Top

Published in:

01-06-2015 | Original Article

Mom Power: preliminary outcomes of a group intervention to improve mental health and parenting among high-risk mothers

Authors: Maria Muzik, Katherine L. Rosenblum, Emily A. Alfafara, Melisa M. Schuster, Nicole M. Miller, Rachel M. Waddell, Emily Stanton Kohler

Published in: Archives of Women's Mental Health | Issue 3/2015

Abstract

Maternal psychopathology and traumatic life experiences may adversely impact family functioning, the quality of the parent–child relationship and the attachment bond, placing the child’s early social-emotional development at risk. Attachment-based parenting interventions may be particularly useful in decreasing negative outcomes for children exposed to risk contexts, yet high risk families frequently do not engage in programs to address mental health and/or parenting needs. This study evaluated the effects of Mom Power (MP), a 13-session parenting and self-care skills group program for high-risk mothers and their young children (age <6 years old), focused on enhancing mothers’ mental health, parenting competence, and engagement in treatment. Mothers were referred from community health providers for a phase 1 trial to assess feasibility, acceptability, and pilot outcomes. At baseline, many reported several identified risk factors, including trauma exposure, psychopathology, poverty, and single parenthood. Ninety-nine mother-child pairs were initially recruited into the MP program with 68 women completing and providing pre- and post-self-report measures assessing demographics and trauma history (pre-assessment only), maternal mental health (depression and post-traumatic stress disorder (PTSD)), parenting, and intervention satisfaction. Results indicate that MP participation was associated with reduction in depression, PTSD, and caregiving helplessness. A dose response relationship was evident in that, despite baseline equivalence, women who attended ≥70 % of the 10 groups (completers; N = 68) improved on parenting and mental health outcomes, in contrast to non-completers (N = 12). Effects were most pronounced for women with a mental health diagnosis at baseline. The intervention was perceived as helpful and user-friendly. Results indicate that MP is feasible, acceptable, and holds promise for improving maternal mental health and parenting competence among high-risk dyads. Further research is warranted to evaluate the efficacy of MP using randomized controlled designs.

Aday LA (2001) At risk in America : the health and health care needs of vulnerable populations in the United States, 2nd edn. Jossey-Bass Publishers, San Francisco

Ammerman RT, Putnam FW, Stevens J, Bosse NR, Short JA, Bodley AL, Van Ginkel JB (2011) An open trial of in-home CBT for depressed mothers in home visitation. Matern Child Health J 15(8):1333–1341. doi:10.1007/s10995-010-0691-7 CrossRefPubMedCentralPubMed

Ammerman RT, Putnam FW, Altaye M, Stevens J, Teeters AR, Van Ginkel JB (2013) A clinical trial of in-home CBT for depressed mothers in home visitation. Behav Ther 44(3):359–372. doi:10.1016/j.beth.2013.01.002 CrossRefPubMedCentralPubMed

Arata CM, Lindman L (2002) Marriage, child abuse, and sexual revictimization. J Interpers Violence 17(9):953–971. doi:10.1177/0886260502017009003 CrossRef

Azzi-Lessing L (2013) Serving highly vulnerable families in home-visitation programs. Infant Ment Health J 34(5):376–390. doi:10.1002/imhj.21399 CrossRef

Bakermans-Kranenburg MJ, van Ijzendoorn MH, Juffer F (2003) Less is more: meta-analyses of sensitivity and attachment interventions in early childhood. Psychol Bull 129(2):195–215. doi:10.1037/0033-2909.129.2.195 CrossRefPubMed

Banyard VL (1997) The impact of childhood sexual abuse and family functioning on four dimensions of women’s later parenting. Child Abuse Negl 21(11):1095–1107. doi:10.1016/S0145-2134(97)00068-9 CrossRefPubMed

Barnes JE, Noll JG, Putnam FW, Trickett PK (2009) Sexual and physical revictimization among victims of severe childhood sexual abuse. Child Abuse Negl 33(7):412–420. doi:10.1016/j.chiabu.2008.09.013 CrossRefPubMedCentralPubMed

