IMPACT OF REFLECTIVE SUPERVISION ON EARLY CHILDHOOD INTERVENTIONISTS’ PERCEPTIONS OF SELF‐EFFICACY,JOB SATISFACTION,AND JOB STRESS

Despite widespread recognition of the importance of reflective practice in the field of infant mental health, little quantitative research exists regarding the impact of reflective supervision on professionals’ self‐efficacy, job satisfaction, and work‐related stress. Thirty‐three early childhood interventionists received approximately 9 months of reflective supervision and completed pre‐ and post‐assessments of their job‐related stress and self‐efficacy using a modified version of the Reflective Supervision Self‐Efficacy Scales for Supervisees (S. Shea, S. Goldberg, & D.J. Weatherston, 2012). At the post‐assessment, participants also rated their overall experience of reflective supervision. Reported self‐efficacy increased significantly from pre‐ to post‐assessment, and participants reported a positive overall impact of reflective supervision with respect to a variety of indices, such as job satisfaction, professional development, and the ability to cope with job‐related stress. These results provide necessary quantitative data demonstrating a positive impact of reflective supervision on early childhood professionals and suggest the value of reflective supervision for supporting workforce development.     

PREDICTORS OF SELF‐REPORTED GAINS IN A RELATIONSHIP‐BASED HOME‐VISITING PROJECT FOR MOTHERS AFTER CHILDBIRTH

We assessed mothers’ self‐reported gains from a postpartum home‐visiting (HV) project in which home visitors are volunteer mothers from the community. Hypotheses were that gains are positively related to (a) mothers’ felt‐closeness with their home visitor, (b) mothers’ level of sociodemographic risk, and (c) the home visitors’ preproject training in support services for families or children (Professionalism). One hundred sixty‐four clients returned written evaluations of the HV project. Items assessing gains were reduced to two factors: Improved Well‐Being (“Self”) and Improved Infant Care (“Infant”). Repeated measures general linear models, with Gains (Self, Infant) as the repeated measure, and multiple regression analyses evaluated the hypotheses. Across the sample, gains on both factors were moderate, although gain scores were higher regarding Self than for Infant. Results show that (a) Mothers’ felt‐closeness with their volunteer was strongly related to mothers’ gains; (b) high‐risk mothers gained more from the project than did mothers of lower risk, particularly regarding Infant Care; and (c) mothers visited by volunteers who were professionals reported more substantial gains than did mothers visited by volunteers who were not professionals. Findings can help explain variance in mothers’ gains from such projects and could be useful in improving their efficacy.     

ATTACHMENT IN INFANTS WITH CLEFT LIP AND/OR PALATE: MARGINAL SECURITY AND ITS CHANGES OVER TIME

This study examines the attachment quality and how this changed over time among infants who had cleft lip and palate (CLP), by conducting a prospective longitudinal study addressing the effects of this type of perinatal event on the parent–infant relationship and the emotional development of the infants. At 12 months of age, the Strange Situation Paradigm (SSP; M. Ainsworth, M.C. Blehar, E. Waters, & T. Wall, 1978) was administered to a sample of 38 CLP infants (born between 2003 and 2010) and 17 healthy controls. At 4 years of age, the Attachment Story Completion Task (ASCT; I. Bretherton, D. Ridgeway, & J. Cassidy, 1990) was administered to 32 individuals from the CLP sample and 14 from the control group. As reported in the literature, CLP infants display secure attachment behaviors as frequently as do control infants (55%). However, a more detailed analysis of the attachment scales revealed that CLP infants show more avoidance and less proximity seeking. In addition, a closer examination of the subcategories of attachment styles revealed that most CLP infants (71%) displayed distal attachment strategies such as the B1/B2 or A1/A2 subcategories. At 4 years old, CLP infants clearly displayed more deactivation and less security than did the control sample. Moreover, when detailing the evolution of attachment individually, almost 60% of the CLP children showing distal strategies at 12 months became deactivated or disorganized when they reached 4 years. Indeed, subtle differences in attachment behaviors at 12 months old—which can be considered marginally secure at that age—may reveal attachment vulnerabilities, which seem to be more apparent over the course of development.     

