His life as a younger brother to a sister with Down syndrome helped shape Robert Keefe’s career.
His sister, Sandra, struggled with mental and physical disabilities while the siblings grew up in southwest New Hampshire. Their parents, Dorothy and Richard, were forced to maneuver the limited services in the “Live Free or Die” state at a time when no laws mandated an education for children with special needs.
“Among my earliest memories is my mother, during the 1960s, with white gloves on, in church, cornering this lady,” said Keefe, a University at Buffalo social work professor. “It turns out she was head of the school board. My mother would take my sister and me every single day to school and we would just sit there waiting for them to take my sister to a class.”
This helps explain why Keefe has spent the last two decades researching the needs of mothers and children of color, including a groundbreaking research study released recently that showed low-income African-Americans and Latinos with postpartum depression are less likely to respond to typical treatment: counseling and antidepressant medications.
Keefe, 54, holds a bachelor’s degree in sociology from Ithaca College, a master’s in social administration from Case Western Reserve University in Cleveland and a doctorate in social welfare from the State University at Albany. He taught at Syracuse University before coming to UB in 2005. He has lived – and conducted much of his research – in Rochester while at both schools.
Q. How can diversity challenge a community support system?
I grew up in Newport, N.H. Its only claim to fame is that Grace Metalious lived nearby when she wrote “Peyton Place.” When I grew up there, it was so homogenous. Everyone was white and had a similar ethnic background. That made things easier when you were planning services. How you go about planning things and responding to people in need when you’re in a place like Buffalo, which is so very diverse, you have to find diverse ways of approaching the problem.
The group I work with now is primarily mothers of color, and what has impressed me so much is that these women are dealing with amazing life problems. ... I have been very impressed with how they soldier on.
Q. Why do you think the rate of postpartum depression is higher in women of color?
In the population in general, we say that 12 to 15 percent of new mothers have postpartum depression. In mothers of color, we see about 38 percent. Part of the reason we’re seeing this dramatic difference is that mothers of color are less apt to go for services themselves. A lot of these mothers have a lot of trauma and they live in communities where there’s a lot of crime, where they’re used to hearing gunshots, where they don’t have access to healthy foods, where they don’t feel comfortable going to parks. Because they tend to live in areas of high crime, they repeatedly face trauma and the trauma seems to mask that depression ...
These mothers do get themselves up, they do get going. These mothers might be experiencing depression – they score very high on those scales – but they refuse to acknowledge it. They’re too busy. They have to feed these kids. They may live in housing where lead paint is an issue. There may be problems with infestations. There’s lead in the water in some cases. That’s what they’re dealing with. So when I talk to them about depression, they go, “Pick a number.” In some respects, it’s a healthy way to be. They may not be able to acknowledge it but there’s so many other things to cope with.
Q. What were some of the key conclusions?
One of the things is that traditional therapy does not seem to be cutting the mustard here. If we look at just the mother in isolation, if we don’t look at the community in which she lives, if we don’t look at her access to healthy things – recreation, food, housing, transportation – those are the things we need to be addressing. Antidepressants aren’t going to take those things away. And the therapy is not going to take the problems away unless the therapy is helping you address these bigger issues, bigger pictures.
Q. This seems pretty intuitive.
It is, once we look at the big picture. When you’re doing individual therapy, you’re not necessarily asking, “How’s your car running?” They ask, “Have you thought about hurting your baby? About hurting yourself?”
Q. But not so much, “Do you have enough food for your child?”
And, “Is the food healthy food?” We have things in place that make sure a child is well taken care of – WIC and well baby checks, for instance – whereas the mother has one visit with an OB/GYN after she gives birth and often that’s it.
Q. How do you work with these mothers?
Often, mothers of colors tend to go to clinic-based services. In a clinic, if you’re seeing lots of mothers, you don’t want to necessarily intervene at an individual level. You want to start doing more group work. In the group work, you can focus on the counseling, but also on building friendship networks. And you need to start reaching out to where the mothers go: churches. One of the things I’ve started to do in Rochester is to make relationships in some of the African-American churches. What I’m finding so far is that in these churches, there are any number of older women who would be very happy to get involved with being birth coaches, with how they can be mothering to a pregnant woman, helping to make sure she’s taking care of herself. What does that look like? It means getting prenatal vitamins, eating three meals a day. ... In many inner-city communities, churches are like oases in the desert. You walk in and do feel a sense of peace.
The church is always there. Often, with African-American churches, they’re the biggest service provider. You go there and you’ll meet people who are largely non-judgmental, who can relate to the life experiences that you have.
Q. Are Buffalo and Western New York set up to administer to these needs successfully?
We’re getting there. Because we’re having such an influx of refugees and new immigrants, we’re realizing we need to take a look at our whole service delivery system anyway. ... The problem is more reimbursement for the services. If these women are getting more from churches or volunteer transportation that aren’t being reimbursed, that becomes more of an issue.