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Beginnings Guides Blog
Health Literacy
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Sandra Smith, PhD: Posted on Tuesday, May 01, 2012 7:26 PM
Action research identifies best
practices for promoting maternal health literacy Following is a brief summary of
findings from our program of action research* with home visitation programs
that have
Home
Visiting (MECHV) is an effective channel to promote
maternal health literacy, Overall mothers (N=2572 including 23
men and a few grandparents) who participated in enhanced home visitation for
12-18 months achieved significant improvement in their use of information and
Promoting
Maternal Health Literacy reduces disparities Additional findings suggest the
intervention reduced disparities related to literacy and age:
•
Lower skilled readers made greater gains than
their more skilled counterparts.
•
Teen mothers started at a major disadvantage but
made impressive gains in the first six months of service to nearly catch up
with their more experienced counterparts.
Depression
and Maternal Health Literacy closely linked
•
Both depressed and not-depressed mothers
improved their management of personal and child health and healthcare. Depressed mothers made greater gains
than not-depressed mothers, again reducing disparities.
Depression
does not interfere with health literacy promotion efforts
•
Depression improved slightly but significantly
over the service period. Home visitors were successful in supporting mothers to overcome multiple barriers to obtain depression treatment, demonstrating
increased understanding and utilization of health services -- that’s health
literacy. Major improvements in health literacy occurred even when changes in
depression were minor, suggesting the effect on health literacy is separate
from the effect (full text free online).
Maternal
Health Literacy may predict child developmental outcomes Preliminary
findings from our current study on the same database as the above studies
suggests maternal health literacy is closely related to child development, so
that efforts to promote health literacy also promote child development. Stay tuned.
Is
it feasible and effective to integrate health literacy promotion
into Medical
Home Outreach?
This question is being addressed over
the next two years with Anthem/WellPoint as it pilots the intervention in 12
state Medicaid managed care organizations. WI is up. TX is next. Stay tuned.
Integrating
health literacy promotion into Parents As Teachers
curriculum is feasible and effective That is the preliminary finding from the Parents As Teachers Health Literacy
Demonstration Project that winds up this summer. The participating Parent
Educators and other stakeholders will review and interpret the results at a
Reflection Conference May 11. Stay tuned.
* Action research, sometimes called “practitioner
research”, is a reflective process in which practitioners undertake research to
improve their own practice by learning from experience. The process
identifies ineffective practices to drop; promising practices to hone and
finally best practices to
disseminate.
See Forest, M.E. & McNiff, J. (2007). Learning and
teaching in action. Health Information and Libraries Journal, 24, 222-226.
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Posted on Monday, April 16, 2012 8:55 AM
A reflective question is one that requires the mother to think about
facts and feelings, link to her knowledge and experience, and formulate a
purposeful response. For health action planning, reflective questions
help the mother clarify what she wants for herself and her child,
clarify what is currently supporting or in the way of her desired
outcome, and clarify the next step. Hint: a Yes or No question is not
reflective.
Home Visitor Asks - Demonstrates it matters what a mother knows
- Builds mother's confidence
- Creates a teachable moment
- Suggests a way to think about a current problem
- Presents the mother opportunity to recognize & apply her knowledge & experience-to use her power
- Presents the mother opportunity to notice gaps in her knowledge & to seek info
- Teaches responsively-leaves the power with the mother by supplying info only in response to her request
- She empowers the mother
Mother Reflects - Feels respected, knowledgeable, self-confident in caring for herself & baby
- Taps into her experience, uses her knowledge
- Evaluates her experience, values, knowledge, feelings
- Applies and so learns from her experience
- Recognizes her need to know & need for info
- Asks for info-takes charge of her learning
- Increases knowledge
- Develops her life skills-problem solving, resource utilization, info seeking
- Changes behavior
- Improves baby care, interaction, teaching
- She is empowered
Baby Benefits - Has his/her needs met
- Establishes trust in the mother
- Achieves secure attachment
- Enjoys improved health & well being
- Learns appropriate behaviors
- Reduced risk of abuse & neglect
- Innate curiosity is supported
- Improved school readiness
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Posted on Tuesday, April 03, 2012 5:06 PM
Reports have been circulating on the
Internet: researchers find that the recommendation to exclusively breastfeed
babies for six months is just too hard for modern women and is making mothers
feel bad. The study author suggests the advice is fine for the developing
world, but should be changed to “breastfeed as long as you can and introduce
solids as close to six months as possible”.
