Maternal ACES, Family Engagement in Home Visiting, and Maternal-Child Health

• In Event: 3-096 - Stress and Trauma in Home Visiting: Predictors of Family Engagement and Maternal-Child Health Outcomes

Integrative Statement

Adverse Childhood Experiences (ACES) are prevalent among women enrolled in evidence based home visiting programs, yet it is unknown how maternal ACES impact family engagement in home visiting, or the efficacy of home visiting as related to infant outcomes. This knowledge is critical to inform refinement of the Maternal Infant Early Childhood Home Visiting (MIECHV) initiative to address disparities in maternal and child health. The current study examined the impact of maternal ACES on a) family engagement in MIECHV, and b) the efficacy of MIECHV for enhancing maternal and infant psychosocial health.

Two hundred and ninety-five mother-infant dyads who were referred to MIECHV in the prenatal period participated in this study. Mothers ranged in age from 18-44 years (Mean = 26 years) and were racially and ethnically diverse (40% Hispanic; 42% white, 19% black, 7% biracial, 32% other races). Sixty-one percent of mothers had less than or equal to a high school degree, 66% of mothers were unemployed, and 44% were first time mothers. Fifty-four percent of infants were female.

Mothers reported on their ACES and pregnancy stressors in the prenatal period. At 12 months postpartum, mothers completed interviews and questionnaires to assess infant behavior problems and maternal mental health. State home visiting records were reviewed to determine family enrollment and retention in MIECHV.

One hundred and eleven of the 295 women (38%) enrolled MIECHV. Women who enrolled in MIECHV had more ACES than women who did not enroll in MIECHV at trend level (M = 2.7 ACES versus 2.2 ACES; p = .09). In contrast, maternal ACES were negatively associated with retention in MIECHV (r = -.24, p = .01). Mothers with more ACES withdrew from MIECHV earlier than mothers with fewer ACES. Maternal ACES also moderated effects of MIECHV on maternal and infant health. There was a significant interaction of MIECHV enrollment and maternal ACES in the prediction of maternal depressive symptoms at 12 months postpartum (B = -.23, p = .03; Figure 1). Maternal ACES were positively associated with depressive symptoms among women who did not enroll in MIECHV (r = .47, p < 001), but ACES were not associated with depressive symptoms among women who enrolled in MIECHV (r = .04, p = .76). Likewise, there was a significant indirect effect of maternal ACES on infant externalizing behavior problems through maternal depressive symptoms among women who did not enroll in MIECHV (B = .08, SE = .04, CI = .0194 - .1736; Figure 2). Among women who enrolled in MIECHV, there was no indirect effect of ACES on infant externalizing behavior problems (B = .01, SE = .03, CI = -.0411 - .0960).

These results suggest that women with more ACES are more likely to initially enroll in MIECHV, but are harder to retain the program. Results also suggest that MIECHV buffers both mothers and infants from the effects of maternal ACES on maternal depressive symptoms and infant behavior problems. Addressing maternal ACES in MIECHV may enhance family engagement, and subsequently maternal and infant health.

Authors

• Stephanie H. Parade, Bradley Research Center/Brown University
  Presenting Author

• Kristine Campagna, Rhode Island Department of Health
  Non-Presenting Author

• Blythe Berger, Rhode Island Department of Health
  Non-Presenting Author

• Ronald Seifer, Brown University
  Non-Presenting Author