The National Association of Perinatal Social Workers
Volume 37 Number 1
Winter 2017
Every baby, every family...supported with competent and compassionate care.
www.napsw.org
FROM THE AUTHOR OF B R E A T H E…
HOPE is the thing with feathers…
By Kelly Kittel
T
hey say there’s no greater
agony than bearing an untold
story inside of you. For me,
that story is told in my
memoir, Breathe. I was born with a
book clutched in my fist and always
knew that some day I’d write one, but
I certainly never dreamed that life
would place this particular tale in my
hands. I wrote Breathe to tell the
story of our sons, Noah and Jonah,
and I also wrote it to help other people. But I carried this story inside of
me, cleaved to my heart, for 10 long
years before I wrote even one word.
The Book Of Noah
My husband, Andy, and I met in the
Peace Corps in Jamaica in 1985 and
when our fourth child, Noah, was
born 11 years later on May 18, 1996,
we had good careers and loving families. We were 34 years old, college
educated and our feet were planted
firmly on the prescriptive path that
defines success in our society. There
was no reason to think we wouldn’t
continue raising our family and contributing to our 401K accounts, retiring some day as successful professionals. Breathe takes place mostly in
Oregon, where I worked as a fish biologist in Portland for the Bonneville
Power Administration. We lived in
Portland when our second and third
children, Christiana and Micah, were
born but had moved to Salem by the
time Noah graced our lives.
Noah was our first baby who
emerged looking like I thought all of
them would. He had reddish blonde
hair and blue eyes like me. My first
blue-eyed baby, he was just beautiful.
He was born in the wee hours of a
Saturday morning and that day the
sun came out for the first time after
40 days and 40 nights of rain, making
Noah the most fitting name for him.
Our family seemed complete with
two girls and two boys, matched sets,
and life seemed to be as perfect as it
could possibly be. Andy is the
youngest of eight children and we
rocked along in our ark, surrounded
by his large, loving family.
Until the dreadful day, August 10,
1997, when Noah, who was only 15
months old, was run over by our 16year-old niece in my in-law’s driveway on the Oregon coast. The world
crashed over us like a tsunami and
spit us out on a foreign shore, gasping
for breath. Life, as we knew it, was
over. This was the end of “normal”
for us.
The Book of Jonah
Less than one month after Noah died,
I discovered I was pregnant and I was
gobsmacked. I was sick, so skinny
and sick, that I was simply shocked
that somehow new life had taken
ahold inside of me. It felt like a miracle and I cradled it like a delicious
secret. Like hope. This baby helped us
all learn to crawl and walk again. It
helped us get through all those terrible firsts without Noah.
We weathered the first Halloween
and at Thanksgiving, when I was
three months along, we took a family
trip to Jamaica where I gave thanks
for our Peace Corps experience,
knowing that for most of the world
life is hard. And that even today I
could sit with any woman in the socalled third world and having lost one
son wouldn’t be so unusual.
We made it through Christmas and
Easter, and when I was seven months
pregnant, I
went on a
business trip
with Andy to
Hawaii
where I took
my baby
snorkeling in
Hanama Bay.
My belly was
like a beach
ball and the
two of us floated in the warm, salty
water while I hummed Beach Boys
tunes to my baby, this most amazing
blessing. We were moving along, getting through our grief one day at a
time. It was still very painful but, like
sea glass, the sharp edges were starting to wear smooth.
I tried so hard to be happy, tried not
to cry, thinking it would make the
baby sad. My due date was June 3 but
continued on page 4
In this issue …
From the President ........................... 2
Baltimore Takes on Infant
Mortality ........................................8
Interdisciplinary Recommendations
for Psychosocial Support .............11
Portland Conference .......................13
Book Review ....................................14
Regional Spotlight ...........................15
Innovation Programs/Research
Grant ............................................16
NAPSW Award for Excellence
Nomination Form .......................17
NAPSW Leadership
Nominations................................19
Social Action ...................................20
2 NAPSW FORUM
Winter 2017
NAPSW FORUM
Published quarterly online at www.napsw.org
by the National Association of Perinatal Social
Workers. Views and opinions published in
NAPSW FORUM are those of the authors and
not necessarily those of the Association.
Managing Editor: Margery Pentland, LICSW
Co-Managing Editor: Dasi Schlup, MSW, LCSW
Production Editor: George Hatzfeld
from the president
NAPSW Officers:
President:JaNeen Cross, DSW, MBA, LCSW
Philadelphia, PA
[email protected]
Vice-President: Hannah Raiden-Wright, LCSW
Berkeley, CA
[email protected]
Secretary: Evelyn Mascarenas, MSW
Oakland, CA
[email protected]
Treasurer: Diane Glenn, MSW, LASW
Seattle, WA
[email protected]
Immediate Past President:
Lisa Baker, LCSW, PhD
Vestavia Hills, AL
[email protected]
Board of Directors:
Elizabeth Allen, LCSW**
Colorado Springs, CO
Will Crowder, LCSW**
Charlottesville, VA
Jenny Duffy, MSW, LISW *
Iowa City, IA
Sandy Dykstra, MSSW, APSW*
Milwaukee, WI
Joan Hebert, LCSW, ACSW*
Orlando, FL
Kara Marriott, MSW, LCSW **
South Elgin, IL
Barbara Menard, LCSW**
San Diego, CA
Beth Paul, LSW*
Newburgh, IN
Dasi Schlup, MSW, LCSW**
Jefferson City, MO
Alison Tiedke, MSW, LCSW*
Arnold, MD
*2015-2017 **2016-2018
The National Association of Perinatal Social Workers was incorporated in Oklahoma City in 1980 as a
nonprofit educational, professional organization
whose mission is to promote and support excellence in perinatal social work to maximize healthy
outcomes for babies and their families.
Every baby, every family...supported with
competent and compassionate care.
A
s we move forward with President-elect Donald Trump, there
appears to be many things unknown
about the future direction of the
country. Although our country is
grappling with more questions than
answers, there is little doubt that
sweeping changes will occur. The
health care landscape and immigration reform are areas that may
undergo many major changes.
During his campaign speeches,
President-elect Trump promised to
repeal Obamacare but also stated that
he may preserve some parts of it. It is
possible to repeal Obamacare using
the budget reconciliation process that
will expedite considerations for controversial budget and tax measures.
At this time we are not sure how the
new administration would modify or
replace Obamacare. Perinatal social
workers must stay abreast of any
changes to Obamacare that directly
impact access and quality of health
care services to families.
Another area of focus is women’s
health and reproductive rights. Trump
expresses support for abortion bans
after 20-weeks but conversely states
that he is pro-choice. Trump appears
to be in favor of six weeks paid leave
for new families, particularly mothers. Similarly, these policy areas have
direct impact on the type of reproductive health services and postpartum
support pregnant and postpartum
mothers can receive. This is another
area that perinatal social workers
need to focus on with the new administration.
Trump’s immigration reform is of
particular concern for social workers.
Trump states that his agenda includes
deportation of undocumented individuals and families and abolishing sanctuary communities by removing federal funds to states. Immigration
reform is of special interest to perinatal social workers who often provide
perinatal services and support to
undocumented women. Trump’s policy initiatives may decrease the
amount of undocumented women
seeking perinatal, mental health, and
other needed social work services due
to fear. Physical and mental health
outcomes for these women then
become exacerbated without services
and support. Immigration policy
changes require close monitoring by
perinatal social workers.
It is imperative that social workers
remain cognizant of these macro
changes because they will have direct
practice implications at the micro and
mezzo level of practice. The ability
to provide perinatal social work services and access to those services may
be more difficult with the incoming
administration. The repeal of Obamacare (also the expansion of Medicaid) and conservative fiscal policies
may limit access to health care,
diminished funding, support and
resources to families across the country. Policy changes made in health
care specifically will have far reaching
consequences for all Americans, not
just the marginalized and oppressed.
Winter 2017
Although as perinatal social workers
we know that it is the most vulnerable of populations that are at highest
risk.
Based on the widespread concerns
and implications for potential policy
changes, the new administration was
met by turbulent protests around the
country. Leaders of the social work
community released statements solidifying and reinforcing the values and
mission of the social work
profession.
