Adverse Childhood Experiences (ACES) are prevalent among women enrolled in evidence based home visiting (EBHV) programs, yet it is unknown how early adversity in the parent generation impacts family engagement in EBHV, or the efficacy of EBHV as related to parenting and infant outcomes. This knowledge is critical to inform refinement of the Maternal Infant Early Childhood Home Visiting (MIECHV) initiative that is funded by the federal Affordable Care Act to address disparities in maternal and child health among families in poverty. The proposed research will examine the impact of ACES in the parent generation on 1) infant health and development, 2) family engagement in MIECHV, and 3) the efficacy of MIECHV for enhancing parenting and infant health and development. Three hundred mothers and their infants will participate. Mothers will be recruited from Women Infants and Children (WIC) clinics in the prenatal period, and nearly all families will be living in poverty. Mothers will complete interviews and questionnaires to assess early adversity and prenatal stressors at the time of a prenatal enrollment assessment. When infants are 6 and 12 months of age mothers and their infants will engage in observations of parent-child interaction to assess parental behavior and infant temperament and emotion regulation. Mothers will complete interviews and questionnaires to assess the home environment, infant developmental progress and behavior problems, and postpartum stressors. Pediatric medical records will be reviewed to determine infant health history and chronic illness. Home visiting records will be reviewed to determine family enrollment and retention in home visiting. The proposed research is directly relevant to MCHB Strategic Research Issues II (addressing health disparities in MCH) and IV (promoting the healthy development of MCH populations) by considering a preconception risk factor (parental ACES) for disparities in maternal and child health in the perinatal period. Understanding the impact of ACES in the parent generation on family engagement in EBHV, as well as the efficacy of EBHV to enhance parenting and infant health and development, will inform implementation of the Affordable Care Act through continuous quality improvement efforts aimed at addressing parental early adversity in the MIECHV population. Refinement of individual EBHV models, as well as the implementation of MIECHV on a national scale, will mitigate health disparities and promote maternal and child health.
Adverse Childhood Experiences in the Parent Generation: Impact on Family Engagement and Program Efficacy of MIECHV Home Visiting