There are several health literacy
lessons to be learned from this questionable reporting on questionable
research.
The
evidence is exceptionally clear and strong First, we should note that the
recommendation to feed infants only breast milk for at least six months is not
just a suggestion from some guy in a diner. It is the evidence-based consensus
from the U.S. Centers for Disease Control, American Academy of Pediatrics, the World Health Organization, and
virtually all health agencies on the planet. This level of consensus is rare
and requires an extremely strong evidence base.
Is
the recommendation unhelpful for mothers? and child that last a lifetime and save
billions in healthcare costs. The study’s author says the recommendation is
“idealistic” and
“unhelpful” as an
individual goal and calls for balance between these “theoretical” longterm
benefits and immediate family well being.Fair enough. But that can be done at the individual level without undoing worldwide policy making and without concluding that women are incapable of (or just too busy) for this womanly skill.
The
perfect food is free The big problem for breastfeeding is
this: it’s free. This study feeds a broadly-held perception that breastfeeding
is for poor people in backward countries that cannot afford or reliably use
formula.
With this twisted thinking we are
willing to disregard all the science behind the global breastfeeding
recommendation in favor of the belief that in 30 years scientists have made a
better formula than what Mother Nature developed over millennia.
Health
Literacy Lessons Literacy means the cognitive and social skills which determine
the motivation and
ability of mothers to gain access to, understand, and use information in ways
that promote and maintain their
health and that of their children.
Part of health literacy for mothers,
health promoters and clinicians alike, is reading critically, asking where is
this information coming from and how reliable is it? What does it mean to me in my situation? How can Iuse it
for health?
Read it for yourself. The study is published in BMJ Open-
that’s British Medical Journal Open, an open access journal.
BMJ ought to be a reliable source. But
here’s the detail that matters (it’s in the abstract): 541 pregnant women in
Scotland were invited to participate in monthly interviews; 72 volunteered to
participate. Of these, 36 were interviewed along with some of their partners
and relatives.
This
is not a representative sample. People who volunteer to participate in
surveys typically feel very strongly one way or the other. We need to ask, how
are these 36 women different from the 505 who declined? Further, the sample is too small to draw any conclusions beyond the individuals involved.
Telling
them what to do does not work Breastfeeding advocates, health
educators, parent educators, home visitors, clinicians can learn an important
lesson re: promoting maternal health literacy from this article. When education is perceived as “unrealistic, overly technical and rule based”, it is not going
to motivate anyone to take action for health. But you already knew that...The problem here is not the breastfeeding policy; it’ s the
delivery of information.
Stay tuned for a model reflective conversation to
promote breastfeeding.
To balance the oft quoted Scottish
mothers who were not well served by their lactation consultants and who
struggled with breastfeeding, see our Facebook Poll for comments from
our volunteer sample of mothers who work in women’s health. We asked: Do you think recommending
breastfeeding for
a minimum of 6 months is unrealistic or unattainable?
No one said Yes.
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Posted on Thursday, March 22, 2012 3:41 PM
Betty, a parent educator presented a challenging case in reflective supervision. She reported that the 19-year old mother and her seven month-old daughter live with her mother. And Grandma smokes like a chimney. Mom smokes, too. She’s begun making efforts to smoke outside. But Grandma says to Mom, “I smoked all through my pregnancy and your childhood; you didn’t die, and neither will this
child”. She bristles at any request to stop smoking or take
steps to protect the baby.
I have a lot of respect for grandmothers and their wisdom (I am one!). But this time, this grandmother is just plain wrong. Her smoking probably will not kill the child this year, and hasn’t killed the mother yet, but it might kill them both before their time.
Second-hand smoke is as harmful as first hand smoke,
and more so for an infant with small size and still-developing
lungs. Exposure to second hand smoke has been linked to increased risk of SIDS, ear infections, and respiratory disease in children. Annually, 150,000 to 300,000 cases of bronchitis or pneumonia in children under 18 months of age are attributed
to second hand smoke. And new research reported by the journal
Respirology this week shows that a child’s reduced lung function
from exposure to second-hand smoke nearly doubles the risk of
lung disease in adulthood.
Mom smoking outside does begin to reduce harm to the baby by reducing the second hand smoke in the air that Baby breathes. Betty, the home visitor rightly praises this effort and continues to encourage Mom to take the next step. Mom is in a bind because she needs a safe place to live. And, for now, living with her
mother is her best option. She has set a goal to get a job so she
can get her own place. She is taking courses for a college degree. It’s a long path to her goal. Meanwhile, Betty reports, she takes the baby to the doctor “all the time” for recurring colds and ear infections.
