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Poster #158 - Linking Hostile/Helpless Maternal Representations in Pregnancy and Later Child Protection Involvement: A Pilot Study

Thu, March 21, 12:30 to 1:45pm, Baltimore Convention Center, Floor: Level 1, Exhibit Hall B

Integrative Statement

There is a relative absence of attention -- in theoretical and in clinical literatures -- to the prenatal period as a critical developmental phase for both mother and child. Further, little is known about whether precursors of maltreatment can be detected before the baby is born. The purpose of this research was to determine whether Hostile/Helpless (HH) states of mind – characterized by pervasively contradictory, unintegrated mental states regarding attachment relationships – can be detected in the narratives of at-risk pregnant women, and further, whether these mental states might help clinicians identify child maltreatment potential in pregnancy, a crucial time for the development of the caregiving system and caregiving representations. During the first study phase, the Hostile/Helpless Classification system (Lyons-Ruth et al., 1995-2005), which detects mental states associated with trauma, disturbances in early attachment, and severe pathology, was adapted for use with the Pregnancy Interview (PI), a semi-structured clinical interview (Slade, 2003) that assesses a woman's emotional experience of pregnancy, and the quality of her developing relationship with her baby. During the second phase, the adapted system was used to code a sample of previously collected pregnancy narratives. The sample was drawn from a replication study of the Minding the Baby® (MTB) reflective parenting home-visiting intervention currently underway in the United Kingdom, and included 26 first-time mothers. All participants were medically underserved and socioeconomically disadvantaged, living in low-income urban and remote rural areas. A total of 13 women in the sample had their infants removed from custody by child protective services within 2 years of childbirth, while 13 women did not have their infants removed from care. Interviews were coded for HH by two coders trained to reliability; both were naïve to postnatal outcomes. Results indicated that maternal HH states of mind during pregnancy – measured both categorically and continuously – were strongly associated with infant removal. An analysis of variance (ANOVA) revealed that mothers whose infants were removed from custody had significantly higher HH scores than mothers of infants who were not removed from their care, F(1, 24) = 14.500, p < .001. A Chi-Square analysis of independence indicated that the relation between overall HH classification and removal status was also significant, 2(1, N=26) = 12.462, p < .001. Findings add to the literature linking HH representations and problematic parenting, extending its reach into the prenatal period. Pregnancy, an already tumultuous, emotional, and challenging time for expectant mothers, is profoundly disorganizing for women with pervasively contradictory, unintegrated mental states. The characteristic disorganization of HH mental states appears to have a detrimental effect on the expectant mother’s sense of herself as a caregiver, and on her relationship to her fetus. Thus, there is considerable risk for transmission of trauma-related pathology, and for a disrupted, disordered mother-infant relationship in the context of the HH constellation. Results provide preliminary support for a prenatal approach to maltreatment risk assessment in at-risk populations, and represent a first step toward optimizing intervention and ultimately assisting in preventing early maltreatment in at-risk dyads before birth.

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