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Early Dyadic Parent/Caregiver-Infant Interventions to Support Early Relational Health: A Meta-Analysis

October 2022

DOI:10.1101/2022.10.29.22281681

Authors:

Andréane Lavallée

Columbia University

Jennifer Warmingham

Columbia University

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Importance In 2021, the American Academy of Pediatrics published a policy statement seeking to create a paradigm shift away from a focus on childhood toxic stress and toward the emphasis on early relational health (ERH) as a buffer for childhood adversity and promoter of life-course resilience. A comprehensive appraisal of the efficacy of contemporary parent/caregiver-child interventions in – primarily – improving ERH, and – secondarily – enhancing child well-being and neurodevelopment is needed to guide wide- spread implementation and policy. Objective Determine the effectiveness of contemporary early dyadic parent/caregiver-infant interventions on ERH, child socio-emotional functioning and development, and parent/caregiver mental health. Data Sources PubMed, Medline, Cinhal, ERIC, and PsycInfo were searched on April 28, 2022. Additional sources: clinical trial registries (clinicaltrials.gov, ISRCTN Registry, EU Clinical Trials Register, Australian New Zealand Clinical Trials Registry), contacting authors of unpublished/ongoing studies, backward/forward reference-searching. Study Selection Studies targeting parent/caregiver-infant dyads and evaluating effectiveness of a dyadic intervention were eligible. Study selection was performed in duplicate, using Covidence. Data Extraction and Synthesis Cochrane’s methodological guidance presented per PRISMA guidelines. Data extraction and risk of bias assessment were completed in duplicate with consensuses by first author. Data were pooled using inverse- variance random effects models. Main Outcomes and Measures The primary outcome domain was ERH. Secondary outcome domains were child socio-emotional functioning and development, and parent/caregiver mental health, and were only considered in studies where at least one ERH outcome was also measured. The association between dose of intervention and effect estimates was explored. Results 93 studies (14,993 parent/caregiver-infant dyads) met inclusion criteria. Based on very low to moderate quality of evidence, we found significant non-dose-dependent intervention effects on several measures of ERH, including bonding, parent/caregiver sensitivity, attachment, and dyadic interactions, and a significant effect on parent/caregiver anxiety, but no significant effects on other child outcomes. Conclusion Current evidence does not support the notion that promoting ERH through early dyadic interventions ensures optimal child development, despite effectively promoting ERH outcomes. Given the lack of an association with dose of intervention, the field is ripe for novel, innovative, cost-effective, potent ERH intervention strategies that effectively and equitably improve meaningful long-term child outcomes.

Intervention Characteristics

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Early Dyadic Parent/Caregiver-Infant Interventions to Support Early Relational

Health: A Meta-Analysis

Andréane Lavalléea, PhD, Lindsy Panga, Jennifer M. Warminghama, PhD, Ginger Atwooda, BSc, Imaal

Ahmeda, Marissa Lanoffa, Morgan A. Finkela, MD, MS, Ruiyang Xua, Elena Arduina, Kassidy K.

Hamera, Rachel Fischmana, Sharon Ettingera, Yunzhe (Jessica) Hua, Kaylee Fishera, Esther A.

Greemana, Mia Kuromarua, Sienna S. Durra, Elizabeth Flowersa, MD, Aileen Gozalia, David Wil-

lisb, MD, Dani Dumitriua, MD, PhD

aDepartment of Pediatrics, Columbia University Irving Medical Centre, New York, NY 10032

bCenter for the Study of Social Policy, Washington, DC 20005

Corresponding Author:

Dani Dumitriu

dani.dumitriu@columbia.edu

ABSTRACT

Importance: In 2021, the American Academy of Pediatrics published a policy statement seeking to create

a paradigm shift away from a focus on childhood toxic stress and toward the emphasis on early relational

health (ERH) as a buffer for childhood adversity and promoter of life-course resilience. A comprehensive

appraisal of the efficacy of contemporary parent/caregiver-child interventions in – primarily – improving

ERH, and – secondarily – enhancing child well-being and neurodevelopment is needed to guide wide-

spread implementation and policy. Objective: Determine the effectiveness of contemporary early dyadic

parent/caregiver-infant interventions on ERH, child socio-emotional functioning and development, and

parent/caregiver mental health. Data Sources: PubMed, Medline, Cinhal, ERIC, and PsycInfo were

searched on April 28, 2022. Additional sources: clinical trial registries (clinicaltrials.gov, ISRCTN Re-

gistry, EU Clinical Trials Register, Australian New Zealand Clinical Trials Registry), contacting authors

of unpublished/ongoing studies, backward/forward reference-searching. Study Selection: Studies target-

ing parent/caregiver-infant dyads and evaluating effectiveness of a dyadic intervention were eligible.

Study selection was performed in duplicate, using Covidence. Data Extraction and Synthesis:

Cochrane’s methodological guidance presented per PRISMA guidelines. Data extraction and risk of bias

assessment were completed in duplicate with consensuses by first author. Data were pooled using inverse-

variance random effects models. Main Outcomes and Measures: The primary outcome domain was

ERH. Secondary outcome domains were child socio-emotional functioning and development, and par-

ent/caregiver mental health, and were only considered in studies where at least one ERH outcome was

also measured. The association between dose of intervention and effect estimates was explored. Results:

93 studies (14,993 parent/caregiver-infant dyads) met inclusion criteria. Based on very low to moderate

quality of evidence, we found significant non-dose-dependent intervention effects on several measures of

ERH, including bonding, parent/caregiver sensitivity, attachment, and dyadic interactions, and a signifi-

cant effect on parent/caregiver anxiety, but no significant effects on other child outcomes. Conclusion:

Current evidence does not support the notion that promoting ERH through early dyadic interventions en-

sures optimal child development, despite effectively promoting ERH outcomes. Given the lack of an as-

sociation with dose of intervention, the field is ripe for novel, innovative, cost-effective, potent ERH in-

tervention strategies that effectively and equitably improve meaningful long-term child outcomes.

(which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprintthis version posted October 31, 2022. ; https://doi.org/10.1101/2022.10.29.22281681doi: medRxiv preprint

NOTE: This preprint reports new research that has not been certified by peer review and should not be used to guide clinical practice.

INTRODUCTION

In 2021, the American Academy of Pediatrics

(AAP)1 made a paradigm-shifting statement –

promoting early relational health (ERH), or the

ability to form and maintain safe, stable, and nur-

turing parent/caregiver-child relationships, is a

priority in pediatrics. There is incontestable evi-

dence that exposure to adverse childhood experi-

ences (ACEs), including maltreatment and abuse,

poverty, racism, and household dysfunction, con-

veys risk for adverse mental and physical health

outcomes across the life-course.2,3 ACE-associ-

ated adverse outcomes range from biological

changes, like altered immune and inflammatory

responses, or altered vagal regulation,4,5 to life-

long impacts like decreased executive function-

ing and cognitive skills,6-9 mental illness, obesity,

diabetes, cardiovascular disease,10,11 and lower

income.12 In North America, the total annual cost

associated with ACEs is estimated at $748 bil-

lion.13 Conversely, there is emerging evidence

that ERH plays a fundamental role in child phys-

ical health, cognitive and socioemotional devel-

opment, well-being,14-16 resilience building, pro-

tection against the negative effects of ACEs1,4,17-

19, as well as parent/caregiver mental health.20

The AAP’s policy statement therefore posits that

interventions that promote ERH might buffer the

impact of ACEs leading to a high return on in-

vestment for society in improving the health and

well-being of both children and their par-

ents/caregivers.

ERH has been studied from a variety of the-

oretical perspectives, and thus encompasses

many concepts which all aim at describing the

healthy or impaired components of the relation-

ship that forms between infants and their par-

ents/caregivers. Bonding and attachment are

terms that are often erroneously used inter-

changeably.21 Four decades ago, Klaus and Ken-

nell22 initially conceptualized bonding as a unidi-

rectional mother-to-infant emotional tie fixed

during the immediate postpartum period.23 Con-

temporary literature still posits bonding as a ma-

ternally-driven concept, characterized by the

feelings mothers have for their infant, from birth

and beyond.24 Caregiver behaviors, often de-

scribed as sensitive or responsive, constitute an-

other caregiver-driven component of ERH. Many

systematic reviews have established sensitive,25-

27 responsive23,27,28, and synchronous27

paremt/caregiver behaviors as the main early pre-

dictors of later child attachment quality.

Attachment is a child-centered manifestation

of ERH. Child-to-parent/caregiver attachment

develops over time, 29 and this tie can be classi-

fied into three categories: secure, insecure-am-

bivalent, or insecure-avoidant.30 Bowlby showed

that children with secure attachment are more

likely to have an available and responsive care-

giver,31 who acts as a base for developing optimal

social and behavioral skills.32,33 Conversely, chil-

dren with insecure attachment patterns are at

greater risk for poor interpersonal and cognitive

skills,34,35 depression,36 anxiety,37 as well as eat-

ing,38 post-traumatic,39 and obsessive-compul-

sive disorders.40 Additionally, children with inse-

cure attachment can be characterized as disor-

ganized,41 which is a predictor of poor socio-

emotional functioning.42

Finally, parent/caregiver-infant relation-

ships can also be viewed through a dyadic lens,

such as the lenses of emotional connection,43

emotional availability,44 dyadic synchrony,45 dy-

adic attunement46 or dyadic mutuality,47 in which

strong dyadic parent/caregiver-child interactions

are mutually sensitive and reciprocal. While var-

ious theoretical constructs define the origins and

mechanisms of healthy and impaired caregiver-

infant relationships differently, at their core, they

are unified by the incontestable evidence sup-

porting the role of strong parent/caregiver-infant

relationships. Therefore, we use “ERH” as a

blanket term for all concepts describing the tie

between parents/caregivers and infants, indis-

criminate to their theoretical origins, which are

outside of the scope of this systematic review.

As ERH crucially relies on how parent/care-

giver and infant come together as a dyad,43,48,49

the overarching aim of this systematic review is

to determine the effectiveness of contemporary

early dyadic parent/caregiver-infant

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interventions in both fostering ERH, as well as in

promoting secondarily associated outcomes, i.e.,

child socio-emotional functioning and develop-

ment, and parent/caregiver mental health. The as-

sociation between the dose of dyadic intervention

provided in infancy and overall effect estimates

is also explored.

METHODS

This systematic review follows Preferred Report-

ing Items for Systematic Reviews and Meta-

Analyses (PRISMA) guidelines (eTable1),50 and

was registered prospectively in International Pro-

spective Register of Systematic Reviews (PROS-

PERO; registration number: CRD42022329894).

Abbreviated methods are included here, and de-

tailed methods are presented in eMethods1.

Eligibility Criteria

Randomized controlled trials (RCT) of any type

published on or after January 1, 2000, in English

or French and comparing an early dyadic par-

ent/caregiver-infant intervention to any compar-

ator.

Population. Any parent/caregiver-child dyad.

Intervention. “Dyadic” interventions, defined as

targeting at least one primary caregiver and the

infant together, with at least one intervention ses-

sion occurring within the first 6 months postpar-

tum. Prenatal interventions without postnatal ses-

sions were excluded. No exclusion criteria for in-

tervention length or intensity.

Comparator. Any type, i.e., control or active in-

tervention.

Outcomes. Primary outcome domain was ERH

measures, e.g., attachment, sensitivity, bonding,

emotional connection. Secondary outcome do-

mains were child socio-emotional functioning

and development, and parent/caregiver mental

health. Secondary outcomes were only consid-

ered in studies where at least one ERH outcome

was measured.

Information Sources and Search Strategy

PubMed, Medline, Cinhal, ERIC, and PsycInfo

via EBSCO were searched on April 28, 2022 and

targeted two concepts: (1) parent/caregiver-in-

fant dyadic interventions and (2) ERH (full

search strategies in eMethods2). Unpublished

and ongoing studies were identified in clinical

trial registries (clinicaltrials.gov, ISRCTN Re-

gistry, EU Clinical Trials Register, Australian

New Zealand Clinical Trials Registry) and au-

thors contacted. Backward/forward reference-

searching of included studies was conducted.

Selection Process

Identified studies were uploaded to EndNote

V9.3.351 then Covidence.52 Duplicates were re-

moved. Studies were screened for eligibility in-

dependently by teams of two authors. Disagree-

ments were resolved by the first author. The same

process was followed for full-text review of po-

tentially eligible studies. Reasons for exclusion

were documented at the full-text screening stage.

Data collection process

Data extraction was performed in duplicate and

independently, using a data extraction form spe-

cifically developed for this review. Consensuses

were resolved by the first author.

Study-level. Aim, study design, number of

groups, target population, inclusion and exclu-

sion criteria, group differences, unit of randomi-

zation, sample size, withdrawals.

Intervention-level. Based on the Template for In-

tervention Description and Replication (TI-

DieR)53: intervention name, framework or under-

lying theory, rationale, materials, dyadic and

non-dyadic procedures, provider(s), location(s),

dose, intensity.

Result-level. Outcome name, scale, procedure

description for observational outcomes, timing

assessment, infant age, means/medians, standard

deviations (SD), standard error (SE), 95% confi-

dence interval (95%CI)/ Inter Quartile Range

(IQR)/ events (for binary outcomes).

Raw unadjusted means analyzed in intention-

to-treat were preferred over adjusted means/me-

dians. SE, 95%CI and IQR were converted to

SDs following Cochrane guidelines.54 If numeri-

cal data were only presented in figures, data was

(which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

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extracted using Engauge Digitizer55 v12.1 or

PlotDigitizer56. Corresponding authors were con-

tacted for missing data.

Data Items, Effect Measures and Synthesis

Methods

Pairwise meta-analyses comparing intervention

versus control (standard care, attention control,

or active control) were performed separately on

four outcomes from the primary outcome domain

and eight outcomes from the secondary outcome

domains. Separate analyses were conducted per

time frame, defined by child’s age at assessment

(0-4, 5-12, 13-24, 25-60 months).

The unit of analysis was parent/caregiver-in-

fant dyad. A summary of methodological deci-

sions to avoid unit-of-analysis issues is presented

in eTable2. Continuous outcomes were analyzed

using weighted standardized mean differences

(SMD) with 95%CIs. Categorical variables were

analyzed using weighted odds ratios (OR) with

95%CIs. An inverse variance random-effects

model was chosen because of study design and

population-induced variability. Significance

level was set at 0.05. Cochran’s Q test and I2 sta-

tistic were used to assess the heterogeneity and

I2>50% or p<0.10 indicated statistically signifi-

cant heterogeneity.

Sensitivity analyses were conducted to de-

termine whether pooled effect estimates were ro-

bust to inclusion of cluster RCTs, inclusion of ac-

tive controls, inclusion of long-term follow-ups,

and inclusion of studies with a high risk of bias.

Associations between intervention dose (in pro-

vider minutes) and effect estimates were ex-

plored with a meta-regression using a random-ef-

fects DerSimonian Laird model, with minutes as

predictors and SMD or log-OR as outcomes.

Analyses were conducted on each outcome pool-

ing at least 10 studies.57

Analyses were conducted with Review Man-

ager V5.458 or SPSS V24.59

Study Risk of Bias and Certainty Assessment

Two independent authors assessed risk of bias in

individual studies using Cochrane Collaboration

Risk of Bias Tool 2.60 Confidence in pooled out-

comes was based on Grades of Recommendation,

Assessment, Development and Evaluation

(GRADE) guidelines.61 Summary of findings ta-

bles were generated using GRADE profiler

Guideline Development Tool software and

GRADE criteria (2015, McMaster University

and Evidence Prime Inc.). Within the GRADE

assessment, risk of publication bias was esti-

mated by funnel plot inspection.

RESULTS

Study-Level Characteristics

A total of 93 primary studies (n=14,993 par-

ent/caregiver-infant dyads) were identified (Fig-

ure 1). Most study designs were parallel-group

RCTs (n=79, 85%), nine were cluster RCTs

(10%), and five were pragmatic RCTs (5%).

Across studies reporting demographic character-

istics (n=77), the sample is comprised of

48.87±7.30% female infants and 94.79±20.92%

biological mothers. The predominant population

was parents and their preterm or low birthweight

infants (n=31, 33.3%), followed by mothers with

a confirmed diagnosis of any psychopathology

(n=16, 17.2%), parents of low socio-economic

status (n=12, 12.9%), parents with two or more

risk categories (n=10, 10.8%), first-time mothers

(n=5, 5.4%), infants with early health or devel-

opmental conditions (n=3, 3.2%), foster or adop-

tive parents (n=3, 3.2%), adolescent mothers

(n=2, 2.2%), dyads at increased risk for maltreat-

ment (n=2, 2.2%), and mother-infant dyads in

prison (n=1, 1.1%). Only one study (1.1%) spe-

cifically targeted father-infant dyads, and 7

(7.5%) targeted parent/caregiver-infant dyads

without any particular risk factor. Full study-

level characteristics are presented in eTable3.

Twelve parent/caregiver-reported, and 41 obser-

vational assessments of ERH were identified and

thoroughly described in eMethods3 and eMeth-

ods4, respectively.

Intervention-Level Characteristics

Main intervention characteristics are presented in

Table 1 and interventions are thoroughly

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Figure 1. PRISMA flow diagram

described in eMethods5. We found that early dy-

adic interventions could be classified into 11 cat-

egories, focusing on: sensitivity (infant observa-

tion/interaction/social communication) (n=24,

24.81%), video feedback (n=21, 22.58%), attach-

ment (n=14, 15.05%), skin-to-skin contact/baby-

wearing (n=7, 7.53%), infant massage/touch

(n=6, 6.45%), music/maternal voice (n=6,

6.45%), Playing and Learning Strategies (PALS)

(n=5, 5.38%), Parent Infant Transaction Program

(MITP) (n=4, 4.30%), Auditory-Tactile-Visual-

Vestibular (ATVV) (n=3, 3.23%), Happiness,

Records identified from:

PubMed (n = 8742)

CINAHL (n = 1075)

Medline (n = 1127)

PsycInfo (n = 1100)

ERIC (n = 213)

Registers (n = 0)

Hand searching (n = 9)

Duplicate records removed by automation

tool (n = 1535)

Records screened

(n = 10731)

Records excluded

(n = 10434)

Reports sought for retrieval

(n = 297)

Reports not retrieved

(n = 0)

Reports assessed for eligibility

(n = 297)

Reports excluded (n = 186):

Wrong type of paper (e.g., protocol,

abstract) (n = 46)

Not English or French (n = 4)

Wrong study design (not RCT) (n = 44)

Intervention not dyadic (n = 34)

Wrong timing of intervention (n = 33)

No relational health outcome (n = 25)

RCTs included in review

(n = 93)

Reports of included RCTs

(n = 110)

RCTs included in meta-analysis

(n = 80)

Identification

Screening

Included

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Understanding, Giving and Sharing (HUGS)

(n=2 studies, 2.15%), and cognitive/motor devel-

opment (n=1, 1.08%). Interventions averaged

10.64±12 (min-max: 0-72) sessions of

60.09±30.5 (min-max: 0-175) minutes each, for

an overall mean total dose of 797.31±1,211.30

(min-max: 0-8,640) minutes. Providers were

mostly nurses (n=26, 28%). Other providers in-

cluded therapists (n=10, 10.8%), mixed

healthcare professionals, e.g., nurses, and/or so-

cial workers, and/or psychologists (n=9, 9.7%),

PhDs or MDs (n=9, 9.7%), master’s prepared

professionals (n=6, 6.5%), parents (n=6, 6.5%),

or trained non-healthcare workers (n=3, 3.2%).

The rest had no provider (online intervention,

n=1, 1.1%) or unclassified providers (n=23,

24.7%). Interventions began prenatally (n=10,

10.8%), in-hospital perinatally (n=30, 32.3%),

within the first six months post-discharge (n=25,

25.8%), or at a less specific time (e.g., “any time

between birth to 3 years of age”, n=29, 31.2%).

Meta-Analysis Results

Meta-analytic results are shown in Figure 2. Sen-

sitivity analyses are presented in eTable4.

Dyadic Interventions Promote ERH

After participating in a dyadic intervention, par-

ents/caregivers self-report significantly higher

levels of bonding in the first 4 months postpartum

(SMD=0.80, 95%CI=[0.25, 1.34], p=0.004,

I2=94%), but not at 5-12 months (SMD=-0.10,

95%CI=[-0.46, 0.26], p=0.59, I2=81%). Obser-

vational assessments of parent/caregiver behav-

iors show improved sensitivity/responsivity in

the first 4 months postpartum (SMD=0.32,

95%CI =[0.09, 0.55], p=0.006, I2=76%), and this

effect is maintained at 5-12 months (SMD=0.37,

95%CI=[0.25, 0.49], p<0.001, I2=57%), 13-24

months (SMD=0.40, 95%CI=[0.10, 0.70],

p=0.008, I2=74%), and 25-60 months

(SMD=0.20, 95%CI=[0.10, 0.31], p<0.001,

I2=0%).

Dyadic interventions are also effective in in-

creasing odds of secure attachment (OR=1.44,

95%CI=[1.07, 1.93], p=0.01, I2=29%), and

decreasing odds of disorganized attachment

(OR=0.57, 95%CI=[0.41, 0.79], p<0.001,

I2=0%), in 12–18-month-old children. There are

no significant differences on insecure (OR=0.72,

95%CI=[0.50, 1.03], p=0.07, I2=34%) or orga-

nized attachment (OR=1.77, 96%CI=[0.92,

3.41], p=0.09, I2=43%) at the same age, or on se-

cure (OR=4.03, 95%CI=[0.29, 56.61], p=0.30,

I2=58%) and insecure attachment (OR=1.01,

95%CI=[0.44, 2.31], p=0.99, I2=0%) after 21

months of age.

Finally, parent/caregiver-child dyadic inter-

actions are significantly increased at 0-4 months

(SMD=0.19, 95%CI=[0.01, 0.36], p=0.04,

I2=48%), remaining significant at 5-12 months

(SMD=0.30, 95%CI=[0.11, 0.49], p=0.002,

I2=66%), but not 13-24 months (SMD=0.17,

95%CI=[-0.06, 0.34], p=0.17, I2=36%), or 25-60

months (SMD=0.39, 95%CI=[-0.16, 0.93],

p=0.17, I2=81%).

Sensitivity analyses generally affirmed these

results, but 0-4 months dyadic interactions and

12-18 months secure attachment becomes non-

significant, and organized attachment becomes

significant when removing studies at high risk of

bias, and 13-24 months sensitivity becomes non-

significant and secure attachment becomes sig-

nificant when removing long-term follow-ups

(eTable4).

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Table 1. Intervention Characteristics

Name of Interven-

tion

Study ID

Target

Population

Short Description

Provi-

der

Location

# Sessions with

provider

(length/session

[mins])

Length of

interven-

tion

Timing of 1st and

last session

Skin-to-skin contact (SSC)/Baby wearing

Skin-to-skin contact

(SSC)

*Chiu 200962

Preterm/

Low birth-

weight in-

fants

Mother-infant SSC.

Nurses

NICU

-- (--)

5 days

As soon as possi-

ble after birth, un-

til 2-5 days after

birth.

Contact Intervention

(kangaroo care)

*Feldman 201463

Preterm/

Low birth-

weight in-

fants

Mother-infant SSC (1hr

daily).

Nurses

NICU

14, daily (--)

14 days

Birth, until post-

natal wk 2.

Kangaroo Care

*Neu 201064

Preterm/

Low birth-

weight in-

fants

Nurse provided instruction

and encouragement in hold-

ing infants, adapted from

the kangaroo holding ap-

proach and helped parents

to recognize and respond to

infants’ cues.

Nurses

NICU and

Home

10: 4 biweekly

and 6 weekly

(45-60)

8 wks

Within 4 wks af-

ter birth, for 8

wks.

Skin-to-Skin Contact

(SSC)

*Rheinheimer 202265

Mothers

and in-

fants (no

risk fac-

tor)

Mother-infant SSC (1hr

daily).

Home

2 + weekly

phone calls (--)

Postna-

tal wk 5

From 34-36

weeks’ gestation

(prenatal informa-

tional session),

until postnatal wk

Continuous Skin to

Skin Contact (SSC)

*Sahlén Helmer 202066

Preterm/

Low birth-

weight in-

fants

Mother-infant continuous

SSC.

Nurses

NICU

Instructions +

daily SSC (--)

7 days

Birth, until post-

natal day 7.

Community-initiated

Kangaroo Mother

Care (ciKMC)

*Taneja 202067

Preterm/

Low birth-

weight in-

fants

Home visits to explain and

initiate SSC, breastfeeding,

and parental support.

Mixed

profe-

ssionals

Home

9 (--)

28 days

Discharge from

hospital, until

postnatal day 28.

Infant Carrier

Williams 202068,69

Low SES,

Adolescent

mothers

Formal instruction from a

certified babywearing edu-

cator on how to use the car-

rier. Caregivers were en-

couraged to babywear for a

minimum of 1hr, daily.

Home

1 (--)

6 mo

2-4 weeks post-

partum, until 6.5-

7mo of age.

Music/Maternal Voice

Maternal singing

Cevasco 200870

Preterm/

Low birth-

weight in-

fants

Mothers sang lullabies that

were recorded and played

for infants during their

NICU stay.

NICU

1 (20-60)

Mean of

13.3

days

Birth (average 4-

17 days), until

discharge from

NICU.

Music therapy

*Corrigan 202171

Preterm/

Low birth-

weight in-

fants

Mothers were provided with

a custom CD of the infant’s

heartbeat mixed with a song

that was meaningful to them

and were instructed to use

the recording as they

wished.

Thera-

pists

NICU

1 (--)

1 wk

As soon as possi-

ble after birth dur-

ing NICU stay,

until postnatal day

Music Therapy

*Gaden 202272

Preterm/

Low birth-

weight in-

fants

Parent-led, infant-directed

singing supported by a mu-

sic therapist.

Thera-

pists

NICU

3/week: maxi-

mum of 27,

mean 9.98 (30)

Through-

out NICU

stay

Birth, until dis-

charge from

NICU.

Contingent Lullaby

*Robertson 201973

Parents

and in-

fants (no

risk fac-

tor)

Parents wrote an original

lullaby with researcher and

were instructed to sing

when the infant is in alert,

receptive state.

Thera-

pists

Hybrid:

hospital

and home

1 (--)

Up to 6

wks

24-hr after birth,

until postnatal wk

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The copyright holder for this preprintthis version posted October 31, 2022. ; https://doi.org/10.1101/2022.10.29.22281681doi: medRxiv preprint

Name of Interven-

tion

Study ID

Target

Population

Short Description

Provi-

der

Location

# Sessions with

provider

(length/session

[mins])

Length of

interven-

tion

Timing of 1st and

last session

Singing Intervention

*Wulff 202174

Maternal

psycho-

pathology

Singing- and music-based

interactions were facilitated

between parent-infant dy-

ads.

Thera-

pists

Home

1-3 (45)

10 wks

Postnatal wk 2,

until postnatal

week 12.

Maternal Voice Re-

cording

*Yu 202275

Preterm/

Low birth-

weight in-

fants

Recording of maternal

voice was obtained and

played to their infant start-

ing before and during heel

stick procedures in the

NICU.

NICU

1 (--)

3 days

3rd day after de-

livery, in NICU

Playing and Learning Strategies (PALS)

My Baby and Me

*Akai 200876

Low SES

Semi-structured interviews,

sensitivity training, discus-

sion, and practice to im-

prove sensitivity (PALS).

Parents

Home

12-14 (90)

Mean of

15.3

wks

Postnatal 3.5-

5.5mo, until 8-

10mo.

Internet-adapted

PALS program (In-

fant-Net)

Baggett 201077

Low SES

Computer program that

used videos that sought to

improve parents' sensitivity

to infants' signals and be-

haviors.

Mixed

profe-

ssionals

Home

-- (15 for intro-

duction)

6 mo

Postnatal 3-8mo,

until 9-12 mo.

Baby-Net (ePALS)

Baggett 201778

Low SES

Elevated

risk of

maltreat-

ment

Online adaptation of PALS

home visiting content fo-

cused on observation and

interpretation of infant cues.

Mixed

profe-

ssionals

Home

11 internet-

based sessions +

coach calls (30

for coach calls)

6 mo

Postnatal 3.5-

7.5mo, until 9.5-

13.5mo.

Adapted Play and

Learning Strategies

program (ePALS)

*Feil 202079

Low SES

English/Spanish computer

program incorporating vid-

eos that sought to improve

parents' sensitivity to in-

fants' signals and behaviors.

Mixed

profe-

ssionals

Home

11 internet-

based sessions +

1 coach session

(--)

11 wks

Postnatal 3.5-

7.5mo, until 14.5-

18.5mo.

Playing and Learn-

ing strategies

(PALS)

Landry 200680

Low SES,

Preterm/

Low birth-

weight in-

fants

In-person intervention in-

volved coaching parents to

try to improve responsive

parenting behaviors em-

ploying video feedback as

one component.

Home

10, weekly (90)

Mean of

14.5

wks

Postnatal month

6, until 10mo of

age.

Infant massage/Touch

Touching and ca-

ressing; tender in

caring (TAC-TIC)

*Barnes 202281

Preterm/

Low birth-

weight in-

fants

Parents were taught a spe-

cific protocol of systematic

touch.

NICU

11 (3)

10 days

Postnatal day 28

(mean of 11.7

[4.2]), for 10

days.

Massage class + Sup-

port group

*Onozawa 200182

Maternal

psycho-

pathology,

First time

mothers

Infant massage sessions and

support groups designed to

help parents recognize and

respond to infant cues.

Hospital

5 massage class

(60) + 5 support

group (30)

5 wks

Postnatal week 9,

until postnatal

week 14.

Infant Massage-Par-

enting Enhancement

Program (IMPEP)

*Porter 201583

Maternal

psycho-

pathology

Group-based massage and

psychoeducation to improve

maternal confidence.

Nurses

Classroom

4, weekly (120-

240)

4 wks

First year of life,

for 4wks.

Occupational Ther-

apy Intervention

Sajaniemi 200184

Preterm/

Low birth-

weight in-

fants

Parents were thought to use

stimulation to help their in-

fant cope with the sensory

demands of social and phys-

ical world, and to help sen-

sitize parents to infant’s be-

havioral cues.

Thera-

pists

Home

24, weekly (60)

6 mo

Postnatal month

6, until 12mo of

age.

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The copyright holder for this preprintthis version posted October 31, 2022. ; https://doi.org/10.1101/2022.10.29.22281681doi: medRxiv preprint

Name of Interven-

tion

Study ID

Target

Population

Short Description

Provi-

der

Location

# Sessions with

provider

(length/session

[mins])

Length of

interven-

tion

Timing of 1st and

last session

Massage interven-

tion

*Shoghi 201885

First time

mothers,

Preterm/

Low birth-

weight in-

fants

Parents were taught to per-

form massages on their in-

fants and were overseen by

the interventionist as they

performed their first mas-

sage on their infant.

NICU

2 training ses-

sions (60) +

daily massage

sessions (15)

5 days

During NICU

stay.

Infant intervention

*Teti 200986

Preterm/

Low birth-

weight in-

fants

Combined psychoeducation,

administration of the Brazel-

ton Neonatal Behavioral As-

sessment Scale (NBAS), and

maternally administered in-

fant massage.

Home

8 (60-120)

20 wks

Postnatal 34-

38wks of cor-

rected age, until

3-4mo of cor-

rected age.

Video Feedback

Maternal Sensitivity

Program

*Alvarenga 202087

Low SES

Used a video intervention

model, where parents were

filmed while playing with

their babies, rewatched the

video with the intervention-

ist, and discussed ways to

facilitate the infant’s devel-

opment.

PhDs;

MDs

Home

8 (60)

7 mo

Postnatal month

3, until 10mo of

age.

Video Interaction

Guidance (VIG)

*Barlow 201688

Preterm/

Low birth-

weight in-

fants

Used a combination of video-

feedback (focused on

mealtimes) and self-guided

therapy to improve maternal

eating disorders, prevent or

reduce parent-infant conflict,

and enhance parent-child in-

teraction.

Home

3 (--)

NICU discharge,

until unclear.

Early intervention

program

*Borghini 201489

Preterm/

Low birth-

weight in-

fants

Multi-components, including

NBAS assessment, joint obser-

vation where parents were en-

couraged to comment on the in-

fant’s reaction and behavior,

semi-structured interviews, and

interaction guidance based on

free play.

Nurses

Hybrid:

NICU and

home

4: 1 (30-60) + 3

(40-60)

~22 wks

33wks postcon-

ceptional age, un-

til 4mo corrected

age.

Parent-centered in-

tervention program

*Brisch 200390

Preterm/

Low birth-

weight in-

fants

Attachment-oriented group

and individual psychother-

apy sessions, as well as

video-based sensitivity

training.

Nurses

Hybrid:

NICU and

home

12 (--)

3 mo

Birth, until 3mo

corrected age.

Video Interaction

Project (VIP)

*Cates 201891

Low SES

Videorecording during play

that is reviewed with an inter-

ventionist to promote mater-

nal self-reflection and rein-

force positive parenting be-

haviors.

Pediatric

primary

care

Up to 15 (25-

30)

Up to 3

yrs

Birth, until 3yrs

old.

Adaptation of Step

Towards Effective and

Enjoyable Parenting

(STEEP-b)

*Firk 202192

Adolescent

mothers

Employs video-feedback

techniques to target mater-

nal attachment representa-

tions and to enhance social

support.

PhDs;

MDs

Home

12 to 18 (--)

9 mo

Postnatal month

3-6 (mean of 5.4),

until 12-15mo of

age.

Video Interaction

Guidance (VIG)

*Hoffenkamp 201593

Preterm/

Low birth-

weight in-

fants

Recording and reviewing

video recordings of parent-

infant interactions, using

positive reinforcement to

emphasize communication

Nurses

NICU

3 (--)

1 wk

Birth, until post-

natal day 7.

(which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprintthis version posted October 31, 2022. ; https://doi.org/10.1101/2022.10.29.22281681doi: medRxiv preprint

Name of Interven-

tion

Study ID

Target

Population

Short Description

Provi-

der

Location

# Sessions with

provider

(length/session

[mins])

Length of

interven-

tion

Timing of 1st and

last session

and moments of responsive

parenting.

Video Feedback of

Infant-Parent Inter-

action (VIPI)

*Høivik 201594

Infant

with early

health or

develop-

mental

conditions

Individually tailored video-

feedback sessions that tar-

get parental sensitivity.

Mixed

profe-

ssionals

Home

At least 6 con-

sultations with

the opportunity

for more; 8

video feedback

sessions (30)

2-3 mo

Birth to 24mo old

(mean of 7.3),

from maximum 3

mo.

Book with Video

Feedback via home

visits

*Juffer 200595

Foster/

Adoptive

parents

Video-feedback on parent-

infant interaction that fo-

cused on sensitive respon-

siveness.

Home

3 (60)

3 mo

Postnatal month

6, until 9mo of

age.

Video-Feedback In-

tervention to Pro-

mote Positive Par-

enting (VIPP)

*Klein Velderman

200696,97

First time

mothers

Standardized video-feed-

back sessions of parent-in-

fant interactions.

Mixed

profe-

ssionals

Home

4 (90)

3-4 wks

Mean of 6.83mo,

for approximately

1 month.

Education Program

*Magill-Evans 200798

Fathers

and their

infants

A father-focused, video-

feedback intervention.

Home

2 (60)

1 mo

Postnatal month

5, until 6mo of

age.

Video Interaction

Project (VIP)

*Mendelsohn 200799

Low SES

Videorecording during play

that is reviewed with an in-

terventionist to promote

self-reflection and reinforce

positive parenting behav-

iors.

Pediatric

primary

care

Maximum of 12

(30-45)

3 yrs

First well-child

visit, until 3yrs of

age.

Promoting First Re-

lationships (PFR)

*Oxford 2021100

Maternal

psycho-

pathology

Caregiver-child interactions

that are recorded and used

to guide discussion focusing

on parenting strengths and

interpretating infants' cues.

Master's

prepared

Home

9 to 10 (60-75)

9-10

wks

Postnatal wk 8-

12, for 10 wks.

Circle of Security In-

tervention (COS-I)

*Ramsauer 2020101

Maternal

psycho-

pathology

Group sessions with thera-

pists that covered maternal

emotion, cognition, and

self-reflection, and occa-

sionally used video feed-

back.

PhDs;

MDs

20 (90)

20 wks

Postnatal 4-9mo

(mean of 6.03),

for 20 wks.

Smart Beginnings:

Video Interaction

Project (VIP) +

Family Check-Up

*Roby 2021102,103

Low SES

Coaches record and review

parent-child interactions,

highlighting parental

strengths and helping care-

givers to plan for their inter-

actions with the infant at

home.

Pediatric

primary

care

14 (25-30)

Varia-

ble, can

be de-

livered

during

first

three

years of

life

Birth, until to 3yrs

of age.

Video-Feedback In-

teractional Treat-

ment

*Stein 2006104

Maternal

psycho-

pathology

Targeted parent-infant inter-

actions during mealtime

that used video-feedback.

Thera-

pists

Home

13 (60)

6-8 mo

Postnatal month

4-6, until 12mo of

age.

(which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprintthis version posted October 31, 2022. ; https://doi.org/10.1101/2022.10.29.22281681doi: medRxiv preprint

Name of Interven-

tion

Study ID

Target

Population

Short Description

Provi-

der

Location

# Sessions with

provider

(length/session

[mins])

Length of

interven-

tion

Timing of 1st and

last session

Video-Feedback

Therapy (VFT) +

Cognitive Behavioral

Therapy (CBT)

*Stein 2018105

Maternal

psycho-

pathology

Video-feedback interac-

tional treatment that aimed

to prevent or reduce parent-

infant conflict and enhance

parent-child interaction in

addition to guided cognitive

behavior self-help for eating

disorders.