Third-hand smoke is as harmful as first hand smoke, too. What makes Grandma’s house hazardous to Baby’s health, in
addition to smoke in the air from her current cigarette, is the
accumulation of smoke in the furniture, curtains, carpet, bedding, dust; in her hair and clothes, and in her car. This is third-hand
smoke. It toxins remain toxic. Baby has her face in it all the time.
Information on third-hand smoke will be added to the upcoming
Rating Moms and Grandma’s Health Literacy Betty has made certain that both Mom and Grandma have plenty
of information about smoking and resources to support quitting. Both understand the information. Grandma rejects it outright.
She warrants a low score of 1 (dysfunctional) on the “Use of
Literacy Scale. She has low health literacy, not because she can’t read, but because she does not use information and resources for
health.
Mom’s health literacy is increasing. With Betty’s support she has come to recognize the risk to her child, if not to herself. She has established a medical home for the child and seeks care appropriately.
She has begun to take action to change her living situation in order to improve her health and that of her child. In this case, the barrier
to health literacy promotion is not the mother’s reading skill, it is the grandmother’s beliefs.
Promoting Health Literacy Betty planned to keep bringing information on smoking to each visit
with this family, as she has for a year now, and continue to do whatever she can to “get them to stop smoking”. When we reviewed the mother’s goals and motivations - she aims to complete her
schooling so she can get a job so she can move to a more healthful environment - a different approach emerged that is likely to be more effective and less frustrating for all parties.
Betty has been trying to fix the family and rescue Baby by
getting Mom and Grandma to stop smoking. If she could shift from pushing for her own goal to supporting what Mom wants for herself and the baby, she could build on Mom’s motivation
to graduate and get a job, celebrate smoking outside and going to school as steps in the right direction, and support Mom’s
step-by-step progress toward independent living and a smoke-free environment for her and Baby.
Epilogue At the end of the case presentation, we learned the baby
had just been taken to the local ER with seizures and
airlifted to the regional medical center. We cannot say that second- and third-hand smoke caused the seizures, but the
evidence is clear that smoke in an infant’s environment
weakens lung function and increases other health risks.
Mom is right. Time to move.
References Winickoff JP, Friebely J, Tanski SE, et al. (2009). Beliefs
about the health effects of “third hand smoke and
home smoking bans. Pediatrics 123: e740e79.
Chan S.& Lam TH. (2003). Preventing exposure to second-hand smoke.
Seminars in Oncology Nursing 19 (4): 284-290
MedlinePlus Secondhand Smoke in Childhood Linked to Lung
Disease Years Later (available until 6/17/2012)
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Sandra Smith, PhD: Posted on Tuesday, February 28, 2012 4:40 PM
I conducted an informal Facebook poll to test directly
the proposition that some parents are
going to choose co-sleeping, despite the widely publicized recommendations of experts that infants sleep alone to prevent SIDS. Some of
these parents may be unaware of the risk, or may not understand the message. I
surmised that parents engaging in parenting-related Facebook discussions are
likely to be aware of the message and to understand it.
I asked: When you child was an infant (up to 8 months old), did you bring
the
baby to your bed? Often Never Routinely Occasionally
The single question poll was posted on
Facebook for the month of February. Almost immediately, an anonymous reader added
a response option, “every night”, which received by far the most votes. Here’s the tally.
37 every night 3 never 3 routinely 1 if he woke up we brought him in 1 occasionally
Talk
about safe bed-sharing Non-scientific as it is, the result
makes it clear; we need to talk about how to make co-sleeping as safe as
possible. Simple advice that Baby must always sleep alone in his/her own crib
is not going to fly. But this is
the proper advice when parents
habitually use alcohol or drugs, or are taking prescription medications that
suppress arousal.
“Baby
Back to Sleep” still the most important message Parents have enough anxiety. It is important to emphasize the risk
period for SIDS peaks at 2-4 months. SIDs is rare before age 1 month and after
age 6 months. A safe solution during the early months seems to be temporary
bed-sharing, where the baby shares the parents’ bed for feeding and cuddling
and then is returned to a crib within sight. Use of a pacifier at sleep time
(not other times) reduces risk of SIDS. So does a firm mattress, tightly fitted
bedding and removal of all things fluffy and soft. In all cases and places, Baby sleeps face-up.
