Longitudinal associations between parental reflective functioning and maternal mind-mindedness.

Little work has examined longitudinal associations between parental reflective functioning (PRF) and mind-mindedness (MM), limiting the understanding of separate or bidirectional trajectories of these related but distinct forms of mentalization. We examined cross-lagged associations between PRF, assessed via interview, and MM, coded from play interactions, over 12 months among 90 parents (86% female; 57% White, 43% Black) of infants (Mage = 10.56 months, SD = 8.20) who were participating in The Michigan Model of Infant Mental Health Home Visiting. Data were collected at study enrollment Time 1 (T1) and at 6-month Time 2 (T2) and 12-month Time 3 (T3) postenrollment. Mind-minded comments were coded as appropriate, reflecting accurate interpretation of mental states or nonattuned, characterizing inaccurate interpretations. PRF and appropriate MM each remained stable over time. PRF at the T1 positively predicted appropriate MM at T2. No other cross-lagged associations between PRF and appropriate MM were significant. Concurrent correlations between appropriate MM and PRF were significant only at T3. Nonattuned MM showed stability from T1 to T2 but nonattuned MM at the T2 did not predict nonattuned MM at T3. Greater PRF at T1 predicted less nonattuned MM at T2. No other cross-lagged associations between PRF and nonattuned MM were significant. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Relationships reduce risks for child maltreatment: Results of an experimental trial of Infant Mental Health Home Visiting.

Background: Research examining the effectiveness of home visiting programs that reduce child maltreatment or associated risks yield mixed findings; some find positive significant impacts on maltreatment, whereas others find small to no effects. The Michigan Model of Infant Mental Health Home Visiting (IMH-HV) is a manualized, needs-driven, relationship-focused, home-based intervention service that significantly impacts maternal and child outcomes; the effect of this intervention on child maltreatment has not been sufficiently evaluated. Objective: The current study examined associations between treatment and dosage of IMH-HV and child abuse potential in a longitudinal, randomized controlled trial (RCT). Participants and setting: Participants included 66 mother-infant dyads (Mother M age = 31.93 years at baseline; child M age = 11.22 months at baseline) who received up to 1 year of IMH-HV treatment (Mdn = 32 visits) or no IMH-HV treatment during the study period. Methods: Mothers completed a battery of assessments including the Brief Child Abuse Potential Inventory (BCAP) at baseline and at the 12-month follow-up assessment. Results: Regression analyses indicated that after controlling for baseline BCAP scores, those who received any IMH-HV treatment had lower 12-month BCAP scores compared to those who received no treatment. Additionally, participation in more visits was associated with lower child abuse potential at 12 months, and a reduced likelihood of scoring in the risk range. Conclusion: Findings suggest that greater participation in IMH-HV is associated with decreased risk for child maltreatment 1 year after initiating treatment. IMH-HV promotes parent-clinician therapeutic alliance and provides infant-parent psychotherapy which differentiate it from traditional home visiting programs.

Parenting and Lead Mitigation at Home: A Multifaceted Community Partnership Model Promoting Parent Engagement in Lead Exposure Prevention.

Young children are at high risk of lead poisoning, which can damage early cognitive and behavioral development and have long-lasting impacts. Home environments are persistent sources of exposure for children in urban, low-income settings. Community-academic partnerships are essential for public health intervention strategies addressing residential household lead exposure, yet community organization staff and home visitors often experience strain and burnout. We describe Parenting and Lead Mitigation at Home, a multifaceted partnership project to (a) develop and implement a community-based, peer-delivered education program for parents of young children in neighborhoods at risk for home lead exposure and (b) support the home visitors delivering programming. We developed, delivered, and initially evaluated Lead 101, a lead-exposure prevention curriculum informed by the Community Organizing and Family Issues (COFI) model. The goals were to educate parents around lead exposure risks and empower parents to reduce their child's risk. We developed a novel Reflective Practice pilot curriculum designed to provide emotional support to peer educators and community organization staff who delivered home-based programming. We trained 11 peer educators who delivered Lead 101 to 62 families. We pilot-tested the Reflective Practice curriculum with five community organization staff. The implementation process and pilot evaluation data suggest increased parent knowledge and self-efficacy regarding mitigation of home-based lead hazards, and high satisfaction with reflective practice. Using this model to develop multifaceted partnerships among universities, community-based organizations, and focal communities may facilitate community-engaged program development for families and systematic support for individuals working directly with families, thereby indirectly promoting child health and well-being.

