Minding the Baby (MTB)

About This Program

Target Population: Young, first-time parents (ages 14-25) and their children (prenatal-24 months) residing in underserved communities

For children/adolescents ages: 0 – 2, 14 – 25

For parents/caregivers of children ages: 0 – 2, 14 – 25

Program Overview

Minding the Baby® (MTB) is an interdisciplinary preventive intervention that is provided in the home by a team made up of a pediatric nurse practitioner and a licensed clinical social worker. Together, the team works to promote positive health, mental health, life course, and attachment outcomes in babies, mothers, and their families. MTB is geared toward meeting the needs of at-risk mothers, children, and their families. Home visits begin in pregnancy and continue through to the child’s second birthday.

Based on an applied research model grounded in attachment theory, the MTB integrated model of care bridges primary care and mental health approaches to promote and strengthen the mother-infant relationship. In addition to providing discipline specific (i.e., nursing or social work) care, clinicians are trained in enhancing reflective parenting, supporting the development of secure attachment, and providing trauma-informed care.

Program Goals

The goals of Minding the Baby® (MTB) are:

  • Promote healthy physical, emotional, and social development in infants and toddlers
  • Support parents’ efforts to overcome the impact of intergenerational cycles of toxic stress and early childhood adversity
  • Strengthen the early relationships of young and vulnerable first-time parents and their families
  • Promote secure attachment, parental reflectiveness, health & mental health, and self-efficacy
  • Support reflectiveness through relationships using an interdisciplinary approach

Essential Components

The essential components of Minding the Baby® (MTB) include:

  • MTB is a manualized and trademarked intervention.
  • Although certain adaptations and modifications may be necessary, especially to fit international contexts, any MTB program must:
    • Be delivered by a graduate level interdisciplinary nurse/mental health clinician team working jointly to promote positive health, mental health, and parenting outcomes, preferably master’s prepared clinicians.
    • Aim to enhance parental capacities to reflect upon their children’s thoughts and feelings (i.e., use reflective parenting) as a means to better understand and make sense of these thoughts and feelings. Reflective parenting is critical to the development of secure and robust attachments, in which the child feels known and kept in mind by his parents.
    • Work intergenerationally to promote satisfying and loving relationships as well as the development of secure attachment.
    • Focus on the development of the clinician-parent relationship as the primary agent of change.
    • Focus on prevention and the development of resources to limit the long-term impact of trauma, adverse childhood experiences, and toxic stress on both current and later physical and mental health.
    • Deliver intensive services in the home with appropriate duration beginning during mid-to-late pregnancy, preferably late second trimester.
    • Utilize a flexible curriculum based on the MTB manual but matched to families’ needs and suited to families of diversity with respect to their economic, social, and racial/ethnic backgrounds.
    • Include an evaluation component with agreed upon data submitted to the MTB National Office at regular intervals.

Program Delivery

Child/Adolescent Services

Minding the Baby (MTB) directly provides services to children/adolescents and addresses the following:

  • A variety of risk factors associated with being born to a parent in their teens or young adulthood in underserved communities, including socioeconomic disadvantage, family histories of trauma, abuse, and/or neglect, or lack of social support

Parent/Caregiver Services

Minding the Baby (MTB) directly provides services to parents/caregivers and addresses the following:

  • At-risk parents with possible histories of disruption, trauma, child protective involvement, etc.
Services Involve Family/Support Structures:

This program involves the family or other support systems in the individual's treatment: MTB mothers identify who is in their family, and all family members (at the mother’s discretion) are invited to participate and engage in the home visits.

Recommended Intensity:

Typically one-hour-long weekly home visits through the child’s first birthday, then every other week during the child’s second year of life

Recommended Duration:

27 months

Delivery Settings

This program is typically conducted in a(n):

  • Birth Family Home
  • Community Agency
  • Community Daily Living Setting
  • Homeless Shelter
  • Outpatient Clinic

Homework

This program does not include a homework component.

Languages

Minding the Baby (MTB) has materials available in languages other than English:

Danish, Spanish

For information on which materials are available in these languages, please check on the program's website or contact the program representative (contact information is listed at the bottom of this page).

