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 their 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 clinicians (pediatric nurse practitioner and a social worker) 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/selfefficacy, 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 (PI) and Parent Development Interviews (PDI) at the last trimester of pregnancy and at 24 months;4) to conduct costbenefit/ 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 of the child's life. 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 detailed 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.

Public Health Relevance

PROJECT RELEVANCE This is a study of Minding the Baby (MTB), a home visiting program (beginning in pregnancy and extending until the child's second birthday) for young families living in an urban community. MTB is a unique preventive program that is implemented by master's-trained home visitors (nurse and social worker), provides direct mental health services during home visits, and focuses on the mother's capacity to understand her infant's emotional needs as well as provide the needed physical care. The study will evaluate the effects and the costs/benefits of the program with young first-time at-risk mothers, their children, and families.

Agency
National Institute of Health (NIH)
Institute
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Type
Research Project (R01)
Project #
5R01HD057947-05
Application #
8512753
Study Section
Nursing Science: Children and Families Study Section (NSCF)
Program Officer
Haverkos, Lynne
Project Start
2009-09-30
Project End
2014-08-31
Budget Start
2013-09-01
Budget End
2014-08-31
Support Year
5
Fiscal Year
2013
Total Cost
$497,505
Indirect Cost
$192,781
Name
Yale University
Department
None
Type
Schools of Nursing
DUNS #
043207562
City
New Haven
State
CT
Country
United States
Zip Code
06520
Ordway, Monica Roosa; Sadler, Lois S; Dixon, Jane et al. (2014) Lasting effects of an interdisciplinary home visiting program on child behavior: preliminary follow-up results of a randomized trial. J Pediatr Nurs 29:3-13
Ordway, Monica R; Sadler, Lois S; Dixon, Jane et al. (2014) Parental reflective functioning: analysis and promotion of the concept for paediatric nursing. J Clin Nurs 23:3490-500
Moriarty Daley, Alison; Sadler, Lois S; Dawn Reynolds, Heather (2013) Tailoring clinical services to address the unique needs of adolescents from the pregnancy test to parenthood. Curr Probl Pediatr Adolesc Health Care 43:71-95
Sadler, Lois S; Slade, Arietta; Close, Nancy et al. (2013) Minding the Baby: Enhancing reflectiveness to improve early health and relationship outcomes in an interdisciplinary home visiting program. Infant Ment Health J 34:391-405
Flaherty, Serena Cherry; Sadler, Lois S (2011) A review of attachment theory in the context of adolescent parenting. J Pediatr Health Care 25:114-21
Sadler, Lois S; Newlin, Kelley H; Johnson-Spruill, Ida et al. (2011) Beyond the medical model: interdisciplinary programs of community-engaged health research. Clin Transl Sci 4:285-97