... Pre- and Postnatal Education and Care for Young and Expecting Mothers: An Occupational Therapy Case Report Angela L. Kilbride May 1, 2023 A capstone project submitted in partial fulfillment for the requirements of the Doctor of Occupational Therapy degree from the University of Indianapolis, School of Occupational Therapy. Under the direction of the faculty capstone advisor: Alissia Garabrant, OTD, MS, OTR Paige McIntire, OTD, OTR, TBRI Practitioner Pre- and Postnatal Education and Care for Young and Expecting Mothers: An Occupational Therapy Case Report PRE- AND POSTNATAL EDUCATION FOR YOUNG & EXPECTING MOTHERS TABLE OF CONTENTS ABSTRACT....................................................................................................................... 2 I. INTRODUCTION................................................................................................. 3 II. BACKGROUND................................................................................................... 4 III. THEORY............................................................................................................... 6 IV. PROJECT DESIGN & IMPLEMENTATION...................................................... 7 V. OUTCOMES......................................................................................................... 9 VI. SUMMARY......................................................................................................... 12 VII. CONCLUSION................................................................................................... 13 REFERENCES................................................................................................................ 15 TABLES.......................................................................................................................... 18 APPENDIX..................................................................................................................... 22 1 PRE- AND POSTNATAL EDUCATION FOR YOUNG & EXPECTING MOTHERS 2 ABSTRACT Introduction: Occupational therapists (OTs) utilize a holistic approach with individuals receiving services through considering risk factors and addressing areas of development, physicality, and mental health. One unique setting OTs are not frequently seen in are Juvenile Justice Systems and addressing maternal care. At the Dickinson Juvenile Justice Center, there is a need for female education in pre- and postnatal care. Project Purpose: To provide educational resources for expecting and new mothers on pre- and postnatal self-care for mothers, fetal and infant development, development of sensory processing skills, and forming healthy/strong attachment styles to mitigate possible risk factors associated with birth. Case Description: The participant in this single case report is a female within the juvenile justice system expecting her first child. She voluntarily agreed to evidence-based education sessions in juvenile probation for 5 weeks with pre- and post-surveys. She reported to be 21 weeks pregnant with the desire to stay sober and out of the system in the future. PRE- AND POSTNATAL EDUCATION FOR YOUNG & EXPECTING MOTHERS 3 INTRODUCTION Johnson County Juvenile Detention, JCJD, located just south of Indianapolis has a population of both males and females ages 12-18, but typically males. The detention system is created to fit males, limiting the resources available to females, specifically for juvenile expecting mothers. Occupational Therapy education creates a role within this setting to benefit their life skills and healthy coping mechanisms, as well as education and resources available to residents in the system. The aim of the capstone project at Johnson County Juvenile Community Corrections is to complete a single-participant case study to promote pre- and postnatal education and self-care for young and expecting mothers. The project will provide evidence-based education and material to the participant that encourages healthy development in the infant/baby and promotes healing and healthy lifestyle choices for mothers post pregnancy. I will assess the knowledge of the participants prior to education to understand her level of knowledge, access to resources, and areas of concern relating to the pregnancy. This aids in understanding the level of prior knowledge and education that she has going into her pregnancy, and specifically what is a necessity to address. This will help in understanding what areas are lacking in this area, and what supports are necessary for access to resources and overall healthy development with her child. Occupational Therapists are educated and trained on developmental milestones, teaching life skills, and introducing compensatory strategies for those skills when dealing with a variety of patients, in this case, young and expecting mothers. There is limited research and exposure to occupational therapy in the juvenile justice system for expecting mothers, as well as, decreased resources for this population. The purpose of this project is to provide educational resources for expecting and new mothers on pre- and postnatal self-care for mothers, fetal and infant PRE- AND POSTNATAL EDUCATION FOR YOUNG & EXPECTING MOTHERS 4 development, development of sensory processing skills, and forming healthy/strong attachment styles to mitigate possible risk factors associated with birth. Following the evidence-based education, I will assess the knowledge of the participant and receive feedback over the resources shared to educate young and expecting mothers. BACKGROUND The Johnson County Juvenile Detention (JCJD) is located in Franklin, Indiana, with the ability to reach up to 48 individuals at a time (County Office, 2022). The JCJD serves youth from various counties across the state of Indiana. These individuals consist of over 24% of the Johnson County population (U.S. Census Bureau: Johnson County, Indiana, 2021). The Johnson County Community Juvenile