Examining program quality in early childhood home visiting: From infrastructure to relationships

Although there are many examples of evidence-based early childhood home-visiting programming, the field itself struggles with modest outcomes and variable levels of program effectiveness. This article documents the experience of creating a statewide monitoring system to assess home-visiting program quality and compliance to identified standards, integrating multiple sources of information across different domains of functioning. Monitoring results from 57 programs are summarized, with variable but promising levels of quality. Programs generally report satisfaction and benefit from the process. In addition, the relationship between direct observations of home visits and home-visitor report of their approach to working with families is analyzed. Results suggest significant, albeit small, associations. Although there are trade-offs between comprehensiveness of information gathering and practical application, the use of monitoring findings to support home-visiting programs holds potential for quality improvement.     

Maternal depression and infant attachment security: A meta-analysis

The purpose of this study is to clarify the magnitude of the association between maternal depression and infant attachment nonsecurity, and to identify possible moderators of this relationship. An extensive literature search was conducted using multiple databases of both published and unpublished studies. A meta-analysis was conducted to determine the relationship between maternal depression and infant attachment security and to establish the effect size. The main findings from this meta-analysis, which included 42 studies, indicate that there is a small, yet significant, relationship between maternal depression and infant attachment nonsecurity. The rate of nonsecurity in infants of mothers with depression was approximately 20% higher than expected rates in a nonclinical population, and the association between depressive symptoms and nonsecurity was small, but significant. Infants of mothers with depression were nearly twice as likely to have a nonsecure attachment than were infants of healthy mothers. Depression measure and maternal sample source were identified as significant moderators of the odds ratio effect size. Results of this study demonstrate that there is a significant relationship between maternal depression and infant attachment nonsecurity, and suggest that interventions that focus on both maternal mental health and the attachment relationship are warranted.     

Reflective Capacity: An Antidote to Structural Racism Cultivated Through Mental Health Consultation

Effecting a paradigm shift from “reproductive health” to “reproductive justice” within the perinatal field requires changes simultaneously at the levels of the individual healthcare provider and the system of care. The Infant-Parent Program at the University of California, San Francisco (UCSF) has extended its pioneering infant and early childhood mental health consultation to perinatal service systems applying an infant mental health approach to programs caring for expecting and new parents. In partnership with two nursing programs, UCSF consultants direct their efforts at supporting reflective practice capacities and use-of-self in patient–provider relationships. Both nursing programs serve vulnerable groups of expectant and new parents who grapple with challenges to health and well-being stemming from structural racism. As reflective capacities are supported within the consultation case conferences, providers spontaneously identify the need for tools to effectively address issues of race, class, and culture and to combat structural racism throughout the healthcare system. Policies and procedures that uphold structural racism cease to be tolerable to providers who bring their full selves to the work that they are trained to do. Using these nurse consultation partnerships as organizational case studies, this article describes a range of challenges that arise for providers and delineates steps to effective engagement toward reproductive justice.     

Reconceiving the field: Infant mental health,intersectionality, and reproductive justice

The field of infant mental health is conventionally comprised of professional discourses including developmental science, psychology, and psychiatry, among others, and involves spheres of practice as wide-ranging as pediatrics, maternal/child health, early intervention, early care and education, and child welfare. The World Association of Infant Mental Health [WAIMH] put out its position paper on the rights of infants in 2014 (amended in March 2016) in recognition of the human rights implications of professional understanding of infants’ unique, yet universal, developmental capacities and needs. This article links the policy issues outlined in the WAIMH position paper with critical issues in the field of reproductive justice, extending the reach of WAIMH's call to action on behalf of infants’ rights, and pointing the way toward potent alliances among interconnected movements. Connecting the dots among economic injustice, race-based health disparities, and gender inequities, the article demonstrates that it is not possible to safeguard infant mental health unless we make reproductive justice a reality.     

Maternal experience of their infants’ crying in the context of war trauma: Determinants and consequences

We examined, first, how prenatal maternal mental health and war trauma predicted mothers’ experience of their infant crying, indicated by emotions, cognitions, and behavior; and second, how these experiences influenced the mother–infant interaction and infant development. Participants were 511 Palestinian mothers from the Gaza Strip, reporting their war trauma, symptoms of posttraumatic stress disorder (PTSD), depression, and perceived stress during pregnancy (Time 1). They reported experiences of infant crying at 4 months (Time 2), and the mother–infant interaction and infant sensorimotor and language development at 12 months of infants’ age (Time 3). Results revealed that maternal mental health problems, but not war trauma, were important to experiences of infant crying. A high level of PTSD symptoms predicted negative emotions evoked by infant crying, and high depressive symptoms predicted low active and positive responses to crying. Unexpectedly, high prenatal perceived stress predicted high active and positive responsiveness. Concerning the consequences, mothers’ sensitive interpretation of infant crying predicted optimal infant sensorimotor development, and mothers’ active and positive responses predicted high emotional availability in mother–infant interaction. Crying is the first communication tool for infants, and mothers’ sensitive responses to crying contribute to infant well-being. Therefore, reinforcing mother's optimal responses is important when helping war-affected dyads.     

