Maternal and Child Health Journal最新文献

{"title":"State-Level Spending on Children Associated with Unequal Benefits to School Readiness.","authors":"Taryn W Morrissey, Katherine Engel, Margot I Jackson","doi":"10.1007/s10995-025-04068-9","DOIUrl":"https://doi.org/10.1007/s10995-025-04068-9","url":null,"abstract":"<p><strong>Objectives: </strong>To examine associations between state-level public investments in programming for children and parents' reports of their children's kindergarten readiness.</p><p><strong>Methods: </strong>We use regression approaches with publicly available, nationally representative data to examine how time and state variation in public spending on children relates to parents' concerns about children's development. We link data on annual state-level spending on health and early learning from the Urban Institute's State-by-State Spending on Kids Dataset and the National Institute for Early Education Research to child-level data from the 2003/2004, 2007/2008, and 2011/2012 waves of the National Survey of Children's Health (NCHS), focusing on a subsample of parents with one or more children under age six (N = 56,736).</p><p><strong>Results: </strong>Child-related public spending on both health and early education is associated with decreases in parents' concerns about their children's physical health and motor development. A 15% increase in average health spending and early education spending per child per year is associated with a reduction in parents' concerns about children's health and motor development of about 3% and 2% of a standard deviation (SD), respectively. Associations between spending and concerns about early learning and social-emotional development are negative but not significant. Among socioeconomically disadvantaged or racial and ethnic minority parents, spending is associated with smaller reductions in concerns.</p><p><strong>Conclusions for practice: </strong>Public spending on children is associated with fewer parents' concerns about their children's development, but less so among disadvantaged families. It is possible that public spending levels are not adequate to narrow disparities in early opportunity and outcomes.</p>","PeriodicalId":48367,"journal":{"name":"Maternal and Child Health Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143415946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perceived Stress and Early Postpartum Depressive Symptoms in Women with Recent GDM: Implications for Postpartum Lifestyle Programs.","authors":"Jennifer M Dias, Estelle C Kelty, Jacinda M Nicklas, John T Doucette, Sue E Levkoff, Ellen W Seely","doi":"10.1007/s10995-025-04045-2","DOIUrl":"https://doi.org/10.1007/s10995-025-04045-2","url":null,"abstract":"<p><strong>Objectives: </strong>To inform the development and adaptation of lifestyle programs to prevent type 2 diabetes, we sought to identify factors associated with depressive symptoms in the early postpartum period among women with recent gestational diabetes (GDM).</p><p><strong>Methods: </strong>Participants are from the Balance after Baby Intervention (BABI) study, a two-year randomized clinical trial of a lifestyle program for women with recent GDM conducted in Boston, MA, and Denver, CO between 2016 and 2019. The Edinburgh Postpartum Depression Scale (EPDS) and Perceived Stress Scale (PSS-10) were administered at an average of 8-weeks postpartum. We defined an EPDS score of ≥ 9 as depressive symptoms and reviewed medical records for medical history. We conducted bivariate analyses to identify predictors of postpartum depressive symptoms, then modeled the odds of postpartum depressive symptoms using multivariable logistic regression and selected the best fit model.</p><p><strong>Results: </strong>Our analysis included 181 women. Thirty-five (19%) scored ≥ 9 on the EPDS. While both perceived stress and whether this was the first pregnancy complicated by GDM were significant in the bivariate analysis, only perceived stress remained a significant predictor of postpartum depressive symptoms in the multivariate regression model (OR 4.34, 95% CI [2.58-7.31]). The effect of first GDM pregnancy was no longer significant in the multivariate model (OR 2.00, 95% CI [0.63-6.33]). Additionally, a mediation model determined that perceived stress fully mediated the effect of first GDM pregnancy on depressive symptoms (Effect ratio, 0.5507/1.5377 = 0.358, p = 0.036).