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Beginnings Guides Blog
Prenatal Education
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Simone Snyder: Posted on Monday, April 29, 2013 11:22 AM
Coloring is meditative. With crayon in hand one is able to
access a different part of the brain, a non-thinking part that is intuitive and
reflective.
Beginnings Guides Heartwork was designed to tap in to this powerful
place.
The drawings were created by Laurel Burch.
They invite reflection on one of the key concepts found in the Beginnings
Guides curriculum the concepts are
related to managing personal and family
health. Each drawing is linked to a
booklet and key concept. The client is able
to learn the concept the drawing
illustrates while encouraging her to visualize
her future as a mother,to dream
ahead, to imagine and plan. Perhaps she may even
reflect on her own childhood, things she would like to carry over in to her own
experience, things she would like to do differently.
 Beginnings Guides Heartwork encourages reflection, which is
key to understanding health information, affects the ability to make healthy
decisions and therefore improves outcomes. A simple, powerful method to promote
maternal health literacy.
Using the coloring pages can help to set up thinking and
sharing quality to a visit, it is hands on, and will encourage the client to find deeper meaning and to speak from the heart. She may uncover new
information or a previously unrecognized need. Therefore the home visitors
handbook includes a chapter on how to use the coloring pages safely and
effectively to color a conversation.
There are some key factors to keep in mind. Client safety is very
important when working with the coloring pages. Because
the exercise has the
potential to bring up deep emotions and/or repressed
feelings it is important
to have program protocols in place to assist the home visitor. A client may
bring up depression, domestic violence, child abuse or
substance abuse.Heartwork can be deeply powerful therefore if you do not
have a protocol set up through your organization avoid using this exercise until something can be implemented.
 Be sure to organize your visit effectively. Heartwork
requites trust and a certain
level of comfort. They were not designed to be used on the first or second visit. It is also suggested that you wait until the
end of a booklet to do the coloring pages.
If needed you can introduce the page
and
leave it with them to complete on their own time. They could also be
encouraged to journal or write about their experience
on the back of the page.
Be sure to provide crayons or makers and encourage your client to find a quite
place to do the work where she won’t be interrupted. Be sure to listen,
respond, follow their lead and listen to your instinct.
Do you use Heartwork in your practice? Would you like to
share your experiences and
clients drawings? We would love to hear from you.
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Sandra Smith, PhD, MPH: Posted on Thursday, September 20, 2012 10:38 AM
of Beginnings
Guides to promote maternal health literacy. So the Guides need to
fit the audience, US pregnant women including those
with low resources and limited literacy, and to facilitate use of health
information and services. In Part 3 addresses two
additional factors that determine the literacy demand of information,
writing
style and sentence construction.
Writing
Style is Conversational Easy-to-use health information uses a
conversational tone. Read aloud the information you are reviewing It should sound like something you
would actually say to a person sitting with you. Some clinicians may pan a
conversational style as “unscientific” or “unprofessional”, a reflection of professional
training that rewards multisyllabic latinized
terms in long complex sentences like this one as
demonstration of deep knowledge.
But that is not the point here.
The point is to make the information
easy to understand, personalize, and apply in
real life. Conversational tone is familiar and expected, so quickly grasped
and not intimidating. Rather it invites reflection and interaction.
Conversation nearly always uses the
active voice: “ Jason hit the ball” is active. I can see
the action in my
mind’s eye. “The ball was hit” is
passive; it creates an incomplete mental
picture. It does not engage the
reader.
Conversation uses short simple
sentences, and sometimes incomplete sentences. No
embedded information. In the
first paragraph above, the third sentence intentionally contains multiple
phases and embeds mostly irrelevant information about professional training
demonstrating that long involved sentences and extraneous facts slow reading
and reduce comprehension. So instead of
“Patients are advised to take vitamins daily”; say it the regular way:
“Take your vitamins every day”.
Beginnings
Guides get a Superior rating for using conversational style and simple Sentence
Construction: Context first The way the sentence is built makes a
big difference in comprehension. Readers recall the last thing they read, that
is, the end of the sentence. Starting with what the reader already knows,
provides context and increases understanding.
Start with the context - the part the
reader already knows: “While you are pregnant....”;
end with new information:
“...your uterus is big enough to hold the baby. Right after birth, it shrinks
to the size of a grapefruit.” (Beginnings Pregnancy Guide Book 6 page
77)
If I state the new information first, the reader is likely to miss
or forget it.