Thera-

pists

Home

13: 11 sessions

before 12

months + 2

boosters before

24 months (90)

15-19

Postnatal month

4.5-9mo postpar-

tum, until 2yrs of

age.

Compétences Paren-

tales et Attachement

dans la Petite En-

fance: Diminution

des risques liés aux

troubles de santé

mentale et Promotion

de la resilience Pro-

ject (CAPEDP)

Tereno 2017106

Low SES,

First time

mothers

Instructional materials, in-

cluding brochures and

DVDs, but also video feed-

back, to promote secure at-

tachment.

PhDs;

MDs

Home

44 (60)

24-27

Prenatal (3rd tri-

mester), until 2yrs

of age.

Video feedback

*Tryphonopoulos

2020107

Maternal

psycho-

pathology

Video recording and feed-

back of parent-infant teach-

ing interactions.

Nurses

Home

3 (mean of

74.79 minutes)

6 wks

Postnatal month

6, until 7.5mo of

age.

Preterm Infant–Par-

ent Programme for

Attachment (PIPPA)

*Twohig 2021108

Preterm/

Low birth-

weight in-

fants

Semi-structured interview

with parents covering vari-

ous aspects of the pre-,

ante-, and postnatal periods.

The third session was a re-

view of edited and prepared

clips of optimal parent-in-

fant interaction.

PhDs;

MDs

NICU

3 (50-90)

2-4wks after birth

in NICU, before

NICU discharge.

Parent-Baby inter-

vention

*van Doesum

2008109,110

Maternal

psycho-

pathology

Video-feedback of parent-

child interactions, using

techniques such as model-

ing and infant massage.

Master’s

prepared

Home

8 to 10 (60-90)

3-4 mo

Birth to 12mo of

age, for 3-4mo.

Sensitivity interventions: Infant observation/Interaction/Social communication

Family Nurture In-

tervention (FNI)

*Hane 2015111-114

Preterm/

Low birth-

weight in-

fants

Emotional exchange, skin-

to-skin contact, and scent-

cloth exchange to facilitate

parent-infant emotional

connection.

Nurses

NICU

Mean of 17.5

(mean of 109)

~5 wks

Birth (mean of 7

days), until dis-

charge from

NICU.

Sugira Muryango

*Betancourt 2020115

Low SES

Parenting coaching to pro-

mote play, nutrition, and

hygiene, as well as live

feedback of parent-child in-

teractions.

Home

12 (90)

3-4 mo

Postnatal month

3-36, for 3-4mo.

Demonstration and

interaction (Assess-

ment of Preterm In-

fant Behavior

(APIB))

*Browne 2005116

Preterm/

Low birth-

weight in-

fants

Eliciting, observing, and

discussing newborn behav-

iors.

Nurses

NICU

1 (45)

During NICU

stay.

Home Visitation and

Group Intervention

Constantino 2001117

Parents

and in-

fants (no

risk fac-

tor)

Educational videos, discus-

sion, journaling, and men-

tored practice with play

techniques.

Master’s

prepared

10 (60)

10 to 20

3–18mo (mean of

8.3); for 10 to

20wk

(which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprintthis version posted October 31, 2022. ; https://doi.org/10.1101/2022.10.29.22281681doi: medRxiv preprint

Name of Interven-

tion

Study ID

Target

Population

Short Description

Provi-

der

Location

# Sessions with

provider

(length/session

[mins])

Length of

interven-

tion

Timing of 1st and

last session

Mother-Infant Rela-

tionship Intervention

*Cooper 2009118,119

Low SES

Supportive counseling and

items from the neonatal be-

havioral assessment

(NBAS) to sensitize parents

to their infant’s capacities

and needs.

Trained

non-

health-

care

workers

Home

16 (60)

6 mo

Late pregnancy,

until 5mo postpar-

tum

Index (R-HV)

*Cooper 2015120

Maternal

psycho-

pathology

Used three components:

supportive counseling,

items from the neonatal be-

havioral assessment

(NBAS), and specific, tar-

geted strategies to manage

infant behavioral problems.

Home

11 (--)

Up to 6

Prenatal (20wks

gestation), until

16wks postpar-

tum.

Parent Baby Inter-

action Program

(PBIP)

*Glazebrook 2007121

Preterm/

Low birth-

weight in-

fants

Combination of tactile, dis-

cussion, verbal, and obser-

vational techniques to im-

prove maternal sensitivity.

Nurses

Hybrid:

NICU and

home

Mean of 8.04

(60)

Up to 6

wks af-

ter

NICU

dis-

charge

Birth (NICU hos-

pitalization), op-

tional 6wks cor-

rected age.

Parent Participation

Improvement Pro-

gram

*Heo 2019122

Preterm/

Low birth-

weight in-

fants

Parental participation in

nursing care as well as the

identification of, and reflec-

tion about caretaking and

infant interaction.

Nurses

NICU

9 structured ses-

sions + individ-

ualized interac-

tion at initial

phase (50-60)

2 wks

Mean of 33.6wks

of corrected age,

for 2wks during

NICU stay.

My Baby’s First

Teacher (MBFT)

*Herbers 2020123

Low SES

Group sessions that fol-

lowed an education curricu-

lum, emphasizing the im-

portance of healthy early

developmental milestones.

Group sessions also in-

volved video modeling to

demonstrate skills and inter-

actions (participants them-

selves were not recorded).

Shelters or

community

locations

5 (60-90)

5 wks

Birth to 12mo of

age (mean of 6.43),

for 5wks.

Interaction Coach-

ing for At-Risk Par-

ents (ICAP)

*Horowitz 2001124

Maternal

psycho-

pathology

Teaching, guidance, demon-

stration, and positive rein-

forcement during parent-in-

fant face-to-face interac-

tions

Nurses

Home

3 (15)

8-14

wks

Postnatal wk 4,

until 18wks post-

partum.

Communicating and

Relating Effectively

(CARE)

*Horowitz 2013125

Maternal

psycho-

pathology

Teaching and behavioral

coaching about interpreting

infant’s cues.

Nurses

Home

6 (30-40)

5 mo

Postnatal wk 4,

until 6mo postpar-

tum.

The Getting Ready

Intervention

*Knoche 2012126

Low SES

Used strategies to improve

the parent’s attentiveness to

their child’s strengths, en-

couraged sharing, suggest-

ing, and discussing develop-

mental expectations, and

brainstorming collabora-

tively with parents around

issues related to the child’s

social, motor, cognitive, or

communicative develop-

ment and learning.

Mixed

profe-

ssionals

Home

Mean of 45.8

(60-90)

16 mo

Birth to 24mo of

age (mean of

11.02), for 16mo.

Newborn Behavioral

Observations (NBO)

*Kristensen 2020127

Parents

and in-

fants (no

risk fac-

tor)

Combination of observation

of the infant and active in-

volvement of the parent in a

shared dialogue aimed to

identify and interpret infant

behaviors.

Nurses

Home

4 (12-25)

2-3 mo

Postnatal wk 3,

until 3mo postpar-

tum.

(which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprintthis version posted October 31, 2022. ; https://doi.org/10.1101/2022.10.29.22281681doi: medRxiv preprint

Name of Interven-

tion

Study ID

Target

Population

Short Description

Provi-

der

Location

# Sessions with

provider

(length/session

[mins])

Length of

interven-

tion

Timing of 1st and

last session

Guided Participation

to Infant Positioning

(GP_Posit)

*Lavallée 2022128

Preterm/

Low birth-

weight in-

fants

Nurses worked with parents

to strengthen maternal abil-

ity to detect infant behav-

ioral stress and stability

cues, with the goal of im-

proving maternal sensitivity

and developing communica-

tion skills with their infants.

Nurses

NICU

4 (30-45)

NICU

stay

Birth (preterm),

until 35wks cor-

rected age.

The Infant Behav-

ioral Assessment and

Intervention Pro-

gram (IBAIP)

*Meijssen 2010129-131

Preterm/

Low birth-

weight in-

fants

Uses the Infant behavioral

assessment to sensitize par-

ents to their baby’s re-

sponses to sensory infor-

mation.

Thera-

pists

Home

6 to 8 (60)

6-8 mo

NICU discharge,

until 6-8mo of

age.

Creating Opportuni-

ties for Parent Em-

powerment (COPE)

*Melnyk 2006132

Preterm/

Low birth-

weight in-

fants

4-part intervention, deliv-

ered via audiotapes and

written materials, that

taught parents and infant

development and infants’

behavioral cues to facilitate

interactions.

None

NICU

0 (0)

Variable

based

on ges-

tational

age at

birth

2-4 days after

birth, until wk

post discharge.

Newborn Behavioral

Observations (NBO)

System

Nugent 2017133

Parents

and in-

fants (no

risk fac-

tor)

Combination of observation

of the infant and active in-

volvement of the parent in a

shared dialogue aimed to

identify and interpret infant

behaviors.

Hybrid:

home and

hospital

2 (12-25)

1 mo

Within 2 days af-

ter birth, until

1mo postpartum

Incredible Years

Parents and babies

(IYPB)

*Pontoppidan

2016134,135

First time

mothers

Group sessions where par-

ents receive educational

material, including video

content, to learn and refine

parenting skills.

8 (120)

8 wks

Discharge from

hospital to 4mo

after discharge

(mean of 1.59mo),

for 8wks.

Nurture and Play

(NaP)

*Salo 2019136

Maternal

psycho-

pathology

Group sessions that in-

volved interaction therapy

and incorporated infant

massage, singing, rhythmic

movements, and activating

maternal reflectiveness

about her pregnancy, mater-

nal representations of her

childhood history, as well

as their present experience

of parenthood.

11 (90)

9-11

wks

Pregnancy, until

7wks postpartum.

Home Intervention

Based on Infant

Health and Develop-

ment Program

(IHDP)

*Schuler 2000137,138

Maternal

psycho-

pathology

A multi-pronged, home-

based intervention that

sought to improve infant-

parent interaction through

maternal empowerment and

the optimization of infant

development. The infant-fo-

cused component used

games and activities, while

the parent-focused aspect

taught parents how to use

family and social supports

to manage self-identified

problems.

Trained

non-

health-

care

workers

Home

Mean of 8.9

home visits

(mean of 30.1

minutes)

6 mo

Postnatal week 2,

until 6mo of age.

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Name of Interven-

tion

Study ID

Target

Population

Short Description

Provi-

der

Location

# Sessions with

provider

(length/session

[mins])

Length of

interven-

tion

Timing of 1st and

last session

Baby Triple P

*Tsivos 2015139

Maternal

psycho-

pathology

Involved interventionist

feedback and parental self-

evaluation.

Master’s

prepared

Home

8: 4 (60-90) +4

(40-60)

8 wks

Birth to 12mo of

age (mean of 6.7);

for 8 sessions.

Crianza Temprana

*Valades 2021140

Adolescent

mothers

Non-directive counselling

approach to sensitize the

parent to the infant’s cues

and engage them in social

interactions.

Trained

non-

health-

care

workers

Home

16 (60)

6-8 mo

Late pregnancy,

until 6mo postpar-

tum.

Maternal Support

for Becoming a

First‐Time Parent

(AMACOMPRI)

*Vargas-Porras

2021141

First time

parents

Nurse‐delivered home‐

based and telephone‐based

sessions of a multi-modal

nursing intervention.

Nurses

Home

8: in person (90-

120), phone

calls (15)

3-4 mo

Postnatal days 6-

10, until 4mo of

age.

Cues

*Zelkowitz 2011142,143

Preterm/

Low birth-

weight in-

fants

Observational exercises to

help sensitize parents to in-

fants’ behavioral cues.

Nurses

Hybrid:

NICU and

hospital

6 (60)

1-2 mo

NICU stay (mean

of 33 days after

birth), until 6-

8wks corrected

age.

Attachment-Based Interventions

Primeiros Laços

*Alarcão 2021144,145

Low SES,

Adolescent

mothers,

First time

parents

Custom-designed care plans

aimed to strengthen mater-

nal capacity for warm and

responsive care.

Nurses

Home

40-42 sessions by

12 months, 60-62

sessions by 24

months (--)

Up to 24

First trimester of

pregnancy, until

24mo of age.

Healthy Families

Durham (HFD)

*Berlin 2017146

Maternal

psycho-

pathology,

Adolescent

mothers,

First time

parents

Handouts, toys, and activi-

ties designed to encourage

parent-child interaction.

Master’s

prepared

Home

Mean of 28.69

(--)

1 yr

Before birth or

within first three

months postpar-

tum, until 12mo

of age.

Early Head Start

Plus Attachment and

Biobehavioral

Catch-up (ABC)

*Berlin 2018147

Low SES

Attachment-based interven-

tion where coaches ad-

dressed particular parenting

topics and provided com-

ments that connect parent-

ing behaviors to infant de-

velopment.

Parents

Home

10, weekly (--)

13 wks

Postnatal month

6-20 (mean of

12.7), for 10wks.

Attachment and Bi-

obehavioral Catch-

up Intervention

(ABC)

*Bernard 2012148

Elevated

risk for

maltreat-

ment

Attachment-based interven-

tion where coaches ad-

dressed particular parenting

topics and provided com-

ments that connect parent-

ing behaviors to infant de-

velopment.

Parents

Home or

Shelter

10, weekly (60)

10 wks

1 to 21mo of age,

for 10wks.

Attachment and Bi-

obehavioral Catch-

up Intervention

(ABC)

Bick 2013149

Foster/

Adoptive

parents

Promoting parental sensitiv-

ity through commenting

during spontaneous parent-

child interactions, struc-

tured activities, and by us-

ing video feedback.

Parents

Home

10, weekly (60)

10 wks

From 1 to 22mo

postpartum, for

10wks.

Attachment and Bio

behavioral Catch-up

Intervention (ABC)

Dozier 2009150

Foster/

Adoptive

parents

Promoting parental sensitiv-

ity through commenting

during spontaneous parent-

child interactions, struc-

tured activities, and by us-

ing video feedback.

Parents

Home

10 (60)

10 wks

Birth to 3yrs of

age, for 10wks.

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Name of Interven-

tion

Study ID

Target

Population

Short Description

Provi-

der

Location

# Sessions with

provider

(length/session

[mins])

Length of

interven-

tion

Timing of 1st and

last session

Parent–Infant Psy-

chotherapy (PIP)

*Fonagy 2016151

Low SES,

Maternal

psycho-

pathology

Dyadic psychotherapy ses-

sions that focused on paren-

tal and infant mental states

and parent-infant communi-

cation.

Thera-

pists

Mean of 16 (--)

12 mo

Birth to 12mo of

age (mean of 3.9),

for 12+mo.

Focused parent-in-

fant psychotherapy

(fPIP)

*Georg 2021152

Infant

with early

health or

develop-

mental

conditions

Targeted the parent’s inter-

nal representation of her in-

fant to improve the parent-

infant relationship.

PhDs;

MDs

Hospital

4: 3 (50) + 1

(90)

12 wks

4 to 15mo of age

(mean of 8.84),

for 12wks.

Attachment and Bi-

obehavioral Catch-

up (ABC)

*Perrone 2021153

Parents

and in-

fants (no

risk fac-

tor)

Promoting parental sensitiv-

ity through commenting

during spontaneous parent-

child interactions, struc-

tured activities, and by us-

ing video feedback.

Parents

Home

10 (60)

10 wks

5 to 22mo of age

(mean of 11.82),

for 10wks.

Minding The Baby

(MTB)

*Sadler 2013154-156

First time

mothers

Home-visiting program that

employed an interdiscipli-

nary, mentalization-based in-

tervention, covering topics

ranging from child health and

development, maternal men-

tal health, parenting, social

support, maternal life course,

maternal and infant mental

health, and environment and

safety.

Master's

prepared

Home

3-4 visits per

month for 2

years (45-90)

2 yrs

Prenatal (3rd tri-

mester), until 2yrs

of age.

Secure Attachment

Promotion Program

*Santelices 2010157

First time

mothers

Prenatal lectures, group dis-

cussions, observation, and

psychoeducation designed

to promote secure parent-in-

fant attachment.

PhDs;

MDs

Hybrid:

home and

hospital

10: 6 (120) + 4

(60)

~15 mo

Prenatal, until 1yr

of age.

New Beginnings In-

tervention

*Sleed 2013158

Mother-

infant dy-

ads in-

carce-

rated

Discussion, handouts, work-

sheets, and homework that

covered relationship pat-

terns between parents and

babies.

Thera-

pists

Mean of 7.1

(120)

4 wks

Birth to 23mo of

age (mean of 4.9),

for 4wks.

Group Attachment-

Based Intervention

(GABI)

*Steele 2019159

Elevated

risk for

maltreat-

ment

Parent-child interaction,

video filming and feedback,

a “reunion” episode follow-

ing filming, and a review of

video footage.

Clinic

72, 3/week

26 wks

Birth to 3yrs of

age, for 5.5mo.

SAFE

*Walter 2019160

Parents

and in-

fants (no

risk fac-

tor)

Attachment based parental

training that used psy-

choeducation and pre-rec-

orded videos to encourage

parental reflection.

Mixed

profe-

ssionals

Hospital

13: 10 group, 3

individual (--)

15 mo

Enrolled prena-

tally before 28wks

of gestation (mean

of 24.34wks), un-

til 12mo postpar-

tum.

Cognitive/motor development intervention

Curriculum and

Monitoring System

(CAMS)

*Badr 2006161

Infant

with early

health of

develop-

mental

conditions

Three-component interven-

tion that used supportive

counseling, the Neonatal

Behavioral Assessment

Scale (NBAS), and targeted

assistance to manage behav-

ioral problems.

Nurses

Home

36 (60-120)

12 mo

Discharge from

hospital, until

12mo.

Parent Infant Transaction Program (MITP)

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Name of Interven-

tion

Study ID

Target

Population

Short Description

Provi-

der

Location

# Sessions with

provider

(length/session

[mins])

Length of

interven-

tion

Timing of 1st and

last session

PremieStart pro-

gram (adaptation of

MITP)

*Milgrom 2013162,163

Preterm/

Low birth-

weight in-

fants

Psychoeducational parent-

training program adapted

from the parent-Infant

Transaction Program

(MITP).

PhDs;

MDs

Hybrid:

NICU and

home

10 (60)

9 wks in

NICU

and one

home

session

NICU stay + 1

home visit after

discharge.

Mother Infant

Transaction Pro-

gram (MITP)

*Newnham 2009164

Preterm/

Low birth-

weight in-

fants

Thought parents to recog-

nize and respond to infant

cues. The intervention also

employed kangaroo care,

infant massage, and encour-

aged mutual enjoyment

through play.

PhDs;

MDs

Hybrid:

NICU and

home

9: 7 in hospital

and 2 after dis-

charge (30-60)

Variable

depend-

ing on

gesta-

tional age

at birth

Birth, until 2mo

corrected age.

Mother Infant

Transaction Pro-

gram (MITP)

Ravn 2011165

Preterm/

Low birth-

weight in-

fants

Nurse helped sensitize par-

ents to infants' cues and

self-regulation.

Nurses

Hybrid:

NICU and

home

11 (60)

13 wks

Last week before

NICU discharge,

until 3mo cor-

rected age.

Mother Infant

Transaction Pro-

gram (MITP) home

visits

*Youn 2021166

Preterm/

Low birth-

weight in-

fants

A combination of group vis-

its with a specialized physi-

otherapist and home visits

with a nurse aimed to pro-

mote parental understanding

of infants' behavioral cues,

to support and encourage

secure attachment between

parents and infants, and to

promote the infants’ gross

motor development and

sensory stimulation.

Nurses

NICU

16: 4 home vis-

its + up to 12

groups (90)

6 mo

Postnatal day 5,

until 6mo cor-

rected age.

Auditory-Tactile-Visual-Vestibular (ATVV)

Auditory-Tactile-

Visual-Vestibular

(ATVV)

Holditch-Davis

2014167

Preterm/

Low birth-

weight in-

fants

A multimodal stimulation

intervention that combined

auditory, visual, and tactile

stimulation.

Nurses

Hybrid:

NICU and

home

1 (60) + 2 con-

tacts (--)

2+ mo

Birth, until 2mo

corrected age.

Auditory-Tactile-

Visual-Vestibular

(ATVV)

*Nelson 2001168

Infants

with early

health or

develop-

mental

conditions,

Preterm/

Low birth-

weight in-

fants

A multimodal stimulation

intervention that combined

auditory, visual, and tactile

stimulation.

NICU

1 (15)

4 mo

33wks postcon-

ceptional age, un-

til 2mo corrected

age.

H-Hope Intervention

*White-Traut 2013169

Preterm/

Low birth-

weight in-

fants

Combines auditory, visual,

eye and vestibular stimula-

tion (ATTV) with parental

education about preterm in-

fants' behavioral cues.

Nurses

NICU

6: 2 in-hospital,

2 home visits, 2

phone calls (--)

1+ mo

32wks postcon-

ceptional age, un-

til 1mo corrected

age.

Happiness, Understanding, Giving and Sharing Intervention (HUGS)

Community HUGS

(CHUGS)

*Ericksen 2018170

Maternal

psycho-

pathology

Group-based intervention

with 4 modules that seek to

improve the parent-infant

relationship and maternal

mental health.

Mixed

profe-

ssionals

Public hos-

pital or

community

setting

10 (60-90)

10 wks

Birth to 12mo of

age (mean of

4.94), for 10wks.

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Name of Interven-

tion

Study ID

Target

Population

Short Description

Provi-

der

Location

# Sessions with

provider

(length/session

[mins])

Length of

interven-

tion

Timing of 1st and

last session

HUGS

*Holt 2021171

Maternal

psycho-

pathology

Group-based intervention

that targets parent-infant in-

teraction and employed a

combination of psychoeduca-

tion and behavioral exercises,

including infant massage.

Nurses

Community

center

4 (90)

4 wks

Birth to 12mo of

age (mean of

3.13), for 4 wks.

Notes: *Indicates studies included in the meta-analysis, -- indicates missing information. mo: month(s).

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Figure 2. Meta-Analytic Results. Brown effect sizes: self-reported outcomes. Green effect sizes: observational outcomes. Black hori-

zontal bars: 95% Confidence Intervals. Red diamonds: significant effects. Att.: Attachment. Socio-Emot.: Socio-Emotional. SMD: Stand-

ardized Mean Differences. OR: Odds Ratios. E: Favors Experimental. Quality of Evidence: +Very Low, ++Low, +++Moderate, +++High.

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No Evidence of Effectiveness of Dyadic Inter-

ventions on Child Socio-Emotional Function-

ing Or Development

Parent/caregiver-reported child behaviors

showed no improvement after participating in a

dyadic intervention at either 13-24 months

(SMD=-0.22, 95%CI=[-0.07, 0.51], p=0.14,

I2=77%), or 25-60 months (SMD=0.07,

95%CI=[-0.28, 0.42], p=0.70, I2=65%). Par-

ent/caregiver-reported child socio-emotional

functioning was also non-significant at both 5-12

months (SMD=-0.03, 95%CI=[-0.13, 0.07],

p=0.56, I2=0%), and 13-24 months (SMD=0.18,

95%CI=[-0.22, 0.58], p=0.37, I2=0%). Observer-

based assessments of child development (Bayley

Scales of Infant Development) also did not show

evidence of effectiveness of early dyadic inter-

ventions on cognitive development (4-12

months: SMD=0.14, 95%CI=[-0.10, 0.38],

p=0.24, I2=69%; 13-24 months: SMD=0.11,

95%CI=[-0.08, 0.30], p=0.24, I2=36%), language

development (5-12 months: SMD=-0.07,

95%CI=[-0.22, 0.07], p=0.31, I2=0%; 13-24

months: SMD=-0.01, 95%CI=[-0.19, 0.17],

p=0.90, I2=0%), or motor development (4-12

months: SMD=-0.10, 95%CI=[-0.23, 0.02],

p=0.11, I2=0%; 13-24 months: SMD=-0.21,

95%CI=[-0.56, 0.14], p=0.24, I2=77%).

Dyadic Interventions Promote Lower Par-

ent/Caregiver Anxiety, But Have No Effect On

Parenting Stress and Depression

Pooled effect estimates showed that dyadic inter-

ventions significantly reduce parent/caregiver

anxiety (SMD=-0.27, 95%CI=[-0.49, -0.06],

p=0.01, I2=65%), but are not effective in lower-

ing stress (SMD=-0.05, 95%CI=[-0.21, 0.11],

p=0.53, I2=46%) or depression (SMD=-0.09,

95%CI=[-0.19, 0.02], p=0.10, I2=58%).

Association Between Dose of Dyadic Interven-

tion and Effect Estimates

Unexpectedly, we did not find a significant asso-

ciation between dyadic intervention dose and any

ERH outcome effect estimates (Figure 3).

We did, however, find a significant associa-

tion between dose and parent/caregiver-reported

Figure 3. Overview of Meta-Regression Results. DerSimonian

Laird model meta-regressions with minutes as predictors and

Standardized Mean Differences (SMD) or log-Odds Ratios (log-

OR) as outcomes. Analyses conducted only on outcomes pooling

³10 studies. (A) No significant associations were identified in the

primary outcomes of bonding 0-4mo (β=.003, p=.41), sensitivity

0-4mo (β=6.2-5, p=.86), sensitivity 5-12mo (β=-6.47-5, p=.74),

dyadic interactions 0-4mo (β=-9.30-5, p=.66), or dyadic interac-

tions 5-12mo (β=1.84-5, p=.90). (B) No significant associations

were identified in the primary outcomes of secure attachment 12-

18mo (β=8.46-5, p=.70), insecure attachment 12-18mo (β=-.001,

p=.11), or disorganized attachment 12-18mo (β=-1.84-5, p=.93).

ent/caregiver anxiety, with longer interventions being associated

with higher reduction of anxiety (β=-.001, p=.03). No significant

associations were identified for the secondary outcomes of par-

enting stress (β=-6.27-5, p=.64) or depression (β=-1.26-5, p=.94).

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anxiety, with longer interventions being associ-

ated with higher reduction of anxiety (β=-0.01,

p=.03). The association between intervention

dose and child socio-emotional functioning and

development could not be tested due to small

number of studies (<10) in those meta-analyses.

Risk of Bias Within and Across Studies

Using GRADE guidelines, we conclude that our

results are mostly based on very low to moderate

quality of evidence (eTable5) attributable to two

factors: (1) moderate to high risk of biases in

identified studies (eFigures1-47) driven by lack

of blinding of participants, high drop-out rates,

not using standardized or validated outcome as-

sessments, selective outcome reporting, and lack

of prospective registration; and (2) high hetero-

geneity in our meta-analyses, explainable by high

variability in study populations, intervention

components, and outcome assessments.

DISCUSSION

To operationalize AAP’s recent prioritization of

ERH promotion in pediatrics,1 this systematic re-

view identified 93 actionable dyadic early in-

fancy interventions, amenable to primary and ter-

tiary care settings. Figure 4 summarizes the con-

temporary landscape regarding efficacy. Our

meta-analysis pooling 80 RCTs shows that dy-

adic interventions promote ERH, demonstrated

by higher levels of bonding in early infancy,

higher parent/caregiver sensitivity through age 5,

increased odds of secure attachment, decreased

odds of disorganized attachment, and improve-

ment of parent/caregiver-infant dyadic interac-

tions in the first year of life.

But does this improved ERH spill over into

secondary child outcomes? ERH promotion is

currently hypothesized to buffer the detrimental

long-term effects of ACEs on child socio-emo-

tional functioning and development.172 Yet, data

presented here do not support this notion, with

our meta-analysis failing to identify significant

improvements on child socio-emotional, behav-

ioral, or developmental outcomes. Positive ERH

is also strongly associated with improved par-

ent/caregiver mental health.20 In this regard, our

meta-analysis supports the evidence for dyadic

interventions lowering anxiety, though no

improvement in stress or depressive symptoms

was observed.

The disheartening finding that contemporary

interventions bolster ERH without effectively

targeting secondary outcomes that are strongly

associated with ERH in numerous observational

studies173,174 may be a case of “correlation does

not equal causation”. More likely however, our

results are attributable to limitations in the scope

of studies carried out in this field to-date. Criti-

cally, effect estimates represent mostly very low

to moderate confidence, mainly because of high

risk of biases and high heterogeneity in interven-

tion characteristics (e.g., design, dose, setting).

Additionally, only 20 RCTs, representing less

than a quarter of the field, measured at least one

child developmental outcome. Conceivably, this

subset of RCTs were too few to yield significant

pooled effect estimates, implemented too

early,175 or not potent enough for a spillover ef-

fect. The latter is supported by minimal to small

magnitude of experimental effects on most ERH

outcomes, which also appear to fade over time.

The AAP policy statement further empha-

sizes that family-centered pediatric medical

homes (FCPMH) are integral to the universal

promotion of ERH.1 Despite this, only three iden-

tified RCTs91,99,102 were implemented by pedia-

tricians or in FCPMH. Also, a majority of identi-

fied studies focused on biological mothers and

parent/caregiver-infant dyads at high risk of im-

paired ERH. The ERH field has thus far ne-

glected the development, evaluation, and imple-

mentation of more universal interventions that

any parent/caregiver-infant dyad, including fa-

thers,176 could benefit from.

A counterintuitive but optimistic finding is

that intervention effects on ERH are non-dose-

dependent, affirming a prior meta-analysis result

of ‘less is more’.177 This suggests that promoting

ERH is amenable to short, cost-effective inter-

ventions. Thus, investment in universal, wide-

spread implementation of ‘light touch interven-

tions’ in FCPMH has the potential to achieve

large public health benefit.

CONCLUSION

In the wake of AAP’s 2021 policy statement

highlighting the buffering effects of the

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parent/caregiver-child relationship on the nega-

tive impact of infant toxic stress, ERH interven-

tions are heralded to hold great promise. Meta-

analyses presented here show that contemporary

interventions improve ERH non-dose-de-

pendently, but effect sizes are currently small,

time-limited and do not spill over into other child

developmental measures. These results both of-

fer glimmers of hope and demand us to embark

on a comprehensive research agenda to develop

and refine effective, scalable, equitable, evi-

dence-based ERH interventions. For rapid re-

sults, the field could benefit from a bold, cohe-

sive research strategy done in a relationally-

grounded way—in partnership, across a large

network of parents/caregivers, researchers, fun-

ders, and clinicians—and guided by principles

that have yielded results in other areas, including

contributing to the incontestable evidence for

life-course impact of ACEs.178 These principles

include large collaborative team science that gen-

erates big data in an open science framework,179

with cross-species investigation of meaningful

long-term outcomes, parallel mechanistic studies

evaluating biological endpoints, and comparative

effectiveness and implementation research.180

Figure 4. Contemporary landscape regarding efficacy of early dyadic interventions. Top: Number of identified interventions: cumulative

number of interventions identified and active at specified age on timeline. Bottom: Meta-analysis results indicate significant non-dose-de-

pendent intervention effects on several measures of ERH, including bonding, parent/caregiver sensitivity, attachment, and dyadic interactions,

and a significant effect on parent/caregiver anxiety, but no significant effects on secondary child outcomes. Bold text=significant effect;

*Small effect size; **Medium effect size; ***Large effect size.

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Funding

This work was supported by grant

R01MH126531 from National Institute of

Mental Health (Dumitriu), grant P-6006251-

2021 from W.K. Kellogg Foundation (Dumitriu),

gift funds from Einhorn Collaborative (Dumitriu),

and grant 201910MFE-430349-268206 from Ca-

nadian Institutes of Health Research (Lavallée).

Conflicts of Interest

Dr. Dumitriu reported personal fees for lectures

and round-table discussions from Medela outside

the submitted work. The Nurture Science Pro-

gram (NSP) at Columbia University Irving Med-

ical Center has conducted one RCT included in

this systematic review (Hane 2015) prior to Dr.

Dumitriu being appointed director of the NSP.

No other disclosures were reported.

Author Contribution

Concept and design: Lavallée and Dumitriu.

Acquisition, analysis, or interpretation of data:

Lavallée, Warmingham, Atwood, Ahmed,

Lanoff, Xu, Arduin, Hamer, Fischman, Ettinger,

Hu, Fisher, Greeman, Kuromaru, Durr, Flowers,

Pang and Gozali.

Drafting of the manuscript: Lavallée, Dumitriu,

and Finkel. Ahmed and Lanoff (eMethods3 and

eMethods4). Atwood, Hamer, Fischman, Kuro-

maru, Ahmed and Warmingham (eMethods5).

Critical revision of the manuscript for important

intellectual content: Lavallée, Warmingham,

Willis and Dumitriu.

Acknowledgements

We thank Drs. Bernard and Badr, corresponding

authors of studies identified by our systematic re-

view, who agreed and shared unpublished data

for inclusion in our meta-analysis. We also thank

Drs. Bakermans-Kranenburg and White-Traut

for being responsive to our request though addi-

tional data was unavailable for inclusion in our

analysis. Finally, we also thank Nikki Shearman,

PhD, partner in our ongoing exploration of ERH,

who gave valuable input to the interpretation of

our analysis.

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The copyright holder for this preprintthis version posted October 31, 2022. ; https://doi.org/10.1101/2022.10.29.22281681doi: medRxiv preprint

Early Dyadic Parent/Caregiver-Infant Interventions to Support Early

Relational Health: A Meta-Analysis

Andréane Lavalléea, PhD, Lindsy Panga, Jennifer M. Warminghama, PhD, Ginger Atwooda, BSc,

Imaal Ahmeda, Marissa Lanoffa, Morgan A. Finkela, MD, MS, Ruiyang Xua, Elena Arduina,

Kassidy K. Hamera, Rachel Fischmana, Sharon Ettingera, Yunzhe (Jessica) Hua, Kaylee Fishera,

Esther A. Greemana, Mia Kuromarua, Sienna S. Durra, Elizabeth Flowersa, MD, Aileen Gozalia,

PhD, David Willisb, MD, Dani Dumitriua, MD, PhD

aDepartment of Pediatrics, Columbia University Irving Medical Centre, New York, NY 10032

bCenter for the Study of Social Policy, Washington, DC 20005

"#$$%&'#()*(+!,-./#$0!

Dani Dumitriu

dani.dumitriu@columbia.edu

1234%!#5!"#(.%(.!

eTable 1. PRISMA Checklist

eMethods 1. Full Systematic Review Method

eMethods 2. Full Search Strategies

eTable 2. Summary of methodological decisions to avoid unit-of-analysis issues

eTable 3. Full Study-Level Characteristics

eMethods 3. Parent/Caregiver-Report Assessments of Relational Health

eMethods 4. Observational Assessments of Relational Health

eMethods 5. Description of Included Interventions

eTable 4. Summary of Sensitivity Analysis

eTable 5. GRADE Summary Table

eFigure 1. RCT Risk of Bias Summary

eFigure 2. Cluster RCT Risk of Bias Summary

eFigure 3. RoB (RCT) – Bonding (0-4 months)

eFigure 4. RoB (RCT) – Bonding (5-12 months)

eFigure 5. RoB (RCT) – Sensitivity (0-4 months)

eFigure 6. RoB (cluster RCT) – Sensitivity (0-4 months)

eFigure 7. RoB (RCT) – Sensitivity (5-12 months)

eFigure 8. RoB (cluster RCT) – Sensitivity (5-12 months)

eFigure 9. RoB (RCT) – Sensitivity (13-24 months)

eFigure 10. RoB (RCT) – Sensitivity (25-60 months)

eFigure 11. RoB (cluster RCT) – Sensitivity (25-60 months)

eFigure 12. RoB (RCT) – Secure Attachment (12-18 months)

eFigure 13. RoB (cluster RCT) – Secure Attachment (12-18 months)

eFigure 14. RoB (RCT) – Insecure Attachment (12-18 months)

eFigure 15. RoB (RCT) – Organized Attachment (12-18 months)

eFigure 16. RoB (RCT) – Disorganized Attachment (12-18 months)

eFigure 17. RoB (cluster RCT) – Disorganized Attachment (12-18 months)

eFigure 18. RoB (RCT) – Secure Attachment (21+ months)

eFigure 19. RoB (RCT) – Insecure Attachment (21+ months)

eFigure 20. RoB (RCT) – Dyadic Interactions (0-4 months)

eFigure 21. RoB (cluster RCT) – Dyadic Interactions (0-4 months)

eFigure 22. RoB (RCT) – Dyadic Interactions (5-12 months)

eFigure 23. RoB (cluster RCT) – Dyadic Interactions (5-12 months)

(which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprintthis version posted October 31, 2022. ; https://doi.org/10.1101/2022.10.29.22281681doi: medRxiv preprint

eFigure 24. RoB (RCT) – Dyadic Interactions (13-24 months)

eFigure 25. RoB (RCT) – Dyadic Interactions (25-60 months)

eFigure 26. RoB (cluster RCT) – Dyadic Interactions (25-60 months)

eFigure 27. RoB (RCT) – Child Behaviors (13-24 months)

eFigure 28. RoB (RCT) – Child Behaviors (25-60 months)

eFigure 29. RoB (cluster RCT) – Child Behaviors (25-60 months)

eFigure 30. RoB (RCT) – Socio-Emotional Functioning (5-12 months)

eFigure 31. RoB (cluster RCT) – Socio-Emotional Functioning (5-12 months)

eFigure 32. RoB (RCT) – Socio-Emotional Functioning (13-24 months)

eFigure 33. RoB (RCT) – Child Cognitive Development (4-12 months)

eFigure 34. RoB (cluster RCT) – Child Cognitive Development (4-12 months)

eFigure 35. RoB (RCT) – Child Cognitive Development (13-24 months)

eFigure 36. RoB (cluster RCT) – Child Cognitive Development (13-24 months)

eFigure 37. RoB (RCT) – Child Language Development (5-12 months)

eFigure 38. RoB (RCT) – Child Language Development (13-24 months)

eFigure 39. RoB (RCT) – Child Motor Development (5-12 months)

eFigure 40. RoB (cluster RCT) – Child Motor Development (5-12 months)

eFigure 41. RoB (RCT) – Child Motor Development (13-24 months)

eFigure 42. RoB (cluster RCT) – Child Motor Development (13-24 months)

eFigure 43. RoB (RCT) – Parent/Caregiver Parenting Stress

eFigure 44. RoB (cluster RCT) – Parent/Caregiver Parenting Stress

eFigure 45. RoB (RCT) – Parent/Caregiver Anxiety

eFigure 46. RoB (RCT) – Parent/Caregiver Depression

eFigure 47. RoB (cluster RCT) – Parent/Caregiver Depression

(which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprintthis version posted October 31, 2022. ; https://doi.org/10.1101/2022.10.29.22281681doi: medRxiv preprint

eTable 1. PRISMA Checklist

Section and

Topic

Item

Checklist item

Location

where

item is

reported

TITLE

Title

Identify the report as a systematic review.

