Engaging Indigenous communities in research to inform practice: The multisite implementation evaluation of Tribal home visiting
Community engagement (CE) is widely acknowledged as a way to enhance the ethics, rigor, and impact of research. Additionally, CE is a demonstrated way to integrate Indigenous and colonial (western) research systems. For these reasons and others, designers of the Multi-site Implementation Evaluation of Tribal Home Visiting (MUSE) used a community-engaged approach to study the implementation of federally funded home-visiting programs across 17 Indigenous communities throughout the United States. This paper describes MUSE's community-engaged approach and its practical applications from the perspective of the MUSE study team. The paper highlights key outcomes attributable to CE, addresses barriers to CE, and details responses to these barriers and their impacts. Adding to the rich evidence base demonstrating the value of community-engaged approaches, MUSE demonstrates that in-depth CE is feasible and valuable in multisite studies done in partnership with Indigenous communities.
Characteristics and outcomes of infants admitted to a parent-infant inpatient psychiatric unit: A pilot study
Inpatient parent-infant psychiatric units (PIUs) are considered "gold standard" for treating maternal mental illness, with well-documented positive outcomes for mothers. However, little research addresses outcomes for infants in these units, who often face significant developmental and socio-emotional adversity. This pilot study aimed to evaluate the characteristics and progress of an Australian PIU population, focusing on the impact of PIU admission on infant outcomes. Over 3 months, 31 consecutively admitted mother-infant pairs (dyads) were assessed through interviews, observations, and standardized measures to evaluate maternal and infant characteristics and progress from admission to discharge. Maternal well-being and the mother-infant relationship improved. Infants exhibited high levels of physical (29%) and developmental concerns (80.6%). 22.6% receiving an Axis I infant mental health diagnosis. Infant socio-emotional responsiveness improved significantly, as measured by the modified Alarm-Distress Baby Scale, indicating a positive impact of PIU admission. The small sample size and reliance on clinician-observed measures limit the generalizability of the findings. PIU infants are particularly vulnerable, and PIU admission may ameliorate socio-emotional responsiveness. Further research with larger samples and extended follow-up is needed to determine the most effective intervention strategies during and after PIU admission to maximize benefits for these infants.
Enlisting toddler cooperation through structure and autonomy support: The amplifying role of suboptimal relationship mutuality
Regular repair of normative mother-toddler conflict is required for relational health; yet, we still need improved delineation of regulation strategies that can promote child cooperation. Contemporary conceptualizations of positive parenting propose that structure and autonomy support each facilitate children's optimal engagement; however, toddler studies rarely address their joint impact and conditional moderation. This observational study examined both dimensions in predicting cooperation among 106 U.S. 30-month-olds and their primarily European-American mothers during a demanding request situation. We also assessed mutuality, an indicator of mother-child relationship quality, from two situations with minimized power differentials to explore whether it moderated associations. Regression analyses confirmed the unique and additive impact of both maternal behavioral dimensions in predicting toddler cooperation and also an interaction effect such that the positive association between maternal autonomy support and toddlers' level of cooperation was accentuated depending on the dyads' mutuality. Results suggest that maternal structure and autonomy support may serve as effective approaches for enlisting or maintaining child cooperation during hierarchical negotiations, and that suboptimal relationship mutuality magnifies toddlers' responses to maternal levels of autonomy support. Findings are likely relevant to parenting programs that advance mother-child relational health during the transition from infancy to early childhood.
Scaling up Attachment and Biobehavioral Catch-up with Latine families: Implementation processes and effectiveness
Attachment and Biobehavioral Catch-up (ABC) is an evidence-based early intervention promoting attachment security and self-regulation by enhancing parental sensitivity. When scaling up an evidence-based intervention to the community, it is essential to consider families' preferences and cultural values to ensure cultural appropriateness, while maintaining fidelity to the intervention's core components. In this article, we aimed to test the effectiveness of ABC in improving parental sensitivity when implemented in Spanish at a community level in the USA. The effectiveness of ABC when implemented in Spanish in the community was assessed through pre-post changes in observed parental sensitivity in 79 Latine families with children ages 6 months to 4 years. Parental sensitivity increased from pre- to post-test, with a similar effect size to previous studies (d = .67). Results and practice implications are discussed, highlighting the importance of the support to providers reaching families of diverse origins.