Beck CT, Gable RK (2001) Further validation of the postpartum depression screening scale. Nurs Res 50(3):155–164CrossRefPubMed

Beitchman JH, Zucker KJ, Hood JE, DaCosta GA, Akman D, Cassavia E (1992) A review of the long-term effects of child sexual abuse. Child Abuse Negl 16(1):101–118. doi:10.1016/0145-2134(92)90011-F CrossRefPubMed

Bowlby J (1969) Attachment. Basic Books, New York

Bowlby J (1988) A secure base: parent–child attachment and healthy human development. Routledge, London

Brand SR, Engel SM, Canfield RL, Yehuda R (2006) The effect of maternal PTSD following in utero trauma exposure on behavior and temperament in the 9-month-old infant. Ann N Y Acad Sci 1071:454–458. doi:10.1196/annals.1364.041 CrossRefPubMed

Cicchetti D, Toth SL, Rogosch FA (1999) The efficacy of toddler-parent psychotherapy to increase attachment security in offspring of depressed mothers. Attach Hum Dev 1(1):34–66. doi:10.1080/14616739900134021 CrossRefPubMed

Cicchetti D, Rogosch FA, Toth SL (2006) Fostering secure attachment in infants in maltreating families through preventive interventions. Dev Psychopathol 18(3):623–649PubMed

Cloitre M, Stolbach BC, Herman JL, van der Kolk B, Pynoos R, Wang J, Petkova E (2009) A developmental approach to complex PTSD: childhood and adult cumulative trauma as predictors of symptom complexity. J Trauma Stress 22(5):399–408. doi:10.1002/jts.20444 CrossRefPubMed

Cohen LR, Hien DA, Batchelder S (2008) The impact of cumulative maternal trauma and diagnosis on parenting behavior. Child Maltreat 13(1):27–38. doi:10.1177/1077559507310045 CrossRefPubMedCentralPubMed

Cole PM, Woolger C, Power TG, Smith KD (1992) Parenting difficulties among adult survivors of father-daughter incest. Child Abuse Negl 16(2):239–249. doi:10.1016/0145-2134(92)90031-L CrossRefPubMed

Crockenberg S (1987) Predictors and correlates of anger toward and punitive control of toddlers by adolescent mothers. Child Dev 58:964–975CrossRefPubMed

Desai S, Arias I, Thompson MP, Basile KC (2002) Childhood victimization and subsequent adult revictimization assessed in a nationally representative sample of women and men. Violence Vict 17(6):639–653. doi:10.1891/vivi.17.6.639.33725 CrossRefPubMed

Digiuseppe R, Linscott J, Jilton R (1996) Developing the therapeutic alliance in child-adolescent psychotherapy. Appl Prev Psychol 5(2):85–100. doi:10.1016/s0962-1849(96)80002-3 CrossRef

Dobson KS (2009) Handbook of cognitive-behavioral therapies: Guilford Press

Erickson M, Egeland B (1999) The STEEP program: linking theory and research to practice. Zero Three 20(2):11–16

Feerick M, Snow K (2005) The relationships between childhood sexual abuse, social anxiety, and symptoms of posttraumatic stress sisorder in women. J Fam Violence 20(6):409–419. doi:10.1007/s10896-005-7802-z CrossRef

Field T, Healy BT, Goldstein S, Guthertz M (1990) Behavior-state matching and synchrony in mother-infant interactions of nondepressed versus depressed dyads. Dev Psychol 26(1):7–14. doi:10.1037/0012-1649.26.1.7 CrossRef

First MB, Spitzer RL, Gibbon M, Williams JBW (1996) Structured clinical interview for DSM-IV axis i disorders, clinician version (SCID-CV). American Psychiatric Press, Inc., Washington, DC

Flynn HA, Henshaw E, O’Mahen H, Forman J (2010) Patient perspectives on improving the depression referral processes in obstetrics settings: a qualitative study. Gen Hosp Psychiatry 32(1):9–16. doi:10.1016/j.genhosppsych.2009.07.005 CrossRefPubMedCentralPubMed

Foa EB, Ehlers A, Clark DM, Tolin DF, Orsillo SM (1999) The posttraumatic cognitions inventory (PTCI): development and validation. Psychol Assess 11(3):303–314. doi:10.1037/1040-3590.11.3.303 CrossRef