On November 9, 2016, the
National Association of Social Workers released a statement in response
to the election, stating:
“The NASW Code of Ethics makes
clear the importance of social justice. We cannot support any efforts
to marginalize or oppress any group
of people, and will always work to
assure that human rights extend to
everyone. Social workers continue
to strongly advocate for our country’s most vulnerable
populations.”
Similarly, on November 15, 2016,
the Dean of the University of Southern California, Marilyn L. Flynn
stated:
“Modern social work and nursing
as professions were born under conditions of profound social and political upheaval in the 19th century.
We have been committed ever
since to the struggle for social
change, social justice, healing and
protection of vulnerable populations. We increasingly recognize
the impact of social determinants
on health and positive outcomes
for all. As dean, I want to reaffirm
this dedication to social justice and
our determination to support a fair,
democratic and open nation. One
of our most important contributions to the social fabric is the
work we do in the management of
painful transitions for individuals,
groups, communities and societies.
The next four years may be one of
our greatest challenges.”
I reiterate the social work values of
social and economic justice. The
vision of NAPSW is to serve “every”
baby and family. This includes families of diverse ethnic and religious
NAPSW FORUM 3
background and regardless of immigration/citizenship status. We will
continue to serve and advocate on
behalf of all families and execute the
mission of NAPSW.
The purpose of NAPSW is to
“share” our knowledge base and this
will be important. As perinatal social
workers we will need to communicate with one another, society, and
state officials about the changes that
will occur and how these changes are
impacting the clients and families we
serve. As a national organization we
have perinatal social workers across
the country and Canada. We need to
leverage our information and support
networks as we transition into a new
administration. Our NAPSW website
(connections, community and circles)
and Listserv are fantastic mediums to
share resources, news, and information. NAPSW will serve as a source
of information and information broker for perinatal social workers via
Facebook and Twitter.
These most recent political developments and policy concerns occur
amidst the holiday season. I chose to
focus on these recent and potential
changes in our political direction
because these issues are important for
perinatal social workers. During this
time of uncertainty and transition,
remember that our profession
includes leaders such as Barbara
Mikulski, Frances Feldman, Grace
Coyle, Jeanette Rankin, Maurice
Daniels, Alberto Godenzi, Ruby
Gourdine, Mariko Yamada, Frances
Perkins, and Jane Addams responding
to women’s rights, suffrage, civil
rights, segregation, health care needs,
social and economic injustice. In the
upcoming years we may revisit some
of these social issues and like our
social work leaders we will be poised
to address them and “maximize
healthy outcomes for the families we
serve.”
As the holidays symbolize hope
and prosperity for humankind we
should be inspired by these themes. It
is important that we look back,
reflect and give thanks for our families and dedicated social work colleagues and leaders. Please keep our
country and the families we serve in
your thoughts and reflections as we
move forward. Happy New Year from
NAPSW!
Warmly,
JaNeen Cross, DSW, MSW, MBS,
LCSW
Philadelphia, PA
[email protected]
4 NAPSW FORUM
Winter 2017
Hope is the Thing with Feathers
Stillbirth
continued from page 1
Stillbirth is not a word you say or
hear very often in the larger world.
It’s not mentioned in polite company.
It’s surrounded by stigma. Taboo. In
the hospital they call it “fetal death”
or, as in Jonah’s case, “intrauteral
fetal demise.” Fetal. Fetus. These
terms are used to describe the death
of a baby between 20 weeks gestation
and before birth. And yet, in the wonderland of the NICU, they can save
babies as early as 21 weeks gestation,
babies who weigh only 10 grams.
Babies, not fetuses. I delivered my
“fetus” at 37 weeks gestation and
Jonah weighed over six pounds.
Mothers who suffer a stillbirth do
not receive official recognition in 25,
or half, of our 50 states. There is no
certificate of birth, rendering their
labor and delivery and their babies
virtually invisible.
One of the many things we feel
when our babies die is shame, the
dancing partner of blame. The most
basic instinct a parent has is to protect their child from harm and we
failed. Regardless of the circumstances. We couldn’t prevent that car
from backing up and we couldn’t prevent our babies from dying inside of
I didn’t get that far. My blood pressure
began to destabilize and, as I neared
the third trimester, I was put on bed
rest. My blood pressure kept worsening so at 36 weeks my doctor started
an induction with Cytotec, or Misoprostol, but after a day without too
much progress, she sent me home. It
was Mother’s Day.
Four days later, on May 14, 1998, I
stood up at Micah’s music program to
go to my doctor’s appointment and
had a sudden and complete abruption.
Andy rushed me to the hospital
where I nearly died from blood loss
delivering another beautiful boy we
named Jonah, who was stillborn. This
time, I felt like the world had paused
for a moment to honor Jonah’s
silence, and then it simply rolled
right on over me, crushing me in its
trajectory.
The doctors threw up their hands,
said that abruption and pre-eclampsia
were the two great mysteries of pregnancy. Nothing anybody could do. So
sorry. Each year in the U.S., over
26,000 mothers deliver a stillborn
child. That’s one in every 160 births.
And I believed that I was simply one
of them.
The world crashed over us like a tsunami and spit us
out on a foreign shore, gasping for breath. Life, as we
knew it, was over.
us. And we often suffer in silence.
And the final stillness, the lasting
silence is the inability of others to
acknowledge our loss, as if we moms
should just quietly take our lumps or
sweep it all right under the rug. As
my own mother-in-law counseled,
“You just have to look at it like it
wasn’t meant to be.” “It” meaning
my baby, her grandson, Jonah.
I’m assuming things have changed
since 1998 and I’m happy, if so, for
our evolution, but I never had a perinatal social worker assigned to me
when Jonah was stillborn and I definitely could have used one. The
recovery was terrible, especially the
physical recovery. I’d nursed Noah
until the day he died but that was
nothing compared to this. My milk
came in as scheduled on the third day
and they said no, there are no drugs
for this, take Tylenol and wear ice
packs and two jog bras. I had horrible
night sweats and my boobs were up to
my chin.
“Don’t pump, never pump,” they
said. In those days before Google, I
searched the yellow pages, called the
La Leche League and everyone I could
think of to take my milk but they
said, no, they were too afraid of AIDS
even though I’d clearly tested negative in my pregnancy. They said
maybe I could send my breast milk to
Canada, which was ridiculous. I tried
to find a foster baby but they said
nobody was allowed to nurse a foster
baby. I suffered and I begged God to
leave a baby on my doorstep. He
never did.
Books are some of my best friends
and, like my beloved books, I wanted,
I needed, a happy ending. I needed to
heal, first and foremost, but after
that? I needed to put joy back in our
family. And the best way I knew to do
this was to have another baby.
The Book of Isaiah
I was raised to believe that family is
the most important thing. My ancestors jumped off the Mayflower and I
spent my childhood tromping around
cemeteries behind my Mom and my
grandmother, Mimi. Our Mayflower
ancestors were so much a part of our
lives I half expected them to show up
Winter 2017
for Thanksgiving dinner each year.
My Dad, on the other hand, is 100%
Irish. That means that half of my
blood runs hot with a fierce, stubborn
determination and even though I felt
close to defeat, still, I couldn’t give
up. I had three small children and I
was their role model. I didn’t want to
teach them that when life gets hard
you give up. I dreamed of having a
large family and I was still trying, still
hoping, to make my dreams come
true.
My mom called Andy and I “East
Meets West” because Andy hails from
Oregon and I’m from Rhode Island.
Breathe is not only a story about losing my sons, it’s a story about how we
were forced to redefine our family and
relinquish the members who were
hurting us. After Noah’s death, our
extended family fell apart. Our second
child, Christiana, is now a Forester
and she taught me that trees selfprune, which means that they cut off
nutrients to branches that are broken
or diseased and are no longer contributing to the growth of the whole.
Likewise, we ultimately had to prune
our own family tree. We moved back
east to RI with yet another little passenger along for the journey.
After we settled in, I found a great
doctor in Providence. Jonah was born
in Salem Hospital, which was a community hospital that didn’t have
either a NICU or the capacity for
emergency C-sections so I did my
research and determined I’d deliver
this next baby at Women & Infants,
which had both. We still believed
Jonah’s death was a mystery but Dr,
O’Brien kept me on my b/p medication and sent us to consult with a
high risk doctor, Dr. Carr, just in case.