Evaluation of the Pregnancy to Parenthood program: A dyadic intervention for mothers with perinatal mental disorders and their infants
Dyadic interventions targeting maternal mental health and the mother-infant relationship in the perinatal period are critical due to the potential consequences of perinatal mental illness and relational disturbance for the mother, the infant, and their family. This paper describes the Pregnancy to Parenthood (P2P) model of care, a dyadic mother-infant community-based program designed to support vulnerable families in Western Australia in the context of an identified need to build workforce capacity. A pragmatic service evaluation study was conducted by analyzing routine clinical data collected from 105 dyads who completed pre- and post-intervention measures, including the Edinburgh Postnatal Depression Scale (EPDS), Perinatal Anxiety Screening Scale (PASS), and the Mother Object Relations Scale-Short Form (MORS-SF). Reliable change index and cut-off analyses indicated a clinically reliable pre-post reduction in perinatal depressive and anxiety symptoms for 71% and 68% of the sample, respectively. Significant pre-post improvements with medium effect sizes (r = -.46, r = -.32) were found for caregiving representations on the MORS-SF, suggesting representations became more balanced. These results provide provisional evidence that the P2P model of care may be effective in improving maternal mental health and caregiving representations. Further research is required to evaluate the efficacy of P2P in relation to enhancing family well-being, and to inform policy and mental health service development.
Self-criticism, maternal emotional distress, and maternal hostility among Bedouin mothers with preterm infants
This study examined the links between maternal self-criticism, maternal postpartum emotional distress (PPED), and maternal non-hostility among Arab-Bedouin mothers living in southern Israel. We proposed a moderated mediation model in which self-criticism would be related to PPED, which, in turn would be related to maternal non-hostility. One hundred five Arab-Bedouin mothers and their preterm (n = 48) and full-term (n = 57) infants were recruited shortly after birth and were followed up when infants were 6 months old (corrected for prematurity). The self-report measures were done shortly after birth, and, the measurement of observation was done at the 6-month visit. Findings demonstrated evidence for a moderated mediation model in which higher levels of maternal self-criticism correlated over time with higher levels of maternal PPED, and this, in turn, predicted lower levels of maternal non-hostility. This model was found only among the preterm group.
Possibilities and power during early Head Start Home visits: Comparing family- and home visitor-opened decision-making
Decision-making by families and professionals about how to support children's development is an integral aspect of home visits. This study investigated home visit decision-making in a US program for families experiencing poverty, Early Head Start (EHS), through the following questions: What types of decisions do home visitors and families make about children's development during EHS home visits? How and to what extent do home visitors and families participate during these decisions? A convergent mixed methods research design was implemented to investigate participation through frequency counts and discourse analysis of home visit transcripts. Home visitor participants were four women, three white and one Black. Twelve families participated (12 mothers, 2 fathers). Parents identified as white (n = 8), Black (n = 3), and multiracial (n = 3; Black and white). One parent was a bilingual Arabic and English speaker. A total of 66 decisions about children's development were identified, with 49 decisions initiated by home visitors and 17 initiated by families. Although families talked more and took on active roles when they initiated (i.e., opened) decisions, home visitors predominantly controlled decision-making. Quantitative and qualitative participation differed only in the beginning of family-opened decisions, and home visitors gradually took more control.
Actively changing the narrative: An exploration of culturally grounded parenting and social skills
Recognizing culturally salient aspects of socialization practices and understanding how these practices support culturally valued aspects of development is an integral component in conducting anti-racist research and validating the lived experiences of minoritized families. With this aim, we explored how Active Direction, an observational rating of an African American approach to parenting measured during mother-child interactions at age 2.5 (n = 172), supported social skills and emotion regulation for children living in a Southwestern metropolitan area of the United States concurrently, in kindergarten (n = 109), and in 1st grade (n = 108). Descriptive findings indicated few significant associations between Active Direction and socials skills or emotion regulation. Exploratory analyses, which included traditional parenting behavior measures of Sensitivity and Intrusiveness, also indicated limited significant relations between any measure of parenting and child skills. However, moderation analyses indicated that high levels of Active Direction attenuated the effects of sensitivity on aspects of child social skills. The lack of significant findings across the current study highlight how extant measures-of child social skills and parentings behaviors-are not performing as expected within these African American families.
