Hospital and Home Support Interventions During Infancy

Guide to Effective Programs
for Children and Youth

HOSPITAL AND HOME SUPPORT INTERVENTIONS DURING INFANCY

OVERVIEW

The Hospital and Home Support Interventions during Infancy program is a combined hospital and home-based intervention using trained paraprofessionals for mothers with newborn infants. The hospital-based component of the program promotes early and extended contact between the mother and infant. The 3-month home-based component encourages the mothers’ involvement with their infants and offers support to mothers in coping with various situational stressors. In a random assignment study of 321 women in their third trimester of pregnancy, participants were assigned to one of four groups: 1) Both the hospital and home-based interventions, 2) only the hospital intervention, 3) only the home-based intervention, and 4) no intervention. The home-based intervention and the combination of home and hospital-based interventions had no impacts on maternal attachment. Furthermore, none of the programs had a significant impact on healthcare utilization or incidences of child abuse and neglect within the first 12 months after birth. Receiving the hospital intervention explained a significant amount of variance in some but not all indicators of maternal attachment, though the contributed variance was small and became smaller at 12 months.

DESCRIPTION OF PROGRAM

Target population: Low-income new mothers and their infants

Hospital and Home Support Interventions during Infancy is a dual-component program that emphasizes positive interactions between mothers and their newborn infants. There is a hospital-based and a home-based component.

The hospital-based component emphasizes early and extended contact and requires 45 minutes of mother-infant contact during the first three hours after delivery and at least five additional hours each day during the hospital stay. This is compared to the brief contact between mothers and infants that typically follows delivery and the standard 2.5 hours of contact each day while in the hospital.

The home-based component consists of nine home visits during the first three months of the infant’s life. These visits are aimed at promoting the mothers’ involvement with their infants. The workers also offer support to mothers facing a wide variety of situational stressors. The home visits are conducted by paraprofessionals who have received 200 hours of pre-service training on the following topics: mother-infant attachment; child care and development; importance of play and stimulation for infant learning and language development; special needs of mothers and infants during the early months; use of community resources appropriate to meeting these needs; skills in relating to mothers; other family members and community resources; and infant care workers as mutually supporting teams. The workers also receive continuous supervision from child development experts throughout the course of the interventions.

EVALUATION(S) OF PROGRAM

Siegel, E., Bauman, K.E., Schaefer, E.S., Saunders, M.M., & Ingram, D.D. (1980). Hospital and Home Support during Infancy: Impact on Maternal Attachment, Child Abuse and Neglect, and Health Care Utilization. Pediatrics, 66, 183-190.

Evaluated population: 321 expecting mothers in their third trimester of pregnancy served as the study sample for this investigation. These were low-income women who were receiving care at the public prenatal clinic and who delivered at the community hospital in Greensboro, NC, between January of 1976 and October of 1977. Approximately one-quarter of the mothers were white, and roughly one-third were currently married. The mothers averaged 11 years of educational attainment and 21 years of age.

Approach: In order to be eligible for the study, mothers had to meet the following criteria: had an uncomplicated pregnancy and no previous delivery of a stillborn baby; were not expecting twins; intended to remain in the area for a year or more; were not already in the study; and did not have a family member in the study. 321 expecting mothers were randomly assigned to one of four groups: 1) Both early and extensive contact in the hospital and home-based interventions, 2) only the hospital intervention, 3) only the home-based intervention, and 4) no intervention. Initial interviews were given during the last trimester of pregnancy and collected information on background and demographic variables.

Mothers assigned to receive the hospital intervention engaged in 45 minutes of mother-infant contact during the first three hours after delivery and at least five additional hours each day during the hospital stay. In contrast, mothers in groups that did not receive the hospital intervention had brief initial contact with their infants and 2.5 hours of contact each day while in the hospital

Mothers assigned to receive early and extensive contact in the home-based intervention received nine home visits from trained paraprofessionals during the first three months of their infants’ lives. The workers attempted to promote the mother’s involvement with their infants. They also offered support to mothers who were facing various situational stressors. Mothers who were not assigned to groups receiving the home-based intervention received typical and routine care during the three months following their infants’ births.

The second data collection phase consisted of in-home observations of mother-infant interactions and interviews with the mothers. This round of data collection occurred when the infants were four and 12 months of age. Mother interviews addressed utilization of healthcare services for their infants. The observations included roughly 30 items of mother and infant attachment behaviors recorded by two observers following situations such as bathing, dressing, feeding, and play. Additionally, ratings on a 92-item Attachment Inventory assessing maternal acceptance vs. rejection and involvement vs. detachment were completed after the home visits; however the evaluation did not specify who provided these ratings.

Administrative hospital, health, and welfare information for each of the participants were also collected when the infants were 12 months old. Data regarding the utilization of healthcare services for the infants were obtained from clinic emergency room and hospital records, as well as in the four and 12-month mother interviews. Reports of child abuse and neglect through the first year of the infant’s life were obtained from the county unit for protective services and the state central registry.

Results: Receiving the hospital intervention explained a significant amount of variance in some but not all indicators of maternal attachment, though the contributed variance was small and became smaller at 12 months. Receiving only the home intervention or the hospital and home interventions did not explain a significant amount of additional variance in maternal attachment. Furthermore, there were no significant differences across any of the groups for utilization of healthcare services or reported incidents of child neglect and abuse.

Analyses revealed that the background variables explained substantially more variance in maternal behavior than did the hospital or home-based interventions. Specifically, background variables played a substantial role in explaining the mother’s acceptance of the infant, positive interaction and stimulation of the infant, and consoling of a crying infant at four months and the mother’s interaction and stimulation of the infant at 12 months. The evaluation did not specify which background variables were most influential in these relationships. Babies in the nursery had no significant impacts.

It is important to note that, of the 321 participants, 84 were missing information on measures involving maternal attachment (described below) at 4 and 12 months. These cases were distributed randomly across experimental and control groups, and the differences on various measured background variables were negligible. Therefore, data on the attachment outcome variables were available for 237 women, and data on all other variables were available for the entire sample of 321 women.

SOURCES FOR MORE INFORMATION

A description of the training program may be obtained from:

Minta Saunders, Ph.D.

Assistant Secretary, Department of Human Resources

325 N. Salisbury St.

Raleigh, NC 27611

References:

Program categorized in this guide according to the following:

Evaluated participant ages: Birth to one year

Evaluated participant grades: N/A

Program age ranges in the guide: Early Childhood

Program components: Mentoring/Tutoring, Counseling/Therapy, Clinic/Provider-Based, Home Visiting, Parent or Family Component

Measured outcomes: Social and Emotional Health, Physical Health

Program information last updated on 10/30/08.