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Women and Infants Mental Health Program

Parenting and Fatherhood

It has been said that having a child changes everything.  During pregnancy and the early postpartum period, parents are adjusting to major role transitions in their families, at work and within their communities, all while caring for a child.  Attachment, or the important relationship that develops between parents and children, is based on the emotional tone and quality of day-to-day interactions.  Securely attached children are able to rely on their parents for generally consistent, responsive, and sensitive care, and are able to use their parents as a “secure base” when exploring the environment and as a “safe haven” in times or distress or vulnerability.  A parents’ capacity for sensitive responsiveness is key for promoting young children’s resilience to stress, self-esteem, ability to self-soothe, problem solving skills and success in future relationships.  TheWIMH Program is interested in learning more about the needs of parents and children during this vulnerable time and designing effective interventions that address those needs.

Experiences during the postpartum period are often studied from the maternal perspective. However, fathers also experience significant changes in life after childbirth, many of which are similar to the experiences mothers and are often overshadowed. Fathers must also adjust to an array of new and demanding roles and tasks during the early postpartum period. This critically depends on the level and quality of cooperation between the mother and father. Clearly, the postnatal experience poses many challenges to men’s as well as women’s lives and mental health. Research at the WIMH Program examines men’s experiences in fatherhood.

Research Activity:

Interventions, Treatments, and Complimentary Alternative Medicine

Swaddled Babies, Happy Families

The “Swaddled Babies, Happy Families” program is an extension of Dr Harvey Karp's Happiest Baby on the Block for couples with a focus on first time fathers aiming to increase their confidence and skill set around the needs of both a new mother and a newborn baby.   The goal of this project is to evaluate a group called “Swaddled Babies, Happy Families” for first time parents and their newborns in Ypsilanti and Ann Arbor, MI. This program is an educational intervention for couples with a focus on increasing new fathers’ confidence and skill sets around the needs of both a new mother and a newborn baby.  This program meets the needs of high-risk families by inviting them to come together to support the developing exploration of what fatherhood means to the dad, how to make sense of his roles and learn how he can positively contribute to the mother’s, and his own, postpartum mental health, particularly by reducing the infant’s crying. All participants will be assessed through questionnaires and interviews to be conducted before and after the group.    

Investigators:
Maria Muzik (PI), Nicole Miller, Emily Stanton

Mom Power

Mom Power is a parenting and attachment skills group for mothers receiving Medicaid and their children under age 6 who are interested in learning more about parenting. Mothers participate in a 10-week educational curriculum that helps mothers from a variety of backgrounds and skill levels to safely cope with their current stressful life circumstances and mental health symptoms, all of which may pose risk to their parenting and child’s safety.  Each week has a different focus related to parenting and the mother’s emotional needs. Topics include child development, understanding how past traumatic stress affects parenting skills and mother/child bonding, self-care skills (including breathing and relaxation techniques and medications), and how to connect and play with children. At each session the child receives an age-appropriate toy or book that moms are encouraged to use as a way to engage with their child, and mothers are reimbursed for their travel. Moms receive a certificate at the end of the group proclaiming them “powerful moms’.

Findings:
On average, two thirds of graduates of Mom Power are connected with care within the community following the intervention. Mothers self-rating of depression and PTSD symptoms, as well as parenting competence improve after Mom Power.

Investigators:
Maria Muzik (PI), Katherine Rosenblum, and Sheila Marcus

Partnering for the Future

The Partnering for the Future project enrolled pregnant women with an active substance use disorder receiving care at a high-risk OB clinic.  In addition to standard-of-care medical and psychological services, participants received several interventions to enhance maternal-infant bonding, including enhanced ultrasounds, a hospital tour/baby shower and a psychoeducational group (Mom Power-Substance Abuse), integrating attachment-based parenting, substance abuse treatment and self-care skills.  This project, which was a collaboration with Home of New Vision, was completed in 2011.

The current project is focused on delivering the Mom Power-Substance Abuse intervention to similar women, starting in pregnancy.  Recruitment is on-going.

Findings:
This population is very difficult to engage and retain, due to profound trauma and the nature of their addiction disorders. However, building an atmosphere of non-judgment and empathy, combined with supportive interventions such as the structured ultrasounds and baby shower, is crucial for seizing upon this time of expectedly high motivation for sobriety.  Despite a small sample size (N=21), all interventions were well received.  The psychoeducational group fostered an enhanced commitment to sobriety, supported the development of higher parental reflectivity and provided a rare source of peer support, which participants found enormously helpful in seeking treatment and reducing the powerful stigma surrounding being pregnant while in recovery.  Qualitatively, women said that the ultrasound interventions made the baby “more real” to them and that these feelings of attachment helped them maintain their sobriety. Finally, study participation significantly reduced symptoms of depression and post-traumatic stress disorder (PTSD). 

Investigators:
Maria Muzik (PI), Patrick Gibbons, Jennie Jester, Sheila Marcus, Susan McDonough, Katherine Rosenblum and Marjorie Treadwell

STRoNG Military Families

Parenting across the deployment cycle raises special challenges for military families with young children. The STRoNG Military Families parenting group program is offered for military service members, their spouses or partners, and their children birth to 8 years old. STRoNG Military Families provides a 10-week parent and child group experience designed to support and enhance the resilience of military families by creating opportunities for families to come together to learn, support one another, and grow in their ability to navigate the unique challenges they face.  Each group session includes dinner which the whole group eats together; separate play time for the children at which time they are interacting with a trained therapists; sessions on parenting skills with group discussion for the adults; and interaction time with children and parents together at the end of the session.

