Abstract
There is variability in home visiting program impacts on the outcomes achieved by high risk families. An understanding of how effects vary among families is important for refining service targeting and content. The current study assessed whether and how maternal attributes, including relationship security, moderate short- and long-term home visiting impacts on maternal psychosocial functioning. In this multisite RCT of home visiting in a population-based, ethnically-diverse sample of families at risk for maltreatment of their newborns (n = 643), families were randomly assigned to home visited (HV) and control groups. HV families were to receive intensive services by trained paraprofessionals from birth-3 years. Outcome data were collected when children were 1, 2, and 3 years old and 7, 8, and 9 years old. Overall, short- and long-term outcomes for HV and control mothers did not differ significantly. Demographic attributes, a general measure of overall maternal risk, and partner violence did not moderate program impact on psychosocial functioning outcomes. Maternal relationship security did moderate program impact. Mothers who scored high on relationship anxiety but not on relationship avoidance showed the greatest benefits, particularly at the long-term follow-up. Mothers scoring high for both relationship anxiety and avoidance experienced some adverse consequences of home visiting. Further research is needed to determine mediating pathways and to inform and test ways to improve the targeting of home visiting and the tailoring of home visit service models to extend positive home visiting impacts to targeted families not benefiting from current models.
Similar content being viewed by others
References
Abidin, R. R. (1990). Parenting Stress Index Short Form test manual. Charlottesville, VA: Pediatric Psychology Press.
Administration on Children, Youth and Families, Children’s Bureau. (2008). Supporting evidence-based home visitation programs to prevent child maltreatment, funding opportunity number: HHS-2—8-ACF-ACYF-CA-130. Washington, DC: Author.
Alterman, A. I., McDermott, P. A., Cook, T. G., Cacciola, J. S., McKay, J. R., McLellan, A. T., & Rutherford, M. J. (2000). Generalizability of the clinical dimensions of the Addiction Severity Index to nonopioid-dependent patients. Psychology of Addictive Behaviors, 14, 287–294.
Bair-Merritt, M. H., Jennings, J. M., Chen, R., Burrell, L., McFarlane, E., Fuddy, L., & Duggan, A. (2010). Reducing maternal intimate partner violence after the birth of a child. Archives of Pediatric Adolescent Medicine, 164, 16–23.
Berwick, D. M., Murphy, J. M., Goldman, P. A., Ware, J. E., Barsky, A. J., & Weinstein, M. C. (1991). Performance of a five-item mental health screening test. Medical Care, 29, 169–176.
Bowlby, J. (1973). Attachment and loss: Vol. 2. Separation. New York: Basic Books.
Burrell, L., McFarlane, E., Tandon, S. D., Fuddy, L., Leaf, P., & Duggan, A. K. (2009). Home visitor relationship security: Association with perceptions of work, satisfaction and turnover. Journal of Human Behavior in the Social Environment, 19, 592–610.
Diggle, P. J., Liang, K. Y., & Zeger, S. L. (1996). The analysis of longitudinal data. Oxford, UK: Oxford University Press.
Dozier, M. (1990). Attachment organization and treatment use for adults with serious psychopathological disorders. Development and Psychopathology, 2, 47–60.
Dozier, M., Lomax, L., Tyrrell, C. L., & Lee, S. W. (2001). The challenge of treatment for clients with dismissing states of mind. Attachment & Human Development, 3, 62–76.
Duggan, A. K., Berlin, L. D., Cassidy, J., Burrell, L., & Tandon, S. D. (2009). Examining maternal depression and attachment insecurity as moderators of the impacts of home visiting for at-risk mothers and infants. Journal of Consulting and Clinical Psychology, 77, 788–799.
Duggan, A. K., Caldera, D., Rodriguez, K., Burrell, L., Rohde, C., & Crowne, S. S. (2007). Impact of a statewide home visiting program to prevent child abuse. Child Abuse & Neglect, 31, 829–852.
Duggan, A. K., Fuddy, L., Burrell, L., Higman, S. M., McFarlane, E., Windham, A., & Sia, C. (2004a). Randomized trial of a statewide home visiting program to prevent child abuse: Impact in reducing parental risk factors. Child Abuse & Neglect, 28, 623–643.
