Abstract
Low-income women experience disproportionately high rates of adverse maternal mental health outcomes, such as pregnancy-related depression, and have less access to behavioral health support. Adverse maternal mental health affects children through compromising bonding, impeding early childhood development, and increasing risks of child maltreatment. Integrated behavioral health approaches can improve access to behavioral health services by locating services in community-based settings routinely accessed by low-income families. Warm Connections is an innovative integrated behavioral health program delivered in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and rooted in an infant and early childhood mental health (IECMH) framework. This exploratory study describes Warm Connections and provides evaluation results from its pilot implementation. Findings suggest Warm Connections may reduce distress and increase parenting efficacy among low-income mothers and support further research of this program’s feasibility.
Similar content being viewed by others
References
Abidin, R. R. (2012). Parenting stress index. Lutz, FL.: PAR. Retrieved September 3, 2020 from https://www4.parinc.com/Products/Product.aspx?ProductID=PSI-4:SF.
Alhusen, J. L., Gross, D., Hayat, M. J., Rose, L., & Sharps, P. (2012). The role of mental health on maternal-fetal attachment in low-income women. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 41(6), E71-81. https://doi.org/10.1111/j.1552-6909.2012.01385.x
Association of Maternal and Child Health Programs. (2019) Facilitating attuned interactions (FAN). In. Innovation Station Practice Summary and Implementation Guidance: Association of Maternal and Child Health Programs.
Bekman, S., John-Larkin, C. S., Paul, J. J., Millar, A., & Frankel, K. (2017). Update on screening, referring, and treating the behavioral, social, and mental health problems of very young children. Current Treatment Options in Pediatrics, 3(1), 15–31.
Bloom, T., Glass, N., Curry, M. A., Hernandez, R., & Houck, G. (2013). Maternal stress exposures, reactions, and priorities for stress reduction among low-income, urban women. Journal of Midwifery Womens Health, 58(2), 167–174. https://doi.org/10.1111/j.1542-2011.2012.00197.x
Bridges, A. J., Andrews, A. R., 3rd., Villalobos, B. T., Pastrana, F. A., Cavell, T. A., & Gomez, D. (2014). Does integrated behavioral health care reduce mental health disparities for Latinos? Initial findings. Journal of Latinx Psychology, 2(1), 37–53. https://doi.org/10.1037/lat0000009
Center on the Developing Child at Harvard University. (2016). From best practices to breakthrough impacts: A science-based approach to building a more promising future for young children and families. Retrieved August 27, 2020 from www.developingchild.harvard.edu.
Christian, E., & Curtis, R. (2012). Introduction to integrated care. In E. C. R. Curtis (Ed.), Integrated care: Applying theory to practice (pp. 3–19). Hoboken, NJ: Taylor and Francis.
Dozier, M., Peloso, E., Lindheim, O., Gordon, M. K., Manni, M., Sepulveda, S., & Ackerman, J. (2006). Developing evidence-based interventions for foster children: An example of a randomized clinical trial with infants and toddlers. Journal of Social Issues, 62(4), 767–785.
Gilkerson, L., Hofherr, J., Steier, A., Cook, A. C., Arbel, A., Heffron, M. C., & Paul, J. J. (2012). Implementing the fussy baby network approach. Zero to Three, 33(2), 59–65.
Gress-Smith, J. L., Luecken, L. J., Lemery-Chalfant, K., & Howe, R. (2012). Postpartum depression prevalence and impact on infant health, weight, and sleep in low-income and ethnic minority women and infants. Maternal and Child Health Journal, 16(4), 887–893. https://doi.org/10.1007/s10995-011-0812-y
Grube, W. A., & Liming, K. W. (2018). Attachment and bio behavioral catch-up: A systematic review. Infant Ment Health J, 39(6), 656–673. https://doi.org/10.1002/imhj.21745
Harris, P. A., Taylor, R., Thielke, R., Payne, J., Gonzalez, N., & Conde, J. G. (2009). Research electronic data capture (REDCap)–a metadata-driven methodology and workflow process for providing translational research informatics support. Journal of Biomedical Informatics, 42(2), 377–381. https://doi.org/10.1016/j.jbi.2008.08.010
Holden, K., McGregor, B., Thandi, P., Fresh, E., Sheats, K., Belton, A., & Satcher, D. (2014). Toward culturally centered integrative care for addressing mental health disparities among ethnic minorities. Psychol Serv, 11(4), 357–368. https://doi.org/10.1037/a0038122
Howell, E. A., Mora, P., & Leventhal, H. (2006). Correlates of early postpartum depressive symptoms. Maternal and Child Health Journal, 10(2), 149–157. https://doi.org/10.1007/s10995-005-0048-9
Kataoka, S. H., Zhang, L., & Wells, K. B. (2002). Unmet need for mental health care among U.S. children: Variation by ethnicity and insurance status. American Journal of Psychiatry, 159(9), 1548–1555.
