Parent mentoring: Improving infant health practices and postnatal maternal depression through home visiting

Purpose: Maternal depression has been associated with many adverse health and developmental outcomes among children. Some of the behavioral difficulties observed among children of depressed mothers are thought to arise from poor parenting practices. Research has also found that the amount of time required for delivering all of the child well-health preventive services, including the necessary support and guidance for families, is not feasible during routine well-health care. The centrality of families in children's well-being forms the theoretical base for providing parents with anticipatory child guidance and mentoring, and promoting family-centered care through home visiting in supporting the delivery of well-baby health services. This study examines the effectiveness of parent mentoring intervention implemented through home visiting with Latino and African American low income families in an urban area.

Method: The theoretically-based intervention was developed through a multidisciplinary protocol from social work, nursing, and special education. Bi-lingual parent coaches mentored families based on EPSDT health schedule in weekly visits from the child's birth to 18 months. Two waves of families were recruited and consented. Thirty-five intervention families (70%) completed the project during first wave, and 38 (76%) during the second. The first-wave was evaluated through pre-post quasi-experimental design and compared with static but matched comparison group. Matching used criteria for project-enrollment, based on prior research. The second-wave was randomized into a two-group pre-post experiment. Outcomes for children included immunization, emergency-room visits, developmental assessment (ASQ, Ages & Stages) and vocabulary (MacArthur CDI, Short-form); for parents, adequacy of resources (Family Resources, Dunst & Leet), parenting (AAPI-2, Bavolek & Keene), resilience (RAS, Briscoe & Harris), and postnatal depression (EPDS, Cox et al.). Measures of central tendency and variability describe wave-participants. For continuous measures, paired t-tests compare mean outcomes changes in each group within each wave. Independent t-tests compare mean outcomes at post-tests between intervention and comparison group in each wave. For categorical measures, chi-square compares frequencies between groups and waves. MRA examines relationship between intervention participation and maternal depression while controlling for other variables. Repeated measures of ANOVA is used to test group differences over multiple time points. Criterion alpha .05 is set for statistical significance.

Results: Both waves had similar drop-outs from baseline to exit. Drop-outs and comparison families did not significantly differ in family characteristics from intervention families: poverty-level income, less than high school, low family resources, inadequate health insurance coverage, focus child had medically-normal birth. In both waves, intervention families showed significant gains (p<.05) in both child and family outcomes from baseline to exit. Wave 1 showed significant improvements in all outcomes when compared to matched comparison families. Wave 2 also showed significant improvements compared to control families. Intervention participation and gained maternal resilience significantly predicted maternal depression at exit, accounting for 58% of variance. Limitations of findings are considered.

Implications: These findings demonstrate that intensive mentoring during early childhood can improve health practices and maternal depression among children and families struggling with poverty, and offer a healthy start. To create an effective intervention for child guidance requires a multidisciplinary collaboration.