Duggan, A. K., McFarlane, E., Fuddy, L., Burrell, L., Higman, S. M., Windham, A., & Sia, C. (2004b). Randomized trial of a statewide home visiting program to prevent child abuse: Impact in preventing child abuse and neglect. Child Abuse & Neglect, 28, 597–622.
Duggan, A. K., Windham, A., McFarlane, E., Fuddy, L., Rohde, C., Buchbinder, S., & Sia, C. (2000). Hawaii’s Healthy Start Program of home visiting for at-risk families: Evaluation of family identification, family engagement and service delivery. Pediatrics, 105, 250–259.
DuMont, K., Mitchell-Herzfeld, S., Greene, R., Lee, E., Lowenfels, A., & Rodriguez, M. (2006). Healthy Families New York (HFNY) randomized trial: Impacts on parenting after the first two years. Child Abuse & Neglect, 32, 295–315.
Eckenrode, J., Ganzel, B., Henderson, C. R., Smith, E., Olds, D. L., Powers, J., Cole, R., …Sidora, K. (2000). Preventing child abuse and neglect with a program of nurse home visitation: The limiting effects of domestic violence. Journal of the American Medical Association, 284, 1385–1391.
Feeney, J. A., Noller, P., & Hanrahan, M. (1994). Assessing adult attachment. In M. B. Sperling & W. H. Berman (Eds.), Attachment in adults: Clinical and developmental perspectives (pp. 128–152). New York: Guilford.
Fiellin, D. A., Reid, M. C., & O’Connor, P. G. (2000). Screening for alcohol problems in primary care: A systematic review. Archives of Internal Medicine, 160, 1977–1989.
George, C., Kaplan, N., & Main, M. (1996). Adult Attachment Interview protocol, 3rd edition. Unpublished manuscript, University of California at Berkeley.
Healthy Families America. (2011). Frequently asked questions. Retrieved from http://www.healthyfamiliesamerica.org/about_us/faq.shtml
Heinicke, C. M., Goorsky, M., Levine, M., Ponce, V., Ruth, G., Silverman, M., & Sotelo, C. (2006). Pre- and postnatal antecedents of a home-visiting intervention and family developmental outcome. Infant Mental Health Journal, 27, 91–119.
Korfmacher, J. (2000). The Kempe Family Stress inventory: A review. Child Abuse & Neglect, 24, 129–140.
Korfmacher, J., Adam, E., Ogawa, J., & Egeland, B. (1997). Adult attachment: Implications for the therapeutic process in a home visitation intervention. Applied Developmental Science, 1, 43–52.
Landsverk, J., Carrilio, T., Connelly, C. D., Ganger, W., Slymen, D., Newton, R., & Jones, C. (2002). Healthy Families San Diego clinical trial: Technical report. San Diego, CA: The Stuart Foundation, California Wellness Foundation, State of California Department of Social Services: Office of Child Abuse Prevention.
Leonhard, C., Mulvey, K., Gastfriend, D. R., & Shwartz, M. (2000). Addiction Severity Index: A field study of internal consistency and validity. Journal of Substance Abuse Treatment, 18, 129–135.
Mayfield, D., McLeod, G., & Hall, P. (1974). The CAGE questionnaire: Validation of a new alcoholism screening instrument. The American Journal of Psychiatry, 131, 1121–1123.
McDowell, I., & Newell, C. (1996). Depression. In I. McDowell & C. Newell (Eds.), Measuring health: A guide to rating scales and questionnaires (2nd ed., pp. 238–286). New York: Oxford University Press.
McFarlane, E., Burrell, L., Derauf, D. C., Fuddy, L., & Duggan, A. K. (2008, May). Home visiting for at-risk families of newborns: Home visitor and maternal attachment security as factors for engagement. Poster session presented at the annual meeting of the Society for Prevention Research, San Francisco, CA.
McFarlane, E., Burrell, L., Fuddy, L., Tandon, S. D., Derauf, D. C., Leaf, P., & Duggan, A. K. (2010). Association of home visitors’ and mothers’ attachment style with family engagement. Journal of Community Psychology, 38, 541–556.
