Brianna M. Lombardi

Adult Attachment and Stepparenting Issues: Couple Relationship Quality as a Mediating Factor

Using a sample of 390 stepparents, we assess the influence of insecure attachment and couple relationship quality on stepparenting issues. We also examine the extent to which relationship quality mediates connections between attachment and stepparenting issues. Results from ordinary least squares regression and Sobel tests indicate greater levels of attachment avoidance and anxiety are associated with greater levels of stepparenting issues. Results also indicate greater levels of relationship satisfaction and stability are associated with less stepparenting issues. Relationship satisfaction and stability significantly mediate the influence of attachment anxiety on stepparenting issues. Limitations, implications, and directions for future research are discussed.

Adverse Childhood Experiences and Child Health Outcomes: Comparing Cumulative Risk and Latent Class Approaches

Objectives This study seeks to further the work exploring adverse childhood experiences (ACEs) by proposing a novel approach to understanding the impact of ACEs through applying advanced analytical methods to examine whether combinations of ACEs differentially impact child health outcomes. Methods Using National Survey of Children’s Health data, we use latent class analysis to estimate associations between classes of ACEs and child health outcomes. Results Class membership predicts child poor health, with differences found for specific ACE combinations. A subgroup of children exposed to poverty and parental mental illness are at higher risk for special healthcare needs than all other groups, including children exposed to 3 or more ACEs. Conclusions Different combinations of ACEs carry different risk for child health. Interventions tailored to specific ACEs and ACE combinations are likely to have a greater effect on improving child health. Our findings suggest children who experience specific ACE combinations (e.g., poverty and parental mental illness) are at particularly high risk for poor health outcomes. Therefore, clinicians should routinely assess for ACEs to identify children exposed to the most problematic ACE combinations; once identified, these children should be given priority for supportive interventions tailored to their specific ACE exposure and needs.

Integrated Primary Care and Social Work: A Systematic Review

Objective: Behavioral and physical health services are increasingly being integrated, with care provided by interprofessional teams of physicians, nurses, social workers, and other professionals. The objective of this study was to describe the functions of social workers on interprofessional teams in primary care and to assess the impact of interprofessional teams that include social workers in integrated care settings. Method: We undertook a systematic review of randomized controlled trials (RCTs) of routine vs. integrated primary care where social workers served on interprofessional teams. A 5-phase search process to identify RCTs from 9 electronic databases and the gray literature published between 2000 and 2016 was used. We calculated effect sizes across identified studies and conducted 2 subsample meta-analyses for behavioral health outcomes. Results: The searches recovered 502 citations. After screening, 107 reports were retained for a full-text review, and 32 of those (from 26 RCTs) met study criteria. In the 26 RCTs, social workers engaged in 3 patient-centered activities: behavioral health treatment, care management, and referral for social services. Conclusion: Although mixed, the findings suggest that, compared to routine services, integrated primary care provided by interprofessional teams that include social workers significantly improves the behavioral health and care of patients.

Traumatic Experience, Polytraumatization, and Perinatal Depression in a Diverse Sample of Adolescent Mothers

This study examines the prevalence of trauma subtypes, polytraumatization, and perinatal depression (PND) in a diverse sample of adolescent mothers to help inform PND prevention, screening, and treatment efforts. We conducted a secondary analysis of a sample (N = 210) of adolescent mothers aged 14 to 20 years from a prospective longitudinal study of PND. Participants were recruited from a county-based, public health prenatal clinic, and data were collected in the prenatal and postpartum periods. In this sample, 81% of adolescent mothers reported at least one trauma experience and 75% reported lifetime experience of intimate partner violence (IPV). The most prevalent trauma types among adolescent mothers reporting PND were sexual trauma prior to age 13 (11.9%), loss of a caregiver or sibling (28.3%), emotional adversity (17.1%), and polytraumatization (43%). Trauma is alarmingly prevalent among adolescent mothers. Results suggest standards of care for adolescent mothers should include screening adolescent mothers for trauma history and provision of appropriate referrals for IPV. Findings support the need for trauma-informed treatment in perinatal public health clinics to decrease potential health risks to both mother and baby.

