Caring Connections - Valentine’s Day Red Flags: Recognising Warning Signs Of An Unhealthy Relationship

 Roses are red, as are warning flags and red flags should not be ignored in any healthy relationship. This Valentine’s Day focus on yourself and take an honest look at how those in your life are treating you. BACP counsellor Margaret Ward-Martin, founder of The Grace Project looks at the warning signs of an unhealthy relationship,  how a relationship can affect you emotionally and psychologically and how to protect yourself.  

We’re approaching Valentine’s Day at warp speed, feeling soft and mushy after our festive fill of romcoms, so it’s worth reflecting on our own relationships, not just those served up in celluloid with a side of soft focus. While feelgood stories are appealing, they can result in a tendency to ignore, minimise, or deny, red flags. Such overly sweet happiness is rarely the stuff of real life.

Margaret comments: “To stay safe in relationships I would suggest paying equal, if not more, attention to how you feel as well as what you hear and see. Often, predators and abusers are adept at saying the right things, knowing what you likely want to hear and what works. They are accomplished manipulators. Initially, you may be told how handsome/gorgeous/successful you are and how fortunate this potential partner feels to have found you. There may be gifts and trips and flattery and it’s all, simply perfect, except you are feeling stressed or unsure or something that you cannot describe but it feels “off.”

You may have anxiety because of poor treatment in previous relationships and wariness is a fair position to take but if it feels like anything listed below, give yourself credit for protecting yourself.

Instead of being distracted by the superficial, trust your feelings in the relationship. All may look fine but what’s going on for you emotionally and psychologically? There may be a tendency to minimise the internal warning signs or underplay the implications of a difficult conversation or situation, to keep the peace. Please don’t. Advocate for yourself. 

Recognising warning signs of an unhealthy relationship - ask yourself do you feel:

• Confused:  This may result from a contradiction between what is said to you and what you see or know to be fact.

• Unsafe:  You want to question something your partner said or did but don’t in case it escalates. If there is any kind of physical intimidation, please get to safety. You do not deserve to be shouted at, pushed, and shoved or have things thrown around. That is violence. 

• Dismissed:   Being told that you are “too sensitive,” “emotional,” “uptight,” “frigid” and similar when you object to an unpleasant comment.

• Criticised:  Because you have an opposing opinion, decided to spend money or do something without “permission,” or have a different way of doing something that results in you being called useless and stupid.

• Anxious:  If you are waiting to see what mood a person is in then that is not good. Not good at all. It means you are constantly in a state of alertness, and this is stressful. That is no life.

• Controlled: Maybe it doesn’t sound like control, more like – “are you sure you should eat that?”;  “I don’t want you to go out and get tired, stay with me tonight, your friends can see you another time”; “You look cold, maybe another jumper?”.  Control often creeps into relationships and can be devious and cunning. Tracking, in the name of looking out for you, is sometimes control that goes unrecognized. It’s controlling because if you bring it up it may be met with defensiveness or an attack in which you are characterized as spoiled, ungrateful and unappreciative of a partner who cares that much. If you did not give consent and feel it’s off then you are likely, spot on. 

• Diminished:  After some time, your spirit may dim. You have less hope, energy, friends, hobbies, and ambition. You may be propping yourself up with coping strategies; alcohol, food, sex, substances – look at what behaviours you are engaged in in this relationship that numb the feelings. Honestly assess their role, without judgement. 

Family and friends may not be supportive. They, too, may have been charmed, groomed, and manipulated as much as you. Don’t expect everyone to understand the pain you are in. Manage your expectations when you start to move away from the relationship – disappointed parents who want a grandchild, the friends who say “you look so good together” and those who try and convince you that you are going to regret this decision.  Stick close to those who genuinely care about you. 

This Valentine’s Day focus on yourself and take an honest look at how those in your life are treating you. If it is less than respectful, gift yourself the decision to walk away.

BACP Counsellor and Psychotherapist Margaret Ward-Martin holds over 30 years’ experience in the mental health industry as a teacher, coach and therapist with a special interest in narcissistic abuse and coercive control survival, addiction and early childhood trauma. She founded The Grace Project in 2021 to raise awareness about emotional and psychological abuse in the world in which we live. Margaret continues to advocate for better access to mental health services and for greater understanding and destigmatization of diagnosis.