Justice System reaches juveniles that are at a heightened risk for occupational deprivation, social injustice, and mental health deficits (Edgemon et al., 2020; Young et al., 2018). The residents within the juvenile justice system can range from six to eighteen years of age. This facility works to rehabilitate the residents by improving both behavioral, emotional, and occupational skills. In addition, the occupational therapist on site emphasized the importance of encouraging the residents to take responsibility for their lives and build their life skills and independence to become successful members in their community. During the needs assessment, the site noted the need for maternal education for females pregnant in the juvenile justice system. This need was made even more apparent when at the site as a juvenile was in that position with limited education and resources available. Currently, within the juvenile justice system, there are challenges involving the behaviors, victim-blaming, and social demands of this population. The term juvenile justice system includes juvenile detention, probation, and youth correctional facilities (Javdani, 2019; Underwood & Washington, 2016). This, in combination with additional resources, can benefit PRE- AND POSTNATAL EDUCATION FOR YOUNG & EXPECTING MOTHERS 5 the community and the individuals to decrease the challenges faced by these individuals and the consequential actions (Mulvey & Iselin, 2008). At JCJD, the occupational therapist focuses on advocating the needs of the residents to improve the services provided, regulating emotions in the moment (pre-/post-court, etc.), and educating on coping mechanisms for life skills. Occupational Therapy in Juvenile Justice Occupational therapists take all impacting aspects in the individuals life, including environmental and personal factors, to better understand where the individual is mentally and physically. Furthermore, OT takes a holistic approach, taking into consideration risk factors along the lines of development, physicality, and mental health of the individual receiving the services (American Occupational Therapy Services, 2021; Picotin et al., 2021). Occupational therapists can be seen as social change agents due to their role and ability to impact population health and occupational justice in the individuals they reach through holistic and evidence-based practice (Picotin et al., 2021, p. 231). This can be done by addressing the individual's needs while encouraging and advocating for those needs. As occupational therapists, we can positively impact change and increase the resources individuals have for themselves (Picotin et al., 2021). The drive for evidence-based practice within all areas of occupational therapy has also shown to have an important impact on the interventions provided in the juvenile justice system. These interventions include cognitive-behavioral therapy, structured interventions, family-based interventions, and behavioral expectation training (Amani et al., 2018; Johnson-Kwochka et al., 2020). Expecting Mothers in Juvenile Justice The Coalition for Juvenile Justice reported in 2019 that There are no concrete or current nationwide figures on the number of pregnant youths who are justice-involved. However, there is PRE- AND POSTNATAL EDUCATION FOR YOUNG & EXPECTING MOTHERS 6 clear evidence that the rates of teenage pregnancy among incarcerated youths are significantly higher than those of the general population. A 2004 Juvenile Facilities Census found that 2.1% of girls in juvenile justice facilities are pregnant at any given time (Ades, 2019). With the limited numbers, come decreased resources for the expecting mothers in juvenile justice. Occupational Therapy, with assistance from the Person-Environment-Occupational model, allows these areas to be addressed, advocacy for the case study participant, and education on preand postnatal strategies for lifestyle improvements during pregnancy. Project Purpose The purpose of this project is to provide educational resources for expecting and new mothers on pre- and postnatal self-care for mothers, fetal and infant development, development of sensory processing skills, and forming healthy/strong attachment styles to mitigate possible risk factors associated with birth. Through a single-participant case study, As the individuals within the juvenile justice system are a vulnerable and at-risk group of individuals, it is important to address all areas limiting their abilities to withstand on their own and in the community (Zajac et al., 2016). When you add in the component of a juvenile being an expecting mother, more complications arise in limitation of educational resources in and outside of the juvenile detention. THEORY The model and frame of reference that will aid in the project approach are PersonEnvironment-Occupation (PEO) model, the lifespan and the developmental frames of reference. Aspects of the model and frames of reference will assist throughout the project to better understand the life experiences and knowledge of the participant, and assist in selecting education provided. The PEO model emphasizes the interaction and relationship between the three components. This model will aid in better understanding the impact of the different areas PRE- AND POSTNATAL EDUCATION FOR YOUNG & EXPECTING MOTHERS 7 on the individuals life and how the new role of being a mother will affect it. There is an additional emphasis on collaborating with the individual to establish client-centered goals for therapeutic success through a top-down approach. This will allow the educational sessions to be shaped to best meet the needs of the case study participant (Cole & Tufano, 2008). The lifespan and developmental frame of reference can be used by occupational therapists to guide reasoning, set goals for different times in life, and provide meaning to lifes occupations. The overall goal with the use of lifespan and developmental frame of