The transactional model of early home intervention

This article describes a developmental model for early home intervention and treatment of environmentally and biologically at-risk infants and their parents: The Transactional Model of Home Intervention. The model identifies the development of both infants and parents as targets of intervention and considers their ongoing interactions or transactions within the family context as the vehicle of intervention. The child and his physical/social environment are conceptualized as actively influencing one another in their reciprocal transactions. An early intervention program based on this transactional model is described. The intervention is tailored to suit the needs of both child and parents and, more generally, the needs of the family. The intervention process involves a problem-solving model of education by which parents acquire cognitive strategies that will enable them to assess the needs of their child and to design a program to fulfill these needs.     

Increasing parenting self-efficacy: The Fussy Baby Network® intervention

High levels of infant crying place families at risk for disrupted relationships, parenting stress, and even for child maltreatment. We conducted an evaluation of the Fussy Baby Network^® (FBN), a program supporting families struggling with infant crying and related concerns. The study contrasted 29 families who sought help from FBN with 27 families with excessively crying infants who did not seek services. Researchers measured parenting self-efficacy, depression, and stress in each group before and after the intervention. Results from hierarchical multiple regression analysis indicated greater improvements over time in parenting self-efficacy for parents receiving FBN services. Furthermore, the greater improvements in parenting self-efficacy in the intervention group were not directly attributable to reductions in infant crying. These findings provide preliminary evidence that the FBN approach may be effective at boosting the confidence of parents struggling with caring for their infants. Future research with larger samples with baseline equivalence and stronger research designs should explore this intervention further. This study also suggests that interventions for families with excessively crying infants should move beyond the focus of reducing infant crying to a broader strategy of supporting parents and strengthening relationships between parents and their infants to build parenting capacity.     

Perceptions of neonatal behaviors by different caregivers

The current study compared nurses', mothers', and NBAS examiners' perceptions of infant behavior along dimensions of the NBAS using the Newborn Behavior Inventory (NBI; Anderson & Standley, 1979). The hypothesis was that the three observers would differ in their perceptions based on their unique backgrounds. A total of 26 high-risk premature infants and 28 healthy full-term infants were assessed on the Brazelton Neonatal Scale (Brazelton, 1973), which provided a reference point for comparing the observers' views. Multivariate analysis of variance (MANOVA) revealed that the preterm infants obtained significantly lower scores on the cluster of autonomic regulation and on the reflex cluster. A two-way analysis of variance for repeated measures was performed to analyze the NBI data. Rater disagreement appeared on four NBAS clusters of orientation, regulation of state, range of state, and motoric processes. Agreement among observers on the autonomic cluster reflected actual group differences on the NBAS. The variability in ratings is discussed in relation to the observers' differential experience with the infants.     

Read your baby: A follow-up intervention program for parents with NICU infants

An intervention model designed to provide education and support to parents of sick or preterm infants throughout their first year of life is described. The intervention focused on helping parents communicate more skillfully with their infant and encouraging parents to maximize their infant's participation in the family system. Seventeen medium-risk infants received intervention; another seventeen served as controls. Independent evaluations of all families at 12 months adjusted age revealed that intervention babies were significantly advanced on Bayley Scales of Infant Development and Mastery Motivation tasks and that their mothers viewed them as easier to care for and less irritable.     

An outreach approach to high risk parents and their infants

This paper describes a special project designed to evaluate services to high risk parents and their infants. Twenty-three families were served by intensive outreach and home-based model of intervention. Sixty-one percent of these parents had significant mental health problems prior to referral. The paper describes the sample, outlines the approach to therapy and gives a specific case example. The data post-treatment is summarized and results detailed.     

Parenting and Prematurity: Understanding Parent Experience and Preferences for Support

Infants born very preterm are at risk of developmental and behavioural problems and their parents are at risk of psychological distress and compromised parenting. This study has two key aims: (1) to identify, from the parents’ own perspective, the unique aspects of parenting an infant born very preterm and (2) to assess parent preferences for support including opinions of a new, tailored parenting intervention, Prem Baby Positive Parenting Program (Triple P). A qualitative approach was taken with focus groups of 18 parents of infants born preterm and a thematic analysis conducted. Parents identified several unique aspects of parenting an infant born preterm including: difficulty coping with the stress of hospitalisation; institutionalisation to the hospital environment; a lack of preparation for the transition to parenthood; grief; isolation; getting into “bad parenting habits” of overnurturance and a lack of certainty about developmental expectations. Parents preferred parenting support that is tailored to parents of infants born preterm, has flexible delivery, enhances coping skills and the spousal relationship and is sensitive to the emotional context of parenting an infant born preterm. Understanding the experiences and the preferences of parents of infants born preterm is an important step in tailoring parenting interventions to fit their needs.     