Fun Freetime - BagelFest West (4/12, LA)

  The bagel is going west. Following years of sold-out success in New York, BagelFest presented by King Arthur Baking Company, is expanding to the West Coast with the launch of BagelFest West. Taking place Sunday, April 12, at the Audrey Irmas Pavilion, in partnership with the Jewish Food Lab of Wilshire Boulevard Temple, the inaugural West Coast edition marks a major milestone for the fast-growing event that has transformed the beloved everyday carb into a cultural and industry phenomenon. Hosted in Koreatown, the culinary epicenter of Los Angeles, BagelFest West is expected to attract 800 to 1,000 attendees and feature 30 exhibitors, uniting bagel artisans, bakers, food entrepreneurs and bagel lovers. The venue’s dramatic, multi-level architecture further sets the stage for an unforgettable gathering.

 

“A global bagel boom is underway, and the West Coast has fully arrived,” says Sam Silverman. “BagelFest West is to celebrate the artisans who are breaking the outdated idea that world-class bagels can only be made with New York water.”

 

The BagelFest West experience will unfold across an entire weekend, beginning with an Industry Mixer on Saturday, April 11, from 6:30 p.m. to 9:30 p.m., hosted at the landmark Wilshire Boulevard Temple. Designed as an intimate networking evening, the mixer will bring together bagel makers, bakers, shops and industry leaders to break bread, share ideas and make meaningful connections ahead of the main event.

 

On Sunday, BagelFest West will feature two distinct sessions designed to serve both the trade and the public. A morning industry-only session from 10:00 a.m. to 1:00 p.m. will convene chefs, buyers, and bagel-adjacent brands for focused networking, education and curated tastings. The afternoon public session, running from 1:00 p.m. to 5:00 p.m., will open the doors to bagel enthusiasts of all ages, offering an immersive celebration of flavor and community with culinary panels and unlimited bagel and schmear sampling throughout the event.

 

Throughout the day, guests will experience a dynamic and interactive program featuring a curated bagel showcase from top shops, themed discussions led by expert bakers and industry voices, live demonstrations, and friendly competitions that highlight excellence across categories, including: Best of the West, Best Bagel, Best Sandwich, Most Creative, Rising Star, and Schmear of the Year. Winning a top BagelFest award has helped propel regional brands into the national culinary spotlight, including PopUp Bagels (Best Bagel winner in 2021 and 2022, now scaling toward 300 locations nationwide) and Starship Bagel (Best Bagel winner in 2023 and 2025, Schmear of the Year in 2024), which has since become a two-time James Beard Award nominee and been featured on “Diners, Drive-Ins and Dives with Guy Fieri.” Attendees will have the opportunity to participate directly by voting alongside a distinguished panel of judges that includes James Beard Award winners, Michelin-starred chefs, restaurant owners and cookbook authors.

 

A dedicated kids’ section will offer hands-on, creative activities throughout the afternoon, including make-your-own aprons, bagel themed coloring stations, and chef hat decorating, ensuring younger guests are actively engaged while families explore the festival together. Toby L. Neiman, Associate Executive Director and Head of Strategic Programming, Wilshire Boulevard Temple says, “BagelFest West aligns beautifully with the Jewish Food Lab’s mission to use food as a gateway to culture and connection. By welcoming families into the experience, the festival turns culinary exploration into a multigenerational conversation.”

 

BagelFest West is produced by BagelUp, the experiential food company founded by Sam Silverman, New York’s Bagel Ambassador. What began in 2019 as a small gathering of 300 bagel enthusiasts in Bushwick has grown into the premier trade and consumer event for the bagel industry, helping bagel brands gain national recognition, funding, and expansion opportunities. In addition to the festival, BagelUp produces year-round bagel-centric experiences including hands-on bagel baking classes and curated bagel tours.

 

“King Arthur Baking is excited to follow BagelFest West as the presenting sponsor for the inaugural west coast edition, celebrating bagels, bagel makers, and fans of the iconic bread,” says Jeff Yankellow, Director of Bakery Food Service, King Arthur Baking. “Our participation aligns with our vision to bring people together, inspire, and share the joy of baking to build stronger communities. There’s no better example of this happening than at local bagel shops in communities around the country and world.”

 

BagelFest West invites Los Angeles to experience the ultimate celebration of bagel culture, where craftsmanship and community converge. Tickets start at $65 and are available at https://www.bagelfest.com/tickets. Use code EARLYBAGEL for 18% off, while supplies last. All-Access Tickets are available for $199, which includes on-site parking. 