reference, from the occupational therapy perspective, is to assist the participant in healthy lifestyle changes and to gain knowledge to promote the growth of her baby, during and after pregnancy. Aspects of the model and frame of reference will assist throughout the project to better understand the mothers knowledge and education received prior to and during pregnancy. In addition, it will increase resources available to females that are pregnant within the juvenile justice system, as they are so limited (Barnert et al., 2020). Dickinson Juvenile Community Correction will have additional resources for their residents and juveniles on probation, and for future connections. PROJECT DESIGN & IMPLEMENTATION This project was conducted as both the juvenile justice system and maternal health are emerging areas relative to occupational therapy. There are various topics occupational therapists can address within these practice areas, but many are not due to the lack of research and OT exposure in the settings. The intent of this project is to provide evidence-based education and resources to the Dickinson Juvenile Community Corrections to use in future collaborations with hospitals in how OTs can use a holistic approach for advocacy and evidence-based education. This can in turn mitigate possible risk factors associated with birth. The ultimate goal was to PRE- AND POSTNATAL EDUCATION FOR YOUNG & EXPECTING MOTHERS 8 avoid early trauma for the child to decrease the likelihood of children engaging in risky behaviors that may lead them into contact with the juvenile justice system. The project was a single-participant case study performed at Dickinson Juvenile Community Corrections in juvenile probation. The participant, at 21 weeks pregnant, voluntarily agreed to participating in a pre- and post-survey, as well as the educational sessions. For the educational portion, six presentations were created for five educational sessions with the case study participant. Within the first session, the participant completed a pre-survey (Appendix A) and the Adverse Childhood Experiences (ACEs) Assessment. The ACEs Assessment was completed to understand the participants childhood experiences that will play into how to cope with stress and to understand her risk of high stress, or toxic stress. The pre-survey gathered demographic information on the participant and her level of knowledge prior to education. Evidence-based education included presentations on fetal development, prenatal education and self-care, building healthy attachment with your fetus/baby, sensory processing and toys, infant development and developmental milestones, and postnatal education and self-care. Education included factual information, educational videos and flyers, one book, and worksheets/handouts. I provided her with the educational material to best benefit her and the life of her unborn child. This information was provided to bridge the gap for her as a mother and give community resources to best fit their needs. With the fifth session, the participant completed a voluntary post-survey (Appendix B) to best understand the knowledge gained by the participant and gain feedback from her, to compare to the knowledge pre-survey. This provides insight into what areas are still lacking, and what supports are necessary for these specific populations, expecting mothers and expecting mothers in juvenile justice. PRE- AND POSTNATAL EDUCATION FOR YOUNG & EXPECTING MOTHERS 9 Challenges when implementing this project presented with communication barriers, time constraint, and overall limitation in research on pregnancy within the juvenile justice system. Communication to create the collaboration was one of the most important things especially when it comes to developing it in a timely manner, staying positive, following-up, and being consistent with information provided. Once the participant voiced a desire to participate in the education, communication became easier. However, with the fifth educational session, the participant did cancel three times, setting the project back two weeks. We were able to meet over the phone, go over the final education portion and complete the post-survey with minimal complications. One of the main successes during project implementation was the participant engagement and willingness to participate in the education. She had a strong desire to provide a healthy, good life for her unborn child, driving the motivation for the educational material. In addition, another huge success was meeting the needs of the participant on an educational level, and creating the education in a way that is easy to understand. Participant Educational Sessions The participant received one-on-one educational sessions with Paige McIntire, OT at Dickinson Juvenile Community Corrections, supervising and incase assistance was necessary. There were six presentations for the five participant sessions. The six presentations were on fetal development, prenatal education and self-care, building healthy and strong attachment with fetus/baby, sensory processing and toys for babies, infant development and developmental milestones, and, lastly, postnatal education and self-care with a mental health component. The participant asked for additional information regarding breast pumping and feeding a newborn, Sudden Infant Death syndrome (SIDs) and safe sleeping, perineal tearing, car seats, medical terminology, and birth plans. It was noted that at the beginning of each session, the participant PRE- AND POSTNATAL EDUCATION FOR YOUNG & EXPECTING MOTHERS 10 updated on her current state, any struggles, and any existing or new questions that had come up. Sessions lasted between 90 to 120 minutes at a time with the participant verbalizing a good attitude towards the material at the end of each session. OUTCOMES The participant completed the ACEs Assessment in the first educational session. Results from this assessment demonstrated an increased risk