Embedding Mental Health Consultation Within Prenatal Home Visiting to Prevent Child Maltreatment and Violence Exposure

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Abstract Adverse childhood experiences (ACES) is a major public health problem that exacts tremendous cost to the United States each year. Exposure to ACES during infancy, including child maltreatment and child exposure to adult intimate partner violence, undermines health across the lifespan. Infants are at greatest risk for fatality resulting from maltreatment in the first week of life, and nearly a third of infants who experience maltreatment in the first year have been maltreated by one week postpartum. Thus, intervening in the postpartum period to prevent maltreatment and exposure to intimate partner violence is too late. Furthermore, mothers with their own history of adversity or trauma are much more likely to experience risk factors in the postpartum period for perpetrating violence. Intervening prenatally to support mothers into the postpartum transition, particularly mothers with their own trauma history, is critical to reducing maltreatment and violence exposure in children. Home visiting programs, with their emphasis on maternal-child health, are an important bridge to support mothers with a trauma history across the perinatal transition, and an ideal setting for primary prevention of child maltreatment and violence exposure. The proposed research will focus on RFA Objective #3: Effectiveness research to evaluate a primary prevention strategy that incorporates a dual-generation approach. Through close collaboration with the Rhode Island Department of Health (RIDOH) and the Rhode Island Department of Children, Youth, and Families (RI DCYF), we will capitalize on established infrastructure to innovate and enhance a statewide short-term home visiting program. Our primary prevention program, Enhanced First Connections, will draw upon an infant mental health perspective to provide prenatal infant and early childhood mental health consultation in the context of the home visiting program. We will focus on a selected high-risk population, mothers with a history of adversity or trauma, with the goal of preventing ACES exposure among infants. Primary outcomes of the proposed randomized control trial (RCT) will include the prevention of child maltreatment (child abuse and neglect) and exposure to adult intimate partner violence. Secondary outcomes of the proposed RCT will include increases in family engagement in longer- term evidence based home visiting programs, increases in family engagement in specialized support services to address maternal adversity and trauma, reductions in maternal risk factors, and the promotion of positive parenting and the parent-child relationship. We will use gold-standard assessments to measure our outcome variables including review of child protection records, interview and observational assessments, and review of home visiting records. Our focus on infant and early childhood mental health consultation is highly innovative as no prior research has empirically tested this strategy for the primary prevention of child maltreatment and child exposure to adult intimate partner violence. Results will be of high interest given the national focus on supporting infant and early childhood mental health consultation within home visiting.