Maternal self-efficacy during infancy: Investigating the roles of depression and social support among mothers in rural Pakistan
Maternal self-efficacy during infancy is shaped by many factors, including maternal mental health and social support. This study examines how depression, emotional support, and childcare support relate to maternal self-efficacy among mothers of infants in rural Pakistan. Participants included 885 mothers assessed at 3 and 6 months postpartum. At 3 months postpartum, mothers completed interview measures of depression, emotional social support, support with day-to-day childcare tasks (daily childcare support), and childcare support when they were unable to care for their child (childcare support when needed). At 6 months postpartum, participants reported on maternal self-efficacy. Generalized estimating equations were used to test the associations between depression and social support at 3 months and maternal self-efficacy at 6 months, as well as the interaction between depression and social support. Depression at 3 months was not associated with maternal self-efficacy at 6 months when controlling for depression at 6 months. Emotional support was associated with increased self-efficacy, but daily childcare support was not. We found weak evidence that childcare support when needed was associated with increased self-efficacy only among mothers with depression. Results suggest that emotional support and childcare support when needed may be helpful for promoting mothers' self-efficacy.
"When I hold my daughter, she quiets, no need [for]any verbal conversation": A qualitative understanding of responsive caregiving in rural, Sindh Pakistan
Responsive caregiving is associated with secure attachment and positive child developmental outcomes. However, there is some debate on whether responsive caregiving is a universal construct. Few studies have researched responsive caregiving in diverse cultural settings, particularly in low- and middle-income countries. In this study, we explore if and how responsive caregiving is conceptualized among mothers of children under 3-years-old in rural, Sindh Pakistan. A phenomenological qualitative study was implemented in Naushahro Feroze through in-depth interviews with twenty mothers. Mothers were asked about their aspirations for their children and how they would respond in a variety of different scenarios. Data were analyzed using thematic content analysis with an inductive-deductive coding scheme. There was substantial variation in mothers' described responsive behaviors and beliefs. Almost all mothers described using some form of responsive parenting. Responding to children's demands while the mother was preoccupied, using verbal responses to console children, and if mothers believed that children should be praised, lacked consensus. Most mothers described using breastfeeding for consolation and highlighted the importance of immediately consoling their crying child. The results suggest that there is a need for a more nuanced approach to understand caregiver behaviors across contexts.
The effects of parental marital quality on preschool children's social-emotional competence: The chain mediating model of parent-child and sibling relationships
With the swift advancements in China's education system and society, preschool children's social-emotional competence is becoming increasingly important for adapting to complicated situations. While research shows parental marital quality as a key factor, studies on its specific mechanisms within the Chinese context are limited. Grounded in the framework of family systems theory and incorporating perspectives from the spillover hypothesis, emotional security theory, and attachment theory, this research explores how parental marital quality influences preschool children's social-emotional competence, emphasizing the mediating roles of parent-child and sibling relationships in China. This study examined 227 preschool children (124 boys and 103 girls) from two-child families in six kindergartens across China as research participants. Mother reports on the quality of marital, sibling, and parent-child relationships were collected cross-sectionally to assess the direct and indirect effects on children's social-emotional competence using path models. Results show that parental marital quality positively influences preschool children's social-emotional competence. Additionally, parent-child and sibling relationships not only serve as independent mediators but also create a chain mediating effect. This finding emphasizes the importance of parental marital quality in shaping preschool children's social-emotional competence. It underscores the necessity of nurturing healthy parent-child and sibling interactions via family education.
Low-income fathers are emotionally resilient: A qualitative exploration of paternal emotions across early parenting
Emotions play an important role in fostering positive parenting and healthy child development. This qualitative study explored the affective experiences of racially diverse US fathers with low income across the prenatal, postnatal, and early childhood periods. Semi-structured interviews were conducted with 24 fathers. Interview questions asked about fathers' early parenting experiences that elicit parenting emotions of different valence. Results from thematic analysis demonstrated activation of multiple emotions depending on different proximal and distal experiences. Specific to proximal experiences, fathers reported feeling both excited and anxious about pregnancy and joyful and disappointed at childbirth. Related to distal experiences, fathers reported feeling encouraged by their social support networks that further aid their parenting, but feeling marginalized given systematic barriers (e.g., societal bias, high incarceration rates of Black fathers). Most importantly, fathers' parenting emotions, especially negative ones, led to them resolving to stay involved in their children's lives, gaining a sense of responsibility, and changing behaviors to do right by their children. Fathers resorted to various coping strategies to regulate their negative emotions. Overall, fathers with low income are emotionally resilient. Infant and early childhood health professionals should support fathers' mental health to promote father-child engagement and thus, ultimately, young children's mental health and wellbeing.
