Maternal Home Research Articles

Evidence-Based Early Home Visiting for Mothers and Parents With Intellectual Disability: Home Visitor Perceptions and Practices.

Evidence-based maternal, infant, and early home visiting (EBHV) is a potential strategy to support parent and child health and well-being among families headed by a parent with an intellectual disability (ID). Little is known about the capacity of EBHV programs to meet the needs of parents with ID effectively. This study examined home visitor practices and perceptions of services for parents with ID. Home visiting staff recruited from a national practice-based research network participated in web-based surveys. Practices and perceptions varied widely across sites and were associated with home visitor knowledge and self-efficacy and site implementation supports, such as policies, curricula, and community collaboration. More work is needed to understand and strengthen EBHV services for parents with ID.

Epidemiological features of infections/colonization, caused by vancomycin-resistant enterococci in Saint-Petersburg hospitals in 2017–2020

Relevance. Enterococcus are ubiquitous, and can cause various infections, up to endocarditis. Vancomycin-resistant enterococcus (VRE) infections are difficult and expensive to treat. According to the AMRmap (Online Platform for Analysis of Antimicrobial Resistance Data in Russia) data for 2017–2020, VRE cases were reported in all federal districts of the Russian Federation, with one of the highest VRE rates in St. Petersburg (4.27%, 95% confidence interval [95% CI] 2.1–8.6)). But further, larger studies in each region are required. Aims. The study is to identify the epidemiological features of infections/colonization caused by VRE in Saint-Petersburg hospitals in 2017–2020. Materials and methods. A retrospective analysis of the prevalence of VRE isolated from hospital patients (51 hospitals of various profiles) in St. Petersburg for the period from 2017 to 2020 was performed. Results. During the study period, VRE rate was 5.3% (95% CI 5.1–5.6). The highest proportion (11.6%, 95% CI 10.4–13)) and incidence (0.6 per 1000 patients) of VRE was observed in children hospitals, the lowest – in maternity homes 0.5% (95% CI 0.3– 0.7). Throughout the analysis period VRE were detected in clinical specimens of patients from most of the departments. In adult hospitals, the proportion of VREs was significantly higher in oncohematology 14.6% (95% CI 9.6–21.7), neurology 10.8% (95% CI 7.4–15.6), and intensive care units 10.1% (95% CI 9.4–11.0). In 2020, there was a dramatic increase in VREs in neurology, cardiology, and infection departments in adult hospitals. Neonatology and intensive care units in children hospitals had the highest proportion of VRE, 40.7% (95% CI 34–48.3) and 29.8% (95% CI 21.04–40.3), respectively. In departments of other profiles, this rate varied from year to year, which may be related with clusters in hospitals and departments. Sporadic cases were detected in both neonatal and obstetric departments of maternity homes. The most common clinical specimen with isolated VRE was urine; this was characteristic of departments of almost all profiles and for children intensive care patients also VRE was isolated in gastric fluid and feces often. Conclusions. The proportion of VRE isolated from clinical specimens from patients in St. Petersburg hospitals is at an average level compared to other regions of the Russian Federation and other countries. The highest prevalence of VRE was noted in pediatric hospitals. Risk groups are patients of neonatology and intensive care departments in children's hospitals and oncohematology, neurology and intensive care departments in adult hospitals. VRE are most commonly found in the urine of patients. Screening for VRE among patients in at-risk units and contact precautions should be taken to VRE-infected/colonized patients.

Maternal Warning Signs Education During Home Visiting: Results from a Formative Evaluation in Maryland.