EARLY HEAD START FAMILIES’ EXPERIENCES WITH STRESS: UNDERSTANDING VARIATIONS WITHIN A HIGH‐RISK,LOW‐INCOME SAMPLE

The federal Early Head Start program provides a relevant context to examine families’ experiences with stress since participants qualify on the basis of poverty and risk. Building on previous research that has shown variations in demographic and economic risks even among qualifying families, we examined possible variations in families’ perceptions of stress. Family, parent, and child data were collected to measure stressors and risk across a variety of domains in families’ everyday lives, primarily from self‐report measures, but also including assay results from child cortisol samples. A cluster analysis was employed to examine potential differences among groups of Early Head Start families. Results showed that there were three distinct subgroups of families, with some families perceiving that they experienced very high levels of stress while others perceived much lower levels of stress despite also experiencing poverty and heightened risk. These findings have important implications in that they provide an initial step toward distinguishing differences in low‐income families’ experiences with stress, thereby informing interventions focused on promoting responsive caregiving as a possible mechanism to buffer the effects of family and social stressors on young children.     

UNDERSTANDING THE CONNECTION BETWEEN ATTACHMENT TRAUMA AND MATERNAL SELF‐EFFICACY IN DEPRESSED MOTHERS

Maternal self‐efficacy predicts sensitive and responsive caregiving. Low maternal self‐efficacy is associated with a higher incidence of postpartum depression. Maternal self‐efficacy and postpartum depression can both be buffered by social support. Maternal self‐efficacy and postpartum depression have both been linked independently, albeit in separate studies, to the experience of violent trauma, childhood maltreatment, and spousal abuse. This study proposed a model in which postpartum depression mediates the relation between attachment trauma and maternal self‐efficacy, with emotional support as a moderator. Participants were 278 first‐time mothers of infants under 14 months. Cross‐sectional data were collected online. Mothers completed questionnaires on attachment trauma, maternal self‐efficacy, postpartum depression, and emotional support. A moderated mediation model was tested in a structural equation modeling framework using Mplus’ estimate of indirect effects. Postpartum depression fully mediated the relation between trauma and maternal self‐efficacy. Emotional support moderated only the pathway between postpartum depression and maternal self‐efficacy. Attachment trauma's implications for maternal self‐efficacy should be understood in the context of overall mental health. Mothers at the greatest risk for low maternal self‐efficacy related to attachment trauma also are those suffering from postpartum depression. Emotional support buffered mothers from postpartum depression, though, which has implications for intervention and future research.     

A LONGITUDINAL,PERSON‐CENTERED ANALYSIS OF EARLY HEAD START MOTHERS’ PARENTING

This study used a person‐centered approach to examine stability and change in parenting typologies across early childhood. Profiles were associated within and across time with contextual covariates, including demographic characteristics, risk factors, and Early Head Start participation. Participants were drawn from the Early Head Start Research and Evaluation Project (N = 2, 876). Parenting profiles were identified based on observed parenting dimensions at 14, 24, and 36 months, and pre‐Kindergarten (pre‐K). Results suggested a four‐profile solution at each time point: Supportive, Lukewarm (14 & 24 months)/Sufficient (36 months and pre‐K), Harsh, and Detached. Supportive was the largest, most stable, and most likely transitioned into profile while Harsh and Detached represented rare profiles with moderate to low membership stability across time. Depression and family conflict emerged as important correlates of unsupportive parenting profiles both within and across time. Findings are discussed in terms of their relevance for both policy and implementation practices for low‐income mothers with young children.     

MEDIATING ROLE OF MATERNAL SENSITIVITY: ENHANCING LANGUAGE DEVELOPMENT IN AT‐RISK FAMILIES

Home‐visiting programs have gained increasing importance in family‐centered prevention and intervention. However, few studies have examined the mechanisms underlying early intervention treatment effects. The goal of this study is to analyze the mediating role of maternal sensitivity in enhancing language development with the home‐visiting program Parents as Teachers (PAT). Data were collected and analyzed within the ongoing, long‐term ZEPPELIN study, a randomized controlled trial with 251 participating at‐risk families. Via longitudinal mediation analysis, we examined whether effects of the PAT on receptive and expressive language outcomes at 24 and 36 months were mediated by maternal sensitivity at 12 months. Within a moderated mediation framework, we investigated whether the level of family psychosocial stress affects this mediation. Results showed that intervention effects on language outcomes are mediated by maternal sensitivity—weakly and through specific pathways. Moderation and moderated mediation analyses indicated that effects of the PAT and also specific mediation effects increase with the level of psychosocial stress. Implications of the results for practice are discussed.     