Investigators:
Katherine Rosenblum (PI), Michelle Kees, Sheila Marcus and Susan McDonough

Circle of Security

The Circle of Security study is a 12-week attachment-based parenting intervention group that aims to shift patterns of attachment/caregiving interactions in high-risk mother-child dyads to more developmentally appropriate pathways. Pre- and post- group assessments are conducted in hopes of establishing statistical evidence for the use of the COS Program in enhancing parental coping, improving parental behavior, and developing attachment security between dyads. Such assessment covers several domains of parenting and group treatment efficacy, including: videotaped mother-child interactions, genetic and biological data, semi-structured maternal interviews, child emotion-regulation tasks, and maternal fMRI brain scans. For more information on COS, please see the fMRI/Brain Behavior section.

Investigators:
Maria Muzik (PI), Katherine Rosenblum and Sheila Marcus

Consultants:
Robert Marvin and William Whelan, The Mary D. Ainsworth Child-Parent Attachment Clinic, University of Virginia

Other Research

Family Transitions Study: Family Transitions Following the Birth of a Sibling

FTS is a longitudinal investigation of 241 families expecting their second child. The main goal of FTS was to examine changes in the firstborn child’s adjustment following the infant sibling’s birth and changes in family relationship functioning including marital relationships, parental well-being, family social supports, and work-family stress. The study involved five assessment periods starting in the last trimester of the mother’s pregnancy with the second born (Prenatal assessment) and then again when the infant was 1, 4, 8, and 12 months of age. Families were visited predominantly in their homes throughout the course of the study where we conducted parent interviews, videotaped observations of parent, sibling, and marital interaction, and assessments of children’s social understanding.

  • How does the older sibling adjust to the arrival of a baby brother or sister?
  • How do parents cope with the changes occurring during this time?
  • What role do fathers play in the family during this developmental transition?
  • How do changes in family life and the older sibling’s adjustment affect the developing infant?

Investigators:
Brenda L. Volling (PI), Heather Flynn, Richard Gonzalez, Timothy Johnson, Susan Nolen-Hoeksema

For more information on the Family Transitions Study, please visit the lab website.

Muzik. Community-Participatory Teen Parenting Project in Western Wayne County. MDCH. Funded 10/1/2011-9/30/2012

Muzik. Empathic Shifts in Therapy: Changes in Maternal Insightfulness Predict Improvements in Child Attachment Outcomes. American Psychoanalytic Association. Funded 2/1/2011-1/31/2012

Muzik. Infant sleep, stress, and inflammation: Are these valid biomarkers for predicting depression in preschoolers? Rachel Upjohn Clinical Scholars Award, funded 9/1/2010-12/31/2012

Muzik. Infant stress response: effects of maternal PTSD and infant genes. NIMH/NICHD K23, funded 9/22/2008-6/30/2012

Muzik. Transmission of Emotion Regulation:  From Maternal Brain to Child Behavior. MICHR Collaborative Pilot RD 10. Funded 5/1/2011-5/15/2012

Muzik. Young Mothers as Mentors: Community-based Peer Support Program for Mothers with Young Children. MDCH. Funded 10/1/2011-9/30/2012 

Selected Publications:
LePlatte, D., Rosenblum, K. L., Stanton, E., Miller, N., & Muzik, M. (2012). Mental health in primary care for adolescent parents. Mental Health & Family Medicine, In press.

Shah P, Muzik M, Rosenblum KL (2011) Optimizing the Early Parent-Child Relationship: Windows of Opportunity for Parents and Pediatricians. Curr Probl Pediatr Adolesc Health Care. 41:183-187

Marcus, S., Rosenblum, K. L., Fluent, T., McDonough, S., Smith, K., Kees, M., & Muzik, M. (2010). STRoNG Families: A Parenting Intervention offering Support to Restore, Nurture, and Grow Military Families. Paper presented at the American Asssociation of Child and Adolescent Psychiatry/Canadian Asssociation of Child and Adolescent Psychiatry Joint Annual Meeting, Toronto, Canada.

Muzik, M., Hadi, Z., Rosenblum, K. L., Jaffe, A., Stanton, E., & Waxler, E. (2010). Comprehensive care model for mothers and children in need: The Mom Power project. Paper presented at the 12th World Congress of the World Association for Infant Mental Health, Leipzig, Germany.

Kim, P., & Swain, J. E. (2007). Sad dads: paternal postpartum depression. Psychiatry (Edgmont (Pa. : Township)), 4(2), 35-47.

Hoffman, K. T., Marvin, R. S., Cooper, G., & Powell, B. (2006). Changing toddlers' and preschoolers' attachment classifications: the Circle of Security intervention. Journal of consulting and clinical psychology, 74(6), 1017-1026.

Klier, C.M. & Muzik, M. (2004). Mother-Infant Bonding Disorders and the Use of the Parental Bonding Questionnaire in clinical practice. World Psychiatry 3: 102-103.

Miller, A. L., McDonough, S. C., Rosenblum, K. L., & Sameroff, A. J. (2002). Emotion Regulation in Context: Situational Effects on Infant and Caregiver Behavior. Infancy, 3(4), 403-433.

Klier, C., Muzik, M. Mother-child interaction in the postpartum period. In: Klier, C.M., Demal, U., Katschnig, H. (eds). Mutterglück, ­ Mutterleid. Diagnose und Therapie der postpartalen Depression. Facultas Verlag, Wien (2001).

Volling, B. L., & Belsky, J. (1992). The contribution of mother-child and father-child relationships to the quality of sibling interaction: a longitudinal study. Child Dev, 63(5), 1209-1222.