From zero to thrive: A model of cross-system and cross-sector relational health to promote early childhood development across the child-serving ecosystem.

Early relational health between caregivers and children is foundational for child health and well-being. Children and caregivers are also embedded within multiple systems and sectors, or a "child-serving ecosystem", that shapes child development. Although the COVID-19 pandemic has made this embeddedness abundantly clear, systems remain siloed and lack coordination. Fostering relational health amongst layers of this ecosystem may be a way to systematically support young children and families who are facing adversity. We integrate theory, examples, and empirical findings to develop a conceptual model informed by infant mental health and public health frameworks that illustrates how relational health across the child-serving ecosystem may promote child health and well-being at a population level. Our model articulates what relational health looks like across levels of this ecosystem from primary caregiver-child relationships, to secondary relationships between caregivers and child-serving systems, to tertiary relationships among systems that shape child outcomes directly and indirectly. We posit that positive relational health across levels is critical for promoting child health and well-being broadly. We provide examples of evidence-based approaches that address primary, secondary, and tertiary relational health, and suggest ways to promote relational health through cross-sector training and psychoeducation in the science of early development. This model conceptualizes relational health across the child-serving ecosystem and can serve as a template for promoting child health and well-being in the context of adversity.

La salud de la temprana relación entre quienes prestan cuidado y los niños es fundamental para la salud y el bienestar del niño. Los niños y quienes les cuidan forman parte de múltiples sistemas y sectores, o un "ecosistema de servicio al niño," que moldea el desarrollo del niño. Aunque la pandemia del COVID-19 ha demostrado abundante y claramente esta pertenencia, los sistemas permanecen aislados y les hace falta coordinación. Fomentar la salud de la relación entre las capas del ecosistema pudiera ser una manera de apoyar sistemáticamente a los niños pequeños y familias que se enfrentan con situaciones adversas. Presentamos un modelo conceptual con base en marcos de trabajo de la salud mental infantil y la salud pública que ilustra cómo la salud de la relación a lo largo del ecosistema de servicio al niño pudiera promover el desarrollo del niño al nivel de grupo de población. Nuestro modelo articula cómo aparece la salud de la relación a lo largo de los niveles del ecosistema desde las relaciones entre quien presta el cuidado primario y el niño, hasta las relaciones secundarias entre quienes prestan el cuidado y loa sistemas de servicio al niño, y las relaciones terciarias entre sistemas que amoldan directa e indirectamente los resultados en el niño. Una positiva salud de la relación a través de todos los niveles es esencial para promover la salud y el bienestar del niño de manera amplia. Describimos ejemplos específicos de salud de la relación primaria, secundaria y terciaria, y sugerimos maneras de promover la salud de la relación a través del entrenamiento intersectorial y la educación sicológica dentro de la ciencia del desarrollo temprano. Este modelo conceptualiza la salud de la relación a lo largo del ecosistema de servicio al niño y puede ser un esquema patrón para promover el desarrollo del niño dentro del contexto de situaciones adversas.

