The Early Intervention Parenting Partnerships (EIPP) program is a multidisciplinary home visiting program that provides health screenings, education, counseling, and service coordination to expectant parents and families who experience pregnancy-related risk factors such as inadequate prenatal care or social risk factors including insufficient basic resources, depression, or violence in the home. This study examined whether EIPP was associated with receipt of postpartum visits in the first 90 days post-birth, overall and stratified by adequacy of prenatal care. EIPP participants (n = 611) who enrolled prenatally from 2013 to 2017 were matched to a comparison group of families identified from birth certificates using coarsened exact matching. Study outcomes included receipt of postpartum visits before 21 days, 21 to 60 days, and 61 to 90 days post-birth based on healthcare claims codes using a definition of postpartum care based on Healthcare Effectiveness Data and Information Set (HEDIS) and an expanded definition that included additional codes used by providers to document postpartum care including visits related to contraception, feeding, and depression screening. Weighted regression models assessed differences in the odds of postpartum visit receipt (using HEDIS and expanded definitions) between the EIPP and comparison groups, with subsequent models examining adequacy of prenatal care as a moderator. Using the expanded definition, EIPP participants had 51

Home visiting is a common modality for delivering services to families, particularly those with young children. At the core of home visiting is the relationship between the parent and the service provider, the home visitor. This paper focuses on characterizing parent-provider relationships in home visiting contexts. We discuss current conceptualizations of parent-provider relationships in home visiting and introduce a proposal to use RelationalCultural Theory (RCT) and Critical Race Theory (CRT) as theoretical foundations for conceptualizing and enhancing parent-provider relationships - especially for Black families. Further, we present suggestions meant to enhance providers' knowledge and implementation of the proposed theoretical frameworks in home visiting. Limitations such as the large responsibility on home visitors to apply and integrate theory-driven strategies and future directions are discussed.

Despite strong evidence self-regulation skills are critical for school readiness, there remains a dearth of longitudinal studies that describe developmental trajectories of self-regulation, particularly among low-resource and underrepresented populations such as Spanish-English dual-language learners (DLLs). The present study examined individual differences in trajectories of self-regulation among 459 Spanish-English DLLs who were Hispanic from four different samples and three geographic locations in the U.S. Self-regulation was assessed in all samples using repeated administration of the Head-Toes-Knees-Shoulders (HTKS) task from early childhood through early elementary school. Results of latent growth curve analyses revealed that growth was best represented by quadratic trajectories. Latent class growth analyses captured significant individual differences in self-regulation trajectories. One group of children (41%) started with higher HTKS scores and displayed rapid early growth in performance. A similar percentage of children (41%) displayed intermediate growth in self-regulation, starting with lower HTKS scores but displaying rapid growth commencing arrange 4.5 years. Finally, about 18% of the sample did not display growth in HTKS performance until after entry to elementary school, around age 6 years. Girls were half as likely as boys to be in this later developing group. Likewise, children from families at the upper end of the socioeconomic distribution in this low-income sample were significantly less likely to be in the later developing group relative to children from families with lower SES. Study findings indicate the importance of monitoring growth rates in self-regulation as a means of identifying children at risk for entering school without the requisite self-regulation skills.

Research on adverse childhood experiences demonstrates long-term implications of childhood abuse and family dysfunction for health and well-being in adulthood. The present study expanded prior research on the effects of adverse experiences in childhood to include community-based childhood adversities (e.g., community violence) and to investigate childhood adversities in relation to later parenting/maltreatment risk. We used a resilience framework to examine whether current resources (e.g., social support, community engagement) would buffer early adversity. A diverse U.S. sample (19

Unfortunately, family homelessness is a crisis in the United States. The majority of families experiencing homelessness are headed by single mothers and half of children who experience homelessness are less than five years of age. In the current study, we investigated whether children's school attendance and stability mediated the association between early experiences of homelessness (in infancy and toddlerhood) with children's school performance on standardized assessments of math and English language arts administered in the spring of third grade in a sample of children of young mothers. We used a person-centered analytic technique (i.e., repeated measures latent class analysis) to identify three classes of children's patterns of school attendance and stability from kindergarten through third grade that consisted of (a) High Absenteeism, (b) Decreasing Absenteeism, and (c) Low Absenteeism classes. Early experiences of homelessness were directly and indirectly associated with math, but not English language arts scores, through the three identified classes. The results of the current study have important implications for young children who experience homelessness and suggest promoting school attendance as one avenue to support academic achievement. In addition, supporting families and children early (i.e., before they begin pre-kindergarten) will be key in ensuring that young children who experience homelessness are successful in educational environments.

