Program

Jan 16, 2013

OVERVIEW

The Transactional
Model of Early Home Intervention is designed for mothers who give birth to low
birth-weight infants. The program focuses on improving child development,
which is often slower for low birth-weight infants, by improving mother-child
interaction and parent responsiveness through the first year of life. A
randomized, experimental evaluation of the intervention found that it was
effective in improving the home environment of the child and some aspects of
the child’s cognitive development. Up to 16 months, the parent-child
interaction, or Transactional, program had a larger impact. In the second
year of life, the parent-child interaction program enhanced children’s
security, while the developmental program enhanced children’s social
competence, relative to a no-treatment control group. The intervention
had limited or no impacts on child temperament, parent interactive behaviors,
and child interactive behaviors.

DESCRIPTION OF
PROGRAM

Target population: Low
birth-weight infants

Early Home Intervention is different from many infant
home-visiting programs in that it focuses on improving the quality of interactions
between the mother and child instead of the child’s health or
developmental progress. The program seeks to teach parents observational
skills so that they can better understand their child’s body language and
better respond to it. It is thought that the program improves a child’s
development by improving parental responsiveness to the child’s needs.
The intervention lasts for one full year. Families in the program are
visited by an infant-parent therapist for 1-2 hours each week for four months of
the program, every other week for the next five months, and then monthly for
the last three months for a total of approximately 28 visits. In each
visit, the infant-parent therapist helps the parent learn to recognize the child’s
specific body cues and appropriately react to them. The therapist also
works with the parent to develop a plan for different interaction situations.

EVALUATION(S) OF
PROGRAM

Barrera, M. E., Rosenbaum, P. L., & Cunningham, C. E.
(1986). Early home intervention with low-birth-weight infants and their
parents. Child Development, 57, 20-33.

Evaluated population: 59 parents of infants who were born pre-term and 24 mothers of infants who were born at full-term in Ontario, Canada. Approximately 55 percent of the pre-term sample were males. The average birth-weight of the pre-term infants was approximately 1677 grams; normal birth-weight is considered to be between 2,500 and 4,000 grams. Most mothers were
married, around 94 percent and the average age of mothers was around 27
years.

Approach: To be eligible for the study, pre-term
infants had to have a birth-weight less than 2,000 grams, gestational age less
than 37 weeks, a good prognosis for survival, released from hospital 2 weeks
before the study, and had to be living in the area. The full-term infants
had to meet similar criteria except for birth-weight and gestational age which
had to be in the normal range. The full-term infants were all assigned to
a no treatment comparison group for comparison. It should be noted that
this is not intended to be a comparison for program effectiveness but as a
benchmark for the pre-term infant’s development. Pre-term infants
were matched on sex, birth weight, socioeconomic status, and pre- and post-term
complications. After matching, pre-term infants were randomly assigned to
one of three conditions: a no-treatment control condition, the Transactional
Model parent-infant intervention, and a comparison developmental programming intervention.
The Transactional intervention consisted of a series of home visits which were
designed to improve parent-infant interaction. The developmental
programming intervention consisted of the same number of home visits but with a
focus on improving the child’s developmental functioning which was done
through activities designed to stimulate the child. The infants were
assessed at 4, 8, 12, and 16 months on measures of infant development, home
environment, and parent-child interactions.

Results: At pre-test, the pre-term groups of parents
and infants did not differ significantly on any demographic or birth
variables. As expected, the pre-term group did differ significantly from
the full-term group on many variables including birth-weight, gestational age,
and pre- and post-natal complications.

At 4 months, children in the pre-term conditions had lower
scores on mental skills, motor skills, development, and home environment.
By 16 months, children in both intervention conditions had caught up to the developmental
levels of full-term control children, meaning that there were not significant
differences in developmental scores. By 12 and 16 months, children in
both intervention conditions had also caught up with full-term comparison
children in terms of motor development. At 8 and 12 months, children in
both intervention conditions had achieved similar home environment. At 16
months, children in the full-term comparison group and children in the pre-term
Transactional Model intervention group had higher home environment scores than
those in the pre-term control group and pre-term developmental programming
intervention. Infants in the full-term comparison and pre-term
intervention conditions engaged in independent verbal play more often than
those in the pre-term control group. Parents in the pre-term intervention
conditions were less likely to become unresponsive to infants when compared
with those in the pre-term control condition.

The program had no impacts on children’s temperament
and the only differences observed were changes over time across all 4
groups. Similarly, the program had no impacts on infant interactive
behaviors or mother interactive behaviors.

Barrera, M. E., Doucet, D. A., & Kitching, K. J.
(1990). Early home intervention and socio-emotional development of
preterm infants. Infant Mental Health Journal, 11(2), 142-157.

Evaluated population: 59 parents of infants who were
born pre-term and 24 mothers of infants who were born at full-term.
Approximately 55 percent of the pre-term sample were males. The average
birth-weight of the pre-term infants was approximately 1677 grams; normal
birth-weight is considered to be between 2,500 and 4,000 grams. Most
mothers were married, around 94 percent and the average age of mothers was around
27 years.

Approach: This study reports additional results of
data collection from the previously mentioned study. The purpose of this
study was to assess infant security and social competence after the conclusion
of the program. Infant security was measured using the Flint Infant
Security Scale and social competence was measured using the Vineland Social
Maturity Scale.

Results: The Transaction intervention program had no
impacts on social competence at any of the follow-up periods, 4, 8, 12, and 16
months. At the 16-month follow-up, children in the developmental
intervention group had higher social competence scores than children in the
pre-term control group. In terms of infant security, children in the
Transaction intervention were more secure than those in both the pre-term
control group and those in the developmental intervention. At 16 months,
children in the developmental intervention were as socially competent as
children in the comparison group.

SOURCES FOR MORE
INFORMATION

References:

Barrera, M. E., Doucet, D. A., & Kitching, K. J.
(1990). Early home intervention and socio-emotional development of
preterm infants. Infant Mental Health Journal, 11(2), 142-157.

Barrera, M. E., Rosenbaum, P. L., & Cunningham, C. E.
(1986). Early home intervention with low-birth-weight infants and their
parents. Child Development, 57, 20-33.

Program categorized in this guide according to the
following:

Evaluated participant ages: birth to 1 year / Program
age ranges in the Guide: early childhood

Program components:
home visiting; parent or family component

Measured outcomes: social and emotional health and
development

Program information last updated 12/5/07.

Subscribe to Child Trends

Short weekly updates of recent research on children and youth.