SAM gives an Adequate rating to
materials that present the context first half the time. Beginnings Guides get a
Superior rating for consistently providing context before new information.
Next:
Vocabulary & Road Signs |
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Sandra Smith, PhD, MPH: Posted on Thursday, August 16, 2012 12:13 PM
Beginnings
Guides to pregnancy and parenting translate the science of prenatal care
and early child development into practical guidance for parents.
The Pregnancy Guide, first published in 1989 as Beginnings: A practical guide
through your pregnancy, is now in its
8th edition (2011). It has been distributed by home visitation programs,
prenatal care providers and health insurance plans to more than 310,000
families. In surveys, mothers report sharing Beginnings with their partners, friends and relatives, and their
doctors. Six months after close of
service, nearly all mothers who participated in New Mexico’s Families First program were able to report where their copy of the Pregnancy Guide would be found. For example, one mother said,
“They are stored with the newborn clothes for my next pregnancy.” Another said,
“I gave it to my cousin who is pregnant.”
Beginnings
Pregnancy Guide is not your usual pregnancy book. Let me count the ways:
1) Conversational tone is easy,
encouraging. It sounds like something you would actually say to a mother
sitting next to you. The text reflects the conversations a caring, articulate,
“patient-centered” practitioner who is up-to-date on the research would have
with each mother at each visit if time allowed. Readability pioneer Rudolf
Flesch documented that conversational tone using personal pronouns and common
words increases readability and comprehension.
2) Staged
learning keeps info immediately applicable. Information is like medication; it
is easier to take and more effective is small doses. Adults learn in order to
solve problems they have now. Information that is not immediately applicable is
likely to be ignored or discarded and may be overwhelming. So the Beginnings Guides present essential information in a series of six booklets
referenced by gestational age and the usual course of prenatal care.
Selectively cover the content of each booklet in one or more visits depending
on the family’s interests and needs and your frequency of visits.
3) It’s short. Short words in short sentences in
short paragraphs in short booklets increase readability, comprehension and
recall. This “commitment to short” means focus is on the essentials. Even
experienced mothers and educated first-timers who read everything about
pregnancy welcome Beginnings’ focus
on what really matters at a particular point in pregnancy. We converted to
the 8.5 x 5.5” booklets after
mothers told us that format is easy to carry and store and “they don’t look or feel like homework”.
4) It’s designed to promote maternal
health literacy. More on that next time. ss
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Sandra Smith, PhD: Posted on Thursday, July 05, 2012 5:37 PM
Spanking, slapping, shoving are common
punishments for children in the US and Canada. Hitting a child is socially
acceptable by many parents as a form of discipline or to protect children by
teaching them to respect authority.
A large new Canadian study documents that these punishments are associated with
lifelong mental and emotional problems.
ACEs - Adverse Childhood
Experiences- are a frequent topic in this space. ACEs include experiencing or witnessing physical or sexual
violence or abuse. ACEs are closely linked to a surprisingly long list of
physical and mental problems in adulthood. But that is not what we’re talking
about here.
Here’s the main survey question put to
over 20,500 adults: “As a child
how often were you ever pushed, grabbed,
shoved, slapped or hit by your parents or any adult living in your house?"
Never,
Almost never,
Sometimes, Fairly
often, Very often
If you answered Sometimes or more
often, these researchers would say you experienced harsh physical punishment
and you would be among the 6% of study participants whose experience is
similar. Those who also reported ACEs were excluded from the analysis.
Adults who were punished as children,
but not to the point of full-scale maltreatment, were at increased risk for
depression, mood swings, anxiety, alcohol and drug abuse, and personality
disorders.
This from Beginnings Parents
Guide:
What do you want to teach?