 

About BagelFest

 

BagelFest celebrates bagels and the artisans behind them. Sample signature bites and schmears from the best bagel bakers in the world, meet the makers, and experience bagel culture like never before with hands-on programming, one-of-a-kind competitions, and family-friendly activities for all ages. BagelFest is produced by BagelUp.

 

About King Arthur Baking Company

 

King Arthur Baking Company has been dedicated to spreading the joy of baking since its beginning in 1790. Proudly certified as a B Corp and 100% employee-owned, King Arthur stands as the premier baking resource for both home bakers and professionals. Committed to excellence and innovation, King Arthur delivers unparalleled quality flour and technical support to bakery, foodservice, pizzeria, and culinary customers, ensuring impeccable results with every bake. Explore products, support, and resources tailored to bakery and foodservice customers at KingArthurBaking.com/pro.

 

About The Jewish Food Lab

 

The Jewish Food Lab at Wilshire Boulevard Temple is dedicated to celebrating the tastes and traditions of global Jewish food and culture. Grounded in the richness of Jewish experience and history, the Jewish Food Lab strives to create educational and experiential opportunities for all the senses. The initiative serves as a cornerstone of community outreach and cultural programming at Wilshire Boulevard Temple and throughout Los Angeles.

Healthy Habits - New Study: Children Spending 4+ Hours a Day On Screens Face Up to 61% Higher Depression Risk

  A new Nature Portfolio study reveals that excessive screen time in children is associated with significantly detrimental mental health outcomes across several disorders: ADHD, anxiety, behavioural problems and even depression.

According to clinicians from Flow Neuroscience, a company behind the first FDA-approved non-drug, non-invasive depression treatment, the issue is even bigger than the study reveals, as these children are often overprescribed antidepressants and have limited treatment alternatives due to their age.

Based on data from over 50,000 US children aged 6-17, the study revealed that excessive screen time, categorized as four or more hours per day, is associated with increased odds of mental health issues, raising the likelihood of depression by 61%, anxiety by 45%, behavioural or conduct problems by 24% and ADHD by 21%.

“What is most concerning about these results is the high probability of depression,” says Dr. Hannah Nearney, M.D., clinical psychiatrist and UK Medical Director at Flow Neuroscience. “While there are effective treatments for depression, treatment from a young age can present challenges that may further negatively impact a patient’s life, partly due to the side effects associated with antidepressant use. Unfortunately, non-drug alternatives are often limited to talking therapy, leaving a gap in the provision of services and exposing vulnerable children to increased risk.”

According to the study, physical activity emerges as the most influential protective factor between screen time and mental health problems, accounting for up to 39% of that relationship.

In comparison, irregular bedtimes are culpable for up to 23,9%, and short sleep duration explains around 7,24% of the relationship between screen time and mental health issues.

“What’s most important is that we now know the main determinants and protective factors regarding a range of mental health issues in children. The odds can be significantly reduced with adjustments in behaviours such as physical activity, and expanding the tools we can use to combat these illnesses,” highlighted Dr. Nearney.

The data from the study also indicated that this problem will escalate, as nearly one in every three children spends too much of their time in front of screens, suggesting the behaviour is normalized.

Meeting guidelines for physical activity (which is more than 60 minutes per day) is already low, with only one out of five children achieving this standard. And just one out of four children maintains a consistent weekday bedtime routine.

Given the limitations and risks associated with prescribing SSRIs to children, including a small but measurable increase in suicidality, there is a growing need to explore alternative, non-pharmacological treatments.

In this context, the first FDA-approved non-drug treatment, based on transcranial direct current stimulation (tDCS), is expected to become available in the US later this year. However, it is not approved for children under 18.

“Due to long waiting times, not enough attention is given to children and adolescents with mental health problems such as depression. Too often, they’re pushed into the trial-and-error pathways with antidepressants, even at a young age. We hope that such tools as brain stimulation will become available for these young people too, but what we can do in the meantime is to follow the suggestion of studies like the latter one, and not only avoid screen time, but also regulate our sleep schedules, add physical activity to children’s daily lives, and explore other similar options,” highlighted Dr. Nearney.

Even though currently, children don’t have non-drug, at-home, FDA-approved tools for depression treatment, an increasing amount of research supports that such technologies as tDCS are safe for pediatric use.

In the meantime, this Nature study reframes youth mental health as largely a preventable behavioural challenge and shows that many risks stem from modifiable habits like screen use, physical activity, and sleep.

