Melanie Lutenbacher

THE EFFECTS OF MATERNAL PSYCHOSOCIAL FACTORS ON PARENTING ATTITUDES OF LOW-INCOME, SINGLE MOTHERS WITH YOUNG CHILDREN

BACKGROUND Although recent evidence implies linkages among depression or depressive symptoms, self-esteem, history of childhood abuse, and parenting attitudes, the evidence does not clearly elucidate the relationships among these variables. OBJECTIVES To investigate the relationships among maternal psychosocial factors (history of childhood abuse, everyday stressors, self-esteem, and depressive symptoms) and parenting attitudes of low-income, single mothers who have young children. METHODS Secondary analyses of data from in-home interviews with 206 low-income, single mothers from a southeastern United States urban area were conducted. A variety of scales, including the Adult-Adolescent Parenting Inventory (AAPI), were used to measure maternal psychosocial factors. RESULTS Using the AAPI, a Modified Parenting Attitudes Measure (MPAM), and subscales, a three-stage regression procedure was used to test the model. For stages 1 and 2, everyday stressors were the strongest predictor of self-esteem. Childhood sexual abuse, everyday stressors, low self-esteem, and control variables accounted for 58% of variance in depressive symptoms. In the third stage for the AAPI, only control variables were retained except in the Lack of Empathy subscale, where depressive symptoms and control variables accounted for 16% of the variance. The third stage for the MPAM yielded, by subscale: Only control variables predicted Corporal Punishment Beliefs; depressive symptoms were the strongest predictor for the total MPAM (19% of variance) and of the Inappropriate Emotional Expectations subscale (17%); and childhood physical abuse was the only predictor of Role Reversal. CONCLUSIONS Depressive symptoms mediated the effects of childhood abuse, everyday stressors, and self-esteem and provided the linkage between these variables and at-risk parenting attitudes. Self-esteem decreased as everyday stressors increased but did not directly affect parenting attitudes. A relationship was not found between childhood abuse and low self-esteem. This study highlights the complexity of parenting and the need to identify other factors of at-risk parenting not accounted for in this study.

Relationships between psychosocial factors and abusive parenting attitudes in low-income single mothers.

BackgroundLinkages among family violence, maternal mental health, and parenting attitudes are not clearly understood. ObjectiveTo investigate the relationships of abuse (childhood and/or partner), everyday stressors, self-esteem, depressive symptoms, and anger with abusive parenting attitudes. MethodCross-sectional analysis of data collected in interviews with 53 low-income, single mothers from wave two of a 3-wave study. A conceptual framework and bivariate correlations guided a series of multiple regressions to identify the best predictors for each variable. ResultsA high prevalence of abuse, depressive symptoms, and abusive parenting attitudes was found. Few women had ever received mental health treatment. Abuse (partner and childhood physical) predicted higher everyday stressors which in turn predicted lower self-esteem. Childhood abuse and lower self-esteem predicted more depressive symptoms. More depressive symptoms were related to higher levels of state anger. More everyday stressors and more depressive symptoms predicted higher levels of trait anger. Higher levels of anger expression were associated with higher everyday stressors and lower self-esteem. The presence of partner abuse best predicted higher levels of overall abusive parenting attitudes and more parent-child role reversal. Less parental empathy was associated with higher levels of state anger. ConclusionsThis study partially explains the relationships of maternal abuse history and mental health status with parenting attitudes. Other predictors of parenting attitudes remain to be identified. The findings underscore the need for healthcare providers to consider the mental health status and abuse histories of low-income, single mothers. The potential disturbance in the parenting process of single mothers in abusive relationships warrants further investigation.

Crossing community sectors: challenges faced by families of children with special health care needs.

This article identifies unmet needs and challenges of 37 families caring for children with special health care needs (CSHCN). Data were collected in focus groups. Data saturation occurred in the third group. Another group was conducted to ensure adequate inclusion of rural participants. Mean age of participants was 36 years. Most participants were women (92%), Caucasian (65%), high school graduates (89%), and employed, with 38% from rural communities. All families had health care insurance, primarily Medicaid (87%). An interdisciplinary team used NVIVO software to facilitate content analysis. Seven areas emerged: family support systems, early intervention/school systems, coordination of care, lack of knowledge, provider/family relationships, parent roles, and insurance systems. Caregivers noted the critical role of nurses but a lack of nurse presence in community care systems. This study adds to the multidimensional nature of caring for CSHCN and highlights the importance of considering how families interface with multiple community sectors.

