The Ecological Context of Families and Implications for Home Visiting: Findings from the Michigan Imh-Home Visiting Model

Background and Purpose:

Social worker Selma Fraiberg's pioneering work with infants, toddlers, and families nearly 50 years ago led to the development of the multidisciplinary field of infant mental health. The intent was to promote the socioemotional health of the infant. The Michigan Model of Infant Mental Health Home Visiting (IMH-HV), derived from the Fraiberg model, is a home-based family intervention focused on the developing parent-infant relationship. Prior studies of the IMH-HV model have found evidence for its efficacy in promoting child social-emotional health, language development, and stress regulation. This study reports on findings regarding the ecological context of maternal caregiving representations and maternal reflectivity, and infant attachment security.

Methods:

Data come from a community sample of 57 families who participated in all waves of a randomized control trial testing the efficacy of an infant mental health home visiting treatment model. Eligible mothers were 18 years or older, had legal custody of their age-eligible child (ages 0–24 mo. at enrollment), and denied symptoms of substance use disorders or psychosis. Participants had to endorse sociodemographic risk factors typical of those receiving IMH-HV services in the community. Using race (as a proxy for exposure to structural racism) and income as constants, this particular study explored three facets of parenting: maternal caregiving representation, maternal reflectivity, and maternal disrupted caregiving behavior and associations with infant security.

Results:

For mothers with lower incomes, lower reflectivity was associated with lower infant attachment security scores, and higher reflectivity was associated with higher infant/toddler security. However, when the family income-to-needs ratio was higher, that association was non-significant; at higher levels of income, infant/toddler security and parent reflectivity were unrelated. The incomes of mothers with non-balanced representations (i.e., those with distorted, or disengaged caregiving representations of their child) were substantially lower than the incomes of mothers with balanced representations. Older infants/toddlers of mothers with non-balanced representations had lower security scores compared to younger infants/toddlers with mothers with non-balanced representations (β = 1.20, 95% CI [.023, 2.37]). Post-intervention follow-up studies are underway to examine if IMH-HV demonstrates efficacy in improving infant attachment security.

Conclusions:

This study provides further evidence that the ecological context of a family, particularly at low-income levels, may negatively influence parental reflectivity and infant security. Larger samples and more longitudinal research are necessary to explore whether programs offering a monthly basic income moderate the associations between income and infant/toddler attachment. At a more proximal policy level, there is an urgent need to train social workers to appropriately utilize and interpret cost-effective, evidence-based available tools to measure infant/toddler and parent relational health, including attachment quality. The interaction effect of maternal representation and infant age suggests that prenatal and early infancy intervention is necessary when there is evidence of distorted or disengaged maternal representations. The longer an infant/toddler lives under the weight of malevolent, hostile, or confused maternal representations, the greater the toll on their basic sense of the safety and their developing sense of self, increasing the risk of later diagnosis of internalizing and externalizing disorders.