NAPSW FORUM 5
Happily, my pregnancy went
smoothly but as we neared the
dreaded 37 weeks when I’d abrupted
with Jonah, Dr. O’Brien did a laterterm amnio to test the baby’s lung
function. The results were positive,
the baby’s lungs were mature, so we
induced and delivered what I figured
must be a girl, given my good health.
But I was wrong about that and
another son entered our world on
November 30, 1999. Joy filled every
single cell in my body. He weighed 6
lbs. 4 oz. and passed his Apgar with
flying colors and we were busy shouting the news to family and friends
when the nurse said, “I’m just going
to wheel him down the hall to the
NICU for observation.”
Later, they told us that by the time
they got down that hall, our son was
blue. The LS Ratio was also wrong.
His lungs weren’t ready. And by the
time we saw him again he was
drugged and intubated. His name tag
said “Baby Kittel.” We hadn’t even
named him yet.
But, don’t worry. In spite of his
rough start, Isaiah Martin became a
happy ending. He received two doses
of surfactant and spent 10 days in the
NICU learning to breathe and he’s 16
years old today thanks to Dr. Merritt
who discovered surfactant in the
1980’s while working on a March of
Dimes research grant. I’m eternally
indebted to Dr. Merritt as well as the
NICU nurses and doctors and, yes,
our very first perinatal social worker.
Her job was fairly easy, given what
we’d already been through. Isaiah was
good news, after all. Now they call
these babies born after loss, Rainbow
Babies. I didn’t know that then, but
that’s what he is and we brought our
rainbow home in time for Christmas.
Medical Malpractice
Once we had the baby joy of Isaiah
back in our home, we could contemplate the next steps for us as a family
and one giant step was to file a medical malpractice lawsuit against our
doctor and Salem Hospital for Jonah’s
death. Our decision was largely based
on the lessons we’d learned from my
pregnancy with Isaiah, including
when Dr. Carr, the high risk doctor,
said, “Your baby, Jonah, shouldn’t
have died, but Dr. O’Brien and I are
probably the only ones who will ever
admit that to you.”
As it turned out, I’d had toxemia
with Jonah and they’d drawn the labs
in the hospital when they’d tried to
induce me but nobody had ever bothered to look at the lab results. Until
we filed our lawsuit, that is, when Dr.
Carr, himself, figured it out. Toxemia
sent my risk for abruption skyrocketing so it wasn’t just another “mystery
of pregnancy” after all. We had a
seven-day trial and, ultimately, prevailed. And thanks to that, we now
know full well what happened to
Jonah.
We filed the lawsuit for Jonah so
that others wouldn’t have to suffer
like us and you might think that having a medical malpractice verdict
decided against a doctor would be
easy information to discover, but it
isn’t. Even in this day and age when
you can Google practically anything.
Ultimately, my doctor lost her privileges at Salem Hospital but that was
years later and I have no idea how
much our lawsuit had to do with that.
6 NAPSW FORUM
Winter 2017
1. I didn’t talk about it in the article, but if you’d like to check it out, here is
the link to Dance performance from that night:
https://www.youtube.com/watch?v=7BUm7pNO8r4
2. In addition to my own considerable experience, I moderate a closed FB
group for The Compassionate Friends for Miscarriage and Stillbirth so I read
stories every single day about stillborn babies and I’ve formulated the following hard-earned birth advice, what I’m calling:
The Five Most Critical Things for your Birth Plan
1. Don’t give birth at home unless it’s an emergency. Yes, I know the pioneers
gave birth at home and it seems so natural. But why does pregnancy make us
suddenly nostalgic for the Little House on the Prairie? Those pioneering women
also made their own soap. Do you?
2. Choose a hospital with a NICU. Don’t choose a hospital for its newly remodeled
birthing wing. Delivery isn’t a vacation and nice wallpaper won’t save your
baby’s life. Birth is a miracle and when it goes wrong, it goes wrong quickly and
often catastrophically.
3. Never go over your due date. You have nothing to gain besides a bigger baby.
Ouch. And the longer you wait, the more things can go wrong. The placenta
deteriorates and meconium develops. As soon as your baby is ready, get it out.
4. If you want to have a midwife, invite her to join you in the hospital—that one
with the NICU.
5. Stop thinking you have to do everything naturally. Don’t worry about creating a
perfect birthing plan. No drugs for pain in a normal birth? Fine, if it works for
you. No induction when the baby is overdue? Not so fine. Life is what happens
while we’re busy making other plans. Your body has been growing a miracle for
nine months. The only plan you need is to deliver it into the world in the safest
way possible.
Miscarriage
I usually say I’m part fish because I
swim in the ocean almost every day
and because I do keep moving forward, no matter what life puts in my
path. I had 13 pregnancies and four of
those ended in miscarriage after Isaiah was born. Four in a row. Isaiah
was all alone at the end of our family
and I wanted to have another baby to
keep him company. But, the best laid
plans of mice and men often go awry.
In the United States, one in four
pregnancies ends in miscarriage. My
first was early on, at six weeks. They
say that once the heartbeat is heard,
usually at the end of the sixth week
or beginning of the seventh, the baby
has crossed a major developmental
milestone and the miscarriage rate
drops. Then at 7-12 weeks the risk
drops again to 5 percent and I had two
of those, one at eight weeks and
another at 12 weeks and for that last
one I had to have a D&C.
The risk of miscarriage after 12
weeks drops again to 3-4 percent so
that was me at 16 weeks when I lost
the fourth baby and this required the
dreaded D&E. Needless to say, I don’t
derive much hope from statistics.
Horrible, both the D&C and the
D&E, which were outpatient surgeries with nobody to talk to. Instead,
they handed me a packet of graham
crackers and a cup of cranberry juice
and sent me off with a maxi pad,
bleeding heavily.
I had terrible withdrawals from the
anesthesia with the D&C so I opted
for a spinal with the D&E and ended
up in Maine for my 13th wedding
anniversary weekend with a painful
spinal headache. And no idea what it
was. Just more suffering. They did
perform autopsies on the last two
babies and concluded that they were
normal male fetuses. But I never saw
them. Never got their remains. I
didn’t think about it at the time, but I
wouldn’t have minded having the
option of burying them. As it was,
nobody really even recognized them
as ever having existed.
Word for the day: Exulansis. Exulansis means “The tendency to give
up trying to talk about an experience
because people are unable to relate to
it.” Exulansis is such a fitting word
for both miscarriage and stillbirth.
After so much loss, I was the last
person anybody wanted to hear was
pregnant again. That was not good
news in the books of most people I
knew, people like my mom. And
maybe that was as it should be. These
people loved me and didn’t want to
lose me, after all. But I simply wasn’t
done having babies. And I do believe
that women know themselves, or
they should anyway. We should be
given more encouragement to listen
to our inner voices, as crazy as they
may sometimes seem to others.
Nobody lives your life for you.
When your baby dies, everyone else
goes home and hugs their kids a little
tighter. You are the one left trying to
wedge ice packs into sports bras with
your aching, empty arms. So we really
should encourage women to heal, first
and foremost, and then each should
be able to decide for ourselves which
path to choose. Everyone should have
permission to be the author of her
own story.
The Book of Bella
But my story didn’t end with that
spinal headache either. Lucky for me,
in spite of all the naysayers, I have a
husband who indulged my need for a
happy ending. I loved being pregnant
Winter 2017
and Andy loved practicing. Happily,
my story ends with Bella, our thirteenth baby and the exclamation
mark at the end of our family!
After those four miscarriages, they
did every test they could think of and
determined that maybe I was throwing off blood clots so with my final
pregnancy, I took a baby aspirin every
day. And because of that lawsuit, I
now knew I had a history of toxemia
so we weren’t totally surprised when
it reared its ugly head again. At 30
weeks I was put on bed rest at W&I
and for a month they monitored me
while my baby grew and my toxemia
worsened.
At 34 weeks they did another lateterm amnio and it was positive, again,
so they induced labor, again! But this
time they strapped blue pads on my
bed in case I had a seizure, which
wasn’t very comforting, and then the
baby flipped in labor. They tried an
inversion but it didn’t work so I ended
up having my first C-section with my
last baby and I was truly happy to
have it because neither one of us was
doing very well.
