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

“Parents learn how to function as a secure base and a safe haven for their child (Bowlby 1988); how to meet a child’s needs while exploring and connecting with a caregiver; how to repair a disruption in the relationship; how to co-regulate a child’s emotions; and how to create an atmosphere of warmth, joy, and delight…”

“There is a growing body of evidence that mind–body skills such as these are effective for preventing and treating stress, depression and anxiety, post-traumatic stress disorder, traumatic brain injury, and pain syndromes (Hofmann et al. 2010; Kimbrough et al. 2010; Moore et al. 2011).”

“…support (Reid 2004), exposure to childhood maltreatment, domestic violence, and ongoing conflict with family of origin (Margolin and Gordis 2004; Patel et al. 2007), maternal psychopathology can critically undermine healthy child development (Shonkoff and Meisels 2000; Tough et al. 2008),…”

“Specifically, mental illnesses such as depression and post-traumatic stress disorder (PTSD) have been shown to interfere with sensitive parenting (Lovejoy et al. 2000; Schechter et al. 2004) as mothers may be less able to interpret the infants’ distress cues (Schuetze and Zeskind 2001), be less consistently and affect…”

“focused therapy (Lipchik 2002), motivational interviewing (MI; (Miller and Rollnick 2002), as well as elements from cognitive–behavioral (CBT; (Dobson 2009) and dialectical behavior therapy (DBT; (Robins et al.”

“Parent–child intervention Maternal mental health has been shown to have significant effects on parenting quality and child outcomes (Goodman and Gotlib 1999).”

“…increasing a parent’s ability to accurately perceive, interpret, and respond to their infant’s cues has been shown to improve attachment security (Bakermans-Kranenburg et al. 2003; van IJzendoorn et al. 1995), while sensitively augmenting protective factors, such as increasing access to social…”

“External validity is good, as shown by adequate agreement (kappa=.77) with a clinician-administered structured interview (SCID), high sensitivity of 0.99, and adequate Table 1 Baseline assessment: demographics Participants with baseline data (N=99) Characteristic M (SD) or % Characteristic M (SD) or % Mother’s age (ye…”

“Social–cognitive (Horowitz 1988; Janoff-Bulman and Frieze 1983) and information-processing theories (Foa et al. 1999) discuss trauma exposure’s impact on a person’s world view (safety, relational trust) and self-efficacy.”

“MP is a complex intervention with conceptual roots in attachment theory (Bowlby 1969) and trauma theory (Cloitre et al. 2009; Herman 1992b) and blends elements from several evidenced-based modalities including child–parent psychotherapy (CPP; (Cicchetti et al.”

“Interpersonal trauma impacts multiple domains of psychosocial functioning, and victims have increased risk for depression, posttraumatic anxiety (Beitchman et al. 1992; Feerick and Snow 2005; Gladstone et al. 2004), high rates of re-traumatization (Arata and Lindman 2002; Barnes et al.”

“Indeed, women with histories of interpersonal trauma, with or without psychopathology, are more likely to engage in parenting practices that are insensitive, harsh, or overly permissive (Banyard 1997; Cole et al. 1992; Robinson et al. 1995).”

“With trauma, these assumptions are often violated, and this may lead to poor follow through with help-seeking (Liang et al. 2005).”

“Such intervention models are available (Erickson and Egeland 1999; Lieberman and Van Horn 2004; Lowell et al. 2011; Olds 2006; Weatherston 2000), yet are typically delivered as long-term programs and require several years of treatment commitment on the mother’s side.”

“1996), and more intrusive or disengaged (Field et al. 1990; Lovejoy et al. 2000).”

“Social–cognitive (Horowitz 1988; Janoff-Bulman and Frieze 1983) and information-processing theories (Foa et al. 1999) discuss trauma exposure’s impact on a person’s world view (safety, relational trust) and self-efficacy.”

“…theory (Cloitre et al. 2009; Herman 1992b) and blends elements from several evidenced-based modalities including child–parent psychotherapy (CPP; (Cicchetti et al. 1999, 2006; Lieberman et al. 2006; Toth et al. 2006), trauma-informed care (Substance Abuse and Mental Health Services…”

“The presence of psychopathology such as depression or posttraumatic stress heightens risk for poor parenting, increases risk for child abuse, and may lead to disorganized attachment between mother and child (Lyons-Ruth and Block 1996; Lyons-Ruth et al. 1999).”