La Santé Relationnelle Précoce entre les personnes prenant soin des enfants et les enfants est fondamentale pour la santé de l'enfant et son bien-être. Les enfants et les personnes prenant soin d'eux sont encastrés dans de multiples systèmes et des secteurs, ou un « écosystème ¼ servant l'enfant qui forme le développement de l'enfant. Bien que la pandémie du Covid19 ait rendu cet encastrement très clair, les systèmes demeurent compartimentés et manquent de coordination. Cultiver la santé relationnelle au sein des couches de l'écosystème pourrait s'avérer être une manière de soutenir des jeunes enfants et les familles faisant face aux obstacles. Nous présentons un modèle conceptuel informé par les structures de la santé mentale du nourrisson et de la santé publique qui illustre la manière dont la santé relationnelle au travers de l'écosystème servant les enfants peut promouvoir le développement de l'enfant au niveau de la population. Notre modèle articule ce à quoi la santé relationnelle ressemble au travers des niveaux de l'écosystème, des relations entre la personne principale qui s'occupe de l'enfant et l'enfant aux relations secondaires entre les personnes prenant soin de l'enfant et les systèmes servant l'enfant, jusqu'aux relations tertiaires entres les systèmes qui donnent forme aux résultats directement et indirectement. Une santé relationnelle positive au travers de tous les niveaux est critique pour la promotion de la santé de l'enfant et de son bien-être en général. Nous décrivons des exemples spécifiques de santé relationnelle primaire, secondaire et tertiaire, et suggérons des manières de promouvoir la santé relationnelle au travers de la formation entre secteurs et de la psychoéducation dans la science du développement précoce. Ce modèle conceptualise la santé relationnelle au travers de l'écosystème servant l'enfant et peut servir de modèle pour la promotion du développement de l'enfant dans le contexte de l'adversité.

Infant mental health home visiting: intervention dosage and therapist experience interact to support improvements in maternal reflective functioning.

This study examined changes in parental reflective functioning (PRF) among mothers enrolled in Infant Mental Health-Home Visiting (IMH-HV) and explored whether parental risk, treatment dosage or therapist experience predicted change in PRF. Participants included 75 mothers and their children who were enrolled in IMH-HV delivered by Community Mental Health therapists. Results indicated significant improvements in PRF from baseline to 12-months. Maternal demographic and psychosocial risk, therapist experience and treatment dosage were not directly associated with changes in PRF. However, Mothers who received more treatment sessions from therapists with six or more years of experience demonstrated the greatest improvements in PRF, while mothers who received more treatment sessions from therapists who had been practicing IMH for less than 15 months showed a decline in PRF. Therapists working with very high-risk families may need specific training and ongoing reflective supervision over a period of years to promote improvement in PRF.

Predictors of Intimate Partner Violence Victimization by Multiple Partners Over a Period of 8 Years.

Intimate partner violence (IPV) is a pervasive social issue with broad physical and mental health implications. Although 35%-56% of women report IPV victimization with more than one violent partner, few studies have identified factors that increase the risk of experiencing IPV across multiple partners (i.e., IPV reengagement). In the current study, multilevel modeling was used to examine the roles of trauma exposure, mental health, and sociodemographic factors in the risk for reengagement in a sample of women (N = 120) with IPV victimization. Participants were drawn from a randomized control trial of an intervention for mothers who had experienced IPV. The results revealed that more psychological but less sexual IPV was associated with increased reengagement. Higher degrees of posttraumatic reexperiencing symptoms were associated with less reengagement. Depressive symptoms were also significantly associated with reengagement such that lower levels of positive affect and increased somatic symptoms were associated with increased reengagement. Higher income levels and less housing instability were associated with more reengagement, ßrange = -.13-.16. Finally, compared to the control condition, participation in the intervention program was significantly associated with lower levels of reengagement at 8-year follow-up, ß = -.75, p = .001. These findings suggest that it is not what happened (i.e., experiences of abuse) but rather a woman's posttraumatic experience (i.e., posttraumatic stress and depressive symptoms) that creates risk for reengagement. The findings support the long-term effectiveness of a brief intervention in reducing reengagement.

Locating Infant and Early Childhood Mental Health at the Heart of Social Work.