About Flow Neuroscience

 

Flow Neuroscience is a healthcare company that focuses on tDCS therapies and devices. In 2016, it was co-founded in Sweden by Daniel Mansson, a clinical psychologist, and Erik Rehn, an engineer. Erin Lee joined as CEO in 2022, having previously worked at Google, Uber, and Babylon, and the company is now based in the UK. Flow is the only at-home medical tDCS device with clinically proven effectiveness in treating depression, approved in all major markets: by the American Food and Drug Administration (FDA), the UK’s National Health Service (NHS), the Australian Therapeutic Goods Administration (TGA), and having passed regulations in Europe, Norway, Switzerland, and Hong Kong.

 

Book Nook - Calm Leadership: Developing leaders that last

The UK's National Association of Headteachers (NAHT) warns that school leaders have been driven to “crisis point”, with nearly two-thirds reporting that their mental health has suffered in the past year due to work-related stress.¹ Nearly a third of principals leave the post within five years.² For school leaders and educators of colour, who face the added pressure of systemic bias and discrimination, the tenure is shorter still.³

Calm Leadership, a new book by North London Principal Patrick Cozier, offers a solution to this problem: a framework for staying resilient, calm and grounded in one of the most demanding roles in education.

Patrick has been Principal of Highgate Wood School, a successful secondary school in Haringey, since 2006. When he stepped into the role, he was one of only eleven Black male headteachers in the UK and, since then, he has steered his school to success, overcoming a period of poor exam results, a disappointing school inspection outcome and a deficit budget, without burning out. It is his approach to the job, which he calls Calm Leadership, that has helped him navigate the highs and lows inherent in all leadership positions.

At the heart of Calm Leadership is Patrick’s ‘CALM’ model:

• Confronting uncalm feelings
• Adapting to the feeling of leadership
• Leading with humanity and understanding
• Maturing into the leader you are meant to be

The book draws on Patrick’s firsthand experience in the role to provide tools for managing stress, navigating impostor syndrome and maintaining a positive outlook for lasting leadership. It also shines a light on Patrick’s experience as a Black leader in a majority-white education sector, which offers inspiration to both current and aspiring leaders of colour.

Patrick says:
'I’ve seen, over nearly two decades as a principal, how the pressures of leadership can consume even the most capable people. Too often, leaders are left feeling isolated, overwhelmed, or forced into reacting rather than leading with intention. This book is my attempt to offer something different... a reminder that you can be strong and decisive without losing your humanity, and that calmness is not weakness, it is power.

It is about reminding leaders that they already have the strength and wisdom within them to thrive. Calm isn’t about doing less or lowering expectations; it’s about leading with balance, confidence and purpose, even in the most demanding of times.

My hope is that readers will close the book feeling energised, hopeful, and equipped with practical tools to sustain themselves and inspire those around them. Ultimately, leadership is a privilege. It's not what we've GOT to do... it's what we GET to do!'

Essential for current and aspiring school leaders at all levels.

Patrick Cozier is an experienced secondary school principal. He leads Highgate Wood School in Haringey. In addition to his day job, he is a member of the Headteacher's Roundtable, who consult and advise senior officials on national education policy. He serves as a trustee of the national charity Show Racism the Red Card (of which he is co-vice chair). More locally, he takes a leading role in the work of the Haringey Racial Equity Group (part of the Haringey Education Partnership) on its focus to reduce racial inequality and improve the outcomes and experiences for children of colour. As a member of the Black community, he is passionate about seeking equality, justice and fair outcomes for people of colour.

¹ ‘School leaders quitting amid mental health toll, union warns’, NAHT, April 2025. Available at: https://www.naht.org.uk/News/Latest-comments/Press-room/ArtMID/558/ArticleID/2708/School-leaders-quitting-amid-mental-health-toll-union-warns.

² Tom Belger, ‘A third of new secondary heads ‘leave profession within five years’’, Schools Week, 2022. Available at: https://schoolsweek.co.uk/headteachers-school-leaders-leaving-profession-pay-workload/.

³ What makes minority ethnic teachers stay in teaching, or leave?’, UCL, 2021. Available at: https://www.ucl.ac.uk/ioe/research-projects/2021/jul/what-makes-minority-ethnic-teachers-stay-teaching-or-leave.