Examining the relationship between parents' self-reported mindfulness and observed language use in attachment-relevant communication
Parents' language use is an important context for early socialization. We examined the relationship between parents' self-reported mindfulness and observed language use in two forms of attachment-relevant communication. Sixty-three parents of 6-18-month-old infants from Australia (n = 32) and New Zealand (n = 31) completed the five facets of mindfulness-short form (FFMQ-SF) questionnaire, the adult attachment interview (AAI), and a 10-min play session with their infant. We examined parents' frequency of word usage within the categories of the linguistic inquiry word count (LIWC) text analysis program to explore the relationship between mindfulness and language use. Mindfulness was associated with cognitive, affective, perceptual, and time orientation language use in the AAI. However, fewer associations were identified between mindfulness and language use in the parent-infant play session. Results are discussed in terms of their relevance to mindfulness and attachment.
Mother-infant bonding: The role of postpartum depression, violence, and bonding established with one's own mother during childhood
Mother-infant bonding is influenced by several risk and protective factors, and the literature has investigated the relationships between these factors independently. This study aimed to verify the interrelationships of some of these factors and how they influence mother-infant bonding in Brazil. In this study, 361 mothers participated, and the outcome variable of mother-infant bonding was assessed using the Postpartum Bonding Questionnaire (PBQ). Multivariate regression analysis was performed using a hierarchical model with three blocks structured according to the influence exerted on mother-infant bonding. The PBQ's factor scores were estimated and used in the subsequent analyses to decrease measurement error. The variable "violence experienced by mothers" was statistically significant for explaining the second block model but not significant for the third block. Network analysis was performed after multiple regression, showing that the violence experienced by mothers does not directly influence mother-infant bonding but rather is mediated by postpartum depression. This explains why violence is not significant in the hierarchical multiple regression when maternal depression is added to the model. This study's strengths lie in its utilization of PBQ factor scores and network analysis, enabling the estimation of conditional relationships among variables. This approach provides deeper insights into factors affecting mother-infant bonding.
Development of coparenting during the transition to parenthood: Integrating parents' representations with observed interactions
The transition to parenthood is a significant period of transformation and adjustment for all members of a new family, reshaping relational dynamics that often endure throughout the initial years of a child's life. This qualitative and longitudinal study aimed to explore coparenting representations held by both partners in a parental couple, along with observations of their family interactions, at three distinct points in time, with the aim to better understand the interaction between these representational and behavioral observations. In-depth interviews were conducted with 17 heterosexual, first-time parents in Santiago de Chile, during pregnancy and at two different times during the first year of their child's life. Family interactions were assessed using the Lausanne Trilogue Play task (LTP) on all occasions. Three main coparenting representation categories emerged: traditional, ambiguous, and co-responsible. On observation, approximately half of the couples showed cooperative coparenting interactions, while the other half had conflictual interactions. Couples generally followed stable trajectories over time. Cooperative couples demonstrated co-responsibility and open dialogue, while conflictual couples tended to follow traditional gender roles with tacit communication styles. This study highlights the importance of promoting co-responsibility and dialogue for fostering cooperative relational dynamics during the critical transition to parenthood.
An invited commentary on mentoring in infant mental health: A symposium commemorating Robert N. Emde
This paper is based on a symposium on mentoring in infant mental health that took place at the 18th World Association for Infant Mental Health (WAIMH) conference. The symposium commemorated Robert N. Emde who was one of the founders of the field of Infant Mental Health, and devoted much of his career to mentorship. From an IMH perspective, mentoring experiences are best thought of as relationships, significant for both mentor and mentee, with positive mentoring experiences crucial for the development of IMH clinicians and researchers. The symposium participants, two pairs of mentor-mentee dyads, first gave an opening statement about what mentoring meant for them generally and personally, and then addressed three issues: the goodness of fit between mentor and mentee, "light and shadow" in mentoring relationships, and balancing old wisdom with new trends in mentoring. The paper brings the participants' views and personal experiences regarding these issues in their own words, highlighting key personal and professional issues related to mentorship from the perspectives of both mentor and mentee.