Here’s a summary of references and
resource from our review of evidence on SIDS:
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Sandra Smith, PhD: Posted on Tuesday, February 21, 2012 5:38 PM
Lead
is a toxic metal that is harmful if inhaled or swallowed.
Lead is found in air, soil, dust,food
and water. The greatest
exposure to lead is swallowing or breathing lead paint
chips
and dust. Another risk is drinking water contaminated by lead
plumbing or
water lines. Blood lead levels in the US dropped
dramatically after 1978 with
the ban on lead in gasoline.
Blood
lead levels continue to drop, but no safe threshold has
been identified.
Current efforts and recommendations focus
on primary prevention.
Lead
is especially dangerous to infants and toddlers because
they live close to
the ground with their hands in dust and soil;
and their favorite way to explore
anything is to put it in their
mouths.
Also, growing bodies absorb more lead and growing brains and nervous
systems are more sensitive to harmful
effects.Blood lead levels peak around
age 2 when most toddlers
stop chewing on everything in reach; then they decline
without
treatment unless exposure continues.
Here’s
the big worry: harmful effects are long lasting, perhaps
permanent,
potentially including brain and nervous system
damage resulting in lower IQ and
behavior problems (reduced
ability to pay attention and follow instructions,
hyperactivity,
aggression, reading disabilities, hearing and balance problems).
These symptoms can occur even with low exposures.
The
source of most lead poisoning in children is dust and chips from lead paint
on interior surfaces. Lead paint was taken off
the market in the 1970s. But it
is still present in homes built before
1978. In most cases, lead paint in good
condition is not a hazard.
But when it chips, peels, or flakes; and when it is
sanded or
otherwise disturbed, it’s highly toxic. U.S. water sources are lead free, but old plumbing can be toxic. (The Latin word for
plumbing translates literally as lead.) Children
living in poverty are most at risk. The American
Academy of Pediatrics
recommends that all Medicaid-eligible children be tested for lead at age1 and
again at age 2.
Medicaid covers the two
tests and requires one at age 2,
which may be too late to prevent
damage. Other children should be
tested if their living conditions or parents’
occupations warrant.
Beginnings
Parents Guide first addresses lead poisoning on a
page 26 (Book 1, 2-12
weeks).. The text focuses on avoiding
Baby’s exposure to lead carried on the
shoes, clothes and skin
of parents/caregivers in certain occupations. The new
2012
edition will add content to aid parents in assessing and ensuring
the
safety of their home, particularly the presence of lead paint and lead
plumbing.
Test
all Medicaid eligible children at age 1 and 2. The current
edition suggests a lead test at six months, and
includes a self-test for parents to determine if their chid needs a lead test.
This
information will be revised and relocated to reflect the policy
of testing
all Medicaid eligible children at age 1 and 2 years,
and other at-risk
children, including those who spend time in a
home built before 1978.
New
Resources on this Beginnings Guides website. Find out about lead in
drinking water in your area. National Hotlines and the
National Lead Info
Center. Info for families renting, repairing or
References: American
Academy of Pediatrics, Committee on Environmental Health. (2005) Policy
Statement. Lead Exposure in Children: Prevention,
Detection, and Management. Pediatrics 116 (4) p1036-1046
Note,
this policy was reaffirmed in 2009
National Lead Information
Center 1-800-424-LEAD
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Sandra Smith, PhD, MPH: Posted on Thursday, February 16, 2012 9:05 AM
Part of health literacy is
understanding information. But it is using
information that makes
a difference in outcomes. Last time in this space we
discussed new federal regulations from the Consumer Products Safety Commission
that aim to improve crib safety.
That’s good information for health promoters and healthcare professionals,
but how can we offer this information to parents in a way they can use it?
To use information, we first
personalize it using interactive and reflective skills. When a
mother
personalizes health info, she reflects on: What
does this mean for me, in my
situation,in my family with my income,
experience, education, values and living conditions?
And then: Now that I have this information, how do I
want to respond? What do I want to do?
Information is
most easily personalized and applied in context when it uses familiar words
that do not require judgment or background knowledge.
For example, if the info says,
“Slats should be less than 3” apart”, it will pass the readability tests, but
the learner must know the meaning of slats,
know that the symbol “ means inches,
and know or how to use a ruler to measure. And s/he must judge whether should means the
distance between the slats is a vital concern or
just a suggestion, so that she can judge
whether it worth the trouble to go
find the ruler or someone who knows how to measure.
I found few parents used the word slats. More parents used – and nearly
all understood bars.
