Minding the baby: enhancing reflectiveness to improve early health and relationship outcomes in an interdisciplinary home-visiting program.
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® (MTB), an interdisciplinary, mentalization-based intervention in which home visiting services are provided by a team that includes a nurse practitioner and a clinical social worker. Families are recruited during mother's pregnancy and continue through the child's second birthday. Analyses revealed that intervention families were more likely to be on track with immunization schedules at 12 months, had lower rates of rapid subsequent childbearing, and were less likely to be referred to child protective services. In addition, mother-infant interactions were less likely to be disrupted at 4 months when mothers were teenagers, and all intervention infants were more likely to be securely attached, and less likely to be disorganized in relation to attachment at one year. Finally, mothers' capacity to reflect on their own and their child's experience improved over the course of the intervention in the most high-risk mothers.
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Strong parental reflective functioning is associated with more secure attachment relationships.
“Strong parental reflective functioning is associated with more secure attachment relationships, and is thus a target of many attachment-focused interventions for parents with and without SUDs (Pajulo et al., 2006; Paris et al., 2015; Sadler et al., 2013; Stover et al., 2017; Zayde et al., 2020)”
From Home‐based family recovery supports: Feasibility, acceptability, and adoption of training home visitors in “Mothering from the Inside Out” (2025) · cites this paper as Sadler et al., 2013
In Sadler et al. (2013), children whose mothers received the MTB intervention were significantly more securely attached and less disorganized than children whose mothers did not receive the intervention.
“Conversely, children whose mothers received the intervention were significantly more securely attached and less disorganized”
From Mentalizing makes parenting work: a review about parental reflective functioning and clinical interventions to improve it (2017) · cites this paper as Sadler et al., 2013
In Sadler et al. (2013), maternal reflective functioning improved in both the MTB intervention and standard care groups, with no significant difference between mothers who received the MTB intervention and those who did not.
“Results showed that maternal RF improved in both groups without significant differences between mothers who received the MTB intervention and those who did not.”
From Mentalizing makes parenting work: a review about parental reflective functioning and clinical interventions to improve it (2017) · cites this paper as Sadler et al., 2013
In Sadler et al. (2013), a significantly greater improvement in maternal reflective functioning was found only in mothers in the intervention group who had absent or very low RF before the birth of the child (PI-RF < 3).
“A significantly different improvement in maternal reflective functioning was found only in mothers in the intervention group who had absent or very low RF before the birth of the child (PI-RF < 3).”
From Mentalizing makes parenting work: a review about parental reflective functioning and clinical interventions to improve it (2017) · cites this paper as Sadler et al., 2013
Sadler et al. (2013) conducted a cluster randomized controlled trial investigating improvement in reflective functioning in mothers who received the MTB intervention and in mothers who received standard care at their local community health center when the children were 2 years old.
“Among other outcomes, a cluster randomized controlled trial (Sadler et al., 2013) investigated the improvement in reflective functioning in mothers who received the MTB intervention and in mothers who received the standard care at their local community health center when the children were 2 years old.”
From Mentalizing makes parenting work: a review about parental reflective functioning and clinical interventions to improve it (2017) · cites this paper as Sadler et al., 2013
Maternal reflective functioning develops not only during the first years of life but also throughout adolescence, so the young age of mothers in the sample could have contributed to the unexpected findings.
“In addition, they highlighted that maternal RF develops not only during the 1st years of life, but also throughout adolescence, thus they argued that the young age of the mothers in their sample could have contributed to their unexpected findings.”
From Mentalizing makes parenting work: a review about parental reflective functioning and clinical interventions to improve it (2017) · cites this paper as Sadler et al., 2013
Two recent studies (Sadler et al., 2013; Fonagy et al., 2016) found a general improvement in the mother-child relationship, but did not find a significant increase in PDI-RF when comparing the outcomes of mentalization-based treatment with the outcome of other interventions.
“However, two recent studies (Sadler et al., 2013; Fonagy et al., 2016) found a general improvement in the mother-child relationship, but quite notably they did not find a significant increase in PDI-RF when comparing the outcomes of mentalization-based treatment with the outcome of other interventions.”
From Mentalizing makes parenting work: a review about parental reflective functioning and clinical interventions to improve it (2017) · cites this paper as Sadler et al., 2013
Data from a home-based mentalization intervention with maternal a sample suggested that infants in the intervention (vs. controls) were more likely to have a secure attachment and show less disorganization at one year of age.
“Consistent with these findings, data from a home-based mentalization intervention with maternal a sample suggested that infants in the intervention (vs. controls) were more likely to have a secure attachment and show less disorganization at one year of age (Sadler et al., 2013).”
From Investigating the association between parental reflective functioning and distress tolerance in motherhood. (2015) · cites this paper as Sadler et al., 2013
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“…to a control group of families receiving care as usual in their community, younger mothers enrolled in MTB had less disrupted interactions with their infant at 4 months, and across all mothers, children of mothers in MTB had higher rates of secure attachment at 24 months (Sadler et al., 2013).”
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- Authors
- Sadler, L. S., Slade, A., Close, N., Webb, D. L., Simpson, T., Fennie, K., & Mayes, L. C.
- Affiliations
- Yale University (US)
- Corresponding author
- Sadler, Lois S.
- Venue
- Infant Mental Health Journal
- Publisher
- Wiley
- Published
- 2013-08-08
- Volume
- 34
- Issue
- 5
- Pages
- 391-405
- ISSN
- 0163-9641 (ISSN-L)
- 1097-0355
- PMC
- PMC3774299
- OpenAlex
- W1527140437
- Cited by
- 313
- References
- 48
- Citations by year
- 2026: 17 · 2025: 17 · 2024: 23 · 2023: 31 · 2022: 25 · 2021: 34 · 2020: 28 · 2019: 28 · 2018: 29 · 2017: 29 · 2016: 21 · 2015: 20 · 2014: 8 · 2013: 3
- FWCI
- 17.68
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Infant Mental Health Journal (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Nursing Research (P30NR008999)
- National Center for Research Resources (UL1RR024139)
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD057947, R21HD048591)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
- Social Sciences › Psychology › Social Psychology › Attachment and Relationship Dynamics
- Keywords
- mentalization-based interventions, home visits, maternal attachment, secure attachment, disorganized attachment, vaccination schedule, child protective services referrals, adolescent mothers, high-risk mothers
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