ABSTRACT

Abstract

See the PRISMA 2020 for Abstracts checklist.

INTRODUCTION

Rationale

Describe the rationale for the review in the context of existing knowledge.

Objectives

Provide an explicit statement of the objective(s) or question(s) the review addresses.

METHODS

Eligibility criteria

Specify the inclusion and exclusion criteria for the review and how studies were grouped for the syntheses.

Information

sources

Specify all databases, registers, websites, organisations, reference lists and other sources searched or consulted to identify

studies. Specify the date when each source was last searched or consulted.

Search strategy

Present the full search strategies for all databases, registers and websites, including any filters and limits used.

eMethods2

Selection

process

Specify the methods used to decide whether a study met the inclusion criteria of the review, including how many reviewers

screened each record and each report retrieved, whether they worked independently, and if applicable, details of automation tools

used in the process.

Data collection

process

Specify the methods used to collect data from reports, including how many reviewers collected data from each report, whether

they worked independently, any processes for obtaining or confirming data from study investigators, and if applicable, details of

automation tools used in the process.

3-4

Data items

10a

List and define all outcomes for which data were sought. Specify whether all results that were compatible with each outcome

domain in each study were sought (e.g. for all measures, time points, analyses), and if not, the methods used to decide which

results to collect.

10b

List and define all other variables for which data were sought (e.g. participant and intervention characteristics, funding sources).

Describe any assumptions made about any missing or unclear information.

Study risk of

bias

assessment

Specify the methods used to assess risk of bias in the included studies, including details of the tool(s) used, how many reviewers

assessed each study and whether they worked independently, and if applicable, details of automation tools used in the process.

Effect measures

Specify for each outcome the effect measure(s) (e.g. risk ratio, mean difference) used in the synthesis or presentation of results.

Synthesis

methods

13a

Describe the processes used to decide which studies were eligible for each synthesis (e.g. tabulating the study intervention

characteristics and comparing against the planned groups for each synthesis (item #5)).

13b

Describe any methods required to prepare the data for presentation or synthesis, such as handling of missing summary statistics,

or data conversions.

13c

Describe any methods used to tabulate or visually display results of individual studies and syntheses.

13d

Describe any methods used to synthesize results and provide a rationale for the choice(s). If meta-analysis was performed,

(which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprintthis version posted October 31, 2022. ; https://doi.org/10.1101/2022.10.29.22281681doi: medRxiv preprint

Section and

Topic

Item

Checklist item

Location

where

item is

reported

describe the model(s), method(s) to identify the presence and extent of statistical heterogeneity, and software package(s) used.

13e

Describe any methods used to explore possible causes of heterogeneity among study results (e.g. subgroup analysis, meta-

regression).

13f

Describe any sensitivity analyses conducted to assess robustness of the synthesized results.

Reporting bias

assessment

Describe any methods used to assess risk of bias due to missing results in a synthesis (arising from reporting biases).

Certainty

assessment

Describe any methods used to assess certainty (or confidence) in the body of evidence for an outcome.

RESULTS

Study selection

16a

Describe the results of the search and selection process, from the number of records identified in the search to the number of

studies included in the review, ideally using a flow diagram.

16b

Cite studies that might appear to meet the inclusion criteria, but which were excluded, and explain why they were excluded.

Study

characteristics

Cite each included study and present its characteristics.

Table 1

+eTable3

Risk of bias in

studies

Present assessments of risk of bias for each included study.

eFigures

1-47

Results of

individual

studies

For all outcomes, present, for each study: (a) summary statistics for each group (where appropriate) and (b) an effect estimate

and its precision (e.g. confidence/credible interval), ideally using structured tables or plots.

Figure 2

Results of

syntheses

20a

For each synthesis, briefly summarise the characteristics and risk of bias among contributing studies.

6, 19

20b

Present results of all statistical syntheses conducted. If meta-analysis was done, present for each the summary estimate and its

precision (e.g. confidence/credible interval) and measures of statistical heterogeneity. If comparing groups, describe the direction

of the effect.

6, 19

20c

Present results of all investigations of possible causes of heterogeneity among study results.

6, 19

20d

Present results of all sensitivity analyses conducted to assess the robustness of the synthesized results.

6, eTable4

Reporting

biases

Present assessments of risk of bias due to missing results (arising from reporting biases) for each synthesis assessed.

eTable4

Certainty of

evidence

Present assessments of certainty (or confidence) in the body of evidence for each outcome assessed.

Figure 2

+eTable5

DISCUSSION

Discussion

23a

Provide a general interpretation of the results in the context of other evidence.

20-21

23b

Discuss any limitations of the evidence included in the review.

20-21

23c

Discuss any limitations of the review processes used.

20-21

23d

Discuss implications of the results for practice, policy, and future research.

20-21

(which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprintthis version posted October 31, 2022. ; https://doi.org/10.1101/2022.10.29.22281681doi: medRxiv preprint

Section and

Topic

Item

Checklist item

Location

where

item is

reported

OTHER INFORMATION

Registration

and protocol

24a

Provide registration information for the review, including register name and registration number, or state that the review was not

registered.

24b

Indicate where the review protocol can be accessed, or state that a protocol was not prepared.

24c

Describe and explain any amendments to information provided at registration or in the protocol.

Support

Describe sources of financial or non-financial support for the review, and the role of the funders or sponsors in the review.

Competing

interests

Declare any competing interests of review authors.

Availability of

data, code and

other materials

Report which of the following are publicly available and where they can be found: template data collection forms; data extracted

from included studies; data used for all analyses; analytic code; any other materials used in the review.

(which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprintthis version posted October 31, 2022. ; https://doi.org/10.1101/2022.10.29.22281681doi: medRxiv preprint

%6%./#)&78!9-44!:;&.%<2.*=!>%?*%@!6%./#)!

Eligibility Criteria

We considered randomized controlled trials (RCT) of any type that compared an early dyadic parent/caregiver-

infant intervention to any comparator. Only English or French-language papers, as well as published and

unpublished study results retrieved from corresponding authors, were eligible. In order to focus on contemporary

interventions with the potential for further development and widespread implementation, we limited the review to

studies published on or after January 1, 2000.

Population. Any parent/caregiver-child dyad.

Intervention. We defined as “dyadic” any intervention that targeted at least one primary caregiver and the

infant together, as a dyad, by promoting physical, emotional, or face-to-face interactions, e.g., skin-to-skin, massage,

video interaction guidance. Interventions were eligible for inclusion if at least one intervention session occurred

within the first 6 months of the infant’s life. Prenatal interventions without postnatal sessions were excluded. No

exclusion criteria were considered for the length or intensity of the intervention.

Comparator. Any type of comparator was considered, i.e., control or active intervention.

Outcomes. The primary outcome domain was ERH. Specific outcomes within this domain included

established and validated proxy measures of ERH, e.g., attachment, sensitivity, bonding, emotional connection.

Secondary outcome domains were child socio-emotional functioning and development, and parent/caregiver mental

health. Secondary outcomes were only considered in studies where at least one ERH outcome was also measured.

Information Sources and Search Strategy

Systematic literature searches were conducted in five databases: PubMed, Medline, Cinhal, ERIC, and PsycInfo via

EBSCO. The search strategy was designed to focus on two main concepts: (1) parent-infant dyadic interventions and

(2) ERH (see eMethods 2 for full search strategies). Searches were conducted on April 28, 2022. To identify

unpublished and ongoing studies, we searched clinical trial registries (clinicaltrials.gov, ISRCTN Registry, EU

Clinical Trials Register, Australian New Zealand Clinical Trials Registry). Authors of unpublished and ongoing

studies were contacted. After completing the selection process described below, we conducted backward, and

forward reference searching of included studies.

Selection Process

Identified study records were uploaded to EndNote V9.3.31 and subsequently to Covidence.2 Duplicates were

removed and study records were screened for eligibility independently by teams of two review authors.

Disagreements were resolved by the first author for consistency. The same process was followed for the full-text

review of potentially eligible studies. Reasons for exclusion were documented at the full-text screening stage.

Data collection process

Data extraction was performed in duplicate and independently, using a data extraction form specifically developed

for this review. Consensuses were done by the first author. We extracted data at the study-, intervention-, and

outcome-level.

• Study-level: aim, study design, number of groups, target population, inclusion and exclusion criteria, group

differences, unit of randomization, sample size and withdrawals.

• Intervention-level, based on the Template for Intervention Description and Replication (TIDieR)3 checklist:

name of the intervention, framework or underlying theory, rationale, materials, dyadic and non-dyadic

procedures, provider(s), location(s), dose, and intensity.

• Result-level: name of the outcome, scale, description of the procedure if outcome was observational, timing and

age of infant at assessment, means or medians, standard deviations (SD), standard error (SE), 95% confidence

interval (CI) or Inter Quartile Range (IQR), or events for binary outcomes.

Raw unadjusted means analyzed in intention to treat were preferred over adjusted means and medians for

consistency across studies. Only post-test measures were extracted, except for studies where outcomes were

measured after one full year of a much longer intervention.4,5 SE, 95% CI and IQR were converted to SDs following

the Cochrane guidelines.6 If numerical data were only presented in figures, we extracted data from the figures using

software such as Engauge Digitizer7 v12.1 and PlotDigitizer8. When necessary, we contacted corresponding authors

to retrieve missing data.

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Data Items

The primary outcome of this systematic review was parent/caregiver-child ERH measured at any time point.

Established child social and developmental outcomes and caregiver mental health were considered as secondary

outcomes.

Effect Measures and Synthesis Methods

We performed pairwise meta-analyses on three outcome domains, looking at specific outcomes separately:

i) Primary Outcome Domain – ERH:

a. self-reported maternal bonding,

b. observed parent/caregiver sensitivity,

c. observed child attachment,

d. observed dyadic interactions.

ii) Secondary Outcome Domain - Child Socio-Emotional Functioning and Development:

a. parent/caregiver reported child behaviors,

b. parent/caregiver-reported child socio-emotional development,

c. observed cognitive development,

d. observed language development,

e. observed motor development.

iii) Secondary Outcome Domain – Parent/Caregiver Mental Health:

a. self-reported parenting stress,

b. self-reported anxiety,

c. self-reported depression.

As only four studies used an active intervention as a comparator, our pairwise comparison was early dyadic

intervention vs. control, i.e., standard care, attention-control, or active control. Sensitivity analyses were conducted

to determine whether pooled effect estimates were robust to the inclusion of the active controls. To facilitate pooling

of studies, we also conducted separate analyses per time frame, defined by child’s age at assessment, i.e., 0 (term

equivalent age)-4 months old, 5-12 months old, 13-24 months old, more than 25 months. To account for the

different timing of assessments, we did a sensitivity analysis to test whether our results were robust to the inclusion

of long-term follow-ups, defined as assessments done more than 6 months after the conclusion of the intervention.

When studies had more than one outcome within a domain for the same time frame, or multiple time points within a

time frame, we chose the outcome that provided the most comprehensive measure of the domain, and the latest time

point within a time frame.

The unit of analysis was parent/caregiver-infant dyads. To avoid unit-of-analysis issues, we combined

cluster-RCTs with individually randomized trials by using a direct estimate of the required effect measure, e.g., odds

ratio with 95% CI, from analyses that properly accounted for the cluster design. Alternatively, based on Cochrane

guidelines,9 we used the intra-cluster correlation coefficient (ICC) to correct the sample size to account for the

design effect. ICCs were ideally extracted from the study itself, or from a similar trial. However, when neither

adjusted analyses, nor the mean cluster size were reported, we couldn’t adjust for the design effect and accounted for

it in our sensitivity analyses. For studies with three arms, we combined intervention groups together, combined two

control groups together, or dropped one of the three groups, depending on what was most appropriate. A summary

of our methodological decisions to avoid unit-of-analysis issues is presented in eTable2.

Continuous outcomes were analyzed using weighted standardized mean differences (SMD) with 95% CIs.

Categorical variables were analyzed using weighted odds ratios (OR) with 95% CIs. An inverse variance random-

effects model to account for study design and patient population induced variability was chosen. Significance level

was set at 0.05 for all analyses. Cochran’s Q test and I2 statistic were used to assess the heterogeneity and I2 values

>50% or p-value <0.10 indicated statistically significant heterogeneity. We also conducted a sensitivity analysis to

examine if our results were robust to the inclusion of studies with an overall high risk of bias.

Finally, we explored associations between the dose of intervention, i.e.., the amount of time in minutes a

provider spent with parents/caregivers as part of the experimental intervention, and the primary and secondary

outcome domain effect estimates. A meta-regression was performed using a random-effects DerSimonian Laird

model, using minutes as predictors and SMD or log-OR as outcomes. Analyses were conducted on each outcome

pooling at least 10 studies.10 In studies where it was not possible to estimate the amount of time in minutes, we

imputed with the mean number of minutes per sessions, times the number of sessions. All analyses were conducted

with Review Manager V5.411 and SPSS V24.12

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Study Risk of Bias and Certainty Assessment

Two independent review authors assessed risk of bias in individual studies using the Cochrane Collaboration Risk of

Bias Tool 2.13 Confidence in pooled outcomes was based on the Grades of Recommendation, Assessment,

Development and Evaluation (GRADE) guidelines.14 Summary of findings tables were generated using the GRADE

profiler Guideline Development Tool software and the GRADE criteria (2015, McMaster University and Evidence

Prime Inc.). Within the GRADE assessment, we estimated the risk of publication bias by funnel plot inspection.

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%6%./#)&A8!9-44!:%2$=/!:.$2.%+*%&!

Run date: 04/28/2022

Database

Total

PubMed

8 742

CINAHL

1 075

ERIC

213

PsycInfo

1 100

Medline

1 127

Total

12 257

PubMed

Results

"treatment outcome"[MeSH Terms] OR "early intervention, educational"[MeSH

Terms] OR (Program*[Title/Abstract]) OR (Intervention*[Title/Abstract])

3 058 072

((((Infant[MeSH Terms]) OR (infant, newborn[MeSH Terms])) OR (infant,

premature[MeSH Terms])) OR (child, preschool[MeSH Terms])) OR

(((((Babies[Title/Abstract]) OR (Infant*[Title/Abstract])) OR

(Baby[Title/Abstract])) OR (Newborn*[Title/Abstract])) OR

(Child*[Title/Abstract]))

2 714 044

(((((parenting[MeSH Terms]) OR (maternal behavior[MeSH Terms])) OR

(mother child relations[MeSH Terms])) OR (parent child relations[MeSH

Terms])) OR (object attachment[MeSH Terms])) OR

((Connect*[Title/Abstract]) OR (Nurtur*[Title/Abstract]) OR

(Sensitiv*[Title/Abstract]) OR (Responsiv*[Title/Abstract]) OR

(Attach*[Title/Abstract]) OR (Bond*[Title/Abstract]) OR

(Interact*[Title/Abstract]) OR (Relation*[Title/Abstract]))

5 942 408

1 AND 2 AND 3

111 815

((clinicaltrial[Filter] OR randomizedcontrolledtrial[Filter]) AND (english[Filter]

OR french[Filter]) AND (2000:2022[pdat]))

8 742

Cinhal via EBSCO

Results

TI ( (infant* OR bab* OR newborn* OR birth*) ) OR AB ((infant* OR bab* OR

newborn* OR birth*))

243 685

TI ( (parent* OR mother* OR father* OR maternal OR paternal OR famil*) N5

(attach* OR bond* OR interact* OR relation* OR sensitiv* OR respons* OR

nurtur*) ) OR AB ( (parent* OR mother* OR father* OR maternal OR paternal

OR famil*) N5 (attach* OR bond* OR interact* OR relation* OR sensitiv* OR

respons* OR nurtur*) )

56 291

(MH "Parent-Child Relations+") OR (MH "Parenting") OR (MH "Maternal

Behavior") OR (MH "Parental Behavior") OR (MH "Family Relations") OR (MH

"Attachment Behavior") OR (MH "Nurturing Behavior") OR (MH "Family

115 171

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Attitudes+") OR (MH "Parental Attitudes+") OR (MH "Mothers/PF") OR (MH

"Fathers/PF") OR (MH "Parents/PF")

2 OR 3

145 916

(TI attachment N3 intervention OR AB attachment N3 intervention) OR (TI

parent* N3 training OR AB parent* N3 training) OR (TI parent* N3 intervention

OR AB parent* N3 intervention) OR (TI family N3 intervention OR AB family

N3 intervention) OR (TI relationship N3 intervention OR AB relationship N3

intervention) OR (TI bonding N3 intervention OR AB bonding N3 intervention)

OR (TI family N3 training OR AB family N3 training)

18 192

1 AND 4 AND 5

Limited to 2000 to 2022

1 075

ERIC via EBSCO

Results

TI ( (infant* OR bab* OR newborn* OR birth*) ) OR AB ((infant* OR bab* OR

newborn* OR birth*))

28 876

TI ( (parent* OR mother* OR father* OR maternal OR paternal OR famil*) N5

(attach* OR bond* OR interact* OR relation* OR sensitiv* OR respons* OR

nurtur*) ) OR AB ( (parent* OR mother* OR father* OR maternal OR paternal

OR famil*) N5 (attach* OR bond* OR interact* OR relation* OR sensitiv* OR

respons* OR nurtur*) )

33 811

(SU "Parent Child Relationship") OR (SU "Parenting skills") OR (SU

"Parenting styles") OR (SU "Parents") OR (SU "Family Relationship") OR (SU

"Attachment Behavior") OR (SU "Family Attitudes+") OR (SU "Mothers

attitudes") OR (SU "Fathers attitudes")

48 876

2 OR 3

66 552

(TI attachment N3 intervention OR AB attachment N3 intervention) OR (TI

parent* N3 training OR AB parent* N3 training) OR (TI parent* N3 intervention

OR AB parent* N3 intervention) OR (TI family N3 intervention OR AB family

N3 intervention) OR (TI relationship N3 intervention OR AB relationship N3

intervention) OR (TI bonding N3 intervention OR AB bonding N3 intervention)

OR (TI family N3 training OR AB family N3 training)

8 710

1 AND 4 AND 5

Limited to 2000 to 2022

213

PsychInfo via EBSCO

Results

TI ( (infant* OR bab* OR newborn* OR birth*) ) OR AB ((infant* OR bab* OR

newborn* OR birth*))

156 874

TI ( (parent* OR mother* OR father* OR maternal OR paternal OR famil*) N5

(attach* OR bond* OR interact* OR relation* OR sensitiv* OR respons* OR

nurtur*) ) OR AB ( (parent* OR mother* OR father* OR maternal OR paternal

OR famil*) N5 (attach* OR bond* OR interact* OR relation* OR sensitiv* OR

respons* OR nurtur*) )

148 661

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(MA "Parent Child Relations") OR (MA "Parenting") OR (MA "Family

Relations") OR (MA "Attachment Behavior") OR (MA "Family Attitudes+") OR

(MA "Parental Attitudes+") OR (MA "Mothers Child Relations") OR (MA

"Fathers Child Relations") OR (MA "Parents/PF")

29 549

2 OR 3

167 851

(TI attachment N3 intervention OR AB attachment N3 intervention) OR (TI

parent* N3 training OR AB parent* N3 training) OR (TI parent* N3 intervention

OR AB parent* N3 intervention) OR (TI family N3 intervention OR AB family

N3 intervention) OR (TI relationship N3 intervention OR AB relationship N3

intervention) OR (TI bonding N3 intervention OR AB bonding N3 intervention)

OR (TI family N3 training OR AB family N3 training)

32 454

1 AND 4 AND 5

Limited to 2000 to 2022

1 100

MEDLINE via EBSCO

Results

TI ( (infant* OR bab* OR newborn* OR birth*) ) OR AB ((infant* OR bab* OR

newborn* OR birth*))

849 745

TI ( (parent* OR mother* OR father* OR maternal OR paternal OR famil*) N5

(attach* OR bond* OR interact* OR relation* OR sensitiv* OR respons* OR

nurtur*) ) OR AB ( (parent* OR mother* OR father* OR maternal OR paternal

OR famil*) N5 (attach* OR bond* OR interact* OR relation* OR sensitiv* OR

respons* OR nurtur*) )

131 479

(MH “Parenting”) OR (MH “Maternal Behavior”) OR (MH “Mother-Child

Relations”) OR (MH “Paren-Child Relations”) OR (MH “Object Attachment”)

OR (MH "Family Relations")

68 310

2 OR 3

178 506

(TI attachment N3 intervention OR AB attachment N3 intervention) OR (TI

parent* N3 training OR AB parent* N3 training) OR (TI parent* N3 intervention

OR AB parent* N3 intervention) OR (TI family N3 intervention OR AB family

N3 intervention) OR (TI relationship N3 intervention OR AB relationship N3

intervention) OR (TI bonding N3 intervention OR AB bonding N3 intervention)

OR (TI family N3 training OR AB family N3 training)

25 552

1 AND 4 AND 5

Limited to 2000 to 2022

1 127

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eTable 2. Summary of methodological decisions to avoid unit-of-analysis issues

Unit-of-analysis

issue

Study ID

Methodological decision

RCTs with 3 arms

Borghini 2014

Term control group dropped.

Browne 2005

Education and control group combined to form the

comparator.

Cates 2018

Data for maternal sensitivity was only presented for the VIP

and Control group. Building Blocks group was dropped.

Juffer 2005

Book only group and control group were combined to form

the comparator.

Klein Velderman

2006

VIPP and VIPP-R groups were combined to form the

exposed group.

Neu 2010

Blanket holding group and control group were combined to

form the comparator.

Porter 2015

PEP group dropped because not dyadic and we decided to

not pool another active control into the comparators. We

used IMPEP and the exposed group and the standard care

control group.

Cluster RCTs

Barnes 2022

Sample size adjusted using the ICC reported in Kristensen

2020 and mean cluster size of 20.

Betancourt 2020

Sample size adjusted using ICC of 0.03, and a mean

cluster size of 5.

Feldman 2014

Sample size not adjusted: mean cluster size not reported.

Glazebrook 2007

Sample size not adjusted: mean cluster size not reported.

Herbers 2020

Sample size adjusted using ICC reported in Betancourt

2020 and mean size 6.5.

Knoche 2012

Sample size not adjusted: mean cluster size not reported.

Kristensen 2020

Sample size adjusted using ICC of 0.001 and mean cluster

size of 66.

Sadler 2013

Sample size not adjusted: mean cluster size not reported.

Sleed 2013

Sample size not adjusted: mean cluster size not reported.

(which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

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eTable 3. Full Study-Level Characteristics

Study ID

Country

Sample characteristics

Design

Intervention

Control

Mothers

(%)

Female infants

(%)

Population

Akai

2008

USA

100.00

N/R

Low SES

Parallel-

group RCT

My Baby and Me

Standard

care/Attention

control

Alarcão

2021

Brazil

100.00

46.45

Low SES,

Adolescent mothers,

First time mother

Parallel-

group RCT

Primeiros Laços

Standard

care/Attention

control

Alvarenga

2020

Brazil

100.00

38.65

Low SES

Parallel-

group RCT

Maternal Sensitivity

Program (video

feedback)

Standard

care/Attention

control

Badr

2006

USA

100.00

31.25

Infant with early

health or

developmental

impairments

Parallel-

group RCT

Curriculum and

Monitoring System

(CAMS)

Standard

care/Attention

control

Baggett

2010

USA

100.00

45.00

Low SES

Parallel-

group RCT

Internet adaptation

of PALS program

(Infant-Net)

Standard

care/Attention

control

Baggett

2017

USA

159

100.00

N/R

Low SES,

Elevated risk for

maltreatment

Parallel-

group RCT

Internet adaptation

of PALS Program

(ePALS Baby-Net)

Standard

care/Attention

control

Barlow

2016

100.00

38.70

Preterm/Low

birthweight infants

Parallel-

group RCT

Video interaction

guidance (VIG)

Standard

care/Attention

control

Barnes

2022

100.00

52.50

Preterm/Low

birthweight infants

Cluster

RCT

Touching and

caressing; tender in

caring (TAC-TIC)

Standard

care/Attention

control

Berlin

2017

USA

336

100.00

50.00

Maternal

psychopathology,

Adolescent mothers,

First time mothers

Parallel-

group RCT

Healthy Families

Durham (HFD)

Standard

care/Attention

control

Berlin

2018

USA

208

100.00

51.00

Low SES

Parallel-

group RCT

Early Head Start

Plus Attachment

and Biobehavioral

Catch-up (ABC)

Standard

care/Attention

control

Bernard

2012

USA

120

100.00

42.00

Elevated risk for

maltreatment

Parallel-

group RCT

Attachment and

Biobehavioral

Catch-up (ABC)

Developmental

Education for

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Study ID

Country

Sample characteristics

Design

Intervention

Control

Mothers

(%)

Female infants

(%)

Population

Families (DEF)

Intervention

Betancourt

2020

Rwanda

198

68.23

N/R

Low SES

Parallel-

group RCT

Sugira Muryango

Standard

care/Attention

control

Bick

2013

USA

0.00

48.00

Foster/Adoptive

parents

Parallel-

group RCT

Attachment and

Biobehavioral

Catch-up

Intervention (ABC)

Developmental

Education for

Families (DEF)

Intervention

Borghini

2014

Switzerland

100.00

49.00

Preterm/Low

birthweight infants

Parallel-

group RCT

Early Intervention

Program

Standard

care/Attention

control

Brisch

2003

Germany

100.00

45.77

Preterm/Low

birthweight infants

Parallel-

group RCT

Parent-centered

Intervention

Program

Standard

care/Attention

control

Browne

2005

USA

100.00

N/R

Preterm/Low

birthweight infants

Parallel-

group RCT

Demonstration and

Interaction

Standard

care/Attention

control

Cates

2018

USA

675

100.00

27.30

Low SES

Parallel-

group RCT

Video Intervention

Project (VIP)

Standard

care/Attention

control

Cevasco

2008

USA

100.00

N/R

Preterm/Low

birthweight infants

Parallel-

group RCT

Maternal Singing

Intervention

Standard

care/Attention

control

Chiu

2009

USA

100

100.00

52.00

Preterm/Low

birthweight infants

Parallel-

group RCT

Skin-to-skin contact

(SSC)

Standard

care/Attention

control

Constantino

2001

USA

148

100.00

39.00

Mothers and infants

(no risk factor)

Parallel-

group RCT

Home Visitation

and Group

Intervention

Standard

care/Attention

control

Cooper

2009

South Africa

449

100.00

48.10

Low SES

Parallel-

group RCT

Mother-infant

Relationship

Intervention

Standard

care/Attention

control

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Study ID

Country

Sample characteristics

Design

Intervention

Control

Mothers

(%)

Female infants

(%)

Population

Cooper

2015

301

100.00

48.45

Maternal

psychopathology

Parallel-

group RCT

Index (R-HV)

Standard

care/Attention

control

Corrigan

2021

USA

100.00

76.50

Preterm/Low

birthweight infants

Parallel-

group RCT

Music Therapy

Standard

care/Attention

control

Dozier

2009

USA

0.00

50.00

Foster/Adoptive

parents

Parallel-

group RCT

Attachment and Bio

behavioral Catch-

up Intervention

(ABC)

Developmental

Education for

Families (DEF)

Intervention

Ericksen

2018

Australia

100.00

N/R

Maternal

psychopathology

Parallel-

group RCT

Community HUGS

(CHUGS)

Standard

care/Attention

control

Feil

2020

USA

164

100.00

55.80

Low SES

Parallel-

group RCT

ePALS

Standard

care/Attention

control

Feldman

2014

Israel

146

100.00

N/R

Preterm/Low

birthweight infants

Parallel-

group RCT

Contact

Intervention

(kangaroo care)

Standard

care/Attention

control

Firk

2021

Germany

100.00

48.00

Adolescent mothers

Parallel-

group RCT

Adaptation of Step

Towards Effective

and Enjoyable

Parenting (STEEP-

Standard

care/Attention

control

Fonagy

2016

100.00

36.50

Low SES,

Maternal

psychopathology

Parallel-

group RCT

Parent–Infant

Psychotherapy

(PIP)

Standard

care/Attention

control

Gaden

2022

Argentina,

Colombia,

Israel,

Norway, and

Poland

213

100.00

51.00

Preterm/Low

birthweight infants

Parallel-

group RCT

Music Therapy

Standard

care/Attention

control

Georg

2021

Germany

154

100.00

43.50

Infant with early

health or

Parallel-

group RCT

Focused Parent-

Infant

Standard

care/Attention

control

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Study ID

Country

Sample characteristics

Design

Intervention

Control

Mothers

(%)

Female infants

(%)

Population

developmental

impairments

Psychotherapy

(fPIP)

Glazebrook

2007

233

100.00

52.50

Preterm/Low

birthweight infants

Cluster

RCT

Parent Baby

Interaction

Programme (PBIP)

Standard

care/Attention

control

Hane

2015

USA

150

100.00

47.85

Preterm/Low

birthweight infants

Parallel-

group RCT

Family Nurture

Intervention (FNI)

Standard

care/Attention

control

Heo

2019

South Korea

97.00

40.30

Preterm/Low

birthweight infants

Parallel-

group RCT

Parent Participation

Improvement

Program

Standard

care/Attention

control

Herbers

2020

USA

100.00

38.00

Low SES

Cluster

RCT

My baby's first

teacher (MBFT)

Standard

care/Attention

control

Hoffenkamp

2015

The

Netherlands

150

100.00

44.00

Preterm/Low

birthweight infants

Parallel-

group RCT

Video Interaction

Guidance (VIG)

Standard

care/Attention

control

Høivik

2015

Norway

158

98.70

51.00

Infant with early

health or

developmental

impairments

Parallel-

group RCT

Video Feedback of

Infant-Parent

Interaction (VIPI)

Standard

care/Attention

control

Holditch-Davis

2014

USA

240

100.00

53.60

Preterm/Low

birthweight infants

Parallel-

group RCT

Auditory-Tactile-

Visual-Vestibular

(ATVV)

Standard

care/Attention

control

Holt

2021

Australia

100.00

N/R

Maternal

psychopathology

Parallel-

group RCT

Happiness,

Understanding,

Giving and Sharing

Intervention

(HUGS)

Standard

care/Attention

control

Horowitz

2001

USA

122

100.00

N/R

Maternal

psychopathology

Parallel-

group RCT

Interaction

Coaching for At-

Risk Parents

(ICAP)

Standard

care/Attention

control

(which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

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Study ID

Country

Sample characteristics

Design

Intervention

Control

Mothers

(%)

Female infants

(%)

Population

Horowitz

2013

USA

144

100.00

N/R

Maternal

psychopathology

Parallel-

group RCT

Communicating

and Relating

Effectively (CARE)

Standard

care/Attention

control

Juffer

2005

The

Netherlands

130

0.00

49.23

Foster/Adoptive

parents

Parallel-

group RCT

Book with Video

Feedback via

Home Visits

Standard

care/Attention

control

Klein Velderman

2006

The

Netherlands

100.00

50.62

First time mothers

Parallel-

group RCT

Video-feedback

Intervention to

Promote Positive

Parenting (VIPP)

Standard

care/Attention

control

Knoche

2012

USA

234

94.00

48.30

Low SES

Cluster

RCT

The Getting Ready

Intervention

Standard

care/Attention

control

Kristensen

2020

Denmark

2366

100.00

N/R

Mothers and infants

(no risk factor)

Cluster

RCT

Newborn

Behavioral

Observations

(NBO)

Standard

care/Attention

control

Landry

2006

USA

264

100.00

55.00

Low SES,

Preterm/Low

birthweight infants

Parallel-

group RCT

Playing and

Learning Strategies

(PALS)

Standard

care/Attention

control

Lavallée

2022

Canada

100.00

65.00

Preterm/Low

birthweight infants

Parallel-

group RCT

Guided

Participation to

Infant Therapeutic

Positioning

(GP_Posit)

Standard

care/Attention

control

Magill-Evans

2007

Canada

183

0.00

47.00

Fathers and infants

Parallel-

group RCT

Education Program

Standard

care/Attention

control

Meijssen

2010

The

Netherlands

176

100.00

48.33

Preterm/Low

birthweight infants

Parallel-

group RCT

The Infant

Behavioral

Assessment and

Intervention

Program (IBAIP)

Standard

care/Attention

control

(which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

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Study ID

Country

Sample characteristics

Design

Intervention

Control

Mothers

(%)

Female infants

(%)

Population

Melnyk

2006

USA

260

100.00

51.50

Preterm/Low

birthweight infants

Parallel-

group RCT

Creating

Opportunities for

Parent

Empowerment

(COPE)

Standard

care/Attention

control

Mendelsohn

2007

USA

150

100.00

38.30

Low SES

Parallel-

group RCT

Video Intervention

Project (VIP)

Standard

care/Attention

control

Milgrom

2013

Australia

123

100.00

51.20

Preterm/Low

birthweight infants

Parallel-

group RCT

PremieStart

Program

Standard

care/Attention

control

Nelson

2001

USA

100.00

50.50

Infant with early

health or

developmental

impairments,

Preterm/low

birthweight infants

Parallel-

group RCT

Auditory-Tactile-

Visual-Vestibular

Intervention (ATVV)

Standard

care/Attention

control

Neu

2010

USA

100.00

51.50

Preterm/Low

birthweight infants

Parallel-

group RCT

Kangaroo care

Standard

care/Attention

control

Newnham

2009

Australia

100.00

52.00

Preterm/Low

birthweight infants

Parallel-

group RCT

Mother-Infant

Transaction

Program (MITP)

Standard

care/Attention

control

Nugent

2017

USA

100.00

55.00

Mothers and infants

(no risk factor)

Parallel-

group RCT

Newborn

Behavioral

Observations

(NBO) System

Standard

care/Attention

control

Onozawa

2001

100.00

32.50

Maternal

psychopathology,

First time mother

Parallel-

group RCT

Massage class +

Support group

Standard

care/Attention

control

Oxford

2021

USA

252

100.00

47.65

Maternal

psychopathology

Parallel-

group RCT

Promoting First

Relationships

(PFR) Intervention

Standard

care/Attention

control

(which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

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Study ID

Country

Sample characteristics

Design

Intervention

Control

Mothers

(%)

Female infants

(%)

Population

Perrone

2021

USA

200

96.00

51.00

Mothers and infants

(no risk factor)

Parallel-

group RCT

Attachment and

Biobehavioral

Catch-up (ABC)

Standard

care/Attention

control

Pontoppidan

2016

Denmark

and Norway

112

72.00

51.00

First time mothers

Pragmatic

RCT

Incredible Years

Parents and Babies

(IYPB) Intervention

Standard

care/Attention

control

Porter

2015

USA

138

100.00

53.40

Maternal

psychopathology

Pragmatic

RCT

Infant Massage-

Parenting

Enhancement

Program (IMPEP)

Standard

care/Attention

control

Ramsauer

2020

Germany

100.00

44.45

Maternal

psychopathology

Parallel-

group RCT

Circle of Security

Intervention (COS-

Standard

care/Attention

control

Ravn

2011

Norway

118

100.00

47.35

Preterm/Low

birthweight infants

Parallel-

group RCT

Mother Infant

Transaction

Program (MITP)

Standard

care/Attention

control

Rheinheimer

2022

The

Netherlands

127

100.00

51.13

Mothers and infants

(no risk factor)

Parallel-

group RCT

Skin-to-skin contact

(SSC)

Standard

care/Attention

control

Robertson

2019

USA

100.00

42.22

Mothers and infants

(no risk factor)

Parallel-

group RCT

Contingent Lullaby

Standard

care/Attention

control

Roby

2021

USA

403

N/R

49.00

Low SES

Parallel-

group RCT

Smart Beginnings:

Video Interaction

Project (VIP) +

Family Check-Up

Standard

care/Attention

control

Sadler

2013

USA

139

100.00

48.00

First time mothers

Cluster

RCT

Minding the Baby

(MTB)

Standard

care/Attention

control

Sahlén Helmer

2020

Sweden

100.00

45.16

Preterm/Low

birthweight infants

Parallel-

group RCT

Continuous Skin to

Skin Contact (SSC)

Standard

care/Attention

control

Sajaniemi

2001

Finland

115

N/R

49.65

Preterm/Low

birthweight infants

Parallel-

group RCT

Occupational

Therapy

Intervention

Standard

care/Attention

control

(which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

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Study ID

Country

Sample characteristics

Design

Intervention

Control

Mothers

(%)

Female infants

(%)

Population

Salo

2019

Finland

100.00

N/R

Maternal

psychopathology

Parallel-

group RCT

Nurture and Play

(NaP)

Standard

care/Attention

control

Santelices

2011

Chile

100

100.00

N/R

First time mothers

Parallel-

group RCT

Secure Attachment

Promotion Program

Standard

care/Attention

control

Schuler

2000

USA

192

100.00

53.55

Maternal

psychopathology

Parallel-

group RCT

Home Intervention:

Based on the

program used by

the infant health

and development

program (IHDP)

Standard

care/Attention

control

Shoghi

2018

Iran

100.00

60.00

First time mothers,

Preterm/Low

birthweight infants

Parallel-

group RCT

Massage

Intervention

Standard

care/Attention

control

Sleed

2013

163

100.00

60.68

Mother-infant dyads

incarcerated

Cluster

RCT

New Beginnings

Intervention

Standard

care/Attention

control

Steele

2019

USA

228

100.00

N/R

Elevated risk for

maltreatment

Parallel-

group RCT

Group Attachment-

Based Intervention

(GABI)

Steps Toward

Effective,

Enjoyable

Parenting

(STEP)

Intervenion

Stein

2006

100.00

53.75

Maternal

psychopathology

Parallel-

group RCT

Video-Feedback

Interactional

Treatment

Standard

care/Attention

control

Stein

2018

144

100.00

51.39

Maternal

psychopathology

Parallel-

group RCT

Video-Feedback

Therapy (VFT) +

Cognitive

Behavioral Therapy

(CBT)

Standard

care/Attention

control

Taneja

2020

India

552

100.00

58.50

Preterm/Low

birthweight infants

Parallel-

group RCT

Community-

initiated Kangaroo

Mother Care

(ciKMC)

Standard

care/Attention

control

(which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

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Study ID

Country

Sample characteristics

Design

Intervention

Control

Mothers

(%)

Female infants

(%)

Population

Tereno

2017

France

120

100.00

52.50

Low SES,

First time mothers

Parallel-

group RCT

“Compétences

Parentales et

Attachement dans

la Petite Enfance:

Diminution des

risques liés aux

troubles de santé

mentale et

Promotion de la

resilience” project

(CAPEDP)

Standard

care/Attention

control

Teti

2009

USA

173

100.00

53.00

Preterm/Low

birthweight infants

Parallel-

group RCT

Infant Intervention

Standard

care/Attention

control

Tryphonopoulos

2020

Canada

100.00

58.35

Maternal

psychopathology

Parallel-

group RCT

Video Feedback

Standard

care/Attention

control

Tsivos

2015

100.00

55.25

Maternal

psychopathology

Parallel-

group RCT

Baby Triple P

Standard

care/Attention

control

Twohig

2021

Republic of

Ireland

100.00

54.05

Preterm/Low

birthweight infants

Pragmatic

RCT

Preterm Infant–

Parent Program for

Attachment

(PIPPA)

Standard

care/Attention

control

Valades

2021

El Slavador

100.00

N/R

Adolescent mothers

Parallel-

group RCT

Crianza Temprana

(Early Parenting)

Standard

care/Attention

control

van Doesum

2008

The

Netherlands

100.00

40.50

Maternal

psychopathology

Parallel-

group RCT

Mother-Baby

Intervention

Standard

care/Attention

control

Vargas-Porras

2021

Columbia

100.00

53.00

First time mothers

Parallel-

group RCT

Maternal Support

for Becoming a

First-time Mother

(AMACOMPRI)

Standard

care/Attention

control

(which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

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Study ID

Country

Sample characteristics

Design

Intervention

Control

Mothers

(%)

Female infants

(%)

Population

Walter

2019

US and

Germany

169

52.16*

49.70

Parents and infants

(no risk factor)

Parallel-

group RCT

Secure Attachment

Family Education

(SAFE)

Standard

care/Attention

control

White-Traut

2013

USA

198

100.00

47.00

Preterm/Low

birthweight infants

Parallel-

group RCT

H-Hope

Intervention

Standard

care/Attention

control

Williams

2020

USA

100.00

42.35

Low SES,

Adolescent mothers

Parallel-

group RCT

Infant Carrier

Standard

care/Attention

control

Wulff

2021

Germany

120

100.00

N/R

Maternal

psychopathology

Parallel-

group RCT

Singing Intervention

Standard

care/Attention

control

Youn

2021

South Korea

151

100.00

50.80

Preterm/Low

birthweight infants

Parallel-

group RCT

Mother–Infant

Transaction

Program (MITP)

home visits

Standard

care/Attention

control

2022

Taiwan

100.00

51.56

Preterm/Low

birthweight infants

Parallel-

group RCT

Maternal Voice

Recording

Standard

care/Attention

control

Zelkowitz

2011

Canada

122

100.00

50.00

Preterm/Low

birthweight infants

Parallel-

group RCT

Cues

Standard

care/Attention

control

*Results presented for mothers and fathers separately.