“As outlined above, the MP intervention curriculum blends therapeutic elements consistent with several evidence-based practices (e.g., CPP, MI, and others), yet the group delivery also adds practices informed by social learning theory (Grusec 1992).”

“Interventions that focus both on enhancing sensitive parenting as well as improving maternal mental health have a greater potential for positive impact on a broader range of outcomes, including maternal, child, and family system functioning (Forman et al. 2007; Nylen et al. 2006; van IJzendoorn et al. 1995).”

“…(Beitchman et al. 1992; Feerick and Snow 2005; Gladstone et al. 2004), high rates of re-traumatization (Arata and Lindman 2002; Barnes et al. 2009; Desai et al. 2002), increased risk for substance and/or alcohol dependence (Cohen et al. 2008; Najavits et al. 1997) and increased risk of single…”

“…Herman 1992b) and blends elements from several evidenced-based modalities including child–parent psychotherapy (CPP; (Cicchetti et al. 1999, 2006; Lieberman et al. 2006; Toth et al. 2006), trauma-informed care (Substance Abuse and Mental Health Services Administration, n.d.), solution- focused…”

“…re-traumatization (Arata and Lindman 2002; Barnes et al. 2009; Desai et al. 2002), increased risk for substance and/or alcohol dependence (Cohen et al. 2008; Najavits et al. 1997) and increased risk of single parenthood and poverty (Lipman et al. 2001) which may all influence parenting behaviors.”

“…that focus both on enhancing sensitive parenting as well as improving maternal mental health have a greater potential for positive impact on a broader range of outcomes, including maternal, child, and family system functioning (Forman et al. 2007; Nylen et al. 2006; van IJzendoorn et al. 1995).”

“…of psychosocial functioning, and victims have increased risk for depression, posttraumatic anxiety (Beitchman et al. 1992; Feerick and Snow 2005; Gladstone et al. 2004), high rates of re-traumatization (Arata and Lindman 2002; Barnes et al. 2009; Desai et al. 2002), increased risk for substance…”

“2004), high rates of re-traumatization (Arata and Lindman 2002; Barnes et al. 2009; Desai et al. 2002), increased risk for substance and/or alcohol dependence (Cohen et al.”

“…elements from several evidenced-based modalities including child–parent psychotherapy (CPP; (Cicchetti et al. 1999, 2006; Lieberman et al. 2006; Toth et al. 2006), trauma-informed care (Substance Abuse and Mental Health Services Administration, n.d.), solution- focused therapy (Lipchik 2002),…”

“…et al. 2000; Schechter et al. 2004) as mothers may be less able to interpret the infants’ distress cues (Schuetze and Zeskind 2001), be less consistently and affectively attuned to their child (Digiuseppe et al. 1996), and more intrusive or disengaged (Field et al. 1990; Lovejoy et al. 2000).”

“…inadequate social support (Reid 2004), exposure to childhood maltreatment, domestic violence, and ongoing conflict with family of origin (Margolin and Gordis 2004; Patel et al. 2007), maternal psychopathology can critically undermine healthy child development (Shonkoff and Meisels 2000;…”

“There is a growing body of evidence that mind–body skills such as these are effective for preventing and treating stress, depression and anxiety, post-traumatic stress disorder, traumatic brain injury, and pain syndromes (Hofmann et al. 2010; Kimbrough et al. 2010; Moore et al. 2011).”

“…re-traumatization (Arata and Lindman 2002; Barnes et al. 2009; Desai et al. 2002), increased risk for substance and/or alcohol dependence (Cohen et al. 2008; Najavits et al. 1997) and increased risk of single parenthood and poverty (Lipman et al. 2001) which may all influence parenting behaviors.”

“The CHQ yields three scales and has demonstrated good psychometric properties (Solomon and George 2011).”

“1995), while sensitively augmenting protective factors, such as increasing access to social support and clinical care can ameliorate some of the common consequences of maternal mental illness (Crockenberg 1987; van IJzendoorn et al. 1995).”