Ford JD, Russo E (2006) Trauma-focused, present-centered, emotional self-regulation approach to integrated treatment for posttraumatic stress and addiction: trauma adaptive recovery group education and therapy (TARGET). Am J Psychother 60(4):335–355PubMed

Ford JD, Steinberg KL, Moffitt KH, Zhang W (2008) Breaking the cycle of trauma and criminal justice involvement: the mothers overcoming and managing stress (MOMS) study. CT: University of Connecticut Health Center, Department of Psychiatry, Farmington

Forman DR, O’Hara M, Stuart S, Gorman LL, Larsen KE, Coy KC (2007) Effective treatment for postpartum depression is not sufficient to improve the developing mother-child relationship. Dev Psychopathol 19:585–602PubMed

Gladstone GL, Parker GB, Mitchell PB, Malhi GS, Wilhelm K, Austin M-P (2004) Implications of childhood trauma for depressed women: an analysis of pathways from childhood sexual abuse to deliberate self-harm and revictimization. Am J Psychiatry 161(8):1417–1425. doi:10.1176/appi.ajp.161.8.1417 CrossRefPubMed

Goodman SH, Gotlib IH (1999) Risk for psychopathology in the children of depressed mothers: a developmental model for understanding mechanisms of transmission. Psychol Rev 106(3):458–490. doi:10.1037/0033-295x.106.3.458 CrossRefPubMed

Gopalan G, Goldstein L, Klingenstein K, Sicher C, Blake C, McKay MM (2010) Engaging families into child mental health treatment: updates and special considerations. J Can Acad Child Adolesc Psychiatry / J Acad Can Psychiatrie de l'enfant et de l'Adolesc 19(3):182–196

Graham-Bermann SA, Miller LE (2013) Intervention to reduce traumatic stress following intimate partner violence: an efficacy trial of the Moms’ Empowerment Program (MEP). Psychodyn Psychiatry 41(2):329–349. doi:10.1521/pdps.2013.41.2.329 CrossRefPubMed

Griffin JA, Cicchetti D, Leaf PJ (1993) Characteristics of youths identified from a psychiatric case register as first-time users of services. Hosp Community Psychiatry 44(1):62–65PubMed

Grusec JE (1992) Social learning theory and developmental psychology: the legacies of Robert Sears and Albert Bandura. Dev Psychol 28(5):776–786. doi:10.1037/0012-1649.28.5.776 CrossRef

Herman (1992a) The aftermath of violence—from domestic abuse to political terror, vol 33. Basic Books, New York

Herman J (1992b) Trauma and recovery: the aftermath of violence—from domestic abuse to political terror. Basic Books, New York

Hofmann SG, Sawyer AT, Witt AA, Oh D (2010) The effect of mindfulness-based therapy on anxiety and depression: a meta-analytic review. J Consult Clin Psychol 78(2):169–183. doi:10.1037/a0018555 CrossRefPubMedCentralPubMed

Holton JK, Harding K (2007) Healthy Families America®: ruminations on implementing a home visitation program to prevent child maltreatment. J Prev Interv Community 34(1–2):13–38CrossRefPubMed

Horowitz MJ (1988) Person schemas. Psychodynamics and Cognition, 13

Janoff-Bulman R, Frieze IH (1983) A theoretical perspective for understanding reactions to victimization. J Soc Issues 39(2):1–17. doi:10.1111/j.1540-4560.1983.tb00138.x CrossRef

Kimbrough E, Magyari T, Langenberg P, Chesney M, Berman B (2010) Mindfulness intervention for child abuse survivors. J Clin Psychol 66(1):17–33. doi:10.1002/jclp.20624 PubMed

Klier CM, Muzik M, Rosenblum KL, Lenz G (2001) Interpersonal psychotherapy adapted for the group setting in the treatment of postpartum depression. J Psychother Pract Res 10(2):124–131PubMedCentralPubMed

LePlatte D, Rosenblum KL, Stanton E, Miller N, Muzik M (2012) Mental health in primary care for adolescent parents. Ment Health Fam Med 9(1):39–45PubMedCentralPubMed