Perceptions of Health Status and the Relationship With Abuse History and Mental Health in Low-Income Single Mothers

This article examines the relationships among maternal abuse experiences, psychosocial factors, and perceptions of health status in a sample of 59 low-income mothers with young children. Data were collected in the first wave of a 3-wave panel study during structured in-home interviews. Sixty-four percent of the sample reported some form of childhood abuse, with approximately 41% of the women reporting an abusive relationship during the past 12 months. More than 59% of the mothers reported high depressive symptoms, but few women had received mental health treatment. High everyday stressors and high depressive symptoms were associated with poorer perceptions of maternal and child health status. Histories of abuse were not associated with levels of self-esteem. Nurses working with low-income single mothers must evaluate mothers’ risk status relative to mental health and family violence on an ongoing basis and provide appropriate treatment or referral.

Planning youth violence prevention efforts: decision-making across community sectors.

PURPOSE To identify practical components of decision-making for youth violence prevention program planning and to identify differences in decision-making across various provider sectors of the community. METHODS Data were collected in seven focus groups (n = 82) representing seven key sectors of the community involved in youth violence prevention activities (e.g., educators, law enforcement officers, and healthcare providers). Discussion was guided by a series of open-ended questions that we developed. Transcript-based content analysis using NVivo software identified common themes among and across sectors. RESULTS Similarities and differences in planning and selecting prevention efforts were found across sectors. Educators targeted behaviors that disrupt the school process, while other sectors focused on precursors and concurrent factors of violent behavior and the development of desirable behaviors. Public health and public policy participants underscored outcome measures, benchmarks, and a match between funding and effective programs as essential elements. Youth identified the need for respect from adults and the recognition of positive youth behaviors. All groups noted the lack of a systematic method of considering potential programs, the importance of youth and parental involvement in efforts, the lack of a scientific base for many programs, concerns about exposure to violence, and inappropriate role models in multiple environments. CONCLUSIONS Healthcare providers often participate in the development of youth violence prevention programs. Understanding similarities and differences in focus among key sectors of the community is essential in developing coordinated interdisciplinary approaches.

Psychometric assessment of the Adult-Adolescent Parenting Inventory in a sample of low-income single mothers.

The Adult-Adolescent Parenting Inventory (AAPI) is a 32-item inventory widely used to identify adolescents and adults at risk for inadequate parenting behaviors. It includes four subscales representing the most frequent patterns associated with abusive parenting: (a) Inappropriate Expectations; (b) Lack of Empathy; (c) Parental Value of Corporal Punishment; and (d) Parent-Child Role Reversal. Although it has been used in a variety of samples, the psychometric properties of the AAPI have not been examined in low-income single mothers. The purposes of this study were to: (a) examine the reliability and validity of the Adult-Adolescent Parenting Inventory (AAPI) in a sample of 206 low-income single mothers; (b) assess the mother’s risk for inadequate parenting by comparing their AAPI subscale scores with normative subscale scores on the AAPI; (c) assess the construct validity of the AAPI by testing the hypothesis that mothers with lower AAPI scores have a higher level of depressive symptoms and lower self-esteem in comparison to mothers with higher AAPI scores; and (d) determine whether the 4-factor structure proposed by Bavolek (1984) could be replicated. AAPI scores indicated these mothers were at high risk for child abuse when compared with normative data for parents with no known history of abuse. Higher risk for abusive parenting was associated with a higher level of depressive symptoms, less education, and unemployment. The subscales, Inappropriate Expectations and Parental Value of Corporal Punishment demonstrated poor internal consistency with Cronbach’s alphas of .40 and .54, respectively. Hypothesis testing supported the construct validity of the AAPI. Bavolek’s 4-factor structure was not supported. A 19-item modified version of the AAPI with three dimensions was identified. This modified version of the AAPI may provide a more efficacious tool for use with low-income single mothers.

Leveraging Resources to Improve Clinical Outcomes and Teach Transitional Care Through Development of Academic-Clinical Partnerships.

Nurse educators need to provide students with clinical experiences that prepare them for our rapidly changing health care environments. This article describes how nurse educators used academic and clinical resources to develop a partnership between a school of nursing and clinical entity to facilitate successful transitions from hospital to home for adult heart failure and pediatric asthma patients.

Breastfeeding initiation in the context of a home intervention to promote better birth outcomes.