Background:Maternal mortality rate reviews have identified the need for improved patient education regarding the warning signs of maternal complications to reduce preventable deaths. Maternal and child home visiting programs have the potential to deliver this education in communities.Aims:This study sought to evaluate the baseline provision of warning signs education among home visiting programs in Maryland and to assess the acceptability of and preferences for warning signs education materials among program staff.Materials and Methods:This sequential exploratory, mixed-methods study included qualitative interviews and focus group discussions followed by a web-based survey of all home visiting programs providing early postpartum visits in Maryland.Results:Twenty-five home visiting program staff took part in qualitative data collection, and survey responses were submitted by a manager from 40 of 58 eligible home visiting programs (69% response rate). All survey respondents agreed that home visiting programs should provide warning signs education and more than 80% of programs provided some warning signs education during pregnancy and the postpartum period. Printed pamphlets were provided by 68% of programs for pregnancy complications and 43% for postpartum complications. Only 33% of respondents were satisfied with their existing warnings signs education materials; 98% were interested in new illustrated pamphlets and 88% were interested in education videos. Qualitative participants considered pamphlets with simple designs, limited text, and visuals, as the most accessible for home visiting clients.Conclusions:There are opportunities to strengthen and expand warning signs education in Maryland through home visiting programs using new printed and video education materials.

O22 Determining Stakeholders’ Perceptions and Barriers on Using Digital Nutrition Education Modules in Home Visitation Programs

<h3>Background</h3> Home visitation programs that reach families of young children offer a unique opportunity to prevent early childhood obesity. Technology has become an integral part of continuing services as a result of COVID-19, yet no standardized digital curriculum targeting childhood obesity prevention currently exists. <h3>Objective</h3> To determine the perceptions and barriers of key stakeholders on using technology to enhance home visitation programs, as well as preferred digital learning formats related to the development of a digital nutrition education curriculum. <h3>Study Design, Setting, Participants</h3> Key stakeholders of the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program (N = 27) in Florida participated in a one-time, 30-minute qualitative interview via Zoom with a trained researcher using a semi-structured script based on the Technology Acceptance Model. <h3>Measurable Outcome/Analysis</h3> Interviews were audio-recorded, transcribed verbatim, and coded by two researchers using an inductive thematic approach. <h3>Results</h3> Since the onset of the COVID-19 pandemic and implementation of virtual home visits, participants expressed positive attitudes surrounding the use of technology, such as greater flexibility in scheduling and increased access to readily available information for both parents and home visitors. Further, they were receptive to continued virtual programming opportunities, but identified several barriers, including limited access to smartphones and internet access, privacy concerns, and lack of personal connection to parents. Recommendations included providing families with technology devices, using secure platforms, and developing brief digital nutrition education modules with interactive and personalized features. <h3>Conclusions</h3> Perceptions surrounding the use of technology for nutrition education in home visitation programs were positive. This promising formative research will be used to determine future directions for the development steps of a technology-based home visitation early childhood obesity prevention curriculum. <h3>Funding</h3> University of Florida Mowery Innovative Research Fund.

Prevalence of Toxoplasma gondii and Brucella Species in Infertile Women In District Dir Lower, Khyber Pakhtunkhwa, Pakistan

Toxoplasmosis and Brucellosis are zoonotic infections having worldwide distribution. Toxoplasma gondii and Brucella species are the causative agents of these infections. The human can be infected by contact with infected animals. These infections affect the reproductive system of humans and animals. The study aimed to determine the prevalence of Toxoplasma gondii and Brucella species in infertile women of District Dir Lower. A cross-sectional study was conducted in General Hospital and Maternity Home District Dir Lower and a total of 576 infertile women were screened for the detection of Toxoplasma gondii and Brucella antibodies. ICT method was used for the detection of Anti-T. gondii and the detection of Brucella antibodies, the serum agglutination method was used. The overall prevalence of T.gondii was 11.3% (IgG=10.6% and IgM=0.7%), Brucella Abortus was 14.5% and the prevalence of Brucella Melitensis was 15.1%. The highest prevalence of T.gondii was observed among the age group 26-34 years while the lowest prevalence was observed among the age group 15-25 years. The highest prevalence of Brucella species was observed among the age group 35-45 years and the lowest prevalence was observed among the age group 15-25 years, and the prevalence of Brucella species was higher than T. gondii.