Levendosky AA, Graham-Bermann SA (2001) Parenting in battered women: the effects of domestic violence on women and their children. J Fam Violence 16(2):171–192. doi:10.1023/a:1011111003373 CrossRef

Liang B, Goodman L, Tummala-Narra P, Weintraub S (2005) A theoretical framework for understanding help-seeking processes among survivors of intimate partner violence. Am J Community Psychol 36(1–2):71–84. doi:10.1007/s10464-005-6233-6 CrossRefPubMed

Lieberman A F, & Van Horn P (2004) Don’t hit my mommy: a manual for child–parent psychotherapy with young witnesses of family violence author: Alicia F. Lie

Lieberman AF, Ghosh Ippen C, Van Horn P (2006) Child–parent psychotherapy: 6-month follow-up of a randomized controlled trial. J Am Acad Child Adolesc Psychiatry 45(8):913–918. doi:10.1097/01.chi.0000222784.03735.92 CrossRefPubMed

Lipchik E (2002) Beyond technique in solution-focused therapy: working with emotions and the therapeutic relationship: Guilford Press

Lipman EL, MacMillan HL, Boyle MH (2001) Childhood abuse and psychiatric disorders among single and married mothers. Am J Psychiatry 158(1):73–77. doi:10.1176/appi.ajp.158.1.73 CrossRefPubMed

Lovejoy MC, Graczyk PA, O’Hare E, Neuman G (2000) Maternal depression and parenting behavior: a meta-analytic review. Clin Psychol Rev 20(5):561–592. doi:10.1016/S0272-7358(98)00100-7 CrossRefPubMed

Lowell DI, Carter AS, Godoy L, Paulicin B, Briggs-Gowan MJ (2011) A randomized controlled trial of Child FIRST: a comprehensive home-based intervention translating research into early childhood practice. Child Dev 82(1):193–208. doi:10.1111/j.1467-8624.2010.01550.x CrossRefPubMed

Lyons-Ruth K, Block D (1996) The disturbed caregiving system: Relations among childhood trauma, maternal caregiving, and infant affect and attachment. Infant Ment Health J 17(3):257–275. doi:10.1002/(sici)1097-0355(199623)17:3<257::aid-imhj5>3.0.co;2-l CrossRef

Lyons-Ruth K, Bronfman E, Parsons E (1999) Atypical attachment in infancy and early childhood among children at developmental risk. IV. Maternal frightened, frightening, or atypical behavior and disorganized infant attachment patterns. Monogr Soc Res Child Dev 64(3):67–96, discussion 213CrossRefPubMed

Margolin G, Gordis EB (2004) Children’s exposure to violence in the family and community. Curr Dir Psychol Sci 13(4):152–155CrossRef

Miller WR, Rollnick S (2002) Motivational interviewing: Preparing people for change, 2nd edn. Guilford Press, New York, NY, US

Moore M, Brown D, Money N, Bates M (2011) Mind-body skills for regulating the autonomic nervous system. Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury, Arlington, VA

Muzik M, & Stanton E (2009) Mom Power group evaluation. Unpublished Survey

Muzik M, Hadi Z, Rosenblum KL, Jaffe A, Stanton E, Waxler E (2010) Comprehensive care model for mothers and children in need: the Mom Power Project. Paper presented at the 12th World Congress of the World Association for Infant Mental Health, Leipzig, Germany

Muzik M, Ads M, Bonham C, Lisa Rosenblum K, Broderick A, Kirk R (2013) Perspectives on trauma-informed care from mothers with a history of childhood maltreatment: a qualitative study. Child Abuse Negl 37(12):1215–1224. doi:10.1016/j.chiabu.2013.07.014 CrossRefPubMed

Muzik M, Schmicker M, Alfafara E, Dayton C, Schuster M, Rosenblum KL (2014) Predictors of treatment engagement to a parenting intervention among Caucasian and African-American mothers. J Soc Serv Res 40(5):662–680. doi:10.1080/01488376.2014.917451

