Infant mental health home visiting therapists’ fidelity to the Michigan IMH-HV model in community practice settings

Implementation research suggests that fidelity to a therapeutic model is important for enhancing outcomes, yet can be difficult to achieve in community practice settings. Furthermore, few published studies have reported on characteristics of treatment fidelity. The present study examined fidelity to the Infant Mental Health Home Visiting (IMH-HV) model among 51 therapists with a range of experience practicing in community settings across the state of Michigan. IMH therapists completed fidelity checklists after every session with participating families to track use of 15 treatment strategies central to the IMH-HV model across the 12-month study period. Results indicated that the most commonly endorsed components utilized in home visits were developmental guidance and infant–parent psychotherapy, followed by the provision of emotional support. Use of IMH-HV components did not vary over time for the entire sample; however, patterns of strategies used showed somewhat more variability among more experienced therapists and when serving higher risk families. Findings demonstrate that IMH-HV therapists report a range of adherence to the model in community settings, with greatest fidelity to several model core components. Ongoing training in the flexible use of all core strategies may further enhance fidelity and contribute to positive outcomes for caregivers and their children receiving IMH-HV services.     

Infant mental health home visiting therapists’ reflective supervision self-efficacy in community practice settings

In recent years, there has been an increase in the research on reflective supervision, including the development of tools designed to measure reflective practice in the context of reflective supervision. The Reflective Supervision Self-Efficacy Scale for Supervisees (RSSESS) is a self-report measure that has been used in previous evaluations and is designed to assess perceived reflective practice self-efficacy for Infant Mental Health-Home Visiting (IMH-HV) therapists. Properties of the RSSESS including factor structure and reliability are explored in a first study that lays the foundation for the use of the RSSESS in an IMH-HV evaluation in the State of Michigan. IMH-HV therapists completed the RSSESS at 4 time points over a 12-month period and also completed a Clinician Profile Form that included questions about their IMH background and their work experience, including job satisfaction and burnout. Results indicated that the RSSESS is a reliable tool to measure change in reflective practice skills. IMH-HV therapists demonstrated growth in their use of reflective practice skills with families and their observational skills over the 12-month period. In addition, results indicated correlations between reflective supervision self-efficacy and job satisfaction as well as burnout.     

Decision-making styles and mental health—A person-oriented approach through clustering

Previous research examining the associations between decision-making styles and mental health has neglected to look at the configurations of styles. The study identifies mutually exclusive groups of people according to their combination of the five decision-making styles and examines the differences between them in mental health-related variables in two studies. In Study 1, decision-making styles, mental health indicators (well-being, depression, stress) and socio-psychological protective factors (resilience, optimism, social support) were examined in university students in two rounds 1 year apart. A cluster analysis revealed three distinct decision profiles—independent/nonintuitive, avoidant/spontaneous and rational/nonavoidant. The best values of mental health-related variables were found in the rational/nonavoidant profile and the most negative values in the avoidant/spontaneous profile. The decision-making styles were stable after 1 year although they were not able to explain changes in mental health-related variables. Study 2 identified three similar clusters in a more general sample—spontaneous/irrational, dependent/avoidant and rational/nonavoidant—with the lowest level of psychological distress symptoms in the rational/nonavoidant cluster. The study highlights the usefulness of combinations of decision-making styles with regard to mental health as well as noting their specificity according to sample characteristics.