“reported on depressive symptoms using the Postpartum Depression Screening Scale (PDSS; (Beck and Gable 2001).”

“…theory (Cloitre et al. 2009; Herman 1992b) and blends elements from several evidenced-based modalities including child–parent psychotherapy (CPP; (Cicchetti et al. 1999, 2006; Lieberman et al. 2006; Toth et al. 2006), trauma-informed care (Substance Abuse and Mental Health Services…”

“The Trauma Affect Regulation: Guide for Education and Therapy (TARGET; (Ford and Russo 2006)) is a trauma-focused psychotherapy for the concurrent treatment of PTSD and substance use disorders (SUDs) and has been also adapted by the developers for mothers of young children (MOMS Study; (Ford et al.…”

“Indeed, women with histories of interpersonal trauma, with or without psychopathology, are more likely to engage in parenting practices that are insensitive, harsh, or overly permissive (Banyard 1997; Cole et al. 1992; Robinson et al. 1995).”

“Such intervention models are available (Erickson and Egeland 1999; Lieberman and Van Horn 2004; Lowell et al. 2011; Olds 2006; Weatherston 2000), yet are typically delivered as long-term programs and require several years of treatment commitment on the mother’s side.”

“Prior work has suggested that engaging high-risk individuals into longer-term therapeutic programs may require a therapeutic process and may not be achievable through a one-time encounter (Gopalan et al. 2010; Scott and Dadds 2009).”

“Less sensitive parenting may lead to less optimal infant emotion regulation capacity (Brand et al. 2006; Tikotzky et al. Manber 2010) and to the development of less secure mother-child attachments (Levendosky and Graham-Bermann 2001).”

“Interventions that focus both on enhancing sensitive parenting as well as improving maternal mental health have a greater potential for positive impact on a broader range of outcomes, including maternal, child, and family system functioning (Forman et al. 2007; Nylen et al. 2006; van IJzendoorn et al. 1995).”

“…to assess the caregiver’s ability to recognize various psychological processes (mental states), such as thoughts, beliefs, desires, intentions, and feelings both in the self and child and has been validated against maternal behavior during interaction with her child (Rosenblum et al. 2008).”

“Indeed, women with histories of interpersonal trauma, with or without psychopathology, are more likely to engage in parenting practices that are insensitive, harsh, or overly permissive (Banyard 1997; Cole et al. 1992; Robinson et al. 1995).”

“…ongoing conflict with family of origin (Margolin and Gordis 2004; Patel et al. 2007), maternal psychopathology can critically undermine healthy child development (Shonkoff and Meisels 2000; Tough et al. 2008), contributing to poorer outcomes for both parents and children (Sameroff and Seifer 1990).”

“Such reluctance is likely due to many reasons, ranging from lack of child care or transportation to distrust of health-care professionals (Newman et al. 2000; Stenius and Veysey 2005).”

“…developed and tested an In-Home Cognitive Behavioral Therapy (IH-CBT) ad-on program for depressed mothers receiving home visitation, which demonstrated significant reductions in maternal clinical depression after 15 intervention sessions added to the home visitation (Ammerman et al. 2011, 2013).”

“We have recently published on mothers’ accounts of health-care needs during postpartum in a sample of women with trauma histories suffering depression and PTSD (Muzik et al. 2013).”

“Many high-risk women are reluctant to take advantage of services even when made readily available (Flynn et al. 2010; Griffin et al. 1993).”

“Interpersonal trauma impacts multiple domains of psychosocial functioning, and victims have increased risk for depression, posttraumatic anxiety (Beitchman et al. 1992; Feerick and Snow 2005; Gladstone et al. 2004), high rates of re-traumatization (Arata and Lindman 2002; Barnes et al.”

“…ongoing conflict with family of origin (Margolin and Gordis 2004; Patel et al. 2007), maternal psychopathology can critically undermine healthy child development (Shonkoff and Meisels 2000; Tough et al. 2008), contributing to poorer outcomes for both parents and children (Sameroff and Seifer 1990).”

