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Implementing Minding the Baby®

Meets HHS criteria for an evidenced based model

Model Overview

Last Updated

April 2018

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The information in this profile reflects feedback, if provided, 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 HHS 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 Europe. Through the MTB National Office, researchers and staff at the Yale Child Study Center and Yale School of Nursing support implementation and replication in collaboration with local community health centers and/or other local agencies.

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Theoretical Model

MTB is based on a multi-generation model of care that aims to integrate primary care and infant mental health services by pairing a nurse with a mental health professional to conduct home visits. MTB is grounded in the theories of attachment, reflective parenting, social ecology, and self-efficacy. The intervention 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 young parents, ages 14 to 25, living in low-income settings. Mothers who are using drugs prenatally or who have a serious medical condition are ineligible to participate. As guided by the mother, home visit activities include fathers or other family members. The model serves families beginning in the second or early third trimester of pregnancy and extending until the child’s second birthday.

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Targeted Outcomes

The model aims to promote secure attachment; parental reflection (in which parents reflect on their children’s thoughts and feelings and 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 keep their babies in mind 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 model 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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Model Components

MTB consists of home visits with a nurse and a mental health professional. The home visitors primarily 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 visits to visits every other week, 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 mental health 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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Model Intensity and Length

The intervention lasts for 27 months, beginning in the second or early 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 sometimes 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 Connecticut and Florida, the United Kingdom, and Denmark.

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Adaptations and Enhancements

In the Florida site, MTB is delivered to court-involved teen mothers and their families. The clinical team includes a social worker who provides case management, a court liaison, and other types of support. The MTB National Office considers this an enhancement of the MTB model. The Florida 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.

Other sites have expanded the target population to include women up to age 30 and mothers expecting their second child, although preference is given to those under age 25 expecting their first child.

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Notes

The information contained on this page was last updated in April 2018. Recommended Further Reading lists the sources for this information. In addition, the information contained in this profile was reviewed for accuracy by Crista Marchesseault, Lois Sadler, and Arietta Slade with the Minding the Baby® National Office at Yale Child Study Center and Yale School of Nursing on January 16, 2018. HomVEE reserves the right to edit the profile for clarity and consistency.

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