Finding New Ways to Reach Out to At-Risk Mothers
Among the lessons that Emily Feinberg has gleaned from her years as a pediatric nurse at Dorchester House Multi-Service Center is this: Take notice of who accompanies babies to their first medical appointments.
Feinberg, an assistant professor at the BU School of Public Health and School of Medicine, recalls missing the signals years ago, when the husband of a patient who had recently given birth began showing up with the baby for check-ups. Feinberg assumed that the husband was just pitching in — until she talked with the young mother later.
“She told me she had really severe post-partum depression — something I hadn’t known,” Feinberg recounted. “It really made me aware that there was a gap in our care for families, that if you don’t really understand what’s going on with the parents, it can be harder to understand what’s going on with the kids.”
Filling that gap in care has become the latest challenge for Feinberg, a member of the Maternal and Child Health Department, who has made a mark on the state healthcare system by using her clinical work as a springboard for research into health issues impacting low-income children and adolescents.
After years of examining health policy issues such as access to insurance and affordable housing, Feinberg has shifted her attention to the inner workings of families.
In the past few years, Feinberg has been involved in projects that seek to identify and address maternal depression in pediatric-care settings. Depression in young mothers remains under-identified and under-treated, despite its impact on maternal and child health, largely because women have fragmented contact with the healthcare system. Feinberg said pediatric well-child visits offer an alternative setting to detect and manage maternal depression.
“There’s a move nationally to do more to screen mothers for depression,” Feinberg said. Pediatric visits “have been seen as a missed opportunity” to reach out to at-risk mothers.
Feinberg and colleagues at Boston Medical Center (BMC) were instrumental in integrating a maternal mental-health screening and referral protocol in pediatric settings affiliated with BMC. The screening is embedded in the pediatric electronic medical record at all health centers that are part of the BMC network, and providers have received training to use it.
Feinberg is now pursuing other ways to reach mothers who may be at risk for depression. She is working with the state’s Early Intervention Program, which provides services to young children with developmental difficulties, to add a mental-health intervention for mothers who may be at risk. Several Early Intervention workers already have received training in the intervention, which teaches problem-solving strategies, and Feinberg and colleagues will study how well the approach works. Two SPH doctoral students are working with her.
“We don’t do a particularly good job of getting low-income mothers into mental-health services,” Feinberg said. “So the question is, can we bring the services to them, through an existing program? . . . I’m interested in building a community capacity to address mothers’ mental-health issues and see if we can work within programs that are already established.”
She said the intervention being piloted in the Early Intervention Program is designed for women with low-level risk factors, not full-blown depression.
“Our goal is really to look at people who may be at risk and see if this helps how they feel and how they interact with their children,” she said.
Feinberg also is pursuing a research interest concerning child-feeding practices. She led a research team that recently reported in a study that mothers who worry about having enough food for their families are more likely to give their children “compensatory foods,” such as high-energy supplements and perceived appetite stimulants.
The study, published in the October issue of Pediatrics, analyzed survey data from urban African-American and Haitian-American mothers with children ranging in age from 2 to 13 years old. It found that household food-insecurity “was significantly associated with two … compensatory feeding practices that may increase the risk for overweight (children) in a population in which prevalence of childhood overweight is high.”
Now, Feinberg is involved in a project through the Dorchester House Multi-Service Center, which serves a significant Vietnamese population, to improve culturally competent care to Vietnamese families by educating clinicians about that population’s child-feeding practices. The project is funded by the Massachusetts BlueCross BlueShield Foundation.
Feinberg said the project grew out of concerns about weight trends among Vietnamese children, who tend to be underweight as infants but overweight as toddlers. Her team is producing a package of educational materials — in print, on DVD and on the web — designed to help healthcare providers understand Vietnamese child-feeding practices and to promote healthy eating. Feinberg said the materials will be disseminated nationally.
“What we’re hoping to do is provide some guidance to providers in understanding cultural issues, so that when we have a discussion with a family about healthy eating, we’re not saying things that are totally out of context for them,” she explained.
Feinberg received her clinical training at BU and Simmons College and completed her doctoral work in public health at Harvard. Over the years, she has examined issues of access to care, including perceived barriers to Medicaid enrollment, and has worked closely with the Bureau of Family and Community Health of the Massachusetts Department of Public Health (DPH).
Recently, her work with the DPH has focused on strategies to address maternal depression. She has served on advisory committees for the department’s Maternal and Infant Mental Health Partnership and Perinatal Connections projects.
Feinberg said she continues to benefit from her dual roles as a clinician and a health services researcher.
“I’ve come at some of the research from my perspective as a clinician — seeing that we’re missing major things going on in families’ lives,” she said. “There are access issues, but there are also ways we can improve our interventions…
“I think we have some new ideas about how to do that. The next question is, are they working?”
Submitted by Lisa Chedekel
chedekel@bu.edu