Bella Grace was born on Feb 17,
2004 weighing only five pounds. She
was six weeks early but she could
breathe just fine. I wore Bella like a
medal, skin to skin, what they now
call kangaroo care. I was 42 years old
and I did, finally, know that I was
done having babies. If Isaiah was our
rainbow baby, Bella is the pot of gold.
She was definitely the light at the end
of a long, long tunnel for us.
I’ve lost more babies than not, but I
do have five amazing children and I
realize that this is still a good number
in many people’s eyes. Maybe too
many even. But I fully expect my
kids, and my book, to change the
world. Having been in the Peace
Corps, we’ve raised our kids to be the
change they want to see in the world.
And I hope that they’ll march forth
and make the world a better place,
that they’ll be treated kindly, loved
greatly, and live long, long lives.
Emily Dickinson
Emily Dickinson wrote: “Hope is the
thing with feathers, that perches in
the soul, and sings the tune without
the words and never stops at all.”
Emily Dickinson is one of my
favorite poets and this verse is one
NAPSW FORUM 7
Hope is the thing with feathers, that perches in
the soul, and sings the tune without the words
and never stops at all
that I first read after Noah died. It was
written on the front of one of the
hundreds of cards we received and it
spoke directly to my heart. I never
forgot it. And given that I was in the
midst of a time when even words
failed, the fact that it registered with
me says a lot.
Emily Dickinson was born in 1830
in Amherst, MA where her grandfather founded Amherst College. She
was well-educated and never married.
She lived most of her life alone in her
bedroom where she wrote over 1800
poems and maybe today people would
have considered her depressed. Or
odd. Emily was unconventional. She
blazed a new trail with both her
structure and her topics, as most of
her work deals with the themes of
death and immortality.
Like me, Emily spoke the language
of loss. One thing I discovered when
Noah died is that there are no opposites, like I’d been taught in second
grade. Things like joy and sorrow, or
pain and pleasure, or even birth and
death are not linear opposites, they
are circular, they’re part of a continuum. Because without knowing one,
you cannot truly know the other.
And so, just as Emily wrote about
despair, she also spoke of hope. Hope,
which is freely and eternally given,
even when our children die and our
patients are in pain. Hope, which
beckons to us even in the darkest
days of our despair. Hope, which asks
for nothing in return.
“‘Hope’, she wrote, “is the thing with
feathers—
That perches in the soul—
And sings the tune without the
words—
And never stops—at all—
And sweetest—in the Gale—is
heard—
And sore must be the storm—
That could abash the little Bird
That kept so many warm—
I’ve heard it in the chillest land—
And on the strangest Sea—
Yet, never, in Extremity,
It asked a crumb—of Me.”
Kelly Kittel is the author of the book
Breathe: A Memoir of Motherhood, Grief,
and Family Conflict. Kelly was the opening
speaker at the 2016 NAPSW conference in
Providence, RI, and her book was reviewed
in our Autumn issue of Forum (please note
her name was misspelled in that article).
Kelly met her husband while working as a
fish biologist, and now lives with him and
their youngest children on Aquidneck Island
in Rhode Island.
8 NAPSW FORUM
Winter 2017
BALTIMORE TAKES ON THE ELEPHANT IN THE CITY
Infant Mortality
By Min Kim, CHES, Tamira Dunn,
MS and Veronica Land-Davis, LCSW
I
n 2009, Baltimore City had the
fourth highest infant mortality
rate in the United States among
major metropolitan cities (Costa
& Dineen, 2013). Black infants were
five times more likely to die than
white infants. This resulted in 54
more black infant deaths (Horon,
2014). National statistics state that
one in four women experience a pregnancy loss (Kendig, 2015). This number excludes unreported deaths and
infant deaths. In response to these
statistics, in 2009, B’more for Healthy
Babies (BHB) was launched. BHB is a
citywide initiative to reduce infant
mortality in Baltimore City.
The initiative is led by the Baltimore City Health Department
(BCHD) and co-led by Family League
of Baltimore (FLB) and HealthCare
Access Maryland (HCAM). BHB’s
vision is that “all of Baltimore’s
babies are born at a healthy weight,
full term, and ready to thrive in
healthy families.” The initiative is
composed of high-impact service
areas that address healthcare, prenatal
care, home visiting, nutrition, substance-use (smoking, drugs, alcohol),
behavioral health, safe sleep education, breastfeeding, and family planning. In 2015, Baltimore City’s total
infant mortality rate dropped to a
record low at 8.4 per 1,000 births,
which equates to a 39% decline from
2009; the black infant mortality rate
was 9.7 per 1,000 births compared to
12.8 per 1,000 births in 2014.
Recognizing a need for services for
families and mothers following a loss,
BHB partnered with Roberta’s House
to implement the Healing Ourselves
through Peer Empowerment (HOPE)
Project. The HOPE Project is an interconception (between pregnancies)
care program that is composed of two
support groups and home visiting
services, all facilitated and led by
peers. Peers of the HOPE Project are
mothers who experienced a pregnancy
loss or infant death and are trained
and equipped to provide support services to other mothers with similar
experiences.
Roberta’s House is a communitybased grief and loss center that provides support to the bereaved.
Roberta’s House is a leader in bringing awareness, education, and support
services to families and communities
experiencing losses and trauma due to
a death of someone close, especially
those deaths that are sudden or due to
violence. Roberta’s House offers multiple peer support programs for all
ages, trainings, workshops, and a safe
place to those in urban communities
who need it most. Its mission is to
provide a safe haven and resource in
the community to promote recovery
and healing from the loss of a loved
one while addressing grief as a public
health preventative service.
One of the major questions that
emerged while designing the program
was identifying what theory or
approach to adopt that addresses specific disenfranchised grief, loss and
trauma. Disenfranchised grief, a term
coined by Dr. Kenneth Doka in the
1980s, is when grief arises in any circumstance in which society denies
our need, right, role or capacity to
grieve (Doka, 1989). Society identifies
a loss as disenfranchised and not
acknowledged when
1. society deems the relationship is
not important
2. the death and relationship are
stigmatized by society
3. the loss itself is not recognized
as grief worthy because it is not a
death (What’s Your Grief, 2013).
Many times, the deaths cannot be
openly mourned by the grievers.
Many families experiencing a stillbirth receive ambiguous responses
from family and friends because it is
difficult for many cultures to grasp
the idea of a parent burying their children.
Although there are many theories
addressing grief and loss, Worden’s
four tasks of grief were adopted to
address the grief work of mothers
experiencing prenatal and infant
deaths. One moving factor driving
the decision to adopt this theory is
the verity that Dr. William Worden, a
psychologist, is recognized as one of
the pioneers in the field of understanding grief and loss. In his book
Grief Counseling and Grief Therapy,
Worden describes four tasks one must
accomplish to work through grief.
The tasks are nonlinear and can be
revisited. The four tasks are:
1. Accept the reality of the death –
the mother accepts and acknowledging the death so it becomes real. It is
important to allow individuals to
grieve at their own pace.
2. Experience the pain — important
to allow the mothers to express the
wide ranges of feelings and emotions
associated with a loss. Vital for the
person’s support to listen, validate
Winter 2017
NAPSW FORUM 9
The HOPE Project is staffed purely by peers, mothers who have experienced a
pregnancy loss or infant death themselves.
feelings, allow silence and not give
advice.
3. Adjust to the environment with
the deceased missing — the mother
makes emotional, social and physical
adjustments to their environments
directly resulting from the loss.
Adjustments can range from physically adjusting the space where the
infant would have slept to emotionally adjusting to the fact that you will
not be able to parent the child in a
traditional way.
4. Withdraw emotional energy and
reinvest it in other relationships – the
mother must find a way to emotionally stay connected to her son/daughter who died while finding ways to
move on with life.
The HOPE Project began as a 10week peer-based support group for
women who experienced a pregnancy
or infant death before the child’s first
birthday. Dearea Matthews, a resident
of Baltimore City and a mother whose
one-month-old baby died, expressed a
need to serve bereaved mothers and
their families based on her own experience. A champion for all the mothers who experienced a loss, Dearea led
the program planning process and
facilitated the support group. Named
after her son, Charlie’s Circle began
in 2012.