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%6%./#)&!B8!C2$%(.D"2$%+*?%$E>%'#$.!,&&%&&<%(.&!#5!>%42.*#(24!F%24./!

Among the 93 studies included in the systematic review, we identified 12 distinct Parent/Caregiver-reported

assessments of relational health. An overview of the main characteristics of these scales is presented in the table

below and an in-depth description of these scales is subsequently provided. Based on information provided in the

reviewed literature, a narrative description of each observational assessment is also provided after the table (links

auto-direct to a description of each observation assessment). Note that summaries of each instrument are drawn only

from the reviewed studies; detailed information about instrument development, and validity are not included in scale

descriptions.

Main Characteristics of Parent/Caregiver-reported Assessments of relational

health

Scale

Acronym

Construct

measured

Main reference(s)

Studies using this

scale

Attachment

Diaries

Attachment

behaviors during

distressing situations

Stovall and Dozier

200015

Dozier 200916

Maternal

Attachment

Inventory

Caregiver

attachment and

emotional bonding

within the dyad

Muller 199417

Heo 201918

Vargas-Porras

202119

Mother-Infant

Bonding Scale

Maternal rating of

mother-infant bond

Cevasco 200820

Mother-to-Infant

Bonding Scale

MIBS

Mother’s feelings

toward her infant

Corrigan 202121

Mother-to-Child

Attachment

MCA

Youn 202122

Mother-Infant

Bonding

Inventory

Mother’s thoughts,

feelings and

commitment toward

her baby

Sheih, Ying, Li, and

Hsieh 201523

Yu 202224

My Baby and I

Questionnaire

MBI

Parent-infant

relationship

Furman and O’Riordan25

Hoffenkamp 201526

Parent-to-Infant

Attachment

Questionnaire

PIA

Parent-child

relationship quality

Barnes 202227

Parenting Your

Baby

Questionnaire

PYB

Parental warmth

Canfield 202028

Roby 202129

Postpartum

Bonding

Questionnaire

PBQ

Mother-infant

bonding

Brockington, Oates, and

George 2001;

Brockington, Fraser, and

Wilson 2006 30,31

Gaden 202232

Hoffenkamp 201526

Holt 202133

Tsivos 201534

Williams 2020

35Wulff 202136

Working Model

of the Child

Interview

WMCI

Maternal feelings

about their

relationship with their

child

Zeanah and Benoit

199537

Meijssen 201038

Meijssen 201139

Yale Inventory

of Parental

Thoughts and

Actions

YIPTA

Parental bonding and

postpartum distress

Feldman, Weller,

Leckman, Kuint, and

Eidelman, 199940

Hoffenkamp 201526

(which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

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,..2=/<%(.!G*2$*%&!

The Attachment Diaries allow parents to self-report infants’ behaviors during distressing situations.15

Populations. Not specified.

Scoring. Parents document infants’ initial attachment-seeking behaviors as well as their own behavioral responses

and the infants’ reactive responses during distressing situations. They also provide a narrative of the incident.

Parents keep track of these incidents over the course of three days. Scores are determined by summing the instances

of proximity seeking by the child, successful calming by the parent, avoidance, or resistance. Proximity seeking and

successful calming scores are summed to achieve a secure score for behavior. Behaviors on behalf of both the child

and parent can be classified as secure, avoidant, or resistant. Secure behaviors include moving toward the parent or

being soothed by the parent without expressions of anger or ambivalence. Avoidant behaviors include suppressing

hurt or fear or moving away from the parent. Resistant behaviors include outward displays of angry behavior such as

kicking, screaming, biting, or continual fussiness. Documented situations that are deemed not sufficiently distressing

(i.e., child left with a familiar caregiver) are considered not relevant and missing.

Psychometric Properties. Not specified.

,..2=/<%(.!H(?%(.#$;!

The Maternal Attachment Inventory measures caregiver attachment and emotional bonding to their infants.17

Populations. This scale has been culturally adapted and translated into Korean41 and Spanish.42 It has been validated

for use in Colombian first-time mothers of term infants and for parents with preterm infants.

Scoring. This self-report questionnaire is comprised of 2419 to 2618 items rated on a 4-point Likert scale. Higher

scores correlate with better attachment to infants. Scores are rated as low (85 or less), moderate (86 to 89 points), or

high (90 or more).

Psychometric properties. Cronbach's alpha ranges from 0.8518 to 0.90.19

6#./%$EH(52(.!I#()*(+!:=24%!

The Mother-Infant bonding scale is a self-report tool used to assess the quality of maternal-infant bond.

Populations. Not specified.

Scoring. Bonding is assessed using a 5-point Likert scale for four indices relating to how the mother rates her

relationship to her infant. A low score of 4 indicates low mother-infant bonding, and a high score of 20 indicates a

positive mother-infant bond.

Psychometric properties. Not specified.

6#./%$E.#EH(52(.!I#()*(+!:=24%!J6HI:K!

The Mother-Infant bonding scale is used to measure mother-infant bonding by assessing the degree of emotional

connectedness mothers have toward their infants.43

Populations. Not specified.

Scoring. This self-report tool directs mothers to rank a series of 8 different feelings they may experience in relation

to their infant, such as loving, neutral or resentful on a scale from very much like them, to not at all like them. This

scale is scored 0-24, with higher scores indicating worse mother-infant bonding, and scores of 2 or more indicating

clinically compromised maternal-infant bonding.

Psychometric properties. The MIBS has been found to have acceptable criterion-related validity and construct

validity.44

(which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprintthis version posted October 31, 2022. ; https://doi.org/10.1101/2022.10.29.22281681doi: medRxiv preprint

6#./%$E.#E"/*4)!,..2=/<%(.!J6",K!

The Mother-to-Child Attachment (MCA) scale is used to measure attachment in mother-child dyads.22

Populations. Not specified.

Scoring. Not specified.

Psychometric properties. Not specified.

6#./%$EH(52(.!I#()*(+!H(?%(.#$;!

Mother-Infant Bonding Inventory is used to measure maternal thoughts, feelings and commitment in relation to her

infant.

Populations. Not specified.

Scoring. The scale consists of four domains: proximity, parental adjustment, commitment, and confidence of

reciprocity. Each item was scored using a 6-point Likert scale with scores of 1-6 corresponding to strongly disagree,

disagree, slightly disagree, slightly agree, agree, and strongly agree, respectively. Higher scores indicate better

bonding.

Psychometric properties. The Cronbach's α of the inventory was 0.88–0.89.23

6;!I23;!2()!H!L-%&.*#((2*$%!J6IHK!

The My Baby and I Questionnaire is used to assess the parent’s feelings about the parent-child relationship in terms

of responsiveness, enjoyment, and separation anxiety.

Populations. Not specified.

Scoring. MBI-W measures worry in three items, producing scores ranging from 3-15. Greater scores on the MBI-W

indicate greater infant-related concerns. MBI-ER measures Enjoyment and Responsiveness in seven items,

producing scores from 7-31. Higher scores on the MBI-ER indicate more positive feelings about the infant and

higher responsiveness to the infant. MBI-SA measures separation anxiety in four items, producing scores of 4-20.

Greater scores on the MBI-SA indicate greater parental anxiety when leaving the infant.

Psychometric properties. Internal consistency ranged from acceptable to very good across the dimensions MBI-W

(mothers: 0.90 and 0.77, fathers: 0.88 and 0.75), MBI-ER (mothers: 0.83 and 0.60, fathers: 0.83 and 0.67), and MBI-

SA (mothers: 0.70 and 0.82, fathers: 0.70 and 0.75).26

C2$%(.E.#EH(52(.!,..2=/<%(.!L-%&.*#((2*$%!JCH,K!

The Parent-to-Infant Attachment Questionnaire (PIA) is a self-report tool that is used to assess the emotional bond

or tie of affection experienced by the parent toward the infant. The Parent-to-infant attachment questionnaire

(PIA56) is a 19-item scale with 3 subscales including quality of attachment, absence of hostility, and pleasure in

interaction.

Populations. Not specified.

Scoring. Not specified.

Psychometric properties. The test-retest reliability and internal consistency of the instrument are acceptably high.45

All 19 items have high face validity in terms of reflecting various facets of the emotional experience of the parent

toward their infant.45 The criterion validity of the instrument has yet to be established.45

(which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprintthis version posted October 31, 2022. ; https://doi.org/10.1101/2022.10.29.22281681doi: medRxiv preprint

C2$%(.*(+!M#-$!I23;!L-%&.*#((2*$%!JCMIK!

The Parenting your baby Questionnaire (PYB) is a self-report questionnaire regarding parental experience. In our

study, two authors utilized the PYB’s Supporting and Enjoying subscale to measure parental warmth.

Populations. This scale has shown high construct, convergent, and predictive validity in children at school entry46

and has been widely used with toddlers and young children.28

Scoring. This eight-item subscale asks parents about their parenting activities and feelings in the past month,

including items like “play with your child in a way that was fun for him/her” and “feel confident in reading your

child’s cues.” Items are rated on a 7-point scale from 1 (not at all) to 7 (most of the time).

Psychometric properties. This scale has shown high construct, convergent, and predictive validity.29 Cronbach’s

alpha in Roby (2021)’s sample ranged from 0.67 to 0.73.29

C#&.'2$.-<!I#()*(+!L-%&.*#((2*$%!JCILK!

The Postpartum Bonding Questionnaire (PBQ) is a self-report tool that measures mother-infant bonding in the

period following birth.30 The PBQ targets the mother’s feelings, experiences and attitudes toward her infant.32

Populations. The PBQ has been validated in the UK,30,31,47 Germany,48 Japan,49,50 Spain,51 Italy,52 India,53 and

France,54 in general and clinical populations.

Scoring. The PBQ contains four subscales: general impaired bonding, rejection and pathologic anger, anxiety about

the infant, and incipient abuse.32 The questionnaire consists of statements about the mother’s feelings toward her

infant, rated on a 6-point Likert scale with responses ranging from “always” to “never.” The total score ranges from

0 to 125, with higher scores indicating an impaired bond.26,32

Psychometric properties. The PBQ has good internal consistency and high test-retest reliability.34 The PBQ has

also been found to have acceptable criterion and construct validity.44

N#$O*(+!6#)%4!#5!./%!"/*4)!H(.%$?*%@!JN6"HK!

The Working Model of the Child Interview aims to elicit parents’ feelings about their relationships with their

children.37 Developed in reference to the Adult Attachment Interview (AAI), the WMCI focuses on the parent’s

emotional reactions during pregnancy, perception of the infant’s personality and development, characteristics of the

bond with the infant, reactions to infant behavior, and anticipated difficulties in later development.38 Additionally,

parents are asked to provide anecdotes about their infant that would help illustrate the child’s personality and

behavior.

Populations. Not specified.

Scoring. The interviews are videotaped and take about 60 minutes to complete. The children are not present for the

interview. The interviews are rated with a 5-point Likert scale in six scales: richness of perception, openness to

change, intensity of involvement, coherence, caregiving sensitivity and acceptance. Based on the caregiver’s

narrative answers to the questions, their children are then classified by score into one of three attachment

representations: balanced (secure), disengaged (insecure), or distorted (insecure).

Psychometric properties. Not specified.

M24%!H(?%(.#$;!#5!C2$%(.24!1/#-+/.&!2()!,=.*#(&!JMHC1,K!

The Yale Inventory of Parental Thoughts and Actions (YIPTA) measures parental bonding and distress postpartum.

Populations. The YIPTA has been validated for use in parents with term or preterm infants.

Scoring. The self-report questionnaire is comprised of 27-items falling into five subscales:

Frequency of Thoughts and Worries (YIPTA-FTW; 9-items), Distress Caused by Thoughts and Worries (YIPTA-

DTW; 5-items), Compulsive Checking (YIPTA-CC; 4-items), Affiliative Behavior (YIPTA-AB; 5-items), and

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Attachment Representations (YIPTA-AR; 4-items). Each item is scored on a 4-point scale, for a maximum overall

score of 108. Higher scores correlate to more infant-related worries and distress, or greater bonding and caregiver

behaviors depending on the subscale.

Psychometric properties. The scale exhibited strong internal consistency for YIPTA-FTW (mothers: 0.92; fathers:

0.90), YIPTA-DTW (mothers: 0.87; fathers: 0.86), and YIPTA-CC (mothers: 0.81; fathers: 0.77). The scale

demonstrated moderate consistency for YIPTA-AB (mothers: 0.55; fathers: 0.66) and YIPTA-AR (mothers: 0.55;

fathers: 0.59).26

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%6%./#)&!P8!Q3&%$?2.*#(24!,&&%&&<%(.&!#5!>%42.*#(24!F%24./!

Among the 93 studies included in the systematic review, we identified 41 observational assessments of relational

health. An overview of the main characteristics of these scales is presented in the table below. Based on information

provided in the reviewed literature, a narrative description of each observational assessment is also provided after

the table (links auto-direct to a description of each observation assessment). Note that summaries of each instrument

are drawn only from the reviewed studies; detailed information about instrument development, validity, and an

exhaustive list of paradigms are not included in scale descriptions. For a systematic review of observational coding

instruments for use in infancy, see Lotzin et al., 2015.55

Observational Assessments of Relational Health

Scale

Acronym

Construct

measured

Main

reference(s)

Paradigm(s)

Studies using

this assessment

Adult Play

Scale

Physical and

emotional child-

caregiver

connection

Howes and

Stewart

198756

Free play

Constantino

200157

Ainsworth’s

Maternal

Sensitivity

Scales

Maternal

sensitivity

towards the

infant

Ainsworth,

Bell, and

Slayton 1971,

197458,59

Free play,

Bathing

Klein Velderman

200660

Rheinheimer

202261

Sahlen-Helmer

201962

Attachment Q-

Sort

AQS

Infant

attachment

behavior

Waters

199563

Naturalistic

dyadic home

observation

Klein Velderman

200660

Stein 201864

van Doesum

200865

Attachment

Story

Completion

Task

ASCT

Child attachment

representations

Verschueren

and Marcoen

199466

Bretherton,

Ridgeway,

and Cassidy

199067

Child-led

story

completions

van Doesum

200865

Atypical

Maternal

Behavior

Instrument for

Assessment

and

Classification

Scale

AMBIANCE

Affective

communication

and behavior

between

caregivers and

infants

Bronfman,

Madigan, and

Lyons-Ruth

1992-200968

Bronfman,

Parsons, and

Lyons-Ruth

1992-200869

Face-to-face

dyadic

interactions

Sadler 20135

Tereno 201770

Avant

Maternal

Attachment

Behaviors

Scale

Dyadic

attachment

Avant 197871

Face-to-face

interaction

Shoghi 201872

Barrier Task

Regulation and

dysregulation of

child behaviors

Goldsmith

and Rothbart

199373

Barrier Task

Valades 202174

Child Adult

Relationship

Evaluation

Index

CARE-Index

Quality and

patterns of

parent-infant

interaction

Crittenden

1979-200475

Crittenden

1979-201076

Free play,

Semi-

structured

play

Barlow 201677

Borghini 201478

Nugent 201779

Oxford 202180

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Scale

Acronym

Construct

measured

Main

reference(s)

Paradigm(s)

Studies using

this assessment

Tryphonopoulos

202081

Tsivos 201534

Twohig 202182

Coding

Interactive

Behavior

CIB

Maternal and

infant behavior

and quality of

mother-infant

interactions

Feldman

199883

Free play

Fonagy 201684

Sleed 201385

Steele 201986

Coding system

by Piccinini,

Alvarenga and

Frizzo (2007)

Maternal

sensitivity in

maternal-infant

interactions

Piccinini,

Alvarenga

and Frizzo,

200787

Free play

Alvarenga 202088

Dyadic

Mutuality

Code

DMC

Responsivity,

mutuality, and

synchrony in the

dyadic

relationship

Censullo,

1991;

Censullo,

Bowler,

Lester, &

Brazelton,

1987

Free play

Horowitz 200189

Nelson 200190

White-Traut

201391

Emotional

Availability

Scales and

Emotional

Attachment

Zones

Evaluation

EAS

EA-Z

Quality of dyadic

interactions and

the global dyadic

relationship

Biringen,

2008; EA-Z,

Wurster,

Sarche,

Trucksess,

Morse, &

Biringen,

2019;

Biringen,

Robinson, &

Emde, 1998

Free play

Firk 202192

Fonagy 201684

Georg 202193

Hoivik 201594

Klein Velderman

200660

Salo 201995

van Doesum

200865

Eye gaze

Quality of

mother-infant

interactions

Beebe, Jaffe,

Markese,

Buck, Chen,

Cohen,

Bahrick,

Andrews,

Feldstein 96

Face-to-face

interaction,

Free play

Hane 201597

Global Rating

Scale

GRS

Dyadic

interaction

patterns and

overall quality of

dyadic

interactions

Murray,

199698

Still Face

(reunion

phase)

Valades 202174

Williams 202035

Zelkowitz 201199

Holditch-Davis

Coding

System

Mother-infant

interaction

behavior

patterns

Holditch-

Davis et al.,

2007100;

Holditch-

Davis, Miles,

Burchinal, &

Goldman,

2011101

Naturalistic

dyadic

interaction

Holditch-Davis

2014102

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Scale

Acronym

Construct

measured

Main

reference(s)

Paradigm(s)

Studies using

this assessment

The Home

Observation

for

Measurement

of the

Environment

Inventory

HOME-

Inventory

Quality of the

home

environment in

supporting child

development

Caldwell and

Bradley,

1978103

Observations

of the home

environment

Alarcao 2021104

Badr 2016105

Betancourt

2020106

Glazebrook

2007107

Holditch-Davis

2014102

Index of

Parental

Behavior

IPB

Quality of dyadic

interactions

Melnyk et al.,

1998108

Face-to-face

dyadic

interactions

Melnyk 2006109

Infant and

Caregiver

Engagement

Phases

ICEP

Infant and

caregiver affect,

engagement,

and the quality of

the engagement

Weinberg &

Tronick,

1999110

Still Face

Meijssen 201038

Landry Parent-

Child

Interaction

Scales

Quality of

maternal-infant

interactions

Landry et al.,

1996111;

Landry,

Smith, Miller-

Loncar, &

Swank,

1998112

Freeplay,

Book reading

activities

Baggett 2010113

Baggett 2017114

Feil 2020115

The Looking,

Touching,

Talking,

Smiling

Parent-Infant

Interaction

Coding Scale

LoTTS

Frequency of

interaction

behaviors

Beatty et al.,

2011116

Free play

Robertson

2019117

Maternal

Behavioral Q-

set

MBQ

Maternal

sensitivity toward

the infant

Pederson &

Moran,

1995118

Naturalistic

observation

Teti 2009119

Maternal

Caregiving

Behaviors

Quality of

feeding, holding,

and other

maternal

caregiving

behaviors

Hane & Fox,

2006120;

Hane &

Philbrook,

2012121

Feeding and

holding

interactions

Hane 201597

Maternal

Interactive

Behaviors

Likert Scales

Quality of

maternal

interactive

behavior

Erickson,

Sroufe &

Egeland,

1985122;

Smeekens,

Riksen-

Walraven, &

Van Bakel,

2008123

Free play,

Structured

discourse

task

Kersten-Alvarez

2010124

van Doesum

200865

Maternal

Sensitivity and

Responsivity

Scales

MSRS

Maternal

attunement to

infant behaviors

during

interaction

Cenciotti,

Tronick, &

Reck, 2004125

Still Face

Sahlen-Helmer

202062

Meijssen 201038

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Scale

Acronym

Construct

measured

Main

reference(s)

Paradigm(s)

Studies using

this assessment

Mini-Maternal

Behavior Q-

Sort for Video

Coding

Mini-MBQS-V

Maternal

sensitivity

Moran

2009126

Free-play,

Diaper

change,

Book sharing

Ramsauer

2019127

Mother-Infant

Interaction

Rating Scales

Quality of

parent-child

interaction

Cowan &

Cowan,

1992128;

Cowan &

Cowan

1992129

Feeding

interaction

Schuler 2000130

Schuler 2002131

Mutually

Responsive

Orientation

MRO

Responsiveness

of parent-child

relationship

defined as close,

mutually binding,

cooperative, and

affectively

positive

interactions

Kochanska,

2002132

Free play

Herbers 2020133

National

Institute of

Child Health

and Human

Development

Scales

(Qualitative

Scales of the

Observational

Record of the

Caregiving

Environment)

NICHD Scales

Maternal

sensitivity and

responsiveness

NICHD,

1999134,135

Play

Berlin 2018136

Hoffenkamp

201526

Ravn 2011137

Peronne, 2021138

Nursing Child

Assessment

Feeding Scale

& Teaching

Scales

NCAFS

NCATS

Parental

sensitivity and

relational

effectiveness

Sumner &

Spietz,

1994139

Feeding,

Teaching

Badr 2006105

Chiu 2009140

Glazebrook

2007107

Horowitz 2013141

Lavallée 2022142

Nelson 200190

Oxford 202180

Tryphonopoulos

202081

White-Traut

201391

Observation

Checklist on

Mother-Infant

Interaction

OMII

Infant and

maternal

interactive

behaviors,

secure/approach

and insecure/

avoidant

measures as

well as maternal

warmth and

negative affect,

Ukeje,

Bendersky,

and Lewis

(2001)143

Playtime and

temporary

separation

Porter 2015144

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Scale

Acronym

Construct

measured

Main

reference(s)

Paradigm(s)

Studies using

this assessment

and infant

positive affect

and anger

Observation of

Mother-Child

Interaction

OMCI

Mother-child

interaction for

responsive

caregiving skills

Landry et al.,

2006145

Dyadic

interactions

Betancourt

2020106

Parent-

Caregiver

Involvement

Scale

P/CIS

Quality of

mother-child

interaction,

maternal

sensitivity, and

maternal

intrusiveness

Knoche et

al.2012 146

Free play

Cooper 2009147

Parent Child

Early

Relational

Assessment

ERA

Quality of

mother-child

relationships

Clark,

2015148

Free play

Holt 202133

Parent-Child

Interaction

Rating Scales

– Infant

Adaptation

PCIRS-IA

Parental

sensitivity and

quality of parent-

child interaction

Clark,

1999149

Free play

Canfield 202028

Roby 202129

Pediatric

Infant Parent

Exam

PIPE

Quality of

parent-infant

interactions

Fiese,

Poehlmann,

Irwin,

Gordon, &

Curry-Bleggi,

2001150

Dyadic

interactions

while playing

a game

Ericksen 2018151

Preterm

Mother-Infant

Interaction

Scale

PREMIIS

Mother-infant

relationship for

sensitive and

responsive

caregiving

Newnham,

Milgrom, and

Skouteris

2009152

Undressing,

bathing, and

dressing

Milgrom 2013153

Sensitivity and

Cooperation

Maternal

sensitivity and

responsiveness

Ainsworth et

al., 197459

Ainsworth,

Bell, and

Slayton

197158

Free play

Juffer 2005154

Still Face

Procedure

SFP

Infant response

to social

challenge

Ainsworth

1978155

Still face

Meijssen 201038

Valades 202174

StimQ2

Caregiver

cognitive

stimulation

Dreyer,

Mendelsohn,

& Tamis-

LeMonda,

1996156

Structured

interview

Cates 2018157

Mendelsohn

2007158

Mendelsohn

2011159

Roby 202129

Strange

Situation

Procedure

SSP

Infant

Attachment

Ainsworth et

al., 1978155

Strange

situation

Berlin 2017160

Bernard 2012161

Brisch 2003162

Cooper 2009147

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Scale

Acronym

Construct

measured

Main

reference(s)

Paradigm(s)

Studies using

this assessment

Klein Velderman

200660

Sadler 20135

Santelcies

2011163

Tereno 201770

Synchrony

Scale

Mother-infant

interaction for

reciprocity and

synchrony

Milgrom &

Meitz,

1988164

Free play

Newnham

2009152

,)-4.!C42;!:=24%!!

The Adult Play Scale is used to rate parent-infant interactions.56

Paradigms. Mothers and infants engage in a 20-minute videotaped free-play session. This provides an opportunity

to assess the appropriateness and extent of parental physical and emotional engagement with the child.

Populations. Not specified.

Scoring. Interactions for which mutual eye gaze was sustained for more than a moment or in which parents were

actively involved with the child are rated according to clearly defined criteria. Child behavior or dyadic engagement

is not scored. Caregiver behavior was rated: (0)Ignores, if the caregiver ignored the child; (1) Routine, if the

caregiver touches the child for routine care, but made no verbal responses; (2) Minimal, if the adult touched the

child for discipline or in response to requests for help; (3) Simple, if the caregiver verbally responds to the child, but

did not elaborate; (4) Elaborated, if the caregiver made positive physical gestures or stayed in close proximity to the

infant; or (5) Intense, if the caregiver hugged the child, engaged in conversation with the child, repeated child

statements, or played with the child56.

The scale point for each interaction is multiplied by the duration of exchange, summed, and then divided by the total

session time (20 minutes) to determine the mean level of play.

Psychometric properties. Test-retest reliability (0.85) was determined by assessing four children a week after the

initial assessment.56 There was a significant correlation between scores on the Adult Play Scale and overall scores

for quality of care in 55 family daycare homes, r = 0.52, p < 0.01.56

Coding Manual/Training. Not specified.

,*(&@#$./R&!62.%$(24!:%(&*.*?*.;!:=24%&!

The Ainsworth’s Maternal Sensitivity Scales are used to assess maternal sensitivity towards the infant58,59,155.

Paradigms. Ainsworth’s Maternal Sensitivity Scales have been used to code maternal behavior in free-play

paradigms. For example, in free-play paradigms, mothers could be instructed to play with their infants as they

normally would for ten minutes with a standardized collection of toys (i.e. squeaking duck, mirror, rattles) provided

by the researchers (as done in Klein-Velderman, 2006). Behavior during the bathing routine has also been coded

using the same scales61.

Populations. This scale has been validated for use in infants 3-24 months of age62

Scoring. Maternal behavior is assessed on the following subscales: sensitivity, interference-cooperation, availability,

acceptance-rejection, and positive and negative regard. Infant behavior is assessed on responsivity, involvement, and

negative mood. Negative mood, positive regard, and negative regard are scored on a 7-point scale while the

remaining subscales range from 1-9, with lower scores corresponding to less secure behaviors (i.e. 1 corresponds to

highly insensitive or highly interfering mothers). The infant responsivity and involvement scales are averaged to

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determine a composite score. Maternal sensitivity and cooperation scales were also averaged to create a composite

score61,165. For double-scored videos (n = 52%), published research uses a final score that is determined by

averaging the individual scores of the two coders. If the scores differed by one point, the score that deviated more

from the mean was chosen. If the scores differed by more than a point, a third coder rated the video, and the scores

of the two coders with the most agreement were used to determine the final score61.

Psychometric properties. The scales have been tested for validity and reliability. Infant responsivity and

involvement were highly correlated (r = 0.90) as well as maternal sensitivity and cooperation (r = 0.93). T1 pre-test

scores strongly correlated with T2 post-test scores (r = 0.45, p < 0.001; see Klein-Velderman, 2006).

Coding Manual/Training. Not specified.

,..2=/<%(.!LE:#$.!J,L:K!

The AQS is used to measure infants’ attachment behavior in a home setting (AQS63,166).

Paradigms. As described in Klein-Velderman and colleagues (2006): Trained observers watch a 1.5 to 2.5-hour

videotaped observation of the mother and infant interacting naturally in their home setting. The first segment of the

visit is approximately two hours of unstructured interactions, including lunch and other daily activities. This is

followed by the child playing a hammering game, the dyad playing with clay for 15 minutes, and dyadic play

without toys for five minutes.

Populations. The AQS has been validated for use in children aged 12-48 months65.

Scoring. The AQS consists of 90 descriptive statements of attachment behaviors. Statements are sorted into a nine-

category, ten-card distribution from “most characteristic of the child” to “least characteristic of the child.” Security

scores were derived by correlating the Q-sort description to the criterion sort. Security scores range from –1.00 for

an extremely insecure infant to +1.00 for an extremely secure infant.

Psychometric properties. The AQS has been shown to be reliable and has good discriminant, convergent, and

predictive validity of attachment security in all domains except the avoidance scale (α = 0.15;167.

Coding Manual/Training. A coding manual has been published by Waters & Deane (1985)166.

,..2=/<%(.!:.#$;!"#<'4%.*#(!12&O!J,:"1K!!

The Attachment Story Completion Task is used to measure child attachment representations66,67,168.

Paradigms. Children are given a mother and a child doll. They are instructed to complete five story stems that

activate their attachment representations. Two of the story beginnings deal with emotionally charged and

relationship-acknowledging interactions between the dyad: (1) the child gives the mother a handmade present and

(2) the child says, “I’m sorry, Mom.” The other three stories deal with distress or external conflict: (1) the child’s

bike is stolen by an unfamiliar child; (2) there is a monster in the child’s bedroom; (3) the child is crying because

they argued with another child at school66. This paradigm provides the opportunity to observe the extent to which

the child views themselves in a secure relationship with the mother as well as maternal responsiveness to positive

social signals from the child, when the child feels threatened, and to signals of distress from the child168.

Populations. In addition to the task described above that is typically used among preschool-aged children, the

ASCT has been adapted for use in 5-year-olds169.

Scoring. Videotaped transcriptions of the story completions are rated on a 5-point security scale. Stories scored as a

4 or 5 were classified as secure if the child completed the story with minimal hesitation and displayed positive

interactions with a responsive mother. Stories scored as a 1 or 2 were categorized as ambivalent/bizarre or avoidant,

both of which were considered insecure categories. Ambivalent/bizarre stories had negative and hostile interactions

between the child and mother mixed with brief, positive interactions. Avoidant stories had minimal child-mother

interactions, or the child hesitated to complete the story. Stories with a score of 3 were not clearly secure or insecure

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and were categorized as secure/insecure. The scores for all the story completions were summed to achieve an overall

attachment security score. Higher scores indicate a more secure attachment with the attachment figure.

Psychometric properties. The scale was also tested for reliability and consistency of the stories, yielding a

Cronbach’s alpha of 0.68 in a study by Kersten-Alvarez and colleagues (2010)124.

Coding Manual/Training. For an unpublished coding manual, see Verschueren and Marcoen (1994)66.

,.;'*=24!62.%$(24!I%/2?*#$!H(&.$-<%(.!5#$!,&&%&&<%(.!2()!"42&&*5*=2.*#(!J,6IH,S"TK!!

The Atypical Maternal Behavior Instrument for Assessment and Classification is used to measure affective

communication and behavior between caregivers and infants68,170.

Paradigms. This scale is used to assess videotaped face-to-face interactions between the mother and infant.

Populations. The AMBIANCE scale was originally developed to code maternal behavior during the 12-month

Strange Situation170 and has been validated for use with 4-month-old infants and their mothers171.

Scoring. The six dimensions of the scale include affective communication errors, role confusion,

fearfulness/disorientation, intrusiveness/negativity, withdrawal, and controlling behavior. A frequency score for

each of the dimensions is calculated by coders masked for any participant status characteristics. Overall disrupted

communication is also scored on a 7-point scale: 1 (sensitive communication), 3 (mostly positive with some

disrupted communication), 5 (repeated disruptive communication), or 7 (disruptive communication with little or no

amelioration). Higher scores indicate greater levels of disrupted communication. Scores of 5 or above are considered

“disrupted” while scores less than 5 are considered “not-disrupted” 68,172.

Psychometric properties. This assessment has been correlated with the Strange Situation as well as dyadic

behavior in the home170,173. The AMBIANCE scale also demonstrates strong stability over time174 and is predictive

of child behavioral problems from toddlerhood to 20 years old175-177.

Coding Manual/Training. Training information is provided online at:

https://www.challiance.org/academics/research/family-studies-lab/ambiance-training

,?2(.!62.%$(24!,..2=/<%(.!I%/2?*#$&!:=24%!

The Avant Maternal Attachment Behaviors Scale is used to assess emotional attachment between dyads71.

Paradigms. In Shoghi and colleagues’ (2018) intervention study, dyadic attachment was measured before the

intervention started as well as on the first, third, and fifth days after the intervention commenced. Dyads engaged in

naturalistic interactions for 15 minutes. This session was observed directly by a member of the research team who

was masked to intervention group assignment. Attachment assessment was performed an hour after the intervention

session (i.e., massage) but before breastfeeding.

Populations. Used with mothers and newborn infants in Shoghi and colleagues’ (2018) study72 and also published

in research with infants conducted by the scale developer71,178.