Shopping Savings - WonderWorks Pigeon Forge Is Spreading the Love With Local Discount Days

 February is all about love, so WonderWorks Pigeon Forge is celebrating their love for locals with exclusive discount admission days. Local residents of qualifying counties can score tickets for only $15, plus tax, per person at the door from February 14-28, 2026. Plus, this local appreciation event is the perfect time to experience WonderWorks’ newest exhibit, Magic Canvas, which beautifully combines art and technology.

 

“We love our locals! Residents of the Pigeon Forge area really keep the fun going all year long, both inside and outside of the upside-down house. We’re excited to show them our appreciation with this extra special event!” said Malcolm Hale, guest relations manager at WonderWorks Pigeon Forge.

WonderWorks Pigeon Forge invites local residents and workers to explore the attraction at a discounted rate during the Love Our Locals event, running from February 14-28, 2026. All Access tickets are only $15, plus tax, per person at the door for all those living and working in the counties of Blount, Cocke, Jefferson, Knox, and Sevier. To get the special rate, proof of residency or employment must be presented at the admission desk. Then the fun begins!

 

Visitors should also be on the lookout for extra wonderful interactions with the WonderWorks team members, who have been challenged to perform random acts of kindness to further celebrate the month of love. This may include holding the door open for others, volunteering throughout town, and even giving away WonderWorks goodie bags or tickets. The whole team is dedicated to spreading the love and showing appreciation for this fantastic community.

 

When it comes to providing the perfect place to explore, have fun, and create memories with loved ones, WonderWorks Pigeon Forge can’t be beat. Visitors can engage in a wide variety of activities, including going head-to-head at exhibits like the Titanic Ice Water challenge, playing laser tag, racing at Speed of Light, and trying the rock-climbing wall. Other popular exhibits include the Xtreme 360 Bikes, the glow-in-the-dark ropes course, the giant floor piano, and the Bubble Lab. There is something for everyone, making it a multi-generational, fun place to be.

 

“Our entire team is thrilled to unveil our first new exhibit of the year!” said Joe Baumgartner, general manager at WonderWorks Pigeon Forge. “Guests are already having a blast creating amazing masterpieces with just their fingertips.”

 

WonderWorks Pigeon Forge is excited to announce a new exhibit, Magic Canvas, that returning and first-time guests will not want to miss. Magic Canvas gives people the ability to bring their artwork to life. They can simply draw the prompt given on the small screen, then watch it be enhanced and brought to life on the big screen. This gives people a fun way to create a STEAM masterpiece, as it combines art and technology.

 

With over 100 interactive hands-on exhibits for guests, there's something for everyone inside WonderWorks. They offer the perfect spot for family fun, gatherings with friends, sports team bonding, class field trips, and more. With over 42,000 square feet of “edutainment,” WonderWorks is an indoor amusement park for the mind. Activities include physical challenges, a space discovery zone, natural disaster simulators, light and sound experiences, and an illusion art gallery. WonderWorks Pigeon Forge is open daily from 9:00 a.m. to 9:00 p.m. this winter, with the last ticket sold one hour before closing. For more information, visit https://www.wonderworksonline.com/pigeon-forge/.

 

About WonderWorks

WonderWorks, a science-focused indoor amusement park, combines education and entertainment. With over 100 hands-on exhibits, there is something unique and challenging for all ages. Feel the power of 71 mph hurricane-force winds in the Hurricane Shack. Make giant, life-sized bubbles in the Bubble Lab. Get the NASA treatment in the Astronaut Training Gyro and experience zero gravity. Nail it by lying on the death-defying Bed of Nails. Conquer your fear of heights on the indoor Glow-In-The-Dark Ropes Course. For more information, visit WonderWorksTN.com, and follow @WonderWorksTN on Facebook and X (Twitter), @WonderWorks_TN on Instagram, and @WonderWorksOfficial on TikTok.

 

Healthy Habits - One Parent’s Perspective: The Adult Conversation on Youth Mental Health Is Missing the Mark

In a new blog series titled “One Parent’s Perspective,” CEF Executive Director Glen Weiner explores topics related to youth mental health and wellbeing, sharing his perspective as both a parent and his role leading CEF, including learnings and insights from conversations with experts, educators and young people themselves.

The first blog touches on a conversation Weiner recently had with his college-aged nephew, where he challenged a familiar claim in the discussion around youth wellbeing – that overuse of social media and phones is the leading driver of the decline in youth mental health. Weiner’s nephew was adamant that, while phones and social media can amplify stress and distractions, they are not alone responsible for the challenges his generation faces.