The group focuses on grief and coping, relationships, feelings, reproduc-
tive life planning, and stress mediation. After changes to the program,
the group was re-named to Still a
Mom (SAM) in 2015. Mothers felt
connected with and supported by the
group, so they expressed an interest in
having a supplemental support group
after graduation. Stemming from recommendations from the mothers,
BHB and Roberta’s House implemented Healing through Quilting.
Healing through Quilting is a continuation of SAM and a 10-week support
group that allows participants work
through their grief through art form.
Using keepsakes from their babies
such as sonograms, clothing, photos,
etc., participants create quilts or
scrapbooks to memorialize their baby.
With both supportive programs in
place, participants are able to learn
healthy ways to cope while preparing
for their future.
There was still a need to service
these mothers more intensively. One
of the reasons for focusing on this
population of bereaved mothers is
that they are at high risk of becoming
pregnant soon after a loss and thus at
risk for another poor birth outcome.
Realizing this need, BHB brainstormed ways to service this population. In partnership with the Healthy
Families America (HFA) National
Office, BHB received approval to
adapt the evidence-based model to
become considered a promising practice. This is an innovative program
that is the first to receive adaptation
Through BHB and its partners, there is citywide home visiting coverage.
10 NAPSW FORUM
approval from the HFA model, which
requires extensive support from the
national office and frequent site visits. BHB also partnered with Florida
State University (FSU) to edit their
research-based Partners for a Healthy
Baby Curriculum for interconception
care. FSU is in the process of having
their curriculum evaluated as an evidence-based curriculum.
HFA HOPE was in full implementation to provide interconception care
home visiting services in Baltimore
City in 2015. As an adaptation of the
HFA model, all staff completed all
required trainings of HFA and also
were trained 24 hours in grief and loss
by Roberta’s House. The peer home
visitors were also trained in family
planning counseling, motivational
interviewing, safe sleep education,
goal setting, and professional boundaries.
Outcomes of HFA HOPE include
healthy adaptation to the death,
increased feelings of self-efficacy and
social support, decreased maternal
stress, and consistent use of a family
planning method that supports the
mother’s reproductive life plan. In
order to determine if the outcomes
are achieved, HFA HOPE uses
Cohen’s Perceived Stress Scale (4item), Perinatal Grief Scale (33-item),
Edinburgh Postnatal Depression Scale
(10-item), and Adult Hope Traits
(Future) Scale (12-item). Additionally,
Winter 2017
HFA HOPE is undergoing a process
evaluation in the form of client and
staff interviews and focus groups by
an outside evaluator.
From the moment a mother knows
she is carrying a baby in her womb,
she immediately begins to think
about whom the baby will look like,
what the baby will be interested in
when the baby grows up, and mothers
even start to make future plans and
dreams. When the baby dies, mothers
are expected to let go of all of those
wishes and dreams and begin to
process what the new norm and new
life will be without the baby. With
programs like the HOPE Project,
mothers whose babies die do not have
to suffer in solitude silence.
References
Costa, C. & Dineen, R. (2013). Fetalinfant mortality review in Baltimore
City FY 2013 Annual Report.
Retrieved from http://healthybabiesbaltimore.com/uploads/file/pdf
s/2013_07_29_FIMR%20Annual%2
0Report%20FY%202013.pdf
Doka J. Kenneth (1989) Disenfranchised
Grief: Recognizing Sorrow
Horon, I., (2014). Infant mortality in
Maryland, 2014. Maryland Vital Statistics. Retrieved from
http://dhmh.maryland.gov/vsa/Doc
uments/imrrep14_draft%201.pdf
Kendig, S., (2015). Preconception and
interconception health: a life course
approach to improving perinatal
outcomes. Retrieved from March of
Dimes website http://www.marchofdimes.org/pdf/missouri/Sue_Ke
ndig_Preconception_Health.pdf
What’s Your Grief? (2013) Retrieved
from www.whatsyourgrief.com.
Worden, J. William, (2008). Grief Counseling and Grief Therapy: A Handbook for the Mental Health Practitioner, 4th Edition.
About the authors: Min Kim, CHES; Tamira
Dunn, MS; Veronica Land-Davis, LCSW
Min Kim is the Program Manager for Home
Visiting at Family League of Baltimore, currently pursuing her Masters in Science in
Health Science.
Tamira Dunn has a BS in Psychology and
MS in Human Service Administration. Devastated by the loss of her son, Ms. Dunn cofounded Elijah’s Hope Foundation, Inc.,
which supports pregnancy and infant loss in
Baltimore and doctoral students who are
majoring in women and reproductive
health. At Roberta’s House, she is Program
Manager for the HOPE Project.
Executive Director Veronica Land-Davis,
LCSW-clinical, comes to Roberta’s House
with 30 years’ experience working with children, adults and families in the Baltimore
Metropolitan area. She is responsible for the
overall health, safety and operations of the
program and services.
NAPSW.org Has a New Look!
With much excitement, NAPSW has rolled out its new website
and online membership system. Our new membership system
offer members the opportunity to take full advantage of a private
online community in which members can connect with each other
to network, share information and form local communities to get
support and develop best practices.
We encourage members to take full advantage of everything
our new website offers from easy access to past FORUM issues,
reading the topic specific discussion boards, connecting with others in your practice specialty or to others in your local area. We
encourage you to log on to the members’ only area to complete
your profile, explore our offerings, and make connections with
other members. Be sure to keep a lookout for new educational
offerings this year in addition to our annual conference.
We are available to help you take full advantage of this site! For any questions or for help, please email
us at [email protected].
Winter 2017
NAPSW FORUM 11
Interdisciplinary Recommendations for
Psychosocial Support of NICU Parents
By JaNeen Cross
N
APSW partnered with
National Perinatal Association (NPA) and many other
professional healthcare
organizations to develop Interdisciplinary Recommendations for Psychosocial Support of NICU Parents. The
purpose for the recommendations is
to improve the level of psychosocial
support for NICU families and
improve training and support for
NICU providers. The outcomes from
this interdisciplinary organizational
collaboration include published standards in the Journal of Perinatology
and Support 4 NICU Parents website
and toolkit. The Interdisciplinary
Recommendations for Psychosocial
Support of NICU Parents have been
presented at many national & international conferences,
received a
poster presentation award
and is well
received and
acknowledged
in interdisciplinary
arenas.
This article
will highlight
the key elements of these
standards for
perinatal social
workers and
identify them
as reference
tools to
improve psychosocial support services to families
and improve training and support for
NICU providers. If you feel that your
NICU needs to improve in these areas
then this article will provide valuable
information and guidance about the
focus areas that need attention and
resources for how to commence transformational change within your
respective NICU. This article will
direct perinatal social workers to the
fully published standards and corresponding toolkit.
Family Centered Developmental
Care
This area of need recommends family
support, including antenatal consultation, whenever a maternal or fetal
condition is identified that may
require a NICU stay. The primary
focus at admission should be parentinfant interaction. According to the
recommendations, support of NICU
families includes a welcoming environment at admission and culturally
appropriate interactions. Families
should be provided with written
introductory resources and receive a
review of NICU staff, routines, and
equipment. Families need to be provided with 24/7 access to their infant.
It is important that parents are
involved in all aspects of infant care
and receive mentoring and support by
NICU staff.
Peer-to-Peer Support
Peer-to-peer support should be offered
to every NICU parent from the antenatal period until discharge. In person
peer-to-peer support with a veteran
NICU parent is a best practice. Other
peer support models include, internet,
phone, support group, peer support
specialist, sibling education and play
groups. Peer-to-peer support should be
extended to other family members
and extended family.
Palliative & Bereavement Care:
Standard Family Centered
Integrative Approach
Parents need to receive participatory
guidance related to the bereavement
process. Parents should be
able to participate in grieving
rituals. Psychosocial support
needs to be offered to the parents and all members of the
family including use of the
various peer support models.
Parents need specific counseling related to attempting
another pregnancy after a loss.
In cases where NICU care will
not be provided, an interdisciplinary approach should be
used to provide palliative and
bereavement care.
