A Controlled Trial Evaluating the Impact of a Home-Visiting Program on Maternal Disruptive Communication in a Vulnerable Population.

Attachment disorganization is a significant high-risk factor for infant mental health. Its association with high-risk psychosocial contexts has been clearly identified, but the link between these difficult social contexts and maternal disruptive communication has been poorly explored. The CAPEDP (Compétences Parentales et Attachement dans la Petite Enfance; Parental competences and attachment in early childhood) study assessed the effects of a manualized home-intervention on the mental health of children and its major determinants. In this controlled trial, 440 young, first-time mothers belonging to socially vulnerable populations were recruited. Mothers in the intervention group received psychological support from the 27th week of pregnancy through to their child's second birthday, while both groups received assessment visits at the 3rd, 6th, 9th, 18th, and 24th months of age of the child and benefited from assistance by the research team. When the children reached 12 months of age, an ancillary study, the CAPEDP-Attachment ( = 119) evaluated the effects of this intervention on attachment. The current paper describes the program's impact on this subsample concerning maternal disruptive behavior, while exploring the role of socioeconomic risk factors. Our results showed that: (a) mothers in the intervention (IG) group presented significantly less disruptive communication than those in the control group (CG), even though the CG received a significant level of care over and above that which is available to the public in the French health system as 'care as usual'; (b) having a "low income" and "having given birth prematurely" was associated with maternal disruptive communication; and (c) the intervention impact increased when the model was adjusted for these two variables. Results suggest that attachment focused intervention programs should invest both maternal interactional skills and social and economic vulnerability.