Klawetter, S., & Frankel, K. (2018) Infant mental health: A lens for maternal and child mental health disparities. Journal of Human Behavior in the Social Environment, 28(5):557–569.
Klawetter, S., McNitt, C., Hoffman, J. A., Glaze, K., Sward, A., & Frankel, K. (2020). Perinatal depression in low-income women: A literature review and innovative screening approach. Current Psychiatry Reports. https://doi.org/10.1007/s11920-019-1126-9.
Kohl, P. L., Jonson-Reid, M., & Drake, B. (2011). Maternal mental illness and the safety and stability of maltreated children. Child Abuse and Neglect, 35(5), 309–318. https://doi.org/10.1016/j.chiabu.2011.01.006
Kozhimannil, K. B. (2011). Racial and ethnic disparities in postpartum depression care among low-income women. Psychiatric Services. https://doi.org/10.1176/ps.62.6.pss6206_0619
Lieberman, A. F., Gosh-Ippen, C., & Van Horn, P. (2006). Child-parent psychotherapy: 6-month follow-up of a randomized controlled trial. Journal of the American Academy of Child and Adolescent Psychiatry, 45(8), 913–918. https://doi.org/10.1097/01.chi.0000222784.03735.92
Lipkind, S. H., Curry, M. A., Huyn, M., Thorpe, L. E., & Matte, T. (2010). Birth outcomes among offspring of women exposed to the September 11, 2001 Terrorist attacks. Obstetrics and Gynecology, 116(4), 917–925.
Marvin, R., Cooper, G., Hoffman, K., & Powell, B. (2002). The circle of security project: Attachment-based intervention with caregiver-pre-school child dyads. Attach Hum Dev, 4(1), 107–124. https://doi.org/10.1080/14616730252982491
McKelvey, L., Schiffman, R. F., Brophy-Herb, H. E., Bocknek, E. L., Fitzgerald, H. E., Reischl, T. M., & Cunningham Deluca, M. (2015). Examining long-term effects of an infant mental health home-based early head start program on family strengths and resilience. Infant Mental Health Journal, 36(4), 353–365. https://doi.org/10.1002/imhj.21518
Minkovitz, C. S., Strobino, D., Mistry, K. B., Scharfstein, D. O., Grason, H., Hou, W., & Guyer, B. (2007). Healthy steps for young children: Sustained results at 5.5 years. Pediatrics, 120(3), 658–668. https://doi.org/10.1542/peds.2006-1205
O’Brien, K. M., Tronick, E. Z., & Moore, C. L. (2013). Relationship between hair cortisol and perceived chronic stress in a diverse sample. Stress Health, 29(4), 337–344. https://doi.org/10.1002/smi.2475
Ordway, M. R., McMahon, T. J., Kuhn, D. L. H., & L., & Suchman, N. E. . (2018). Implementation of an evidenced-based parenting program in a community mental health setting. Infant Mental Health Journal, 39(1), 92–105. https://doi.org/10.1002/imhj.21691
Perry, D. F., Le, H. N., Villamil, J. Y., & Boateng, A. O. (2015). Integrating perinatal depression screening into WIC at a federally qualitified health center. Proress in Community Health Partnerships: Research, Education, and Action, 9(2), 253–259. https://doi.org/10.1353/cpr.2015.0035
Plant, D. T., Pariante, C. M., Sharp, D., & Pawlby, S. (2015). Maternal depression during pregnancy and offspring depression in adulthood: Role of child maltreatment. British Journal of Psychiatry, 207(3), 213–220. https://doi.org/10.1192/bjp.bp.114.156620
Pooler, J., Perry, D. F., & Ghandour, R. M. (2013). Prevalence and risk factors for postpartum depressive symptoms among women enrolled in WIC. Maternal and Child Health Journal, 17(10), 1969–1980. https://doi.org/10.1007/s10995-013-1224-y
Price, S. K., Coles, D. C., & Wingold, T. (2017). Integrating behavioral health risk assessment into centralized intake for maternal and child health services. Health and Social Work, 42(4), 231–240. https://doi.org/10.1093/hsw/hlx037
Samuelson, K. W., Wilson, C. K., Padron, E., Lee, S., & Gavron, L. (2017). Maternal PTSD and children’s adjustment: Parenting stress and emotional availability as proposed mediators. Journal of Clinical Psychology, 73(6), 693–706. https://doi.org/10.1002/jclp.22369
Sanchez, K., Ybarra, R., Chapa, T., & Martinez, O. N. (2016). Eliminating behavioral health disparities and improving outcomes for racial and ethnic minority populations. Psychiatric Services, 67(1), 13–15. https://doi.org/10.1176/appi.ps.201400581
Shea, S. E. (2018). Reflective supervision for social work field instructors: Lessons learned from infant mental health. Clinical Social Work Journal, 47(1), 61–71. https://doi.org/10.1007/s10615-018-0677-2
Shonkoff, J. P., & Phillips, D. A. (2000). From neurons to neighborhoods: The science of early childhood development. Washington, DC: The National Academies Press.
