Lori Burrell

Examining Maternal Depression and Attachment Insecurity as Moderators of the Impacts of Home Visiting for At-Risk Mothers and Infants

Home visiting programs for at-risk mothers and their infants have proliferated nationally in recent years, yet experimental studies of home visiting have yielded mixed findings. One promising strategy for explicating the effects of early home visiting is to examine moderators of program impacts. This study assessed the roles of maternal depression and attachment insecurity as moderators of the impacts of Healthy Families Alaska home visiting services for at-risk mothers and their infants. At-risk families (N = 325) were randomly assigned to home visiting or community services as usual (n = 162 and 163, respectively). Maternal depression and attachment insecurity (attachment anxiety and discomfort with trust/dependence) were measured at baseline. Maternal psychosocial and parenting outcomes were measured when children were 2 years old via maternal self-report, observation, and review of substantiated reports of child maltreatment. Maternal depression and attachment insecurity interacted in their moderation of program impacts. For several outcomes, home visiting impacts were greatest for nondepressed mothers with moderate-to-high discomfort with trust/dependence and for depressed mothers with low discomfort with trust/dependence. Implications for practice and policy are discussed.

Evaluating a statewide home visiting program to prevent child abuse in at-risk families of newborns: fathers' participation and outcomes

This study sought to describe fathers’ participation in a statewide home-visiting program to prevent child abuse and to assess program impact on their parenting. This randomized trial followed 643 at-risk families for 3 years. Data were collected through program record review, staff surveys, and annual maternal interviews. Participation in visits varied by the parents’ relationship and paternal employment, violence, and heavy drinking at baseline. Overall, the program had no apparent impact on fathers’ accessibility to the child, engagement in parenting activities, and sharing of responsibility for the child’s welfare. The program promoted parenting involvement for nonviolent fathers in couples who lived together but also for violent fathers in couples with little contact at baseline; it decreased the father’s accessibility to the child in couples who lived apart but saw each other frequently at baseline. Infrequent participation in visits and differential program impact on violent versus nonviolent fathers demonstrate the need to consider family context in developing, implementing, and studying home-visiting models.

Concurrent and Long-Term Impact of Intimate Partner Violence on Employment Stability

Previous research suggests that experiencing intimate partner violence (IPV) may negatively affect employment outcomes. This study explores the relationship between IPV and employment stability both concurrently and longitudinally among a sample of 512 predominantly Asian American and Pacific Islander young women living in Hawaii. Women in this study were identified as being at risk of child maltreatment. About half of women indicated that their current relationship status was married or living together. More than two-thirds of women had graduated from high school and half had worked in the past year. The study explored the concurrent association of IPV and employment by assessing them simultaneously over a 12 month time period. The study examined the longitudinal impact of IPV by analyzing violence at two time points as predictors of unstable employment 6 to 8 years later. The study also explored the mediating effects of depression. Study results demonstrated both concurrent and longitudinal negative associations of IPV with employment stability. Women who experienced violence were more likely to be experiencing unstable employment concurrently. Women who experienced IPV at one point in time had lower levels of employment stability six years later. This decrease was partially mediated by experiencing depressive symptoms. Women who identified their primary ethnicity as Native Hawaiian or Pacific Islander were much more likely to experience unstable employment than Asian American women. More research is needed to explore the roles of mental health, race and ethnicity, and types of violence in the relationship between IPV and employment.

Impact of Intimate Partner Violence on Children's Well-Child Care and Medical Home

OBJECTIVES. Intimate partner violence has been linked to poor child health. A continuous relationship with a primary care pediatric provider can help to detect intimate partner violence and connect families with needed services. The objectives of this study were to determine the relationship between intimate partner violence and (1) maternal report of a regular site for well-child care, (2) maternal report of a primary pediatric provider, (3) well-child visits in the first year of life, (4) up-to-date immunizations at 2 years of age, (5) maternal report of medical neglect, and (6) maternal report of the pediatric provider–caregiver relationship. METHODS. This retrospective cohort study evaluated data from 209 at-risk families participating in the evaluation of the Healthy Families Alaska program. Research staff interviewed mothers near the time of an index childs birth and again at the childs second birthday. Medical charts were abstracted for information on well-child visits and immunizations. RESULTS. Mothers who disclosed intimate partner violence at the initial interview (n = 62) were significantly less likely to report a regular site for well-child care or a primary pediatric provider. In multivariable models, children of mothers who disclosed intimate partner violence tended to be less likely to have the recommended 5 well-child visits within the first year of life and were significantly less likely to be fully immunized at 2 years of age. Differences in medical neglect were not statistically significant. Of mothers who reported a specific primary pediatric provider, those with intimate partner violence histories trusted this provider less and tended to rate less favorably pediatric provider–caregiver communication and the overall quality of the pediatric provider–caregiver relationship. CONCLUSIONS. Future research should explore effective ways to link intimate partner violence–exposed children with a medical home and a primary pediatric provider and to improve relationships between pediatric providers and caregivers who face violence at home.

Patterns and Predictors of Involvement Among Fathers of Children Born to Adolescent Mothers

Father involvement may be an important support for children born to adolescent mothers. This study examines patterns and predictors of father involvement, as reported by adolescent mothers, from their childs infancy through toddlerhood. Data were collected from urban, primarily African American, adolescent mothers (N = 138) in four interviews, over a 24-month period. The percentage of fathers categorized as “highly involved” decreased significantly from baseline to 12-month follow-up and was stable through 24 months. The romantic status of the mother–father relationship was the strongest predictor of whether father involvement was consistently high, consistently low, or decreased over time.