Neonatologists and nurse
practitioners should follow
American Academy of Pediatrics guidelines when discussing NICU care (initiating
or continuing) for a baby who
may not survive. A bioethics consult
is required when there is disagreement between the NICU team and
the parents/family. In cases of discharge for infants with life-limiting
conditions, the medical team needs to
develop a home care plan and parents
12 NAPSW FORUM
Winter 2017
Peer-to-peer support should be offered to every NICU parent from the
antenatal period until discharge.
should be offered practical psychosocial supports and hospice. When there
is loss prior to discharge, parents
should receive contact by a member
of the NICU team after discharge.
Parents should receive a conference at
4-6 weeks after discharge to review
autopsy and other results.
potential psychosocial stresses at
home. NICU providers need to engage
and help empower parents at discharge by promoting involvement in
infant care. Home visitation should
be offered to all families after they go
home.
Staff Education
Role of Mental Health
Professionals
NICUs with 20 or more beds need to
have a full-time MSW and a full or
part-time, doctoral level, licensed psychologist. These roles may overlap in
terms of screening, counseling, teaching parenting skills, and educating
parents and staff. Mental health professionals should meet with NICU
parents within 1-3 days of admission
and screen for emotional distress
within the first week of admission.
NICU parents should be screened
again for emotional health and wellbeing 48 hours prior to discharge.
Mental health support should be layered at all different levels of support
and made available to all parents.
Post-Discharge Follow-Up
All NICUs need to have a designated
trained person for discharge and transition planning. The designated NICU
provider should coordinate discharge
plans and post-referrals and confirm
that equipment needs are met. The
discharge person should confirm that
medical information is sent to the
appropriate care providers and that
follow-up appointments are set. The
discharge person needs to communicate any risk factors with the medical
team. At discharge, parents need to
receive anticipatory guidance about
All staff should receive appropriate
NICU training. NICU training content needs to include normal and
expected parental responses, perinatal
mood and anxiety disorders, communication skills (active listening and
how to deliver bad news), methods of
providing psychosocial support to
families (improving family centered
developmental care, and culturally
effective care). NICU providers need
to receive training around elements of
self-care (management of work stress,
work/life balance, and life-skills management). Staff support need to be
integrated into every day NICU operations. In addition, staff should support one another and respect each discipline’s contribution.
As NICU providers, we know that
parents experience a great deal of
stress and need a tremendous amount
of support. In response, NICUs must
put forth their best efforts to provide
comprehensive family support. In
order to provide comprehensive support to NICU families, staff must be
properly trained to do this and receive
support as care providers to NICU
families. The investment in training
and support of NICU families will
yield returns with healthier NICU
families.
This article primarily focused on
key recommendations and standards.
If you want to learn more and or see
these standards in their entirety,
please review the published recommendations in detail on the NPA
website or directly at:
http://www.nature.com/jp/journal/v3
5/n1s/index.html#rv. NPAs corresponding website Support 4 NICU
Parents was developed from these
standards and can be found at
http://support4nicuparents.org/.
Below are the other organizations
involved in the development of the
recommendations:
• Academy of Neonatal Nurses,
American Academy of Pediatrics —
Pediatric Division
• National Premature Infant Health
Coalition
• Association of Women’s Health
Obstetric & Neonatal Nurses
• Nurse Family Partnership
• Council of International Neonatal
Nurses
• Oklahoma Infant Alliance
• Healthy Mother Healthy Babies
• Postpartum Support International
• March of Dimes
• Preeclampsia Foundation
• National Association of Neonatal
Nurses
• Society of Maternal Fetal Medicine
• National Association of Neonatal
Therapists; Society of Pediatric
Psychology
• National Association of Pediatric
Nurse Practitioners;
• Society of Pediatric Psychology
Special Care Special Kids
• Transcultural Nursing Association
JaNeen Cross, DSW, is a Health Policy Fellow at NASW. She is currently residing in
Washington, DC and is involved in health
policy practice. Dr. Cross continues to teach
as a Clinical Assistant Professor at Widener
University.
Winter 2017
NAPSW FORUM 13
Plan For Portland’s
2017 NAPSW CONFERENCE
By Tanya Correll-Blaha
P
reparations are underway for a fabulous annual
conference in Portland, Oregon!
We are very excited to announce our inspirational keynote speaker, Jennifer Jako, an
HIV/AIDS activist and filmmaker. She will talk
with us about living an empowered life. From her
biography: “Jako is a powerful advocate for AIDS education and prevention. Infected in 1991, Jako is a twenty-five
year survivor of HIV/AIDS. Her documentary film about
HIV+ youth, Blood Lines, broadcast for five years on MTV.
This award winning film is now used around the world to
educate youth about HIV/AIDS.
She has spoken directly with
over 350,000 people and her
media outreach has communicated with tens of millions. Her
interviews have appeared in
print: Glamour, The New York
Times, USA Today; and television: Lifetime, Discovery Channel, MTV, CNN. She is included
in the books Girlfriends and
Women of Courage. In May of
2006, she appeared pregnant on
the cover of Newsweek Magazine’s commemoration of the
25th anniversary of AIDS in America. Currently, she is a
face of Alicia Key’s Empowered campaign. She continues
to empower and inform the public about HIV disease.”
We are planning some really wonderful sessions for the
conference. Our focus is to present innovative topics that
yield pragmatic skills and knowledge that attendees can
take home with them. Sam Stevens, LMFT, is a local
therapist who focuses on working with new fathers and
their adjustment to parenthood. He will talk about this as
well as fathers’ experiences in the NICU.
We are also fortunate to have Wendy N. Davis, PhD
presenting. She is the Executive Director of Postpartum
Support International and founding director of (and now
Clinical Consultant for) Portland’s Baby Blues Connection organization. She will talk with us about perinatal
mood disorders and screening for PMDs in NICU parents.
Mandy Davis, PhD, LCSW, Research Associate,
Regional Research Institute, School of Social Work, Portland State University and Trauma Informed Oregon CoDirector, will provide us with an in depth look at trauma
informed care. She has provided some intensive workshops for NICU staff in the area in the past. “Trauma
Informed Oregon serves as a centralized source of information and resources and coordinates and provides train-
ing for healthcare and related systems.” Learn more about
this statewide collaboration here http://traumainformed
oregon.org/.
Two films will be offered for viewing. “Mothering
Inside” is a documentary from filmmaker Brian Lindstrom and “chronicles the experiences of incarcerated
women and their children as they participate in the Family Preservation Project, a program designed to interrupt
the cycle of intergenerational criminal justice involvement, poverty, and addiction, and promote healthy
mother-child relationships, support successful reentry,
and decrease recidivism.” A panel discussion will accompany the screening and includes the filmmaker, mothers
who were featured in the film,
and the social worker who started
the program.
“Finding Jenn’s Voice” is a documentary that looks at the relationship between pregnancy and
Intimate Partner Violence. The
filmmaker, Tracy Schott, is a
social worker who practiced for
15 years before going on to obtain
an MS in Telecommunications.
“Since that time she has she
directed, written and produced
video content for hundreds of
projects including television commercials, short films, non-profit and corporate communications, live theatrical events, and television programming. ‘Finding Jenn’s Voice’ is Tracy‘s first feature film.”
Rebecca Peatow Nickels, MSW, Executive Director of
Call to Safety, will facilitate a discussion following the
film. Call to Safety (formerly known at Portland Women’s
Crisis Line) is a 24/7 crisis line serving people of all genders in Oregon and Washington. They also provide sexual
assault services, follow-up advocacy, and community outreach and education.
Our night out event committee is busy cooking up a
fabulous time for attendees. Lagunitas Brewing Company
will be providing the space and beverages in their new and
gorgeous Portland Community Room. Listen to live
music, get to know your fellow attendees, and devour
delicious food, Portland style, at food carts parked right
outside, just for us!
We look forward to seeing everyone in 2017! Please let
us know if there’s anything we can do to help you plan
your stay in Portland. NAPSW members will receive an
email when conference registration opens in February but
you can reserve your hotel room anytime through the following link https://aws.passkey.com/event/15846298/
owner/4173/home.
14 NAPSW FORUM
Winter 2017
BOOK REVIEW
Somebody’s Else’s Kids
by Torey Hayden
Reviewed by Beth Paul, LSW
I
was looking forward to reading a
new book and writing this book
report for the FORUM, but now I don’t
want to share. I seriously enjoyed this
book. Hands down, I could relate to
every emotion Torey Hayden
expressed, and I wish I could be the
type of social worker that she was as
a teacher to “somebody else’s kids.”