Silverstein, M., Cabral, H., Hegel, M., Diaz-Linhart, Y., Beardslee, W., Kistin, C. J., & Feinberg, E. (2018). Problem-solving education to prevent depression among low-income mothers: A path mediation analysis in a randomized clinical trial. JAMA Network Open, 1(2), e180334. https://doi.org/10.1001/jamanetworkopen.2018.0334
Silverstein, M., Diaz-Linhart, Y., Cabral, H., Beardslee, W., Hegel, M., Haile, W., & Feinberg, E. (2017). Efficacy of a maternal depression prevention strategy in head start: A randomized clinical trial. JAMA Psychiatry, 74(8), 781–789. https://doi.org/10.1001/jamapsychiatry.2017.1001
Talmi, A., Stafford, B., & Buchholz, M. (2009). Providing perinatal mental health services in pediatric primary care. Zero to Three, 29(5), 10–16.
Thomas, R., & Herschell, A. D. (2013). Parent-child interaction therapy: A manualized intervention for the therapeutic child welfare sector. Child Abuse and Neglect, 37(8), 578–584. https://doi.org/10.1016/j.chiabu.2013.02.003
Turney, K. (2012). Pathways of disadvantage: Explaining the relationship between maternal depression and children’s problem behaviors. Social Science Research, 41(6), 1546–1564. https://doi.org/10.1016/j.ssresearch.2012.06.003
United States Department of Agriculture (2013). About WIC: How WIC helps. Retrieved March 1, 2020 from https://www.fns.usda.gov/wic/about-wic-how-wic-helps.
United States Department of Agriculture (2015). About WIC: WIC at a glance. Retrieved March 1, 2020 from https://www.fns.usda.gov/wic/about-wic-wic-glance.
Wenz-Gross, M., Weinreb, L., & Upshur, C. (2016). Screening for post-traumatic stress disorder in prenatal care: Prevalence and characteristics in a low-income population. Maternal and Child Health Journal, 20(10), 1995–2002. https://doi.org/10.1007/s10995-016-2073-2
World Health Organization. (2018). Depression. Retrieved March 1, 2020 from https://www.who.int/en/news-room/fact-sheets/detail/depression.
Zeanah, C., & Zeanah, P. (2019). Infant mental health. In C. H. Zeanah (Ed.), Handbook of infant mental health (pp. 5–24). New York: The Guilford Press.
ZERO TO THREE (2002) Infant mental health task force: What is infant mental health? In. Washington DC: ZERO TO THREE
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflicts of interest
This project was submitted to the Colorado Multiple Institutional Review Board and determined to be exempt research because information was collected as part of a program evaluation project and all data was de-identified. Because this project used de-identified, previously collected data, informed consent was not possible. The authors affirm they do not have conflicts of interest. All authors meet the International Committee of Medical Journal Editors’ definition of “author” and certify their responsibility for the conduct and interpretation of analyses of this study, have participated in the conceptualization and writing of this manuscript, and approve the final version of this manuscript.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Appendix A
Appendix A
Rights and permissions
About this article
Cite this article
Klawetter, S., Glaze, K., Sward, A. et al. Warm Connections: Integration of Infant Mental Health Services into WIC. Community Ment Health J 57, 1130–1141 (2021). https://doi.org/10.1007/s10597-020-00744-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10597-020-00744-y