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Implementing Minding the Baby®

Meets DHHS criteria for an evidenced based model

Implementation Experiences

Last Updated

August 2014

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Summary of Sources

Information in this section is based on studies included in the HomVEE review. For Minding the Baby (MTB), we reviewed two randomized controlled trials (RCTs). (Please see the study database for a list of the studies.)

The two articles we reviewed were about the same trial of MTB. Because of this overlap, we refer to these as one study. One of the articles focused on a subsample of participants after they finished the program, but we describe the characteristics and program experiences of the full group of participants.

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Characteristics of Program Model Participants

MTB was offered to first-time mothers attending nurse-midwifery prenatal care sessions at a community health center. Of the 139 mothers who were eligible to participate in the trial of MTB, 60 were enrolled in the program.

The average age of participating mothers was 19.5 years old. Almost half (49 percent) of the children in the program were female and 51 percent were male.

Approximately 22 percent of participating mothers identified as African American, 67 percent identified as Latina, and 12 percent identified as other. All program participants were enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children. Mothers completed approximately 11 years of school, on average.

Participation in MTB was voluntary.

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Location and Setting

The study did not describe the location of this program.

This program was implemented by Yale University with the assistance of the Fair Haven Community Health Center. The community health center helped recruit families for participation in the program and the health providers at the center communicated with home visitors about mutual clients.

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Staffing and Supervision

Home visits were conducted by a two-person team composed of a pediatric nurse practitioner and a licensed clinical social worker who alternate visiting the families. The program also included supervisors and administrative staff.

The nurse practitioners and licensed clinical social workers who conducted home visits were required to have master’s-level training in their disciplines. The study did not provide information on the education level of the supervisors.

The study reviewed did not include information on pre- or in-service training provided to home visitors or supervisors.

According to the study, home visitor pairs received joint supervision and individual discipline-focused supervision (that is, focused on nursing or clinical social work) on a weekly basis. Home visitors also attended weekly meetings with all the home visiting teams, supervisors, and select administrative staff. The study did not provide information on the supervisors’ caseloads.

The study did not include information about the home visitors’ caseloads.

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Program Model Components

Home visits were intended to occur weekly beginning in the mother’s third trimester of pregnancy until the child’s first birthday, at which point visits should take place biweekly until the child’s second birthday. The visits were intended to last approximately one hour, although this varied based on a family’s needs.

Home visits were carried out on an alternating basis by a team composed of a nurse practitioner and licensed clinical social worker; that is, the family saw the nurse one week and the social worker the next, except for the last home visit during which both home visitors met with the family. The nurse practitioner educated mothers about prenatal health care (such as nutrition and fetal development) and assessed for and educated parents on the child’s physical health and development (such as through diagnosing and treating illnesses and teaching injury prevention). The clinical social worker assessed psychological distress in the mother and child (including diagnosing depression, anxiety, and psychiatric illness) and provided treatments (such as infant–parent psychotherapy, crisis intervention, and case management). Both home visitors taught and modeled reflective parenting, which MTB defines as a parent’s capacity to envision the mental states of herself and her child. The home visitors also promoted mother–child attachment and modeled and fostered parenting skills. The home visiting clinicians conferred regularly about each of their shared families. They also maintained contact with families’ health providers at the community health clinic from which families were recruited.

During the third trimester of pregnancy, a pregnancy interview was administered to all participants to assess the mother's reflective functioning capacity. The interview assessed the mother’s emotional experience during pregnancy and her expectations and fantasies regarding her future relationship with her child.

The study reported that the MTB approach has been manualized around a set of principles, protocols, and guidelines contained within a treatment manual.

The study did not include information about available languages for the program.

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Program Model Adaptations or Enhancements

The study did not include information about program adaptations or enhancements.

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Dosage

Similar to the recommended program intensity, the study reported that mothers enrolled in the late second or early third trimester of pregnancy, and received an average of 3.4 home visits a month, each lasting 45 to 90 minutes, until the child’s second birthday.

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Fidelity Measurement

The study did not include information about fidelity measurement.

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Costs

The study did not include information about program costs.

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Lessons Learned

The study did not include information on lessons learned for implementing the program.

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