PARENTAL CHILDHOOD ADVERSITY,DEPRESSIVE SYMPTOMS,AND PARENTING QUALITY: EFFECTS ON TODDLER SELF‐REGULATION IN CHILD WELFARE SERVICES INVOLVED FAMILIES

Parents who are involved with child welfare services (CWSI) often have a history of childhood adversity and depressive symptoms. Both affect parenting quality, which in turn influences child adaptive functioning. We tested a model of the relations between parental depression and child regulatory outcomes first proposed by K. Lyons‐Ruth, R. Wolfe, A. Lyubchik, and R. Steingard (2002). We hypothesized that both parental depression and parenting quality mediate the effects of parental early adversity on offspring regulatory outcomes. Participants were 123 CWSI parents and their toddlers assessed three times over a period of 6 months. At Time 1, parents reported on their childhood adversity and current depressive symptoms. At Time 2, parents’ sensitivity to their child's distress and nondistress cues was rated from a videotaped teaching task. At Time 3, observers rated children's emotional regulation, orientation/engagement, and secure base behavior. The results of a path model partly supported the hypotheses. Parent childhood adversity was associated with current depressive symptoms, which in turn related to parent sensitivity to child distress, but not nondistress. Sensitivity to distress also predicted secure base behavior. Depression directly predicted orientation/engagement, also predicted by sensitivity to nondistress. Sensitivity to distress predicted emotion regulation and orientation/engagement. Results are discussed in terms of intervention approaches for CWSI families.     

PATERNAL AND MATERNAL REFLECTIVE FUNCTIONING IN THE WESTERN AUSTRALIAN PEEL CHILD HEALTH STUDY

While past research on the care of infants has been mostly with mothers, in recent times there has been a renewed attention to the father–infant relationship. This study examined differences between mother and father parental reflective functioning (PRF) or parental mentalizing; that is, the parental capacity to reason about their own and their children's behaviors by taking into consideration intentional mental states. Data were collected from 120 couples with a 1‐year‐old child who were participants in the West Australian Peel Child Health Study. Parental mentalizing was assessed using the Parental Reflective Functioning Questionnaire (PRFQ; Luyten, Mayes, Nijssens, & Fonagy, 2017 ). Results showed that mother and father mentalizing with their children was independent and that mothers scored slightly higher levels of mentalizing than did fathers. Paternal mentalizing was weakly associated with family income and father education, and was more strongly associated with family functioning than with maternal mentalizing. Implications for theorizing on PRF and fatherhood more generally are discussed.     

THERAPISTS’ EXPERIENCES OF MOTHER–INFANT PSYCHOANALYTIC TREATMENT: A QUALITATIVE STUDY

As part of a larger research project in Sweden, a qualitative study investigated psychotherapists’ experiences of mother–infant psychoanalysis (MIP). A randomized controlled trial compared two groups of mother–infant dyads with psychological problems. One had received Child Health Center care, and the other received MIP. Previous articles on long‐term effects have found that mothers who had received MIP were less depressed throughout a posttreatment period of 3½ years, and their children showed better global functioning and psychological well‐being. The present study's objectives were to describe the therapist's experiences of MIP and deepen the understanding of the MIP process. Six months after treatment began, all therapists were interviewed. Transcribed interviews with therapists from 10 (of 33 total) MIP treatments were randomly selected and analyzed in detail by thematic analysis. Therapists worked successfully with mother and infant together and found different ways of cooperation during MIP sessions. Therapists reported overall positive experiences; however, in cases where mothers needed more personal attention, it would be important to adapt the method to them.     