Scoring. The Avant Scales71 are comprised of 14 observable behaviors that assess emotional behaviors (kissing,

looking, cuddling, talking, smiling, etc.), proximity behaviors (hugging with no contact with the mother’s body,

hugging with little contact to the mother’s body, hugging by wrapping arms around the neonate), and caring

behaviors (changing the diaper or clothes, burping the neonate, organizing the neonate’s clothes). These attachment

behaviors are scored in 15 one-minute sections: the researcher observes the mother’s behavior for the first 30

seconds and records them in the latter 30 seconds. If a behavior was observed, it received a score of 1; otherwise, a

zero was recorded. The maximum score for each behavior is 15, and the maximum overall score is 210. Higher

scores correlate with better dyadic attachment.

Psychometric properties. No specified.

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Coding Manual/Training. Not specified.

I2$$*%$!12&O!

This measure was developed to assess infants’ reactions to non-social challenges73.

Paradigms. The infant is presented with a novel toy and allowed to play with it for 30 seconds. The toy is removed

from the infant’s possession and placed behind a transparent barrier in their line of sight for one minute. During this

paradigm, the mother is near the infant, but she is instructed to have a still, neutral face. This task presents the

opportunity to determine infants’ capacity to face challenges in a regulated way and to assess infants’ use of

communication in distressing circumstances74.

Populations. Not specified.

Scoring. A coding scheme developed by Bozicevic and colleagues (2016)179 was used to code videos in Valades and

colleagues’ (2021)74 intervention study. Interactions were coded for the presence or absence of various regulated and

dysregulated behaviors on a 1-s time basis. Regulated behaviors include (a) Social: either through gaze or

referencing (looking toward mother or researcher and/or pointing or vocalizing for the toy); (b) Non-social goal-

directed: gazing or reaching for the toy; and (c) Non-social not goal-directed: distraction or play/exploration.

Dysregulated behaviors include escape/aversion and tantrums.

Psychometric properties. Not specified.

Coding Manual/Training. Not specified.

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The CARE index is used to assess the quality and patterns of parent-infant interaction in regard to affect and

cognition, and it is a robust indicator for future attachment behaviors (CARE-Index; Crittenden, 1979–200475; ICI;

Crittenden,1979–201076).

Paradigms. Dyads are typically instructed to engage in free play77,82 or semi-structured play79 for 3-5 minutes.

Mothers have the option to use toys, either their own or those provided by the experimenters80.

Populations. This measure has been validated for use in infants from birth78,81 to 15 months of age81,82 and has also

been used at 30 months78.

Scoring. The CARE Index has several subscales to assess both mother and infant relational measures. Mothers are

rated on sensitivity, control, and unresponsiveness. Infants are rated on their levels of cooperativity, compulsivity,

difficultness, and passivity. Behaviors of interest include facial and verbal expression, positional and body contact,

affection, turn-taking, control, and choice of activity81. Each scale is scored from 0-7 points78 or 0-14 points34,77,79-82.

Higher scores indicate more of that behavior (i.e., 0 being highly insensitive and 14 being highly sensitive); lower

scores on the infant scales reflect more positive interaction. Maternal sensitivity scores ranging from 0–4 indicate

the need for child protection, psychotherapy, or other forms of intervention. Scores from 5 to 6 also indicate the

need for intervention, but no outward hostility or lack of empathy towards the child is exhibited. Scores of 7–8

indicate adequate play with brief periods of dyssynchrony. Scores of 9–14 reflect satisfactory or excellent parental

sensitivity. Infant cooperativity is categorized as such: 0-4 (difficult/passive), 5-9 (mixed cooperative), or 9-14

(cooperative). A binary variable can be created to categorize scores greater than 9 as satisfactory maternal sensitivity

or infant cooperativeness and scores less than 9 as maternal insensitivity or infant uncooperativeness79. The CARE

index can also yield a score for dyadic synchrony (the global quality of the interaction). Lower scores on the dyadic

synchrony scale reflect lower dyadic synchrony.

Psychometric properties. The CARE-Index can be used in families across different socioeconomic backgrounds

and has been well validated for assessing parent-infant interaction, attachment quality, child interactive behavior,

childrearing problems like abuse or neglect, and the effectiveness of interventions79,180,181. It is strongly correlated

with the Strange Situation, especially at infants’ one year82. Previous studies have also shown the CARE-Index to be

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highly stable182. Maternal and infant scales are typically correlated with each other (i.e., maternal sensitivity is

related to infant cooperativity).

Coding Manual/Training. P. M. Crittenden, 1979–2004, CARE-Index: Coding Manual, unpublished. The author

of the coding scheme (Crittenden) oversaw the coders’ work in Oxford and colleagues’ investigation using this

coding system (2021)80.

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The Coding Interactive Behavior (CIB) system measures the quality of mother-child interactions as well as maternal

and infant behaviors (Feldman, 1998183).

Paradigms. Mothers are typically instructed to play with their infant as they normally would in a 5184 to 10-

minute85,86 free-play episode. This provides an opportunity to assess maternal and child behavior in a naturalistic

setting.

Populations. The CIB system has been validated for use in both normative and high-risk populations184.

Scoring. The CIB is comprised of 4386 to 4585 discrete items, rated on a 5-point scale describing the frequency and

intensity of maternal behaviors, child behaviors, and overall quality of the dyadic interaction. Higher scores indicate

higher frequency or intensity. Videos were coded in 10-second intervals for categories of interest, and each category

is comprised of mutually exclusive codes. CIB behavioral categories can be aggregated into various subscales or

composites using factor analysis including, but not limited to, (a) maternal hostility, dyadic constriction, supportive

maternal presence, and dyadic reciprocity (used in Steele, 2019); (b) dyadic attunement, parental positive

engagement, and child involvement (used in Sleed, 2016; Fonagy, 2018; Sleed, Baradon & Fonagy, 2013); (c)

maternal affiliative behavior, maternal stimulatory touch, and infant alert (used in Feldman, 2007); or (d) sensitivity,

intrusiveness, limit setting, involvement, withdrawal, compliance, dyadic reciprocity, and dyadic negative states

(used in Pontoppidan, 2022).

Psychometric properties. This system has been well-validated, demonstrating concurrent and discriminative

validity, and is sensitive to change and various risk factors such as maternal substance use, delivery pain, infant

prematurity, and massage therapy for preterm infants185-189. Internal consistency among previously published studies

are as follows: Dyadic Attunement (α = 0.40), Parent Positive Engagement (α = 0.833), and Child Involvement (α =

0.85785); total score (α = 0.92), sensitivity (α = 0.92), intrusiveness (α = 0.53), involvement (α = 0.71), withdrawal

(α = 0.26), reciprocity (α = 0.84), and negative states (α = 0.41).184

Coding Manual/Training. Mother-Newborn Coding System of the Coding Interaction Behavior Manual (CIB,

Feldman, 1998).183

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This coding system is used to assess maternal sensitivity during maternal-infant interactions87.

Paradigms. Dyads typically engage in a 10-minute free play episode during which the mother was asked to play

with the infant with novel toys provided by the experimenter (a rattle, rubber puppy, and small rubber ball). In an

intervention study conducted by Alvarenga and colleagues (2019), two different toys (a turtle-shaped toy with

geometric puzzle pieces and a medium ball) were used to better match the infants’ current developmental stage. This

enables researchers to assess verbal and non-verbal maternal behaviors.

Populations. Not specified. In Alvarenga and colleagues (2019) study, infants were assessed at 3 and 11 months.

Scoring. The initial 5-minutes of the free-play session is usually coded at intervals of 12 seconds. In Alvarenga

(2019), coding procedures included (a) infant behavior: smiles, emits sounds (stammers or attempts to vocalize), or

cries; (b) maternal responses to infant behaviors: interprets, speaks, smiles, holds, touches/stimulates, or acts

intrusively. The latter included maternal non-sensitive behaviors. All behaviors were coded as mutually exclusive,

except for pacifier sucking, sneezing, coughing, and yawning. Infant behaviors are coded for the first 6 seconds of

the 12-second interval while maternal behaviors were coded for the full 12-second interval.

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Psychometric properties. Not specified

Coding Manual/Training. More details about the coding system can be found in Piccinini, Alvarenga, and Frizzo

(2007).87

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The Dyadic Mutuality Code measures mutuality, responsivity, and synchrony in dyadic interactions190,191.

Paradigms. The mother is instructed to have the infant in her lap or in an infant seat so that the pair can engage in

face-to-face interaction. The pair engage in normal play for 5 minutes without a toy or pacifier. Sessions are either

observed live or video-recorded for later scoring.

Populations. This scale has been validated for use in healthy and preterm infants as well as high-risk infants192-194.

Scoring. The DMC consists of six scales: mutual attention, positive affect, mutual turn-taking, maternal pauses,

infant clarity of cues, and maternal sensitivity190. Items are scored as 1 (none or very brief) or 2 (more than half the

time) and are summed to yield a total score (ranging from 6-12). Scores are categorized as low (6-8), moderate (9-

10), or high responsiveness (11-1289).

Psychometric properties. This scale shows evidence of concurrent and construct validity191. Cronbach’s alpha was

0.66, 0.63, and 0.70 across evaluation windows in a study done by Horowitz and colleagues (2001)89.

Coding Manual/Training. Not specified.

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The Emotional Availability Scales and Emotional Attachment Zones Evaluation are used to measure the quality of

dyadic interactions and the overall dyadic relationship, with a particular focus on attachment-related behaviors195-197.

Paradigms. Typically, dyads are videotaped for 1593,95 to 2060,95 or 30-minute94 interactions in which the mothers

are instructed to play with their child as they normally would, with or without toys. If the assessment is given

prenatally, mothers are instructed to perform playful activities with the fetus for the duration of the session such as

playing an instrument to the fetus198.

Populations. The EAS/EA-Z has been validated for use prenatally or in children from birth up to 4 years195,197.

Scoring. The EAS consists of six subscales: (a) adult (sensitivity, structuring, non-intrusiveness, and non-hostility)

and (b) child (responsivity and involvement). Higher scores are more optimal for all the subscales. Scales can be

assessed on a 3-, 5-, 7-, or 9-point system. A Likert 7-point scale (1-low, 7-high) was used for all subscales in most

studies research reviewed that applied this coding system92,93,95. Van Doesum and colleagues (200865) used the

following scoring: parental sensitivity (9-point), structuring, non-intrusiveness, and non-hostility (5-point), and child

responsivity and involvement (7-point). EA-composite scores for the caretaker (EA-P) and the infant (EA-C) are

calculated by summing the corresponding scores. An EAS total score can be calculated by summing individual

subscale scores84,93. A binary variable can be created to categorize the proportion of dyads rated as sensitive or

responsive, which was defined by EA scores of 5.5 (low end of neutral-moderate sensitivity or responsivity) to 7

(high/optimal sensitivity or responsivity)92.

Emotional availability can be assessed prenatally by combining the sensitivity and non-hostility scales198,199. The

EA-Z is scored on a 100-point scale that is divided into four categories: (a) emotionally available, (b) complicated,

attachment styles: secure, insecure-anxious, insecure-avoidant, and insecure-disorganized, respectively92,196,200.

Higher scores indicate better emotional availability.

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Psychometric properties. The EAS and EA-Z have been well-validated and strongly correlate with assessments of

attachment/infant attachment security201,202. Cronbach’s alpha was 0.97 across three different time points across

infancy in a prior publication using this measure94.

Coding Manual/Training. In prior studies that use these scales, raters were trained by the scale developer, Z.

Biringen, and certified for reliability (e.g., as done in Georg, 202193; Hoivik, 201594).

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This is used to assess the quality of mother-infant interactions96.

Paradigms. Dyads are seated opposite each other, and mothers were told to play with their babies as they normally

would, without toys, for a 10-minute episode. Synchronized cameras mounted on opposite walls allowed researchers

to achieve a split-screen view of mothers and infants during the interaction.

Populations. In one study reviewed, this paradigm was used among infants at 4 months old203.

Scoring. Coders score the first 2.5 minutes of the 10-minute interaction episode on a 1-s time basis. For multiple

behaviors occurring in one second, the behavior occurring during the latter half is recorded. Behaviors of interest

included eye gaze (on/off partner’s face), infant vocal affect (high positive, neutral/positive, none, fuss/whimper,

angry-protest, or cry), mother touch (affectionate, static, playful, none, caregiver jiggle, infant-directed oral touch,

object-mediated, centripetal, rough, or high intensity-intrusive). For mother touch, type of touch, location, and

intensity are all accounted for. Mother-infant modality pairings are developed to analyze self- and interactive

contingency: (1) infant gaze-mother gaze; (2) infant gaze-mother touch; (3) infant vocal affect-mother touch; and (4)

infant vocal affect-mother gaze203.

Psychometric properties. Not specified.

Coding Manual/Training. Not specified.

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The Global Rating Scale is used to assess the quality of dyadic interactions98.

Paradigms. Reference the reunion phase of the Still Face paradigm.

Populations. Not specified.

Scoring. Maternal behavior is rated on four subscales: sensitivity, intrusiveness, remoteness, and depression. Infant

behaviors are rated on three continuum subscales: happy vs. distressed, fretful vs. non-fretful, and attentive vs.

avoidant. The overall quality of the interaction is also scored. Individual items on the maternal subscales behaviors

were coded on a 5-point scoring system ranging from less optimal to more optimal. These are then summed and

averaged to calculate the subscale score, ranging from 1 to 5. Higher scores reflect more positive behavior. For

infant behavior, the happy-distressed scale is coded by determining the amount of time the infant engaged in happy

(smiling or positive vocalizations), neutral (neutral affect and no signs of distress), or distressed behaviors (crying,

shouting, withdrawing, frowning, etc.). The fretful-non-fretful scale is coded by counting the number of seconds

infants engaged in crying, shouting, pushing the caregiver, or arching their back. The attentive-avoidant scale is

coded by determining the amount of time the infant was attending to the caregiver’s face.

Raw scores for the happy-distressed scale were calculated by adding the amount of time the infant was happy and

half of the neutral time together. The resulting scores could range from 0 (100% distressed) to 1 (100% happy). For

example, if the infant was happy 30% of the time and neutral 50% of the time, the raw score would be 0.30 +

(0.50/2) = 0.55. Raw scores can be further categorized into quintiles: 1 (<0.20), 2 (0.21-0.40), 3 (0.41-0.60), 4 (0.61-

0.80), and 5 (0.81-1.00). Infants with GRS scores of 3 were assigned secondary ratings (3N, 3(1), 3(2), or 3(3)) to

differentiate between infants who were neutral most of the time versus infants who had a broad range of emotions

and scored a 3. If the infant is neutral more than 74% of the time, they were assigned 3N. If the infant is distressed

most of the time, they were assigned 3(1) or 3(2). If most of the distressing noises (>66%) occurred in the first part

of the paradigm, they were assigned 3(1). If most occurred in the second part of the paradigm, they were assigned

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3(2). Infants with a happy/distressed score of 3 that don’t fall into the above categories were assigned 3(3). The

fretful-non-fretful and attentive-avoidant scales are also categorized into quintiles on 5-point scales35,204.

Psychometric properties. This scale has been validated cross-culturally, for use in both low- and high-risk groups,

including among mothers with elevated depression symptoms205. The infant subscales have been validated and

correlate with attachment categories206.

Coding Manual/Training. Not specified

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The Holditch-Davis Coding System is used to assess the quality of the dyadic relationship and dyadic

interactions100,101.

Paradigms. Mother-infant interactions are typically assessed through a 45-minute videotaped session, at 2 and 6

months corrected age, when the infant was alert and due for a feeding. Mothers are instructed to care for their

children as they normally would. This setup provided the opportunity to record naturalistic mother and child

behaviors.

Populations. This scale was used in a population of pre-term infants and their mothers102.

Scoring. Maternal and infant behaviors were coded in 10-second intervals; if a behavior occurred repeatedly in that

interval, the behavior was only counted once. Maternal behaviors of interest included touch, talk, interaction,

involvement with the child, positive affect, teaching, mother touch, and playing with the child. Infant behaviors of

interest included expression of positive or negative affect, locomotion, gesturing, vocalizations, and independent

play with objects. Coded behaviors were recorded as a percentage of the total videotape. Child activity level (asleep,

sedentary, moderate activity, or very active) was also noted.

Psychometric properties. Not specified.

Coding Manual/Training. Not specified.

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The HOME Inventory is used to assess the appropriateness of the home environment (i.e., quality of support and

stimulation) for promoting infant development103.

Paradigms. Assessments are made from videotaped or live observations of the home environment and parenting

behaviors as well as interview questions with the caregiver.

Populations. This scale has been validated for use in children aged 0-3 years (Caldwell & Bradley, 1980).

Scoring. The HOME Inventory is a 43-item106 or 45-item102,104 instrument. Scores can be broken down into six

dimensions: emotional and verbal responsivity, avoidance of restriction and punishment, organization of the

physical/temporal environment, provision of appropriate play materials, parental involvement with the child, and

opportunities for variety in daily stimulation. The responsivity subscale and maternal involvement subscales were of

particular interest in research reviewed102,107.

Two maternal dimensions (maternal positive involvement and developmental stimulation) can be generated from 8

maternal behaviors and the parental involvement subscale. Behaviors comprised of positive mood, touch, hold,

interaction, uninvolved with child (reversed), play with the child, mother talking, and teaching. Similarly, three child

dimensions (child social behaviors, developmental maturity, and child irritability) can be generated from 7 child

behaviors. Behaviors consisted of expression of positive affect, gesturing, vocalizations, independent play with

objects, locomoting, negative mood, and fuss as a percent of time with the mother100,207. Dimension scores were

calculated by converting each variable to Z-scores and averaging them.

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Psychometric properties. The HOME inventory is strongly correlated with child cognitive development102,

especially at 3 years105, as well as maternal and child behaviors208-210. The assessment has been translated into

Brazilian Portuguese104. Cronbach’s alpha for the HOME total was 0.84 at 2 months and 0.83 at an assessment

conducted at 6 months102 and 0.76 in another sample106 ; for the maternal involvement subscale, alpha was 0.70 in a

prior study102. Internal consistency for the derived maternal and child dimensions were 0.78 (maternal positive

involvement), 0.69 (developmental stimulation), 0.68 (child social behaviors), 0.58 (developmental maturity), and

0.91 (child irritability) as reported in Holditch-Davis and colleagues (2014)102.

Coding Manual/Training. Not specified.

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The Index of Parental Behavior (IPB) is used to assess the quality of dyadic interactions108.

Paradigms. Dyads are typically observed for 30 minutes in the NICU which provided the opportunity to assess

parent-infant interactions.

Populations. Infants in the NICU.

Scoring. The IPB consists of 15 statements measuring parental behaviors (i.e., parent seeks to interact face-to-face

with infant) related to the infant. Parental behaviors are rated on a dichotomous scale (1-behavior present or 0-

behavior not present). Higher scores indicate more sensitive maternal-infant interactions. Two subscales were

derived through factor analysis: positive interaction with the infant in a quiet, alert state (7 items) and altering

environment and interaction with a stressed infant (8 items; see Melnyk, 2006109).

Psychometric properties. Eight maternal-child experts and a cultural competence expert established content

validity for the IPB (Melnyk, 2006).

Coding Manual/Training. Not specified.

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The Infant and Caregiver Engagement Phases (ICEP) measures infant and caregiver affect and engagement as well

as the quality of the engagement110.

Paradigms. The Still Face Procedure is typically used. This paradigm is usually conducted at the hospital, clinic, or

in the home, with all distractors (i.e., television, music, phones) removed. The paradigm is typically videotaped

using two cameras, one aimed at the infant, and one aimed at the mother.

Scoring. The ICEP assesses several different infant and caregiver behavioral phases. Infant behavioral phases

include negative engagement (fussiness, protest, crying, negative facial expressions), object/environment

engagement, social monitoring or mother-focused behavior, social positive engagement (positive facial expressions,

smiles, or coos), sleep, oral self-comforting, self-clasp (infant’s hands are touching), distancing, and infant

autonomic stress indicators (hiccupping or spitting up).

Caregiver behaviors include negative engagement (stern, sad, angry, etc.), intrusiveness, withdrawn, non-infant-

focused engagement, social monitoring without speech or with neutral speech, social monitoring with positive

speech, social positive engagement, exaggerated positive engagement (laughter, play, surprise, etc.), rough touches,

and procedural violations. All infant and maternal behaviors are mutually exclusive. Infant and maternal behavior

were coded on separate runs. The duration of each behavior was recorded and converted to a percentage for each

episode of the Still Face paradigm (normal play, still-face, reunion).

Psychometric properties. Not specified.

Coding Manual/Training: See Weinberg & Tronick, (1999)110

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The Landry Parent-Child Interaction Scales are used to assess naturalistic dyadic interactions between mother and

infant111,112.

Paradigms. Mothers are instructed to engage with their infants as they normally would during a 30-minute

videotaped session. Session breakdown are typically either 30 minutes of free-play113, 20 minutes of free-play and

10 minutes of a book read activity114.

Populations. Not specified, used mostly with parents and their infants in the reviewed literature.

Scoring. The Landry scales are scored on a 5- to 7-point Likert scale. Maternal behaviors of interest include positive

affect, warmth, flexible responding, positive verbal content, intrusive behavior, verbal and affective negativity, and

book-sharing techniques. Infant behaviors of interest include attention/arousal, warmth-seeking, positive behavior,

behavioral regulation, expressive and receptive language, and negative affect.

Psychometric properties. The Landry Scales have been widely used and adequate reliability and predictive validity

have been established, specifically in relation to child socio-emotional outcomes211,212. Higher scores are also

correlated with more positive child behavioral and developmental outcomes114. In one study, factor analysis of the

warm/positive and flexible responding observational codes for parents yielded a single parenting factor (factor

loadings of > .3), explaining 44-47% of variance in coded behavior ratings114.

Coding Manual/Training. Not specified.

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The Looking, Touching, Talking, Smiling Parent-Infant Interaction Scale is used to measure the frequency of

interaction behaviors between dyads116.

Paradigms. Mothers are instructed to play with their infants as they normally would for a four-minute videotaped

session.

Populations. Not specified.

Scoring. Behaviors of interest consisted of touching, looking, talking, smiling116, and singing117; these behaviors are

recorded every 20 seconds. Maternal responsiveness and warmth were globally rated on a 5-point scale, with higher

scores representing more positive interactive behaviors.

Psychometric properties. Not specified.

Coding Manual/Training. Not specified.

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This assessment measures maternal sensitivity towards the infant118.

Paradigms. In the reviewed literature, dyads are typically assessed during a 1–2-hour naturalistic home observation

in which mothers were told to interact with their children as they normally would.

Populations. Not specified.

Scoring. The Q-set is comprised of 90 items related to maternal behavior including interaction style, sensitivity to

infant state, feeding interactions, etc. Experimenters organize these items into a rectangular distribution with 10

items in each of nine piles, ranging from least characteristic of the mother’s behavior (pile 1) to most characteristic

(pile 9). Items that are not directly observed during the session (i.e., diaper change) must go in the middle piles118,213.

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Psychometric properties. The MBQ has well-established criterion and construct validity as well as test-retest

reliability214.

Coding Manual/Training. A coding manual for the MBQ can be found in Appendix B of Pederson & Moran

(1995).118

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The Maternal Caregiving Behaviors scale is used to assess observations of feeding, holding, and other maternal

caregiving behaviors 120,121.

Paradigms. Dyads are typically scheduled for a videotaped caregiving observation when the infants reached 36

weeks gestational age. Recordings have taken place at the infant crib in the NICU. Mothers were instructed to hold

their child in a chair adjacent to the crib. This was followed by bottle feeding. The entire session lasts 15 minutes,

and mothers were told to soothe their babies as they normally would. The tripod is set up in the curtained area by a

research assistant, but the dyad was alone for the videotaped portion that is subsequently coded.

Populations. This scale has been used in previous research with full-term 9-month-olds and full-term neonates

during feeding, bathing, and changing episodes120,121.

Scoring. The MCB holding score is determined using the acceptance-rejection, consideration-intrusiveness,

psychological availability, quality of physical and vocal contact, and expressed joy-delight subscales of Ainsworth’s

original scales. An MCB feeding score was derived using the sensitivity to the infant’s nursing pace, quality of

feeding transitions, psychological availability, quality of physical and vocal contact, and amount of visual contact

subscales. All scales were scored on a 9-point system, with 9 being the most sensitive. Higher scores indicate highly

sensitive and attentive feeding or holding sessions with more positive affect, skin-to-skin contact, face-to-face gaze,

etc. Overall MCB composite scores were derived by averaging the feeding and holding scores.

Psychometric properties. In investigations conducted by Hane and Fox (2006)120 and Hane and Philbrook

(2012)121, MCB holding and feeding scores have been shown to be strongly correlated, r (63) = 0.57, p < 0.001.

Composite MCB scores were normally distributed (mean = 4.74, SD = 0.91). The scores and normality of the

distribution resemble those from previous research with neonates and 9-month-olds.

Coding Manual/Training. Coders were trained using the Maternal Caregiving Coding Manual for use in High-Risk

Population of Infants in the NICU developed by Amie Hane, PhD97.

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The Maternal Interactive Behaviors Likert Scales assesses the quality of maternal interactive behaviors122,123.

Paradigms. Two episodes of dyadic interactions were videotaped during a home visit. The first segment was 10-15

minutes of free play. The second segment involved a structured discourse task in which dyads were given an image

of a child displaying a particular emotion (i.e., happy, anxious, sad, or angry). The child was then asked to label how

the child in the picture was feeling and was subsequently asked, “Have you ever felt like this?” and, if yes: “What

made you feel like this?”

Scoring. The discourse task assessed maternal behavior using five 7-point scales including supportive presence,

respect for child autonomy, structure and limit setting, quality of instruction, and hostility (Erickson, Sroufe, &

Egeland, 1985). The free play segment was scored using a different 7-point scale that measures scaffolding (i.e., the

provision of developmentally appropriate guidance123). The two composite scores were summed to determine the

overall score for the quality of maternal interactive behavior.

Psychometric properties. These scales have been well-validated215. Composite scores for the discourse task and

free-play task correlated with an r = 0.52, p < 0.001 in a study conducted by Kersten-Alvarez and colleagues

(2010)124.

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62.%$(24!:%(&*.*?*.;!2()!>%&'#(&*?*.;!:=24%&!J6:>:K!

The Maternal Sensitivity and Responsivity Scales measures maternal attunement to the infant during interaction

behaviors125.

Paradigms. Reference the Still Face Paradigm. This scale is used to code behavior during phase 1 (face-to-face

normal interaction) and 3 (reunion face-to-face interaction) of the Still-Face Paradigm.

Populations. Not specified.

Scoring. The MSRS has three subscales scored on a 5-point rating. The first scale measures sensitivity/responsivity,

from 1 (mothers with ignoring behavior) to 5 (responsive behavior). Sensitive and responsive behavior includes

detecting the infant’s behavioral cues and appropriate reactions to them. The second scale assesses

undercontrol/withdrawal, from 1 (an engaged response) to 5 (extremely withdrawn response). Undercontrolling

behavior includes disengagement in the interactions as well as flat affect. The last subscale measures

overcontrol/intrusiveness, from 1 (aware, but nonintrusive) to 5 (strongly overcontrolling). Intrusive behavior is

defined as the mother privileging her own behavior and disregarding infant cues and behaviors38.

Psychometric properties. There is limited information available about the validity of the MSRS62.

Coding Manual/Training. See Cenciotti, Tronick, and Reck, 2004125.

6*(*E62.%$(24!I%/2?*#$!LE:#$.!5#$!]*)%#!"#)*(+!J6*(*E6IL:E]K!

The Mini-Maternal Behavior Q-Sort for Video Coding is used to measure maternal sensitivity126.

Paradigms. Mothers and their infants are recorded in free-play episodes, a diaper-changing session, and a book-

sharing episode.

Scoring. This assessment is a short 25-item version of the Maternal Behavior Q-Set. Maternal behavior is described

by matching the description of generic maternal behavior and observed maternal behavior into five categories (very

like, like, neither, unlike, and very unlike mom). The sensitivity score is based on the correlation between the

descriptive sort and a criterion sort of a characteristically sensitive mother. These scores range from least sensitive at

-1.0 to most prototypically sensitive at 1.0.

Psychometric properties. Reliability was confirmed in a 10-minute play interaction in infants aged 10 months, and

convergent validity was confirmed with the 90-item MBQS completed at infant age six months. This study yielded

Cronbach’s alpha of .95127.

Coding Manual/Training. See Moran (2009)126.

6#./%$EH(52(.!H(.%$2=.*#(!>2.*(+!:=24%&!

The Mother-Infant Interaction Rating Scales are used to assess maternal and infant behavior128,129

Paradigms. Scales can be used to assess either a play or a feeding paradigm.

Populations. These scales are not tied to specific age-related behavior, so they can be used on parents and children

of any age (see Schuler, 2002131).

Scoring. There are two scales, one for parent behavior and one for infant behavior, with each item representing a

global rating of the behavior during the interaction. Each item was scored on a 5-point scale ranging from one (very

low) to five (very high).

Psychometric properties. Internal consistency was measured for both maternal behaviors and infant behaviors with

alpha coefficients of .95 and .90 respectively in a study conducted by Schuler and colleagues (2000130).

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Coding Manual/Training: Not provided.

6-.-244;!>%&'#(&*?%!Q$*%(.2.*#(!J6>QK!

The Mutually Responsive Orientation assessment is used to measure responsiveness within the parent-child

relationship.

Paradigms. Mothers and their infants are recorded in free-play episodes.

Populations. There is support for extensive structural stability in the MRO in children ages seven to 15 months216.

MRO has positive implications for multiple aspects of children’s moral development, both concurrently and

longitudinally. Those positive links hold across multiple ages, multiple assessment types, and diverse contexts.

Scoring. Scores (1-5) show the degree of responsiveness within the relationship, namely, coordinated routines,

communication, cooperation, and emotional ambiance. Higher scores indicate higher levels of responsiveness.

Psychometric properties. This scale was deemed to have good inter-rater reliability, test-retest reliability and

sensitivity to developmental fluctuation55. See above for validity across populations.

Coding Manual/Training: Not provided.

S2.*#(24!H(&.*.-.%!#5!"/*4)!F%24./!2()!F-<2(!G%?%4#'<%(.!:=24%&!JSH"FGK!

The National Institute of Child Health and Human Development Scales (also called the Qualitative Scales of the

Observational Record of the Caregiving Environment) is an observational tool used to measure maternal behavior

and affect toward her infant.

Paradigms. Play interactions were videotaped and coded by raters who were blind to group status.

Populations. Minor adaptations were made to the original tool to accommodate preterm infants in Hoffenkamp and

colleagues (201526).

Scoring. This set of scales includes scoring for maternal sensitivity and responsiveness, maternal intrusiveness, and

maternal positive regard. Maternal sensitivity/responsiveness represents the degree to which the mother showcases

emotionally supportive behaviors that are appropriate and in sync with the infant’s cues. Maternal intrusiveness is

the degree to which the mother exhibited verbal or physical interference with the infant’s needs, interests or

behavior. Lastly, maternal positive regard represents the mother’s ability to express warmth, enthusiasm, and praise

to her infant. In studies by Berlin and colleagues (2018136) and Ravn and colleagues (2011137), a predetermined

scale from 1-5 was utilized to measure the domains of maternal and infant behavior. This five-point scale indicates

the degree to which the displayed behaviors match the behaviors specified in the coding manual based on both the

quality and quantity of the observed interaction. Scales were adapted for use in specific samples in studies by

Hoffenkamp and colleagues (201526; preterm infants). Perrone and colleagues (2021) also stated that scales were

adapted for use138.

Psychometric properties. There has been strong evidence pointing to the validity of these scales from many studies

that link maternal characteristics and child outcomes to various sociodemographic factors such as family cumulative

risk217.

Coding manual/training. “Qualitative Ratings for Parent-Child Interaction at 3–15 months of age218,219” is a

modification of the coding system used by the National Institute of Child Health and Human Development (NICHD)

Study of Early Child Care134.

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The Nursing Child Assessment Satellite Training Program (NCAST) Feeding and Teaching scales139 was developed

to assess the quality of interactional behaviors between infants and parents220. More specifically, the Nursing Child

Assessment Feeding and Teaching Scales measure maternal-infant relational effectiveness and parental

responsiveness to their infants141.

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Paradigms. The Nursing Child Assessment Satellite Training Program (NCAST) Feeding and Teaching scales

either involves a feeding or teaching paradigm, respectively. In the teaching session, the mother is videotaped as she

teaches her infant a task that she believes the infant will not know how to do140. First, the caregiver is shown a list of

sensorimotor skills in increasing order of difficulty and is asked to select the first skill on the list that the child has

not yet acquired107. Examples include following a toy with eye gaze, grasping a toy, or transferring an object from

one hand to another80,107. This scale can be used to code feeding sessions, where mothers are videotaped while they

feed their infants142.

Populations. The feeding scale can be used with infants from birth to one year of age, while the teaching scale can

be used with infants from birth to 3 years of age107,140.

Scoring. Specific behaviors during the interaction are scored present or absent. Dyadic interactive disturbance is

suggested by positive scores for less than 43 items (1–6 months), 46 items (9–12 months), 52 items (13–24 months),

or 53 items (25–36 months)141. An overall summary score is then yielded105. Both the teaching and feeding scales

consist of six subscales that each assesses mother-infant interaction, including: sensitivity to cues, response to infant

distress, social-emotional growth fostering, cognitive growth fostering, clarity of cues, and responsiveness of the

child to the caregiver. Each subscale lists a multitude of caregiver and infant behaviors that the evaluator observes

during a routine feeding episode and a teaching episode. Higher scores indicate an interaction that is richer in

positive affect, sensitivity, synchronicity, vocalization, and reciprocity140.

Psychometric properties. Both the teaching and feeding scales have established validity and reliability. Internal

consistency reliability was reported as .87 for the Overall Total Scale139.

Coding Manual/Training: Not provided.

Q3&%$?2.*#(24!"/%=O4*&.!#(!6#./%$EH(52(.!H(.%$2=.*#(!JQ6HHK!

The Observational Checklist on Mother-Infant Interaction (OMII) scale is used to measure mother-infant interactive

behaviors143.

Paradigms. The OMII utilizes a 5-minute free play period, of which the last three minutes are coded by trained

researchers, as well as the first 2 minutes of the mother-infant reunion period following a planned 2-minute

separation144.

Populations. Not specified.

Scoring. Verbal and educational interaction, visual monitoring, warmth, negative affect, and the structuring of toys

by the mothers were coded using a one-way mirror. Infant positive affect and anger were coded during the play

phase, while attachment style can be coded during the reunion phase. The coding system scored for both frequency

and duration of the interaction. Additionally, a scoring methodology was applied in which points were given for

infant behaviors reflecting secure attachment and subtracted for avoidant, resistant, or insecure behaviors. Higher

scores reflected more positive interactions143,144.

Psychometric properties. Not specified.

Coding Manual/Training: Not provided.

Q3&%$?2.*#(!#5!6#./%$E"/*4)!H(.%$2=.*#(!JQ6"HK!

The Observation of Mother-Child Interaction (OMCI) is used to assess the mother-child interaction for responsive

caregiving skills. The conceptual model for the OMCI was developed by Landry and colleagues (2006145).

Paradigms. Mothers and their children are videotaped in an interaction surrounding a picture book. The same

picture book, compromised of colorful, familiar, and culturally acceptable pictures, was given to the participants by

the lab for the duration of the episode221.

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Populations. The OMCI was developed as part of a battery of maternal and child assessments used in a cluster

randomized controlled trial evaluating interventions on a cohort of mothers and their children aged 0-2222,223.

Scoring. The OMCI contains thirteen items for maternal behaviors, six for child behaviors, and one for mutual

enjoyment behaviors. Scores follow a yes or no binary format.221

Psychometric properties. A positive association was found between OMCI, Responsiveness and Involvement

subscales of the HOME, parenting knowledge and practice, maternal depressive symptoms, child development, and

child growth, suggesting that the scale shows good validity221. Inter-rater reliability was also high in the study

conducted by Rasheed and colleagues (2015)221.

Coding manual/training. See Rasheed and Yousafzai (2015)221.

C2$%(.E"2$%+*?%$!H(?#4?%<%(.!:=24%!JCD"H:K!

The Parent-Caregiver Involvement Scale (P/CIS) is used to assess the amount and quality of involvement between a

caregiver and child224.

Paradigms. Caregivers and their children can be videotaped in either free or structured play episodes147.

Populations. The P/CIS is designed for use with children ages 0-3224. The P/CIS was designed to operate

independently of socioeconomic status and can be used with children across the full range of abilities225.

Scoring. This scale measures 11 parental behaviors: (a) physical involvement; (b) verbal involvement; (c)

responsiveness of caregiver to child; (d) play interaction; (e) teaching behavior; (f)control of activities; (g)

directives, demands; (h) relationship among activities; (i) positive statements/regard; (j) negative statements/regard;

and (k) goal setting. P/CIS behaviors are rated on a scale of 1 (low) to 5 (high), anchored with specific descriptions

of the behaviors that characterize each rating. For analyses, mean scores on each scale were computed. Mean values,

as opposed to sum scores, were used to avoid deflation of scores due to nonapplicable items224. Each of the 11

behaviors is then rated across three distinct dimensions including quality, appropriateness, and amount, for a total of

33 codes. Quality ratings refer to aspects of each of the 11 caregiver behaviors that promote optimal development of

the child such as intensity, sensitivity, fluidity, flexibility, and consistency. Appropriateness is the degree of match

between the caregiver’s behavior and the child’s developmental level and interest during the play episode.

