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Minding the Baby

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Minding the Baby: Program Overview and Summary of Initial Findings

Yale Child Study Center, Yale School of Nursing and Fair Haven Community Health Center, New Haven, CT

Minding the Baby, is one of the first Reflective Parenting programs in the USA. Established in 2002-03, this collaborative program integrates a mental health approach into an advanced practice nursing home-visitation for young, vulnerable first-time parents, and aims to prevent negative maternal and child outcomes. It is a program that provides direct clinical service for young families and simultaneously integrates ongoing research, using a randomized clinical trial design. Minding the Baby is a joint project of the Yale University Child Study Center, the Yale University School of Nursing, and the Fair Haven Community Health Center (FHCHC), and is headed by Drs. Linda Mayes, Lois Sadler, and Arietta Slade. Community collaborators include Katrina Clark, Executive Director, FHCHC, Karen Klein, MSN, PNP and Kate Mitcheom, MSN, CNM, both clinicians from the FHCHC.

Program Description

The Minding the Baby home visiting program combines advanced practice nursing and infant mental health care by pairing a pediatric nurse practitioner and a clinical social worker with at-risk, medically-underserved young families who attend the Fair Haven Community Health Center. This program is based on attachment and social ecology theory and has been patterned after successful interventions developed by Olds and colleagues, Heinecke, and Lieberman and colleagues. Minding the Baby clinicians provide in-home interventions beginning in pregnancy and lasting until the child’s second birthday. The nurse/mental health team brings health, social service and mental health services directly into mothers’ homes on a weekly basis. The focus of each team is to enhance attachment relationships by developing reflective parenting capacities (termed reflective functioning) in parents, and supporting positive parenting behaviors, child health and safety, maternal health, and child development. This unique blend of mental health and nursing approaches is vital to addressing the complex needs of poor, traumatized, and socially isolated mothers and their families living in the inner city. Many of the families served by Minding the Baby are newly-immigrated, all of the families are low-income, and 90% have minority ethnic and racial backgrounds. This is a preventive program that aims to address many of the root causes of impaired parent-child relationships and significant mental health problems within young families living in communities stressed by limited economic resources.

To date, Minding the Baby has had a significant impact on the health, welfare, and quality of life of the first cohort of 55 young families enrolled in the program. Despite high rates of early trauma and mental illness in the mothers, home visitors have had great success in maintaining weekly home visit schedules and establishing relationships with them. We have conducted ongoing research and evaluation studies as the program has been developed and implemented. Initially the team conducted two small feasibility studies with young adult mothers (funded by the Irving B. Harris Foundation) and then with adolescent mothers (P30NR08999). These two studies allowed us to: 1) determine that the home visiting team was effective and well accepted by young adult and adolescent mothers with low attrition rates; 2) pilot test and revise research measures; 3) refine the intervention and develop a preliminary MTB Treatment Manual; 4) document significant mental health concerns in the young women studied, as well as their openness to in-home treatment; 5) document positive outcomes with respect to RF, attachment, maternal life course outcomes and infant health. The intervention was found to be flexible and could be individualized to respond to the needs and beliefs of multi cultural families, and mothers who were still adolescents themselves (Slade, 2002; Slade, Sadler, de Dios-Kenn et al., 2005).


The first wave of findings in our sample have been very encouraging. In the families who have completed the study (n=46) we have noted that none of the intervention group mothers have experienced a second birth (within 24 months of the index birth) while 17% of the control group mothers have given birth to a second child within the same time period. Child health outcomes were equally encouraging. There have been no families in the intervention group that have been referred to child protective services. All children in the intervention group (vs. 80% control) are up to date with their routine pediatric health visits and immunizations. Reflective functioning scores have increased in the MTB mothers and with respect to maternal-child relationship and attachment outcomes, at 12 months, 76% of the infants were classified as secure in the Strange Situation.

Minding the Baby Staff and Research Staff

Denise Webb
Sarah Fitzpatrick
Patricia Miller
Nancy Close
Monica Ordway
Cheryl deDios-Kenn
Hanna Stevens
Rebecca Hommer
Jasmine Ueng-McHale
Maia Miller
Betsy Houser
Kristopher Fennie

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