Minding the Baby^® Home Visiting (MTB-HV)

Minding the Baby^® Home Visiting is designed for young first-time parents living in low-income settings. The model aims to bridge primary care and mental health services for infants by pairing a nurse with a mental health professional to conduct home visits. The home visitors meet with families separately on an alternating schedule, beginning in the second or early third trimester of pregnancy and continuing until the child’s second birthday. Visits take place weekly until the child’s first birthday, then transition to every other week. The home visitors also work closely with the mothers’ prenatal and pediatric clinicians, who may be based in a partnering community health center. The model aims to promote secure attachment; parental reflection (in which parents reflect on their children’s thoughts and feelings and their own development as a parent); and physical and mental health in babies, mothers, and their families. 

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Minding the Baby^® Home Visiting (MTB-HV) is an intensive, preventive intervention based on a multi-generation care model designed to integrate primary care and mental health services for infants by pairing a nurse with a mental health professional to conduct home visits. MTB-HV is grounded in the theories of attachment, reflective parenting, social ecology, and self-efficacy. The intervention aims to enhance maternal and child health, reflective parenting, early attachment between mothers and children, and relationships between families and communities.

MTB-HV was developed by interdisciplinary researchers at the Yale Child Study Center and the Yale School of Nursing in collaboration with Fair Haven Community Health Clinic in New Haven, Connecticut. It began as a demonstration program in 2002 and has since been replicated in parts of the United States and Europe. Through the MTB National Office, researchers and staff at the Yale Child Study Center and Yale School of Nursing support the implementation of MTB-HV in collaboration with local agencies.

Replication sites participate in a six-phase training and consultation program with MTB faculty and staff that encompasses planning and start-up consultation, pre- and in-service training, and technical assistance. MTB National Office staff visit replication sites within 12 to 15 months after the first families enroll. The purpose of this visit is to (1) present and discuss cases, (2) address the site’s questions or concerns, (3) assess how the model is being implemented (including fidelity benchmarks and competencies) and discuss gaps or needs, and (4) address issues related to replication. After the first two to three years of implementation, replication sites might be eligible to decrease the intensity of the training and consultation program. A scaled-back training and consultation program typically includes regular consultation sessions, booster sessions offered through distance learning, and ongoing submission of fidelity and evaluation data.

Additional training and assistance are available on an individual basis.

MTB-HV is intended for young first-time parents between the ages of 14 to 25 who are living in low-income settings. As guided by the mother, home visit activities include fathers or other family members. The model starts serving families in the second or early third trimester of pregnancy and continuing until the child’s second birthday.

The model aims to promote secure attachment, parental reflection (in which parents reflect on their children’s thoughts and feelings and their own development as a parent), and physical and mental health in babies, mothers, and their families. The main goal of MTB-HV is to help mothers and fathers keep the physical and emotional needs of their babies in mind by promoting and enhancing the following:

• Protective factors, skills, and strategies;
• Competent and flexible parenting;
• Psychological health in the mother and child, and between the mother and child;
• Physical health and development of the child; and
• Positive maternal health and life course outcomes.

The model is also designed to help families become better consumers of health care information, improve their connection to their primary care clinicians, and develop their knowledge about obtaining and using needed social services (such as housing, food assistance, or health insurance).

MTB-HV consists of home visits with a nurse and a mental health professional. The home visitors primarily meet with families separately on an alternating schedule, but in the following circumstances both home visitors meet with the family at the same time: at recruitment, at the first and last home visits, when mothers transition from weekly visits to visits every other week, and as needed (such as during a crisis).

During visits, home visitors work to develop mothers’ abilities to become reflective and responsive in their interactions with their infants by doing the following:

• Giving voice to the baby’s experience (both physical and emotional); 
• Giving voice to the mother’s experience of herself as a parent; 
• Highlighting the mother’s positive feelings for the child; and
• Developing the mother’s capacities to reflect and contemplate, especially in the face of difficult emotions.

When indicated, the mental health home visitor conducts a mental health assessment and provides treatment in the home.