Resources Needed to Run Program

The typical resources for implementing the program are:

  • One or more home visiting teams consisting of a credentialed mental health clinician (typically a Licensed Clinical Social Worker) and a licensed nurse or certified nurse practitioner.
  • An interdisciplinary supervisory team including a mental health supervisor and a nurse supervisor.
  • Secure, dedicated office space with adequate storage for supplies and materials
  • Laptop computers and/or tablets for clinical staff
  • Cell phones for clinical & research staff with texting (smart phones preferred)
  • Digital and/or video camera(s) for clinicians (if smart phones aren’t an option)
  • Office supplies and equipment
  • Gifts for families
  • Materials for home visits

Additional recommendations are included in the MTB Operations Manual.

Education and Training

Prerequisite/Minimum Provider Qualifications

Mental Health Home Visitors: Master’s Degree in Social Work or similar mental health field, and at least one year of experience in a mental health care setting with young children, or the equivalent combination of experience and education. LCSW preferred.

Nurse Home Visitors: Active state Registered Nurse (RN) license, and at least one year of pediatric or family experience, or equivalent combination of experience and education required.

Mental Health Supervisors: Master’s degree or higher in social work or a related mental health field (LCSW or PhD in Psychology or similar field preferred); 2-4 years of experience with clinical supervision; training and background in Reflective Supervision, dynamic theory and practice, infant-parent psychotherapy or child-parent psychotherapy, parent and early child development, trauma, attachment, reflective functioning; current knowledge of mandated reporting requirements; home visiting experience preferred. Infant Mental Health Endorsement® encouraged.

Nurse Supervisors: Minimum of a Bachelor’s of Nursing (BSN) with substantive clinical experience; Master’s level or higher in nursing, public health, or a related field preferred; 2-4 years of experience with clinical supervision, pediatric nursing, family health, or midwifery; training in Reflective Supervision; current knowledge of mandated reporting requirements. Home visiting experience preferred.

Education and Training Resources

There is a manual that describes how to implement this program , and there is training available for this program.

Training Contact:
Training is obtained:

An intensive multiday introductory training is delivered either at Yale or on-site for all clinical and administrative staff, with a preferred maximum enrollment of 25-30.

Number of days/hours:

The initial training is typically delivered over 3-4 consecutive days, with an additional half-day of training and technical assistance scheduled within a few weeks following the initial training to review evaluation measures, administrative forms, and the individual roles of each discipline.

Implementation Information

Pre-Implementation Materials

There are pre-implementation materials to measure organizational or provider readiness for Minding the Baby (MTB) as listed below:

The MTB Replication Planning Guide includes details about the model and implementation considerations for agencies or funders interested in pursuing MTB implementation. It is available by request through the program representative (see end of entry for contact information).

Formal Support for Implementation

There is formal support available for implementation of Minding the Baby (MTB) as listed below:

For those wishing to implement the full MTB intervention with required evaluation component, all staff involved with the program are required to complete a full-scale replication program, including introductory training in addition to participation in a combination of on-site and distance consultations over a minimum of a three-year period. Training and consultation fees are negotiated via contractual agreement through Yale University. A price sheet with detailed breakdown of costs is available upon request

Fidelity Measures

There are fidelity measures for Minding the Baby (MTB) as listed below:

MTB model fidelity is measured, monitored, and enhanced across 4 domains, based on recommendations from the U.S. National Institutes of Health (NIH) for best practices. These domains are: Design, Training, Delivery, and Receipt/Enactment. Resources, protocols, measures, and monitor checks for each of these domains are outlined in detail in the MTB Operations Manual. All measures are reviewed as part of the initial training and on-going technical assistance is provided through the MTB National Office. Fidelity measures include checklists; clinician and supervisor competencies; home visit process data; clinician, supervisor, and site self-assessments; and site visits.

Implementation Guides or Manuals

There are implementation guides or manuals for Minding the Baby (MTB) as listed below:

In addition to the MTB Treatment Manual and MTB Clinician’s Quick Reference Guide, the MTB Replication Operations Manual for Implementing Agencies is provided once agencies are under contract to replicate the model.

Research on How to Implement the Program

Research has not been conducted on how to implement Minding the Baby (MTB).

