Minding the Baby®: Maternal Adverse Childhood Experiences and Treatment Outcomes in a Mother-Infant Home Visiting Program

This study examined Adverse Childhood Experiences (ACEs) in a sample of women participating in Minding the Baby® (MTB), a mother-infant home-visiting intervention known to have positive effects on mother-infant attachment. In addition to documenting maternal childhood trauma exposure within the sample, this study explored whether such exposure affected the intervention outcome or service delivery. We looked specifically at whether maternal childhood trauma exposure affected mother-child attachment or frequency of contact with home-visitors. We also examined the relationship between maternal early childhood trauma exposure and reflective functioning capacity (RF), a potential resiliency-promoting factor. Methods: The study’s participants were 29 first-time mothers between the ages of 16 and 26 who were enrolled in the MTB intervention between 2007 and 2015. They were administered the Pregnancy Interview (Slade, 2003) at baseline and the Strange Situation Procedure (Ainsworth, Blehar, Waters, & Wall, 1978) when their infants were 12 months of age. Dose of intervention was calculated as the number of home-visits during the first 15 months of the intervention. This study made use of a unique and novel approach for collecting trauma-related data on intervention participants. Specifically, we asked clinicians who worked with participant mothers over the course of the 27-month intervention to work as a team to fill out an Adverse Childhood Experiences Scale-mini (ACES-mini; Anda et al., 2006) for each client based on their knowledge of mothers’ childhood trauma history. Results: Results indicated that MTB serves a highly traumatized population, as the mean trauma score of 5.52 is considered “high” by CDC standards. However, the level of maternal adverse childhood experiences was not found to be related to attachment outcome, indicating that MTB is serving the needs of even the most traumatized mothers. Mothers with the highest ACE scores also received the highest dose of intervention, but that dose did not moderate the relationship between maternal trauma exposure and child attachment. Finally, although RF was not related to maternal ACE score, there was a trend suggesting that mothers with higher RF who had also been exposed to higher levels of childhood trauma were more likely to obtain secure attachment with their infants than mothers with high childhood trauma exposure but lower RF capacity. Discussion: The findings suggest that the MTB intervention shows promise as a tool to address attachment outcomes in highly traumatized populations, but that despite positive attachment outcomes, the impact of maternal trauma exposure reverberates in the relationship. The findings are further discussed in relation to implications for collecting data on trauma exposure, conducting research within a clinical intervention, and the importance of considering attachment and trauma theories in tande