McHorney, C., & Ware, J. E. (1995). Construction and validation of an alternate form general mental health scale for the Medical Outcomes Study Short-Form 36-Item Health Survey. Medical Care, 33, 15–28.
McLellan, A. T., Kushner, H., Metzger, D., Peters, R., Smith, I., Grissom, G., Pettinati, H., & Argeriou, M. (1992). The fifth edition of the Addiction Severity index. Journal of Substance Abuse Treatment, 9, 199–213.
Mikulincer, M., & Nachshon, O. (1991). Attachment styles and patterns of self-disclosure. Journal of Personality and Social Psychology, 61, 321–332.
Mikulincer, M., & Shaver, P. R. (2007). Attachment in adulthood: Structure, dynamics, and change. New York: Guilford.
Mitchell-Herzfeld, S., Izzo, C., Greene, R., Lee, E., & Lowenfels, A. (2005). Evaluation of Healthy Families New York (HFNY): First year program impacts. Albany, NY: University at Albany, Center for Human Services Research.
National Research Council and Institute of Medicine. (2000). From neurons to neighborhoods: The science of early childhood development. Washington, DC: National Academy Press.
Olds, D. L., Henderson, C. R., Chamberlin, R., & Tatelbaum, R. (1986). Preventing child abuse and neglect: A randomized trial of nurse home visitation. Pediatrics, 78, 65–78.
Radloff, L. S. (1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385–401.
Robinson, J. L., & Emde, R. N. (2004). Mental health moderators of Early Head Start on parenting and child development: Maternal depression and relationship attitudes. Parenting: Science and Practice, 4, 73–97.
Shields, A. L., & Caruso, J. C. (2004). A reliability induction and reliability generalization study of the CAGE questionnaire. Educational and Psychological Measurement, 64, 254–270.
Spieker, S., Nelson, D., DeKlyen, M., & Staerkel, F. (2005). Enhancing early attachments in the context of Early Head Start: Can programs emphasizing family support improve rates of secure infant-mother attachments in low-income families? In L. J. Berlin, Y. Ziv, L. Amaya-Jackson, & M. T. Greenberg (Eds.), Enhancing early attachments: Theory, research, intervention and policy (pp. 250–275). New York: Guilford.
Straus, M. A. (1990). The Conflict Tactics Scales and its critics: An evaluation and new data on validity and reliability. In M. A. Straus & R. J. Gelles (Eds.), Physical violence in American families: Risk factors and adaptations to violence in 8,145 families (pp. 49–73). New Brunswick: Transaction.
Straus, M. A. (2007). Conflict tactics scales. In N. A. Jackson (Ed.), Encyclopedia of domestic violence (pp. 190–197). New York: Routledge.
Sweet, M. A., & Appelbaum, M. I. (2004). Is home visiting an effective strategy? A meta-analytic review of home visiting programs for families with young children. Child Development, 75, 1435–1456.
Teitelbaum, L. M., & Carey, K. B. (2000). Temporal stability of alcohol screening measure in a psychiatric setting. Psychology of Addictive Behaviors, 14, 401–404.
United States Advisory Board on Child Abuse and Neglect. (1991). Creating caring communities. Blueprint for an effective federal policy on child abuse and neglect. (Report Number 9–1991). Washington, DC: US Government Printing Office.
United States Congress (March 23, 2010). Patient protection and affordable care act, Public Law No. 111–148, Government Publications Office. Retrieved from http://frwebgate.access.gpo.gov/cgibin/getdoc.cgi?dbname=111_cong_bills&docid=f:h359oenr.txt.pdf
Ware, J. E., Snow, K., Kosinski, M., & Gandek, B. (1993). SF-36 Health Survey: Manual and interpretation guide. Boston: Health Institute.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
McFarlane, E., Burrell, L., Crowne, S. et al. Maternal Relationship Security as a Moderator of Home Visiting Impacts on Maternal Psychosocial Functioning. Prev Sci 14, 25–39 (2013). https://doi.org/10.1007/s11121-012-0297-y
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11121-012-0297-y