Program

Feb 27, 2009

OVERVIEW

The home-visiting intervention program is aimed to develop
better relationships between depressed mothers and their infant. The study focus
on the quality of mother-child interaction, children socioemotional function and
infant-mother security attachment. This home visiting intervention is found to
have positive impacts on the quality of mother-infant interaction, child
competence, and child attachment security, but no impact on mother’s depression
level.

DESCRIPTION OF PROGRAM

Target population: Depressed mothers and their 1 to
12 months old babies.

The program is designed to enhance the quality of
mother-child interaction, infant-mother attachment security, and children’s
socioemotional functioning. The

Home-visiting intervention consists of 8 to 10 bi-weekly
home visits, lasting from 60 to 90 minutes during the span of 3 to 4 months.
Graduate or postgraduate students of psychology or social psychiatry in
training for prevention or health education are responsible for video recording
and advising depressed mothers after the first home visit. All home visitors are
given a manual, a videotape, and are trained by the first author and child
therapist to prepare them before they visit participant’s home.

During each home-visit, the home visitor video records
mother-child interactions,such as bathing or feeding the baby.
Assessment on the quality of mother-infant interaction, child attachment
security, and infant socioemotional functioning is done through a
multidisciplinary team of specialist in infant mental health care and adult
psychopathology. Home visitors are responsible for discussing the interaction
between mother-child and encouraging them to learn appropriate communicative
behavior. One to four additional techniques were also taught to mothers (e.g.
modeling, cognitive restructuring, practical pedagogical support, and baby
massage) to aid them with their children interaction.

EVALUATION(S) OF PROGRAM

Evaluated population: 60 depressed mothers of Dutch
descent with 11 mothers from other from different ethnic backgrounds (Turkish,
Moroccan, Surinamese, Portuguese, and Australian) with infants were all required
to a) have a child under 12 months old, b) be currently receiving outpatient
treatment for their depression, and c) be sufficiently fluent in Dutch.

Approach: Participants were gathered from local
therapist’s referral or through the national newspapers, women’s magazine, or
websites. The Beck Depression Inventory and International Neuropsychiatric
Interview were used to evaluate mother’s depressive symptoms.Mothers
were randomly assigned to receive either the home-visiting intervention or the
telephone support control group.

The control group received 3 phone calls, each lasted up to
15 minutes for 3 consecutive months, by one of the eight child therapist. The
phone calls were directed towards practical parenting only, and do not focus on
mother-child interaction with the parents.

Trained graduate and postgraduate home-visitors videotaped
mother-child interaction for about 15-20 minutes during each visit. Each video
tape was evaluated through four trained observers who were unaware of the group
assignment. Methods to enhance mother’s sensitivity to child’s signals and needs
are analyzed by a team of specialist. Home visitors delivered these methods to
the parent(s) while they watched the recorded video together, and revised it
according to the mother’s need.

Data were collected on a) maternal sensitivity and related
behaviors, such as nonhostility and nonintrusiveness, b) stressfull life events
and chronic difficulties, c) child internalizing and externalizing symptoms, d)
infant socioemotional functioning, and e) child attachment security. A posttest
was completed two weeks after the last intervention, and a follow-up was
conducted after six months.

Results: Infant in the experimental group had
significantly higher scores for attachment security and competence in the
follow-up assessment when compared to infants in the control group. Also,
maternal sensitivity only increased in the intervention and not the control
group. The program did not impact maternal depression, as depression level for
both groups decreased over time as they continued to receive treatment from
their therapist. Impacts were not found for infant internalizing, externalizing,
or dysregulation. Although this intervention showed positive differences in the
attachment security, it remains unclear if the program also helped prevent
attachment disorganization.

SOURCES FOR MORE INFORMATION

Karin T.M. van Doesum, Prevention Research Centre,
Department of Clinical Psychology, Radboud University Nijmegen, P.O. Box 9104,
6500 HE Nijmegan, the Netherlands.

Email:

k.vandoesum@riagg.ijsselland.nl

References:

Doesum, K. T., Hosman, C. M., Riksen-Walraven, J.M., &
Hoefnagels, C. (2008). A randomized controlled trial of a home-visiting
intervention aimed at preventing relationship problems in depressed mothers and
their infants. Child Development, 79(3), 547 – 561.

KEYWORDS: Early Childhood (0-5), Infants, White or
Caucasian, Home-visitation, Depression/Mood Disorders, Mental Health, Parent-child Interaction,
Mothers

Program information last updated on 2/27/09

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