Psychometric properties. Not specified.

Coding Manual/Training: Not provided.

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The Parent Child Early Relational Assessment (ERA) is used to capture the child’s experience of the parent, the

parent’s experience of the child, the affective and behavioral characteristics that each brings to the interaction as

well as the overall quality of the relationship148.

Paradigms. Mothers are instructed to play with their child as they normally would. A standardized set of toys is

provided. This design facilitates the probability that parents and children will behave as they typically do.

Populations. Not specified.

Scoring. Sixty-five individual items are rated on 5-point Likert-type scales, including 29 parental items, 28 child

items, and 8 dyadic items. Each item is rated in terms of strength and concern. Higher scores indicate more positive

interactions.

Psychometric properties. The ERA is a validated tool that has been used in over 400 programs and projects226.

Coding Manual/Training: Not provided.

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C2$%(.E"/*4)!H(.%$2=.*#(!>2.*(+!:=24%&!_!H(52(.!,)2'.2.*#(!JC"H>:EH,K!

The Parent-Child Interaction Rating Scales-Infant Adaptation is an observational scale that aims to assess the quality

of parent-child interaction149.

Paradigms. The parent and child interact in a free-play episode. Mothers play with their infant by using toys

typically available in homes29.

Populations. Not specified.

Scoring. Five domains are coded: parental sensitivity, parental intrusiveness, parental support for cognitive

development, parental support for language quantity, and parental support for language quality. Parental sensitivity

was scored on a scale from 1-7, low to high, with seven representing a mother that characteristically demonstrated

the described behavior28.

Psychometric properties. Not specified.

Coding Manual/Training: Not provided.

C%)*2.$*=!H(52(.!C2$%(.!TU2<!JCHCTK!

The Pediatric Infant Parent Exam (PIPE) is an observational tool that can be used by community workers to

ascertain the quality of parent-infant interactions150.

Paradigms. Mothers and their infants are observed playing a game. This interaction is evaluated for the degree of

interactional reciprocity and positive affect at the beginning, middle, and end of the episode151.

Populations. Not specified.

Scoring. At each time point, the interaction is scored on a scale of 1 (more favorable interaction patterns) to 6 (less

favorable interaction patterns). A total score for the interaction is then calculated by adding the scores from the

beginning, middle and end.

Psychometric properties. Not specified.

Coding Manual/Training: Not provided.

C$%.%$<!6#./%$_H(52(.!H(.%$2=.*#(!:=24%!JC>T6HH:K!

The Preterm Mother Infant Interaction Scale (PREMIIS) is a behavioral observation tool that assesses the mother-

infant relationship for sensitive and responsive caregiving and awareness of infant cues. The PREMIIS was adapted

from the Synchrony Coding Scales for use in preterm infants153.

Paradigms. Mothers can be videotaped before undressing infants, bathing infants, and then dressing infants at term

equivalent age. Each segment (undressing, bathing, and dressing) lasts approximately 3 min in a study done by

Milgrom and colleagues (2013)153.

Populations. The PREMIIS was specifically adapted from the Synchrony Coding Scales for use in preterm infants.

Scoring. 10 maternal items covering responsiveness and affect on 4-point scales, 7 infant items covering stress cues

and unstressed behaviors, and 2 dyadic measures of overall synchrony on 5-point scales are measured by an

observer.

Psychometric properties. Not specified.

Coding Manual/Training: Not provided.

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:%(&*.*?*.;!2()!"##'%$2.*#(!!

The Sensitivity and Cooperation scale is used to assess parental sensitive responsiveness59.

Paradigms. Mothers and their infants are observed in an 8-minute free-play episode. The infant is placed in a seat in

front of a low table with the mother sitting adjacent to them. The researcher then presents a transparent box

containing 10 toys. The mother is instructed to play with her child as she typically would154.

Populations. Not specified.

Scoring. Sensitive responsiveness is rated with two 9-point rating scales for Sensitivity and Cooperation. Lower

scores are indicative of insensitivity and interference, and higher scores are indicative of cooperation and

sensitivity154.

Psychometric properties. Not specified.

Coding Manual/Training: Not provided.

:.*44E92=%!C$#=%)-$%!!J:9CK!

The Still-Face Procedure is a widely used observational tool used to assess infant response to a social challenge155.

Paradigms. The Still-Face Procedure introduces an age-appropriate developmental task (face-to-face social

interaction) and an age-appropriate episode of mild stress (the mother portraying a still-face and remaining

unresponsive), and a reunion episode in which the infant and mother can reorient with one another after the

disruption of the still-face (as described in Meijjsen, 201038). The mother sits opposite the infant at eye level. The

procedure starts with a 2-minute face-to-face social interaction episode in which the parent is instructed to interact

with the infant as they normally would. The parent is told not to use toys in this part of the procedure. Then the

parent will turn their back to the infant for fifteen seconds, before turning back with a still-face. The parent is

instructed to maintain a still-face and not make any contact with the infant for two minutes. Afterward, the reunion

episode can begin, and the parent can begin to interact with the infant normally again.

Populations. The still-face effect can be found regardless of most sample variations such as gender of infant or risk

status227.

Scoring. Many different coding systems can be used for the Still Face Procedure. In Valades and colleagues study

(2021)74, the coding was based on an established rating scheme228. Videos were coded second by second scanning

for behaviors and marking them as present or absent. These comprised regulated and non-regulated behaviors.

Regulated behaviors include socially positive vocalizations such as coos or laughter. Dysregulated behaviors were

comprised of negative vocalizations such as fussing or crying.

In Meijjsen and colleagues’ study (2010)38, the procedure was observed using two cameras, one facing the infant

and one facing the parent. The two images were combined using a split-screen approach. For scoring, the Observer

5.0 (Noldus) program was used. In this program, all behaviors are scored on a second-by-second basis using the

ICEP coding system.

Psychometric properties. Longitudinal research has shown that regulated infant behavior during the Still Face

procedure is a reliable predictor of later attachment security206,229. Additional meta-analyses also confirmed that

higher maternal sensitivity predicted more positive infant affect during the paradigm. Consequently, infants’ higher

positive affect and lower negative affect during the still-face were found to be predictive of secure attachment at one

year of age227.

Coding Manual/Training: Not provided.

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:.*<L 2!

The StimQ2 measures caregiver cognitive stimulation and interactions in the home using a structured interview156,230.

Populations. This scale has been validated for use primarily in English or Spanish-speaking low-SES

populations156,159.

Scoring. The StimQ2 Infant/Toddler has three subscales: (1) Parent Verbal Responsivity (PVR); (2) Parental

Involvement in Developmental Advance (PIDA); (3) Reading Activities (READ); and (4) Availability of Learning

Materials (ALM). The four subscales are summed for a total score ranging from 0 to 39 (Mendelsohn, 2007) or 43

(Mendelsohn, 2011). PVR assesses verbal interactions between dyads in Everyday Routines and Play and Pretend

(Cates, 2018157; scored 0-11, Mendelsohn, 2011159; or 0-4, Mendelsohn, 2007158). PIDA measures caregiver teaching

and play activities including naming objects and playing pretend with the infant (scored 0-7, Mendelsohn, 2011159;

or 0-10, Mendelsohn, 2007158). READ measures the number, diversity, and frequency of books read to the child as

well as associated interactions across 3 subdomains (Quantity, Quality, Diversity of Concepts, Cates, 2018157; scored

0-19, Mendelsohn, 2011159; or 0-18, Mendelsohn, 2007158). ALM assesses learning materials provided by the

caregiver (scored 0-6, Mendelsohn, 2011; or 0-7, Mendelsohn, 2007).

Psychometric Properties. The StimQ2 has strong internal consistency; Cronbach’s α = 0.76157- 0.88158,159. The

assessment also shows good test-retest reliability (ICC = 0.93) as well as criterion-related validity with the HOME

Inventory (r = 0.5-0.6, p < 0.001158,159). It also demonstrates strong concurrent validity with developmental,

cognitive, and language measures (r = 0.3-0.5) and is correlated with the Bayley Scales of Infant Development

Mental Development Index (semi-partial regression (sr) = 0.45, p < 0.001) and the One Word Picture Vocabulary

Tests (Receptive sr = 0.38, p = 0.01; Expressive sr = 0.33, p = 0.03) in a study done by Mendelsohn and colleagues

(2007)158.

Coding Manual/Training. Not specified.

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The Strange Situation Procedure is a widely used observational assessment that measures infant attachment to a

caregiver155.

Paradigms. The strange situation procedure consists of eight 3-minute episodes of separation and reunion with a

caregiver, specifically designed to induce enough stress in the child to activate attachment behavior127. In the first

separation, the child is left with a female stranger while the mother exits the playroom, and in the second separation,

the child is left fully alone in the playroom. The stranger and mother enter the room in subsequent episodes.

Populations. This laboratory paradigm was intended for 12–18-month-old children. This procedure has been used

successfully with low-income mothers and mothers from various cultural backgrounds5.

Scoring. Infant behavior during the strange situation procedure is indicative of the infant’s attachment pattern.

Infant behavior toward the caregiver can be categorized as secure, insecure-avoidant, insecure-resistant, and

disorganized/disoriented. The Strange Situation Procedure is videotaped and coded using four 7-point scales for

proximity seeking, contact maintaining, avoidance, and resistance and one 9-point scale for disorganization coded

through the Main and Solomon (1990231) system4,70,127. Children are classified as secure if they sought out contact

with and were then soothed by their parent. Children are classified as avoidant if they failed to look to their parent

for reassurance upon returning to the playroom and/or engage in active avoidant behavior during reunions. Children

were classified as resistant if they were not soothed by the parent despite seeking out the parent’s comfort upon

return. Lastly, children were classified as disorganized, as specified by Main and Solomon (1990) if they displayed

contradictory behaviors such as approaching the stranger when distressed, fearful or apprehensive behavior toward

or around the parent, disoriented wandering, or rapid changes in affect (descriptions drawn from Bernard et al.,

2012161).

Psychometric properties. This assessment has good reliability and predictive validity147. Interrater reliability has

been found to be high in numerous studies70,127,160,163.

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Coding Manual/Training: Information not provided in reviewed studies.

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The Synchrony Scale measures mother-infant interaction in terms of behaviors of the mother, the infant, and the

dyad164. The scale was developed based on the rating protocols described by Censullo and colleagues232.

Paradigms. Mothers are asked to play with their infants for 9 minutes as they normally would and then are

instructed to elicit “talking” from their infant for the next 6 minutes.

Populations. Not specified.

Scoring. Mother, infant, and dyadic behaviors are coded in three-minute increments by a researcher masked to the

condition/characteristics of the dyad. Scores range from 0 (lowest) to 3 (highest). The higher the score, the more

frequently behaviors occur.

Psychometric properties. Construct validity has been deemed acceptable by testing associations with the Global

Ratings Scales233. The Synchrony Scale has been used in numerous published reports234.

Coding Manual/Training: Not provided.

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%6%./#)&!`8!G%&=$*'.*#(!#5!H(=4-)%)!H(.%$?%(.*#(&!

Interventions with similar modalities (e.g., skin-to-skin interventions) are grouped together under headings that best

represent the intervention category. Each individual intervention tested in an RCT included in this review is

described. Note that very similar models of intervention are often described separately in this appendix to provide

more details about the intervention variations (e.g., length, interventionist, location, sample) in the studies included

in this review.

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All information about the intervention was obtained from Chiu and Anderson (2009)140 unless otherwise stated.

Intervention Description

Dyads were encouraged to begin SSC as early as possible after birth, and to maintain SSC for as long as possible.

For mothers initiating SSC immediately after birth, infants were placed between their mother’s breasts and covered

with a warming blanket that was tucked under the mother on both sides, covering the infant’s back. Infants wore a

cap that was replaced should it become damp. Mothers who did not begin SSC immediately after birth would hold

their infants between their breasts with either their hospital gown or their own clothing and a blanket folded across

their infant’s back for warmth. Infants wore small diapers and, usually, a cap.

Interventionists were nurse researchers.

Target Population

Preterm mother-infant dyads.

Goal (and framework when applicable)

Skin-to-skin contact (SSC) is synonymous with kangaroo care (KC) and connected kangaroo mother care (KCM),

which usually refers to nearly continuous skin-to-skin contact to facilitate lactation and breastfeeding140.

Physical and Informational Materials

Dyads used large warming blankets. Infants wore small diapers and caps.

Setting

SSC was performed face-to-face in the hospital 140.

Dose and Intensity

SSC began as soon as possible after birth and was performed for 2 to 5 days.

Because the interventionist had little to no role in this intervention, there may only be one intervention session

associated with this intervention (instructional). Most sessions do not involve direct intervention time (i.e., 0 minutes

of staff time).

Studies that Employed this intervention: Chiu, Anderson 140

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All information about the intervention was obtained from Feldman et al. (2014)235 unless otherwise stated.

Intervention Description

Nurses took infants out of incubators, undressed them, and placed them between the mother’s breasts while the

mother sat in a standard rocking chair. Infants remained attached to their cardiorespiratory monitors during the SSC.

Nurses recorded dyadic interactions and would record the exact time of contact. Mothers used a bedside screen for

privacy.

Target population

Preterm mother-infant dyads.

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Goal (and framework when applicable)

This intervention draws on Kangaroo Care (KC), initially developed in Bogota, Colombia, as a strategy to cope with

a lack of incubators. KC helps premature infants to maintain body heat and contributes to the neuromaturation,

autonomic maturity, electroencephalogram complexity, pain response, and physiologic stability of premature

infants. KC has also demonstrated beneficial effects on maternal-infant bonding and maternal mood in early infancy.

Physical and Informational Materials

Physical materials included a cardiorespiratory monitor, a standard rocking chair, and a bedside screen.

Setting

Face-to-face individually, in the NICU

Dose and Intensity

The intervention began at birth and lasted for 14 days.

Studies that Employed this intervention: Feldman, Rosenthal, Eidelman 235

a2(+2$##!"2$%!

All information about the intervention was obtained from Neu and Robinson (2010)236 unless otherwise stated.

Intervention Description

Nurses provided encouragement in holding infants, promoting relaxation during holding infants, information about

early infant development, and education about recognizing and responding to infant cues. Nurses also discussed the

benefits of holding infants with the mothers. Mothers were instructed to use the kangaroo method to hold their

infants for 60 consecutive minutes at least once daily.

Target population:

Preterm mother-infant dyads.

Goal (and framework when applicable)

The Kangaroo Intervention was derived from the kangaroo holding approach, a method that originated in Bogota,

Colombia to support infant survival and care.

Physical and Informational Materials

Mothers were offered a holding diary and were asked to record daily quantities of infant holding, including who held

the infant and the type of holding.

Setting

Dyads were visited in the hospital and in the home. The majority (81.82%) of dyads received 8 of the visits in the

home, and the remaining 18.18% of dyads received 7 of the nurse home visits.

Dose and Intensity

The intervention was provided in 10, 45–60-minute sessions with interventionists. The first 4 sessions occurred

biweekly over the span of 2 weeks, and the remaining 6 sessions occurred weekly.

The intervention began within 4 weeks after birth and lasted for 8 weeks.

Studies that Employed this intervention: Neu, Robinson 236

:O*(E.#E&O*(!=#(.2=.!J::"K!

All information about the intervention was obtained from Rheinheimer et al., (2022)61 unless otherwise stated.

Intervention Description

Mothers were encouraged to undress their infants and to place them in an upright position on the mother’s bare

chest. Mothers were asked to perform one daily uninterrupted hour of SSC from birth until postnatal week 5.

The intervention was delivered by a researcher.

(which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprintthis version posted October 31, 2022. ; https://doi.org/10.1101/2022.10.29.22281681doi: medRxiv preprint

Target Population

Full-term mother-infant dyads.

Goal (and framework when applicable)

This Skin-to-Skin contact intervention was built on Feldman’s biobehavioral theory of parent-infant interactions,

which postulates that repeated mother–infant contact and the resulting exchange of biobehavioral cues in the first

postnatal months, facilitate infants’ maturation of their ability to regulate autonomous stress reactions 237.

Physical and Informational Materials

Mothers used a logbook to record periods of contact (SSC, holding, breastfeeding) The SSC condition received

detailed verbal and written instructions on the intervention by the researcher.

Setting

Face-to-face in person.

Dose and Intensity

The interventionist had little to no role in this intervention after instructions were given outside of phone calls from

research staff. Mothers were asked to perform one uninterrupted hour of SSC per day for 35 days (from birth until

postnatal week 5). Mothers engaged in 21-35 hours of SSC over the course of the intervention.

Mothers also received 2+ weekly phone calls from research staff.

Studies that Employed this intervention: Rheinheimer, Beijers, Cooijmans, Brett, de Weerth 61

"#(.*(-#-&!:O*(E.#E&O*(!=#(.2=.!J::"K!

All information about the intervention was obtained from Sahlen-Helmer et al. (2020)62 unless otherwise stated.

Intervention Description

Infants were placed on their mother’s chest in an upright position as soon as possible after birth, where they

remained as the mother was transferred to the NICU. Mothers were also instructed to record who provided SSC and

whether they paused SSC at any time, for any reason. Additionally, mothers also received a structured education

about identifying and responding to preterm infants’ signals. This educational program was disseminated by a nurse

certified in the Newborn Individualized Developmental Care and Assessment Program (NIDCAP).

Target population

Mothers of infants in the NICU

Goal (and framework when applicable)

The infant education program was influenced by and aligned with Newborn Individualized Developmental Care and

Assessment Program (NIDCAP), a relationship-based model that considers the competence of the infant and the

family and promotes infant comfort and optimizing long-term outcomes.

Physical and Informational Materials

Not reported

Setting

In the NICU (either level 3 NICU at Linköping University Hospital and 1 level 2 NICU at Sachs’ Children’s

Hospital in Stockholm)

Dose and Intensity

1 instruction session (as the nurse places the baby on the mother).

Mothers maintained SSC for 7 days, for almost 24 hours a day, but the active time with the interventionist was not

explicitly stated (and likely only the initial, 15-minute session).

Studies that Employed this intervention: Sahlen Helmer, Birberg Thornberg, Frostell, Ortenstrand, Morelius 62

(which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

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"#<<-(*.;EH(*.*2.%)!a2(+2$##!6#./%$!"2$%!J=*a6"K!

All information about the intervention was obtained from Taneja, Sinha, et al. (2020)238 unless otherwise stated.

Intervention Description

During home visits, a pair of intervention workers visited dyads to explain, initiate, and support the practice of

KMC. Interventionists advised mothers to perform skin-skin contact for as long as possible during the day and night.

The team observed the mom practicing KMC, enquired about SSC and breastfeeding in the previous 24-hour period,

and supported the mother and the family to solve any problems or overcome barriers to effective KMC.

Mothers in both groups also received standard home-based postnatal care (HBNPC) visits by government health

workers (Accredited Social Health Activists; ASHAs)

Target population

Mothers and low birth weight babies

Goal (and framework when applicable)

Draws on "survive and thrive," skin-to-skin contact, and kangaroo mother care (KMC) theories. The intervention

sought to improve survival, prevent infections, and promote nutrition and neurodevelopment.

Physical and Informational Materials

Not reported.

Setting

In the home.

Dose and Intensity

The intervention began as soon as possible after birth and lasted 28 days or until the baby wriggled out and no

longer accepted SSC, whichever happened first.

The pair of interventionists visited mothers daily for the first 3 days, then on days 5 and 7. Then, interventionists

visited dyads twice in the second week and then once a week for the 3rd and 4th week.

The length of each home visit was not reported.

Studies that Employed this intervention Taneja, Sinha, Upadhyay, Mazumder, Sommerfelt, Martines, Dalpath,

Gupta, Kariger, Bahl, Bhandari, Dua, group 238

I23;!N%2$*(+!H(.%$?%(.*#(!

All information about the intervention was obtained from Williams and Turner (2020)35,204 unless otherwise stated.

Intervention Description

Mothers assigned to the infant carrier condition were provided with infant carriers and instructed on how to use the

carrier by a certified babywearing educator. They were asked to wear their babies in the carrier for at least 1 hour

every day. Mothers responded to weekly text messages for three months to report on how often they were using the

carriers.

Target Population

Young, low-income mothers who were enrolled in Healthy Families or Teen Outreach Pregnancy Services.

Goal (and framework when applicable)

The baby wearing intervention was predicated on the theory that the proximity of mothers and infants increases

maternal awareness of the child’s needs and subsequent responsive maternal behavior and promotes secure

attachment between mothers and their infants

Physical and Informational Materials

Infant carrier

Setting

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The training session took place at home.

Dose and Intensity

The intervention included 1 formal training session at 2-4 weeks postpartum, where mothers were instructed on how

to use the infant carrier. The length of this initial session with the interventionist was not reported.

Mothers were asked to use the infant carrier for at least one hour a day for the duration of the intervention (6

months). Mothers self-reported baby wearing an average of 4.2 days a week (SD=1.4) for approximately 77 minutes

a day (range of 16-200 minutes), for a total of 5.9 hours per week (range of 1.3 - 16 hours).

Studies that Employed this intervention: Williams, Turner 35,Williams, Turner 204

6-&*=!2()!62.%$(24!]#*=%!

62.%$(24!:*(+*(+!

All information about the intervention was obtained from Cevasco et al., (2008)20 unless otherwise stated.

Intervention Description

The researcher helped each mother design a song, drawing on a list of songs as inspiration during the hospital stay

after birth. The songs were recorded onto a CD that mothers would take home from the hospital with them. The

researcher also kept a copy of the CD. Infants were not present for the recording of the CD, and mothers were not

present while the CD was subsequently played for the infants.

The CD of the mother’s singing was played for each infant 20 minutes per day, 3 to 5 times per week, until the time

of discharge. The time of day for music listening was determined based on the infant, visiting mother, and nurse’s

schedule. These sessions were often scheduled when the infants were awake, sleeping, receiving feedings, or

receiving routine medical procedures.

Target Population

Preterm mother-infant dyads.

Goal (and framework when applicable)

The goal of this intervention was to determine the effects of mothers’ recorded singing on mother-infant bonding.

An additional goal was to understand the effects of using music in the home in the first two weeks after the infant’s

birth.

Physical and Informational Materials

Mothers were given a notebook containing a list of song titles, including lullabies, children’s songs, and popular

songs (see Table 3 in Cevasco et al., 2008), as well as the lyrics for each song.

An Olympus WS-100 digital voice recorder and Audio-technical ATR35s omni directional microphone were used to

record the singing of mothers of both term and preterm infants. DBpower-AMP Music Converter transferred the

Windows Media Audio files to wave files, and Audacity was used to edit wave files. Nero burning room software

was used to compile and make CDs. Music was played for preterm infants on RadioShack Moisture Resistant

Speaker System MX 1 (Cat No. 40-1400), which was connected to a RadioShack AM/FM Stereo Portable CD

player (Cat. No. 42-6013). A RadioShack Sound Level meter (Cat. No. 33-2055) was used to determine if the

decibel level for each infant’s isolate and open crib was within the guidelines provided by the American Academy of

Pediatrics Committee on Environmental Health

Setting

Face-to-face individually.

Mothers resided in a NICU 1 setting in a regional medical center. The NICU 1 setting provides both basic care and

well care for newborns.

Dose and Intensity

The recording process took approximately 20 –60 minutes, depending on the number of songs the mother chose.

(which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprintthis version posted October 31, 2022. ; https://doi.org/10.1101/2022.10.29.22281681doi: medRxiv preprint

The CD of the mother's singing was played for each infant 20 minutes per day, 3 to 5 times per week until time of

discharge. Recordings ranged from 20 min to an hour, and total listening time ranged from 240 min - 400 min.

The intervention began soon after birth (between 4 and 17 days) and lasted for 13.3 days (average).

Studies that Employed this intervention: Cevasco 20

6-&*=!1/%$2';!

All information about the intervention was obtained from Corrigan et al. (2022)21 unless otherwise stated.

Intervention Description

Mothers met with a board-certified music therapist for music therapy sessions. The therapist assessed the mother's

ability to cope with hospitalization. The infant’s heartbeat was recorded, and the mother chose a song that was

meaningful to them that was paired with the heartbeat. The mothers were told to listen to this recording as often as

they would like for one week. The number of times the mothers listened was self-reported after one week.

Target Population

Preterm mother-infant dyads.

Goal (and framework when applicable)

This intervention was based on a theory that personalizing music evokes emotion and promotes comfort, and that

heartbeat music improves bereavement bonding.

Physical and Informational Materials

Mothers were provided with a CD or digital copy of music containing an infant heartbeat and the mother's music

preference.

Setting

Face to face, individually in the NICU.

Dose and Intensity

The mothers chose how much they listened to their customized CD for one week. The intervention began as soon as

possible after birth and continued until postnatal day 7.

The interventionist was only involved in the initial session.

Studies that Employed this intervention: Corrigan, Keeler, Miller, Naylor, Diaz 21

6-&*=!1/%$2';!J61K!

All information about the intervention was obtained from Gaden et al. (2022) 32 unless otherwise stated.

Intervention Description

The intervention was delivered by 11 music therapists who had training and/or prior clinical experience with music

therapy in the NICU. Sessions took place while the mother was engaged in skin-skin contact, feeding, or while

infants were lying in the incubator or cot. Sessions consisted of parent-led, infant-directed singing, which the music

therapist would facilitate support. The quantity of time per session actively making music varied between sessions,

depending on the infant’s tolerance. During the parts of the session when mothers were not making music, therapists

would engage mothers in a discussion about the family’s needs.

Target population

Preterm mother-infant dyads.

Goal (and framework when applicable)

The hypothesis was that this musical therapy intervention, combined with standard care, would improve mother-

infant bonding and parental mental health relative to dyads who received standard are alone.

Physical and Informational Materials

(which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprintthis version posted October 31, 2022. ; https://doi.org/10.1101/2022.10.29.22281681doi: medRxiv preprint

Melodies were adapted to suit the infant’s state, engagement, and age. For infants aged PMA approximately 26-32

weeks, musical therapy would employ, “single notes, simple melodies, and short musical phrases adapted from

children’s songs or parent-preferred music” 32. After infants were aged PMA 32 weeks, the music increased in

complexity. Throughout the intervention, accompanying instruments were used sparingly to accentuate the parent’s

voice.

Setting

Sessions took place in the NICU, at the mother’s bedside or in the family’s hospital room.

Dose and Intensity

Mothers were offered 3 individual music therapy sessions per week throughout their hospitalization. The maximum

number of sessions was 27, and the average was 9.98.

Sessions lasted approximately 30 minutes.

The intervention began in the NICU and lasted until discharge.

Studies that Employed this intervention: Gaden, Ghetti, Kvestad, Bieleninik, Stordal, Assmus, Arnon, Elefant,

Epstein, Ettenberger, Lichtensztejn, Lindvall, Mangersnes, Roed, Vederhus, Gold 32

"#(.*(+%(.!\-4423;!

All information about the intervention was obtained from Robertson and Detmer (2019)117 unless otherwise stated.

Intervention Description

The researcher helped mothers to write an original lullaby, that would also be recorded as a reference for the

mothers. The researcher would teach each mother how to choose moments to sing the original song to the baby. In

line with their contingent music strategy, mothers were instructed to use the lullaby at moments when their baby was

quiet and alert. In contrast, mothers were taught not to use their lullabies during periods of infant distress (for

example, fussing or crying).

Target population

Full-term mother-infant dyads.

Goal (and framework when applicable)

This intervention uses contingent music, a behaviorism technique where music either starts or stops when an infant

behavior is exhibited. Within the context of this study, this means that when the infant is in a calm state, music is

provided, and that music is not provided when the infant is in a state of distress (ex: fussy, crying).

Physical and Informational Materials

The researcher helped mothers to write an original lullaby that they would use during the intervention. The lullaby

was set to a tune that the mother was familiar with, and the lyrics reflected how mothers felt toward their babies.

Setting

Face-to-face, individually. The study took place in regional medical centers (in Florida and Kentucky, USA).

Dose and Intensity

There was one session with the interventionist and the length of this session was not reported.

The intervention began soon after birth and continued for up to 6 weeks.

Studies that Employed this intervention: Robertson, Detmer 117

:*(+*(+![$#-'!

All information about the intervention was obtained from Wulff et al., (2021)36 unless otherwise stated.

Intervention Description

(which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprintthis version posted October 31, 2022. ; https://doi.org/10.1101/2022.10.29.22281681doi: medRxiv preprint

This intervention employed a singing and music-based interaction between the mother and her infant. Songs and

games were taught to the mothers during group sessions, facilitated by a music therapist and a member of the study

team. If participants requested, the music therapist would incorporate mothers’ requests for specific musical content.

Target Population

Mothers with postpartum depression and their infants.

Goal (and framework when applicable)

Not reported.

Physical and Informational Materials

Intervention sessions involved games, songs, and movements.

Setting

Sessions were conducted in groups of five to ten women, in person at the gymnastic room of the Clinic for

Gynecology and Obstetrics at the University Hospital Duesseldorf.

Dose and Intensity

This intervention consisted of 1-3 45-minute sessions

Infants were between 3-10 weeks old at baseline. The intervention took approximately 2 and a half hours in total.

Studies that Employed this intervention: Wulff, Hepp, Wolf, Fehm, Schaal 36

62.%$(24!]#*=%!>%=#$)*(+!

All information about the intervention was obtained from Yu et al. (2022)24 unless otherwise stated.

Intervention Description

During this intervention, maternal voice recordings were obtained in the NICU and subsequently played for infants

in the intervention group starting at 3 min before a heel stick procedure and lasting until the procedure completion,

13 min in total. The infants received containment and nonnutritive suckling after the procedure if they cried for >1

min. The intervention was recorded using a camera, and the videos were privately shared with the mothers to

facilitate mother–infant bonding and to offer the mothers a visualization of the study process.

Target Population

Preterm mother-infant dyads.

Goal (and framework when applicable)

Not reported.

Physical and Informational Materials

Maternal voice recordings of the mother's reading of a children's book presenting the reflections of a premature

infant's mother239. In this book, premature infants were likened unto “immature persimmons who are nurtured by

their family through patience and affection while undergoing self-exploration and passing through all difficulties to

eventually become sweet and mature fruits” 24,239. Mothers also included words that they wanted their infant to hear.

The recordings were edited into a 13-minute audio files using the music editing software Sound Organizer 2, per

study methods.

Setting

Pre-recording of mother's voice + infant in person, in the NICU.

Dose and Intensity

The intervention began on postnatal day 4.

There were 3 sessions that took place on 3 consecutive days, each lasting approximately 39 minutes.

Studies that Employed this intervention: Yu, Chiang, Lin, Chang, Lin, Chen 24

(which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

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C,\:!JC42;*(+!2()!\%2$(*(+!:.$2.%+*%&K!

6;!I23;!2()!6%!

All information about the intervention was obtained from Akai et al. (2008)240 unless otherwise stated.

Intervention Description

My Baby and Me is an intervention protocol designed to improve early parenting by enabling parents to understand

their baby’s developmental needs. There are three modules: responsiveness training (from the PALS curriculum241),

developmental knowledge training, and loving touch training.

Target population

Mothers who are at risk for problematic parenting, and their 3.5-5.5-month-old infants.

Goal (and framework when applicable)

The main goal of the My Baby and Me program is to improve parenting during a child’s first year. The aim is to

decrease psychological control and increase behavioral control. This is achieved by addressing harsh and intrusive

thoughts for parents, facilitating parental responsiveness to infants’ developmental needs, and encouraging warm

behavior and positive emotional expression.

Physical and Informational Materials

Mothers are given a scripted protocol to aid their responsiveness to infants’ needs. They are given a package of My

Baby and Me training modules. They are also given a “Take Time for Kids” booklet set, which contains one booklet

for each month of the child’s first year.

Setting

Intervention sessions occur face-to-face individually, in the participant’s home.

Dose and Intensity

There are 12 to 14 sessions, each session is 1.5 hours.

The intervention starts when the infant is 3.5-5.5 months old and continues for 12-14 weeks (average of 15.3

weeks).

Studies that Employed this intervention: Akai, Guttentag, Baggett, Noria, Centers for the Prevention of Child 240

H(52(.ES%.!JH(.%$(%.E,)2'.%)!C,\:!C$#+$2<K!

All information about the intervention was obtained from Baggett et al. (2010, 2017)113,114 unless otherwise stated.

Intervention Description

Mothers are given a computer, 6 months of internet connection, and access to the Infant-Net program, an Internet-

adapted version of the PALS program. The intervention content includes video models and multi-media information

on concepts, behaviors, and skills that featured caregivers and infants of diverse in terms of races, ethnicities, and

ages 242,243. The intervention includes self-directed aspects and ongoing contact with a coach. Throughout each

session, there are questions with answers that could be reviewed by the caregivers and the coach after each self-

directed learning session. The program includes summaries of the key concepts and homework based on the various

skills taught during each session. Mother-infant videos were collected throughout the program and revised by the

parent and coach to see how mothers were implementing each of the skills they learned. Coaches provided parents

with individualized support via weekly phone calls.

Through the intervention, mothers were given tools and strategies to maintain the infant’s focus during routine care

activities. The intervention also used therapeutic and educational strategies such as coaching behavioral skills,

personal behavior reflection, and time for parents to practice new skills.

Target population

Mother-infant dyads in low-SES environments 113,114; mother-infant dyads at a higher risk of maltreatment 114.

(which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

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Goal (and framework when applicable)

The PALS intervention was based on attachment theory. This internet version was derived from the traditional

PALS program, which had the goal of supporting the caregiver-infant relationship. The intervention employed

videos and video-feedback to demonstrate infant signals and promote warm, sensitive caregiver responses.

Physical and Informational Materials

A computer with a manual was provided to the participants as well as instructions for how to use the Infant-Net

program.

Setting

This intervention was given at home on the computer with access to a remote coach.

Dose and Intensity

Each session was approximately 90 minutes (about 1 and a half hours) long, with the program consisting of 11

sessions, including an introductory session in which mothers learned how to use the laptop and interface which

lasted approximately 15 minutes. The self-directed part of each session took participants 25-35 minutes on average

and the participants were given a laptop for 6 months 96Mothers also participated in 30-minute weekly coach calls.

In total, participants spent 22.7 hours on this intervention (ranging from 11.6 to 46.1 hours). This total time also

includes the time that mothers optionally spent reviewing completed videos and materials on their own.

The time that participants spent interacting with parenting coaches directly was not reported.

Studies that Employed this intervention: Baggett, Davis, Feil, Sheeber, Landry, Carta, Leve 113,Baggett, Davis,

Feil, Sheeber, Landry, Leve, Johnson 114

,)2'.%)!C42;!2()!\%2$(*(+!:.$2.%+*%&!C$#+$2<!J%C,\:K!

All information about the intervention was obtained from Feil et al. (2020)115 unless otherwise stated.

Intervention Description

This bilingual, 11-session adaptation of the Play and Learning Strategies (PALS) program consisted of

individualized, online coaching sessions. Mothers could select their preferred language (either English or Spanish) at

the beginning or during the intervention. These sessions consisted of:

1. Self-directed skill-learning through video-based teaching, with check-in questions, using immediate

individualized feedback

2. Constructing an action plan that outlines daily homework based on the skills taught

3. Video-recorded practice that is uploaded to a project server

4. Coach calls to co-view weekly videos with mothers, and to provide mothers with individualized support

Sessions were facilitated by coaches, who held at minimum a bachelor’s degree in counseling, psychology, social

work, or early childhood education. Counselors partook in extensive training, including a training course with a

national PALS counselor, meetings with a coach supervisor, and completion of the program from the parent’s

perspective.

Target population

Mother-infant dyads in low-income environments

Goal (and framework when applicable)

The ePALS program draws on the theory that caregivers’ language and responses influence an infant’s social-

emotional, cognitive, and language development and that promoting sensitive and responsive parenting during

infancy supports these developmental outcomes.

Physical and Informational Materials

Materials included a laptop computer, video modeling of skills, skills practice homework, a self-guided instructional

component that resented key concepts, and example videos that included narration with questions to aid the mother’s

completion of the course. Mothers were reminded that they could complete the course at their own pace.

(which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

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Setting

The intervention was performed online, in the home, using a video platform.

Dose and Intensity

11 sessions and one instructional session. The sessions began when infants were between 3.5 and 7.5 months, with

an average baseline age of 4.41 months. The program took 4-6 months to complete.

The estimated time of each session, specifically the time during which participants were meeting actively with a

coach, was not reported.

Studies that Employed this intervention: Feil, Baggett, Davis, Landry, Sheeber, Leve, Johnson 115

C42;*(+!2()!\%2$(*(+!:.$2.%+*%&!JC,\:K!

All information about the intervention was obtained from Landry et al. (2006)145 unless otherwise stated.

Intervention Description

This in-person intervention used a combination of video-recording and immediate feedback. The intervention was

led by PALS facilitators, who were instructed to follow a detailed PALS curriculum, but to disseminate it in a

flexible, individually adapted way.