The Early Intervention Parenting Partnerships (EIPP) program is a home visiting program that provides home visits, group services, assessments and screenings, and referrals delivered by a multidisciplinary team to expectant parents and families with infants who experience socioeconomic barriers, emotional and behavioral health challenges, or other stressors. The present study examines whether EIPP successfully meets its aims of screening families for social and environmental factors that may increase the risk of children's developmental delays and connect them to the larger statewide early intervention (EI) system relative to families with similar background characteristics who do not receive EIPP. Coarsened exact matching was used to match EIPP participants who enrolled between 2013 and 2017 to a comparison group of families identified from birth certificates. Primary study outcomes including EI referrals, evaluations, and service receipt for children from 3 months to 3 years were measured using EI program data. Secondary outcomes included EI referral source, EI eligibility criteria (e.g., presence of biological, social, or environmental factors that may increase later risk for developmental delay), and information on service use. Impacts were assessed by fitting weighted regression models adjusted for preterm birth and maternal depression and substance use. EIPP participants were more likely than the comparison group to be referred to, evaluated for, and receive EI services. EIPP facilitated the identification of EI-eligible children who are at risk for developmental delays due to social or environmental factors, such as violence and substance use in the home, child protective services involvement, high levels of parenting stress, and parent chronic illness or disability. EIPP serves as an entry point into the EI system, helping families attain the comprehensive supports they may need to optimize their well-being and enhance children's development.

Young women aged 18 to 24 years are in the highest risk group for intimate partner violence (IPV), and adolescent mothers are at particularly high risk for IPV and for risky health behaviors. Exposure to IPV may contribute to parenting stress and risky behaviors, and may compromise parenting behavior and healthy child development. The present study examined whether program effects of a statewide home visiting program for adolescent parents on young mothers' parenting stress and risky behaviors measured 2 years post program enrollment were mediated by program effects on their exposure to IPV measured 1 year post enrollment. Using longitudinal data from a subsample of young mothers (n = 448; 58% program, 42% control) who participated in a randomized controlled trial evaluation of a statewide home visiting program, Healthy Families Massachusetts (HFM), we estimated path analyses to examine whether home visiting program effects observed on IPV mediated home visiting program effects on subsequent assessments of parenting distress and mothers' risky behaviors. Findings indicated that IPV mediated associations between home visiting program effects on mothers' parenting distress and risky behavior. Although most newborn home visiting programs do not have an explicitly stated goal of reducing IPV, helping mothers and their partners to reduce violent behavior can have further-reaching impacts on other key goals of home visiting programs, such as parenting stress and risky behaviors.

Attachment and executive function (EF) are two related systems that develop early in life and may mediate associations between care experiences and later functioning. Though theoretically related, the associations between attachment and EF have not been fully explored among children experiencing adversity. In the current study, we took a person-centered approach to examining attachment representations and EF among children of adolescent mothers. Using Latent Profile Analysis, we identified three groups of attachment representations: a “secure” group, an “insecure-avoidant” group, and an “insecure-disorganized” group. We then explored differences in EF performance across the identified groups. Our results indicated that the “secure” group generally outperformed the “insecure-disorganized” and “insecure-avoidant” groups. Though the “insecure-avoidant” group generally outperformed the “insecure-disorganized” group, significant differences were found only on one task. Our findings document links between attachment and EF among children experiencing adversity and may suggest that prevention or intervention efforts to support the development of secure attachments will also foster optimal EF, those higher-order cognitive processes that drive goal-directed behavior.

Home visiting programs support new and expecting parents by strengthening parenting practices, improving parental and child health and well-being, and preventing child maltreatment. Participant retention is often a challenge for home visitation, particularly for young families, potentially reducing program impact. Father engagement in services may be one avenue for supporting continued program take-up for young parents. The current study examined associations between fathers’ formal and informal participation in an infant home visiting program and mothers’ take-up of home visits and whether these associations differed depending on mothers’ relationship status at enrollment or timing of enrollment. Results showed that fathers’ participation in home visiting supported maternal retention, particularly when fathers were formally enrolled. These associations depended on mothers’ relationship status at enrollment but not on whether they enrolled pre- or postnatally. These findings have direct implications for home visiting programs, both in supporting maternal retention and in informing the recruitment and engagement of fathers.