of toxic stress for the participant due to her childhood experiences. This, in turn, emphasizes the need for coping strategies in times of stress, specifically while transitioning into motherhood. In the pre-survey, the participants reported little to no knowledge in five areas including types of attachment, meeting sensory needs, possible risk factors impacting the fetus, How to balance your time between yourself (self-care) and your child, and infant development (Table 2). The participant rated her knowledge as high for one statement: Ability to define substances that can put your child at risk, during and post-pregnancy. This is the area in which she does receive education due to being in the juvenile justice system. She reported a moderately high level of knowledge in two areas including building a strong attachment with the baby and identifying what to do if your baby isn't meeting developmental milestones. The participant exhibited increased knowledge in all areas addressed on the post survey following education except for one (Table 2). The one statement she did not increase knowledge in was: how to build a strong attachment with baby. However, the participant did not lose knowledge, but was able to maintain her level of knowledge in this area rating it a four of five on the likert scale, indicating a moderately high level of knowledge. With that, the participant indicated a high level of knowledge in seven of thirteen categories. The educational material and PRE- AND POSTNATAL EDUCATION FOR YOUNG & EXPECTING MOTHERS 11 resources for this doctoral capstone project presented an overall improvement in her knowledge in twelve of thirteen areas relating to pre- and postnatal care for mother and baby. Anticipated outcomes of this case study doctoral capstone project were increased knowledge on pre- and postnatal self-care, fetus and infant development, strategies to promote babys sensory needs, and strategies for forming healthy attachment with baby. The project was successful in meeting the anticipated outcomes. In addition, I was able to work with the participant to educate on how to advocate for self and navigate through the healthcare system. A medical terminology document was created for increased understanding of information the participant received from doctors. Within the first session, we were able to assist the participant in navigating access to health insurance and acquiring a new birth certificate to then move forward to receive additional proof of identification. Educational Website In addition, a website including all evidence-based educational materials and the five presentations was created for future use and to help educate young mothers in the juvenile system. SUMMARY Juvenile, expecting mothers in the juvenile system have limited resources and support for increased success after the baby is born. In addition, they may not be provided with the life skills following time in detention to meet the daily needs of themselves and their new child. A review of literature showed limitations in the education and research provided to this population; however, there is also a limitation in the amount of research being done on this population. With assistance from an occupational therapist, expecting mothers can better understand how to navigate the pre- and postnatal stages of pregnancy and understand how to navigate the medical PRE- AND POSTNATAL EDUCATION FOR YOUNG & EXPECTING MOTHERS 12 world while advocating for themselves. A single-case, qualitative study was conducted to provide evidence-based educational material and resources to this population, and for young and expecting mothers. Educational material included fetal development, prenatal education and self-care, forming healthy/strong attachment style with baby, infant development and education on care for newborns, sensory development and processing skills, and postnatal education and self-care. Dickinson Juvenile Community Correction has additional resources for their residents and juveniles on probation, but also as a resource for future connections or collaborations to improve overall understanding and life skills during and after pregnancy. Occupational therapists can assist in advocating, educating, and creating compensatory strategies to benefit the expecting mother, with the ultimate goal to decrease likelihood of children engaging in risky behaviors that may lead them into contact with the juvenile justice system. CONCLUSION A single-case, qualitative study was conducted with one participant through probation at the Dickinson Juvenile Justice Center. The participant completed five evidence-based educational sessions with completion of pre- and post-surveys to determine growth in knowledge. The findings support the need for educational material and resources to support this population and, more generally, expecting mothers of all ages. The participant identified several benefits from these experiences, specifically education of advocacy in the medical world, fetal development education, and the variety of resources provided for further education. The development of evidence-based education and resources for this population supports the need for occupational therapy life skills and increase in research in this population. PRE- AND POSTNATAL EDUCATION FOR YOUNG & EXPECTING MOTHERS 13 The OT at Dickinson Juvenile Justice Center manages a variety of different programs while also seeing residents in detention. With my assistance, this education was able to be completed thoroughly which may not have been possible in a short period of time. As the outcomes demonstrated its effectiveness through the post-survey, the OT is able to continue to use the education as needed and share it as a resource to others in the community. Current research related to juvenile justice and occupational therapy is currently limited with minimal resources to benefit the residents and those on probation. Occupational therapy