed to serve parents of minor children who are dually diagnosed with a serious mental illness and a severe substance use disorder.…”

“…Dissolution of parent-child ties is strongly associated with parental substance abuse (Kovalesky, 2001; Suchman, McMahon, & Zhang, 2006), poverty (Holloway, Fuller,Rambaud,&Eggers-Pierola, 1997; Kovach, Becker, & Worley, 2004; Turley, 2003), and homelessness (Cowal et al, 2002; Zima, Wells, Benjamin, & Duan, 1996), all of which often accompany severe mental illness (Cohen, 1993; Dixon, 1999; Draine, Salzer, Culhane, & Hadley, 2002; Gonzales & Rosenheck, 2002; Mowbray & Bybee, 1998) and further complicate the difficult lives of parents caring for minor children (Mowbray et al, 2000). Substance abuse, in particular, has been identified as a primary threat to child well-being and parent-child relationships for adults with serious mental illness (Hoffman & Rosenheck, 2001; VanDeMark et al, 2005), but it is not clear whether dissolutions of parent-child ties are attributable to gradual deterioration in parent traits and functioning due to sustained substance use, the concurrent worsening of psychiatric symptoms, or static life disruptions caused by periodic crises or binges.…”

Empowerment in terms of theoretical perspectives: Exploring a typology of the process and components across disciplines

“…Some authors conducted their research by viewing a single component, such as self-determination (Fetterman, 1996;Sprague & Hayes, 2000), self-confidence (Larson, Walker, & Pearce, 2005), and the promotion of competence (Breton, 1994), as can be seen in Table 2. Other authors conducted their studies by viewing multiple components, such as academic success and bicultural identity (Diversi & Mecham, 2005), mastery and self-determination (Boehm & Staples, 2004), self-determination, self-sufficiency, and decision-making ability (Becker, Kovach & Gronseth, 2004;Kovach, Becker, & Worley, 2004), personal sense of control and efficacy (Speer, 2000), self-efficacy, critical consciousness, and development and cultivation (Lee, 1994), meaning, competence, self-determination, impact (Spreitzer et al, 1997), and advocacy and consciousness raising (Moreau, 1990).…”

“…Mastery includes the notion of sense of meaning, but competence does not include that notion. Third, self-determination was Boehm & Staples (2004) Mastery and self-determination Becker, Kovach, & Self-determination, self-sufficiency, and decision-making ability Gronseth, (2004); Kovach, Becker, & Worley (2004) Fetterman (1996;…”

The Impact of Choice and Control on Women’s Childbirth Experiences

“…One conceptualization of women's health decision making is the Wittmann-Price (2004, 2006 model of "emancipated decision making." This model has five dimensions: reflection, empowerment, personal knowledge, social norms, and a flexible environment (Kovach, Becker, & Worley, 2004;Noone, 2002;Wittmann-Price, 2004). Reflection is the process of questioning common practices that are based solely on authority or tradition ( Wittmann-Price, 2004).…”