EXPERIENCES OF LATINA MOTHERS IN A HOME-VISITING PROGRAM: STORIES OF TRAUMA AND RESILIENCE

1. EXPERIENCES OF LATINA MOTHERS IN A HOME-VISITING PROGRAM: STORIES OF TRAUMA AND RESILIENCE Ruth Paris, PhD & Blanca Alvarado, PhD —Boston University School of Social Work Marybeth Bronson, MSW, Sarah Oo, MSW, Danelle Marable, MA, & Elizabeth Miller, MD, PhD--Massachusetts General Hospital Chelsea HealthCare Center THEMES FROM INTERVIEWS PROBLEM STATEMENT VISITING MOMS PROGRAM • “Suffering” in travels to U.S. and being in new country • Isolation from home and community • Children left behind; Depression • Helpfulness of home-visitors SUFFERING “…it's difficult to come the way that I came. One has to go without food or water. It is difficult because one thinks that they are not going to make it. That they are going to die, from hunger and thirst...” “…we were just walking. We walked a lot. We had to withstand the cold, thunders, and without sleeping or eating. For the dream of being here. One sacrifices and suffers. ISOLATION “At first, I felt really alone... I would stay by myself. I was in a place I did not know. I did not know where to go. I did not even understand the law and how things worked. I would always be inside…” “When I went into delivery I went by myself, I came home by myself. I was alone, totally alone.” “Here, I am alone.” CHILDREN LEFT BEHIND “Because I cried a lot when I used to think about my kids, I wanted to return, but then I thought… About my kids, how they were doing… If they were sick...I did not even know what to think about.” “...well, I felt depressed, without any will to live… I told them, ‘I do not know what to do because my kids are so far away.’ And when I would talk with them it was even harder for me. Because I would cry and cry.” DEPRESSION “Yes, you should have seen me, how depressed I felt. The only thing I would do is cry and cry.” “When I found out I was pregnant, I became really depressed because I tried to call the father of the baby and this man screamed, ‘I am not the father of the baby’. HELPFULNESS OF HOME-VISITORS “When I really felt depressed, where I did not even know what to do… She would tell me to think things through. How could I make myself feel better… I feel that she has helped me in so many ways.’ “…she has been such a support...she has gone from being a social worker/home visitor to being a friend...I appreciate her a lot...” “[when] she visits me I forget I am alone…” “…they have helped me with forms.”; “She has helped me with food vouchers, with things for my daughter…with tax forms…” ; “…toys for the kids…”; “My first HV helped me by singing to the girls, playing with them.”; ” Even the day I delivered she went with me…”; “She helps me with translation.”; She helps me, because instead of lowering my morale she makes me feel better.” • Using a relationship-based model (Heinicke & Ponce, 1999) with paraprofessional bilingual/bicultural staff the intervention works to sustain mothers and infants by using emotional support, parenting education and modeling, advocacy, and referral to resources. • A community health center base enables the home-visitors to interface with referring staff on an ongoing basis. • Because of reduced social distance and an empathic stance stemming from their own experiences,it is hypothesized thatparaprofessional home-visitors have an ability to influence the mother’s motivation to use resources and increase her sense of self-efficacy. • Front-line home-visitors work closely with mothers in their primary language utilizing a nurturing stance, initially addressing their most pressing needs, whether it is housing, infant clothes, depression, or domestic violence. As trust develops and the family attains greater stability the home-visitors are able to concentrate on the complex infant-mother relationship using role modeling and parent education. Average length of intervention is 11 months. • Criteria for eligibility: Health center patient who is pregnant or parenting infant with at least 2 of the following risk factors—extreme isolation, lack of family/social support, extreme poverty, mental health issues, cognitive limitations, undesired pregnancy, child at high risk of neglect or abuse, extreme family stresses. • Many Latino immigrant families left dire conditions in home countries, experienced trauma in their migration to the U.S., currently live in poverty, have minimal social support, and have lost their cultural framework for parenting (Perez Foster, 2001). • The above stressors present as risk factors for child abuse/neglect and/or developmental difficulties in infants and young children (Birman et al., 2005). • Increasingly home-visiting interventions are serving Latino families who are high-risk yet mistrustful of outsiders (Gomby, Culross, & Behrman, 1999). • Few studies describe these home-visiting programparticipants in terms of immigration, life conditions, and perception of assistance received. RESEARCH QUESTIONS AND METHODS SAMPLE DESCRIPTORS (N=14) • Research Questions: • What were participants’ experiences in immigration to U.S. and conditions necessitating referral to the program? • What were the mechanisms of assistance offered by the home-visitors? • How did the participants experience these interventions? • Qualitative interviews with program clients are part of larger program evaluation which includes pre and post quantitative measures of depression and parenting stress. Interviews with Latina mothers 8-12 months into the program (N=14) are a subset of all those conducted with clients (N=20) and staff (N=5). • Semi-structured audio-taped interviews were conducted by bilingual/bicultural research assistant in Spanish and transcribed into English verbatim. Translations were checked by native speakers. • Each transcript was coded independently by 2 research assistants, using QDA software ATLAS.ti, in consultation with Principal Investigator and analyzed for themes. R. Paris, Ph.D., Boston University School of Social Work, 264 Bay State Rd., Boston, MA 02215. rparis@bu.edu, 617-353-3752 IMPLICATIONS • Immigrant Latina participants have traumatic histories of suffering and adaptation. • Visiting Moms Program is experienced as helpful using instrumental and emotional support to decrease isolation and depression and increase adaptation. • Home-visiting programs using bilingual/bicultural staff have the potential to moderate parenting difficulties by supporting mothers and families; direct impact on children needs further exploration.