</p><p><strong>Conclusions for practice: </strong>Perceived stress was predictive of postpartum depressive symptoms in women with recent GDM and was found to mediate the relationship between first pregnancy complicated by GDM and postpartum depressive symptoms. Addressing perceived stress in the early postpartum period may be an important target for future lifestyle programs to maximize diabetes prevention efforts.</p>","PeriodicalId":48367,"journal":{"name":"Maternal and Child Health Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Childbirth Experience Survey (CBEX): An Analysis of Qualitative Survey data.","authors":"Samia Saeb, Lisa M Korst, Ferina Farahnik, Jeanette McCulloch, Naomi Greene, Moshe Fridman, Kimberly D Gregory","doi":"10.1007/s10995-025-04043-4","DOIUrl":"https://doi.org/10.1007/s10995-025-04043-4","url":null,"abstract":"<p><strong>Background: </strong>In collaboration with community research partners, a national cross-sectional online Childbirth Experience Survey (CBEX) of pregnant and postpartum birthing people was administered in 2016. The linked antepartum-postpartum survey included items across 18 domains (e.g., labor management, pain management, newborn care and feeding), and identified 23 childbirth-specific postpartum patient-reported outcomes (PROs) that were associated with hospital satisfaction. CBEX was implemented in 16 California hospitals to identify hospital-specific opportunities for improvement in care. We analyzed postpartum qualitative survey responses (1) to evaluate the content validity to test the representativeness of existing CBEX domains, (2) to assess for any potential new domains or topics of interest within existing domains, and (3) to use these data to provide hospitals with actionable information for practice improvement.</p><p><strong>Methods: </strong>This was an analysis of qualitative survey data based on the following CBEX item: \"Is there anything else you would like to share about your birth experience?\" Patients could provide multiple comments. Using Atlas.ti Version 8, we mapped participant responses to the 18 existing CBEX domains.</p><p><strong>Results: </strong>Of 525 surveys completed between Oct 2018 and Sept 2020, 172 patients responded to the qualitative item. A total of 235 comments were analyzed and all were able to be mapped to the 18 domains. Qualitative responses highlighted subtleties within several CBEX domains: (1) labor management: pressure from the care team to have a labor induction; (2) pain management: epidural effectiveness, timing, dosage, and education; (3) empathy and respect: issues related to students and residents; and (4) newborn feeding: rough physical handling of patients by nurses, specifically during lactation consults.</p><p><strong>Discussion: </strong>CBEX survey data is currently being utilized in hospitals to inform childbirth-specific quality improvement initiatives. By capturing detailed voluntary participant responses, CBEX provides the opportunity to document and explore nuanced aspects of the childbirth experience and subtleties that may be contributing to maternal dissatisfaction.</p>","PeriodicalId":48367,"journal":{"name":"Maternal and Child Health Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143190936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of the COVID-19 Pandemic on Pregnancy, Birth Experiences, and Mental Health: Voices from Women in Puerto Rico.","authors":"Irene Lafarga Previdi, Carmen Vélez Vega, Nobel Hernández Otero, Ana Guzzi Vasques, Génesis Alvelo Colón, Ishwara Ayala, Natacha Guilloty, Jessica Medina, Marialane Cancel, Sofía Contreras, José Cordero, Akram Alshawabkeh","doi":"10.1007/s10995-024-04026-x","DOIUrl":"10.1007/s10995-024-04026-x","url":null,"abstract":"<p><strong>Objectives: </strong>The specific aims of the project are: (1) Examine the impact of COVID-19 on pregnancy experiences and outcomes; (2) Examine the mental health impact of COVID-19 in pregnant women and mothers of children 12 months or younger; (3) Identify risk and protective factors among this population in Puerto Rico.</p><p><strong>Methods: </strong>Participants were recruited from the Puerto Rico Team for Exploring Contamination Threats (PROTECT) Superfund Program, which is composed of pregnant women and mothers from the northern karst region of Puerto Rico. The research had a mixed methods approach with a quantitative survey (n = 184) and qualitative interviews (n = 10); data collection was done in virtual mode.</p><p><strong>Results: </strong>Findings from the qualitative interviews highlight the experiences regarding access to healthcare services, pregnancy and birth experiences, social support, and mental health during the pandemic among women with young children. These narratives serve to illustrate the particular challenges and opportunities that the participants faced during the year 2021 in regard to maternal health in Puerto Rico.