“…interfere with sensitive parenting (Lovejoy et al. 2000; Schechter et al. 2004) as mothers may be less able to interpret the infants’ distress cues (Schuetze and Zeskind 2001), be less consistently and affectively attuned to their child (Digiuseppe et al. 1996), and more intrusive or disengaged…”

“2004), high rates of re-traumatization (Arata and Lindman 2002; Barnes et al. 2009; Desai et al. 2002), increased risk for substance and/or alcohol dependence (Cohen et al.”

“…illnesses such as depression and post-traumatic stress disorder (PTSD) have been shown to interfere with sensitive parenting (Lovejoy et al. 2000; Schechter et al. 2004) as mothers may be less able to interpret the infants’ distress cues (Schuetze and Zeskind 2001), be less consistently and…”

“Engaging high-risk families into ongoing services is a known challenge (Azzi-Lessing 2013; Gopalan et al. 2010) and barriers are multi-fold, ranging from practical (e.”

“…re-traumatization (Arata and Lindman 2002; Barnes et al. 2009; Desai et al. 2002), increased risk for substance and/or alcohol dependence (Cohen et al. 2008; Najavits et al. 1997) and increased risk of single parenthood and poverty (Lipman et al. 2001) which may all influence parenting behaviors.”

“…developed and tested an In-Home Cognitive Behavioral Therapy (IH-CBT) ad-on program for depressed mothers receiving home visitation, which demonstrated significant reductions in maternal clinical depression after 15 intervention sessions added to the home visitation (Ammerman et al. 2011, 2013).”

“Many high-risk women are reluctant to take advantage of services even when made readily available (Flynn et al. 2010; Griffin et al. 1993).”

“Examples of homebased, long-term home visiting interventions are the NurseFamily Partnership program (NFP; (Olds 2006, 2010), Healthy Families America (HFA; (Holton and Harding 2007), and CHILD First (Lowell et al.”

“Examples of homebased, long-term home visiting interventions are the NurseFamily Partnership program (NFP; (Olds 2006, 2010), Healthy Families America (HFA; (Holton and Harding 2007), and CHILD First (Lowell et al. 2011), all of which deliver intensive weekly home visitation over months to years…”

“…their work for pregnant trauma-survivor women with PTSD to whom they deliver a manualized, 10-module self-study psychoeducation program aiming to improve affect regulation, interpersonal reactivity, and PTSD symptoms triggered by pregnancy cues (Survivor Moms’ Companion (SMC); (Seng et al. 2011).”

“We have previously published on specific predictors for treatment engagement and attrition, particularly among African-American mothers (Muzik et al. 2014).”

“…ongoing conflict with family of origin (Margolin and Gordis 2004; Patel et al. 2007), maternal psychopathology can critically undermine healthy child development (Shonkoff and Meisels 2000; Tough et al. 2008), contributing to poorer outcomes for both parents and children (Sameroff and Seifer 1990).”

“…Affect Regulation: Guide for Education and Therapy (TARGET; (Ford and Russo 2006)) is a trauma-focused psychotherapy for the concurrent treatment of PTSD and substance use disorders (SUDs) and has been also adapted by the developers for mothers of young children (MOMS Study; (Ford et al. 2008)).”

“Specific intervention programs including the Circle of Security (Hoffman et al., 2006; Powell et al., 2014), Triple P (Positive Parenting Program) (Sanders et al., 2014), Video Interaction for Promoting Positive Parenting Programme (Van Zeijl et al., 2006), and Mom Power (Muzik et al., 2015), have been validated accor…”

“For example, the attachmentbased, group intervention Mom Power, which emphasizes parenting, self-care, and engagement in treatment, holds promise for supporting positive outcomes for children by supporting maternal mental health and parenting competence.(90) With increased knowledge of evidence-based treatments for fa…”

“…regulatory Mom Power (MP) (LePlatte, Rosenblum, Stanton, Miller, & Muzik, 2012; Muzik, Cameron, Fezzey, & Rosenblum, 2009; Muzik et al., 2014; Muzik et al., 2015; Muzik, Rosenblum, et al., 2016; Rosenblum et al., 2017; Swain et al., 2017; Swain, Ho, Rosenblum, Morelen, & Muzik, 2016) High…”