Recognizing the infant as subject in infant-parent psychotherapy

Drawing on Winnicott's view of infants as subjects entitled to an intervention in their own right, infants as the referred patient have been seen in infant-parent psychotherapy for 20 years at the Royal Children's Hospital, Melbourne, Australia. This is a radically different view of infant symptomatology than viewing it as only expressing an aspect of the mother's unconscious. The clinical pathway differentiates the therapy from much parent-infant psychotherapy. The author describes the theoretical model of a twofold approach to understanding the infant's experience through interactive dialogue between therapist and infant, and sharing this understanding with the parents, and illustrates it with cases of failure-to-thrive infants. She discusses two criticisms: first, that infant-parent psychotherapy may undermine the parents and, second, that brief parent-infant psychotherapy does not alter parents' insecure attachment status. Videotaped sessions often show rapid improvement; parents generally feel relieved. This approach potentially shapes not only parents' and infants' representations, but also their implicit knowledge of relationships-partly, it is suggested, through activating the mirror neuron system to bring about implicit memory change. Change may therefore be longer lasting than psychoanalytic theory presently conceives. The approach is relevant in an outpatient setting: gains were maintained long term in 90% of out-patient cases.     

Providing Relationship Interventions to Same-Sex Couples: Clinical Considerations,Program Adaptations,and Continuing Education

Despite remarkable similarities to different-sex couples in terms of core relationship processes and outcomes, same-sex couples differ from different-sex couples in important ways, including relational strengths (e.g., more egalitarian) and challenges associated with their sexual minority identity (e.g., discrimination). Given that most cognitive-behavioral relationship interventions have been designed for and tested on different-sex couples, clinicians wishing to serve same-sex couples will need to make appropriate adaptations to these interventions in order to remove heterosexist bias and sensitively meet the unique needs of same-sex couples. Further, clinicians should strive to be culturally competent in serving this population by developing knowledge of same-sex couple dynamics and issues, and by building a sense of comfort working with these families, which may involve addressing personal biases. The current paper seeks to provide an introduction to same-sex couple relational processes, and offers clinical recommendations and intervention adaptations to better serve this population. Some examples will refer to the development of the Strengthening Same-Sex Relationships programs, culturally sensitive relationship education programs specifically designed for and successfully piloted with male and female same-sex couples.     

The Michigan infant mental health home visiting model

Selma Fraiberg's pioneering work with infants, toddlers, and families over 40 years ago led to the development of a field in which professionals from multiple disciplines learned to work with or on behalf of infants, very young children, their parents, and the relationships that bind them together. The intent was to promote social and emotional health through enhancing the security of early developing parent–child relationships in the first years of life (Fraiberg, 2018). Called infant mental health (IMH), practitioners from fields of health, education, social work, psychology, human development, nursing, pediatrics, and psychiatry specialize in supporting the optimal development of infants and the developing relationship between infants and their caregivers. When a baby is born into optimal circumstances, to parents free of undue economic and psychological stressors and who are emotionally ready to provide care and nurturing for an infant's needs, an IMH approach may be offered as promotion or prevention, with the goal of supporting new parent(s) in developing confidence in their capacity to understand and meet the needs of the tiny human they are coming to know and care for. However, when parental history is fraught with abandonment, loss, abuse or neglect, or the current environment is replete with economic insecurity, threats to survival due to interpersonal or community violence, social isolation, mental illness, or substance abuse, the work of the IMH therapist may require intervention or intensive treatment and becomes more psychotherapeutic in nature. The underlying therapeutic goal is to create a context in which the baby develops within the environment of a parent's nurturing care without the psychological impingement that parental history of trauma or loss or current stressors such as isolation, poverty, or the birth of a child with special needs, can incur.     

Prolonged Separation and Reunification among Chinese Immigrant Children and Families: An Exploratory Study

The present study explored the lived experiences of Chinese immigrant parents in New York City who went through prolonged separation and faced challenges after reunification in the United States. The study assessed their attitudes, perceptions, and reactions to the separation and reunification process to gain better understanding of the ways prolonged separation and reunification impact on child development and family wellbeing. A phenomenological research approach was used to study qualitatively the narrative data from in-depth interviews. The analytical process was based on data immersion, coding, sorting codes into themes, and comparing the themes across interviews. The sample included 18 Chinese immigrant families who had sent their American-born children to China for rearing and reunited with their children within the past 5 years. Data analyses revealed specific themes that included reasons for separation, parenting methods, child’s initial adjustment, behavior, and family relationship, child’s social, emotional, and academic challenges, parental stress and challenges, and recommendations for services. This study contributed to our knowledge of prolonged separation, a common practice among a vulnerable, hard-to-reach immigrant population. It shed light on specific needs of Chinese immigrant families by examining closely the unique circumstances pertaining to prolonged separation, parenting practice, and related family challenges. An understanding of the approaches these families adopt to cope with life challenges may help inform practitioners in formulating service strategies for these families. Specific assessments in child-care, education, and health care settings are essential to prompt immediate follow-up and intervention when needed.     