Effects of paternal high-fat diet and maternal rearing environment on the gut microbiota and behavior

Exposing a male rat to an obesogenic high-fat diet (HFD) influences attractiveness to potential female mates, the subsequent interaction of female mates with infant offspring, and the development of stress-related behavioral and neural responses in offspring. To examine the stomach and fecal microbiome’s potential roles, fecal samples from 44 offspring and stomach samples from offspring and their fathers were collected and bacterial community composition was studied by 16 small subunit ribosomal RNA (16S rRNA) gene sequencing. Paternal diet (control, high-fat), maternal housing conditions (standard or semi-naturalistic housing), and maternal care (quality of nursing and other maternal behaviors) affected the within-subjects alpha-diversity of the offspring stomach and fecal microbiomes. We provide evidence from beta-diversity analyses that paternal diet and maternal behavior induced community-wide shifts to the adult offspring gut microbiome. Additionally, we show that paternal HFD significantly altered the adult offspring Firmicutes to Bacteroidetes ratio, an indicator of obesogenic potential in the gut microbiome. Additional machine-learning analyses indicated that microbial species driving these differences converged on Bifidobacterium pseudolongum. These results suggest that differences in early-life care induced by paternal diet and maternal care significantly influence the microbiota composition of offspring through the microbiota-gut-brain axis, having implications for adult stress reactivity.

Neurodevelopment Scores at 24 Months Are Associated With Maternal Education, Home Environment, and Linear Growth in Offspring of the Women First Trial

ObjectivesHealthy physical growth has been associated with better performance on neurodevelopmental testing in young children in low resource settings. We examined the relationship of growth indicators from 6 to 24 months of age to the sub-scales of the Bayley Scales of Infant Development-III (BSID-III) at 24 months in offspring of participants in the four-country preconception maternal nutrition trial, Women First (WF), which found the maternal intervention to benefit birth length, which was predictive of length and risk of stunting at 24 months. MethodsWith no post-delivery intervention, follow-up visits for anthropometry were obtained at 6-month intervals; BSID-III and Family Care Indicators (FCI) were completed at 24 months in a random sub-set of the WF offspring, representing 2/3 of infants with valid birth measurements. Multiple covariates (intervention arm, site, cluster within site, maternal education, age, SES, FCI subscales, LBW, and change in anthropometry Z-scores from 6 to 24 months, e.g., length-for-age, DLAZ6-24) were considered as confounders or predictors and were adjusted in a general linear model to predict adjusted mean differences (AMD) in BSID scores. Results1,386 infants (93% of those randomized to sub-set) were included in the analysis (n = 441,486, 459 for Arms 1, 2, 3, respectively). Four covariates were positively associated (p ≤ 0.01) with all 3 of the BSID subscales cognitive(C), motor(M), and social-emotional(SE) scales, respectively: maternal secondary education (+AMD 3.60(C), 3.35(M), 2.80(SE)); DLAZ6-24 (+AMD 1.98(C), 3.15(M), 2.06(SE)); BW > 2500 g (+AMD 1.64(C), 2.20(M), 2.31(SE)); and FCI play materials (+AMD 1.46(C), 1.36(M), 1.72(SE)). No other anthropometric or maternal variables were consistently associated with BSID subscales. ConclusionsThe findings underscore the multiple critical components of nurturing care for early child development, including the caregiver, adequate birth weight, healthy linear growth, and opportunities for learning. Results suggest that the positive effects of maternal nutrition supplementation in the WF trial on birth length and postnatal linear growth may, in turn, have enduring downstream benefits for their children’s neurodevelopment. Funding SourcesThe Bill & Melinda Gates Foundation, NICHD, ODS.

Trauma-Informed Home Visiting Models in Public Health Nursing: An Evidence-Based Approach.