Rationale: It is important to investigate the diversity and variability among adverse childhood experiences (ACEs) in young mothers because they are likely to experience considerable adverse exposures during childhood as well as challenging environments following childbirth. Objective: The current study used latent class analysis with a diverse sample of young mothers to identify subgroups of mothers based on their adverse childhood experiences (ACEs). Subsequent analyses were conducted to examine class specific differences in maternal mental health postpartum and their children's socioemotional functioning at eight years of age. Results: Four classes of participants were identified based on mothers' ACEs, including a high, multiple-risk class, a low-risk class, a high-risk for abuse class, and a high-risk for household dysfunction class. These classes were associated with differences in maternal and child functioning. The low-risk class showed significantly better maternal and child health and well-being than the high-risk class. However, nuanced differences were seen for mothers and their children across all classes; for example, children of mothers in the high-risk for abuse class scored significantly better on internalizing behaviors than children from the high, multiple-risk class, but not better on externalizing behaviors. Further, children of mothers in the high-risk for household dysfunction class scored better than the high, multiple-risk class on externalizing behaviors but not better on scores of internalizing behaviors. Conclusion: Understanding the differences in how certain types of childhood adversity are associated with mothers' and their children's later health and well-being will bolster the use of only a sum score of ACEs for both how we research risk and in supporting clinicians to provide targeted care.

SYNOPSISObjective. Most parents manage some degree of parenting stress without serious concerns, but young mothers experience parenting stress at higher levels than adult mothers; high parenting stress is problematic due to its association with children’s socioemotional and behavior problems and the increased likelihood of maltreatment. Understanding the circumstances that precipitate or mitigate parents’ stress can have lasting impacts for child well-being. Extant research fails to account for both longitudinal and individual variation in young mothers’ parenting stress, leading to equivocal findings about the nature of mothers’ parenting stress trajectories across early childhood. Design. The present study used growth mixture modeling (GMM) to model the trajectories of 544 first-time young mothers’ parenting stress from children’s infancy to school-age. We considered how protective factors (i.e., social support) and psychological vulnerabilities (i.e., depression) experienced during the transition to parenthood were associated with parenting stress trajectories and variation within trajectories when children were of school-age. Results. GMM identified three trajectories of parenting stress: “low stable”, “high increasing”, and “high decreasing.” Protective factors were related to low and decreasing patterns of parenting stress, whereas psychological vulnerabilities were associated with higher parenting stress patterns. Conclusions. This study has implications for programs and services that help young mothers cope with the demands of parenting and reduce parenting stress.

This study investigated associations between child care participation and socioemotional and language development of children born to adolescent mothers. Participants were 704 mothers and their children (mean age = 24 months) enrolled in a randomized controlled-trial evaluation of a voluntary statewide home visiting program for first-time young parents. Findings showed that nonmaternal child care (i.e., organized group care, grandparent care, and other family and friend care) was prevalent in this sample. (Children spent over 30 hr per week in organized group care and nearly 20 hr per week in the care of grandparents and other family and friends.) Furthermore, organized group care was associated with significantly higher performance on assessments of socioemotional competence and language development compared to maternal-only care. These findings have important program and policy implications highlighting the benefits of child care participation and the importance of creating awareness of these benefits, as well as promoting increased access to child care.

Childhood maltreatment (CM) is a pervasive public health problem worldwide, with negative health consequences across the lifespan. Despite these adverse outcomes, identifying children who are being maltreated remains a challenge. Thus, there is a need to identify reliably observable features of parent-child interaction that indicate risk for CM and that can instigate strategically targeted family supports. The aim of this longitudinal study was to assess multiple aspects of observed mother-child interaction from infancy to late adolescence as risk indicators of the overall severity of CM by age 18. Mother-child dyads were assessed in infancy (N = 56), at age 7 years (N = 56), and at age 19 years (N = 56/110). Severity of CM through age 18 was indexed by combined prospective and retrospective assessments. Interactions associated with severity of CM by age 18 included maternal hostility in infancy, maternal withdrawal in infancy and middle childhood, child disorganized attachment behavior in middle childhood and late adolescence, as well as hostile and role-confused interactions in late adolescence. This study identifies new indices of maternal and child behavior as important risk indicators for the severity of CM. These indices could be used to improve early identification and tailor preventive interventions for families at risk for CM.

