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Mothering from the Inside Out: Adapting an evidence-based intervention for high-risk mothers in the Western Cape of South Africa

Published online by Cambridge University Press:  31 January 2019

Nancy Suchman Open the ORCID record for Nancy Suchman [Opens in a new window] ,
Astrid Berg ,
Lameze Abrahams ,
Toni Abrahams ,
Amy Adams ,
Brenda Cowley ,
Cindy Decoste ,
Waseem Hawa ,
Anusha Lachman  and
Bulelwa Mpinda
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Nancy Suchman*
Affiliation:
Yale University School of Medicine, Department of Psychiatry, New Haven, CT, USA Yale Child Study Center, New Haven, CT, USA
Astrid Berg
Affiliation:
University of Cape Town, Department of Psychiatry and Mental Health, Cape Town, South Africa Red Cross War Memorial Children's Hospital, Cape Town, South Africa
Lameze Abrahams
Affiliation:
University of Cape Town, Department of Psychiatry and Mental Health, Cape Town, South Africa Lentegeur Psychiatric Hospital, Cape Town, South Africa
Toni Abrahams
Affiliation:
University of Cape Town, Department of Psychiatry and Mental Health, Cape Town, South Africa Lentegeur Psychiatric Hospital, Cape Town, South Africa
Amy Adams
Affiliation:
Stellenbosch University, Department of Psychiatry, Stellenbosch, South Africa Stikland Psychiatric Hospital, Cape Town, South Africa
Brenda Cowley
Affiliation:
Stellenbosch University, Department of Psychiatry, Stellenbosch, South Africa
Cindy Decoste
Affiliation:
Yale University School of Medicine, Department of Psychiatry, New Haven, CT, USA
Waseem Hawa
Affiliation:
Lentegeur Psychiatric Hospital, Cape Town, South Africa Stellenbosch University, Department of Psychiatry, Stellenbosch, South Africa
Anusha Lachman
Affiliation:
Stellenbosch University, Department of Psychiatry, Stellenbosch, South Africa Tygerberg Hospital, Cape Town, South Africa
Bulelwa Mpinda
Affiliation:
Stellenbosch University, Department of Psychiatry, Stellenbosch, South Africa Stikland Psychiatric Hospital, Cape Town, South Africa
Nasera Cader-Mokoa
Affiliation:
University of Cape Town, Department of Psychiatry and Mental Health, Cape Town, South Africa Lentegeur Psychiatric Hospital, Cape Town, South Africa
Nosisana Nama
Affiliation:
Red Cross War Memorial Children's Hospital, Cape Town, South Africa
Juané Voges
Affiliation:
Stellenbosch University, Department of Psychiatry, Stellenbosch, South Africa Stikland Psychiatric Hospital, Cape Town, South Africa
*
Author for correspondence: Nancy Suchman, Moms ‘n’ Kids Program, One Long Wharf Drive, Suite 310, New Haven, CT06511. E-mail: nancy.suchman@yale.edu.
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Abstract

During South Africa's first two decades as a democracy, the Western Cape Province has undergone radical changes to its healthcare system in an effort to address the extensive socioeconomic inequities that remain in the aftermath of the apartheid era. Although progress has been made, there is a clear need for interventions that support parents and children receiving health services in the public sector who are vulnerable to multiple psychosocial risks associated with extreme poverty. In this mixed-method study, we examined the feasibility and acceptability of adapting an evidence-based parenting intervention called Mothering from the Inside Out that was developed for mothers who are vulnerable to similar risks in the United States. Using qualitative methods, we documented the collaborative process that was guided by principles of community-based participatory research and examined themes in the Western Cape collaborators’ perspectives about the feasibility and acceptability of the intervention. Using quantitative methods, we tested the preliminary efficacy of the adapted version of Mothering from the Inside Out for improving maternal reflective functioning and mother–child interactions. Although findings from both study components indicated preliminary promise, a number of obstacles and challenges at multiple levels underscore the need for (a) flexibility and contextual support for intervention research conducted in under-resourced communities, (b) clinical sensitivity to the unique experiences of parents rearing children in highly stressful, under-resourced environments, and (c) equal partnerships that allow the expertise of local providers to inform the design proposals of consulting investigators.

Keywords

parent interventionimplementation researchcommunity-based participatory researchmaternal addictionmaternal mental illness
Type
Regular Articles
Information
Development and Psychopathology , Volume 32 , Issue 1 , February 2020 , pp. 105 - 122
Copyright
Copyright © Cambridge University Press 2019

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