Relevant Published, Peer-Reviewed Research

Sadler, L. S., Slade, A., Close, N., Webb, D. L., Simpson, T., Fennie, K., & Mayes, L. C. (2013). Minding the Baby®: Enhancing reflectiveness to improve early health and relationship outcomes in an interdisciplinary home visiting program. Infant Mental Health Journal, 34, 391-405. doi:10.1002/imhj.21406

Type of Study: Randomized controlled trial
Number of Participants: 105 families

Population:

  • Age — Parents: Mean=19.7 years; Children: Infants (age not specified)
  • Race/Ethnicity — Parents: 69% Latina, 23% Black, 8% Other; Children: Not specified
  • Gender — Parents: 100% Female; Children: Not specified
  • Status — Participants were primiparous women (i.e., about to have their first child) attending nurse-midwifery group prenatal care sessions.

Location/Institution: Yale Child Study Center

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The purpose of this study was to test the effects of the Minding the Baby (MTB) program with young families. Participants were randomized into the control group (N=45) and into the MTB intervention group (N=60). Measures utilized include health record review, the Pregnancy Interview, the Atypical Maternal Behavior Instrument for Assessment and Classification (AMBIANCE) Scale, the Strange Situation Procedure, the Parent Development Interview – Revised (PDI), the Center for Epidemiological Studies Depression Scale (CES-D), the Brief Symptom Inventory - Short form (BSI), and the Parental Bonding Instrument (PBI). Results indicate that MTB families were more likely to be on track with immunization schedules at 12 months, had lower rates of rapid subsequent childbearing, and were less likely to be referred to child protective services. In addition, for teenage mothers, the mother-infant interactions were less likely to be disrupted at 4 months. All intervention infants were more likely to be securely attached, and less likely to be disorganized in relation to attachment at one year. Finally, mothers’ capacity to reflect on their own and their child's experience improved over the course of the MTB intervention in the most high-risk mothers. Limitations include incomplete data on the longitudinal measures, high attrition, small sample size, and lack of follow-up.

Length of postintervention follow-up: None.

Ordway, M. R., Sadler, L. S., Dixon, J., Close, N., Mayes, L., & Slade, A. (2014). Lasting effects of an interdisciplinary home visiting program on child behavior: Preliminary follow-up results of a randomized trial. Journal of Pediatric Nursing, 29(1), 3-13. doi:10.1016/j.pedn.2013.04.006

Type of Study: Randomized controlled trial
Number of Participants: 50 mother-child dyads

Population:

  • Age — Parents: Not specified; Children 3-5 years
  • Race/Ethnicity — Parents: 69% Latina, 23% Black, and 8% Other; Children: Not specified
  • Gender — Parents: 100% Female, Children: Not specified
  • Status — Participants were mothers of 3 to 5 year old children who had participated in the Minding the Baby study.

Location/Institution: Yale Child Study Center

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study utilizes participants from Sadler et al. (2013). This study was designed as a pilot study to examine the intermediate effects of Minding the Baby® (MTB) on child behavior 1-3 years postintervention. Participants were randomized into either an intervention (MTB, N=24) or a control group (N=26). Measures utilized include the Pregnancy Interview (PI), the Parent Development Interview (PDI), the Center for Epidemiological Studies Depression Scale (CES-D), the Child Behavior Checklist (CBCL), and the Caregiver-Teacher Report Form (CTRF). Results indicate that after 1-3 years the mothers who participated in the MTB intervention reported significantly fewer externalizing behaviors in their children than mothers in the control group. Limitations include small sample size and sample selection bias.

Length of postintervention follow-up: 1-3 years.

Ordway, M. R., Sadler, L. S., Holland, M. L., Slade, A., Close, N., & Mayes, L. C. (2018). A home visiting parenting program and child obesity: A randomized trial. Pediatrics, 141(2). doi:10.1542/peds.2017-1076

Type of Study: Randomized controlled trial
Number of Participants: 158 mother-child dyads

Population:

  • Age — Parents: Mean=19.4-19.6 years; Children: Mean=38.5-39.3 weeks (approximately 8-9 months)
  • Race/Ethnicity — Parents: 68% Hispanic and/or Latino, 24% African American, 7% White, 1% Native Hawaiian and/or Pacific Islander; Children: Unspecified
  • Gender — Parents: 100% Female, Children: 54% Male
  • Status — Participants were mothers and children who had participated in the Minding the Baby study.

