Implementing Minding the Baby® Home Visiting (MTB-HV) Meets HHS Criteria

Model implementation summary last updated: 2020

The information in this implementation report reflects feedback, if provided, from this model’s developer as of the above date. The description of the implementation of the model(s) here may differ from how the model(s) was implemented in the manuscripts 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. Please see the Effectiveness button on the left for more information about any research on the effectiveness of the model, including any version(s) of the model with effectiveness research. Versions of the model that are described in the Adaptations and enhancements section of this implementation report may include (1) versions that were identified by the model’s developer and (2) versions that have been implemented by researchers and have manuscripts that HomVEE rated high or moderate, but that are not supported by the model’s developer.

Model overview

Theoretical approach

Minding the Baby® Home Visiting (MTB-HV) is an intensive, preventive intervention based on a multi-generation care model designed to integrate primary care and mental health services for infants by pairing a nurse with a mental health professional to conduct home visits. MTB-HV 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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Implementation support

MTB-HV was 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 parts of 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 the implementation of MTB-HV in collaboration with local agencies.

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Intended population

MTB-HV is intended for young first-time parents between the ages of 14 to 25 who are living in low-income settings. As guided by the mother, home visit activities include fathers or other family members. The model starts serving families in the second or early third trimester of pregnancy and continuing 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-HV is to help mothers and fathers keep the physical and emotional needs of their babies in mind 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; and
  • Positive maternal health and life course outcomes.

The model is also designed to help families become better consumers of health care information, improve their connection to their primary care clinicians, and develop their knowledge about obtaining and using needed social services (such as housing, food assistance, or health insurance).

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Model services

MTB-HV consists of home visits with a nurse and a mental health professional. The home visitors primarily meet with families separately on an alternating schedule, but in the following circumstances both home visitors meet with the family at the same time: at 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 work 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; and
  • 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 making home visits, the visitors maintain close contact with the mothers’ prenatal and pediatric clinicians, who might 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 be good consumers of health care information and access needed social services.

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Model intensity and length

The intervention lasts about 27 months, beginning in the second or early third trimester of pregnancy and continuing until the child’s second birthday. During pregnancy, MTB-HV’s goal is to deliver at least 8 to 10 weekly visits, although there are sometimes fewer depending on when a mother enrolls and delivers. Home visits take place weekly during the child’s first year and transition to every other week during the second year. Visits vary in length, but average 45 to 90 minutes.

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Location

MTB-HV is currently implemented in Connecticut and Denmark.

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Adaptations and enhancements

Certain modifications are allowed based on community needs or agency requirements, but the model developers must approve all modifications. No information is available on the process for considering modifications to the model.

Some sites have expanded the target population to include older women and families expecting their second child, although preference is given to women under age 25 who are expecting their first child.

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Implementation notes

The information contained on this page was last updated in April 2020. 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 in February 2020. HomVEE reserves the right to edit the profile for clarity and consistency.

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