“Too often, though, we gravitate toward narrow answers that promise quick relief,” Glen wrote. “Focusing on one factor, such as the overuse of devices, risks obscuring the larger, more complicated reality our kids are living in.”

Read the full post here (an excerpt can be found below). Learn more about the importance of comprehensive solutions for youth mental health here.

I recently found myself in a spirited discussion with my college-aged nephew, the kind that starts casually and quickly turns revealing. It began with my daughter lamenting our decision to hold off on getting her a phone, which turned into a discussion about phone bans in schools, which brought us to the broader debate over youth mental health challenges. Without prompting, my nephew pushed back hard on a familiar claim – that overuse of social media and phones is the leading driver of the decline in youth mental health. He was adamant that, while phones and social media can amplify stress and distractions, they are not responsible for the challenges his generation faces.

That exchange stuck with me because it reflects a broader problem in how we approach youth mental health. Faced with rising anxiety, depression and disconnection among young people, many are understandably eager for solutions. Too often, though, we gravitate toward narrow answers that promise quick relief. Focusing on one factor, such as the overuse of devices, risks obscuring the larger, more complicated reality our kids are living in.

Youth mental health challenges do not stem from a single source. They are shaped by a web of interrelated pressures that look different for every child. Some young people struggle with social isolation or relentless academic expectations. Others face housing or food insecurity, exposure to violence, bullying or limited access to mental health care. Many spend less time outdoors and in unstructured play than previous generations. Technology intersects with these issues, but it does not replace them.

This is why comprehensive, lasting solutions matter. Policymakers and community leaders need to listen to a wide range of voices before settling on fixes. Parents, educators, clinicians, community organizations and young people themselves all see different parts of the picture.

Healthy Habits - Texas A&M Health: Rural Engagement Program

 The weeks and months leading up to baby’s arrival are filled with decisions. From choosing nursery colors to selecting the best diapers and bottles, expectant parents spend countless hours preparing for this life-changing event.

 

An even more critical decision for soon-to-be mothers is where to give birth. Expectant moms in larger cities often have multiple options, including birthing centers and community hospitals. It’s a different story entirely for many pregnant women living in rural Texas who have few—if any—nearby options for safely delivering their babies.

 

According to the March of Dimes report “Where You Live Matters: Maternity Care in Texas,” nearly half of Texas counties lack a hospital offering obstetric care, a birth center or adequate access to maternity providers. These conditions create “maternity care deserts” in many rural communities, leaving women without a safe, local facility to give birth.

 

The Center for Healthcare Quality & Payment Reform (CHQPR) reports higher risks of complications and death for both mothers and infants in communities without local maternity care services. The farther a woman must travel to receive maternity care, the greater her risk of maternal morbidity and adverse infant outcomes, including stillbirth and NICU admission.

 

Why rural labor and delivery units are closing

There are several reasons for the discrepancy in maternity care in rural communities compared to larger cities. One major factor is cost. Providing obstetric care—whether in urban or rural facilities—is expensive. Labor and delivery units must be staffed with specialized personnel around the clock. In addition, reimbursement rates from private insurance plans and Medicaid programs often do not cover the high cost of delivering safe, high-quality maternity care.

 

Urban hospitals are often able to offset labor and delivery expenses with revenue generated from other service lines such as orthopedics, cardiology and oncology. Rural hospitals, however, serve smaller patient populations and receive less overall revenue, making the financial burden of supporting a labor and delivery department especially challenging. As a result, these departments are often the first to be eliminated in rural hospitals.

 

Together, these factors point to a growing maternal health care crisis in Texas.

 

Innovative solutions for immediate impact

While health care professionals, policymakers and governmental agencies continue working toward long-term solutions, expectant mothers in rural communities are frequently forced to rely on the nearest emergency room for delivery or pregnancy-related complications, according to the National Rural Health Association. Many rural emergency departments (EDs), however, are not equipped to manage obstetric emergencies due to limited exposure to these cases.

 

Recognizing the need for immediate action, Texas A&M Health—with funding from the 89^thTexas Legislature through the Rural Engagement Program—has developed an innovative, practical solution to train emergency room personnel to care for expectant mothers in rural Texas. This initiative is the first in the state to develop this type of training specifically for rural health care facilities.

