Abstract
A two-step model of intervention for multi-problem mothers was proposed. In order to improve mother-child interaction and later developmental outcomes, the first step is for the practitioner to help the mother change her external competencies (adult social skills) and internal perceptions (support, depression). These changes make the second step possible—the mother then can learn to foster her own child's development. The model was tested in a study of 95 multi-problem women who participated in a nursing intervention program from mid-pregnancy through the child's first birthday. The results supported the two-step model. Improvements in the mothers' external competencies were related to completion of intervention goals. These external improvements also were related to more optimal patterns of mother-child interaction during teaching and feeding episodes at 1 year. Furthermore, an especially insecure type of attachment relationship was found more frequently among the infants of mothers in the group that did not improve. Changes in internal perceptions were unrelated to intervention or interaction measures. These unexpected results suggest that the mother's internal improvements may have a more delayed or a less direct effect upon the child.
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