The format of the intervention included:

1. Asking mothers to review their experiences across the last week related to their efforts to try the targeted

behaviors

2. Describing the current visit’s targeted behavior

3. Watching and discussing with mothers the educational videotape of mothers from similar backgrounds

4. Videotaping mother-infant interactions in situations selected by the mothers (ex. Toy play, feeding, or

bathing) with coaching

5. Supporting mothers to critique their behaviors and the infants’ responses during the videotaped practice

6. Planning with mothers as to how to integrate responsive behaviors into everyday activities with laminated

cards that define the behavior and its importance

Target population

Low-income mothers with low birth weight or term infant

Goal (and framework when applicable)

The PALS intervention builds on attachment theory. The goals of the intervention are to incorporate each family’s

social context into the intervention and to improve infant development by teaching caregivers how to engage in

responsive parenting behaviors.

The goal of each of the ten home visits is provided in Table 1 of the Appendix of Landry et al. (2006)145.

Physical and Informational Materials

PALS facilitators followed a curriculum that included behaviors linked to four aspects of responsiveness. Mothers

were also provided with developmental handouts covering issues such as sleep, feeding, and pacifiers.

Setting

The intervention was performed face-to-face individually, in the home.

Dose and Intensity

10 weekly home visits, each visit was 90 minutes.

The first session was performed when infants were approximately 6-months old. Each family was seen for 14 visits,

including assessments. Therefore, the intervention took 13-14 weeks to complete, with a mean of 14.5 weeks.

Studies that Employed this intervention: Landry, Smith, Swank 145

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H(52(.!62&&2+%D!1#-=/!

1,"E1H"!J1#-=/*(+!2()!=2$%&&*(+b!.%()%$!*(!=2$*(+K!

All information about the intervention was obtained from Barnes et al. (2022)27 unless otherwise stated.

Intervention Description

In the TAC-TIC intervention group, mothers were taught a specific protocol of systematic touch known as TAC-TIC

(Touching and Caressing; Tender In Caring). This version of TAC-TIC was developed for use with relatively

healthy preterm infants. The program consists of 14 individual stroking movements that are repeated continuously 3

times during a 3-minute session without undressing the baby. This version of TAC-TIC was designed to be carried

out by the mother, in contrast to prior versions of TAC-TIC that were designed to be carried out by a researcher.

Mothers were taught how to perform TAC-TIC on a doll first before touching their own baby. The information

provided to mothers was only procedural and involved describing and demonstrating how the baby should be

touched. Once mothers understood the instructions, they proceeded with the first session of the 10-day study period

(1 session of 3 minutes per day) under supervision by a trained psychologist associated with the study.

Target population

Preterm mother-infant dyads.

Goal (and framework when applicable)

Not reported.

Physical and Informational Materials

Mothers were taught the TAC-TIC protocol of systematic touch. The information provided to mothers was only

procedural and involved describing and demonstrating how the baby should be touched.

Setting

Not reported. It is not clear who taught the initial session, but the first supervised session was overseen by the

principal investigator (a trained psychologist).

Dose and Intensity

The intervention began on postnatal day 28 (mean of 11.7; SD = 4.2) and lasted for 10 days.

The initial introduction session was followed by 1 session of 3 minutes per day. The total intervention length was

approximately 33 minutes.

Studies that Employed this intervention: Barnes, N. Adamson-Macedo 27

62&&2+%!"42&&!c!:-''#$.![$#-'!

All information about the intervention was obtained from Onozawaa et al. (2001)244 unless otherwise stated.

Intervention Description

Mothers were taught to recognize and quickly respond to infant self-regulation cues. Mothers attended informal

group discussion sessions led by study staff that covered practical problems and coping strategies. The intervention

also included infant massage sessions. These classes began with a relaxation period where mothers could unwind.

Massage sessions were also taught by instructors trained according to procedures approved by the International

Association of Infant Massage disseminated a curriculum of massage techniques. During massage sessions, the

instructor demonstrated the massage strokes on a doll, while the mother massaged her own infant.

Mothers were taught that massage is most effective when babies are in a quiet, alert state. Engagement cues include

“bright-eyed focused expression, still/calm attentiveness, relaxed arms, shoulders and palms. Disengagement cues

include gaze aversion, yawning, arching, grimacing, anxious tongue poking and legs/arms held stiffly.”

The massage curriculum proceeded as follows:

“The class begins with a short period of relaxation which allows the parents to unwind. Then they place a resting

hand on the infant, and for some very young or sensitive infants this will be as far as they go. If infants indicate that

they are not in the right mood, the massage is not begun. The massage begins with slow rhythmic strokes, the

mother’s speed and timing being guided by the infant’s body signals. Each part of the body is treated in a different

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way, e.g. legs: milking strokes from hip to foot, gentle squeezes and twists in a wringing motion; foot: gentle

pressing on a sole of foot, stroking from toes to ankle on the top of the foot; abdomen: hand over hand strokes in a

paddle wheel fashion, circular clockwise direction strokes avoiding the ribs.” 244

Target population

Mothers with postpartum depression and their infants.

Goal (and framework when applicable)

Not reported.

Physical and Informational Materials

Mothers were taught to observe and respond to their infants’ body language and cues.

Setting

Hospital (Queen Charlotte’s and Chelsea Hospital)

Dose and Intensity

The intervention consisted of 5 dyadic massage classes and 5 non-dyadic support classes, each offered weekly for 5

weeks. Massage classes were 60 minutes, and support group sessions were 30 minutes.

The total combined timing of the intervention was 450 minutes.

Infants were 9 weeks (on average) at baseline.

Studies that Employed this intervention: Onozawaa, Gloverb, Adamsb, Modib, Kumara 244

H(52(.E62&&2+%EC2$%(.*(+!T(/2(=%<%(.!C$#+$2<!JH6CTCK!

All information about the intervention was obtained from Porter et al. (2015)144 unless otherwise stated.

Intervention Description

Groups of 4-6 mother-infant dyads were taught infant massage techniques by certified nurse practitioners. The

sessions were psychoeducational, incorporated both demonstrations and supervised practice, and included massage

practice, interactive group discussions, and question-and-answer sessions focused on childcare. Mothers were taught

simple games and interactive action-based songs to stimulate the infant and facilitate mother-infant communication

while performing infant massage.

The classes included a 10-minute break, which included food and beverages. The last class was a celebration of

completion, where mothers received an appreciation certificate and a gift basket of age-appropriate childcare items.

IMPEP was built off of the parenting enhancement program (PEP) which only consisted of psychoeducational group

sessions.

Target population

Recovering substance-abusing mothers (SAMs) and their infants.

Goal (and framework when applicable)

This intervention was influenced by Bandura’s Social learning theory, which posits that a person’s expectations and

incentives influence a person’s behavior. The aim of the intervention was to empower substance-abusing mothers to

make cognitive behavioral changes through learning and applying new parenting knowledge and skills. Through

doing so, Porter (2015) aimed to improve a mother’s confidence in her knowledge of infant massage and

understanding of her infant’s body signals, and thereby to empower mothers with the knowledge that they can help

relieve their infant’s discomfort.

Physical and Informational Materials

Psychoeducational group sessions incorporated demonstration and supervised practice of infant massage techniques,

interactive group discussions, and question-and-answer periods focused on childcare practices.

Mothers were taught simple games and interactive songs to employ during infant massage.

Sessions included demonstration and practice assessing infant temperature, pulse, respirations, and cardiopulmonary

resuscitation.

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Setting

The intervention was conducted in person, in groups of 4-6 dyads. The sessions took place in a dedicated meeting

space at each study site.

Dose and Intensity

4, weekly 120–240-minute sessions. The baseline age of infants in this study was not reported

Studies that Employed this intervention: Porter, Porter, McCoy, Bango-Sanchez, Kissel, Williams, Nunnewar 144

Q==-'2.*#(24!1/%$2';!H(.%$?%(.*#(

All information about the intervention was obtained from Sajaniemi et al. (2001)245 unless otherwise stated.

Intervention Description

The intervention combined several occupational therapy methods that focused on the child but achieved this through

interaction with the parents. During the sessions, the interventionists instructed parents to provide the right amount

and combination of stimulation at the right time to help the child cope with the sensory demands of the social and

physical world. Therapists also worked with parents to help interpret their infant’s messages.

Target population

Extremely low birth weight infants and their mothers

Goal (and framework when applicable)

The general goals of this intervention were to promote normal sensorimotor development, the development of play,

and social emotional development through supporting the parent-infant relationship. Specific goals were

individually tailored to the specific needs of families.

Physical and Informational Materials

The primary topics covered during sessions included parenting a premature baby, general child development, risk

factors of premature infants, and the development of play in children.

Setting

Face-to-face individually, in the home + clinic visits.

Dose and Intensity

The intervention consisted of 60 minutes of occupational therapy per week, at home, starting when infants were age

6 months to 12 months. The average number of sessions was 20 (approximately 1200 minutes total).

Studies that Employed this intervention: Sajaniemi, Makela, Salokorpi, von Wendt, Hamalainen, Hakamies-

Blomqvist 245

62&&2+%!H(.%$?%(.*#(!

All information about the intervention was obtained from Shoghi et al., (2018)72 unless otherwise stated.

Intervention Description

The massage intervention consisted of 2, 1-hour massage training sessions with a researcher. Mothers were also

provided with an educational booklet and compact disc published by the Neonatal Health Department of the

Ministry of Health of the Islamic Republic of Iran and were shown a training video. The researcher provided a 24-

hour call service to answer any of the mothers’ questions. The researcher was present for the mother’s first 15-

minute session massaging her infant. The mothers continued to massage their infants for 15 minutes, 3 times per day

for 5 days.

During training sessions, mothers were taught massage techniques using infant mannequins.

Target population

First-time mothers and their premature infants. Infants were born in the late preterm birth stage (gestational ages

between 34-37 weeks).

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Goal (and framework when applicable)

The intervention integrates attachment theory and the literature on skin-skin contact. This cost-effective intervention

is intended to improve mother-infant interaction, and thereby promote the formation of a secure attachment between

mothers and infants.

Physical and Informational Materials

Mothers were provided with an education booklet and a compact disk published by the Neonatal Health Department

of the Ministry of Health of the Republic of Iran. Mothers also watched a training video on infant massage.

Setting

Face-to-face in a hospital setting.

Dose and Intensity

2, 1-hour training sessions provided by the researcher.

Mothers continued to massage their infants for 15 minutes, 3 times a day for 5 days. A researcher was present for the

initial massage sessions, and all subsequent sessions were performed independently.

Infants were 7.20 days old (average) at the start of the intervention. The intervention lasted for 5 days.

Studies that Employed this intervention: Shoghi, Sohrabi, Rasouli 72

H(52(.!H(.%$?%(.*#(

All information about the intervention was obtained from Teti et al. (2009)119 unless otherwise stated.

Intervention Description

The intervention contained several components– infant tactile-kinesthetic stimulation, a psychoeducational aspect,

and employment of the Brazelton Neonatal Behavioral Assessment Scale (NBAS).

Interventionists were certified NBAS examiners.

NBAS:The interventionist administered the Brazelton NBAS seven times throughout the intervention, beginning

when the infant was 34-38 weeks PCA 246. This administration was followed by a discussion between the observers

about the infant’s strengths and areas of special need. Parents became increasingly involved in the administration of

the NBAS as the intervention progressed. The NBAS was administered at 36 to 40, 38 to 42, 40 to 44, 44 to 48, 48

to 52, and 52 to 56 weeks PCA. Parents were encouraged to repeat the NBAS with their infants with the goal of

completing the exam, with guidance, by 44 to 48 weeks.

Massage Therapy: Massage therapy was introduced when the infant was 36-40 weeks PCA and was included in the

remaining five intervention sessions, with NBAS administration following the massage session. The massage

protocol was adapted from previous protocols247. The interventionist demonstrated the massage techniques and gave

parents a copy of the massage protocol.

When the infant was between 36-40 weeks PCA, the massage protocol involved alternating 5-minute phases of

tactile and kinesthetic stimulation. During tactile stimulation, parents were taught to use both hands to massage the

infant’s head, neck, shoulder, back, waist, thigh, foot, and arm regions with 10-12 strokes. During the kinesthetic

stimulation phase, the parent administered 5, 1-minute segments of gentle, passive flexing and extending of the

infant’s arms, and legs while the infant was in a supine position.

The interventionist demonstrated the massage technique at 38 to 42, 40 to 44, 44 to 48, 48 to 52, and 52 to 56

weeks’ PCA, followed each time by NBAS administration.

The massage protocol was practiced and discussed during intervention sessions. Parents were also encouraged to

practice massage sessions 2 to 3 times a day, and to record how often they massaged their babies.

Psychoeducation: A 20-minute video titled “Premie Talk: Understanding Your Premature Baby’s Behavior” was

shown to parents when their infants were 32 to 36 and 34 to 38 weeks’ PCA in a private room or, if the infant had

been discharged, in the home 248. The interventionist then facilitated a discussion about premature infants that had

several points:

(a) premature infants are sensitive to their environments and use behavior to communicate

(b) the NICU is a noisy, over-stimulating environment

(d) preterm babies respond best to gentle stimulation

(e) preterm babies have three basic states of consciousness: sleep, awake and alert, and fussy

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(f) the awake and alert state is best for social interaction. Two weeks later, at 34 to 38 weeks’ PCA, the

video was shown again to parents and the interventionist reviewed the points covered at 32 to 36 weeks’

PCA, responded to questions, and covered the following additional points

(g) preterm babies use engagement and disengagement cues to indicate when they are ready to interact and

when they “need a break,”

(h) what to do when the baby shows disengagement cues during interaction

(i) how to awaken a drowsy baby for a feeding

(j) how to calm a fussy baby.

This was followed with a review and recap of all major points.

Target population

African American mothers and their low birth weight and / or premature infants.

Goal (and framework when applicable)

The goal of the intervention is to improve outcomes by targeting both parents and infants, rather than to target one or

the other alone 249. The intervention included parentally administered infant massage (infant tactile-kinesthetic

stimulation) to promote infant development and improve parental knowledge of infant cues. The intervention

included a psychoeducational component that targeted foster parents’ knowledge about preterm infants’ needs and

cues and how to, “read, respond to, and facilitate infant social behavior.119”

Physical and Informational Materials

Interventionists used the Brazelton Neonatal Behavioral Assessment Scale (NBAS), as well as a 20-minute video

entitled “Premie Talk: Understanding Your Premature Baby’s Behavior, that highlights preterm infants’ perceptual

and interactive capacities that can inform caregiving practices 248.

Setting

The intervention was delivered face to face, individually in a private room or, if the infant had been discharged, in

the home.

Dose and Intensity

8 sessions that ranged from 60 to 120 minutes in length (720 minutes total). The intervention began at 32-38 weeks

PCA and lasted for 20 weeks.

Studies that Employed this intervention: Teti, Black, Viscardi, Glass, O’Connell, Baker, Cusson, Hess 119

]*)%#!9%%)32=O!

62.%$(24!:%(&*.*?*.;!C$#+$2<!J6:CK

All information about the intervention was obtained from Alvarenga et al. (2020)88 unless otherwise stated.

Intervention Description

The Maternal Sensitivity Program (MSP) is a short video feedback intervention protocol that focuses on mother-

infant interactions to enhance maternal sensitivity. The intervention is conducted over the course of 8 visits, each

with 2 parts. In the first part, the mother is recorded playing with her infant. During the second part, an intervener

selects scenes from the video recording to watch with the mother and discusses ways to facilitate the infant’s

development.

Target population

Low-income parents with infants under 3 months old.

Goal (and framework when applicable)

The aim of MSP is to improve maternal sensitivity and promote positive infant development among low-income

families.

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Physical and Informational Materials

The intervention includes a manual, which describes the intervener’s role in the visit and specifies optimal mother

and infant behaviors in the videos. The intervention also used the Coding of Early Maternal and Child Interaction

(CITMI-R), a structured coding system, to analyze mother-infant interactions. Interveners were supervised and

given recommendations for theoretical and practical training.

Setting

The intervention occurred in the mother’s home.

Dose and Intensity

MSP consists of 8, 1-hour home visits when the infant was 3 months old and continued until infants were 10 months

old.

Studies that Employed this intervention: Alvarenga, Cerezo, Wiese, Piccinini 88

]*)%#EH(.%$2=.*#(![-*)2(=%!J]H[K

All information about the intervention was obtained from Hoffenkamp et al. (2015) or Barlow et al. (2016)26,77

unless otherwise stated.

Intervention Description

VIG is a short video-feedback intervention that focuses on behavior to encourage parents' self-reflection on

successful parent-child interactions. Parent-infant interactions were recorded and a VIG professional guided the

parent in observation, analysis, and discussion of the infant’s behavior 26.

The core aspects of the VIG model include the following: 1) video recording the parent-infant interaction during

play or daily caregiving; 2) editing the recording to select moments of optimal parent-infant interaction where the

parent attends to their infant’s signals; and 3) joint viewing of these recordings with the VIG guide and the parent.

VIG provides a parent with the opportunity to view their own interactions to evoke feelings of empowerment and

self-efficacy77.

Target population

Preterm infants and their caregivers

Goal (and framework when applicable)

VIG sought to improve parental sensitivity after leaving the NICU and returning home 77. The intervention also aims

to foster parental bonding, improve the quality of parent-infant interactions, and promote parental well-being 26.

VIG is based on the assumption that newborns seek parental contact 26. It is also based on two concepts:

intersubjectivity and mediated learning. Intersubjectivity is modeled by the VIG guide through their interactions

with the parent and is also pointed out in the recorded parent-infant interactions. Mediated learning occurs as the

VIG guide supports the parent’s learning by reviewing the video recordings77.

Physical and Informational Materials

Not reported.

Setting

VIG occurs in both the NICU and the parent’s own home.

Dose and Intensity

VIG occurs in 3 sessions. The duration of these sessions and the total duration of the intervention are not reported 77.

The intervention began at birth and continued until postnatal day 7 26.

Studies that Employed this intervention

Hoffenkamp, Tooten, Hall, Braeken, Eliens, Vingerhoets, van Bakel 26,Barlow, Sembi, Underdown 77

T2$4;!H(.%$?%(.*#(!C$#+$2<!

All information about the intervention was obtained from Borghini et al. (2014)78 unless otherwise stated.

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100

Intervention Description

The early intervention program is a transactional preventative intervention. The intervention occurs in 3 phases: (1)

33 weeks after conception, (2) 42 weeks after conception, and (3) 4 months after 40 weeks of conception. During

phase 1, the mother, NICU nurse, and intervener jointly observe the infant’s behavior in the NICU. During phase 2,

behavioral assessments of the infant are videotaped to identify the infant’s stress reactions and self-regulation

strategies. Mothers address their own emotions and explore symptoms of post-traumatic stress disorder. During

phase 3, video recordings of mother-infant free play are produced to observe the infant and promote the mother’s

caregiving qualities.

Target population

Infants born preterm (less than 33 weeks gestational age)

Goal (and framework when applicable)

This program follows a therapeutic treatment model which incorporates family system theory and preventive

intervention measures.

The goal is to improve parents’ understanding of their infants’ characteristics and competencies in addition to

promoting parental sensitivity and responsiveness.

Physical and Informational Materials

The Neonatal Behavioral Assessment Scale (NBAS) is used as a framework to record and review a behavioral

assessment of the infant.

Setting

The intervention takes place in the NICU.

Dose and Intensity

This intervention takes place over 4 sessions. The first session lasted between 30-60 minutes.is one session that lasts

between 30-60 minutes. During phase 3, there are 3 different sessions, each one week apart. Each session is 40-60

minutes long. During these sessions, the mother and infant take part in 10 minutes of free play. The intervention

begins 33 weeks after conception and ends at 4 months (corrected age).

Studies that Employed this intervention: Borghini, Habersaat, Forcada-Guex, Nessi, Pierrehumbert, Ansermet,

Muller-Nix 78

C2$%(.E"%(.%$%)!H(.%$?%(.*#(!C$#+$2<

All information about the intervention was obtained from Brisch et al. (2003)162 unless otherwise stated.

Intervention Description

This intervention is made up of group psychotherapy, attachment-oriented individual therapy, a home visit, and

video-based sensitivity training. It is intended to help parents cope after their baby’s premature birth, specifically

focusing on their emotions and their experiences with neonatal intensive care. This parent-centered intervention

program deals with the experiences of loss, separation, and positive attachment from the parent’s perspective.

Target population

Parents and their premature infants

Goal (and framework when applicable)

The goal of this intervention is to improve parental coping, optimize attachment, and enhance parent-infant

interaction. This intervention is based on attachment theory.

Physical and Informational Materials

Group therapy sessions, individual therapy sessions, a home visit, and video sensitivity training.

Setting

Hybrid, some sessions took place in the NICU and others took place in the home.

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101

Dose and Intensity

There are approximately 12 sessions in total, although the actual number of sessions varied. Five sessions took place

in a group setting (range of 1-8 group sessions in the study reviewed); 5 were individual sessions (range of 1-10 in

the study reviewed). Families additionally took part in 1 home visit and 1 sensitivity training. The length of the

sessions was not reported. The intervention begins when the infant is In the NICU and continues until they are 3

months (corrected age).

Studies that Employed this intervention: Brisch, Bechinger, Betzler, Heinemann 162

:.%'!1#@2$)&!T55%=.*?%!2()!T(d#;234%!C2$%(.*(+!3!J:1TTCE3K

All information about the intervention was obtained from Firk et al. (2021)92 unless otherwise stated.

Intervention Description

STEEP-b is an adaptation of the original STEEP, which is an attachment-based program for adolescent mothers.

STEEP-b is designed to be a shorter version of this program and specifically focuses on parental sensitivity. This

intervention uses video feedback to improve material sensitivity. Each session focuses on one of four modules: child

development, maternal sensitivity, frightening and intrusive behaviors of the mother, and sensitive parental

discipline practices. Each module is worked on twice throughout the intervention.

Target population

High-risk adolescent mothers and their infants

Goal (and framework when applicable)

The main goals of STEEP-b are to further secure maternal-infant attachment by advancing parental sensitivity using

video feedback. Video feedback is utilized to capture maternal attachment and its influence on parenting behavior.

The framework behind this intervention is attachment theory as STEEP-b focuses on maternal sensitivity to enhance

attachment security.

Physical and Informational Materials

There is no manual for STEEP-b. All participants receive publicly funded healthcare and social services when

appropriate. All STEEP-b trainers are child and adolescent psychiatrists, psychotherapists, or clinical social workers.

Setting

The intervention takes place in the mother’s home.

Dose and Intensity

STEEP-b occurs in 12–18 sessions over a 9-month period, starting at postnatal month 3-6 (5.41 months average).

Adolescent mothers are visited at home every 2–3 weeks by the same trainer for a duration of 9 months.

Studies that Employed this intervention: Firk, Dahmen, Dempfle, Niessen, Baumann, Schwarte, Koslowski,

Kelberlau, Konrad, Herpertz-Dahlmann 92

]*)%#!9%%)32=O!#5!H(52(.EC2$%(.!H(.%$2=.*#(!J]HCHK

All information about the intervention was obtained from Noivik et al. (2015)94 unless otherwise stated.

Intervention Description

VIPI is a home-based intervention program that targets parental sensitivity by recording and reviewing parent-child

interactions.

Target population

Families with children under 24 months old who had early health or developmental conditions.

Goal (and framework when applicable)

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102

VIPI is based on the Marte Meo method, a home-based intervention that integrates interactional and behavioral

approaches with the representational approach. The intervention was designed to treat families with many different

types of parent-child interactional problems.

Physical and Informational Materials

A VIPI manual was used to standardize the intervention. The manual detailed the order of the intervention’s

sequences, the number of meetings, and homework between sessions. Participants also received videotapes of the

therapists’ feedback.

Setting

The visits took place in the participants’ homes.

Dose and Intensity

There are at least 6 sessions, with the opportunity for additional sessions if necessary. It is recommended that the

sessions occur weekly. In the present study, the average number of sessions was 8, 30 minutes each, for a total of

approximately 4 hours.

The intervention begins when the child is between 0-24 months old, with an average of 7.3 months. The maximum

intervention length is 3 months.

Studies that Employed this intervention: Hoivik, Lydersen, Drugli, Onsoien, Hansen, Nielsen 94

I##O!c!]*)%#E9%%)32=O!J]9K!F#<%!]*&*.&

All information about the intervention was obtained from Juffer et al. (2005)154 unless otherwise stated.

Intervention Description

This intervention consisted of 3 sessions of video feedback along with a personal book, which contains information

focused on sensitive parenting. The book has the infant’s name integrated into the text and includes suggestions for

sensitive and playful mother-child interactions. The mother-child interactions were videotaped and then reviewed

with an intervener.

Target population

Families with an adopted child, with or without birth children.

Goal (and framework when applicable)

The intervention is based on attachment theory. The goal of the book + VF intervention was to promote secure

attachment in mother-child relationships along with infant competence.

Physical and Informational Materials

Mothers were given a personal book with their infant’s name integrated into the text. This book provided

information about sensitive parenting and suggestions for how to practice it.

Setting

Visits occurred in the parent’s home.

Dose and Intensity

The VF intervention occurs in three, 1-hour sessions. The estimated total length of the intervention is 3 hours.

The intervention began when the child was 6 months old and continued for 3 months, ending when the child was 9

months old.

Studies that Employed this intervention: Juffer, Bakermans-Kranenburg, van Ijzendoorn 154

]*)%#E5%%)32=O!*(.%$2=.*#(!.#!'$#<#.%!'#&*.*?%!'2$%(.*(+!J]HCCKb!]HCC!@*./!

>%'$%&%(.2.*#(24!5#=-&!J]HCCE>K!

All information about the intervention was obtained from Klein Velderman et al. (2006)60 unless otherwise stated.

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103

Intervention Description

VIPP is an early and brief video-feedback intervention that focuses on improving maternal sensitivity during the

infant’s first year of life. VIPP-R is a modified version of the VIPP intervention that promotes positive parenting but

has an additional representational focus intended to influence the mother’s representation of attachment.

Target population

First-time mothers with insecure attachment, and their young children (between 7 and 10 months old)

Goal (and framework when applicable)

Both VIPP and VIPP-R are based on attachment theory and Patterson’s coercion theory, which posits that repeated

coercive parent-child interactions establish a behavioral system that reinforces negative and antisocial behaviors.

Physical and Informational Materials

Mothers are asked to complete a “baby’s diary,” to chronicle their baby’s behavior and the activities they do with

their baby. They are also given questionnaires on social support and behavioral problems.

Setting

The intervention sessions occurred in the participant’s home.

Dose and Intensity

VIPP takes place over 4 sessions that are 90 minutes each, for a total of 6 hours. The intervention begins when

infants are between 7-10 months old (average of 6.83 months) and continues for 3-4 weeks.

VIPP-R takes place over 4 sessions that are 3 hours each, for a total of 12 hours. The intervention begins when

infants are between 7-10 months old and continues for 3-4 weeks.

Studies that Employed this intervention: Klein Velderman, Bakermans-Kranenburg, Juffer, van 60

T)-=2.*#(!C$#+$2<!

All information about the intervention was obtained from Magill-Evans et al. (2007)250 unless otherwise stated.

Intervention Description

The intervention consisted of two sessions with identical protocols. Intervention sessions consisted of videotaped

self-modeling and positive feedback regarding father-infant interactions.

Fathers were videotaped while teaching their 5-month-old infant to play with a novel toy (rattle, squeak toy, blocks,

etc.). Fathers selected the toy from a list from the Nursing Child Assessment Teaching Scale 251.

Immediately after the videotape was recorded, the father and home visitor reviewed and discussed the videotape

together. The home visitor would identify, explain, and praise moments when the father recognized and responded

to their infant’s cues. Fathers received a copy of their interactive videotape after the first home visit. Fathers were

provided with handouts that described aspects of parent-infant interaction.

The intervention was delivered by home visitors.

Target Population

Fathers and their infants.

Goal (and framework when applicable)

Videotaped self-modeling sought to reinforce positive behaviors. Literature has found that adults focus their

attention and become emotionally aroused when viewing them-selves on screen 252. Thus, videotaped self-modeling

is hypothesized to be an especially effective route to optimizing parenting behaviors.

Physical and Informational Materials

Fathers selected novel toys (including a rattle, squeak toy, blocks, and other items) to use during the videotaped play

interaction.

Fathers received two handouts that covered various aspects of parent-infant interaction. One handout described

infant behavioral cues while the other outlined "the teaching loop,” which consisted of a series of steps to engage

infants in positive interactions: alerting the baby, showing and explaining, giving the baby time to try, and praising

and providing suggestions.

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104

Setting

Face to face, in the home

Dose and Intensity

Two 60-minute sessions with a home visitor

Studies that Employed this intervention: Magill-Evans, Harrison, Benzies, Gierl, Kimak 250

]*)%#!H(.%$?%(.*#(!C$#d%=.!J]HCK

All information about the intervention was obtained from Mendelsohn et al. (2007) and Cates et al. (2018)157,158

unless otherwise stated.

Intervention Description

At each session, parent-child dyads were video-recorded for approximately 5 minutes while they interacted with a

developmentally appropriate toy and/or book provided by the program. These recorded interactions were reviewed

by the interventionist and the parent together, while the interventionist indicated instances of positive parenting

behaviors during the interaction (ex. responding to vocalizations, engaging in conversation), to reinforce these

behaviors and promote self-reflection on the part of the parent. Parents are also given pamphlets that provide

suggestions for interactions in the contexts of play, shared reading, and everyday routines, and also encouraged to

develop plans for interactions to promote their child’s development. The video and learning material used in the

interaction were both given to the parents to take home.

Sessions are facilitated by an interventionist, who meets one on one with families, providing an individualized,

relationship-based intervention.

Target Population

Low SES mother-infant dyads.

Goal (and framework when applicable)

The goal of the intervention was to enhance parent-child interaction in order to improve language, cognitive and

social-emotional development and ultimately promote school readiness and school performance. The intervention

was built on the principles of Reach Out and Read.

Physical and Informational Materials

To promote the generalization of positive parenting behaviors in the home, the video is given to the parent to take

home, along with the learning material used in the interaction. Parents are also given pamphlets that provide

suggestions for interactions in the contexts of play, shared reading, and everyday routines

Setting

Face to face, individually, in a pediatric primary care setting.

Dose and Intensity

Up to 12, 30- to 45-minute sessions that take place primarily on the day of primary care visits 158 or up to 15, 25- to

30-minute sessions 157. The intervention began at birth 157 or at the first well-child visit 158 and continued until the

child was 3 years of age.

Studies that Employed this intervention: Cates, Weisleder, Berkule Johnson, Seery, Canfield, Huberman, Dreyer,

Mendelsohn 157,Mendelsohn, Valdez, Flynn, Foley, Berkule, Tomopoulos, Fierman, Tineo, Dreyer 158

!C$#<#.*(+!9*$&.!>%42.*#(&/*'&!JC9>K!H(.%$?%(.*#(

All information about the intervention was obtained from Oxford et al. (2021)80 unless otherwise stated.

Intervention Description

Interventionists (master’s-prepared mental health professionals) delivered instructional content and activities based

on the Promoting First Relationships (PFR) manual. Each individual mother had the pace of delivery of components

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105

specifically tailored for them, and the content was adapted for infants. One component was a videotaped interaction

between the caregiver and the infant. Every other week, the intervention session would focus on video-feedback of a

mother-infant interaction. This feedback mainly focused on identifying the mother’s strengths as a parent and her

interpretation of the infant’s cues.

Target Population

Mothers with psychopathology and their infants.

Goal (and framework when applicable)

This intervention was related normalization of stress response systems in children 253,254 as well as reduced child

sleep problems reported by caregivers, mediated in part by reduced separation distress between child and caregiver

255 or by adversity buffering 256.

Physical and Informational Materials

Informational materials and a videotape of parent-infant interactions

Setting

Face to face, individually, at home.

Dose and Intensity

9-10 sessions, lasting between 60 and 75 minutes. Most intervention group participants received a full dose of the

intervention, 82% completed 9–10 sessions, 9% completed 5–8 sessions, and 8% completed 1–4 sessions. A “full

dose” took approximately 9-12.5 hours in total.

The intervention began at postnatal week 8-12 and continued for 10 weeks.

Studies that Employed this intervention: Oxford, Hash, Lohr, Bleil, Fleming, Unutzer, Spieker 80

"*$=4%!#5!:%=-$*.;EH(.%(&*?%!J"Q:EHK

All information about the intervention was obtained from Ramsauer et al. (2019)127 unless otherwise stated.

Intervention Description

The Circle of Security-Intensive (COS-I) intervention involved preparing individualized protocols for each mother-

infant dyad. Each unique protocol was based on their previously recorded interactions and took the infant’s

attachment and autonomy into consideration. COS-I occurred in 3 phases. In the first phase, participants were

presented with information on attachment and human development. The second phase was about self-reflection and

discussion based on video recordings. In the third phase, mothers were shown the positive changes they made and

the difficulties that continued to persist. At the end of the intervention, participants were awarded a COS-I

certificate.

Target population

Mothers with postpartum depression and their infants.

Goal (and framework when applicable)

The purpose of COS-I was to promote secure infant attachment and maternal sensitivity in mothers with postpartum

depression. The goal was to determine whether a mother’s unresolved attachment status affects the intervention.

COS-I is based on attachment theory.

Physical and Informational Materials

A COS DVD and handouts were used to present theoretical and empirical findings about attachment and human

development. Interventionists introduced the “shark music” concept, a metaphor used to make the mother aware of

potentially negative or threatening emotions and cognitions.

Setting

COS-I took place in a video laboratory.

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106

Dose and Intensity

The COS-I intervention took place over 20 sessions. Each session was 90 minutes long.

COS-I began when infants were aged 4-9 months (6.03 months, average) and continued for 20 weeks.

Studies that Employed this intervention: Ramsauer, Muhlhan, Lotzin, Achtergarde, Mueller, Krink, Tharner,

Becker-Stoll, Nolte, Romer 127

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All information about the intervention was obtained from Roby et al. (2021)29 unless otherwise stated.

Intervention Description

The Smart Beginnings (SB) intervention combines the Video Intervention Project (VIP) and the Family Check-Up

(FCU). Families begin receiving the VIP portion of the intervention at birth, but they do not start receiving the FCU

portion until 6 months postpartum.

VIP sessions consisted of a discussion of the child’s development, using developmentally appropriate learning

materials (books, toys) chosen to engage and improve parent-child interactions. The intervention coach would

record the parent-child interaction and immediately review the video with the parent to identify and reinforce

strength in the interaction and promote self-reflection. The parent is given a copy of the video as well as a pamphlet

with information about developmental milestones, suggestions for engaging the child, and parental goals for

interacting with the child at home.

The Family Check-Up (FCU) is an evidence-based home-visiting model that seeks to reduce the development of

early disruptive behavior and to help parents engage with services that improve parenting practices.

Goal (and framework when applicable)

The general goal of the intervention is to positively influence parent-child activities and interactions. The specific

goal of the VIP aspect of the SB intervention is to maximize maternal identification, engagement, and retention

while minimizing costs.

Physical and Informational Materials

Mothers were given book or toy as a part of the VIP intervention. Mothers also received a personalized pamphlet

that includes information about developmental milestones, age- specific suggestions for engaging with their child,

and the parent’s goals for interacting with their child at home.

Setting

Sessions were conducted individually.

FCU was provided in the home and/or in a pediatric primary care setting.

Dose and Intensity

14 sessions of 25-30 minutes (5.83-7 hours total).

The intervention spanned from birth to 3 years of life.

Studies that Employed this intervention: Roby, Miller, Shaw, Morris, Gill, Bogen, Rosas, Canfield, Hails,

Wippick, Honoroff, Cates, Weisleder, Chadwick, Raak, Mendelsohn 29

]*)%#E9%%)32=O!H(.%$2=.*#(24!1$%2.<%(.!

All information about the intervention was obtained from Stein et al. (2006)257 unless otherwise stated.

Intervention Description

This intervention used mother- and infant- targeted sessions as well as video-feedback to attempt to improve

mother-infant interaction, specifically surrounding mealtime. Treatment consisted of three stages. The first stage

concentrated on the infant’s signals, the second stage focused on the mother’s perspective, and the third stage

integrated videotapes to help the mother identify and address potential triggers of mealtime conflict. During this

stage, the therapist videotaped the mother and infant in the home during mealtimes. Then, therapist and mother

would watch and discuss clips of the video to identify the infant’s signals and exploration. The goal of this is to

refine mothers’ observational skills. Seven videotapes are used in total.

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107

In the current study, this intervention was combined with guided cognitive behavior self-help for eating disorders,

which prior research has shown to be useful in a primary care setting. It was adapted to the postnatal period and

administered to mothers during half of the first eight treatment sessions.

Interventionists were therapists who had prior experience in child and family mental health care and undertook

project and intervention model-specific training.

Weekly team meetings, supervised by psychiatrists were held to discuss the progress of therapy and to re-view

videotapes and samples of tape recordings of the treatment sessions to ensure consistency and compliance with the

protocol.

Target Population

The target population was women who met the DSM-IV diagnostic criteria for an eating disorder, either bulimia

nervosa or another eating disorder with similar clinical severity.

Goal (and framework when applicable)

The goal of the video-feedback treatment was to prevent or reduce mother-infant conflict and enhance mother-child

interaction, specifically during mealtimes, by facilitating maternal recognition of and responsiveness to her infant’s

cues and by improving her awareness of the infant’s developing skills and needs.

The goal of the self-help treatment was to help mothers regain control over their eating, reduce vomiting and

laxative use, and reduce extreme concerns about shape and weight.

Physical and Informational Materials

As a part of the self-help treatment, mothers in both groups received a self-help manual that contained information

about eating programs that were tailored to the postnatal period.

Setting

In the mother’s home.

Dose and Intensity

Mothers completed thirteen 1-hour treatment sessions, beginning when the infants were between 4 and 6-months

old, and completed by the time the infants were 12 months old.