allows for work to be done to improve their overall lifestyle through exposure to right from wrong, education on life skills, communicating needs, and behavioral and emotional regulation. This case study doctoral capstone project demonstrates the need for further research in this area, as well as in maternal health or pre- and postnatal care in the justice system. It provides additional evidence-based education and research in occupational therapy, juvenile justice, and pre- and postnatal care. The qualitative outcomes demonstrate a growth in knowledge following the educational material as it relates to pre- and postnatal education and care in young and expecting mothers. In addition, future use was made easily accessible through the educational website. PRE- AND POSTNATAL EDUCATION FOR YOUNG & EXPECTING MOTHERS 14 REFERENCES Ades, Z. (2019). Addressing the needs of pregnant youths. Coalition for Juvenile Justice. Retrieved January 23, 2023, from https://www.juvjustice.org/blog/1144 Amani, B., Millburn, N. G., Lopez, A., Young-Brinn, A., Castro, L., Lee, A., & Bath, E. (2018). Families and the juvenile justice system: Considerations for family-based interventions. Fam Community Health, 41(1):55-63. http://doi.org/10.1097/FCH.0000000000000172 Barnert, E., Sun, A., Abrams, L. S., & Chung, P. J. (2020). Reproductive Health Needs of Recently Incarcerated Youth During Community Reentry: A Systematic Review. BMJ Sexual & Reproductive Health 46(3): 161171. doi:10.1136/bmjsrh-2019-200386. Burger, M., Hoosain, M., Einspieler, C., Unger, M., & Niehaus, D. (2020). Maternal perinatal mental health and infant and toddler neurodevelopment - Evidence from low and middle-income countries. A systematic review. Journal of Affective Disorders, 268, 158-172. doi: 10.1016/j.jad.2020.03.023. Declercq, E.R., Sakala, C., Corry, M.P., Applebaum, S., Herrlich, A. (2014). Major Survey Findings of Listening to Mothers (SM) III: Pregnancy and Birth: Report of the Third National U.S. Survey of Women's Childbearing Experiences. Journal of Perinatal Education, 23(1): 9-16. doi: 10.1891/1058-1243.23.1.9. Edgemon, A. K., Rapp, J. T., Brogan, K. M., Richling, S. M., Hamrick, S. A., Peters, R. J., & ORourke, S. A. (2020). Behavioral skills training to increase interview skills of adolescent males in a juvenile residential treatment facility. Journal of Applied Behavior Analysis, 53(4), 2303-2318. https://doi.org/10.1002/jaba.707 PRE- AND POSTNATAL EDUCATION FOR YOUNG & EXPECTING MOTHERS 15 Javdani S. (2019). Critical issues for youth involved in the juvenile justice system: Innovations in prevention, intervention, and policy. Journal of Prevention & Intervention in the Community, 47(2), 6775. https://doi.org/10.1080/10852352.2019.1575564 Johnson County Juvenile Detention Center - Franklin, IN. County Office. (2022). Retrieved March 30, 2022, from https://www.countyoffice.org/johnson-county-juvenile-detention-center-franklin-in-e94/ Johnson-Kwochka, A., Dir, A., Salyers, M. P., & Aalsma, M. C. (2020). Organizational structure, climate, and collaboration between juvenile justice and community mental health centers: implications for evidence-based practice implementation for adolescent substance use disorder treatment. BMC health services research, 20(1), 929. https://doi.org/10.1186/s12913-020-05777-3 Lederman, R. & Weis, K. (2009). Psychosocial adaptation in pregnancy: Seven dimensions of maternal development (3rd ed.). New York: Springer Pub. Co. Mulvey, E. P. & Iselin, A-M. R. (2008). Improving Professional Judgements of Risk and Amendability in Juvenile Justice. Future Child, 18(2), 35-57. http://doi.org/10.1353/foc.0.0012 Picotin, J., Beaudoin, M., Hlie, S., Martin, A. ., & Carrier, A. (2021). Occupational Therapists as Social Change Agents: Exploring Factors that Influence Their Actions. Canadian Journal of Occupational Therapy, 88(3), 231243. https://doi.org/10.1177/00084174211022891 Sakala, C., Declercq, E. R., Turon, J. M., & Corry, M. P. (2018, September). Listening to mothers reports and Surveys: A population-based survey of womens childbearing experiences. PRE- AND POSTNATAL EDUCATION FOR YOUNG & EXPECTING MOTHERS 16 National Partnership for Women & Families. Retrieved February 13, 2023, from https://www.nationalpartnership.org/our-work/health/maternity/listening-to-mothers.html State of California Department of Health Care Services. (2021, May 13). Learn about screening. ACEs Aware. Retrieved February 20, 2023, from https://www.acesaware.org/learn-about-screening/ Simkin, P., Whalley, J., Keppler, A., Durham, J., & Bolding, A. (2018). Pregnancy, childbirth, and the newborn: The complete guide (5th ed.). Hachette Books. Underwood, L. A., & Washington, A. (2016). Mental Illness and Juvenile Offenders. International Journal of Environmental Research and Public Health, 13(2), 228. https://doi.org/10.3390/ijerph13020228 U.S. Census Bureau: Johnson County, Indiana. (2021, July 1). Retrieved March 30, 2022, from https://www.census.gov/quickfacts/fact/table/johnsoncountyindiana/PST045221 Visger, Joan M., "Predictors Of Psychosocial Adaptation To Pregnancy Among Urban African-American Primiparas" (2013). Wayne State University Dissertations. Paper 712. Young, S., Greer, B., & Church, R. (2017). Juvenile delinquency, welfare, justice and therapeutic interventions: a global perspective. BJPsych Bulletin, 41(1), 2129. https://doi.org/10.1192/pb.bp.115.052274 Zajac, K., Sheidow, A. J., & Davis, M. (2015). Juvenile Justice, Mental Health, and the Transition to Adulthood: A Review of Service System Involvement and Unmet Needs in the U.S. Children and Youth Services Review, 56, 139148. https://doi.org/10.1016/j.childyouth.2015.07.01 PRE- AND POSTNATAL EDUCATION FOR YOUNG & EXPECTING MOTHERS TABLES Table 1 Pre-survey Demographic and Subjective Data Subjective Questions Participant Response Level of education Enrolled in 12th grade, completed 11th Describe the setting you will be raising your child A clean good home