Minding the Baby Home Visiting: Program Evaluation
Study Details
Study Description
Brief Summary
This is an efficacy study of an intensive home visitation intervention, "Minding the Baby" (MTB). This reflective parenting program (aimed at enhancing maternal reflective capacities), is focused on first-time young mothers and infants living in an urban community. The study, grounded in attachment and human ecology theories integrates advanced practice nursing and mental health care by pairing master's level nurse practitioners and social workers with at-risk young families. Aims of the study are: 1) to determine the efficacy of the MTB intervention in young mothers and infants with respect to a) maternal outcome variables including the quality of the mother-infant relationship, maternal reflective capacities, maternal mastery/self-efficacy, parental competence, and maternal health and life course outcomes (educational success, employment, delaying subsequent child-bearing); and b) infant outcome variables including early attachment, infant health, and developmental outcomes; 2) to monitor fidelity and dose of the program with young mothers; 3) to describe the evolution of reflective capacities in adolescent mothers (contrasting intervention group with control group) through descriptive qualitative analyses of transcribed Pregnancy Interviews and Parent Development Interviews at the last trimester of pregnancy and at 24 months; 4) to conduct cost-effectiveness analyses of the program. The longitudinal two-group study (subjects nested within randomly assigned groups), will include multi-method (self report, interview and direct observation and coding of behaviors) approaches with a cohort of first-time multi-ethnic mothers between the ages of 14-25 (and their infants). MTB home visits occur weekly for intervention families (n=69) beginning in mid pregnancy and continuing through the first year, and then bi-weekly through the second year. Mothers and infants (n=69) in the control group will receive standard prenatal, postpartum and pediatric primary care in one of two community health centers (as will the intervention group) and also receive monthly educational materials about child health and development mailed to their homes. Maternal and infant outcome variables will be followed over time (pregnancy, 4, 12, and 24 months) as well as compared between the 2 groups. Cost analyses and analysis of the dose and sample characteristics linked to efficacy, will allow us to plan for translation of the model into clinical care and community sustainability.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
N/A |
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Experimental: Home visits
|
Behavioral: Minding the Baby Home Visiting Program
Weekly home visits for one year followed by bi-weekly home visits until child is 24 months of age provided to young at risk families by a team of nurse practitioner and social worker home visitors
|
| No Intervention: routine primary care at community health center
|
Outcome Measures
Primary Outcome Measures
- Maternal reflective capacities [27 months]
Coded interview data from Pregnancy Interviews in third trimester and Parent Development Interviews at 24 months.
- Infant Attachment [14 months]
Attachment pattern of child as measured by Strange Situation Procedure
- Maternal life course outcomes [24 months]
Ability to delay rapid subsequent childbearing within 24 months of first child's birth
- child abuse or neglect [24 months]
Reports of an open case with child protective services for parents and children within the study; documented by interview and health record
Secondary Outcome Measures
- Dose of intervention [24 months]
Frequency, duration and content of home visits during the intervention
- cost analysis for the program [27 months]
cost analysis of program and outcomes regarding health and health service use
- Description of reflective functioning in pregnant adolescents [baseline]
qualitative analysis of Pregnancy Interview transcripts from adolescent participants in third trimester of pregnancy
Eligibility Criteria
Criteria
Inclusion Criteria:
-
Having a first child
-
Speak English
-
Obtains primary care from community health centers
Exclusion Criteria:
- No psychoses or terminal illnesses
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Fair Haven Community Health Center | New Haven | Connecticut | United States | 06511 |
| 2 | Cornell Scott Hill Health Center | New Haven | Connecticut | United States | 06519 |
Sponsors and Collaborators
- Yale University
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
Investigators
- Principal Investigator: Lois S Sadler, PhD, Yale University
Study Documents (Full-Text)
None provided.More Information
Publications
- Flaherty SC, Sadler LS. A review of attachment theory in the context of adolescent parenting. J Pediatr Health Care. 2011 Mar-Apr;25(2):114-21. doi: 10.1016/j.pedhc.2010.02.005. Epub 2010 May 1. Review.
- Sadler LS, Newlin KH, Johnson-Spruill I, Jenkins C. Beyond the medical model: interdisciplinary programs of community-engaged health research. Clin Transl Sci. 2011 Aug;4(4):285-97. doi: 10.1111/j.1752-8062.2011.00316.x.
- 17098
- R01HD057947