The Importance of Early Parenting in At-Risk Families and Children's Social-Emotional Adaptation to School

OBJECTIVE The aim of this study was to determine the specific aspects of early parenting in psychosocially at-risk families most strongly related to childrens social-emotional adaptation to school. METHODS A cohort study of families (N = 318) identified as at risk for maltreatment of their newborns was conducted. Quality of early parenting was observed in the home when the child was 1 year old. Social-emotional adaptation to school was reported by teachers in first grade. Multivariable models assessed the independent influence of early parenting variables on social-emotional adaptation. RESULTS Early parenting and social-emotional adaptation to school varied greatly across families. Parental warmth was associated with lower teacher ratings of shyness, concentration problems, and peer rejection. Parental lack of hostility was associated with decreased teacher ratings of concentration problems and peer rejection. Parental encouragement of developmental advance was associated with lower ratings of aggression and peer rejection. Provision of materials to promote learning and literacy was associated with lower ratings of concentration problems. CONCLUSIONS In this sample of families with multiple psychosocial risks for child maltreatment, specific aspects of early parenting were associated with better social-emotional adaptation to school in the first grade in theoretically predicted ways. Improving parental knowledge about positive parenting via anticipatory guidance should be a focus of well-child visits. Well-child visit-based interventions to improve the quality of early parenting, especially among at-risk families, should be studied for their impact on parenting behavior and on childrens successful social-emotional adaptation to school. Primary care providers should reinforce complementary services, such as home visiting, that seek to promote positive parenting.

Repeat pregnancy prevention self-efficacy in adolescents: associations with provider communication, provider type, and depression.

Objectives Among adolescent mothers, pregnancy prevention self-efficacy developed during pregnancy may predict the use of contraception following delivery. Communication between patients and their primary care providers (PCPs) is important for adherence to physician recommendations and may be associated with pregnancy prevention self-efficacy. Depression, which is common among adolescent mothers, has been associated with poor self-efficacy. The associations among pregnancy prevention self-efficacy, provider communication, provider type (PCP vs others), and depression are unclear. The objectives of the study were to determine the association of positive provider communication with pregnancy prevention self-efficacy, whether provider type or depression is associated with positive provider communication, and whether the association between provider communication and pregnancy prevention self-efficacy varies by provider type and depression. Methods Cross-sectional study of 164 third trimester Baltimore adolescents measuring pregnancy prevention self-efficacy, perceptions of the quality of provider communication (Ambulatory Care Experiences Survey), provider type, and depressive symptoms. Results Of 164 pregnant teens, 79% reported pregnancy prevention self-efficacy, 72% had a specific PCP, and 17% scored positive for depression. Positive provider communication was associated with pregnancy prevention self-efficacy (odds ratio 1.25; P = 0.04). Adolescents with PCPs had significantly higher communication scores (&bgr; 0.90; P = 0.001). Depressed adolescents had significantly lower communication scores (&bgr; −0.74; P = 0.03). The association between positive provider communication and self-efficacy was significant only for adolescents who reported having a PCP (P = 0.04) and those who were not depressed (P = 0.05). Conclusions Having a PCP and favorable perceptions of provider communication are important for pregnancy prevention self-efficacy among adolescents. Depression negatively affects perceptions of provider communication, which may limit self-efficacy.

Parental Nurturance and the Mental Health and Parenting of Urban African American Adolescent Mothers

This study examined the relationship between a teen mothers perceptions of nurturance from her mother and father and her mental health and parenting attitudes. One-hundred and thirty-eight urban, primarily African American adolescent mothers were interviewed. Multivariate results indicate that teen mothers who felt nurtured by their mothers had greater empathy toward their own children, and those who felt nurtured by their fathers reported greater parenting satisfaction. These findings support the importance of interventions that include supporting nurturing parenting of adolescent mothers by their mothers and their fathers.

Maternal Mental Health during Children's First Year of Life: Association with Receipt of Section 8 Rental Assistance

Prior studies evaluating housing programs have found varied results for the impact of improved housing on maternal mental health. This study evaluated data from 169 families who participated in Hawaiis Healthy Start Program. The studys objective was to determine whether receipt of Section 8 rental assistance in the first year of a childs life decreased the risk of poor maternal mental health. Multivariable logistic regression was used to measure the association of Section 8 housing receipt with poor mental health. Overall, 50% of mothers had poor mental health at baseline, and 32% reported receipt of Section 8 housing at follow-up. Mothers who received Section 8 housing were significantly less likely to have poor maternal mental health at follow-up (adjusted odds ratio = .40; 95% confidence interval, .16–.97; p < .05). Receipt of Section 8 rental assistance in the first year of a childs life may reduce the risk of poor mental health for mothers in housing need.

Association of Substance Use Discussion by Pediatric Providers With the Parent–Provider Relationship and Maternal Behavior Change

A cross-sectional study of data from a randomized, controlled trial was conducted to determine (1) provider and parent attributes associated with discussion of maternal substance use, (2) how substance use discussion related to the parent—provider relationship, and (3) whether discussion was associated with maternal attempts at behavior change. Of the 482 mothers, 34% reported discussing all 3 substance use items (smoking, alcohol, and drug use) with their child’s provider. Mothers who discussed smoking were more likely to report discussing alcohol and other drug use (P < .001). Parent—provider relationship scores, measured by a modified version of the Primary Care Assessment Survey, were positively associated with discussion of each substance (P < .001). Discussion of smoking and drug use were significantly associated with attempted behavior change. Our findings suggest that discussion of parental substance use by pediatricians is positively associated with the parent—provider relationship and may lead to behavior change.