What does your support system look like? I have a good support system Are you in school or working? If yes to either, where? yes both I graduate June right before I have him What experience, if any, do you have raising kids or I help my bestfriends mom with her as a caregiver? kids all the time What parts of raising and caring for a baby are you comfortable with? Anything What worries you or makes you feel uncomfortable when it comes to raising your baby? not feeding him enough or on time Previous history with any health concerns or diagnoses, mental and physical? Nothing *** Preferred method/location of birth? (hospital/home - midwife/doctor) Natural at st. francis Have you been pregnant before? no Currently, what are your biggest areas of concern? how I will feel after I have him 17 PRE- AND POSTNATAL EDUCATION FOR YOUNG & EXPECTING MOTHERS What resources or educational information have you been provided, if any? Angela and Paige What information or resources have you been able to access on your own, if any? what to expect app 18 Note. The participant reported no previous diagnoses of mental health conditions, but was further educated and noted a history of anxiety and depression. PRE- AND POSTNATAL EDUCATION FOR YOUNG & EXPECTING MOTHERS 19 Table 2 Pre- and Post-survey Participant Responses Pre-Education Response Knowledge Questions Post-Education Reponse How to build a strong attachment with baby 4 4 How to identify the different types of attachment 1 4 How to meet you childs sensory needs 1 5 How sensory needs impact the development of your child 3 4 How to describe the development of a fetus 3 5 Ability to identify possible risk factors impacting the fetus 1 4 5 5 2 3 Ability to identify 3 or more pre- or postnatal self-care tasks 2 5 How to balance your time between yourself (self-care) and 1 5 How to describe the development of an infant 1 4 Ability to identify developmental milestones to look for 2 5 (before giving birth) Ability to define substances that can put your child at risk, during and post-pregnancy Ability to identify postpartum mental health complications your child PRE- AND POSTNATAL EDUCATION FOR YOUNG & EXPECTING MOTHERS Ability to identify what to do if your baby isn't meeting developmental milestones 4 20 5 PRE- AND POSTNATAL EDUCATION FOR YOUNG & EXPECTING MOTHERS 21 Appendix A Participant Pre-Survey Questions Project Purpose: to provide educational resources for expecting and new mothers on pre- and postnatal self-care for mothers, development of sensory processing skills, forming healthy/strong attachment styles, and mitigating possible risk factors associated with birth. Educational Topics Development of fetus pre- and postnatal self-care for mothers development of sensory processing skills forming healthy/strong attachment styles mitigating (reducing) possible risk factors associated with birth In addition to this pre-survey, you will also be completing the Adverse Childhood Experience (ACEs) Assessment. Learning about You: Demographic & Subjective Information What is your age? (Short Answer) Level of Education: What grade are you in or what grade did you complete last? (Short Answer) Describe the setting that you will be raising your child in. (Short Answer) What does your support system look like? What kind of help do you expect after having the baby? (Long Answer) Are you still in school or working? If yes to either, where? (Long Answer) PRE- AND POSTNATAL EDUCATION FOR YOUNG & EXPECTING MOTHERS What experience, if any, do you have raising kids or as a caregiver? (Long Answer) What parts of raising and caring for a baby are you comfortable with? (Long Answer) What worries you or makes you feel uncomfortable when it comes to raising your baby? (Long Answer) Previous diagnosis with any health concerns or diagnoses, mental or physical? (Long Answer) Current Pregnancy Number of weeks pregnant? (Short Answer) Preferred method/location of birth? (hospital/home - midwife/doctor) (Long Answer) Have you been pregnant before? o Yes o No If yes to above question, describe your previous pregnancy experience(s) (pre/during/post) (Long Answer) Currently, what are your biggest areas of concern in terms of your pregnancy? (Long Answer) What resources or educational information have you been provided, if any? (Long Answer) 22 PRE- AND POSTNATAL EDUCATION FOR YOUNG & EXPECTING MOTHERS What information or resources have you been able to access on your own, if any? (Long Answer) Pre-Knowledge Instructions: Rate your knowledge on a scale 1-5 1 = little to no knowledge (uncomfortable with the topic) 5 = high level of knowledge (very comfortable with the topic) How to build a strong attachment with baby o1 o2 o3 o4o5 How to identify the different types of attachment o1 o2 o3 o4o5 How to meet your childs sensory needs? o1 o2 o3 o4o5 How sensory needs impact the development of your child o1 o2 o3 o4o5 How to describe the development of a fetus o1 o2 o3 o4o5 Ability to identify possible risk factors impacting the fetus (before giving birth) o1 o2 o3 o4o5 Ability to define substances that can put your child at risk, during and post-pregnancy o1 o2 o3 o4o5 Ability to identify postpartum mental health complications o1 o2 o3 o4o5 Ability to identify 3 or more pre- or postnatal self-care tasks o1 o2 o3 o4o5 How to balance your time between yourself (self-care) and your child? o1 o2 o3 o4o5 How to describe the development of an infant o1 o2 o3 o4o5 Ability to identify developmental milestones to look for 23 PRE- AND POSTNATAL EDUCATION FOR YOUNG & EXPECTING MOTHERS 24 o1 o2 o3 o4o5 Ability to identify what to do if your baby isnt meeting developmental milestones o1 o2 o3 o4o5 References Declercq, E.R., Sakala, C., Corry, M.P., Applebaum, S., Herrlich, A. (2014). Major Survey Findings of Listening to Mothers (SM) III: Pregnancy and Birth: Report of the Third National U.S. Survey of Women's Childbearing Experiences. Journal of Perinatal Education, 23(1): 9-16. doi: 