Clinical Research at CIMHD

The Center on Infant Mental Health and Development is unique in its joint affiliation with the School of Nursing and the Center for Human Development and Disability at the University of Washington , which is ranked in the top ten among the country’s public research universities. According to its mission statement, t he University “advances new knowledge through many forms of research, inquiry and discussion; and disseminates it through the classroom and the laboratory, scholarly exchanges, creative practice, international education, and public service.” The University provides strong institutional support for the CIMHD to be involved in cutting-edge research that promotes early nurturing relationships and the social-emotional well-being of children birth to five, and to be devoted to the broad dissemination of this research for the benefit of our communities and the world beyond.

Research is the backbone of the CIMHD, fueling many of its other education and training, advocacy and public service activities. Some of the recent and current research projects conducted by CIMHD faculty are briefly described below.

National Early Head Start Research and Evaluation Study . Funded by Administration for Children and Families

Retired CIMHD Director Kathryn Barnard and current Director Susan Spieker were principal investigators of one of 17 national sites participating in a randomized trial examining the effectiveness of Early Head Start programs to promote child, family, staff, and community development. The families served by Early Head Start are all low income. Low income families may experience stresses that contribute to children’s serious developmental, emotional, and learning problems. The focus of both the local and national components of this research converges on understanding factors and processes contributing to a child’s readiness for school. Approximately 15-20% of the children were identified as having cognitive or social-emotional disabilities specifically related to emotion regulation, speech and language, developmental delay, or externalizing problem behavior by age three. Our local focus has specifically been on the interpersonal and social contexts in which children in poverty develop, and the individual and emotional characteristics of their mothers that affect how receptive a family is to intervention efforts, and how effective that intervention ultimately can be in promoting social emotional well-being and readiness for school.

Currently, the researchers are conducting a follow-up of the study children at the end of fifth grade.

Influence of Postpartum Depression on Infant Cortisol Stress Levels, Infant Temperament, and the Developing Mother-Infant Relationship , Funded by UW Royalty Research Fund

Dr's. Sandra Jolley and Susan Spieker conducted this pilot study in the CIMHD Birth to Three Lab. The initial results of the study indicate that early postpartum depression predicts specific aspects of infant temperament including his/her startle response and distress to a pop-up toy. This finding suggests either a similarity in the biological predisposition of both mother and infant to distress and anxiety, or that the mother’s early postpartum depression is having an impact on infant temperament. Since postpartum depression occurred in a number of women who were not depressed before the birth of their baby, we view the latter explanation as more plausible.

Initial research findings also indicate that early postpartum depression (3 weeks post birth) affects aspects of later mother-infant interactions. Although mothers with early postpartum depression showed an awareness of their infant’s signals, they appeared less responsive to those signals. This difference was apparent whether the symptoms of postpartum depression continued or subsided. The differences in these interactions appeared to be very subtle as indicated by other characteristics of the mother-infant interaction not being significantly different in dyads with depressed and non-depressed mothers. There is a discrepancy in the research in this area in which research in relatively high-risk samples has found that mothers with postpartum depression tend to either be intrusive or withdrawn in their parenting. Research in relatively low-risk samples, however, has often found no indicators of differences in maternal behavior during mother-infant interactions. This specific, subtle difference in maternal responsiveness in the low-risk mothers with early postpartum depression in this sample may be vital in explaining this discrepancy in research findings. It appears that our results may enrich understanding in the field of the link between early postpartum depression and maternal behavior in low risk samples.

Autonomic Regulation in Infants and Associations with Parent- Infant Relationship and Infant Attachment, Funded by the UW School of Nursing Research and Intramural Funding Program

This pilot study, nicknamed ‘The Biology of Baby Love,’ allowed for further refinements of protocols in the CIMHD Birth to Three Research Lab. It was, conducted by CIMHD Director Susan Spieker, CIMHD faculty and Certificate in Infant Mental Health graduate Sandra Jolley, and former CIMHD post doc Alyson Shapiro.

Feasibility study: Prevention Research with Infants in Foster Care,Funded by the UW Center for Advancement of Health Disparities Research

This pilot study, conducted by Susan Spieker, Sandra Jolley, and former CIMHD post doc Alyson Shapiro, tested the feasibility of research and intervention with infants in foster care and their families. As part of the CIMHD Birth to Three research protocols, saliva from foster infants and infants participating in the Biology of Baby Love study, described above , was collected during a lab visit which included brief separations from the caregiver as a stressor. Salivary cortisol, an index of stress reactivity, was compared for the two groups of children. Although there was no significant difference between the group baseline levels, the foster infants had a significantly steeper increase in cortisol levels over time relative to the control group. This finding in the foster children indicates disruption in the children’s ability to self-regulate and adapt to shifting demands. There are implications for developing relationship-focused interventions for foster parents to promote self-regulation in the foster child. The results of this pilot study have contributed to the development of a large intervention study, Promoting Infant Mental Health in Foster Care.

