Infant Mental Health Home Visiting Improves Children’s Internalizing and Externalizing Symptoms via Parental Reflective Functioning

• In Event: Developmental Pathways Toward Emotional Risk and Resilience: the Role of Parent Characteristics

Abstract

Recent research has sought to understand the relationship between parental reflective functioning (RF) and infant/toddler social-emotional development. Self-reported parental RF has been associated with fewer social-emotional problems (Nijssens et al., 2020; Salo et al., 2021) and greater social-emotional competence, adjustment, and emotional regulation (Ghanbari et al., 2022; Gordo et al., 2020; Nijssens et al., 2020). These results suggest parents’ capacities to accurately understand their children’s mental states may play a valuable role in their social-emotional development. As such, interventions for families of young children often consider increasing parental RF as an important focus of treatment.
However, meta-analyses examining the effectiveness of interventions on improving parental RF report mixed results, with one finding significant increases in RF (Lo & Wong, 2022), and another showing non-significant improvements among randomized controlled trials (RCTs; Barlow et al., 2021). The Michigan Model of Infant Mental Health Home Visiting (IMH-HV) is a needs-driven intervention for parents and their infants or toddlers focused on improving the quality of the parent-child relationship. IMH-HV clinicians work with parents to explore their child’s mental states and provide developmental guidance. Research has shown IMH-HV improves parental RF over the course of treatment (Stacks et al., 2019; 2022), though these studies did not utilize a control group. The current study sought to examine the effects of IMH-HV on parental RF and children’s social-emotional development using a RCT design.
Participants included a sample of 54 parents randomly assigned to receive 12 months of IMH-HV treatment or to a control group. Parental RF was measured via self-reported Interest and Curiosity (IC) on the Parental Reflective Functioning Questionnaire (PRFQ; Luyten et al., 2017) and using the researcher-coded Reflective Parenting Scale (Rosenblum et al., 2008) for the Working Model of the Child Interview (WMCI; Zeanah et al., 1996). Children’s internalizing and externalizing symptoms were assessed using the Infant Toddler Social-Emotional Assessment (ITSEA; Carter & Briggs-Gowan, 2006).
Multiple mediation results revealed significant indirect effects of IMH-HV treatment on children’s externalizing symptoms via parents’ self-reported RF at 6 months and coded reflective parenting by 12 months. Specifically, parents receiving treatment demonstrated higher IC scores, which significantly predicted greater reflective parenting scores, leading to fewer externalizing symptoms by the end of treatment (see Figure 1). Similarly, an indirect effect of treatment on internalizing symptoms was found via IC and coded reflective parenting at 6 months (see Figure 2).
The results of the present study add to the literature by demonstrating the effectiveness of IMH-HV on improving parental RF and children’s early social-emotional development. IMH-HV appears to improve parents’ reflective capacity first by increasing their interest in what their child is thinking or feeling and second, by demonstrating their reflectivity more deeply during interviews about the parent-child relationship. It is possible that increased reflectivity by parents supports more sensitive caregiving behavior, leading to fewer internalizing or externalizing symptoms. These results have important clinical implications for those providing early intervention and demonstrate the important role parental RF plays in supporting children’s social-emotional development.

Group Authors

The Michigan Collaborative for Infant Mental Health Research

Authors

• Jerrica Pitzen, Rochester University
  Presenting Author

• Megan M. Julian, University of Michigan - Ann Arbor

• Holly Elisabeth Brophy-Herb, Michigan State University

• Alissa Huth-Bocks, Case Western Reserve University

• Jamie Lawler, Eastern Michigan University

• Maria Muzik, University of Michigan - Ann Arbor

• Katherine L Rosenblum, University of Michigan - Ann Arbor