10.1891/1058-1243.23.1.9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3894594/ Lederman, R. & Weis, K. (2009). Psychosocial adaptation in pregnancy: Seven dimensions of maternal development (3rd ed.). New York: Springer Pub. Co. Retrieved from: https://nursing-and-health-professions.uiw.edu/_docs/moms/psychosocial-adaptation-to-pr egnancy-third-edition.pdf Sakala, C., Declercq, E. R., Turon, J. M., & Corry, M. P. (2018, September). Listening to mothers reports and Surveys: A population-based survey of womens childbearing experiences. National Partnership for Women & Families. Retrieved from: https://www.nationalpartnership.org/our-work/health/maternity/listening-to-mothers.html PRE- AND POSTNATAL EDUCATION FOR YOUNG & EXPECTING MOTHERS 25 Appendix B Participant Post-Survey Questions Project Purpose: to provide educational resources for expecting and new mothers on pre- and postnatal self-care for mothers, development of sensory processing skills, forming healthy/strong attachment styles, and mitigating possible risk factors associated with birth. Educational Topics Development of fetus pre- and postnatal self-care for mothers development of sensory processing skills forming healthy/strong attachment styles mitigating (reducing) possible risk factors associated with birth In addition to this pre-survey, you will also be completing the Adverse Childhood Experience (ACEs) Assessment. Your Educational Experience Overall, how do you feel about the education you received? (Long Answer) Education Feedback How do you feel about going into your pregnancy, becoming a mother? (Long Answer) Are you feeling prepared, or more prepared after the educational sessions? (Long Answer) What most benefited you? (Long Answer) What could have been done differently? (Long Answer) Currently, what are your biggest areas of concern? Did you receive information on this topic? PRE- AND POSTNATAL EDUCATION FOR YOUNG & EXPECTING MOTHERS (Long Answer) What areas do you feel you need more information in? (Long Answer) Post-Knowledge Instructions: Rate your knowledge on a scale 1-5 1 = little to no knowledge (uncomfortable with the topic) 5 = high level of knowledge (very comfortable with the topic) How to build a strong attachment with baby o1 o2 o3 o4o5 How to identify the different types of attachment o1 o2 o3 o4o5 How to meet your childs sensory needs? o1 o2 o3 o4o5 How sensory needs impact the development of your child o1 o2 o3 o4o5 How to describe the development of a fetus o1 o2 o3 o4o5 Ability to identify possible risk factors impacting the fetus (before giving birth) o1 o2 o3 o4o5 Ability to define substances that can put your child at risk, during and post-pregnancy o1 o2 o3 o4o5 Ability to identify postpartum mental health complications o1 o2 o3 o4o5 Ability to identify 3 or more pre- or postnatal self-care tasks o1 o2 o3 o4o5 How to balance your time between yourself (self-care) and your child? o1 o2 o3 o4o5 26 PRE- AND POSTNATAL EDUCATION FOR YOUNG & EXPECTING MOTHERS 27 How to describe the development of an infant o1 o2 o3 o4o5 Ability to identify developmental milestones to look for o1 o2 o3 o4o5 Ability to identify what to do if your baby isnt meeting developmental milestones o1 o2 o3 o4o5 References Declercq, E.R., Sakala, C., Corry, M.P., Applebaum, S., Herrlich, A. (2014). Major Survey Findings of Listening to Mothers (SM) III: Pregnancy and Birth: Report of the Third National U.S. Survey of Women's Childbearing Experiences. Journal of Perinatal Education, 23(1): 9-16. doi: 10.1891/1058-1243.23.1.9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3894594/ Lederman, R. & Weis, K. (2009). Psychosocial adaptation in pregnancy: Seven dimensions of maternal development (3rd ed.). New York: Springer Pub. Co. Retrieved from: https://nursing-and-health-professions.uiw.edu/_docs/moms/psychosocial-adaptation-to-pr egnancy-third-edition.pdf Sakala, C., Declercq, E. R., Turon, J. M., & Corry, M. P. (2018, September). Listening to mothers reports and Surveys: A population-based survey of womens childbearing experiences. National Partnership for Women & Families. Retrieved from: https://www.nationalpartnership.org/our-work/health/maternity/listening-to-mothers.html PRE- AND POSTNATAL EDUCATION FOR YOUNG & EXPECTING MOTHERS Appendix C Session 1 Worksheet: Highlighting important areas of fetal development 28 PRE- AND POSTNATAL EDUCATION FOR YOUNG & EXPECTING MOTHERS Appendix D Session 2 Worksheet: Prenatal Self-care Goals 29 PRE- AND POSTNATAL EDUCATION FOR YOUNG & EXPECTING MOTHERS Appendix E Session 3 Worksheet: Strategy worksheet for pre- and postnatal attachment 30 PRE- AND POSTNATAL EDUCATION FOR YOUNG & EXPECTING MOTHERS Appendix F Pregnancy Dos and Donts 31 PRE- AND POSTNATAL EDUCATION FOR YOUNG & EXPECTING MOTHERS 32 PRE- AND POSTNATAL EDUCATION FOR YOUNG & EXPECTING MOTHERS 33 PRE- AND POSTNATAL EDUCATION FOR YOUNG & EXPECTING MOTHERS 34 Appendix G Doctoral Capstone Experience and Project Weekly Planning Guide Week DCE Stage Weekly Goal Objectives Tasks Date complete 1/13 1 Orientation Get accustomed to the site, meet employees, and communicate project plan 1. observe OT work in juvenile justice 2. observe nurture group 3. get familiar with staff and site 1. Familiarize self with resident and their current situation 2. create plan with Paige for week 2 and project planning 3. Orient self to THRIVE AA program for juveniles 2 Orientation determine new plan for capstone due to changes from site 1. Project plan for school system 2. Make changes to MOU 1. Continue research for changes to project 2. changes to MOU - new draft 3. attend court sessions 4. project meeting with director of community corrections 5. Begin THRIVE AA program for 12 weeks with juveniles in probation 1/19 3 Screening/ Evaluation Draft new MOU 1. Project Development for Preand Post-natal care collaboration with hospitals 2. Complete introduction due 1/23 3. Reaching out for collaborations with Hospitals in Johnson County 