Dissemination of Family-Centered Prevention for Military and Veteran Families: Adaptations and Adoption within Community and Military Systems of Care

In response to the needs of military families confronting the challenges of prolonged war, we developed Families OverComing Under Stress (FOCUS), a multi-session intervention for families facing multiple deployments and combat stress injuries adapted from existing evidence-based family prevention interventions (Lester et al. in Mil Med 176(1): 19–25, 2011). In an implementation of this intervention contracted by the US Navy Bureau of Medicine and Surgery (BUMED), FOCUS teams were deployed to military bases in the United States and the Pacific Rim to deliver a suite of family-centered preventive services based on the FOCUS model (Beardslee et al. in Prev Sci 12(4): 339–348, 2011). Given the number of families affected by wartime service and the changing circumstances they faced in active duty and veteran settings, it rapidly became evident that adaptations of this approach for families in other contexts were needed. We identified the core elements of FOCUS that are essential across all adaptations: (1) Family Psychological Health Check-in; (2) family-specific psychoeducation; (3) family narrative timeline; and (4) family-level resilience skills (e.g., problem solving). In this report, we describe the iterative process of adapting the intervention for different groups of families: wounded, ill, and injured warriors, families with young children, couples, and parents. We also describe the process of adopting this intervention for use in different ecological contexts to serve National Guard, Reserve and veterans, and utilization of technology-enhanced platforms to reach geographically dispersed families. We highlight the lessons learned when faced with the need to rapidly deploy interventions, adapt them to the changing, growing needs of families under real-world circumstances, and conduct rigorous evaluation procedures when long-term, randomized trial designs are not feasible to meet an emergent public health need.     

Balancing the family and the collective in raising children: why communal sleeping in kibbutzim was predestined to end

This article integrates research data about attachment in kibbutz-raised children with a review of the socio-historical processes that shaped the interrelations between the kibbutz family and the collective and influenced childrearing practices. It uses systems theory to evaluate the changing practices of kibbutz childrearing with particular focus on communal sleeping for infants and children away from their parents, and its impact on the formation of attachment relations to parents and caregivers, transmission of attachment across generations, and later school competence. It argues that artificial childrearing practices such as communal sleeping for infants and children created a unique and unprecedented "social experiment in nature," which, from the perspective of attachment theory, was predestined to be discontinued because it betrayed the essential attachment needs of most parents and children.     

The effects of Brazelton intervention: A review

This article reviews research that has used the Brazelton Neonatal Behavioral Assessment Scale (NBAS; Brazelton, 1984) as an intervention. It discusses separately the various effects NBAS intervention has been found to have in areas such as parent-infant interaction, infant development, temperament, and parental attitudes and satisfaction. Inconsistent findings are noted in each of these areas. This article then addresses issues that may play a role in the effectiveness of NBAS intervention, including the risk status of the population, the intensity of the intervention, and the receptivity of the parent. It concludes by suggesting that realistic goals be set concerning the expectations for early, short-term intervention such as the NBAS.     

‘Someone to talk to who'll listen’: addressing the psychosocial needs of children and families

The paper presents the Lewisham Community Child and Family Service (LCCFS), a community‐based intervention providing psychosocial help for children, young people, parents and families. The service is focused on early intervention, prevention and promotion in the improvement of local health. It works under a service framework based on inter‐agency collaboration, and a counselling model based on community and interpersonal partnerships, grounded in personal construct theory (Kelly, 1955). The policy demands and local need for accessible and acceptable mental health are discussed, and quantitative and qualitative findings of the needs assessment preceding the establishment of the LCCFS are presented, supporting the need for community mental health provision. The feasibility for the LCCFS to reconcile and meet the policy demands and the needs of parents with respect to child psychosocial help and services are discussed. Copyright © 2001 John Wiley & Sons, Ltd.     