Incorporating an Attachment Q-set into Parent-Child Relationship Assessment and Support in Early Head Start , Funded by Administration on Children and Families

This study, conducted by CIMHD Director Susan Spieker and doctoral student and graduate of the CIMHD Certificate Program in Infant Mental Health Marie-Celeste Condon, is funded as a university-Early Head Start partnership. In this study, the focus is on the rationale, process, and outcomes of a project in which university researchers selected a measurement tool developed and used in research to assess the quality parent-child attachment relationships, and collaborated with the two Early Head Start (EHS) programs over a period of three years to evaluate its usefulness in home-based service delivery. The tool is the Toddler Attachment Sort-45 Items (TAS-45), an adaptation of the widely used Attachment Q-Sort (AQS). It is a measure of the quality of attachment relationships between primary caregivers and their children, from age one through the preschool years. The project is based on a parallel process theory of change, which predicts that service providers engaged in reflective, relationship-focused service delivery in a supportive work environment are more able to support sensitive responsiveness and reflective capacity in parents . The aim is for the TAS-45 to be used to assess outcomes and inform service delivery through ongoing cycles of assessment, reflection, planning, and support for the kinds parent-child interactions that are critical to toddlers’ attachment-exploration security.

A Relationship-Focused Approach to Family Stabilization , Funded by the Bill & Melinda Gates Foundation Pacific Northwest Program/Community Grants

The first purpose of this project, lead by CIMHD Co-Director Jean Kelly in collaboration with Kathryn Barnard, Joanne Solchany, and Susan Spieker, was to train program staff working in a transitional housing program for homeless families with young children (birth through 6 years) to promote secure and trusting parent-child relationships using Promoting First Relationships (PFR), an attachment-based curriculum developed by Jean Kelly. The second purpose was to evaluate the effects of training on staff skills and knowledge, and parent and child functioning.

Our encouraging results strongly indicate that delivering PFR training to providers who work with highly stressed parents can have positive outcomes for both staff and parent-child functioning. The ultimate goal of the project was to train staff to help parents increase the trust and confidence of young children, thereby enabling children to be “ready to learn.” School readiness begins at home, in infancy, and the parent-child relationship is foundational to a child’s feelings of security and a child’s development of social and communicative competencies. The results of this project show that, overall, the children in the project became more secure, better interactive partners, and more socially and emotionally competent. These are the very behaviors that allow a child to enter new social and educational environments better able to participate and thrive and more “ready to learn.”

Promoting Infant Mental Health in Foster Care , Funded by the National Institute of Mental Health

Infants and toddlers in foster care often experience frequent changes in their primary caregivers. These experiences may come on top of prenatal exposure to drugs and alcohol, early maltreatment and neglect, or biological vulnerability due to low birth weight or prematurity. All of these factors have been shown to adversely affect the development of early self-regulation and attachment, and as a result, these stressed children pose challenges that make it difficult for their caregivers to provide the nurturing care that they need. This randomized, controlled study is being conducted by CIMHD Director Susan Spieker in collaboration with CIMHD Co-Director Jean Kelly and faculty colleagues from the School of Social Work , Marueen Marcenko and Monica Oxford. The purpose of the project is to compare two different approaches to assisting foster families with infants and toddlers. One program is called Early Education Support (EES), and the other is Promoting First Relationships (PFR). Both are based on research evidence, describing ways to enhance the well-being and development of vulnerable infants and toddlers by supporting the people who care for them.

EES is based on years of research on the importance of the structure and organization of home environments for young children’s learning and development. A specially trained practitioner will meet with the family in their home for the purpose of assessing the developmental status of the child, making referrals to community resources as needed, and collaborating and problem-solving with the caregiver to adapt and use materials, space, and routines in her home that are tailored to the learning needs of this particular foster child.

PFR, an attachment-based curriculum developed by Jean Kelly, draws on years of research on the importance of early social relationships for young children’s learning and development. A specially trained practitioner will meet with the family in their home for the purpose of supporting the caregiver in reading and responding to children’s positive and negative social cues in a way that is tailored to the needs and abilities of this particular foster child.

The children and families in both groups will participate in research visits before and after the intervention. Measures collected will include observations of attachment in interaction, caregiver reports on child behavior, and developmental tests of the child’s social, cognitive, and language competence.