1. New project development plan written 2. Continue research on previous studies done 3. Create write up message about project for hospital 4. Write Introduction for Scholarly Report 01/26 4 Screening/ Evaluation Finalize Project Plan 1. Continue building rapport with residents and employees at site 2. Edit Literature Review for Background 1. Edits to Literature Review 02/03 for Introduction and Background 2. Write and submit background due 01/30 3. Reaching out for collaborations with Johnson Memorial Hospital (call, PRE- AND POSTNATAL EDUCATION FOR YOUNG & EXPECTING MOTHERS 35 email, and in-person visit no response) 5 Screening/ Evaluation Finalize new MOU for case study over Pre- and Postnatal Education 1. New project plan for educational sessions with case study participant 2. Finalize mini MOU 3. Re-work 1. Continuous communication with Alissa and Christine for mini MOU - finalize to be sent 2. Rewrite Intro and background drafts 3. Complete Project Design and Implementation Draft for submission on 02/06 02/10 6 Screening/ Evaluation Educational Session Planning 1. Thorough plan for educational sessions organized into 5-6 categories 2. Continue building rapport with residents and employees at site, and in THRIVE 3. Develop pre-survey 1. Send mini MOU on 02/14 for signatures via email 2. Written out plan for educational components 3. Begin research for educational material and resources for single-participant case study 4. Research for pre-survey and begin draft 5. Develop presentation and worksheets for first educational session with participant 02/17 7 Implementati on Implement Pre- and Postnatal education sessions with case study participant 1. Provide education to participant on fetal development, risk factors, and highlights of development 2. Build rapport and trust with participant for increased success 1. Finalize pre-survey and schedule time with participant 2. Administer pre-survey and ACEs assessment to participant 3. Present first educational material with presentation, videos, and handouts 5. Create five week plan with participant 6. Create presentation for session 2 02/24 8 Implementati on Implement Pre- and Postnatal education sessions with case study participant 1. Provide education to participant on prenatal education and self-care 1. Provide educational presentation, videos, handouts and worksheets over topic 03/03 PRE- AND POSTNATAL EDUCATION FOR YOUNG & EXPECTING MOTHERS 36 2. Continue working alongside other employees in detention, building rapport, and participating in additional programming 2. Additional education on prenatal mental health 3. Create presentation for session 3 9 Implementati on Implement Pre- and Postnatal education sessions with case study participant 1. Provide education to participant on forming healthy/secure attachment with fetus/baby 2. Continue working alongside other employees in detention, building rapport, and participating in additional programming 1. Provide educational presentation, videos, handouts and worksheets over topic 2. Create presentation for Session 4 and add developmental milestones 03/10 10 Implementati on Implement Pre- and Postnatal education sessions with case study participant 1. Provide education to participant on infant development and developmental milestones 2. Continue working alongside other employees in detention, building rapport, and participating in additional programming 1. Provide educational presentation, videos, handouts and worksheets over topic 2. write and submit outcomes draft (not all outcomes completed) initial findings and anticipated outcomes 3. Create presentation for session 5 4. Draft post-survey and check with Paige for approval 03/17 11 Implementati on Implement Pre- and Postnatal education sessions with case study participant 1. educational session on sensory processing and baby sensory needs 2. Continue working alongside other employees in 1. Provide educational presentation, videos, handouts and worksheets over topic 2. Provide list of toys by age and month correlating with 03/24 PRE- AND POSTNATAL EDUCATION FOR YOUNG & EXPECTING MOTHERS Implement Pre- and Postnatal education sessions with case study participant 37 detention, building rapport, and participating in additional programming sensory needs and overall development 3. Create dissemination plan and submit on 03/20 1. provide educational session to participant -canceled 2. Continue working alongside other employees in detention, building rapport, and participating in additional programming 1. Develop website for educational material to be housed with presentations included (for future site use) - resource 2. Planning detention nurture group and conduct with two groups 3. Create presentation for session 5 12 Implementati on 13 Discontinuatio Complete final n education session and begin reviewing qualitative data 1. Create Dissemination Presentation and plan for time to present 2. Post-survey completion by participant 1. Create presentation for 04/07 dissemination of findings, educational material, and website for future use 4. Decide who to be involved in dissemination send invite 2. Begin writing abstract for scholarly report 3. Call participant for final educational session and post-survey due to 1.5 weeks of cancellations - able to complete 4. Review and analyze qualitative data - edit outcomes draft 14 Dissemination 1. Present DCE project to site mentor, judge, director of community corrections, state prosecutor, probation director, and more 1. Prepare and practice for presentation on final day 2. Discuss future use of website as a resource 3. Disseminate to site on 04/14 4. Inform of county resource guide completed in addition Dissemination Presentation to Site 03/31 04/14 PRE- AND POSTNATAL EDUCATION FOR YOUNG & EXPECTING MOTHERS 38 for resident/juvenile use (shelters and food resources) 5. Write and submit Abstract, Summary and Conclusion due 04/10 Doctoral Capstone Experience and Project Weekly Planning Guide ...