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Savoring impacts parents' emotions and parent-child relationship quality. Using data from a randomized controlled trial (N = 164 mothers of 18-27-month-olds, 37 interveners) conducted with a community sample in the United States, this study examined predictors of fidelity and treatment outcomes across two savoring preventative interventions (relational savoring and personal savoring). Treatment outcome indicators were selected from a battery administered immediately post-intervention (maternal closeness to child) and at a 3-month follow-up (maternal sensitivity, reflective functioning). We examined whether intervener education level (bachelor's degree/no bachelor's degree) predicted fidelity (Research Question 1), whether intervener education level predicted treatment outcomes (Research Question 2), and whether fidelity predicted treatment outcomes (Research Question 3). In many cases, intervener education background was not related to fidelity or treatment outcome; however, interveners without bachelor's degrees showed greater adherence to the protocols on some scales (higher positivity, higher secure base, higher calm matching) and sessions with these interveners were associated with greater increases in maternal sensitivity. Regardless of the intervener education level, redirecting attention to the positive and calmly matching participants' tone were associated with higher maternal reflective functioning, and higher secure base scores were associated with greater closeness. Findings have implications for the training and implementation of prevention programs for parents.
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This study examined the associations between maternal depression and oxytocin in pregnancy, caregiving sensitivity and adult attachment style, and infant temperament. One hundred and six women recruited from a public hospital antenatal clinic in Australia, and their infants completed assessments at three time points (Time 1: pregnancy; Time 2: 3-month postpartum; Time 3: 12-month postpartum). Mothers completed self-report questionnaires assessing maternal depression symptom severity at Time 1-3, adult attachment style at Time 2, and infant temperament at Time 3. At Time 1, they also provided a blood sample to assess peripheral oxytocin levels, and at Time 2, participated in a parent-child interaction session, which was later coded for caregiving behavior (sensitivity). Neither maternal depression nor lower levels of oxytocin during pregnancy predicted difficult infant temperament; rather, it was predicted by non-Caucasian ethnicity. When all other variables were free to vary, adult attachment avoidance mediated an association between maternal depression during pregnancy and difficult infant temperament. Results highlight the potential value of interventions focusing on adult attachment insecurity for pregnant women and raise questions about associations between culture/ethnicity and infant temperament.
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Communimetric screening tools help clinicians identify and communicate their patient's areas of need and the corresponding level of action. However, few tools exist to identify mental health (MH) and developmental needs in young children. We aimed to implement and evaluate a new communimetric MH and developmental screening tool for children under 6 (HEADS-ED Under 6) in a community MH agency in Ontario, Canada. Using a prospective cohort design, we explored how intake workers used the HEADS-ED Under 6 screening tool from November 2019 to March 2021. 94.5% of children (n = 535/566) were screened with the HEADS-ED at intake. Total HEADS-ED scores and domains were used to inform the intensity of recommended services. Three clinical domains (Eating & sleeping, Development, speech/language/motor, and Emotions & behaviors) also independently predicted a priority recommendation. The tool showed good concordance with the InterRAI Early Years for children under 4 years old. The HEADS-ED Under 6 was a brief, easy, and valid screening tool, and can be used to identify important MH and developmental domains early, rate level of action/impairment, communicate severity of needs, and help determine intensity of service required.