Effects of male postpartum depression on father–infant interaction: The mediating role of face processing

It is estimated that postpartum depression affects up to 25% of men. Despite such high prevalence, the majority of studies on postpartum depression are focused on mothers, and the role of paternal depression and its effects on infant development have been overlooked by researchers and clinicians. The present study aimed to fill this gap by investigating the effect of paternal postpartum depression on father–infant interactions. In addition, we examined whether differences in face recognition mediated the effects of paternal postpartum depression on father–infant interactions. A total of 61 father–infant dyads (17 postpartum depression, 44 controls) took part in the study. Results revealed that compared to controls, fathers with postpartum depression had a worse pattern of interaction with their infants on measures of responsiveness, mood, and sensitivity; they also had greater difficulty in recognizing happy adult faces, but greater facility in recognizing sad adult faces. Depressed fathers attributed greater intensities to sad adult and infant faces. The tendency to attribute greater intensity to sad adult faces was confirmed as a partial mediator of the effect of paternal postpartum depression on measures of father responsiveness and as a full mediator of the effects of paternal depression on father sensitivity. Clinical implications and suggestions for further studies are discussed.     

Attachment and coparenting representations in men during the transition to parenthood

Coparenting is based on parents’ representations of themselves as coparents. Attachment theory can be a useful framework to understand the way that different coparenting representations are developed during the transition to parenthood. This study aimed to analyze the association between men's attachment and coparenting representations at the first trimester of pregnancy and from the first trimester of pregnancy to 6 months’ postpartum. A sample of 86 men was recruited and completed self-report measures of attachment and coparenting representations at the first and third trimester of pregnancy and at 1 and 6 months’ postpartum. At the first trimester of pregnancy, higher attachment avoidance was associated with higher lack of coparenting support. From the first trimester of pregnancy to 6 months’ postpartum, higher attachment avoidance was associated with (a) a steeper increase on lack of coparenting support, (b) an increase on coparenting conflict (while low attachment avoidance was associated with a decrease), and (c) a lower decrease on coparenting disagreement. This study may contribute to coparenting research by showing new evidence on attachment theory as a useful framework to understand how different coparenting representations are developed in men during the transition to parenthood.     

The Ecology of Experiences for African American Women in Clinical Doctoral Programs

African American women must navigate higher education, in particular, clinical doctoral programs, as a gendered racial minority. These women often endure multiple levels of discrimination to obtain their degree. Findings of this study highlight these experiences and suggest the importance of increasing supports for African American women in clinical doctoral programs. Practices and supports should be put in place so that students of color are not marginalized because of their race. Las mujeres afroamericanas tienen que pasar por la educación superior, y particularmente en programas de doctorado clínico, como una minoría racial y de sexo. Estas mujeres sufren con frecuencia múltiples niveles de discriminación para poder obtener su titulación. Los hallazgos de este estudio destacan estas experiencias y sugieren la importancia de incrementar los apoyos para mujeres afroamericanas en programas de doctorado clínico. Deberían implementarse prácticas y apoyos para que las estudiantes de color no sean marginadas por su raza.     

The Perpetual Outsider: Voices of Black Women Pursuing Doctoral Degrees at Predominantly White Institutions

This qualitative study explored the perceptions and experiences of Black female doctoral students at predominantly White institutions and their impact on academic persistence and overall well‐being. Fifteen Black female doctoral students participated in semistructured interviews, and each one was administered a demographic questionnaire and was extended an opportunity to participate in member checking. All data collected from the semistructured interviews, demographic questionnaires, and member‐checking exercises were analyzed using Black feminist thought as an interpretive lens. Whereas several themes emerged and are discussed in previous articles (Shavers & Moore, 2014a, 2014b), this article focused on the “Perpetual Outsider” theme, comprising the following subthemes: (a) unwelcoming spaces, (b) tokenism, and (c) outsiders at home. Implications are offered based on identity, support systems, and group counseling. Este estudio cualitativo exploró las percepciones y experiencias de estudiantes negras de doctorado en instituciones predominantemente blancas, así como su impacto en la persistencia académica y bienestar general. Quince estudiantes negras de doctorado participaron en entrevistas semiestructuradas, y a cada una de ellas se les administró un cuestionario demográfico y se les ofreció la oportunidad de participar en seguimientos de miembros. Todos los datos recopilados a partir de las entrevistas semiestructuradas, los cuestionarios demográficos y los ejercicios de seguimiento de miembros fueron analizados e interpretados desde la perspectiva del pensamiento feminista negro. Aunque surgieron varios temas que se comentan en artículos anteriores (Shavers & Moore, 2014a, 2014b), este artículo se centra en el tema del “Forastero perpetuo”, que incluye los siguientes subtemas: (a) espacios hostiles, (b) representación simbólica y (c) forasteros en casa. Se ofrecen implicaciones basadas en la identidad, sistemas de apoyo y consejería de grupo.