Feasibility of treating depression in pregnant adolescents using brief interpersonal psychotherapy

ABSTRACT The current study examines a pilot study testing the feasibility of treating antenatal depression in public health clinics serving low-income adolescents using adapted brief interpersonal psychotherapy for depression in pregnant adolescents (IPT-BPA). This research addresses the disproportionate incidence of antenatal depression and its associated negative outcomes, including postpartum depression, among low-income adolescent mothers. Participants (N = 14) were recruited from two county-based public prenatal care clinics. Eligible participants were pregnant adolescents with major depression. Participants received nine sessions of IPT-BPA. Depressive symptoms were measured pre-and post-treatment. Differences were examined using paired t-tests. Most (81%) referred adolescents completed screening, and 73% met eligibility criteria. Of 16 eligible adolescents, 14 (87.5%) consented to participation, and 13 (93%) completed IPT-BPA . Participants who completed IPT-BPA experienced significant decreases in depression. The successful recruitment and retention of pregnant, depressed adolescents combined with significant, positive post-treatment changes in depression support the feasibility of treating adolescent perinatal depression in public health clinics using IPT-BPA.

Social Work Student and Practitioner Roles in Integrated Care Settings

INTRODUCTION Social workers are increasingly being deployed in integrated medical and behavioral healthcare settings but information about the roles they fill in these settings is not well understood. This study sought to identify the functions that social workers perform in integrated settings and identify where they acquired the necessary skills to perform them. METHODS Master of social work students (n=21) and their field supervisors (n=21) who were part of a Health Resources and Services Administration-funded program to train and expand the behavioral health workforce in integrated settings were asked how often they engaged in 28 functions, where they learned to perform those functions, and the degree to which their roles overlapped with others on the healthcare team. RESULTS The most frequent functions included employing cultural competency, documenting in the electronic health record, addressing patient social determinants of health, and participating in team-based care. Respondents were least likely to engage in case conferences; use Screening, Brief Intervention and Referral to Treatment; use stepped care to determine necessary level of treatment; conduct functional assessments of daily living skills; use behavioral activation; and use problem-solving therapy. A total of 80% of respondents reported that their roles occasionally, often, very often, or always overlapped with others on the healthcare team. Students reported learning the majority of skills (76%) in their Master of Social Work programs. Supervisors attributed the majority (65%) of their skill development to on-the-job training. CONCLUSIONS Study findings suggest the need to redesign education, regulatory, and payment to better support the deployment of social workers in integrated care settings. SUPPLEMENT INFORMATION This article is part of a supplement entitled The Behavioral Health Workforce: Planning, Practice, and Preparation, which is sponsored by the Substance Abuse and Mental Health Services Administration and the Health Resources and Services Administration of the U.S. Department of Health and Human Services.

The Accountable Care Workforce: Bridging the Health Divide in North Carolina

Accountable care communities form as health care entities partner with communities to more fully address population health. This partnership requires an adaptable, boundary spanning, and diverse workforce, as well as flexible regulatory and governing structures that adapt to changing payment models, task shifting, and new roles in health care.

Improving Causal Inference: Recommendations for Covariate Selection and Balance in Propensity Score Methods

Objective: This paper is a resource for applied researchers and journal reviewers who wish to learn more about propensity score methods, especially recent published recommendations for selecting and balancing covariates before conducting treatment effect analysis. Method: We reviewed and synthesized methodological studies of propensity score analysis from multiple disciplines in an effort to distill a cogent and defensible set of recommendations for research practice. Results: Selection of covariates for propensity score methods requires good understanding of empirical evidence and theory related to confounders of treatment assignment and the outcome, as well as clarity about the temporal relations among confounders, treatment, and outcome as measured in the data set in use. Some variables are not appropriate for inclusion in a propensity score model, and some data sets do not include sufficient variables for propensity score analysis. Achieving balance in the model covariates after conditioning on the propensity score should be an iterative process where models are respecified until proper balance is obtained. Important steps for propensity score methods include reporting results from iterative modeling and balance checks, and then defending the final sample conditioned on the propensity score before analysis of treatment effects. These steps are often overlooked in published research. Conclusion: Propensity score methods can be useful tools for reducing bias due to observed confounders. To credibly reduce bias, however, researchers must execute recommended practice for selecting and balancing covariates.