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Opioid use disorder (OUD) among pregnant people has increased dramatically during the opioid epidemic, affecting a significant number of families with young children. Parents with OUD commonly face significant challenges as they are often balancing the stress of caring for young children with maintaining recovery and co-occurring psychosocial challenges (e.g., mental health, low social support). Toward designing interventions to address parenting needs among parents with OUD, we conducted a mixed-methods study to understand the acceptability of receiving parenting support prenatally among pregnant people with OUD residing in the United States. Semi-structured interviews were conducted among 18 pregnant and early postpartum people recruited from a substance use treatment program specializing in the care of pregnant and parenting populations. Among all participants, a prenatal parenting program that comprehensively addresses recovery, parenting, and wellbeing was found to be widely acceptable. Regarding content most desirable within a parenting intervention, participants indicated an interest in breastfeeding, caring for newborns with in-utero opioid exposure, parent-infant bonding, infant soothing techniques, their own wellbeing/mental health, and parenting skills. We introduce a prenatal adaptation of the well-established Family Check-up parenting intervention as a novel, prenatal intervention to prevent negative outcomes for caregivers in recovery and their children.
Spillover effects on the relationship with the partner of a mentalization-based intervention for pregnant women
The birth of a child has been associated with a decline in couple satisfaction, which has implications for the child's social-emotional development. This study investigated the potential spillover effect on pregnant women's perceptions of their relationships with their partners of the Supporting the Transition to and Engagement in Parenthood (STEP) program, a brief trauma-informed mentalization-based prenatal group intervention. Participants (94% White) were recruited in prenatal clinics and through online advertisements in Quebec, Canada. Both quantitative and qualitative data were collected from participants assigned to the STEP program (n = 42) and those receiving treatment-as-usual (TAU; n = 125). Women participating in STEP reported significant improvements in their relationships with their partners compared to those assigned to TAU. More precisely, they reported higher couple satisfaction, enhanced communication, and increased interest in their partners' emotional experience. The qualitative analysis further substantiated these results, with participants reporting having involved their partners in their pregnancy, shared their insights about themselves with their partners and gained fresh perspectives on their relationships. Participants in STEP also expressed sharing program materials with their partners and considered that such interventions should be extended to expecting fathers. This study underscores the potential of mentalization-based interventions to indirectly contribute to couple relationships, which may have positive implications for parenting and the infant.
Infants of mothers with early remitted clinical depression and mothers with no postpartum depression: Adaptive functioning in the second year of life
Whether and how remitted clinical depression in postpartum motherhood contributes to poor infant adaptive functioning is inconclusive. The present longitudinal study examines adaptive functioning in infants of mothers diagnosed as clinically depressed at 5 months but remitted at 15 and 24 months. Fifty-five U. S. mothers with early, remitted clinical depression and 132 mothers without postpartum depression completed the Vineland Adaptive Behavior Scales about their infants at 15 and 24 months. Between groups, mothers were equivalent in age, ethnicity, marital status, and receptive vocabulary (a proxy for verbal intelligence), and infants were equivalent in age and distribution of gender. Controlling for maternal education and parity, mothers with early, remitted clinical depression and mothers with no postpartum depression rated their infants similarly on communication, daily living skills, and socialization. Mothers with early, remitted clinical depression rated their infants poorer in motor skills. Girls were rated more advanced than boys in communication at 24 months and daily living skills at 15 and 24 months. Rated infant adaptive behavior skills increased from 15 to 24 months. With exceptions, adaptive functioning in infants may be robust to early, remitted maternal depression, and adaptive functioning presents a domain to promote positive development in this otherwise vulnerable population.
"You go in heavy and you come out light": An interpretative phenomenological analysis of reflective practice experiences in an Irish infant mental health setting
Reflective practice (RP) is a core component of infant mental health (IMH); however, there is limited published empirical research on IMH practitioner experiences of RP. This two-stage, qualitative, multimodal study explored Irish IMH practitioners' experiences of RP spaces. Visual and verbal data from seven individual interviews and a participatory arts-based focus group with seven participants (eight participants in total, all white Irish females) were analyzed using Interpretative Phenomenological Analysis. Five group experiential themes (Just get on with it; What should I be bringing to this space?; Who are my "hands"?; Taking a step back; and You go in heavy and you come out light) were generated by the analysis. These were used to construct a developmental and experiential model of learning in an RP space. The themes portray how a practitioner's RP experience can change over time: influenced by prior experiences and practice development stage, practitioners move from initial uncertainty, anxiety, and perceived pressure in a busy workload to developing the trust and ability to be vulnerable in an RP space. Through relationships (supervisor/facilitator or group members), a shared safe space can be created, which addresses practitioners' needs for containment, allowing for experiential learning through a process of transformational moments.