Traumatic experiences can have significant health effects, particularly when they are experienced during childhood. Structural determinants of health including environmental disasters and limited access to mental health services and affordable housing can contribute additional stress for parents with a personal history of childhood adversity. These factors can directly affect their children, contributing to intergenerational trauma. Pregnant people and families with young children are often referred to public health nursing maternal and child home visiting (HV) programs when there are concerns about historical or evolving childhood trauma. The strict eligibility and participation requirements of existing evidence-based maternal and child HV programs can exclude families that have experienced or are experiencing childhood trauma and its effects and can limit innovation by public health nurses, a hallmark of the field. Therefore, we advocate and describe the implementation of the Trauma Informed Approach in Public Health Nursing (TIA PHN) model, which incorporates a trauma-informed approach into a traditional maternal and child HV program in 3 California counties. TIA PHN, which began enrollment in March 2021, involves public health nurses and community health workers and integrates program evaluations in pursuit of evidence-based status. (Am J Public Health. 2022;112(S3):S298-S305. https://doi.org/10.2105/AJPH.2022.306737).

Effects of COVID-19 on home visiting services for vulnerable families: A cross-state analysis of enrollment, engagement, and attrition patterns.

COVID-19 has resulted in massive health and economic consequences, with effects felt most acutely by populations that were disadvantaged prior to the pandemic. For families with young children, the effects have been compounded by service interruptions, though there is a lack of empirical evidence that demonstrates how COVID-19 has affected home visiting programs. This cross-state study is the first to examine the effects of the pandemic on home visiting enrollment, engagement, and retention patterns. Program implementation records gathered from 2017-2020 in Arkansas and Wisconsin were analyzed. Both states operate a large network of home visiting programs that serve predominantly low-income families and that are supported by the federal Maternal, Infant, and Early Childhood Home Visiting program. Trends prior to COVID were compared to post-COVID trends (March 12 to December 31, 2020) in program enrollments, service capacity, visitation frequency, service modalities, attrition rates, and service duration. Compared to average pre-pandemic enrollments from 2017-2019, post-COVID enrollments decreased by 33-36%. Total visits fell by 15-24%; the percentage of completed visits relative to expected visits declined more modestly. However, the average duration of services increased post-COVID while rates of early program dropout decreased. The findings suggest that enrollment and engagement in home visiting decreased during the COVID-19 pandemic, which is unfortunate given the large number of vulnerable families served nationwide. Further research is needed to examine how COVID affected both consumer and program behaviors. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

A Community-based Responsive Caregiving Program Improves Neurodevelopment in Two-year Old Children in a Middle-Income Country, Grenada, West Indies.

Many young children in low- and middle-income countries (LMICs) are at risk of developmental delays. Early child development (ECD) interventions have been shown to improve outcomes, but few interventions have targeted culturally normative violence such as corporal punishment (CP). We partnered with an existing community-based ECD organization in the LMIC of Grenada to implement a parallel controlled-trial single-blind responsive caregiving intervention that educates parents about the developing brain and teaches alternatives to corporal punishment while building parental self-regulation skills and strengthening social-emotional connections between parent and child. Parents and primary caregivers with children under age two were eligible. Allocation to the intervention and waitlist control arms was unblinded and determined by recruitment into the program. Neurodevelopment was assessed by blinded testers when each child turned age two. Primary comparison consisted of neurodevelopmental scores between the intervention and waitlist control groups (Clinicaltrials.gov registration # NCT04697134). Secondary comparison consisted of changes in maternal mental health, home environment, and attitudes towards CP. Children in the intervention group (n = 153) had significantly higher scores than children in the control group (n = 151) on measures of cognition (p = .022), fine motor (p < .0001), gross motor (p = .015), and language development (p = .013). No difference in secondary outcomes, including CP, was detected.

Using the Tools of Today to Advance the Life Course Interventions of Tomorrow.

Using the Tools of Today to Advance the Life Course Interventions of Tomorrow.

Distance from home to birth hospital, transfer, and mortality in neonates with hypoplastic left heart syndrome in California.