This paper examined heterogeneity in parents’ patterns of goal attainment following home visiting. Young mothers (n = 696) participating in a randomized controlled trial (RCT) evaluation of a statewide home visiting program were classified, using latent class analysis (LCA), according to their pattern of goal attainment (i.e., educational attainment, employment, parenting, personal functioning) two years postpartum. We explored direct and indirect (via social connectedness) associations between program participation and goal attainment. LCA revealed four classes: (a) High Education & Employment/High Parenting & Personal Functioning (n = 286, 41%); (b) High Education & Employment/Low Parenting & Personal Functioning (n = 212, 30%); (c) Low Education & Employment/Low Parenting & Personal Functioning (n = 71, 10%); and (d) Low Education & Employment/High Parenting & Personal Functioning (n = 127, 18%). Home visiting was not directly associated with class membership, but indirectly through social connectedness. This paper contributes to understanding home visiting impacts.

Objectives. To investigate whether a newborn home visiting program for primiparous adolescent mothers (aged 16-20 years at childbirth) reduced recurrence of child maltreatment in child protective services (CPS) reports. Methods. We conducted a randomized controlled trial of Healthy Families Massachusetts, a statewide home visiting program for young parents. A total of 704 first-time young mothers were randomly assigned to a home visiting group, or to a control group who we referred to other services and who received child development and parenting information. The outcome variable was CPS reports (2008-2016) available for 688 families-specifically, rereports following an initial report (up to mean child age of 7 years). Results. Of the 52% of families who experienced initial CPS reports, 53% experienced additional CPS reports. Children of mothers in the home visiting group were less likely to receive a second report and had a longer period of time between initial and second reports. Conclusions. The home visiting program reduced the recurrence of CPS maltreatment report by 32% and increased the length of time between initial and additional CPS reports. Home visiting parenting support and prevention programs may reduce the likelihood of recurrent maltreatment following completion of program services.

Maternal mind-mindedness (MM) reflects a caregiver's tendency to view a child as an individual with an independent mind. Research has linked higher MM with more favorable parenting and child adaptation. The aim of this study was to examine whether MM was associated with toddlers' behavior problems and competence, and the moderating role of trauma and posttraumatic stress disorder (PTSD) in a sample (N = 212) of adolescent mothers and their toddlers. MM was coded from maternal utterances during free play; mothers completed the University of California at Los Angeles Trauma and Posttraumatic Stress Disorder Reaction Index and reported on children's behavior problems and competence using the Brief Infant-Toddler Social and Emotional Assessment. The majority of mothers (84%) experienced trauma; 45% of these mothers met criteria for partial or full PTSD. Trauma was related to greater behavior problems, and PTSD moderated MM-child functioning relations. When mothers experienced full PTSD, there was no relation between MM and behavior problems. With child competence, when compared to children of mothers with no trauma exposure, children of mothers experiencing partial PTSD symptoms were more likely to have delays in competence when mothers made more MM comments. Results are discussed in light of how MM, in the context of trauma and PTSD, may affect parenting.

In the current study, we aimed to determine the effects of Healthy Families Massachusetts (HFM), a statewide home visiting program, on young mothers' experiences with homelessness during enrollment and after program completion. Data were drawn from a longitudinal, randomized control trial evaluation of HFM. Data collection occurred across 5 time points between 2008 and 2015 from a sample of 704 participants. The current analyses were restricted to a subsample of mothers (n=443) with Time 5 data (74 months post-enrollment; 59.1% program, 40.9% control), which was representative of the Time 1 sample. We used data from maternal phone interviews to assess program effects on experiences with homelessness. Young mothers who participated in HFM were less likely to experience homelessness when their children were preschool-age or older than mothers in the control group. During program participation, the number of home visits was negatively associated with concurrent homelessness when children were infants or toddlers.

A maternal history of childhood maltreatment is thought to be a potent risk factor for child abuse and neglect, yet the extent of continuity across generations is unclear, with studies reporting vastly different rates of intergenerational transmission. Disparate findings may be due to lack of attention to the nature of maltreatment experiences in each generation. We sought to expand the current literature by examining the role of maltreatment type, perpetrator identity, and substantiation status of reports to child protective services (CPS) on intergenerational maltreatment among adolescent mothers (n=417) and their children. We found that when mothers had at least one report of childhood maltreatment (substantiated or not), the odds that they maltreated their children increased by 72% (OR=2.52), compared to mothers who are not maltreated, but the odds were considerably lower when we limited analysis to substantiated reports. Both a maternal history of substantiated neglect and multiple type maltreatment (neglect and physical or sexual abuse) were associated with increased risk of child maltreatment, yet the likelihood of children experiencing multiple maltreatment perpetrated with their mothers identified as perpetrators increased over 300% when mothers had a childhood history of multiple maltreatment.