Parental Reflective Functioning on the Parent Development Interview: A narrative review of measurement, association, and future directions
A caregiver's capacity to mentalize is thought to be one of the most important features of secure parent-child relationships. Parental mentalizing can be measured using the Reflective Functioning (RF) coding system applied to the Parent Development Interview (PDI). In this narrative review, we summarize the research using this measure and synthesize what has been learnt about the predictors, correlates and sequelae of parental RF. Studies have consistently shown that PRF on the PDI is associated with both parent and child attachment and is an important factor in the intergenerational transmission of attachment. It is also related to the quality of parental representations, parent-child interactions, and child outcomes. While a number of social and clinical risk factors are associated with lower PRF, it is difficult to disentangle the unique contribution of each of these. We discuss these findings and present the direction of future work that is planned to expand and refine the PRF scale for the PDI.
Parental sensitivity and family conversation: A naturalistic longitudinal study with both mothers and fathers across three time-points in early infancy
Parental verbal sensitivity is known to promote child language skills, but few studies have considered: (a) links between global (i.e., verbal, behavioral, and affective) measures of parental sensitivity and infant-initiated conversations, an important precursor to language development; (b) whether maternal and paternal sensitivity show similar links with infant-initiated conversation; or (c) the transactional role of infant conversation for later parental sensitivity. Addressing these gaps, this study of 186 British first-time parents (93 families) examines the developmental dynamics between parental sensitivity and infant communication across the first year of life. We explore; (i) the role of maternal and paternal sensitivity (assessed during structured home observations at 4 months post-partum) for parent-infant conversational interactions at 7 months (indexed by day-long naturalistic recordings), and (ii) whether these mother-infant and father-infant conversations at 7 months shape maternal and paternal sensitivity at 14 months (also assessed via structured home observations). For both male and female infants, maternal (but not paternal) sensitivity at 4 months predicted infant vocalisations and conversational initiation at 7-months. By contrast, neither index of infant talk predicted maternal or paternal sensitivity at 14 months. Together these findings refine understanding of theoretical models of social development and suggest new possibilities for future research.
Initial validation of the Health Environment Rating Scale-Early Childhood Consultation-Classroom (HERS-ECC-C)
The present study validated a newly developed easy-to-use observational instrument, the Health Environment Rating Scale-Early Childhood Consultation-Classroom version (HERS-ECC-C), to measure the quality of the classroom environment within early care and education centers participating in a mental health consultation program in a diverse area of the southeastern United States. Using a confirmatory factor analysis, three factors emerged capturing critical aspects of a high-quality classroom environment and demonstrated good reliability: (1) Supportive Practices, Positive Socioemotional Practices, and Classroom Management (α = .88), (2) Health and Family Communication (α = .79), and (3) Individualizing to Children's Needs (α = .80). Criterion-related validity was established through concurrent associations between the three HERS-ECC-C subscales and the domains of the Classroom Assessment Scoring System (CLASS) and predictive associations with the Childcare Worker Job Stress Inventory. The HERS-ECC-C Supportive Practices and Health and Family Communication subscales were associated with all three CLASS domains, and the Individualizing to Children's Needs subscale was associated with the CLASS Instructional support domain. Higher HERS-ECC-C subscale scores were associated with lower teacher-reported job stress. Findings provide initial evidence to support the use and continued development of the HERS-ECC-C as a tool to evaluate programs and classrooms engaged in mental health consultation professional development interventions.
Evaluating the use of the AMBIANCE-Brief measure in clinical settings: Assessing acceptability, feasibility, and utility of the AMBIANCE-Brief
Community agencies and practitioners around the globe seek opportunities to learn various assessment tools and interventions rooted in attachment theory. However, information regarding the feasibility of implementation and sustainability of these tools once participants have been trained to use them, is limited. This study investigated the perceived acceptability, feasibility, utility, relevance, fidelity, and sustainability of the Atypical Maternal Behavior Instrument for Assessment and Classification-Brief (AMBIANCE-Brief) among practitioners who had taken a training. Practitioners (N = 59) who attended a virtual AMBIANCE-Brief training originating from Canada between June 2020 and November 2021 completed an online follow-up survey. Practitioners reported that they primarily used the AMBIANCE-Brief for case conceptualization (68%). Additionally, 95% agreed that the AMBIANCE-Brief was relevant to their clinical practice, 98% agreed it was useful for their clinical work, 76% agreed that it was feasible to implement into their clinical work, and 59% found it easy to incorporate into their treatment planning with clients. Findings suggest that the AMBIANCE-Brief may be acceptable, feasible, and useful for practitioners. Avenues for continuing to evaluate the AMBIANCE-Brief include cross-cultural validity, coder drift, and booster sessions. Additional work clarifying how practitioners integrate the measure into practice would be valuable.