Prior studies report a lower risk of mortality among neonates with hypoplastic left heart syndrome (HLHS) who are born at a cardiac surgical center, but many neonates with HLHS are born elsewhere and transferred for repair. We investigated the associations between the distance from maternal home to birth hospital, the need for transfer after birth, sociodemographic factors, and mortality in infants with HLHS in California from 2006 to 2011. We used linked data from two statewide databases to identify neonates for this study. Three groups were included in the analysis: "lived close/not transferred," "lived close/transferred," and "lived far/not transferred." We defined "lived close" versus "lived far" as 11 miles, the median distance from maternal residence to birth hospital. Log-binomial regression models were used to identify the association between sociodemographic variables, distance to birth hospital and transfer. Cox proportional hazards models were used to identify the association between mortality and distance to birth hospital and transfer. Models were adjusted for sociodemographic variables. Infants in the lived close/not transferred and the lived close/transferred groups (vs. the lived far/not transferred group) were more likely to live in census tracts above the 75th percentile for poverty with relative risks 1.94 (95% confidence interval [CI] 1.41-2.68) and 1.21 (95% CI 1.05-1.40), respectively. Neonatal mortality was higher among the lived close/not transferred group compared with the lived far/not transferred group (hazard ratio 1.77, 95% CI 1.17-2.67). Infants born to mothers experiencing poverty were more likely to be born close to home. Infants with HLHS who were born close to home and not transferred to a cardiac center had a higher risk of neonatal mortality than infants who were delivered far from home and not transferred. Future studies should identify the barriers to delivery at a cardiac center for mothers experiencing poverty.

Relationships between maternal body mass index and child cognitive outcomes at 3 years of age are buffered by specific early environments in a prospective Canadian birth cohort.

Fetal and child development are shaped by early life exposures, including maternal health states, nutrition and educational and home environments. We aimed to determine if suboptimal pre-pregnancy maternal body mass index (BMI; underweight, overweight, obese) would associate with poorer cognitive outcomes in children, and whether early life nutritional, educational and home environments modify these relationships. Self-reported data were obtained from mother-infant dyads from the pan-Canadian prospective Maternal-Infant Research on Environmental Chemicals cohort. Relationships between potential risk factors (pre-pregnancy maternal BMI, breastfeeding practices and Home Observation Measurement of the Environment [HOME] score) and child cognitive development at age three (Weschler's Preschool and Primary Scale of Intelligence, Third Edition scale and its subcategories) were each evaluated using analysis of variance, multivariable regression models and moderating analyses. Amongst the 528 mother-child dyads, increasing maternal pre-pregnancy BMI was negatively associated with scores for child full-scale IQ (β [95% CI]; -2.01 [-3.43, -0.59], p = 0.006), verbal composite (-1.93 [-3.33, -0.53], p = 0.007), and information scale (-0.41 [-0.70, -0.14], p = 0.003) scores. Higher maternal education level or HOME score attenuated the negative association between maternal pre-pregnancy BMI and child cognitive outcome by 30%-41% and 7%-22%, respectively, and accounted for approximately 5%-10% greater variation in male children's cognitive scores compared to females. Maternal education and higher quality home environment buffer the negative effect of elevated maternal pre-pregnancy BMI on child cognitive outcomes. Findings suggest that relationships between maternal, social and environmental factors must be considered to reveal pathways that shape risk for, and resiliency against, suboptimal cognitive outcomes in early life.

Maternal pesticides exposure in pregnancy and the risk of wheezing in infancy: A prospective cohort study

