Improving Healthcare Practices for African American/Black Mothers
Counseling Psychology
The Reflective Functioning Mothers project led by Assistant Professor Vivian L. Tamkin’s research lab began as a journey to define reflective functioning rooted in the voices of the African American/Black maternal lived experience. But with the support of Counseling Psychology alum Lizette Hernandez MA ‘24 and a devoted team of graduate research assistants, the project has grown to inform a number of impactful resources, including a children’s book and an inclusive care training journal for medical students.
Reflective functioning is a term used to describe how caregivers interpret and respond to their children’s behaviors and emotions. Historically, models of reflective functioning with parents have held a Eurocentric focus, failing to acknowledge and incorporate the experiences of non-white communities. As a result, an African American/Black mother, for example, may be demonstrating reflective functioning but preexisting models often fail to capture culturally embedded meaning-making and embodied parenting. The Tamkin Qualitative Research Lab (TQRL) set out to operationalize reflective functioning from a culturally rooted Black maternal lived experience.
The team collaborated with a group of five mothers of African ancestry to refine interview questions, then conducted virtual interviews with 20 U.S. based mothers of children aged birth to two years with backgrounds from across the African diaspora. “We talked to them about their personal stories and upbringing, experiences with social stereotypes and discrimination, emotional communication with their children, and messages they want to pass to future generations about what it means to be an African American/Black mother,” says Hernandez.
Thus far, the data have yielded rich narratives of the African American/Black maternal experience which have generated a number of exciting outputs. One being an emerging conceptual model of reflective functioning that is culturally anchored and serves as a foundational shift in the traditional thinking of this construct. Secondly, guided by a class assignment in Lizette’s masters program at the University of Granada, a reflective journal was created as an intervention tool.
“We had to identify a group that experiences prejudice and discrimination and then create an intervention to try and mitigate the negative outcomes. And we’d just collected all of this data from the mothers,” says Hernandez. “In these interviews, we encountered many reflections on the mothers’ birthing experiences, where they recalled medical providers leaning heavily on stereotypes and lacking culturally-informed care.”
From these experiences, Lizette was inspired to create a journal for medical students filled with reflective prompts and real quotes from the mothers. By reading personal accounts on Black maternal experiences and journaling on how these accounts can inform methods of providing care, medical students can reflect on how to ensure the care they provide will be inclusive and culturally affirming. As an additional resource, Lizette also designed a medical reference badge with reminders for practicing physicians about affirmative care practices. TQRL is planning on facilitating a pilot study with healthcare providers across the U.S., where they will track pre- and post-intervention levels of bias in providers and collect patient survey feedback from African American/Black mothers on quality of care received.
“I’m glad that our Reflective Functioning Mothers project has been able to have implications both within the world of Counseling Psychology and beyond it,” says Dr. Tamkin. “My hope is that sharing the mothers’ testimonies with the world will catalyze the systemic dismantling and shift in mindset needed to administer more culturally sensitive health care to the African American/Black community and other non-white populations.”
Dr. Tamkin, Lizette, and the rest of the research team are also in the process of incorporating the project’s findings into a children’s book illustrating the “ABC’s” of reflective functioning. Reading books tends to be an important moment for parents to bond with their children, and with this book, the goal is to ensure both parent and child are feeling seen and affirmed in the ways they interact with each other. All text and stories in the book are derived from mothers’ interview quotes. The team has also presented their findings at conferences both nationally and internationally, and plan to conduct a similar project with African American/Black fathers in the future.