Location/Institution: Yale Child Study Center

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study utilizes participants from Sadler et al. (2013). This study was designed as to examine the intermediate effects of Minding the Baby® (MTB) on the rate of childhood overweight and obesity in the first 2 years of life. Participants were randomized into either an intervention (MTB, N=130) or a control group (N=107). Measures utilized include the Parenting Stress Index (PSI), the Mississippi Scale, the Pregnancy Interview and Parent Development Interview, and the Center for Epidemiological Studies Depression Scale (CES-D). Results indicate that more children in the intervention group had a healthy BMI at 2 years. The rate of obesity was significantly higher in the control group (19.7%) compared with the intervention group (3.3%) at this age. Among Hispanic families, children in the MTB intervention were less likely to have overweight or obesity. Limitations include small sample size, homogeneity due to non-Hispanic African American and non-Hispanic white families, high attrition rate, and sample selection bias.

Length of postintervention follow-up: None.

Slade, A., Holland, M. L., Ordway, M. R., Carlson, E. A., Jeon, S., Close, N., … Sadler, L. S. (2019). Minding the Baby®: Enhancing parental reflective functioning and infant attachment in an attachment-based, interdisciplinary home visiting program. Development and Psychopathology. Advance online publication. doi:10.1017/S0954579418001463

Type of Study: Randomized controlled trial
Number of Participants: 156 mother-child dyads

Population:

  • Age — Parents: 14-25 years (Mean=20.0- 20.1 years); Children: Mean=38.8-39.2 weeks (approximately 8-9 months)
  • Race/Ethnicity — Parents: 106 Hispanic/Latino, 37 African American, 7 White/Non-Hispanic, and 6 Other; Children: Not specified
  • Gender — Parents: 156 Female, Children: 70 Female
  • Status — Participants were mothers and children who had participated in the Minding the Baby study.

Location/Institution: Two community health centers

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study was designed as to examine the intermediate effects of Minding the Baby® (MTB). Participants were randomized to either the MTB group or a control group. Measures utilized include the Strange Situation Procedure, the Pregnancy Interview and Parent Development Interview Revised (PDI), the Atypical Maternal Behavior Instrument for Assessment and Classification (AMBIANCE) Scale, the Mississippi Scale for the Assessment of PTSD- Civilian Form, and the Center for Epidemiological Studies Depression Scale (CES-D). Results indicate that MTB mothers’ levels of reflective functioning were more likely to increase over the course of the intervention than were those of control group mothers. Likewise, infants in the MTB group were significantly more likely to be securely attached, and significantly less likely to be disorganized, than infants in the control group. Limitations include small sample size, high attrition rate, lack of a suitable measure of PTSD and complex trauma, and sample selection bias.

Length of postintervention follow-up: None.

Additional References

Ordway, M. R., Webb, D., & Sadler, L. S. & Slade, A. (2015). Parental Reflective Functioning: An approach for enhancing parent-child relationships in pediatric primary care. Journal of Pediatric Health Care, 29(4), 325-334. doi:10.1016/j.pedhc.2014.12.002

Slade, A., Sadler, L., Close, N., Fitzpatrick, S., Simpson, T., & Webb, D. (2017). Minding the Baby®: The impact of threat on the mother-baby and mother-clinician relationship. In S. Gojman de Millan, C. Herreman, & L. A. Sroufe (Eds.), Attachment across cultural and clinical contexts (pp. 182-205). London: Rutledge.

Slade, A., Simpson, T. E., Webb, D., Albertson, J., Close, N., & Sadler, L. (2017). Minding the Baby®: Developmental trauma and home visiting. In H. Steele & M. Steele (Eds.), Handbook of attachment-based interventions (pp. 151-173). New York: Guilford Press.

Contact Information

Crista Marchesseault, MAT, MA
Agency/Affiliation: MTB National Office
Website: www.mtb.yale.edu
Email:
Phone: (203) 737-1509

Date Research Evidence Last Reviewed by CEBC: October 2018

Date Program Content Last Reviewed by Program Staff: February 2019

Date Program Originally Loaded onto CEBC: February 2019