By: Elizabeth Fitzgerald Clinical Supervisor, LPC Deschutes County and Jennifer Weeks, Maternal Mental Health Specialist
Jennifer Weeks works as a bi-lingual, behavioral health and trauma specialist embedded within the WIC clinic at Deschutes County Health Services. In less than two years, she has served more than 400 women who may not have otherwise sought care due to the stigmas and fears associated with new mothers seeking mental health services. Prior to joining Deschutes County Behavioral Health, Jennifer worked as a trained advocate for Saving Grace, our local domestic violence and sexual assault services agency, serving Spanish and English speaking women in shelter and as part of the outreach program. Jennifer has served as the Regional Volunteer Coordinator for Postpartum Support International (PSI) since 2011, and was instrumental in establishing the successful Maternal Mental Health Warm-line for Central Oregon in conjunction with PSI and Oregon Pediatric Society. Additionally, Jennifer has received advanced training for a pending certification in Eye Movement Desensitization and Reprocessing (EMDR) with special focus on Attachment and Early Trauma Resolution. Jennifer holds certification in Perinatal Mood Disorders through PSI and is a trained labor Doula through Doulas of North America (DONA). As part of the pilot model for this unique, integrated program, Jennifer began tracking the Adverse Childhood Experiences (ACE) scores of all women she serves with the following hope and intention:
- Validating and normalizing the experiences of women with trauma histories
- Fostering healthy and secure parent-child attachment
- Reducing the likelihood of higher ACE scores for future generations
Elizabeth: Can you tell us a little about the kinds of women you see?
Jen: Pregnant, or post-partum women with children up to age 5 (who qualify for W.I.C services). I do occasionally see women with school-aged children, often as referrals from Saving Grace. I also work with high school students who are pregnant through the teen parenting program at Bend High (School).
Elizabeth: At what point in treatment do you screen for ACE’s and how do you present the information?
Jen: Normally at the assessment appointment, unless it feels appropriate to do it in the intake screening. I explain what ACEs are, and explain that they don’t have to answer any of the questions if they don’t feel like it. I explain how the score sets us up for certain behaviors or patterns of behavior. I explain that it screens for physical and emotional health, that our score is linked to those outcomes.
The average ACE score for moms I see is 9, but the original ACE screening doesn’t account for certain traumas like exposure to cultural violence, human trafficking, and childhood medical traumas. Violence against women is really, really high (for her client group) 90% if I had to guess. Reproductive coercion and sexual assault are also very common and how you (as the provider) really have to know how to listen for it. These women often don’t recognize that they are being abused because of their traumatic childhood experiences. A woman might quote her partner or boyfriend calling her something very derogatory or making violent suggestions about the unborn baby but then I’m reflecting for her that those statements are harmful and hurtful and that she and her baby deserve to be treated differently. I often am aiming to “raise the bar’ on the type of treatment my clients are willing to see as normal and acceptable.
Elizabeth: How do women typically respond when they learn about their ACE score and the impact of ACE’s on their overall health?
Jen: Often it’s validating and other times it’s upsetting. Women will say things like ‘It doesn’t surprise me.’ or, ‘I just hate thinking about all that.’ That’s when I’ll use their score to actually validate their strengths by saying there’s nothing wrong with you, but that these awful things happened to you and that we’re not casting blame, we’re just using this tool as a way to understand our health and our behavior. I’ll reinforce the fact that they’re here, in my office, shows they found a way to survive and that it’s actually miraculous. I want them to realize how strong they had to be to get this far.
Elizabeth: How do you screen for resilience or incorporate women’s strengths into the treatment?
Jen: I use a very strengths-based and trauma informed approach to information gathering with the clients I serve, and the ACEs fits in really well. My work is informed by the Adaptive Information Processing Model (AIP) and I focus quite a bit on the influence of early experiences on the development of healthy or unhealthy attachment. Learning as much as I can about a client’s perception of events helps me support the client in tapping into their internal resources as well heal the effects of relational trauma. Building rapport and trust with each client is essential in guiding the client to experience a sense of safety and trust within the therapeutic relationship - allowing them to build supportive and healthy relationships in their personal lives.