IntroductionPesticide exposure in pregnancy may have health effects in the offspring. We studied whether maternal pesticides exposure during pregnancy is associated with infant wheezing. MethodsThe study involved 5997 children from the Italian NINFEA birth cohort, whose mothers were recruited during pregnancy between 2005 and 2016. We used questionnaires completed during pregnancy and 6 months after delivery to derive the following indirect measures of exposure: i) Self-reported pesticide use during the first and the third trimester of pregnancy; (ii) Agricultural activities during the same trimesters. We also evaluated the exposure to agricultural pesticides applied near home using the Corine Land Cover inventory to derive the proportion of a 200-metre buffer area around maternal home address covered by agricultural crops and specific crop types (arable land, fruit trees, heterogeneous cultivations). Questionnaires completed when the child turned 18 months reported information on wheezing between 6 and 18 months of age. We estimated the odds ratios of wheezing adjusting for the following maternal characteristics: age, education, parity, asthma, atopy, smoking in pregnancy, region and area of residence, pet ownership during pregnancy. Crops proximity analyses were restricted to residents in rural areas (N = 1674). ResultsAgricultural activities during pregnancy were not associated with infant wheezing. Compared to no pesticide use, there was a weak positive association for self-reported use in the third trimester (POR: 1.30; 95 %CI 0.95–1.78) and a stronger association for use in both trimesters (POR: 1.72; 95 %CI 1.11–2.65). The relationship between the proportion of crops around the home address and the risk of infant wheezing, was J-shaped, in particular for fruit trees with the lowest risk for mid values and elevated risk for higher values. ConclusionWe found some evidence of association for maternal pesticide use in pregnancy and residential proximity to fruit trees cultivations with infant wheezing.

Assessment of Knowledge, Attitude, and Practice of Obstetricians and Gynecologists Toward Off-Label Medicine Use in Female Reproductive Health Issues.

BackgroundOff-label medication usage (OLMU) is prevalent in the treatment of various diseases, including female reproductive health issues (FRHIs). However, there is a paucity of literature on the perspective of health professionals on this subject. The purpose of the current study was to assess gynecologists/obstetricians' knowledge, attitude and practice toward OLMU in the treatment of FRHIs.MethodsThe current cross-sectional study was conducted in September and October 2021, at five tertiary care hospitals (two public and three private sector), different clinics and maternity homes in a metropolitan city of Karachi, Pakistan. The target population was gynecologists, obstetricians and physicians/residents working in the ob/gyn department in various hospitals and clinical settings of Karachi.ResultsThe overall response rate was 77.1%. The mean age of the study respondents was 36.1 ± 7.7 years; n = 85 (55.9%) respondents were working in primary patient care. The majorly reported OLMU by the respondents were clomiphene citrate in unexplained infertility (n = 66; 43.4%), metformin to improve cycle regularity in females with polycystic ovary syndrome (PCOS) (n = 59; 38.8%) and letrozole to induce ovulation (n = 31; 20.4%). The majorly stated categories of OLMU were at a different dose (n = 95; 62.5%) and at different indications than approved to treat (n = 89; 58.5%). It was reported by the majority of the respondents (n = 95; 62.5%) that they do not follow any guidelines or regulations for OLMU in their work setting; however, the response was statistically varied with the working organization (CI 2.14–2.93; p = 0.037) and practice area (CI 2.85–4.32; p = 0.0001) of respondents.ConclusionsThe present study revealed that the respondents were well-familiar with the practice of OLMU in the treatment of FRHIs. They expressed their concerns about decreasing such practices by being involved in collective decision-making procedures, and they were inclined to accept initiatives aimed at ensuring drug safety in patients.

Selling Anonymity: The Market for Secrecy Around Illegitimate Births

Giving birth out of wedlock was associated for centuries with shame, economic burden, and secrecy. Unmarried pregnant women could escape stigma by travelling away from home and purchasing a confinement elsewhere. They could hide there when the pregnancy started to show, give birth, have their children adopted or sent to foster care, and then return home. This article explores the social economy of this stigma by investigating the market for anonymous births in Sweden through newspaper advertisements addressing unmarried pregnant women during the period 1905–1935. It shows that unmarried pregnant women risked exploitation when entering this market, in which private midwives, private maternity homes and individuals offering accommodation and employment were all operating.

