Adverse childhood experiences (ACEs) are associated with an increased risk of preterm birth. About half of all Florida residents have experienced at least one ACE and 21-30% of Alachua County residents have experienced 2 or more ACEs (Bright et al). In 2017 in Alachua County, 11.7% of live births were less than 37 weeks gestation (FLHealthCHARTS), which is higher than the overall rate in Florida. The aims of this intervention are to build resilience in pregnant women with a history of ACEs and to help reduce the preterm birth rate. These goals will be achieved through a mindfulness in pregnancy course beginning in the fourth month of pregnancy that includes yoga, meditation, and journaling. Resilience improvements will be evaluated with the Connor–Davidson Resilience Scale (CD-RISC) (Connor & Davidson, 2003), and will be compared between the intervention group as well as women in normal prenatal care.
Levels of the Social Ecological Model
The program for mindfulness in pregnancy will address both the individual and interpersonal levels of the Center for Disease Control’s Social Ecological Model (SEM) (ATSDR, 2015). Our program will be teaching and engaging pregnant women on mindfulness practices. It will also be providing them with the tools to engage in these practices outside of our program. These mindfulness skills are part of the individual level of the SEM that may affect individual resilience. The mindfulness program is a group activity, and may facilitate positive relationships among the participants. These relationships may be a good source of support for participants and contribute to their success during pregnancy.
Trauma-Informed Principles
The proposed program will utilize the trauma-informed principles of safety, trustworthiness and transparency, peer support and mutual self-help, and collaboration and mutuality (SAMHSA’s Trauma and Justice Strategic Initiative, 2014). The principle of safety will be utilized through ensuring a safe environment for our program. To ensure the safety of participants, only participants and staff will be allowed to be in the room during sessions. The principle of trustworthiness and transparency will be utilized by our program through open communication about goals and results of the program. At the end of the program, participants will be shown the results for the group as well as their individual results. This will facilitate a trusting relationship between program staff and participants.
The principle of peer support and mutual self-help will be utilized in two ways. First, peer support will occur among participants. The program will give them a safe space to discuss their stories and experiences. By sharing their own experiences, participants can help their peers to know that they are not alone. Secondly, peer support will be used among program staff to prevent compassion fatigue. Once a month, the staff will have a meeting to debrief what happened since the last meeting, and discuss any difficulties they have had dealing with topics discussed by program participants. Finally, the principle of collaboration and mutuality will be addressed by training all staff of the women’s health clinic in trauma-informed practice.
Public Health Framework
The mindfulness in pregnancy program will utilize a public health framework by addressing trauma through primary, secondary, and tertiary prevention. By educating pregnant women about ACEs and their effects, we may be able to prevent their children from experiencing trauma. The mindfulness program can also help to reduce the impact of ACEs on participants in two ways. By screening women for ACEs, we will be able to understand who is impacted and to what extent. Then, those individuals who need care will be able to be connected to the licensed mental health counselor on staff as well as other resources. Furthermore, the impact of ACEs will be reduced through the mindfulness program’s promotion of resilience. With regards to tertiary prevention, further complications from ACEs will be addressed by making a licensed mental health counselor available at all sessions for individuals who are in need of clinical care.
References:
ATSDR. (2015, June 25). Chapter 1: Models and Frameworks. Retrieved March 21, 2019, from https://www.atsdr.cdc.gov/comm...ment/pce_models.html
Bright, M. A., PhD, Alford, S. M., MPH, Yu, B., PhD, & Jiang, J., MPH. (n.d.). Adverse Childhood Experiences among Adult Floridians: Findings from the 2010 Behavioral Risk Factor Surveillance System (Rep.). Retrieved February 9, 2019, from: https://www.pacesconnection.com/g/state-aces-action-group/fileSendAction/fcType/0/fcOid/402120533756356605/filePointer/459409328083868644/fodoid/459409328083868637/FL ACE_Adult_Report_DRAFT6_SCREEN.pdf
Connor, K. M., & Davidson, J. R. (2003). Development of a new resilience scale: The Connor‐Davidson resilience scale (CD‐RISC). Depression and anxiety, 18(2), 76-82.
FLHealthCHARTS. (n.d.). Retrieved February 9, 2019, from http://www.flhealthcharts.com/...dHealth/default.aspx
SAMHSA’s Trauma and Justice Strategic Initiative. (2014). SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach (Rep.). Rockville, MD: Substance Abuse and Mental Health Services Administration.
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