Infant and early childhood mental health (IECMH)-an interdisciplinary field dedicated to advancing understanding of early relationships, socioemotional development, and cultural and contextual influences on caregiving-offers essential tools for social workers to support the well-being of infants, toddlers, preschoolers, and their families. Even though social worker Selma Fraiberg was a founder of the field, and social workers are central to the work of assessment and intervention with young children and their caregivers in many settings, few schools of social work offer training in IECMH, and few social workers are familiar with its core principles, scholarship, and intervention approaches. In this article, faculty members from four U.S. social work programs address the vital role of IECMH in social work training, research, and practice as well as issue a call to the field to recover and renew commitment to a practice perspective and knowledge base with roots in social work. Twenty-five years ago, Social Work published a similar call, but the request has gone largely unheeded. The authors examine the changing landscape and argue that it is more important and timelier than ever for social workers to learn and integrate the relationship-based approach to promotion, prevention, intervention, and treatment offered by IECMH.

Maternal History of Adverse Experiences and Posttraumatic Stress Disorder Symptoms Impact Toddlers' Early Socioemotional Wellbeing: The Benefits of Infant Mental Health-Home Visiting.

BACKGROUND: The present study examined the efficacy of the Michigan Model of Infant Mental Health-Home Visiting (IMH-HV) infant mental health treatment to promote the socioemotional wellbeing of infants and young children. Science illuminates the role of parental "co-regulation" of infant emotion as a pathway to young children's capacity for self-regulation. The synchrony of parent-infant interaction begins to shape the infant's own nascent regulatory capacities. Parents with a history of childhood adversity, such as maltreatment or witnessing family violence, and who struggle with symptoms of post-traumatic stress may have greater challenges in co-regulating their infant, thus increasing the risk of their children exhibiting social and emotional problems such as anxiety, aggression, and depression. Early intervention that targets the infant-parent relationship may help buffer the effect of parental risk on child outcomes. METHODS: Participants were 58 mother-infant/toddler dyads enrolled in a longitudinal randomized control trial testing the efficacy of the relationship-based IMH-HV treatment model. Families were eligible based on child age (<24 months at enrollment) and endorsement of at least two of four socio-demographic factors commonly endorsed in community mental health settings: elevated depression symptoms, three or more Adverse Childhood Experiences (ACEs) parenting stress, and/or child behavior or development concerns. This study included dyads whose children were born at the time of study enrollment and completed 12-month post-baseline follow-up visits. Parents reported on their own history of ACEs and current posttraumatic stress disorder (PTSD) symptoms, as well as their toddler's socioemotional development (e.g., empathy, prosocial skills, aggression, anxiety, prolonged tantrums). RESULTS: Maternal ACEs predicted more toddler emotional problems through their effect on maternal PTSD symptoms. Parents who received IMH-HV treatment reported more positive toddler socioemotional wellbeing at follow-up relative to the control condition. The most positive socioemotional outcomes were for toddlers of mothers with low to moderate PTSD symptoms who received IMH-HV treatment. CONCLUSION: Results indicate the efficacy of IMH-HV services in promoting more optimal child socioemotional wellbeing even when mothers reported mild to moderate PTSD symptoms. Results also highlight the need to assess parental trauma when infants and young children present with socioemotional difficulties.

The Michigan infant mental health home visiting model.

Selma Fraiberg's pioneering work with infants, toddlers, and families over 40 years ago led to the development of a field in which professionals from multiple disciplines learned to work with or on behalf of infants, very young children, their parents, and the relationships that bind them together. The intent was to promote social and emotional health through enhancing the security of early developing parent-child relationships in the first years of life (Fraiberg, 2018). Called infant mental health (IMH), practitioners from fields of health, education, social work, psychology, human development, nursing, pediatrics, and psychiatry specialize in supporting the optimal development of infants and the developing relationship between infants and their caregivers. When a baby is born into optimal circumstances, to parents free of undue economic and psychological stressors and who are emotionally ready to provide care and nurturing for an infant's needs, an IMH approach may be offered as promotion or prevention, with the goal of supporting new parent(s) in developing confidence in their capacity to understand and meet the needs of the tiny human they are coming to know and care for. However, when parental history is fraught with abandonment, loss, abuse or neglect, or the current environment is replete with economic insecurity, threats to survival due to interpersonal or community violence, social isolation, mental illness, or substance abuse, the work of the IMH therapist may require intervention or intensive treatment and becomes more psychotherapeutic in nature. The underlying therapeutic goal is to create a context in which the baby develops within the environment of a parent's nurturing care without the psychological impingement that parental history of trauma or loss or current stressors such as isolation, poverty, or the birth of a child with special needs, can incur.