Najavits LM, Weiss RD, Shaw SR (1997) The link between substance abuse and posttraumatic stress disorder in women. Am J Addict 6(4):273–283. doi:10.1111/j.1521-0391.1997.tb00408.x PubMed

Newman MG, Clayton L, Zuellig A, Cashman L, Arnow B, Dea R, Taylor CB (2000) The relationship of childhood sexual abuse and depression with somatic symptoms and medical utilization. Psychol Med 30(5):1063–1077CrossRefPubMed

Nylen KJ, Moran TE, Franklin CL, O’Hara MW (2006) Maternal depression: A review of relevant treatment approaches for mothers and infants. Infant Ment Health J 27(4):327–343CrossRef

Olds DL (2006) The nurse–family partnership: an evidence-based preventive intervention. Infant Ment Health J 27(1):5–25. doi:10.1002/imhj.20077 CrossRef

Olds DL (2010) The nurse-family partnership: from trials to practice. In: Reynolds A, Rolnick A, Englund M, Temple J (eds) Childhood programs and practices in the first decade of life: a human capital integration. Cambridge University Press, New York, NY, pp 49–75CrossRef

Patel V, Flisher AJ, Hetrick S, McGorry P (2007) Mental health of young people: a global public-health challenge. Lancet 369(9569):1302–1313. doi:10.1016/S0140-6736(07)60368-7 CrossRefPubMed

Reid C (2004) The wounds of exclusion : poverty, women’s health, and social justice. Qual Institute Press, Edmonton, Alta

Resnick HS, Kilpatrick DG, Dansky BS, Saunders BE, Best CL (1993) Prevalence of civilian trauma and posttraumatic stress disorder in a representative national sample of women. J Consult Clin Psychol 61(6):984–991CrossRefPubMed

Robins C J, Ivanoff A M, & Linehan M M (2001) Dialectical behavior therapy. Handbook of personality disorders: Theory, research, and treatment, 437–459

Robinson CC, Mandleco B, Olsen SF, Hart CH (1995) Authoritative, authoritarian, and permissive parenting practices: development of a new measure. Psychol Rep 77(3):819–830. doi:10.2466/pr0.1995.77.3.819 CrossRef

Rosenblum K L, Dayton C, & McDonough S (2006) Communicating feelings: links between mothers’ representations of their Infants, parenting, and infant emotional development parenting representations: Cambridge University Press

Rosenblum KL, McDonough SC, Sameroff AJ, Muzik M (2008) Reflection in thought and action: maternal parenting reflectivity predicts mind-minded comments and interactive behavior. Infant Ment Health J 29(4):362–376. doi:10.1002/imhj.20184 CrossRef

Sameroff AJ, Seifer R (1990) Early contributors to developmental risk. In: Rolf JE, Garmezy N (eds) Risk and protective factors in the development of psychopathology. Cambridge University Press, Cambridge, pp 52–66CrossRef

Schechter DS, Zeanah CH, Myers MM, Brunelli SA, Luebowitz MR et al (2004) Psychobiological dysregulation in violence-exposed mothers: salivary cortisol of mothers with very young children pre- and post-separation stress. Bull Menninger Clin 68(4):319–336CrossRefPubMed

Schuetze P, Zeskind PS (2001) Relations between women’s depressive symptoms and perceptions of infant distress signals varying in pitch. Infancy 2(4):483–499CrossRef

Scott S, Dadds MR (2009) Practitioner review: when parent training doesn’t work: theory-driven clinical strategies. J Child Psychol Psychiatry 50(12):1441–1450. doi:10.1111/j.1469-7610.2009.02161.x CrossRefPubMed

Seng JS, Sperlich M, Rowe H, Cameron H, Harris A, Rauch SA, Bell SA (2011) The survivor moms’ companion: open pilot of a posttraumatic stress specific psychoeducation program for pregnant survivors of childhood maltreatment and sexual trauma. Int J Childbirth 1(2):111–121CrossRef

Shonkoff JP, Meisels SJ (2000) Handbook of early childhood intervention, 2nd edn. Cambridge University Press, Cambridge England; New YorkCrossRef

