The MTB program is different from other existing home visiting programs in several important ways. The central core of the intervention provided by the home visitors revolves around developing parents’ abilities to become reflective and responsive in their interactions with their infants. This capacity has been shown to enhance the parent-child relationship and the child’s sense of secure attachment to the parent, setting the stage for many other positive maternal and child developmental and cognitive outcomes.
The second important way that this intervention differs from other home visiting programs is that the program is delivered by an interdisciplinary team of master’s prepared clinicians who are able to assess and manage the array of complex environmental, family, health, and mental health issues that are common with families living within the stressors of poverty. That is, the MTB program emphasizes an interdisciplinary approach wherein services are delivered by a team that includes an advanced practice nurse and a clinical social worker.
The third important difference is that the program is set up in close collaboration with respected community health clinics located within the urban neighborhoods where MTB families live. This collaboration provides a “value-added” aspect to the provision of care for families by both program and clinic staff.
Recruitment and eligibility guidelines vary slightly based on location. Typically, MTB serves first-time young families. In New Haven, MTB is run in collaboration with two local community health centers and enrolls first-time mothers in the range of 14 to 25 years of age who are receiving prenatal care at one of the two collaborating health clinics. MTB does not accept young women who are active drug users, or are actively psychotic. All MTB mothers are voluntary participants in the program.
The intervention typically begins during the second or third trimester of pregnancy and continues through the child’s second birthday. Home visits occur on a weekly basis during the first year and transition to every other week during the second year.
Minding the Baby® is an interdisciplinary program, which, in this context, has several different meanings. First, it implies that while two distinct kinds of care – nursing and mental health/social service -- are provided by individual team members, the home visitors work together in a number of ways. Within the MTB integrated nursing/mental health model, there is a focus upon the development of reflective capacities, which includes the mother’s interactions with and representations of the child’s body and physical states, and the mother’s interactions with and representations of the child’s mind and mental states. Thus, while the home visitors are working to develop mothers’ reflective capacities in different domains, they share the aim of finding ways to help mothers think about, organize, and regulate their own and their children’s internal experience.
In addition, the two clinicians share a set of basic assumptions about the mothers, the babies, and the value of bearing witness to difficulties in their lives. While home visitors are working from a specific knowledge base and a set of skills unique to their chosen professions, the guiding principles of the MTB intervention blend these perspectives and provide the clinical base for the intervention. On-going training, teamwork, and supervision is inherent to the work, building a core knowledge and common language among clinicians. This kind of approach contributes to a seamless experience of care by the mothers, and is essential to avoiding splitting and fragmentation of the team, and of clinical care.
The alliance between the home visiting program and the community health center (CHC) provides the home visitors with a cohort of professional colleagues with whom to share the challenges of working with families who have numerous physical, medical, and mental health needs. Developing effective methods of communication among the home visitors and the CHC staff and clinicians helps the program better serve multi-need and complex families.
Over the course of time, MTB mothers and families grow to know and trust the home visitors. One of the home visitors’ goals is to facilitate a closer and more collaborative relationship between families and their CHC primary care clinicians. Families learn to become better health care consumers with the help and coaching of the home visitors, by using the phone tree, the answering service, and giving a helpful history of the concern. Families also learn how to access social service or instrumental programs they might need (e.g., housing, food assistance, health insurance benefits, etc). Thus, as families move toward the completion of the MTB program, self-efficacy and knowledge about obtaining and using needed services is accomplished.
There are a number of ways in which you can support the work of MTB, including by advocating for quality home visiting services for families in need. The New Haven MTB program is currently funded entirely by grants and gifts through Yale, and donors are essential in helping us achieve our mission. Please visit our Funding Support page for donation instructions, or to order a beautiful whole cloth quilt designed exclusively by Little Colley Design, for which a portion of the proceeds are donated to MTB in New Haven. Should you choose to make a direct donation to MTB, your gift can have an even greater impact if your company has a matching gift program. In some cases, your spouse's company may match your gift. Find out here if your company will match your contribution. If your company is eligible, request a matching gift from your employer, and send it completed and signed with your gift. The impact of your gift may be doubled or possibly tripled! Some companies also match gifts made by retirees. (Yale's Federal Tax ID: 06-0646973)
Because the MTB program is very unique in design and based on a complex clinical model, in-depth training and on-going consultation are necessary for replication studies and full implementation. Members of the MTB National Office collaborate closely with sites or communities interested in replicating the program, beginning with a needs assessment to determine if full implementation is a right fit. The annual MTB Introductory Training Institute offered in New Haven is aimed at preparing clinicians and other program staff to develop and implement interdisciplinary reflective parenting programs in their own unique communities, also serving as an introductory level training for those interested in replicating the model. For those wishing to implement the full MTB intervention with evaluation component, all staff working on the program are required to complete this first level of training, in addition to a combination of on-site and distance consultations over at least a two-year period. (See below for additional detail.)
Three kinds of training are available. The first is a general, three-day training institute in the MTB model. The training focuses on the theoretical and conceptual frameworks that guide MTB, and provides an in-depth introduction to 1) recognizing, assessing, and enhancing parental reflectiveness, 2) the fundamentals of our interdisciplinary approach, and 3) crucial principles of teamwork, consultation, and supervision.
Ongoing consultation, training, and/or supervision are also available for clinicians and administrators working in reflective parenting programs.
For those wishing to implement the full MTB intervention with evaluation component, all staff working on the program are required to complete the first level of training described above, in addition to a combination of on-site and distance consultations over a two-year period.
The Institute is designed for clinicians such as registered nurses, advanced practice nurses, social workers, and psychologists; as well as program directors and evaluators interested in developing interdisciplinary reflective parenting programs.
The Introductory Training Institute is currently offered annually in the summer, typically in July, and takes place at the Yale Child Study Center in New Haven, Connecticut. Registration is limited and typically opens in March. Please contact MTB Project Director Crista Marchesseault for more information or to inquire about dates or registration.
No – there is no certification available, and the training is not intended to prepare participants to implement or replicate the MTB model. It is important to note that the focus of the Institute and training materials is on the theoretical foundation and strategies used in implementing the clinical approaches and model, not including the research protocol. A certificate of attendance can be provided following the completion of the 3-day training, and CEUs are available.
Yes. This program is approved by the National Association of Social Workers (Approval #886565458-8340) for Social Work continuing education contact hours. Contact hours for continuing nursing education can also be provided. Yale School of Nursing is an Approved Provider of Continuing Nursing Education by the Connecticut Nurses’ Association, an Accredited Approver by the American Nurses Credentialing Center’s Commission on Accreditation.