Learn About the Importance of Healthy Mother/Child Relationships from Yale Researcher Megan V. Smith, DrPH, MPH
As part of our Addiction Speaker Series, in which leading experts present their latest findings, Megan V. Smith, DrPH, MPH, Assistant Professor, Departments of Psychiatry and Child Study Center at Yale School of Medicine and Chronic Disease Epidemiology and Social and Behavioral Sciences at Yale School of Public Health, presented “Addressing Toxic Stress and Adverse Childhood Experiences in Partnership with Mothers." We interviewed Dr. Smith to learn more about her fascinating research.
Why is the two-generation approach so important to fostering healthy mother/child relationships?
Two-generation programs provide opportunities for and meet the needs of parents and their children together. Decades of developmental research have shown that there is no question that poverty and high levels of stress in parents disrupt child development. Parents’ health and children’s health are closely intertwined, and healthier parents have healthier children. Although genetics account for some of this relationship, much of the relationship can be traced to influences from the social environment and behavior. However, there are few programs that operate in this frame that target mental health and family economic success. The two-generational framework presents an exciting opportunity for the field as we strive to optimize programs that improve child health and improve parental skills.
What is a community mental health ambassador (CMHA)? Are CMHAs more effective than the alternatives? How so?
A CMHA is a mother from a community in which mothers we partner with reside. More specifically, a CMHA is a cultural ambassador trained in brief mental health outreach, intervention, screening and referral for maternal mental health. CMHAs also provide psychotherapy and job training interventions alongside clinicians. They are a bit similar to a community health worker, but distinct in that they provide actual clinical interventions and focus very specifically on mental health and child development. We have demonstrated CMHAs to be effective in increasing adherence and utilization to mental health treatment as compared to identical interventions delivered without a CMHA. The value from CMHAs is derived from their ability to apply skills learned in interventions to real-world, culturally relevant situations and also to encourage a level of trust and relationship with a mother that is not typical of other mental health clinicians.
You spoke about how diapers – and the inability to provide them – was the number one concern for economically disadvantaged mothers. Why does an inability to provide diapers so dramatically affect low-income mothers?
Diapers are not covered by any federal entitlement program. Mothers who take their children to a center-based daycare or family daycare provider usually are required to provide a two weeks’ supply of diapers when they leave their child. If mother's cannot afford diapers, then they cannot leave their children at childcare and may be unable to go to work or school. Diaper needs become an economic issue as well as a tangible issue that impacts a parent’s own self-esteem and self-efficacy and ability to sooth a crying child. It can disrupt the parent’s ability to attach effectively with their child.
You mentioned that the two consistent goals of these mothers was stable employment and to make their child proud. What are the barriers for these mothers to accomplish their goals?
Barriers included what mother’s descried as “stress” and referred to depression, trauma and addiction. This maternal stress and its impact on a mother’s daily functioning made gainful employment challenging for many mothers. Barriers to optimal parenting included social isolation. Even mothers who lived in high density housing projects surrounded by the same neighbors for 25 years talked about not knowing their neighbors and a general lack of trust and reciprocity in their community. In turn, mother’s discussed feeling limited in their ability to provide experiences for their children that would increase their child’s social networks and broader access to social capital.
You spoke about MoMBa – your app that connects mothers, encourages socializing, and aims to improve the development of their children. How important are smartphones in engaging these mothers? Would this social connection be possible without smartphones?
I absolutely think this connection is possible through community venues such as libraries, community centers and early care and education settings. The goal with MoMBA is to explore how smartphones can enhance and encourage social networking, but not substitute for it. MoMBa recognizes that socially promoting behavior may need to include incentives in particular subpopulations and geographies, and thus utilizes the power of behavioral economics to spur social connection.
Megan V. Smith, DrPH, MPH
Dr. Smith is an Assistant Professor at the Departments of Psychiatry and Child Study Center at Yale School of Medicine and Chronic Disease Epidemiology and Social and Behavioral Sciences at Yale School of Public Health