Group has been really great for that too, since it is moms relating to each other and learning from each other.
Elizabeth: Yes, I’ve gotten to see some of that in the last few groups I co-led with you. Moms sharing ideas about teething and discovering they’re already doing things to create healthy attachment; they often look surprised and relieved when they’re getting that validation. Or moms learning skills they can teach to their kids in art therapy; that has been really great to witness. The group has been a huge success since you started it last summer.
Your program houses you right inside the WIC clinic. How do your clients feel about being able to access your services this way?
Jen: Integration has really increased access for these moms. They don’t have to go upstairs (outpatient treatment), which is associated with more stigma for them. Doing the warm hand-offs creates the sense that WIC is a safe place and happy to come to. And for most of the women I treat, they already have other agencies or services in their life, so, being co-located with their other appointments is saving them a lot of time. It’s less work for them. And for women who are trying to get out of domestic violence relationships being co-located creates confidential access to help. If a woman is being abused by a controlling partner, she won’t make a mental health appointment. Her partner might control the phone or where she goes. But they will come to WIC because they’re meeting basic needs, like food.
Jen worked as a Saving Grace advocate for about four years.
Elizabeth: Who else do you receive referrals from and how do they access you?
Jen: I get referrals from Nurse Family Partnerships, Oregon Mother’s Care, CaCoon, Saving Grace, the teen parent program at Bend High (School) and WIC in Redmond. I have also been getting a lot of word of mouth clients referred to me by their friends. I’m getting anywhere from five-seven referrals a week through our internal referral system (electronic program) or people from those agencies contact me directly. When I get a referral that’s not a warm hand-off, I’ll do up to two outreach calls, which is different from most of the other behavioral health programs here. Letting them set the pace, meeting each client where they’re at and being flexible and accessible is so important. Most of the women I talk to are so used to dealing with pejorative agencies. It can be defeating and dehumanizing. Being collaborative and transparent is really important when working these moms.
Elizabeth: Are there particular resources you think are missing from complete care for expectant mothers with high ACE scores?
Jen: I really think there should be specific services for substance abuse in maternal mental health. It can be really triggering and shaming for a pregnant woman to enter into recovery groups and even recovery medical care, but if a woman with an addiction history finds out she’s pregnant and wants help, where can she go? There’s so much that needs to happen before we can get to the therapy, emotionally. For many women, in very early recovery and pregnancy, they can feel so easily defeated and overwhelmed because they’re trying to take on so much all at once and typically with not a lot of support. Their addiction had been part of their coping skills and now all of those coping skills are gone away and they’re just raw, with this new tiny baby. None of that is addressed in a typical 12 step program. It’s really a niche that needs exploring and developing.
Elizabeth: Indeed Jen, you are scheduled to begin a mindfulness group geared toward women in recovery here at Deschutes County in just a couple of weeks due to the requests you received directly from your clients. Can you share some of the successful outcomes you’ve experienced which led you to develop this new service within the program?
Jen: Trust is huge. I worked with one mom who had lost her license because of past (criminal) charges; it had been over six years. She had her baby, she was maintaining her sobriety, coming to regular therapy. I helped her get on SR22, a type of insurance you need to have along with a breathalyzer installed in your car so she could get her license back and start working. She was so motivated, but was afraid to access traditional recovery services for fear that they’d make assumptions and try and take her baby away. Within the context of trauma-informed, maternal mental health recovery, there was space what for what she was feeling and needing as a newly sober mom. When I think of what’s going to help keep a new mom sober I think of specific coping skills that are catered to everything happening in her body, physiologically, and in her brain, neurobiologically-all those attachment triggers, triggering her own trauma and stimulating her desire to build this healthy bond with her baby. I help her develop skills to address all of that; a ton of emotional resourcing and resilience work. This particular mom told me, “I feel like a different person.”
Comments (3)