MIXED-METHODS EVALUATION OF PARTICIPANT RECRUITMENT AND RETENTION IN THE MOM POWER PARENTING INTERVENTION PROGRAM.

Parenting group success begins with attendance. Using archival pilot data from 99 mothers who enrolled in the Mom Power (MP) parenting intervention, this study sought to understand the factors that influenced participant engagement and retention. MP is a group-based, early intervention program grounded in attachment theory that utilizes motivational interviewing as a core component to enhance program engagement. Study aims were to qualitatively describe the reasons why mothers were interested in participating in the program, including what they hoped to gain from the experience, and to quantitatively examine the extent to which attendance was associated with demographic, experiential, and psychosocial factors. The qualitative analysis of intake interviews revealed that mothers expected the MP intervention to provide a warm environment for themselves and their children as well as to support and enhance their parenting, and 95% revealed their hopes that the intervention would help them grow and develop as women. Attendance rates were relatively high, with 62% of mothers missing less than one group session. Quantitative analyses using multiple regression to test associations of demographic, experiential, and psychosocial factors with attendance rates were not significant. Results suggest that motivational interviewing may be an important component in promoting participant engagement efforts in parenting interventions.

A community-based randomized controlled trial of Mom Power parenting intervention for mothers with interpersonal trauma histories and their young children.

We conducted a study to evaluate the effectiveness of Mom Power, a multifamily parenting intervention to improve mental health and parenting among high-risk mothers with young children in a community-based randomized controlled trial (CB-RCT) design. Participants (N = 122) were high-risk mothers (e.g., interpersonal trauma histories, mental health problems, poverty) and their young children (age <6 years), randomized either to Mom Power, a parenting intervention (treatment condition), or weekly mailings of parenting information (control condition). In this study, the 13-session intervention was delivered by community clinicians trained to fidelity. Pre- and post-trial assessments included mothers' mental health symptoms, parenting stress and helplessness, and connection to care. Mom Power was delivered in the community with fidelity and had good uptake (>65%) despite the risk nature of the sample. Overall, we found improvements in mental health and parenting stress for Mom Power participants but not for controls; in contrast, control mothers increased in parent-child role reversal across the trial period. The benefits of Mom Power treatment (vs. control) were accentuated for mothers with interpersonal trauma histories. Results of this CB-RCT confirm the effectiveness of Mom Power for improving mental health and parenting outcomes for high-risk, trauma-exposed women with young children. ClinicalTrials.gov Identifier: NCT01554215.

RESTORING SAFETY: AN ATTACHMENT-BASED APPROACH TO CLINICAL WORK WITH A TRAUMATIZED TODDLER.

This clinical case study explores the integration of infancy research, brain development, attachment theory, and models of infant-parent/child-parent psychotherapy to address the needs of abused and neglected young children placed in foster or adoptive homes. Traumatized children employ defensive strategies to survive when there is no "good enough" caregiver (D.W. Winnicott, 1953, p. 94), and helping professionals can provide therapeutic experiences to develop or restore a child's sense of safety. With the case example of Anthony and his foster/adoptive parents, I illustrate how to manage and contain a traumatized child's terror, rage, and grief through therapeutic sessions with the parent and child together, and supportive parental guidance. I promote attention to the child's ability to self-integrate and to regulate his own affect, and encourages secure-base parental responses that facilitate a child's shift toward secure attachment behavior.