Higher Dosage of Community-Delivered Infant Mental Health Home Visiting Is Associated with Increased Positive Parenting

The Infant Mental Health-Home Visiting (IMH-HV) program is a Medicaid-funded intervention provided by the Community Mental Health Services Program for high-risk families from pregnancy through child age 3 years that promotes positive parenting and development for young children. The Michigan Collaborative for Infant Mental Health Research has collected data across Michigan to evaluate the effectiveness of the practice. In the current study, we focus on changes in parenting.

Our sample consists of 78 female caregivers who received IMH-HV intervention over a 1-year period. Caregivers and children (mean age = 9.9 months) were assessed shortly after entry into services, and 6 and 12 months later. Assessment included measures of infant development, caregiver mental health and parenting. The current study uses the sum of two subscales of the Home Observation for Measurement of the Environment (HOME), based on observations in the home, to examine two domains of parenting: 1) refraining from harshness and 2) responsiveness to the child.

IMH-HV services are delivered to families at any point from pregnancy through child age three; length of treatment varies according to factors including child age at entry, family need and treatment objectives, and factors influencing parent/caregiver attendance. Weekly IMH-HV sessions are typically 1.5 to 2 hours in length. Following each home visit, clinicians reported the date and length of visit, which was used to calculate the total number of visits between baseline and 6 months and between 6 and 12 months. The total number of visits in the time preceding the assessment was used as a time-varying predictor in a linear mixed model. Demographic risk was measured by young maternal age at childbirth, crowding in the home, very low income, low education, being unmarried and racial/ethnic status. Psychological risk was measured by maternal psychopathology and history of childhood trauma. A linear mixed model for longitudinal analysis allowing for individual level variance was estimated using SAS 9.4 PROC MIXED with unstructured covariance structure and restricted maximum likelihood estimation. Random effects of intercept and time were included in the model.

Results of the mixed model showed that higher number of home visits preceding an assessment was related to more responsive and less harsh parenting as evidenced by higher HOME scores (estimate = .044, p = .0031), even after controlling for demographic and psychological risk.

These data provide evidence that higher exposure to treatment in the IMH-HV model is related to improved parenting capacity to provide emotional support to their child. This model is implemented in a real-world setting, strengthening the evidence that IMH-HV is effective for high-risk families.