Manuscript Details

Oxford, M. L., Hash, J.B., Lohr, M. J., Fleming, C. B., Dow-Smith, C., & Spieker, S. J. (2023). What works for whom? Mother’s psychological distress as a moderator of the effectiveness of a home visiting intervention. Infant Mental Health Journal, 44(3), 301-318. https://doi.org/10.1002/imhj.22050

Peer Reviewed

Model(s): Promoting First Relationships®
Study Registration: ClinicalTrials.gov
High rating
This manuscript received a rating of high because it is a randomized-controlled trial with low-attrition.

Study reviewed under: Handbook of Procedures and Standards, Version 2.3
Child Development and School Readiness
Outcome Measure Timing of Follow-Up Rating Direction of Effect Effect Size (Absolute Value) Statistical Significance Sample Size Sample Description
Infant Toddler Social Emotional Assessment (ITSEA), Externalizing behavior 12 months old High
0.26 Statistically significant, p= 0.04 252 mother/child dyads PFR vs. comparison, King County, Washington, 2015-2020, full sample
Effect rating key
Favorable finding / Statistically significant
Unfavorable finding / Statistically significant
Ambiguous finding / Statistically significant
No effect / Not statistically significant
Positive Parenting Practices
Outcome Measure Timing of Follow-Up Rating Direction of Effect Effect Size (Absolute Value) Statistical Significance Sample Size Sample Description
Maternal Confidence Questionnaire (MCQ) 12 months old High
0.06 Not statistically significant, p= 0.53 252 mother/child dyads PFR vs. comparison, King County, Washington, 2015-2020, full sample
Nursing Child Assessment Teaching Scale (NCATS), Parenting sensitivity 6 months old High
0.25 Statistically significant, p= 0.05 252 mother/child dyads PFR vs. comparison, King County, Washington, 2015-2020, full sample
Raising a Baby Scale (RAB), Understanding of toddlers 6 months old High
0.21 Statistically significant, p= 0.03 252 mother/child dyads PFR vs. comparison, King County, Washington, 2015-2020, full sample
Raising a Baby Scale (RAB), Understanding of toddlers 12 months old High
0.47 Statistically significant, p= 0.00 252 mother/child dyads PFR vs. comparison, King County, Washington, 2015-2020, full sample
Effect rating key
Favorable finding / Statistically significant
Unfavorable finding / Statistically significant
Ambiguous finding / Statistically significant
No effect / Not statistically significant

Note: Tables do not include findings that HomVEE rated low or indeterminate, or found to be ineligible for review.

This study included participants with the following characteristics at enrollment:

Race/Ethnicity

The race and ethnicity categories may sum to more than 100 percent if Hispanic ethnicity was reported separately or respondents could select two or more race or ethnicity categories.

American Indian or Alaska Native
2%
Asian
3%
Black or African American
17%
Hispanic or Latino
47%
Native Hawaiian or Pacific Islander
2%
White
65%
Some other race
<1%
Two or more races
10%

Maternal Education

Less than a high school diploma
25%
High school diploma or GED
75%

Other Characteristics

Native population
3%
Enrollment in means-tested programs
92%

This study included participants from the following locations:

  • Washington
Study Participants
  • Study participants were pregnant women and mothers with infants younger than 3 months. Mothers were recruited from two community mental health programs and were eligible if they spoke English or Spanish and had received mental health services during pregnancy at one of the programs. 
  • The study included 252 mother-infant pairs, who were randomly assigned to either the Promoting First Relationships intervention group (127 pairs) or a comparison group (125 pairs). 
  • Outcomes were assessed when infants were ages 6 months and 12 months. 
  • At enrollment, mothers were 28 years old on average. Fifty-one percent reported mild to severe depressive symptoms; 54 percent reported mild to severe anxiety symptoms; and 35 percent screened positive for post-traumatic stress disorder. Infants were approximately 2 months old at enrollment, on average. The median annual family income was below $20,000, and about 92 percent of families participated in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).
Setting

The study took place in King County, Washington, in the greater Seattle area.

Intervention condition
Promoting First Relationships®

Note: Navigate to the model page for more information about the home visiting model. See the source manuscript for more information about how the model was implemented in this study.

Comparison Conditions
  • Mothers in the comparison group did not receive any home visiting services.
  • They were mailed a packet of information in their preferred language with handouts on child development and parenting and a list of local resources.
  • They received two check-in phone calls during the study.
Subgroups examined
  • Mothers with high psychological distress
  • Mothers with low psychological distress
Author Affiliation

The authors were affiliated with the University of Washington’s Department of Child, Family, and Population Health Nursing and Department of Psychiatry and Behavioral Sciences. The authors also had a direct institutional relationship with Promoting First Relationships. 

The program was developed at the University of Washington, and the manuscript’s first author, Monica Oxford, served as executive director of Promoting First Relationships at the time of the study.

Funding Sources

This research was supported by Award Number R01 HD052809 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institutes of Health.

Study design characteristics contributing to rating
Design Random assignment compromised? Attrition Baseline equivalence Confounding factors? Valid, reliable measures?
Randomized controlled trial No Low

Not assessed for randomized controlled trials with low attrition

No

Yes
Notes from the review of this manuscript

The findings for the Maternal Confidence Questionnaire at age 6 months and the Nursing Child Assessment Teaching Scale at age 12 months received a low rating because the measures did not meet HomVEE’s reliability standards. The internal consistency values reported for these measures at those time points were below HomVEE’s minimum threshold. Reliability information was drawn from Oxford et al. (2021), and sample size information was obtained through correspondence with one of the study authors.