Discipline: | Spanking: | Teaches
self-control | Teaches
fear | Teaches
your child that hitting is not OK. It hurts | Teaches
here that hitting is OK if you are the biggest and strongest | Teaches
your child to keep the rules out of respect for herself and other | Teachers
her to keep the rules so you will not hit her | Shows
your child she is a good person who learns from mistakes and practice | Teaches
her she is bad; she does not learn well; she deserves to be hurt | Teaches
your child to think for herself and do the right thing | Teaches
her not to think for herself, and to do what keeps her from getting hit | Leaves
you and your child feeling OK about yourselves and each other
| Leaves
your child in pain, feeling bad about herself and you. |
Resource: Parents can talk
anonymously with a counselor, 24-7,
free in 150 languages by calling Childhelp USA National Hotline
800-422-4453
Reference |
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Sandra Smith, PhD: Posted on Friday, June 29, 2012 4:28 PM
All physicians should screen all adults for obesity. So say new guidelines published this week by he US Preventive Services Task Force. The guidelines recommend measuring each persons height and weight to calculate their body mass index or BMI. Everyone with BMI of 30+ should be referred to counseling and behavior change support programs.
It’s a good plan. Screening for obesity and managing weight is particularly important during pregnancy. Extra weight contributes to complications and is rarely lost after birth. Fat bodies produce fat babies building obesity and its attending health risks into the next generation. Weighing is the only prenatal care procedure shown to affect outcomes.
If your doctor does not discuss weight, that does not mean it doesn’t matter.
Although weight management has long been part of a minimum quality prenatal care service, providers infrequently weigh mothers. They say weight is a touchy subject and they don’t want to embarrass or alienate patients, so they don’t talk about it. Others say they do not know how to calculate BMI. (Calculate it yourself with this handy gadget from the Beginnings Guides resources collection.)
The guidelines emphasize traditional approaches that frame weight management as a battle involving diet diaries, calorie counting, exercising and tracking activity
levels. An approach unlikely to be engaging or popular. One of the authors said, “We also need to help people understand why they’re not eating more healthfully or being more active, and help them address those issues.” He is right, partly.
What’s missing from the guidelines is recognition of the links between obesity
and sexual abuse. Research demonstrates that obesity is not just about an individual’s lousy eating habits or laziness. It is shockingly often about a history Fat is protective.
Counseling and support services will need to do more than “get people to eat right”;
they will have to recognize and address underlying social issues, starting with
sexual abuse.
References:
Virginia A. Moyer, on behalf of the U.S. Preventive Services Task Force. Screening for and Management
of Obesity in Adults: U.S. Preventive Services Task Force Recommendation Statement. Annals of Internal Medicine. 2012 Jun 26. Available free online at http://annals.org/article.aspx?articleid=1200996
U. S. Department of Health & Human Services, Public Health Service (1989) Caring for our future: The content of prenatal care. A report of the Public Health Service Expert Panel on the Content of Prenatal Care. NIH Publication No. 90-3182 Washington, DC: National Institutes of Health.
Kogan, M.D., Alexander, G.R., Kotelchuck, M., Nagey, D.A. (1994). Relation of the content of prenatal
care to the risk of low birth weight. Journal of the American Medical Association, 271(17), 1340-1345.
The Adverse Childhood Experiences Study http://www.acestudy.org/
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Sandra Smith, PhD: Posted on Wednesday, June 27, 2012 4:41 PM
parents anytime you are
outdoors or riding in a car. But not for babies.
Two
reasons: Babies skin is very thin; so it absorbs chemicals more easily than
adults. And babies have a lot of skin for their weight so the chemicals have
greater effect.
That means sunscreen on a baby is likely to cause an allergic
reaction or swelling or both.
Shade, long sleeves and long pants, and a hat
with a wide brim are the answer.
Especially the hat. Make sure it shades Baby’s whole
face, ears, and the extra-sensitive back-of-the-neck.
For toddlers, and for Baby when you
really cannot keep him out of the sun, test a dab
of sunscreen on his inner wrist. Use SPF* of 15-30.
Higher than 30 means more chemicals, but only a tiny bit more protection. If
you see no reaction, apply to small areas that
you cannot cover, like cheeks,
hands, and bare feet.
 Remember, too,that small bodies need
extra water in hot weather. Keep water (not soda or juice) handy and keep them
drinking.
and Drug Administration. Download it free to handout or post.
*SPF Sun Protection Factor. It’s a confusing rating.
For a
pretty good explanation of how SPF ratings
are set and why that new SPF 100
sunscreen doesn’t protect much better than 30, see Jeffries, Melissa.
"What do SPF numbers mean?" 16 August 2007.
HowStuffWorks.com.
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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 Friday, March 09, 2012 10:49 AM
I was on the street corner waiting for the light to change as they approached.