OBJECTIVE This secondary analysis examined breastfeeding initiation rates and factors related to initiation in a sample of multiparous women with a history of a prior preterm birth. SUBJECTS AND METHODS Data for a subsample of women (n=130) were derived from a randomized clinical trial testing a home visit intervention to improve birth outcomes. The subsample included women who gave birth to an infant greater than 35 weeks of gestation. All participants received standard prenatal care. Intervention participants (n=73) also received home visits by certified nurse-midwives. Visits were guided by protocols to improve factors associated with poor birth outcomes and maternal and infant health. Descriptive and logistic regression analyses were used, controlling for factors previously associated with breastfeeding. RESULTS Although 85% of women reported an intention to breastfeed, only 65% reported initiating breastfeeding at 48 hours postpartum. After controlling for race, income, marital status, smoking, and age, higher maternal education and lower pregravid body mass index were associated with higher rates of initiation (odds ratio [OR]=1.30, p=0.010 and OR=0.94, p=0.007, respectively). Lower levels of depressive symptoms (OR=0.95, p=0.039) and higher levels of prenatal stress (OR=1.11, p=0.042) increased the likelihood of initiating breastfeeding. No difference between groups emerged, although women in the intervention group with more home visit time were more likely to report breastfeeding (p=0.007). CONCLUSIONS Modifiable risk factors were associated with rates of breastfeeding initiation. It may be possible to use protocols delivered via nurse-midwife home visits within a global intervention to increase breastfeeding initiation.

Enhancing Pediatric Asthma Care and Nursing Education Through an Academic Practice Partnership

Background Home environmental assessments and interventions delivered via academic practice partnerships (APP) between clinics and schools of nursing may be a low or no cost delivery model of pediatric asthma care and professional education. Patients receive enhanced clinical resources that can improve self‐management and healthcare utilization. Additionally, students can practice chronic disease management skills in actual patient encounters. Objective To describe outcomes of the implementation of an APP between a school of nursing and a pediatric asthma specialty clinic (PASC) to deliver a home visit program (HVP). The HVP was designed to reduce emergency department visits and asthma related hospitalizations in PASC patients and provide clinical experiences for nursing students. Methods PASC referred patients to the HVP based on their level of asthma control. Students provided an individualized number of home visits to 17 participants over a nine month period. A 12‐month pre‐ and post‐HVP comparison of emergency department visits and asthma related hospitalizations was conducted. Additional information was gathered from stakeholders via an online survey, and interviews with APP partners and HVP families. Outcomes Children had fewer asthma related hospitalizations post HVP. Findings suggest a reduction in exposure to environmental triggers, improved patient and family management of asthma, and increased PASC knowledge of asthma triggers in the home and increased student knowledge and skills related to asthma management. Conclusions Multiple clinical and educational benefits may be realized through the development of APPs as an infrastructure supporting targeted interventions in home visits to pediatric asthma patients and their families. HighlightsNursing students provide targeted interventions while learning to manage a complex chronic disease in the community setting.Fewer inpatient hospitalizations occurred through the use of home visits in the academic practice partnerships care model.Home visits helped families understand asthma and how to manage their childs asthma.

The Efficacy of Using Peer Mentors to Improve Maternal and Infant Health Outcomes in Hispanic Families: Findings from a Randomized Clinical Trial

Introduction The Maternal Infant Health Outreach Worker (MIHOW) program is a home visiting program, utilizing peer mentors to improve maternal/child health outcomes in underserved communities. Findings are presented from a randomized clinical trial (RCT) testing the efficacy of the MIHOW model in a sample of Hispanic women in Tennessee. We hypothesized maternal and infant outcomes would be better in women assigned to MIHOW than women assigned to the minimal education intervention (MEI) group (receipt of educational materials). Methods Women entered the study during pregnancy (< 26 weeks gestation) and were followed through 6 months postpartum. A total of 188 women were enrolled and randomly assigned (MEI = 94; MIHOW = 94), with 178 women completing the study (MEI = 87; MIHOW = 91). Results Positive and statistically significant (p < 0.01) effects of MIHOW were observed on breastfeeding self-efficacy and exclusivity, levels of depressive symptoms and parenting stress, safe sleep practices, and infant stimulation in the home. No statistically significant differences were noted in number of prenatal visits. Discussion Results expand limited empiric evidence and provide strong support of the effectiveness of MIHOW on improving health outcomes in this sample of Hispanic mothers and their infants. MIHOW is a viable option for providing culturally sensitive services to immigrant and underserved families.