My eyes teared up at times, I held my
breath at times, I got mad at times, I
felt sorry for her and the four exceptional kids in her class, and I wondered how in the world could a
teacher get by with doing some of the
things she did in her class. Again, I
want to have her passion, her caring
attitude and her strength to do the
very best job I can for my families and
babies.
There are five main characters in
this true story. Torey Hayden is a former special education teacher, now
educational psychologist, who has
written seven books. I am thinking of
reading the others. In this book, you
will meet seven-year-old Boothe
(Boo), who attends half-day class due
to his inability to attend full-day
kindergarten. You can feel the love
his mother has for him and the fear
she has for her husband, Boo’s dad.
Like any parent, she just wants to
hear her son call her Mama. Thank
goodness for Torey’s patience and love
for special needs students.
Meet Lori, a first grader who has
brain damage from a savage parental
beating as a baby, whose
twin sister is fine and
thriving. They were
adopted by their foster parents, who love and adore
them both, until the death
of her mother. The sacrifices the father made for
these little girls is heartwarming and he truly
loves his daughters. You
also read how Lori is
treated differently by her first grade
teacher. You will be angered and saddened that a child can be humiliated
in such a manner, but things have
changed since 1981 when this book
was written. Thank goodness for
Torey being her advocate.
Enter Tomasco, age 10, who is full
of anger and hatred for everyone in
general. The things this child witnessed in his home, the numerous
foster homes and relative placements,
will make you wonder “Where was
the social worker?” Thank goodness
for the love and constant reassurance
from Torey, allowing us to see a juvenile delinquent thrive into someone
protecting his own heart and feelings.
Finally, we have 12-year-old Claudia, above average IQ, prominent
Catholic family, who attends a private school, and guess what, she is
pregnant. Her father is over bearing
and strict, mother stands by her man,
and they have all daughters at
home. Claudia wants to have this
baby, so she will have someone to
love her and only her. Thank
goodness for Torey who tries to
find therapeutic services for this
child when no one else sees a
problem in her quiet behavior.
I found interesting the day in
and day out activities Torey experiences and shares with her readers as she struggles in and out of
the classroom. Teachers, like social
workers, are thought to be tough and
their work day ends when you clock
out. Not so, and Torey’s relationships
suffer. I also thought how in the
world can she take these children to
the store, or out for ice cream or
home in her car? How can they stay
after and no one call the school or
come looking for them?
How about the dynamics between
Torey and the other teachers in the
school? I would have a difficult time
if I was regarded less than my peers.
Torey is everything we social workers
are for others; educator, advocate, liaison, researcher, listener, counselor,
and support person and she cares for
the children no one wants in their
classroom. She really and truly cares.
This is how I hope I am remembered someday. Read the book. It’s an
easy, fast, engaging book. The epilogue leaves you feeling complete.
Winter 2017
NAPSW FORUM 15
Spotlight on Region VIII and X
Region VIII
Arizona, California, Hawaii, New
Mexico, Nevada
Perinatal Social Workers in Region
VIII have been busy in innovative
projects including UCSF Benioff Children’s Hospital Oakland’s NICU Vermont Oxford Network Collaborative.
Beginning in February, 2016, Ruth
Crowe, LCSW and Evelyn Mascareñas, LCSW joined their NICU
team in a two year quality improvement project titled “NICU Surgical
Improvement of the Newborn,”
focused on improving family communication and satisfaction. This is a
national quality improvement project
that includes nine other children’s
hospitals. They have had an integral
part in this project with their NICU
and their input is valued to provide
insight on family centered care in the
NICU. They have participated in the
development of assessment and evaluation tools used to collect data in
the project. Additionally, they participate in monthly webinar meetings
with their team and other participating sites. They have traveled to
Florida and Chicago to participate in
three-day meetings. Evelyn had the
opportunity to present our site’s data
on involving families throughout the
newborn surgical care process. Site
representatives met to share their
outcomes, ideas and brainstorm how
to continue their work in this area of
quality improvement. So far, UCSF
Benioff Children’s Hospital Oakland
is the only site that has actively
involved social workers as part of the
core quality improvement team.
NAPSW was represented at the
51st Annual Society of Social Work
Leadership in Health Care Conference
(SSWLHC) in Costa Mesa, CA, October 26-29. Evelyn Mascarenas, LCSW
liaison to the Society, arranged for the
NAPSW Exhibit to be prominently
displayed in the Exhibitor Hall and
promoted the organization to Health
Care Social Workers and Managers
from across the country. Barb Menard,
LCSW and Mary Denato, LCSW also
attended the conference and it was a
great learning and networking opportunity. Information about the 2017
conference in Portland, Oregon was
provided and many managers
expressed interest in sending their
perinatal social workers to the conference and exploring involvement in
becoming members of NAPSW
— Mary Denato, LCSW
Kaiser Roseville Women and
Children’s Center, Roseville, CA
Region X: CANADA
British Columbia, Alberta,
Saskatchewan, Manitoba, Prince
Edward Island, Newfoundland,
Ontario, Quebec, New Brunswick,
Nova Scotia
This year has brought a change — the
Canadian Issues Committee has
become the International Committee
— in order to include interested
members from countries other than
Canada to NAPSW. As the committee chair to the previous Canadian
Issues Committee, Donna Rugamas
was appointed the committee chair of
the International Committee. She
will now attend board meetings as a
non-voting member.
For this Spotlight article, Donna
would like to focus on the arrival of
the Syrian refugees to Canada this
year and their interactions with
health care and the perinatal social
workers in our hospitals. The biggest
barrier that perinatal social workers
are encountering is the language services support. There does not seem to
be ready access to interpreters face to
face and social workers are often left
with using an interpreter over the
telephone. This makes the assessment of the deeper trauma and emotional issues for these families a challenge. Further to this, support
services in the communities in first
language are basically non-existent.
Social workers in Canada are finding
that most Arabic resources in the
communities are private pay which
most families cannot afford.
There are also cultural differences
that come to the forefront after
women have delivered their babies in
Canada. For example, car seat safety
is unfamiliar to many of these families as well as practices with formula
feeding (as opposed to goat milk) so
the learning curve is high and with
limited language services, quite challenging. Another issue that comes up
often is co-bedding and safe sleep
practices. One perinatal social
worker writes, “These families come
from backgrounds where survival is
priority and not such expectations.
Also, it is a cultural norm for many of
them to sleep with their babies. I
struggle with this because I’m hearing
their stories and taking a client-centered/culturally sensitive approach.
However, as a health care team, we
have pressure to educate them about
16 NAPSW FORUM
safe sleeping patterns and expect
them to adhere to this in hospital.
When they do not practice this, it
becomes a “safety concern” and the
family is judged/flagged. Increased
education and awareness of cultural
differences as well as adjustment
issues would be beneficial for bedside
nurses. Perinatal social workers are
stepping in to advocate for the families perspective and provide education
to staff.
Some social workers are finding
Winter 2017
that families are struggling with the
management of their money. The support around budgeting and
preparing for expenses that may seem
foreign is lacking. Financial crisis
often happens when women come in
to deliver, as they may not be prepared with all of the items and supplies needed for baby at home. Of
course, the perinatal social workers
are assisting these families to help
them navigate the resources. There is
a lack of knowledge around availabil-
ity, criteria and intake processes in
order to access services.
In summary, working with the Syrian refugee families has been a challenging and invigorating experience
for perinatal social workers in
Canada. We look forward to identifying and working to fill gaps in service
as we welcome more families into
Canada and the health care system
throughout the year.
— Donna Rugamas
National Association of Perinatal Social Workers Innovation
Programs/Research Grant
The National Association of Perinatal Social Workers
invites applications for the Innovation Programs/Research
Grant. This grant provides seed money for perinatal social
workers to fund special programs or research efforts that
would otherwise be unfunded through their agency or place
of employment.
This purpose of this program is to:
1. Assist social workers in funding new programs
designed to identify or meet the needs of their client
population
2. Encourage the translation of evidence-based findings
to practice through the development of novel or
unique interventions
3. Encourage the evaluation of best practices through
research projects designed to inform practice.
Interested applicants should submit a 3-5 page proposal
that includes the following elements:
1. Discuss how the proposed project contributes to the
objectives of NAPSW.