If the info uses
something familiar and handy as a measure, no one needs to understand inches or use measuring devices to
check the space between bars.
Further, info is easier to
personalize and put into action when it contains only what the
learner needs to
know to take appropriate action. For example, a mother does not need to
know
that the Consumer Product Safety Commission sets crib safety standards. She
needs to know how to tell if her crib
is safe for her baby
Crib Safety Checklist If you can check Yes for all these statements,
you have a
safe crib.
·The bars are
close together so the baby cannot get stuck between them. The space between
bars is no wider than four adult fingers.
[ ] Yes [ ] No
©Practice Development Inc |
Beginnings
Parents Guide makes crib safety info easy to use with a Crib Safety Check
List.
Ideally, the checklist is
the focus of a reflective
conversation on sleep safety, or it may be
used in
self-directed learning. The checklist is interactive and reflective; it
requires the
learner to think and check Yes or No to three
statements. This
takes the learning deeper faster by using muscles in addition to the
brain. In the process, the learner
teaches herself
to determine whether the crib is safe and what
makes it safe or
not.
Here’s
the part about distance between slats. No rulers or knowledge of measurement
needed.
No polysyllabic words. The
text sounds like something a person would actually say in
conversation. See the
full Checklist here (choose Parents Guide and go to page 22).
The
2012 edition will add this item to reflect new safety standards: ·
The sides of the crib do not fold down…. |
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Sandra Smith, PhD, MPH: Posted on Thursday, January 26, 2012 4:30 PM
 Beginnings Parents Guide is temporarily sold out. We are
accepting backorders for the New 2012 Edition. It will, of course, be easy to
read, interactive and evidence based.
Evidence based
content The scientific evidence for each topic
in
the Guide is being reviewed and incorporated into the text. The
Toddlers and Families, as well as the current
public health literature. will be checking all these and other sources for the
latest evidence
and best practices.
Plain Language Beginnings Guides
use plain language and a fourth grade reading level. This does not mean the information is
suitable for a fourth grader. It does not mean the
Guides “talk down” to
readers. Rather it means the information is easy to understand and use independently for about 80% of
individuals with 9 to 12 years of schooling and half of those with 6 to 8
years. Everyone, regardless of reading ability, benefits by review and
discussion. That is because we readers make meaning from information and figure
out how to use it by talking with others.
Using your input The Parents Guide
was developed by and for home visitors and the families
they serve. Over 40
home visitors participated in content development and testing. I routinely
collect comments from parents and their home visitors, parent educators, case
managers and
outreach specialists who rely on Beginnings Parents Guide for teaching and learning about early parenting.
These comments are reviewed first as we plan the update. If you have additions or changes to recommend, now is the time. Send me
email.
Text Reviews I am now working on the text
review. The Parents Guide is one of
the most reviewed documents on the planet. It was first published in 1999 with
technical support from
ZERO TO THREE and has been updated regularly. So the
text is already well honed and mother- tested. Our editorial standards require
that it be easy to read, understand, and especially easy to use. The text serves both as a teaching
aid and for independent learning.
It reads like something you would actually say to a mother sitting
across from you. In fact, you can use the text as a script
to open discussion
of difficult topics that mothers are unlikely to bring up, and that may leave
feeling at a loss for words. So far, I’ve found two bits of American slang to clarify: Do not try to
“go it alone”, and You might feel you are at the “end of your rope”. These common expressions
may not be understood by all parents. They will be clarified.
evidence and decisions regarding changes, additions and deletions. As
always your comment will be
welcome, appreciated and fully considered.
Next: Sleep Safety There is perhaps no
more emotional or controversial issue for new parents
than sleeping
arrangements.
Stay tuned. ss |
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Sandra Smith, PhD, MPH: Posted on Tuesday, January 24, 2012 10:55 AM
Adverse Childhood Experiences are emerging as major
players in adult’s physical and emotional health. ACE refers to growing up
experiencing in the household before age 18:
·
Recurrent
physical abuse ·
Recurrent
emotional abuse ·
Contact sexual
abuse ·
An alcohol
and/or drug abuser in the household ·
An
incarcerated household member ·
Someone who is
chronically depressed, mentally ill, institutionalized, or suicidal ·
Mother is
treated violently ·
One or no
parents ·
Emotional or
physical neglect
Experiences
in these categories, and witnessing them,
are linked to alcoholism, drug abuse,
depression, and suicide attempt, poor self-rated
health, obesity, heart disease, and liver disease.