 

“While there are other simulation-based maternal safety programs, most efforts are centered in urban or tertiary settings,” said Jacquelyn Alvarado, DNP, director of rural maternal health at the Texas A&M Health Rural and Community Health Institute. “We are offering the training to rural EDs in communities without maternity care and those rural hospitals that have a low-volume labor and delivery unit (less than 100 births per year). Texas A&M’s initiative is among the first in Texas to scale this type of training for rural hospitals and critical access facilities.”

 

The training was developed with the Texas A&M College of Nursing and is multidisciplinary. It’s designed for emergency room physicians, advanced practice providers, registered nurses, emergency medical services and other staff who may be the first to respond to an obstetric emergency, Alvarado said. All members of the care team participate together, which strengthens communication and teamwork.

 

Hands-on training, delivered locally

Because rural health care providers often cannot travel to metropolitan areas for training, Alvarado brings mobile simulation directly to emergency departments across Texas. Her hands-on approach strengthens providers’ ability to respond quickly and effectively to obstetric emergencies, helping hospitals stabilize and manage critical patients within facilities that may not have been expressly designed to handle obstetrics.

 

“Our model is unique because the training takes place locally where teams can practice in their own environment,” Alvarado said. “This allows for highly realistic, team-based drills. Because the training is tailored to the local context, staff walk away with practical, immediately applicable lessons.”

 

Each session involves directed simulations with anatomically correct obstetric mannequins—MamaNatalie Birth Simulator. These advanced models have realistic pelvises, replaceable cervices and internal structures which allow medical professionals to engage in emergency scenarios and delivery complications.

 

Teams work through scenarios in real time, followed by a structured debriefing session. Trainings typically last four to six hours, though some hospitals opt for two-day intensives to allow for more staff rotations and multiple runs of each scenario.

 

The goal of these simulation drills is to increase confidence among emergency room staff and improve their ability to quickly recognize and stabilize life-threatening conditions.

 

Prepared in Pearsall

Cassandra DuBose, chief nursing officer for Frio Regional Hospital (FRH) in Pearsall—approximately 55 miles southwest of San Antonio—was among the first to schedule training with Alvarado. She wanted her nurses and emergency staff to be better prepared for maternal care cases that might arrive at their door. She said that Alvarado’s training greatly exceeded her expectations.

 

“She talked through real-life scenarios and visually demonstrated the best ways to handle complications,” DuBose said. “What we learned were things we could not have learned from watching a video.”

 

One particular emergency scenario Alvarado demonstrated to the FRH emergency staff was how to deliver a baby presenting with shoulder dystocia—a complication that occurs when the baby’s shoulder gets stuck behind the mother’s pubic bone or sacrum. Alvarado showed how to properly and safely facilitate this kind of delivery. She then encouraged the participants to practice the procedure on the training mannequin. As a result, the staff members left the training feeling confident in their ability to identify such an obstetric emergency and provide the proper care, DuBose said.

 

Overall DuBose was impressed with Alvarado’s genuine passion for preparing emergency room staff to manage a variety of maternal health complications.

 

“She created a safe environment for participants to ask questions and provided numerous references and materials,” she said.

 

DuBose and her staff have committed to participate in quarterly virtual refresher sessions to reinforce skills and review real-life case applications.

 

Keeping maternal care within reach

To date, Alvarado has completed six OB Emergency Simulation Trainings in cities across Texas, including Mitchell, Knox City, Ward, Haskell and Seymour. Each site received a MamaNatalie birth simulator mannequin for continued practice and training.

 

The goal, according to Alvarado, is to build a rotating calendar so rural hospitals across the state can be reached systematically, with quarterly refresher training to ensure sustained readiness.

 

“We’re not just responding to a crisis; we’re building a blueprint for sustainable maternal care in rural Texas,” Alvarado said. “Every mother deserves access to quality care, regardless of her ZIP code. Our mission is to make equitable, evidence-based care a reality in every rural community.”

 

 

ABOUT TEXAS A&M HEALTH

Texas A&M University Health Science Center (Texas A&M Health) comprises five colleges and schools (dentistry, medicine, nursing, pharmacy and public health), integrated University Health Services, several research centers and institutes, and numerous outpatient clinics with a shared mission of advancing health care for all. We serve the state and beyond with campuses and locations in Bryan-College Station, Dallas, Houston, Round Rock, Kingsville, Corpus Christi, McAllen and Navasota. Learn more at health.tamu.edu or follow @TAMUHealth on X (née Twitter).