The associations between insecure attachment,rooming‐in,and postpartum depression: A 2 months’ longitudinal study

Postpartum depression (PPD) is the most common complication of childbearing, and recent studies have attempted to examine risk factors associated with it. The main study hypothesis was that a protective situational factor at a sensitive time period (full rooming‐in postpartum) would moderate the associations between insecure attachment dimensions and PPD. Three hundred twelve women, in either full or partial rooming‐in, participated in a longitudinal study at the maternity ward of a tertiary healthcare center. A Demographic questionnaire and the Experiences in Close Relationships Scale were administered at 1–4 days postpartum, and the Edinburgh Postnatal Depression scale at 2 months postpartum. PPD was significantly associated with both anxious and avoidant attachment dimensions, but not with rooming‐in conditions. In addition, women in partial rooming‐in showed a positive correlation between insecure attachment dimensions and PPD, whereas no such correlation was found for full rooming‐in women. A situational factor such as full rooming‐in, which occurs at a critical time point for the mother–infant relationship, can moderate the association between maternal avoidant or anxious attachment dimensions and the mother's PPD levels. Postpartum practices, such as rooming‐in, can be personalized and thus beneficial in moderating personal risk factors for PPD.     

IMPLEMENTATION OF AN EVIDENCED‐BASED PARENTING PROGRAM IN A COMMUNITY MENTAL HEALTH SETTING

The process of mental health intervention implementation with vulnerable populations is not well‐described in the literature. The authors worked as a community‐partnered team to adapt and pilot an empirically supported intervention program for mothers of infants and toddlers in an outpatient mental health clinic that primarily serves a low‐income community. We used qualitative ethnographic methods to document the adaption of an evidence‐based intervention, Mothering from the Inside Out, and the pilot implementation in a community mental health clinic. Seventeen mothers and their identified 0‐ to 84‐month‐old children were enrolled in the study. Key lessons from this implementation include (a) the importance of formative work to build community relationships and effectively adapt the intervention to meet the needs of the therapists and their clients, (b) the importance of designing plans for training and reflective supervision that fit within the flow of the clinic and can tolerate disruptions, and (c) that use of an interdisciplinary approach is feasible with the development of a plan for communication and the support of a trained reflective clinical supervisor. These key lessons advance the scientific knowledge available to healthcare managers and researchers who are looking to adapt mental health clinical interventions previously tested in clinical trials to implementation in community settings.     

Enhancing parental reflective functioning through early dyadic interventions: A systematic review and meta‐analysis

Parental reflective functioning (PRF) is an important predictor of infant attachment, and interventions that target parent–infant/toddler dyads who are experiencing significant problems have the potential to improve PRF. A range of dyadic interventions have been developed over the past two decades, some of which explicitly target PRF as part of their theory of change, and some that do not explicitly target PRF, but that have measured it as an outcome. However, no meta‐analytic review of the impact of these interventions has been carried out to date. The aim of this review was to evaluate the effectiveness of dyadic interventions targeting parents of infant and toddlers, in improving PRF and a number of secondary outcomes. A systematic review and meta‐analysis was conducted in which key electronic databases were searched up to October 2018. Eligible studies were identified and data extracted. Data were synthesised using meta‐analysis and expressed as both effect sizes and risk ratios. Six studies were identified providing a total of 521 participants. The results of six meta‐analyses showed a nonsignificant moderate improvement in PRF in the intervention group (standardised mean difference [SMD]: –0.46; 95% confidence interval [CI] [–0.97, 0.04]) and a significant reduction in disorganised attachment (risk ratio: 0.50; 95% CI [0.27, 0.90]). There was no evidence for intervention effects on attachment security (odds ratio: 0.71; 95% CI [0.19, 2.64]), parent–infant interaction (SMD: –0.10; 95% CI [–0.46, 0.26]), parental depression (SMD: –1.55; 95% CI [–3.74, 0.64]) or parental global distress (SMD: –0.19, 95% CI [–3.04, 22.65]). There were insufficient data to conduct subgroup analysis (i.e. to compare the effectiveness of mentalisation‐based treatment with non‐mentalization‐based treatment interventions). Relational early interventions may have important benefits in improving PRF and reducing the prevalence of attachment disorganisation. The implications for future research are discussed.     