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An efficient, multidimensional instrument is needed to screen non-optimal prenatal parental representations predictive of postnatal parenting behavior and child attachment. The present work aimed to revise and validate the Prenatal Caregiving Expectations Questionnaire-Revised (PCEQ-R). Survey data from two independent samples of pregnant, primarily Danish, women (N = 300/322) were collected to 1) test the factor structure and select items for a 20-item version, and 2) confirm the factor structure, examine internal consistency, and establish initial construct validity. Confirmatory factor analysis supported a three-factor model of helpless-dysregulated, anxious-hyperactivated, and avoidant-deactivated caregiving representations. Internal consistency was acceptable (α > .73). Construct validity analyses showed that higher helpless-dysregulated caregiving was associated with low maternal antenatal attachment quality (r = -.36) and intensity (r = -.11), increased risk of perinatal depression (r .37), and trait anxiety (r .37). Higher anxious-hyperactivated caregiving was associated with better maternal antenatal attachment quality (r .20) and higher intensity (r = .26), while avoidant-deactivated caregiving was not associated with maternal antenatal attachment. These findings support the validity and multidimensional structure of the measure. The homogenous nature of the sample limits generalizability of results. Future studies should examine predictive validity of the PCEQ-R and include clinical samples.
The effect of the separation of mother-preterm newborn infants hospitalized during the COVID-19 pandemic on maternal depression and stress levels, infant development, and bonding quality on Chilean dyads
Early infant development is a maturation process critically depends on the infant's interaction with primary caregivers. Hence, neonatal units prioritize their proximity. In COVID-19, parental visitation hours were limited, reducing caregivers time with their infants. This follow-up study analyzes and compares levels of maternal depression and stress, infant development, and bonding quality in preterm mother-infant dyads hospitalized, before and during the pandemic. Out of 66 dyads participated, 36 were admitted before COVID-19, and 30 during COVID-19. The assessed was two video-call sessions in which mothers completed selected questionnaires. No significant differences between mothers' levels of depression and stress. However, low birth weight was associated with greater difficulties in children's communication and interpersonal relationships. Furthermore, infants hospitalized in COVID-19 had a higher risk of experiencing delayed communication. No significant differences were observed in bonding quality. Lower infant gestational age and longer breastfeeding time were associated with better bonding quality in both groups. Psychosocial intervention is considered a valuable tool, capable of preventing maternal mental health difficulties and protecting bonding in premature infants and in highly complex healthcare settings. Nevertheless, it is essential to more actively address the socio-affective needs of newborns during their hospital stay to promote adequate development.
Development of a tool for infant facial emotion recognition (InFER) for postpartum mothers with mental illnesses
Understanding deficits in recognition of infant emotions in mothers with mental illnesses is limited by the lack of validated instruments. We present the development and content validation of the infant facial emotion recognition tool (InFER) in India to examine the ability of mothers to detect the infants' emotions. A total of 164 images of infant faces in various emotional states were gathered from the parents of four infants (two male and two female: up to 12 months old). Infant emotion in each image was identified by the respective mother. Content validation was carried out by 21 experts. Images with ≥70% concordance among experts were selected. The newly developed tool, InFER, consists of a total 39 infant images representing the six basic emotions. This tool was then administered among mothers during their postpartum period-10 healthy mothers and 10 mothers who had remitted from any schizophrenia spectrum disorder, bipolar affective disorder or major depressive disorder. The mean age and mean years of education for both groups were comparable (age∼25 years, education ∼15 years). A significant difference was found between the two groups in their ability to recognize infant emotions (Mann-Whitney U = 12.5; p = 0.004). InFER is a promising tool in Indian settings for understanding maternal recognition of infant emotions.