Program

Oct 30, 2008

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:

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.

KEYWORDS: Infants, Early Childhood (0-5),
Home-Based, Parent-Child Relationship, Mentoring, Tutoring,
Counseling/Therapy, Clinic/Provider-Based, Home Visitation, Parent or Family
Component, Social and Emotional Health, Physical Health, Child Maltreatment,
Like Skills Training, White or Caucasian.

Program
information last updated on 10/30/08.

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