See previous blogs. Home
visitors, case managers, parent educators, social workers and clinical practitioners are very likely to encounter mothers who struggle with the
lifelong effects of ACEs.
Often
the topic is not discussed because no one knows quite how to talk about it.
See how to talk about ACEs. So
today I want to share an excellent webinar that will prepare home visitors to
address ACEs in a respectful reflective way. It is presented by my colleagues at University of WA Northwest
Center for Public Health Practice through a grant from HRSA. I particularly recommend
the second half (about 25 minutes) as part of a staff meeting. It will jump
start your ability to address this issue
that is fundamental in the lives of so
many of the families you work with every day.
Quen
Zorrah discusses how public health nurses [and other practitioners] can
effectively educate
and screen clients for ACES and plan, with the client, ways
to decrease the risk for inter-generational transmission of these experiences,
strengthen the parent-child relationship, and build resiliency for both the
survivor and the child.
The
first half of the webinar will be of particular interest to Parents as Teachers
parent educators and others who work with school districts.
What is your ACE score? A
first step to making information on ACES and how to talk about them meaningful
might be to determine
References:
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Sandra Smith MPH PhD: Posted on Tuesday, January 17, 2012 11:13 AM
 Think Link & Respond
Reflective parents take time to listen, watch and think about what is happening with Baby. They tap
into their knowledge and experience & consider possible explanations; then they choose a response.
Parents who do not reflect, react to their emotions rather than responding to baby's needs.
The Three Moms Three breastfeeding moms all went to a party and ate salsa. Their three babies had reactions to the salsa.
(I know, this is unlikely; please suspend disbelief for the sake of illustration.) Let’s look at their levels of reflective functioning.
At home after the party, Alice’s baby woke crying. Alice thought to herself, “Why is he awake? Uh, oh...
all that salsa. Celeste (her home visitor) told me Baby might have a reaction. Sorry, Baby.” She rocked him
singing softly until he finally fell back to sleep.
Alice thought about – reflected on - why her baby woke up crying. She linked Baby’s crying to her own
behavior (eating salsa) and to what she had learned about breastfeeding. She chose an appropriate response. Alice demonstrates strong reflective functioning and responsive parenting. Remember the reflection
process: Think, Link & Respond – Alice got all three steps.
Across the street, Bella’s baby woke up about the same time. Bella looked for what might be bothering her
daughter. She checked for wet diapers, noise, too much light. Baby wouldn’t eat and would not stop crying. Near panic, Bella loaded Baby into the car and sped to the ER. There she waited. By the time they were seen,
Baby was sleeping soundly. The doctor said he was fine and they went home.
Bella thought about possible explanations for her Baby’s upset. But she missed a Link. Either she did not know,
or did not recall the possible link between eating salsa and Baby’s reaction. Without that link, her thinking
broke down as she approached panic and triggered unnecessary intervention. Cathy exhibits beginning reflective skills, and a gap in knowledge. Happily, the nurse at the ER took time to talk with Bella and filled the information gap. Next time, Bella will make the link.
Down the road, Cathy’s baby woke up crying, too. Cathy covered her ears. The crying continued. She got
up went to the crib and shouted at Baby, “Shut up! There is nothing wrong with you. You are just trying to make me mad and it’s working.” She slammed the door and went back to bed. Eventually Cathy and
her baby both got back to sleep.
Cathy reacted. She did not think or link or respond. She was unable to observe her own behavior and
feelings, consider her possible role in the situation, or see that Baby’s behavior was not directed at her.
She did not consider that she may need more information. She did not weigh the possibilities and options.
Cathy has low (no) reflective function.
Reflect on the Moms' Behavior We can see from the story that one barrier to strong reflective functioning is lack of knowledge. One way to promote reflective, responsive parenting is to increase parents’ background knowledge.
When parents respond inappropriately, assume they are doing the best they can now. Take a cue from the ER nurse who acknowledged Bella’s strong desire to do her best for her Baby. The nurse worked with Bella to discover what knowledge would enable her to formulate a more appropriate response.
Reflect now on Cathy’s unthinking reaction. Wait to judge – assume that she did the best she could at the
time. What might explain her behavior? Perhaps Baby’s crying in the night reminds her of her own childhood
traumas, so she cannot link her feelings to current events. If she is accustomed to chaotic, painful,
overwhelming feelings, she is probably in the habit of shutting down in order not to experience them.
Maybe she does not have the cognitive ability to reflect – that would be an exceptional case. More likely,
she can think about possible explanations and solutions; that just is not her habit.
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