Diversity Corner
In this month’s Diversity Corner, 2023 Anti-Racism Grant Award Winner, Andrea Garcia, provides a project summary and updates on an impactful project shared with Michael Vilensky. The one-year anti-racism grant funds projects that focus on service, clinical activities, activism, training, or research. The goal is to fund projects that intersect pediatric psychology and anti-racism, and lead to sustainable change within the field.
Background
According to the Agency of Healthcare Research and Quality, a newborn baby in the United States is diagnosed every 18 minutes with neonatal opioid withdrawal syndrome (NOWS); an exponential increase from the prior 10 years. Born to individuals with opioid use disorder (OUD, referred to hereafter as OUD birth parents [OUD-BP]), these infants can have tremors, excessive crying, and irritability, along with problems with sleeping and feeding. OUD-BP often experience harmful environments (e.g., domestic violence, poor nutrition), poverty, and comorbid psychiatric issues, leading some OUD-BP to be ill-equipped to take care of a medically complex infant. OUD has systemically impacted rural areas, persons from low socio-economic status, and regions with large increases in opioid prescriptions. Ohio has been at the epicenter of this crisis; its rate of infants born with NOWS is nearly double the national rate, resulting in intergenerational impact. Despite efforts to mitigate the impact of OUD on families, there are persistent barriers to effective care. These barriers include a lack of trust in healthcare providers, unaddressed intergenerational trauma, and fragmented OUD-BP/infant care services.
Societal stigma surrounding OUD is even more intense for Black, Indigenous, and people of color (BIPOC) OUD-BP, exacerbating the intergenerational effects of the opioid crisis. It is crucial to develop evidence-based interventions that address the trauma experiences, psychosocial risks, and contextual challenges faced by OUD-BP. Specific challenges for BIPOC BP recovering from OUD may include limited parental attachment, which contributes to a lack of parental warmth, and understanding of developmental stages, both of which can be addressed through attachment-based therapy. Child-Parent Psychotherapy (CPP) is a dyadic, attachment-based intervention model for children from birth to six years of age. The primary goal of CPP is to support and strengthen the relationship between a child and their caregiver as a catalyst for healthier children, especially among young children and their families.
The Current Project
Working within The Ohio State University’s Substance Abuse Treatment, Education, and Prevention Program (STEPP) clinic, which offers interdisciplinary treatment for addiction during pregnancy and follows OUD-BP up to one year postpartum, provides an ideal setting to identify modifications to CPP that can best support BIPOC OUD-BP and their infants. We conducted a needs assessment with participants of the STEPP clinic as stakeholders and identified values that support their parental attachment and promote family strengths and relationships while helping families heal and grow after stressful experiences. The primary objective of this questionnaire is to identify BIPOC OUD-BP parenting needs, priorities, and barriers faced by BIPOC OUD-BP. We aim to gain insights into the challenges they encounter in promoting sensitive and responsive parenting behaviors and their understanding of child development.
Initial Results and Future Plans
Our work at the STEPP clinic has revealed some preliminary findings. There are significant trauma histories among participants, with the majority reporting experiences of physical and sexual abuse during childhood, often at the hands of family members. These traumatic experiences have profoundly shaped their parenting styles and the challenges they face as caregivers. Specifically, we identified several unique themes that recur among our STEPP group participants, such as hypervigilance and overprotection, which manifest as an intense need to shield their children from perceived dangers. While rooted in a desire to protect, this hypervigilance can sometimes hinder the development of a secure and nurturing parent-child relationship. Another challenge frequently observed is in the realm of communication. Many of our participants struggle to maintain calm when their infants or young children express "big emotions"—intense displays of anger, sadness, or frustration. This difficulty has been reported by STEPP group participants as linked to their unresolved trauma, which triggers anxiety or discomfort when faced with their children's emotional needs. As a result, some parents also reported having difficulty understanding and appropriately responding to their children's emotions.
Despite these challenges, our STEPP participants are acutely aware of the impact that their trauma has on their parenting. They recognize how their responses, or the responses of others, can influence their children's social and emotional well-being. This awareness presents a crucial opportunity for intervention. By addressing these challenges through tailored support and interventions, such as Child-Parent Psychotherapy (CPP), we can help OUD-BP foster more sensitive and responsive parenting behaviors. This, in turn, can promote healthier attachment and developmental outcomes for their children.
Our goal is to leverage this understanding to develop interventions that address the trauma and its effects and build on the inherent strengths and resilience of these families. By doing so, we aim to help these parents create a nurturing and supportive environment that allows them and their young children to heal and thrive despite their significant challenges.