Childhood Emotion Minimization and Maltreatment Predict Maternal Engagement in Evidence Based Home Visiting Programs

• In Event: Engagement and Outcomes of Home Visiting or Small Group Programs in the Transition to Parenthood

Abstract

Evidence based home visiting (EBHV) programs that serve families in the perinatal period promote maternal and child health, positive parenting, and healthy parent-child relationships. Yet family engagement in EBHV remains an obstacle to these programs reaching their full potential. Families often do not enroll in EBHV programs when they are offered, and when families do enroll they frequently withdraw prior to reaching the intended dosage and duration of services. Mothers who experienced maltreatment and less social-emotional support from their own parents in childhood may particularly benefit from these programs, yet home visitors often anecdotally report that these mothers are the most difficult to engage and retain in services. Little prior research has examined the impact of experiences of maltreatment and emotion minimization from parents in childhood on maternal engagement in EBHV.

295 mothers and their infants who were referred to EBHV programs in the prenatal period participated in this longitudinal study. Mothers were 18 to 44 years of age and were racially and ethnically diverse (40% Hispanic; 42% White, 19% Black, 7% biracial/multiracial, 32% other races). 60% of mothers had less than or equal to a high school degree, 65% were unemployed, and all received public assistance. 53% of infants were female.

Mothers reported on their childhood experiences, including experiences of maltreatment and emotion minimization, during a prenatal research assessment. State home visiting records were reviewed to assess three indicators of engagement in EBHV including 1) enrollment in EBHV services, 2) dosage of EBHV (number of completed home visits), and 3) duration of enrollment in EBHV (number of months). Correlations and multiple regression models tested associations of maternal childhood experiences and engagement in EBHV.

All mothers were prenatally referred to EBHV and 110 (37%) subsequently enrolled. Experiences of childhood emotion minimization, but not maltreatment, were associated with enrollment in EBHV such that mothers who experienced more emotion minimization from their own mothers in childhood were more likely to enroll in EBHV services when they were offered (r = .16, p = .007). Childhood maltreatment moderated the impact of maternal emotion minimization on dosage (B = -.42, p = .033) and duration (B = -.62, p = .001) of EBHV, such that emotion minimization was negatively associated with dosage and duration among mothers who experienced childhood maltreatment but positively associated with dosage and duration of EBHV among mothers who did not experience maltreatment (Figure 1). A similar pattern of results was observed when considering experiences of emotion minimization from fathers in childhood, both independently and in interaction with maltreatment. Results were consistent when controlling for prenatal depressive symptoms and socioeconomic adversity, factors that were highly associated with all three indicators of engagement in EBHV in this sample.

Maternal childhood experiences contribute to engagement in EBHV, yet these processes are complex. Mothers who may be in most need of supports to interrupt the intergenerational transmission of adversity may be less likely to remain engaged in EBHV over time. Implications for refinement of EBHV and potential mechanisms of these effects will be discussed.

Authors

• Stephanie H Parade, Brown University
  Presenting Author

• Priya Adora Goncalves Baptista, Emma Pendleton Bradley Hospital

• Lindsay Huffhines, Brown University Medical School

• Jesse L Coe, Centers for Disease Control and Prevention

• Ronald Seifer, University of North Carolina at Chapel Hill