2. Description of the need and population being served.
3. Description of the program implementation or
research plan to include:
a. Aims
b. How those aims will be carried out (specific plan)
c. Outcomes —include evaluation of outcomes or
benchmarks. Time line
4. Budget
5. Agency letter of support
This program is open to social workers of any level currently practicing in a perinatal field, as well as full-time
students currently enrolled in an accredited social work
graduate or undergraduate degree program with a research
agenda that directly relates to perinatal social work. Applicants will receive a one-time funding award of $1,000 and
are expected to submit a poster presentation of their outcomes or research findings at the NAPSW Annual Conference the year following the award. A two-page summary of
findings should accompany the poster presentation. Award
recipients are expected to maintain membership in NAPSW
for the year in which funding is provided.
Please submit proposals via email to Lisa Baker
([email protected]) no later than February 10, 2017. Proposals will be reviewed by committee.
Winter 2017
NAPSW FORUM 17
About the NAPSW Award for Excellence —
Looking ahead to 2017
NAPSW established the Award for Excellence in Perinatal Social Work in
1988 to recognize a member for outstanding clinical achievement in
the field of perinatal social work. In 2002, the board of directors voted
to include consideration of service to NAPSW. Nominations are solicited
from the general membership until mid-February each year. The final
selection is made by the board of directors and announced at the
National Conference each year.
Nominations for the 2017 award, which will be given next spring at the
National Conference in Portland, OR are being solicited by Awards Chair,
Lisa Baker.
Previous recipients include: Charlotte Collins Bursi, Martha Ransohoff
Adler, Carol Mahan Kahn, Regina Furlong Lind, Nancy Harold, Lori
Sheckter, Brenda Sumrall Smith, Audrey Hauser, Cathy Cook, Sally Mack,
Joni Hardcastle, Leora Hughes, Ed Walwork, Laura Dillard, Denise
Knoebel, Kay Ammon, Elissa Truitt, Debby Segi-Kovach, Margery
Pentland, Deborah Calvert, Sharon Williams, Anne-Marie Hallman, Judith
McCoyd, Barbara Menard, Dawn Raadt, Lisa Baker, Linda Debaer, Mary
Denato and Shari Munch.
Please send nomination form (next page) to Lisa Baker
([email protected]) by February 19, 2017. It only takes a few minutes
out of your busy day to nominate a member of NAPSW for this
distinguished award.
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Winter 2017
2017 NOMINATION FORM
NAPSW Award for Excellence in Perinatal Social Work
Information about the person you wish to nominate: (I will contact you with confirmation of your nomination)
Name: ____________________________________________________________________________________________________
Agency/Institution: ________________________________________________________________________________________
Address: __________________________________________________________________________________________________
__________________________________________________________________________________________________________
Phone:_____________________________________Email Address: _________________________________________________
Why are you nominating this person? (Use additional paper if necessary)
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
What are the outstanding achievements of this person? (Use additional paper, if necessary)
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
Information about you:
Name: ____________________________________________________________________________________________________
Agency/Institution: ________________________________________________________________________________________
Address: __________________________________________________________________________________________________
Phone: ___________________________________________________________________________________________________
Please return this form by mail or email no later than February 19, 2017 (earlier submissions preferable—form can
be e-mailed to you upon request)
Lisa Baker
Department of Social Work – HB302D
University of Alabama at Birmingham
1720 2nd Ave S.
Birmingham, AL 35233
205.996.5145
[email protected]
Winter 2017
NAPSW FORUM 19
2017 Leadership for NAPSW
2017 Nomination Form
(for President, Secretary, Board of Directors and Nominating Committee
Member )
NAPSW elects half the executive board and half the Board of Directors each
year and we rely on YOU, the NAPSW membership to suggest people for these
positions. Please recommend several people—or even yourself—for these positions and send the form to Judie McCoyd, Nominations chair. Not every slot
needs to be filled, though we are happy for as many names as you can provide.
I
t is time to think about who to
nominate for the upcoming 2017
elections. WE NEED YOU to think
about who is Board of Director “material”— or to volunteer yourself to
run! During the May 2017 conference
in Portland, we will be electing individuals for the following positions:
President, Secretary, five Board of
Director members, and one Nominating Committee member. We really
want to provide a full ballot with
many options to our membership at
the time of elections.
Nominations are now open and
ready to be received immediately and
no later than February 1, 2017- but
don’t put it off- send your nomination/s NOW. Please consider nominating yourself or other NAPSW
members you know for these positions. Candidates for Board of Director positions need to be members in
good standing for one year prior to
running for the Board of Directors.
Candidates for Officer positions need
to have served at least one term on
the Board of Directors.
This is your opportunity to develop
and share leadership skills and contribute to keeping NAPSW a strong,
vibrant, and relevant organization.
Email your nominations to Judie
McCoyd, Chair, Nominating Committee at [email protected] or
call 215-808-7085. Send nominations
ASAP but no later than February 1,
2017.
Your Name:______________________________________________________________
Thanks!
Have you spoken with the Nominee and is s/he willing to run and serve?
Judie McCoyd, Nominating Chair
Debby Segi-Kovach and Mary Denato,
Nominating Committee Members.
Address: _________________________________________________________________
_________________________________________________________________________
Phone: ____________________________Email: ________________________________
Nominations:
Vice President
1 _______________________________________________________________________
2 _______________________________________________________________________
Secretary
1 _______________________________________________________________________
2 _______________________________________________________________________
Nominating Committee (1 position available)
1 _______________________________________________________________________
2 _______________________________________________________________________
Board of Directors (5 positions available)
1 _______________________________________________________________________
2 _______________________________________________________________________
3 _______________________________________________________________________
4 _______________________________________________________________________
5 _______________________________________________________________________
Send this form (or just an email) to Judie McCoyd at [email protected]
or snail mail to:
Judie McCoyd
7 Bennington Rd.
Havertown, PA 19083
20 NAPSW FORUM
Winter 2017
social action committee
New Administration—Many What-ifs
E
very day, perinatal social workers advocate to make
a difference in our families’ lives within the healthcare setting. We have the power to strengthen the individuals we work with, influence change in the community, and assist during a vulnerable time from
pre-pregnancy through the first year of an infant’s life.
Many programs are offered to this at-risk population
aiming to improve the health and meet the needs of
families, women, and children. It is no surprise that the
Presidency of Donald Trump can and will affect
women’s and children’s issues throughout the United
States, and even within our hospital. From plans to
defunding Planned Parenthood to overturning Roe vs.
Wade, the question is: What is in store for America’s
women and children next?
If Donald Trump ends up favoring pro-life, it has the
potential of repealing women’s abortion rights at the
federal level and rescinding the U.S. Supreme Court law
of Roe vs. Wade, a historic decision affecting thousands
of women each year. Additionally, Trump’s plan to
defund Planned Parenthood could affect lower socioeconomic populations and uninsured women by denying
them affordable reproductive health and contraceptive
services. Statistics reveal only 3 percent of Planned Parenthood’s services involve abortion, with the 97 percent
of their focus on cervical and breast cancer screenings,
birth control and sexually transmitted infection treatments. If Planned Parenthood were to be defunded by
our nation’s President, an alarming number of the
United States women would lose proper resources to
obtain treatment.
Ivanka, Donald Trump’s daughter, holds a rather differing view on the issues of women’s rights and values.
Ivanka has addressed the wage gap between men and
women by supporting the Paycheck Fairness Act ensuring employee salaries remain congruent protecting
equal pay. She stated she is committed to improving the
lives of women and their families by establishing a
guaranteed six weeks of paid maternity leave: the
United States is currently the only industrialized
nation without it. Ivanka spoke about enabling families
to deduct child care expenses from their income taxes
and creating additional policies in society to bring
some heart back into America again. Although no specific outline has been developed to approach these proposals, steps by the Trump family have expressed
advancements towards these goals.
As social workers, many of us witness the circumstances and losses occurring in our patient’s lives and it
is up to us to remain compassionate, recognize their
right to self-determination, and provide them with supportive services wherever needed. It is our duty to
address these issues with our patient’s during their
medical challenges and assist with community
resources by incorporating America’s latest developments in public policy.
By Olivia Flail, BSW, MSW
Intern at Johns Hopkins All Children’s Hospital