</p><p><strong>Conclusions for practice: </strong>COVID-19 restrictions impacted the experiences in receiving healthcare services, particularly regarding the birthing process and the participants' mental health. Social support, particularly from family, was found to be a protective factor for facing the challenges during pandemic times. We expect that the findings can lead to the development of interventions for community health centers, prenatal clinics, non-governmental organizations, and parents/caretakers in Puerto Rico.</p>","PeriodicalId":48367,"journal":{"name":"Maternal and Child Health Journal","volume":" ","pages":"139-147"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11821663/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824547","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and Validation of a Decision Support Tool for Baby Formula Prescription.","authors":"Leonara Carla de Araújo Pereira, Gabrielle Mahara Martins Azevêdo Castro, Anna Cecília Queiroz de Medeiros","doi":"10.1007/s10995-024-04036-9","DOIUrl":"10.1007/s10995-024-04036-9","url":null,"abstract":"<p><strong>Introduction: </strong>Although there are acceptable medical reasons for the use of food supplements, most prescriptions for newborns do not comply with current recommendations, putting continued breastfeeding at risk. This study aimed to create and validate a flowchart for newborn supplement prescription.</p><p><strong>Methods: </strong>The flowchart was created and submitted to two rounds of assessments by a panel of judges, who calculated the content validity index (CVI) (acceptable > 0.80). Flowchart use in clinical practice (applicability) was validated by professional prescribers through the resolution of 3 clinical cases. Data were analyzed using Pearson`s chi-squared test (p < 0.05).</p><p><strong>Results: </strong>The flowchart was assessed by 17 judges and validated regarding its content (CVI = 0.84). Took part in validating the applicability of this study 169 doctors and nutritionists who work in maternal and child health. There was a statistical association between correct case resolution and flowchart utilization in two of the three clinical cases (p < 0.05). In situation 1, the use of a validated flowchart increased the likelihood of correct answers 7.76 times.</p><p><strong>Discussion: </strong>Prescribing baby formula is complex and requires careful assessment of several factors. Thus, knowledge translation is an effective intervention to eliminate the gaps between knowledge and clinical practice. The validated flowchart allows more assertive conduct regarding breastfeeding management and food supplement prescription for newborns.</p>","PeriodicalId":48367,"journal":{"name":"Maternal and Child Health Journal","volume":" ","pages":"249-257"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of COVID-19 Pandemic-Related Workflow Changes on a Clinically-Integrated Breastfeeding Peer Counselor Program.","authors":"Fatima Sattar, Ann E B Borders, Lauren S Keenan-Devlin","doi":"10.1007/s10995-024-04035-w","DOIUrl":"10.1007/s10995-024-04035-w","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate whether Covid-19 related workflow changes to a clinically-integrated breastfeeding peer counseling (ci-BPC) program were associated with poorer breastfeeding outcomes for Medicaid-enrolled patients.</p><p><strong>Methods: </strong>This retrospective chart review included patients who received ci-BPC care during January 2017-March 2020 (\"Pre-Pandemic,\" N = 318); March 2020-September 2020 (\"During-Peak,\" N = 53); and September 2020-May 2021 (\"Post-Peak,\" N = 97). ANOVA evaluated differences in encounter type frequencies for each time point, as well as differences in breastfeeding initiation, exclusivity during inpatient admission, and continuation of breastfeeding at least 6 weeks post-delivery.</p><p><strong>Results: </strong>In-person prenatal counseling significantly decreased from Pre-Pandemic to During-Peak (43.9-8.2%, p < 0.05). Breastfeeding at 6 weeks postpartum significantly increased from the Pre-Pandemic cohort to the During-Peak cohort (67-85%, p < 0.05), and returned to baseline for the Post-Peak cohort (74%).</p><p><strong>Conclusions for practice: </strong>Covid-19 related workflow changes for the peer counselor did not decrease breastfeeding outcomes as anticipated.