A call for integrating a mental health perspective into systems of care for abused and neglected infants and young children

A system of care for abused and neglected infants and young children should adopt a comprehensive perspective, with mental health considerations systematically incorporated into policies and decisions affecting children and their families. Children age birth to 5 years have disproportionately high rates of maltreatment, with long-term consequences for their mental and physical health. Research on normal development and developmental psychopathology has shown that early development unfolds in an ecology of transactional influences among biological, interpersonal, and environmental domains. Psychologists should collaborate with other early intervention disciplines to create systems of care based on an ecological-transactional model of development that includes early mental health principles in order to serve the needs of these young children. Didactic courses, practicums, and internships in infant and early childhood mental health should become integral components of undergraduate and graduate curricula in psychology in order to build capacity to achieve this goal. Recommendations are offered for systemic change by integrating infant and early childhood mental health principles into existing systems of care for young children and their families.     

Training program in psychosocial intervention for high-risk infants and their families

A multidisciplinary training program for psychosocial intervention in the Neonatal Intensive Care Unit (NICU) was developed. The purpose of the program was to train mental health and health care professionals in a psychosocial preventive intervention model for high-risk infants and their families throughout the infants' hospital course in the NICU. The program was divided into modules that include assessment and intervention with the infant, parents, family, and larger caregiving environment. Over a 3-year period 40 trainees from 9 disciplines were trained. A randomized clinical trial was conducted which showed the positive effects of the intervention. A clinical service including inpatient and outpatient follow-up has been established in the NICU based on the psychosocial model developed from the training program.     

Overprotective Parenting: Helping Parents Provide Children the Right Amount of Risk and Responsibility

Overprotective parenting in low-risk environments may have negative consequences for the psychosocial development of children and youth. Though not well studied, a number of different bodies of literature can be used to speculate on the reasons for overprotective parenting and the impact it has on children. In this article, the social and familial dynamics leading to overprotection are discussed. It is shown that overprotection among middle-class families may result from poorly informed parents regarding the psychosocial developmental needs of their children for risk and responsibility and a lack of familiarity with population-wide data which shows that many of today's youth are safer that at any previous time in history. Focusing on the “risk-taker's advantage,” this article uses a case example to illustrate a three-part model of intervention to help challenge overprotective parenting while opening up safe opportunities for youth to experience manageable amounts of risk and responsibility.     

Getting ready: Results of a randomized trial of a relationship‐focused intervention on the parent–infant relationship in rural early head start

The purpose of this study is to investigate the effects of a relational intervention (the Getting Ready intervention) on parenting behaviors supporting the parent–infant relationship for families enrolled in Early Head Start home‐based programming. Two‐hundred thirty‐four parents and their children participated in the randomized study, with 42% of parents reporting education of less than a high‐school diploma. Brief, semistructured parent–child interaction tasks were videotaped every 4 months over a16‐month intervention period. Observational codes of parent–infant relationship behaviors included quality of three parental behaviors: warmth and sensitivity, support for learning, and encouragement of autonomy; two appropriateness indicators: support for learning and guidance/directives; and one amount indicator: constructive behaviors. Parents who participated in the Getting Ready intervention demonstrated higher quality interactions with their children that included enhanced quality of warmth and sensitivity, and support for their children's autonomy than did parents in the control group. They also were more likely to use appropriate directives with their children and more likely to demonstrate appropriate supports for their young children's learning. Results indicate an added value of the Getting Ready intervention for Early Head Start home‐based programming for families of infants and toddlers.     

Assessment as Intervention: A Pilot Study of Short-Term Dyadic Treatment

Assessment, as an intervention, is a hallmark of infant mental health that has not been evaluated for treatment effectiveness. A comprehensive assessment framework was standardized as a short-term intervention model and evaluated for treatment effects based on dynamic systems theory of change. The transdisciplinary interaction-based assessment model embeds nondidactic developmental guidance interpretations in the context of eliciting child functional capacities while engaging the caregiver in direct co-observation and reflection to challenge inflexibility in parents’ representations. The findings of this pilot project, with a community sample of Spanish- and English-speaking families, suggest this assessment as intervention model has the potential to promote an active process of change in parents’ representations toward a “disorderly,” or unstable state, possibly both in perceptions of self as caregiver and in representations of the child. Clinically, this disorderly state would be seen as an opportunity that could perpetuate the change process, recognizing disorderliness of representation as an opening, as emerging permeability of representations. Results indicate that this caregiver-clinician collaborative process is associated with caregiver reports of decreased distress, increased empathy for child’s difficulties, and changes in caregiver representations. A subset of families, caregivers who hold immutable views of their children, are less responsive to the developmental guidance approach and may require different or more long-term treatment.