Smith JC, Cumming A, Xeros-Constantinides S (2010) A decade of parent and infant relationship support group therapy programs. Int J Group Psychother 60(1):59–89. doi:10.1521/ijgp.2010.60.1.59 CrossRefPubMed

Solomon J, George C (2008) The measurement of attachment security and related constructs in infancy and early childhood. In: Cassidy J, Shaver PR (eds) Handbook of attachment: Theory, research, and clinical applications, 2nd edn. Guilford Press, New York, NY US, pp 383–416

Solomon J, George C (2011) Disorganized attachment and caregiving. Guilford Press, New York

Stanton E, Richardson P, Alfafara E, Miller N, Broderick A, Hamilton S, & Muzik M (2011) Parenting and attachment skills curriculum for mothers with trauma, depression, & posttraumatic stress: preliminary results from the Mom Power demonstration group, San Diego, CA, September 11, 2011

Stenius VM, Veysey BM (2005) "It’s the little things": women, trauma, and strategies for healing. J Interpers Violence 20(10):1155–1174. doi:10.1177/0886260505278533 CrossRefPubMed

Substance abuse and mental health services administration (n.d.) Trauma-Informed Care and Trauma Services

Tikotzky L, Chambers AS, Gaylor E, Manber R (2010) Maternal sleep and depressive symptoms: links with infant negative affectivity. Infant Behav Dev 33(4):605–612. doi:10.1016/j.infbeh.2010.07.012 CrossRefPubMed

Toth SL, Rogosch FA, Manly JT, Cicchetti D (2006) The efficacy of toddler-parent psychotherapy to reorganize attachment in the young offspring of mothers with major depressive disorder: a randomized preventive trial. J Consult Clin Psychol 74(6):1006–1016. doi:10.1037/0022-006x.74.6.1006 CrossRefPubMed

Tough SC, Siever JE, Leew S, Johnston DW, Benzies K, Clark D (2008) Maternal mental health predicts risk of developmental problems at 3 years of age: follow up of a community based trial. BMC Pregnancy Childbirth 8:16. doi:10.1186/1471-2393-8-16 CrossRefPubMedCentralPubMed

van IJzendoorn MH, Juffer F, Duyvesteyn MGC (1995) Breaking the intergenerational cycle of insecure attachment: a review of the effects on attachment-based interventions on maternal sensitivity and infant security. J Child Psychol Psychiatry 36(2):225–248CrossRefPubMed

Weatherston DJ (2000) The infant mental health specialist. Zero Three 21(2):3–10

Wolfe J, Kimerling R (1997) Gender issues in the assessment of posttraumatic stress disorder. In: Wilson JP, Keane TM (eds) Assessing psychological trauma and PTSD. Guilford Press, New York, NY US, pp 192–238

Zeanah CH, Benoit D, Hirshberg L, Barton M, Regan C (1994) Mothers’ representations of their infants are concordant with infant attachment classifications. Dev Issues Psychiatry Psychol 1:9–18

Title: Mom Power: preliminary outcomes of a group intervention to improve mental health and parenting among high-risk mothers
Authors: Maria Muzik
Katherine L. Rosenblum
Emily A. Alfafara
Melisa M. Schuster
Nicole M. Miller
Rachel M. Waddell
Emily Stanton Kohler
Publication date: 01-06-2015
Publisher: Springer Vienna
Published in: Archives of Women's Mental Health / Issue 3/2015
Print ISSN: 1434-1816
Electronic ISSN: 1435-1102
DOI: https://doi.org/10.1007/s00737-014-0490-z

At a glance: The STEP trials

Springer Medicine

Mom Power: preliminary outcomes of a group intervention to improve mental health and parenting among high-risk mothers

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 3/2015

A pilot, exploratory report on dyadic interpersonal psychotherapy for perinatal depression

Depression improvement and parenting in low-income mothers in home visiting

Associations of anxiety disorders, depressive disorders and body weight with hypertension during pregnancy

Perinatal Dyadic Psychotherapy for postpartum depression: a randomized controlled pilot trial

Predictors of alcohol and tobacco use prior to and during pregnancy in the US: the role of maternal stressors

An update on sexual function and dysfunction in women