</p>","PeriodicalId":48367,"journal":{"name":"Maternal and Child Health Journal","volume":" ","pages":"148-155"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11863184/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142855802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Referrals to Peer Support for Families in Pediatric Subspecialty Practices: A Qualitative Study.","authors":"Alex Kobrin, Olivia Chan, Emily Crabtree, Joe Zickafoose, Amy Wodarek O'Reilly, Edward Schor, Holly Henry, Allison Gray","doi":"10.1007/s10995-025-04062-1","DOIUrl":"10.1007/s10995-025-04062-1","url":null,"abstract":"<p><strong>Introduction: </strong>Referrals to peer support (PS) can help families of children with special health care needs in providing emotional support, reducing feelings of stress and anxiety, and improving the care experience. This study aimed to gain providers' perspectives about PS referrals for families of children with special health care needs, including their perspectives on logistics of, barriers to, and facilitators of making referrals as well as the perceived impacts of PS referrals.</p><p><strong>Methods: </strong>This study builds on a 2022 survey of California pediatric subspecialists about the value and challenges of PS. The study team conducted 20 semistructured interviews with people from pediatric subspecialty practices in California and used a priori themes derived from the interview protocol to develop a codebook, code interview transcripts, conduct a thematic analysis, and summarize findings.</p><p><strong>Results: </strong>Respondents offered a variety of PS referrals inside and outside their institutions, tailoring referrals to each family's needs and preferences. Social workers and family liaisons were most commonly responsible for making PS referrals. Respondents found that care team collaboration and ease of sharing information about PS resources among colleagues facilitated the referral process. Respondents noted a need for more PS resources, including funding, education, and the need for a network where providers can identify PS resources.</p><p><strong>Discussion: </strong>Encouraging PS program information-sharing within and across organizations could help connect more families to PS services. Future research should assess families' experiences with PS referrals and services to understand approaches that can best meet their needs for information, instrumental, and emotional supports.</p>","PeriodicalId":48367,"journal":{"name":"Maternal and Child Health Journal","volume":" ","pages":"280-286"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11821679/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143060910","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Racial and Ethnic Disparities in Hospital Breastfeeding Care in the US.","authors":"Jane Lazar Tucker, Kimberly Arcoleo, Diane DiTomasso, Brietta M Oaks, Howard Cabral, Thaís São-João","doi":"10.1007/s10995-025-04065-y","DOIUrl":"10.1007/s10995-025-04065-y","url":null,"abstract":"<p><strong>Objectives: </strong>This study examines the associations between race and ethnicity and receipt of Baby Friendly Hospital Initiative (BFHI) key clinical practices that support breastfeeding in US hospitals.</p><p><strong>Methods: </strong>National data from 2016 to 2019 CDC PRAMS were analyzed. Our sample included 60,395 mothers who initiated breastfeeding with healthy, term newborns. We conducted adjusted regression analyses to compare the odds of receiving individual key clinical practices that support breastfeeding, as well as the percent of key clinical practices received.</p><p><strong>Results: </strong>While some key clinical practices were received at high rates, less than 25% of mothers received 100% of recommended key clinical practices. Compared to White non-Hispanic mothers, mothers from various racial and ethnic groups were at lower odds of receiving 100% of key clinical practices: Black non-Hispanic [adjusted odds ratio (AOR) 0.59, 95% confidence interval (CI) (0.47-0.65)], English-Speaking Hispanic [AOR 0.79, 95% CI (0.71-0.88)], Spanish-speaking Hispanic [AOR 0.63, 95% CI (0.53-0.73)], and Asian/Pacific Islander non-Hispanic [AOR 0.54, 95% CI (0.47-0.63)].</p><p><strong>Conclusions for practice: </strong>Despite a steady increase in the number of BFHI hospitals in the US, there are racial and ethnic disparities in the receipt of BFHI key clinical practices. More US hospitals must adopt BFHI key clinical practices and consistently implement those practices for every racial and ethnic group.