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Implementing Minding the Baby®

Meets DHHS criteria for an evidenced based model

Program Model Overview

Last Updated

May 2016

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The information in this profile reflects feedback from this model’s developer as of the above date. The description of the implementation of the model here, including any adaptations, may differ from how it was implemented in the studies reviewed to determine this model’s evidence of effectiveness. Inclusion in the implementation report does not mean the practices described meet the DHHS criteria for evidence of effectiveness.

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Implementation Support

Minding the Baby® (MTB) is a home visiting intervention developed by interdisciplinary researchers at the Yale Child Study Center and the Yale School of Nursing, in collaboration with Fair Haven Community Health Clinic in New Haven, Connecticut. It began as a demonstration program in 2002 and has since been replicated in the United States and United Kingdom. Researchers and staff at the Yale Child Study Center and Yale School of Nursing support its implementation in collaboration with local community health centers or other local agencies.

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Theoretical Model

MTB is based on a two-generation model of care that aims to integrate primary care and infant mental health services by pairing a pediatric nurse practitioner with a licensed clinical social worker (LCSW) to conduct home visits. MTB is grounded in attachment theory, reflective parenting, social ecology theory, and self-efficacy theory. The program aims to enhance maternal and child health, reflective parenting, early attachment between mothers and children, and relationships between families and communities.

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Target Population

MTB is intended for first-time mothers living in low-income settings. As guided by the mother, home visit activities can include fathers or other family members. The site in Connecticut that piloted the program enrolls first-time mothers in their second or third trimester of pregnancy, who are 14 to 25 years of age and receiving prenatal services from a collaborating community health clinic. This site does not accept women who are active drug users or who are experiencing serious physical or psychological illness, including active psychosis.

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Targeted Outcomes

The program aims to promote secure attachment; parental reflection (in which parents reflect on their own development as a parent); and physical and mental health in babies, mothers, and their families. The main goal of MTB is to help mothers and fathers mind their babies in both physical and emotional ways by promoting and enhancing the following:

  • Protective factors, skills, and strategies
  • Competent and flexible parenting
  • Psychological health in the mother and child, and between the mother and child
  • Physical health and development of the child
  • Positive maternal health and life course outcomes

The program also seeks to help families become better consumers of health care information, better connected to their primary care clinicians, and more knowledgeable about obtaining and using needed social services (such as housing, food assistance, or health insurance).

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Program Model Components

MTB consists of home visits with a nurse practitioner and an LCSW. The home visitors meet with families separately on an alternating schedule, except in the following circumstances in which both home visitors meet with the family together: at the time of recruitment, at the first and last home visits, when mothers transition from weekly to bimonthly visits, and as needed (such as during a crisis).

During visits, home visitors aim to develop mothers’ abilities to become reflective and responsive in their interactions with their infants by doing the following:

  • Giving voice to the baby’s experience (both physical and emotional); 
  • Giving voice to the mother’s experience of herself as a parent; 
  • Highlighting the mother’s positive feelings for the child; 
  • Developing the mother’s capacities to reflect and contemplate, especially in the face of difficult emotions.

When indicated, the LCSW home visitor conducts a mental health assessment and provides treatment in the home.

In addition to home visits, the visitors maintain close contact with the mothers’ prenatal and pediatric clinicians, who may be based in a partnering community health center. Clinicians and staff at the community health centers guide home visitors in working with families who have numerous physical, medical, and mental health needs. Home visitors also facilitate a close relationship between families and their primary care clinicians, and coach families on how to consume health care information and access needed social services.

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Program Model Intensity and Length

The intervention lasts for 27 months, beginning in the second or third trimester of pregnancy and extending until the child’s second birthday. During pregnancy, MTB attempts to deliver at least 8 to 10 weekly visits, although there are often fewer visits depending on when a mother enrolls and delivers. Home visits occur weekly during the child’s first year and transition to every other week during the second year. Visits vary in length, averaging 45 to 90 minutes.

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Location

MTB is currently implemented in New Haven, Connecticut; Miami, Florida; and Glasgow, Sheffield, and York in the United Kingdom.

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Adaptations and Enhancements

In the Miami, Florida, site, the clinical team includes a social worker who provides case management, a court liaison, and other types of support. This is considered an enhancement of the MTB model. The Miami site has also adapted the model to recruit pregnant women ages 13 to 22 and allow some nurses to hold bachelor’s degrees instead of master’s degrees.

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Notes

The information contained on this page was last updated in May 2016. Recommended Further Reading lists the sources for this information. In addition, the information contained in this profile was reviewed for accuracy by Crista Marchesseault and Lois Sadler with the Minding the Baby® program office at Yale Child Study Center and Yale School of Nursing on March 28, 2016. HomVEE reserves the right to edit the profile for clarity and consistency.

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