TOP‐DOWN AND BOTTOM‐UP: THE ROLE OF SOCIAL INFORMATION PROCESSING AND MINDFULNESS AS PREDICTORS IN MATERNAL–INFANT INTERACTION

The cross‐generational transmission of attachment appears to reflect a complex interplay of factors, which have been challenging to identify. The current longitudinal study explored the maternal cognitive model of relationships through language use, maternal mindfulness, and attachment style assessed prenatally, as predictors of maternal response to distress and infant behavior at 6 months’ postpartum. Infant behavior to the mother also was examined to provide an understanding of the evolving relationship. Thirty‐two females were interviewed prenatally regarding social and family experiences. At 6 months’ postpartum, each mother participated in a video‐recorded session where she was asked to teach her infant a developmentally appropriate task. Videos were analyzed using the NCAST Teaching Protocol. Language use prenatally as well as the mindfulness facets (acting with awareness and describing) predicted the mothers’ ability to respond to infant distress, indicating greater attunement. Infant's response to mother and clarity of cues also were predicted by maternal pronoun use. The study highlights the role of internal working models reflective of interpersonal beliefs, cognitive models, and current‐moment awareness in maternal behavior. The effect of maternal language on infant behavior arguably indicates the infant's integration of maternal internal working models.     

THE MAGIC OF PLAY: LOW‐INCOME MOTHERS’ AND FATHERS’ PLAYFULNESS AND CHILDREN'S EMOTION REGULATION AND VOCABULARY SKILLS

Using data from a diverse sample of low‐income families who participated in the Early Head Start Research Evaluation Project (n = 73), we explored the association between mothers’ and fathers’ playfulness with toddlers, toddler's affect during play, and children's language and emotion regulation at prekindergarten. There were two main findings. First, fathers’ playfulness in toddlerhood was associated with children's vocabulary skills in prekindergarten whereas mothers’ playfulness was related to children's emotion regulation. Cross‐parental effects were found only for mothers. The association between mothers’ playfulness and children's vocabulary and emotion regulation was strengthened when fathers engaged in more pretend play and when children were affectively positive during the play. These findings show that playfulness is an important source of variation in the vocabulary and emotion regulation of children growing up in low‐income families. They also point to domain‐specific ways that mothers and fathers promote children's regulatory and vocabulary skills, and highlight the importance of children's positive engagement in play.     

INTERFACING INFANT MENTAL HEALTH KNOWLEDGE: PERSPECTIVES OF SOUTH AFRICAN SUPERVISORS SUPPORTING LAY MOTHER–INFANT HOME VISITORS

This article is part of a project investigating the interfacing of clinically and research‐generated knowledge in the field of infant mental health (IMH) with local cultural models of child care and development. The article explores the experiences and challenges reported by psychology‐trained supervisors in supervision with local, lay, trained home visitors. Supervisors and supervisees were drawn from two early intervention programs which apply relational IMH mental health models in socioeconomically deprived townships in South Africa. Literature that considers supervisors’ experiences of conducting supervision with lay counselors has been limited, and even more so in settings where there are marked cultural and contextual differences between supervisors and supervisees. These differences pose particular challenges regarding the finding of a shared theoretical understanding of the work as well as to the establishment of a secure working alliance. While it was found that psychoanalytic and attachment‐informed theories of infant development are applicable in these South African settings, differences in race, language, education, socioeconomic status, and culture between supervisors and supervisees challenge the supervisor–supervisee relationship and require psychological processing and creative solutions to ensure integrity in the application of the model.     

DEVELOPMENT OF THE PARENT‐CHILD PLAY SCALE FOR USE IN CHILDREN WITH FEEDING DISORDERS

The Parent‐Child Play Scale was developed as a scale that complements the Parent‐Child Feeding Scale, created by I. Chatoor et al. (1997), to evaluate mother–infant/toddler interactions in two different caregiving contexts of a young child's everyday life, specifically play and feeding. This Play Scale can be used with infants and toddlers ranging in age from 1 month to 3 years and provides reliable global ratings of mother–child interactions during 10 min of videotaped free‐play in a laboratory setting. The scale consists of 32 mother and infant/toddler interactive behaviors which are rated by trained observers from videotaped observations. Four subscales are derived: Dyadic Reciprocity, Maternal Unresponsiveness to Infant's/Toddler's Cues, Dyadic Conflict, and Maternal Intrusiveness. Construct validity and interrater and test‐retest reliability of the Play Scale have been demonstrated. This Play Scale discriminates between children with and without feeding disorders as well as between children with different subtypes of feeding disorders as defined by the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood, Revised (DC:0–3R) (Feeding Disorder of State Regulation, Feeding Disorder of Caregiver‐Infant Reciprocity, and Infantile Anorexia). It can be used for research or clinical practice in the diagnosis and treatment of early feeding problems, to assess the pervasiveness of mother–infant/toddler difficulties and to monitor changes following therapy.