</p>","PeriodicalId":48367,"journal":{"name":"Maternal and Child Health Journal","volume":" ","pages":"173-182"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11821785/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychometric Evaluation of the New Translated and Culturally Adapted Postpartum Bonding Questionnaire in German-Speaking Women.","authors":"Pia-Cecilia Steinbrueck, Gabriele Meyer, Gertrud Ayerle","doi":"10.1007/s10995-024-04029-8","DOIUrl":"10.1007/s10995-024-04029-8","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to evaluate the construct validity and reliability of the newly adapted German version of the Parental Bonding Questionnaire (PBQ) in a group of mothers drawn from the general population, with children aged 12-24 weeks. This assessment followed a thorough linguistic validation, which was conducted through a systematic, multi-step translation process.</p><p><strong>Methods: </strong>363 women completed the PBQ online 12-24 weeks after delivery. Cronbach's alpha and exploratory factor analysis (EFA) were used to assess internal consistency reliability and construct validity.</p><p><strong>Results: </strong>The original 4-factor model could not be confirmed. The new PBQ provides a single factor solution. Ten items were removed from the original 25-item PBQ to produce the abbreviated German PBQ-15, which showed strong internal consistency. The Cronbach's alpha for this version was 0.86.</p><p><strong>Conclusion: </strong>While further research is needed to establish diagnostic thresholds and strengthen the construct validity of the shortened version, the German-language 15-item version of the PBQ holds promise as an accessible tool for recognizing bonding issues in a general population of German-speaking women 3-6 months postpartum.</p>","PeriodicalId":48367,"journal":{"name":"Maternal and Child Health Journal","volume":" ","pages":"240-248"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11821787/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142733418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Supporting the Advancement of a National Agenda for Pediatric Healthcare Reform: A multi-year Evaluation of a Leadership Education in Neurodevelopmental and Related Disabilities Program.","authors":"Caitlin Koob, Sarah F Griffin, Mackenzie Stuenkel, Kathleen B Cartmell, Kerry Sease","doi":"10.1007/s10995-025-04040-7","DOIUrl":"10.1007/s10995-025-04040-7","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the implementation and sustainability of the effect of a 1-year Leadership in Education for Neurodevelopmental and related Disabilities (LEND) program in a southeastern state, and to examine its impact on advancing the Maternal Child Health Bureau's (MCHB) Blueprint for Change-a national agenda for pediatric healthcare reform.</p><p><strong>Methods: </strong>This study applies the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework to rigorously evaluate LEND implementation and impact between 2018 and 2022. In-depth interviews (N = 24) were conducted among long-term (1-year) LEND trainees, via Zoom, in a southeastern state. A hybrid approach of deductive and inductive thematic analysis was conducted to identify emergent patterns and themes from trainees' experiences, related to the EPIS constructs and national priorities.</p><p><strong>Results: </strong>Exploration and Preparation. Trainees identified insights from multidisciplinary discussions and family panels as key facilitators to their development.</p><p><strong>Implementation: </strong>Trainees reported growth in confidence and communication and improving their service delivery, including implementation of a collaborative approach to patient care, family-centered care, and occasionally facilitating their obtainment of leadership positions. Trainees also reported systemic barriers to implementation, including time and financial constraints. Sustainability. Trainees identify their experienced shift in mindset and statewide connections as drivers for sustained change, with suggestions for follow-up events and networking opportunities to enhance the effect of LEND training.</p><p><strong>Conclusions for practice: </strong>These results may inform LEND objectives to enhance the statewide network and to advance a national framework for prioritizing family well-being and quality of life and access to services.</p>","PeriodicalId":48367,"journal":{"name":"Maternal and Child Health Journal","volume":" ","pages":"205-216"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11821710/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}