Research on the Plane Spatial Form of Economic Housing Based on Space Syntax Theory: Macau EDF. de Alameda da Tranquilidade as an Example

Since the reform and opening up, the city has steadily promoted the renovation of old maternity houses, towns and villages in response to the call of the state, thus promoting urban renewal, realizing urban economic development, industrial upgrading and people's livelihood improvement. The living density of economic housing is high, and the quality needs to be further optimized. However, the current urban renewal needs to improve the living quality of housing to serve the people. Therefore, when planning, constructing and renovating the interior space of public housing and meeting people's basic living conditions, people's intuitive feeling of the environment should be put first, rather than excessive attention to formal beauty—taking the EDF. de Alameda da Tranquilidade in Macau, as an example, based on the theory of space syntax, this paper conducts a convex space analysis and research on the interior space form of the first building of EDF. de Alameda da Tranqui-lidade, including the global integration degree, local integration degree (R=3,6), connectivity, intelligibility, control and Mean Depth, analyze the areas with higher integration, connection value and control value and lower areas, and make suggestions for future plane optimization, related The recommendations also apply to the second and third buildings of Yongning Plaza Building, providing better reference value and reference for relevant government departments.

Global Adipose Tissue Remodeling During the First Month of Postnatal Life in Mice.

During the first month of postnatal life, adipose tissue depots of mice go through a drastic, but transient, remodeling process. Between postnatal days 10 and 20, several white fat depots display a strong and sudden surge in beige adipocyte emergence that reverts until day 30. At the same time, brown fat depots appear to undergo an opposite phenomenon. We comprehensively describe these events, their depot specificity and known environmental and genetic interactions, such as maternal diet, housing temperature and mouse strain. We further discuss potential mechanisms and plausible purposes, including the tempting hypothesis that postnatal transient remodeling creates a lasting adaptive capacity still detectable in adult animals. Finally, we propose postnatal adipose tissue remodeling as a model process to investigate mechanisms of beige adipocyte recruitment advantageous to cold exposure or adrenergic stimulation in its entirely endogenous sequence of events without external manipulation.

Household clutter and crowding constrain associations between maternal sensitivity and child theory of mind.

Social interactions between parents and children are important for developing theory of mind, but these may be disrupted by aspects of the proximal home environment. The current study observed maternal sensitivity and its associations with child theory of mind and the housing environment (index by clutter and crowding) in a sample of mothers and their 3.5-year-old twins (N=250 children). Maternal sensitivity and housing environment were measured from experimenter report and child theory of mind was measured through behavioural tasks. Results show that the association between maternal sensitivity and child theory of mind was moderated by the housing environment, where the positive associations between maternal sensitivity and child theory of mind were only observed at lower levels of clutter and crowding in the housing environment. Additional contextual variables and processes are discussed.

Addressing Maternal Depression Through Home Visiting: One State's Experience With a Breakthrough Series Collaborative.

From 2013 to 2017, a national Breakthrough Series (BTS) collaborative in Maternal, Infant, and Early Childhood Home Visiting programs developed a toolkit that led to improvements in maternal depression outcomes. In 2018, Alabama's home visiting program (First Teacher) aimed to reproduce these impacts with a state-led BTS that enrolled 8 local implementing agencies (LIAs) serving more than 500 families. LIAs tested changes in practices using Plan-Do-Study-Act cycles and tracked data regarding depression screening, referrals, service access, and symptom improvement via run charts. First Teacher administered a post-collaborative survey to assess LIA team members' satisfaction with their BTS experience. Alabama's BTS resulted in positive shifts in maternal depression referrals, service access, and symptom improvement. Change ideas that supported these shifts included the use of a screening script, motivational interviewing, "Mothers and Babies," and a registry. LIAs noted that BTS tools and resources helped build capacity to address the difficult and frequently stigmatized topic of maternal depression. Findings from this study indicate that evidence- and experience-based practices regarding maternal depression screening, referrals, and service access can lead to symptom improvement among mothers enrolled in a state-based home visiting program. Results of this investigation corroborate findings from previous studies while also incorporating feedback from LIAs about the BTS experience.