In addition to making home visits, the visitors maintain close contact with the mothers’ prenatal and pediatric clinicians, who might be based in a partnering community health center. Clinicians and staff at the community health centers guide home visitors in working with families who have numerous physical, medical, and mental health needs. Home visitors also facilitate a close relationship between families and their primary care clinicians, and coach families on how to be good consumers of health care information and access needed social services.

MTB-HV is a manualized model with flexible protocols; it does not follow a prescriptive, established curriculum, but does require specific, intensive training in the model and approaches. MTB-HV protocols and approaches are provided in the training and replication materials.

The intervention lasts about 27 months, beginning in the second or early third trimester of pregnancy and continuing until the child’s second birthday. During pregnancy, MTB-HV’s goal is to deliver at least 8 to 10 weekly visits, although there are sometimes fewer depending on when a mother enrolls and delivers. Home visits take place weekly during the child’s first year and transition to every other week during the second year. Visits vary in length, but average 45 to 90 minutes.

Certain modifications are allowed based on community needs or agency requirements, but the model developers must approve all modifications. No information is available on the process for considering modifications to the model.

Some sites have expanded the target population to include older women and families expecting their second child, although preference is given to women under age 25 who are expecting their first child.

MTB-HV is being implemented mainly by community health centers and nonprofit human services agencies. However, there are no requirements for the type of organization that can implement the model. A variety of organizations can serve as implementing agencies. MTB National Office staff can talk with interested organizations about how the MTB-HV model fits within their organization.

The MTB Fidelity Framework includes a formal site self-assessment and feedback from the MTB National Office on a set of benchmarks. The MTB National Office does not require sites to meet specific thresholds for each benchmark. Please contact the model developer for additional information about these guidelines.

Home visitors are nurses and mental health professionals. The interdisciplinary nature of the intervention means that two supervisors (one nurse and one mental health professional) oversee each team of two home visitors. Other program staff include full-time and/or part-time administrative and oversight staff, such as a program director, program supervisors, or coordinators.

Nurse home visitors must have an active registered nurse’s license, a bachelor’s degree, and at least one year of practice in pediatrics or family care, or an equivalent combination of experience and education. An advanced practice registered nurse licensure (or eligibility) is preferred. Mental health home visitors must have a master’s degree in social work or similar mental health field and at least one year of work experience in a psychiatric care setting, including expertise in infant mental health (endorsement preferred), or the equivalent combination of experience and education. Licensed clinical social workers (LCSWs) are preferred. Supervisors must have a minimum of a master’s degree (a Ph.D. is preferred) in nursing, social work, psychology, or a related field, and 5 to 10 years of work experience as a nurse or mental health professional with high-risk populations.

MTB-HV home visitors must receive three types of supervision: (1) one-on-one supervision specific to their discipline (nursing or mental health), (2) interdisciplinary supervision with their home visiting partner (nurse and mental health professional) and their supervisors, and (3) team meetings with all home visitors and supervisors. The MTB National Office recommends, but does not require, the following rate of supervision: one hour of one-on-one supervision on a weekly or biweekly basis, one hour of interdisciplinary supervision per week, and a one-hour team meeting once a week.

MTB-HV clinical and administrative staff must attend a multi-day in-person pre-service training. To facilitate the support of current and new clinical staff, an optional train-the-trainer component for supervisors at replication sites is available. The training addresses specific supervisory issues and ongoing hiring and training needs. Please contact the model developer for additional information about the pre-service training requirement.

Ongoing training, mentoring, and professional development are required for all staff. In-service training is tailored to each site and encompasses monthly consultation sessions plus quarterly distant learning sessions with model developers, held by videoconference. Please contact the model developer for additional information about the ongoing professional development requirement.

Minding the Baby® National Office
Yale School of Nursing
400 West Campus Drive
West Haven, CT 06477

Phone: (203) 785-5589
Email: mindingthebaby@yale.edu
Website: http://mtb.yale.edu/, https://www.facebook.com/mindingthebaby/