Keeping needs of young families in mind

Linda C. Mayes, M.D., likens her role in the School of Medicine’s Minding the Baby initiative to that of a matchmaker. In 2002, with the goal of establishing a program aimed at combating early maternal depression, Mayes introduced Lois S. Sadler, Ph.D., to Arietta Slade, Ph.D.

Thinking they would make a great team, she paired Slade, who was doing influential research on “parental reflective functioning”—parents’ capacity to understand and express their child’s mental state by observing the child’s behavior—with Sadler, an associate professor at Yale School of Nursing and the medical school’s Child Study Center (CSC), who had worked extensively with young pregnant and adolescent parents.

Now, nearly eight years later, the community-based program, which affords underprivileged mothers nursing and mental health services during pregnancy and after childbirth, has seen such success that it is positioned to be replicated in other local communities.

The clinical staff of Minding the Baby, a collaborative effort between Yale and the Fair Haven Community Health Center (FHCHC) in New Haven, includes two part-time social workers and a full-time nurse practitioner, who work with young mothers in their homes.

In designing the program, “we worked from a very well-known model called the Nurse-Family Partnership,” says Sadler, referring to a program developed by David Olds, Ph.D., and Harriet Kitzman, Ph.D., R.N., in which vulnerable mothers are assigned home-visiting nurses. Slade, professor of clinical and developmental psychology at City University of New York-City College and visiting research scientist at the CSC, and her team sought to expand on this model by adding a mental health component. To that end, they turned to the work of pioneering infant–parent psychotherapists, Alicia F. Lieberman, PH.D., of the University of California, San Francisco, and Christoph Heinicke, Ph.D., of the University of California, Los Angeles.

In the Minding the Baby program, mothers are taught to pay close attention to, and to respond to, a child’s emotional state, and in particular, the baby’s “needs, their desires, their emotions, their wants,” says Sadler, who is also assistant dean for academic affairs at the School of Nursing. The goal, she says, is “to develop and test this intervention and evaluate the outcomes for high-risk families.”

The program’s efficacy is gauged by measuring a number of factors and comparing results from families in the program to those from control families who are not provided with home visitation. Factors being measured include the base rate of security for infants (71 percent in the intervention group, which is considered high and indicates that babies receiving the intervention are more securely attached than babies in the control group) and the base rate of “disorganized attachment” (28 percent, which is low and indicates that babies receiving the intervention are at lower risk for later psychopathology and other maladaptions). Other positive results include a high retention rate of families in the study (90 percent); also, rates of breast-feeding that are well above the national average for high-risk populations. Rapid subsequent pregnancies and referrals to child protective services are also much lower among families in the program than among control families.

“The impact of this program has been tremendous in terms of helping young parents and their babies. This is outside the exam room. It’s what happens the other 24 hours a day,” says Katrina Clark, M.P.H., executive director of the FHCHC. “I heard a wonderful story, in fact—a young woman who was a high school drop-out who came into the program, was motivated by these folks to get her G.E.D., get her clinical assistant degree, and actually is now an employee here. She was very proud, in fact, to speak to one of the funders recently. She said, ‘I want my child to be proud of me.’ ”

Minding the Baby is supported by grants from The Irving B. Harris Foundation, The FAR Fund, The Annie E. Casey Foundation, The Patrick and Catherine Weldon Donaghue Medical Research Foundation, the Pritzker Early Childhood Foundation, the Seedlings Foundation, and the National Institutes of Health’s National Institute of Nursing Research and National Institute of Child Health and Human Development.

Mayes, the Arnold Gesell Professor of Child Development at the CSC and professor of epidemiology and public health, pediatrics, and psychology, says that Minding the Baby is poised to be launched in other communities. By using a program manual the staff has written, she says, “we could train a number of different communities, community health care centers, to replicate it exactly.” But future programs could also be based only on certain core theoretical ideas used in Minding the Baby—particularly the idea that “it’s helping parents to become more reflective about their own psychology as a parent, and their baby’s own emotional life,” Mayes says. “One can teach a lot of clinicians to think in that way by teaching them the basic principles and then letting people go put those principles in place in ways best suited to their individual practice settings.”