What Is Infant Mental Health-Home Visiting?
Introduction
Infant Mental Health Home Visiting (IMH-HV) is a specialized preventive intervention and psychological treatment promoting the healthy social, emotional, and cognitive development of children under the age of 3 that has been implemented through the public mental health system in Michigan for over 50 years. The model was developed by Selma Fraiberg, Betty Tableman, and other pioneering clinicians in the field of infant mental health.
Specifically, Infant Mental Health Home Visiting (IMH-HV) is a needs-driven, relationship-focused intervention for parents and infants/toddlers aged 0 (pregnancy) to 36 months. IMH-HV aims to meet the needs of families at risk for relationship problems, child abuse and/or neglect, and behavioral health concerns. Families are eligible for IMH-HV if either the parent or child have concerns that make them more susceptible to disruptions in the parent-child relationship (e.g., parent mental health, child social-emotional and regulatory concerns). IMH-HV is delivered weekly in families’ homes by Master’s-level providers. Through a multifaceted approach, IMH-HV aims to increase parental competencies, promote mental health and sensitive caregiving, and thus reduce risk for the infant/toddler and lessen the probability of intergenerational transmission of the effects of unresolved loss and trauma in parents.
This program involves the family or other support systems in the individual's treatment: The needs and contributions of significant adults (including other parents who are not direct recipients of services) and other young children in the household are considered and included in the IMH-HV intervention. This may include biological parents, foster parents, and/or kin; and may also involve coordination of care with child welfare system providers, medical providers, early care and education providers, and other professionals involved in support for the infant/toddler and/or family.
IMH-HV Components
- Culturally Responsive Practice
- Relationship/Safety
- Building an Alliance
- Video Recording
- Material Needs
- Developmental Guidance
- Emotional Support
- Infant-Parent Psychotherapy
- Reflective Supervision
- Life Planning
Results
Evaluation results for this evidence-based practice (listed in the California Evidence-based Clearinghouse for Child Welfare) demonstrated that in community-delivered IMH-HV, families who received more IMH-HV sessions in a year had mothers who demonstrated greater maternal sensitivity when interacting with their infants/toddlers. This demonstrates the positive effect of IMH-HV services on parent sensitivity and identifies a unique component of IMH-HV associated with positive parenting.
IMH-HV was also associated with improved child social-emotional development. Specifically, families who received up to 12 months of IMH-HV treatment had infants/toddlers with better social-emotional functioning than families who did not receive this intervention. Additionally, the positive effects of IMH-HV on infant/toddler social emotional development were greatest for infants/toddlers of mothers who entered treatment with more symptoms associated with posttraumatic stress disorder (PTSD). This indicates that IMH-HV is generally successful at supporting healthy infant/toddler social-emotional development, and that it is especially capable of doing so in the context of maternal trauma symptoms. This is important, as generally maternal mental health challenges can restrict the intervention impact on infant/toddler outcomes.
Outcomes of IMH
Similar positive effects on infant/toddler cognitive development were found. Toddlers of mothers with high amounts of childhood adversity who received IMH-HV sessions had similar language development scores as toddlers whose mothers had no or low amounts of childhood adversity. These findings parallel findings from an evaluation of IMH-HV in the court system, which found that IMH services were linked with improvements in child language. This demonstrates the positive impacts of IMH-HV on child cognitive development in the context of intergenerational stress or adversity. Because toddler language is an important indicator of school readiness, the findings also support IMH-HV as a home visitation program that increases school readiness for those at risk.
Findings of the recent evaluation have also supported the use of this intervention in reducing child maltreatment and injury. When evaluating IMH-HV delivered in both a community sample that included 33% of families already involved with the child welfare system, as well as delivered to families in a randomized controlled trial, evaluators found that IMH-HV treatment was linked with lower levels of child abuse potential in parents. Taken together, these studies support the use of IMH-HV with families who are or may be at risk of engaging in child abuse, or at risk of accidental child injury.
Research
Analysis of parent and infant/toddler biological samples (i.e., cortisol measured via hair sample and epigenetic markers of stress measured via salivary samples), which will provide a deep understanding of the biological mechanisms underlying maternal and infant health that may be improved through receipt of IMH-HV was conducted. Early exposure to stress affects risk for mental health outcomes over the lifetime and across generations. One key biological process involved in these processes is DNA methylation, an epigenetic mechanism thought to be linked to environmental stress and intergenerational transmission of adversity. Specifically, methylation of the glucocorticoid receptor gene, NR3C1, is associated with heightened cortisol response and negative socioemotional outcomes. This study examined the efficacy of IMH-HV on the relation between toddlers’ NR3C1 methylation and their socioemotional outcomes in a randomized-controlled trial. Participants included 44 parent-toddler dyads, randomly assigned to 12 months of IMH-HV treatment or to a control group. The overall regression with methylation and treatment group predicting child Socioemotional Competence was significant, and moderation analysis revealed a significant interaction effect. In the control group, higher methylation of NR3C1 predicted lower Socioemotional Competence. However, this association was not observed for children in the treatment group, suggesting that the IMH-HV intervention buffers the effects of NR3C1 methylation on children’s socioemotional outcomes. This is the first study to demonstrate that a targeted relationship-based intervention, such as IMH-HV, can buffer the detrimental effects of stress-related epigenetic modifications on children’s socioemotional outcomes.