She was fashionably dressed, a one-year-old on her hip and shopping bags on
her arm. The five-year-old boy walked along beside her. He struggled with a
backpack that seemed too big for him. She stopped; turned to him and shouted “Get that backpack on before I sock the shit out of you!”
The boy jumped in surprise and alarm. So did I. She seemed so angry so
suddenly.
The boy had been quiet and well-behaved, keeping pace with his mother.
The problem seemed obvious. He was wearing a puffy parka a size too large;
it bunched up at the shoulders when he tried to pull up the straps.
I was speechless.
My instinct was to protest. And I was afraid she would sock the shit out of me,
too. The light changed and I went on.
I have been disappointed in my non-response and worried about the child since. If she socked me, I could have socked her back. The boy could not. If the police
came, he may have gained some protection.
Contemplating the scene, I thought maybe I could have interceded without blaming
or embarrassing her by saying something like, “Gee, your hands are full, can I help
him with the backpack?”
What would you do?
This boy was having an ACE (Adverse Childhood Experience) Thinking about the mother, I suspect ACEs in her background make violence her automatic reaction and prevent her from feeling compassion and raising a
spoke to her and/or perhaps as someone currently speaks to her.
In any case, neither threatening the boy nor actually socking him will teach him to carry his backpack properly, or to obey his mother. It will teach him to fear
his mother and do whatever keeps him from getting hit. It will teach him that socking the shit out of someone is how you solve problems, and that it is OK if you are the biggest and strongest. It will convince him that he is bad and unworthy of respect.
Using Beginnings Parents Guide to talk about discipline vs. hitting If I were her home visitor or parent educator or outreach specialist, I would plan a reflective conversation with this mother. I might start with page 186
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Sandra Smith, PhD: Posted on Wednesday, March 07, 2012 8:56 PM
The dad was carrying his two-year-old son to the park. The boy fussed
and squirmed as Dad talked in his ear. Suddenly, Dad plunked the boy
down on the sidewalk and took three steps away from him. “OK, that’s a three-minute time out!” he said louder than he intended. The fussing
escalated to a cry. Dad sighed heavily, hands on hips, and glowered at
the boy and the passersby.
First, kudos to this dad. He recognized that he and the boy both needed a break. He did not let his frustration get the better of him. He did not
hit or threaten. But he could have used time-out more effectively.
Discipline is Teaching Self Control, Not Punishing “Bad” Behavior Like his dad, when a toddler is upset, he has trouble thinking.The
point of time out is not to punish him, but to help him regain his
calm and self-control; and to create an an opportunity for Dad to regain his calm and self-control, too.
Wrong Place for Time Out A noisy, busy sidewalk with adults and pets bustling between them
and traffic whizzing by is not a soothing environment. If Dad could have made it another half block they would have been in the park
where they could sit on a bench or on the beach to be quiet together, give words to feelings, and regroup. Sitting together would show the boy that his dad did not reject him, only his behavior. It would also
show that everyone (even Dad) gets upset and needs a break sometimes
to regain composure. Naming the boy’s feelings would prepare him to
use words instead of fussing.
Unreasonable Expectations The two-year-old is too young for time out. At his stage of cognitive development, it is unlikely that time-out makes any sense to him.
So now in addition to whatever made him cranky, he feels frightened, rejected and confused to find himself dumped alone on the sidewalk
with his angry dad backing away from him. A two-year old understands that No! means Stop. But he has no idea what to do instead. He does not understand that what he wants and feels is not the same as what his dad wants and feels. He has no clue what three minutes means.
He has an innate fear of being abandoned, a survival mechanism
designed to keep him safely close to his parents; so seeing Dad walk
away is not going to calm him.
Time out is a good form of discipline starting around age three. And
then three minutes is about right, one minute per year of age.
Not the Desired Result Dad wanted to teach self control, but ended up teaching fear. He
wanted his son to be good, but showed him he is bad. He wanted
to feel good about himself and his son, but both were feeling pretty
bad when I saw them.
pages 183 to187. For discipline for a toddler aged 24-30 months,
see Book 7, pages 162-164. This information requires no revisions for the upcoming 4th Edition.
Next: While this dad did not use time out as well as he could have, he is way ahead of a mother I encountered a little later.
More on that next time.
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