Studies that Employed this intervention: Stein, Woolley, Senior, Hertzmann, Lovel, Lee, Cooper, Wheatcroft,

Challacombe, Patel, Nicol-Harper, Menzes, Schmidt, Juszczak, Fairburn 257

]*)%#E9%%)32=O!1/%$2';!J]91K!c!"#+(*.*?%!I%/2?*#$24!1/%$2';!J"I1K

All information about the intervention was obtained from Stein et al. (2018)64 unless otherwise stated.

Intervention Description

This intervention addresses how providing Video-Feedback Therapy (VFT) in conjunction with Cognitive

Behavioral Therapy (CBT) can lead to improved cognitive, language, behavioral, and attachment outcomes in

children of mothers with postnatal depression. Mothers partake in therapy sessions with a single therapist. Each

session alternates between CBT and VFT.

Target population

Women with postnatal depression and their infants.

Goal (and framework when applicable)

The aim of this intervention is to target parental behaviors associated with postnatal depression that may lead to

adverse child outcomes. The aim of the video-feedback therapy portion of the intervention is to improve mother-

child interaction by enhancing maternal attention to the child’s cues, maternal warmth and support, and maternal

sensitivity in the context of the child’s attachment needs.

This intervention is based on the CBT model, specifically focusing on behavioral interaction. This intervention uses

CBT to attend to common symptoms of postnatal depression.

Physical and Informational Materials

Not reported.

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108

Setting

Therapy sessions take place in the mother’s home (or at a mother’s request, may take place at an alternative location

like the Children’s Centre).

Dose and Intensity

Mothers participated in 13 therapy sessions throughout the duration of the intervention. Each session is

approximately 90 minutes. The intervention begins when the child is between 6-8 months old. The first session is

CBT, the second is VFT. The following sessions are equally divided between CBT and VFT, donating 45 minutes to

each therapy per session. The first 6 sessions occur weekly. The next 5 sessions occur every 2 weeks. There are 2

final booster sessions between 6-10 months after the end of the therapy.

Studies that Employed this intervention: Stein, Netsi, Lawrence, Granger, Kempton, Craske, Nickless, Mollison,

Stewart, Rapa, West, Scerif, Cooper, Murray 64

"#<'e.%(=%&!'2$%(.24%&!%.!,..2=/%<%(.!)2(&!42!C%.*.%!T(52(=%0!G*<*(-.*#()%&!$*&f-%&!4*e&!

2-U!.$#-34%&!)%!&2(.%!g<%(.24%!%.!C$#<#.*#(!)%!42!!$%&*4*%(=%!'$#d%=.!J",CTGCKb!",CTGC!

,..2=/<%(.!:.-);!J",CTGCE,K!

All information about the intervention was obtained from Tereno et al. (2017)70 unless otherwise stated.

Intervention Description

CAPEDP uses a blended intervention model that combines home visits of maternal sensitivity training through

video-feedback techniques. Home visits take place during pregnancy and continue through the child’s second year

of life. These visits pertain to routine prenatal and well-baby care, familial involvement, and health education

counseling. Video-feedback is used to address disrupted parenting behaviors. CAPEDP-A uses the same

intervention model but is specifically designed to investigate attachment outcomes. In these interventions, everyday

mother-child interactions are filmed, then the videos are watched and discussed with a psychologist.

Target population

Low SES and first-time mothers and their infants.

Goal (and framework when applicable)

The aim of CAPEDP is to improve developmental and attachment outcomes in impoverished families. The goal is to

promote the development of secure attachment while simultaneously reducing family stress, disorganized infant

attachment, and infant mental health issues. The aim of CAPEDP-A is to further assess the impact of the

intervention on infant attachment and maternal communication. This intervention is based on attachment theory.

Physical and Informational Materials

Families were given information brochures. They are also provided with a series of six DVDs that include short

films on pregnancy, childcare, and child development. A comprehensive document is shared that details infant

emotional development and mother–child attachment quality.

Setting

Visits took place at the participant’s home.

Dose and Intensity

CAPEDP(-A) occurs in 44 sessions, with each session lasting approximately 60 minutes. The intervention begins

during the third trimester, when the mother is about 27 weeks pregnant, and continues until the child is 2 years old.

Studies that Employed this intervention: Tereno, Madigan, Lyons-Ruth, Plamondon, Atkinson, Guedeney,

Greacen, Dugravier, Saias, Guedeney 70

]*)%#E9%%)32=O!H(.%$?%(.*#(

All information about the intervention was obtained from Tryphonopoulos and Letourneau (2020)81 unless otherwise

stated.

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Intervention Description

This program follows a seven-step protocol that focuses on maternal sensitivity and responsiveness to promote

“serve and return” interactions between mothers and infants (e.g., baby smiles, mom smiles back), which are

foundational to an infant’s healthy brain development.

The intervention uses the Nursing Child Assessment Teaching Scale, a structure that provided developmentally

appropriate teaching tasks for mothers to complete with their infants 251.

The intervention also contained a video-feedback protocol 258. Before the intervention, mothers were provided with a

“Children’s Activities Card,” which was a list of activities that increased in difficulty (ex: holding a rattle, tying a

shoelace). Mothers were asked to select the first task on the list that the infant could not perform.

Then, mother-infant interactions were observed and video-recorded in a 5-minute, uninterrupted episode.

Interventionists reviewed the video with the mother multiple times (2-3 times), with opportunities for replaying and

slowly reviewing selected portions. The interventionist used praise to reinforce desired maternal behaviors. A

specific example of feedback from the interventionist is: “That’s great the way you play and talk with him until he

turns his head away to let you know he needs a break.”

Interventionists were nurses. An intervention check list was used for each session to ensure implementation fidelity.

Target population

Mothers with postpartum depression and their infants.

Goal (and framework when applicable)

This Video Feedback intervention uses the Barnard Model as a theoretical framework for understanding how

caregiver sensitivity and other elements are needed for optimal maternal-infant interactions to occur 259.

The Barnard Model characterizes optimal maternal–infant interaction as mutually adaptive and dependent upon both

caregivers and infants fulfilling certain responsibilities. For example, parents must demonstrate affectionate

caregiving by being sensitive and responsive to the infant’s needs, and infants must provide clear cues so that

caregivers can respond appropriately. Contingency (i.e., responding to infant’s smile with a smile) is also central to

Barnard’s Model since infants develop a sense of self-efficacy when caregivers respond reciprocally to their

behavior.

Physical and Informational Materials

Mothers were provided with a Child Activities Card, which is a list of developmentally appropriate teaching tasks

that increase in difficulty. They were also given an intervention checklist to ensure they remain consistent with the

implementation of the intervention.

Setting

Home visits that were offered face-to-face individually with nurse-interventionist.

Dose and Intensity

The intervention consists of 3 video-feedback sessions conducted at three-week intervals. Each session is between

60-90 minutes (mean = 74.79, SD = 7.52), for a total of 3-4.5 hours. The first session occurs when the infant is

between 4-9 months old. The intervention lasts for 6 weeks.

Studies that Employed this intervention: Tryphonopoulos, Letourneau 81

C$%.%$<!H(52(._C2$%(.!C$#+$2<!5#$!,..2=/<%(.!JCHCC,K

All information about the intervention was obtained from Twohig et al. (2021)82 unless otherwise stated.

Intervention Description

The intervention was delivered by a child psychiatrist clinician trained in VIG.

Session One: Semi-Structured, Reflective Interview of the mother.

The questions integrated the Working Model of the Child Interview (WMCI), asking about pregnancy, birth, the

mother’s sense the infant’s personality, as well as the developing mother-infant relationship.

Session Two: Infant Observation and Parent Discussion

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110

A video of approximately five minutes of the caregivers interacting with the infant was made. After watching the

video, there was a supervised discussion between the caregivers and the facilitator, focusing on the parent’s

observation of the baby.

Session Three: Shared Review of Edited and Prepared Video

During this session, the video was edited to exhibit optimal parent–infant interactions and shown to the parents.

Goal (and framework when applicable)

This intervention followed attachment and VIG theories. The goal of this intervention was to enhance caregiver

sensitivity and reduce infant socioemotional issues.

Physical and Informational Materials

Not reported.

Setting

Face to face, individually.

Dose and Intensity

This intervention took approximately 3 total hours, first session: 45 minutes-1.5 hours, second session: ~50 minutes,

third session: 50 minutes-1.5 hours.

This intervention began the third or fourth week after birth, with the timing of the sessions varying based on parent

availability and infant well-being.

Studies that Employed this intervention: Twohig, Murphy, McCarthy, Segurado, Underdown, Smyke,

McNicholas, Molloy 82

C2$%(.EI23;!H(.%$?%(.*#(

All information about the intervention was obtained from van Doesum et al. (2008) and Kersten-Alvarez et al.

(2010)65,124 unless otherwise stated.

Intervention Description

This home-based intervention was used to prevent adverse outcomes by improving the quality of maternal-infant

interactions using video-feedback is used.

Target population

Mothers with postpartum depression and their infants.

Goal (and framework when applicable)

The intervention aims to enhance the quality of mother-child interactions by using video-feedback methods to

enhance maternal sensitivity. The intention is that this intervention will show lasting effects by the time the child is

5 years old.

Physical and Informational Materials

Not reported.

Setting

Visits occur at the mother’s home.

Dose and Intensity

The intervention occurs over a 3–4-month period during which mothers receive 8-10 home visits from a prevention

specialist. Each visit lasts 60-90 minutes. The intervention begins when the child is between 1-12 months, with an

average of 6 months old. Visits initially occur weekly, but then taper to once every other week. There is a follow-up

visit 3 months after the program is complete.

Studies that Employed this intervention: van Doesum, Riksen-Walraven, Hosman, Hoefnagels 65,Kersten-

Alvarez, Hosman, Riksen-Walraven, Van Doesum, Hoefnagels 124

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111

:%(&*.*?*.;!H(.%$?%(.*#(&0!H(52(.!#3&%$?2.*#(DH(.%$2=.*#(D:#=*24!=#<<-(*=2.*#(!

92<*4;!S-$.-$%!H(.%$?%(.*#(!

All information about the intervention was obtained from Hane et al. (2018) and Beebe et al. (2018)97,203 unless

otherwise stated.

Intervention Description

The Family Nurture Intervention (FNI) focused on improving the emotional connection between mothers and infants

through regular calming sessions while infants were in the NICU. The intervention was delivered by nurture

specialists, who were former NICU registered nurses. Sessions involved scent cloth exchange, maternal

vocalizations, sustained eye gaze, frequent skin-to-skin and clothed holding, and family-based support sessions to

develop emotional connection. Mothers also had access to full-time feeding specialists to learn about infant nutrition

and how to use a breast pump. Intervention activities, length of sessions, and number of sessions were recorded by

nurture specialists. Mothers used self-report logs to self-report intervention activities practiced outside of nurture

specialist sessions.

Target population

Preterm mother-infant dyads.

Goal (and framework when applicable)

The goal of FNI is to improve emotional connection, caregiving behaviors, and family support by focusing on

family cooperation and function. It also aims to establish a Calming Cycle routine.

Physical and Informational Materials

Mothers were given two, 5x7 scent-cloths that they exchanged with their infants 203. Mothers were also given

nurture logs to keep track of activities that occurred outside of nurture specialist sessions 97.

Setting

Face-to-face, individually in the NICU

Dose and Intensity

Visits began as soon as possible after delivery (mean = 7 days) and continued until discharge from the NICU 97.

Intervention length and quantity varied between families depending on their individual needs and availability. Both

treatment and control mothers met with researchers at least 4 times a week to fill out questionnaires. Mothers

participated in calming sessions an average of 3.5 times/week (median = 3.7; IQR = 2.7 - 4.1). The mean length of

each session was 1.6 hours, for a total average of 6.4 hours/week. Intervention and control mothers visited the NICU

an average of 4.0 ± .3 and 3.7 ± .3times per week, respectively. Prior to discharge, FNI families met with the PI (a

family psychiatrist) for one session to discuss a post-discharge support plan.

Studies that Employed this intervention: Hane, Myers, Hofer, Ludwig, Halperin, Austin, Glickstein, Welch

97,Beebe, Myers, Lee, Lange, Ewing, Rubinchik, Andrews, Austin, Hane, Margolis, Hofer, Ludwig, Welch 203

:-+*$2!6-$;2(+#!c!"42&&*=!C-34*=!N#$O&!J=CNK!2()D#$!%U'2()%)!'-34*=!@#$O&!J%CNK

All information about the intervention was obtained from Betancourt et al. (2020)106 unless otherwise stated.

Intervention Description

The intervention was organized into 12 modules. Sessions included a 15-minute “active play and communication”

session where caregivers received live feedback while interacting with their child. Throughout the intervention,

CBCs offered active coaching aimed at promoting early stimulation, play, nutrition, hygiene, responsive parenting,

nonviolent interactions, and engagement of female and male caregivers.

Both the Sugira Muryango group and the control group received access to a classic public works (cPW) and / or

expanded public works (ePW) program. This program, entitled Vision 2020 Umurenge Program (VUP), targets

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112

nutrition and early child development through cash transfers, nutrition-sensitive direct support, and public works

program.

The intervention was delivered by community-based coaches (CBCs) who were selected from the community.

Target population

Vulnerable families with children ages birth-36 months classified as Ubudehe 1 (most extreme level of poverty in

the Rwandan government’s household-ranking system)

Goal (and framework when applicable)

The goal of the Sugira Muryango (strengthen the family) program was to reduce family violence and increase

paternal engagement in play and caregiving.

Physical and Informational Materials

Not reported.

Setting

The intervention was offered face-to-face, individually, in the home

Dose and Intensity

12 weekly 90-minute sessions. The estimated total time is 1080 minutes.

Babies were between 6 and 36 months old at baseline. The intervention lasted 3-4 months.

Studies that Employed this intervention: Betancourt, Jensen, Barnhart, Brennan, Murray, Yousafzai, Farrar,

Godfroid, Bazubagira, Rawlings, Wilson, Sezibera, Kamurase 106

G%<#(&.$2.*#(!2()!H(.%$2=.*#(!J,&&%&&<%(.!#5!C$%.%$<!H(52(.!I%/2?*#$!J,CHIK!

All information about the intervention was obtained from Browne and Talmi (2005)260 unless otherwise stated.

Intervention Description

During the Assessment of Preterm Infant Behavior (APIB) intervention, an examiner observes and analyzes infant

behavioral response to environmental stimuli, and then works with the mother to discuss techniques to help the

infant develop self-regulatory behaviors. The infant’s behaviors were quantified for the following systems:

physiologic, motor, regulatory, attention-interaction, sleep and wake states, and amount of examiner facilitation. The

examiner discussed the infant’s behavioral response with the mother both during and after the examination. After

each session, each mother took the Mother’s Assessment of the Behavior of her Infant (MABI), which was

encouraged to be used to observe and elicit specific behaviors from their infant. The intervention occurred 1 week

prior to NICU discharge, and only infants who were expected to stay at least 2 weeks in the NICU were included in

the study.

Target population

Parents from economically disadvantaged households with preterm infants

Goal (and framework when applicable)

The Assessment of Preterm Infant Behavior (APIB) is a refined version of the Brazelton Neonatal Behavioral

Assessment Scale (BNBAS), and the goal is to help mothers observe and elicit specific optimal behaviors from their

infant.

Physical and Informational Materials

Mother’s Assessment of the Behavior of her Infant (MABI) was conducted after the APIB demonstration.

Setting

Face-to-face, one-on-one, in hospital

Dose and Intensity

The intervention was one 45-min session that occurred 1 week prior to NICU discharge.

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113

Studies that Employed this intervention: Browne, Talmi 260

F#<%!]*&*.2.*#(!2()![$#-'!H(.%$?%(.*#(!

All information about the intervention was obtained from Constantino et al. (2001)57 unless otherwise stated.

Intervention Description

The intervention was a 10-session curriculum that aimed to increase parental engagement in home visiting programs

and improve parent-infant interactions. Each session focused on a theme related to relational health development.

Each session consisted of 1) 5-10 minutes free-play and an introduction of the session’s topic, 2) 40-minutes of

guided mentorship of play techniques, 3) viewing a parenting videotape followed by discussion, and 4) a 20-minute

journaling session. During the last intervention session, parents were encouraged to join home visitation programs.

The intervention was delivered by “mentors” who were parents with master's experience in early childhood

education.

Target population

Parents and infants (no risk factor).

Goal (and framework when applicable)

Home visitation programs are public health interventions intended to reduce child abuse and neglect. The

intervention on Cohort 1 aimed to increase enrollment in home visitation programs and consisted of a curriculum

that primarily aimed to educate parents their role in their infant’s development, guide parent-infant play, and provide

participants a support network of other parents.

Physical and Informational Materials

A short reading and a parenting videotape were shared and discussed with participants.

Setting

Each session consisted of 8-10 parent-child dyads and two mentors who conducted the session.

Dose and Intensity

The 10-session curriculum occurred over 10 to 20 weeks, and each session was approximately 60 minutes. Infants

were 3-18 months old (8.3 average, SD=5.7) at baseline.

Studies that Employed this intervention: Constantino, Hashemib, Solisb, Alonb, Haleyb, McClureb, Nordlichtb,

Constantinob, Elmenb, Carlsonc 57

H<'$#?*(+!<#./%$_*(52(.!*(.%$2=.*#(!)-$*(+!*(52(.!5%%)*(+!

All information about the intervention was obtained from Cooper et al. (2009) and Tomlinson et al. (2020)147,261

unless otherwise stated.

Intervention Description

This intervention provided women with parenting guidance and support from a community worker. The intervention

used items from the neonatal behavioral assessment schedule to sensitize mothers to infant’s capacities and needs.

Interventionists were four residents (all women) of Khayelitsha, selected by the local community counsel.

Interventionists were supervised by an experienced community clinical psychologist.

Target Population

Low SES mother-infant dyads.

Goal (and framework when applicable)

The aim of the intervention was to encourage the mother to improve maternal sensitivity during mother-infant

interactions.

Physical and Informational Materials

Items from the neonatal behavioral assessment scale were used to sensitize the mothers to their infants’ needs.

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The intervention was adapted from the Social Baby manual (available at

www.reading.ac.uk/psychology/research/child-development/clinical-subgroup.asp )

Setting

Face to face, individually, at home.

Dose and Intensity

Mothers were visited twice prenatally and then once a week for the first eight weeks postpartum. Mothers were then

visited every two weeks for the following two months. Mothers were then visited monthly for two more months.

There were 16 sessions total, spanning from the prenatal period to five months postpartum.

Each session was approximately 1 hour long.

Studies that Employed this intervention Cooper, Tomlinson, Swartz, Landman, Molteno, Stein, McPherson,

Murray 147,Tomlinson, Rabie, Skeen, Hunt, Murray, Cooper 261

H()%U!J>EF]K

All information about the intervention was obtained from Cooper et al. (2015)262 unless otherwise stated.

Intervention Description

The intervention consisted of three components.

1. Supportive counseling 263. The goal of this element of the intervention was to encourage the mothers to express

their feelings in a non-judgmental and supportive environment.

2. Specific strategies were employed to make mothers more sensitive to their infants’ characteristics. This element

used items from the Brazelton Neonatal Behavioral Assessment Scale (NBAS), 246)

3. Interventionists provided specific, targeted assistance to mothers to help them manage infant behavioral

problems (ex: sleeping feeding crying, outlined in The Social Baby) 264.

Therapists were NHS-employed health visitors who received training in the administration of the NBAS.

Target population

Mothers at risk of postnatal depression and their infants.

Goal (and framework when applicable)

Not reported

Physical and Informational Materials

Interventionists worked with an interactive neonatal assessment, based on the Brazelton Neonatal Behavioral

Assessment Scale, which focused on the infant’s responsiveness to the social and non-social environment (visual

tracking, responding to the mother’s voice), as well as individual differences in infant capacities for regulating their

state and behavioral responses (ex: via habituation and covering the infant’s eyes briefly with a soft cloth).

Setting

Face-to-face individually, in the home

Dose and Intensity

The intervention consisted of 11 home visits; 2 prenatal visits and 9 in the first 16 weeks postpartum.

Studies that Employed this intervention: Cooper, De Pascalis, Woolgar, Romaniuk, Murray 262

C2$%(.!I23;!H(.%$2=.*#(!C$#+$2<!JCIHCK

All information about the intervention was obtained from Glazebrook et al. (2007)107 unless otherwise stated.

Intervention Description

The Parent Baby Interaction Program consisted of four types of activities, as well as principles of developmental

care, such as using incubator covers to shield infants.

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115

1. Tactile (ex: stroking infant)

2. Discussion (ex: infant development)

3. Verbal (ex: greeting infant)

4. Observation (ex: identifying different infant states)

The intervention is delivered by neonatal nurses who are overseen by a senior neonatal nurse.

Target population

Very premature infants (<32 weeks) and their parents.

Goal (and framework when applicable)

The goal of the PBIP program is to enhance parents’ understanding of and sensitivity to infant cues.

Physical and Informational Materials

A PBIP program manual, written by a senior neonatal nurse.

Setting

Face to face, individually. They started in the neonatal care unit and there was an option to continue intervention in

the home for up to 6 weeks after discharge.

Dose and Intensity

The intervention began in the NICU and consisted of weekly, 60-minute sessions that could continue for up to 6

weeks after discharge.

The total number of sessions was determined by the length of time needed to deliver the program and the mother’s

availability.

The mean number of sessions was 8.04 (SD = 4.34). The estimated average total number of minutes is 482.

Studies that Employed this intervention: Glazebrook, Marlow, Israel, Croudace, Johnson, White, Whitelaw 107

C2$%(.!C2$.*=*'2.*#(!H<'$#?%<%(.!C$#+$2<

All information about the intervention was obtained from Heo and Oh (2019)18 unless otherwise stated.

Intervention Description

This was a multi-stage intervention delivered by NICU nurses. The stages progressed as follows:

1. Individualized Interaction: parents identified the factors that impeded their experience of parenting in the

NICU

a. Answers were used to establish mutual goals and promote parent participation in areas such as

feeding, bathing, clothing, holding, and developing an awareness of infant signals.

b. There were individual variations in the quantity and content of goals

c. Mothers and fathers established separate goals

2. Pre-Participation stage: provided parents with information on selected topics based on interviews from the

individualized interaction stage and practical exercises

a. Also involved learning about the ecology of the NICU, infants’ signals, and preterm infants’ sleep

cycles

3. Active Participation stage: premature infants’ parents engaged in nursing care a total of 6 times

a. Took place during regular handling time for premature infants

b. Based on education and practice in pre-participation stage

c. Activities included diaper changes, breastfeeding, soothing, kangaroo care, bathing, clothing,

developmental positioning, singing, and talking.

Target population

Parents and their preterm infants.

Goal (and framework when applicable)

The intervention was based on King’s goal attainment theory and interpersonal system of action, reaction,

perception, and judgment. In-depth interviews with parents that aimed to understand their participation needs and to

select possible activities for their participation in neonatal care were used to design the intervention.

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Physical and Informational Materials

Informational materials were printed in a booklet and provided to parents.

Setting

The intervention takes place face to face, individually, in an education room in the NICU

Dose and Intensity

The first visit was an individualized interaction stage; the duration of this session was not reported. 9 intervention

sessions followed this initial interaction. The first 3 sessions constituted the pre-participation stage. Each of these

sessions lasted 50-60 minutes. There were 6 sessions in the active stage, each lasted 50-60 minutes. The estimated

total time is 495 minutes.

At baseline, infants were (on average), 33.6 weeks corrected gestational age.

The intervention was delivered over the course of 2 weeks.

Studies that Employed this intervention: Heo, Oh 18

6;!I23;R&!9*$&.!1%2=/%$!J6I91K!

All information about the intervention was obtained from Herbers et al. (2020)133 unless otherwise stated.

Intervention Description

The intervention was guided by video modeling that showed pre-recorded videos of families in shelters

demonstrating skills and appropriate parent-infant interactions. Specific skills included sensitively responding to

infant signals and cues, placing infants on their stomachs for active play to develop their core muscles, and infant

massage to encourage soothing touch and affection. These videos included pauses during which facilitators could

break for coaching and practice. The staff would coach parents, and would encourage parents to coach and support

one another in the skills that were taught in the videos

Target population

Parents with infants staying in emergency homeless shelters.

Goal (and framework when applicable)

The goal of the course is to provide parents with the skills to enhance their relationships with their infants.

Specifically, the intervention seeks to emphasize the links between sensory experiences, brain development,

attachment relationships, developmental milestones, and the importance of healthy early development to prevent

later problems.

Physical and Informational Materials

Participating parents received gifts at each session, including blankets, age-appropriate toys, and infant carriers.

Setting

The intervention was conducted face-to-face in groups. Sessions took place in playrooms in an onsite emergency

shelter.

Dose and Intensity

There were 5, weekly group sessions that lasted for 60-90 minutes each (total estimated time was approximately 375

minutes).

Infants were 6.43 months old, on average, at baseline.

The intervention lasted for 5 weeks.

Studies that Employed this intervention: Herbers, Cutuli, Fugo, Nordeen, Hartman 133

H(.%$2=.*#(!"#2=/*(+!5#$!,.E>*&O!C2$%(.&!JH",CK

All information about the intervention was obtained from Horowitz et al. (2001)89 unless otherwise stated.

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117

Intervention Description

The ICAP intervention focuses on mother-infant face-to-face interaction. During each visit, the interventionist asks

the mother to engage in a 5-minute face-to-face play interaction, after which the interventionist coachs the mother in

infant behaviors. The key elements of the intervention include:

1. Teaching the mother to identify the infant’s behavioral cues and to tailor her responses to her infant’s

preferences

2. Guiding the mother to physically position the infant in her line of vision

3. Demonstrating maternal strategies, including the use of pauses, imitation, sequences, and affect, voice, and

touch

4. Encouraging practice of suggestions and learning through trial-and-error

5. Using positive reinforcement of sensitive responsiveness

6. Praising success

Elements of the intervention were individually tailored, repeated, and varied, depending on the needs of each dyad.

Interventionists were four advanced practice nurses.

Target population

Mothers experiencing postpartum depressive symptoms and their infants.

Goal (and framework when applicable)

Designed to strengthen the mother-infant relationship.

Physical and Informational Materials

Not reported

Setting

Face to face, individually, in the patient’s home.

Dose and Intensity

All women received three home visits when their babies were 4-8 weeks (Time 1), 10-14 weeks (Time 2), and 14-18

weeks old (Time 3). Each interactive coaching session took approximately 15 minutes. The total time was

approximately 45 minutes.

Studies that Employed this intervention: Horowitz, Bell, Trybulski, Munro, Moser, Hartz, McCordic, Sokol 89

"#<<-(*=2.*(+!2()!>%42.*(+!T55%=.*?%4;!J",>TK

All information about the intervention was obtained from Horowitz et al. (2013)141 unless otherwise stated.

Intervention Description

The Communicating and Relating Effectively (CARE) intervention uses a combination of behavioral coaching and

teaching to improve maternal awareness and understanding of infant cues. The intervention is divided into 6

sessions, outlined below.

Session 1: Focuses on infant’s cues about their readiness to interact with their environment and their states

(including disengagement cues).

Sessions 2-3: Identifies cues demonstrated by the infant during play observation, having mothers observe infant

cues, and assigning homework to observe baby’s cues and to use Mother’s CARE and Child Communication Cue

forms.

Sessions 2-5: Reviewing homework, discussing observations, reinforcing knowledge about infant’s cues, returning

to session 1, and teaching mothers about new, developmentally relevant cues.

The intervention was delivered by a nurse.

Target population

Mothers with postpartum depression and their infants.

Goal (and framework when applicable)

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118

The goal of the intervention was to promote responsive maternal interaction between depressed mothers and their

infants. Specifically, CARE sought to improve mother’s abilities to interpret infants’ behavioral cues and to respond

sensitivity.

Physical and Informational Materials

Not reported

Setting

Face to face, individually. The study visits were conducted in participants’ residences (although women had the

option to select an alternate site for sessions).

Dose and Intensity

All study participants received a home visit at 6 weeks and 3, 6, and 9 months postpartum.

Dyads in the CARE intervention group also received visits at 2 and 4 months postpartum. These visits lasted for

approximately 30-40 minutes.

The intervention began when infants were approximately 6 weeks postpartum. The duration of the intervention was

approximately 5 months.

Studies that Employed this intervention: Horowitz, Murphy, Gregory, Wojcik, Pulcini, Solon 141

1/%![%..*(+!>%2);!H(.%$?%(.*#(!c!>-$24!T2$4;!F%2)!:.2$.!

All information about the intervention was obtained from Knoche et al., (2012)146 unless otherwise stated.

Intervention Description

The intervention was conducted by 64 Early Childhood Professionals (ECPs) who received extensive training before

delivering the intervention.

During sessions, ECPs guide moms to interact with their children in warm and responsive ways, to support their

children’s autonomy, and to participate in children’s learning. ECPs also engage parents in collaborative interactions

to support learning and development in the home. ECPs used strategies such as modeling, observation, and engaging

in mutual goal setting and activity and event planning.

The Getting Ready Intervention was designed to support and enhance the rural Early Head Start program.

Target population

Families enrolled in rural Early Head Start

Goal (and framework when applicable)

The intervention draws on triadic strategies265, an “early childhood consultation approach that has been validated

with young children with disabilities” 266. The intervention was also based on collaborative consultation models

267,268

The goal of this intervention is to improve parental warmth, sensitivity, and engagement in learning interactions

with their children. Ultimately, the intervention was designed to create a shared responsibility between parents and

interventionists to improve children’s developmental success.

Physical and Informational Materials

None

Setting

Face to face, individually. Monthly group activities were held at the community agency, while individual sessions

were held in the home.

Dose and Intensity

Weekly home visits lasted for 60-90 minutes as a part of EHS. Families received an average of 45.8 (SD = 28.45)

visits over the course of 16 months.

Infants were 11.02 months on average at baseline (SD = 7).

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119

Studies that Employed this intervention: Knoche, Sheridan, Clark, Edwards, Marvin, Cline, Cline, Kupzyk 146

S%@3#$(!I%/2?*#$24!Q3&%$?2.*#(&!JSIQK!:;&.%<!

All information about the intervention was obtained from Nugent et al. (2017) and Kristensen et al. (2020)79,269

unless otherwise stated.

Intervention Description

The NBO is an infant-focused, family-centric intervention that consists of 18 behavioral items that describe the

newborn’s physiological, motor, state, and social capacities over the first 3 months of life. During the intervention,

clinicians guide mothers to understand their infant’s behavioral responses and to formulate caregiving strategies and

handling techniques based upon observations of infant behavior. Types of behavior discussed included motor

behaviors, infant sleep behaviors, feeding cues, and skin-to-skin contact. The intervention is “baby-led,” meaning

that it was shaped by the infant’s behavior.

The intervention is led by a clinician.

Target population

Mothers of full-term newborns 79.

Mothers and their infants in a community setting 269.

Goal (and framework when applicable)

The NBO was based on research with the Neonatal Behavioral Assessment Scale 246,270. The goal of the intervention

was to provide clinicians with a tool that shifted the focus from assessment and diagnosis to observation and

relationship building. Another goal of the intervention was to enhance parents’ understanding of their infant’s cues.

Physical and Informational Materials

Sessions begin with a shared observation of the baby’s initial state.

Infant sleep was used as an opportunity to discuss the infant’s state and caregiving opportunities.

The clinician guides the parents to elicit motor behaviors (ex: grasp, sucking and rooting, and crawling), and once

again, they discuss the implication of the responses for touch and skin-to-skin contact, feeding cues, and sleep

positions.

The intervention also provides opportunities for face-to-face interaction.

There is an emphasis on the infant’s threshold levels of stimulation, and therefore provides opportunities to observe

and monitor the infant’s autonomic, motor, and (state) behavioral self-regulation.

Setting

In the hospital and in the home 79.

Mainly home visits 269.

Dose and Intensity

Mothers received routine hospital care and participated in the NBO within 2 days of delivery. Mother-infant dyads

participated in a second NBO session in the home at 1 month postpartum. The length of the session ranged from 12-

25 minutes, depending on the infant’s state 79.

Mothers received routine hospital care and participated in the NBO 3 weeks after delivery. Mother-infant dyads

participated in one to three more NBO sessions in the home over the first 3 months of the infant’s life. The length of

the session ranged from 12-25 minutes, depending on the infant’s state 269.

Studies that Employed this intervention

Nugent, Bartlett, Von Ende, Valim 79,Kristensen, Juul, Kronborg 269

[-*)%)!'2$.*=*'2.*#(!.#!*(52(.!./%$2'%-.*=!'#&*.*#(*(+!J[ChC#&*.K

All information about the intervention was obtained from Lavallée et al. (2022)142 unless otherwise stated.

Intervention Description

The intervention used Guided participation theory for mothers to participate in their preterm infant’s therapeutic

positioning (GP_Posit). The intervention was delivered by neonatal nurses who guided mothers in detecting their

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120

infant’s behavioral stress and stability cues during caregiving activities. These care activities include diaper changes

followed by supine, side-lying, and prone positioning. Activities were introduced in a progressive manner,

depending on each mother’s confidence level and abilities. The interventionist would introduce additional

caregiving activities, such as bottle-feeding or breastfeeding, in accordance with each mother’s comfort level. The

intervention also included didactic information on how to position preterm infants and infant development.

Target Population

Preterm mother-infant dyads.

Goal (and framework when applicable)

The intervention was based on Attachment theory, guided participation theory, and Als’s Synactive theory of infant

development. The goal of the intervention was to refine mothers’ sensitivity to their infant’s behavioral cues through

positioning as a caregiving activity.

Physical and Informational Materials

Booklet online modules.

Setting

The intervention was conducted face-to-face, individually, in the NICU.

Dose and Intensity

Weekly, 30- to 45-minute sessions were conducted from birth to discharge from the NICU. On average, dyads

received 4 sessions (2 hours total).

Studies that Employed this Intervention: Lavallée, Côté, Luu, Bell, Grou, Blondin, Aita 142

1/%!H(52(.!I%/2?*#$24!,&&%&&<%(.!2()!H(.%$?%(.*#(!C$#+$2<!JHI,HCK

All information about the intervention was obtained from Meijssen et al. (2010a, 2010b) and Meijssen et al.,

(2011)38,39,271 unless otherwise stated.

Intervention Description

The Infant Behavioral Assessment and Intervention Program (IBAIP) provides guidance to parents of pre-term

infants to help them support their infant’s development of self-regulatory competence via centering parental

availability and responsiveness. Interventionists help parents support their infant’s self-regulation by helping the

infant stabilize themselves when they are focused on an object or altering the brightness of a room when the infant

shows behaviors such as turning away or excessive blinking.

The Infant Behavioral Assessment (IBA) is used during intervention sessions as a tool to sensitize parents to their

infant’s self-regulatory behavior to external stimuli.

Target population

Preterm mother-infant dyads.

Goal (and framework when applicable)

The IBAIP, based on the Newborn Individual Developmental Care and Assessment Program (NIDCAP), aims to

improve infant self-regulatory competence and parenting confidence through positive parent-infant interactions. It

relies on ideas that parent availability, attentiveness, and responsiveness strengthen infant competence and

development and parenting confidence. It is based on the Newborn Individual Developmental Care and Assessment

Program (NIDCAP).

Physical and Informational Materials

The mother receives a report of each infant’s neurobehavioral and developmental progress and parenting advice

after each session.

The Infant Behavioral Assessment (IBA) is used during the intervention as a tool to sensitize parents to their infant’s

self-regulatory behavior to external stimuli.

Setting

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121

NICU (level III) in two hospitals and five city hospitals participated in the study. The intervention consisted of face-

to-face (home visits) by pediatric physical therapists trained in IBAIP.

Dose and Intensity

The number of visits was individualized and ranged from 6-8 home visits, and each visit lasted approximately one

hour. The program ran post-discharge up to 6-8 months of age.

Studies that Employed this intervention: Meijssen, Wolf, Koldewijn, Houtzager, van Wassenaer, Tronick, Kok,

van Baar 38,Meijssen, Wolf, van Bakel, Koldewijn, Kok, van Baar 39,Meijssen, Wolf, Koldewijn, van Wassenaer,

Kok, van Baar 271

"$%2.*(+!Q''#$.-(*.*%&!5#$!C2$%(.!T<'#@%$<%(.!J"QCTK

All information about the intervention was obtained from Melnyk et al. (2006)109 unless otherwise stated.

Intervention Description

The COPE intervention is a 4-phase educational-behavioral intervention. Each phase uses audiotapes and written

recordings to provide information on the appearance and behavioral characteristics of premature infants and the

parent-infant relationship.

Phase I: Parents are provided with a set of parenting activities and were instructed to keep a log of the milestones

they experienced in the NICU.

Phase II: Reinforce content of phase I and provided supplemental information on premature infants’ behaviors and

development. This phase also included activities aimed to help parents identify infants’ cues (specifically for stress

and alertness).

Phase III: Provide developmentally appropriate information about infant states and information about how to

interpret and respond to infant stress cues. This phase was also designed to help prepare mothers for discharge from

the NICU.

Phase IV: Provided information about preterm infant development and included activities that foster infants’

cognitive development.

Target population

Preterm mother-infant dyads.

Goal (and framework when applicable)

COPE intervention is based on theories of self-regulation and control. The approach of the intervention involves

reinforcing information with behavioral activities. of the intervention include helping parents meet their infants’

needs, enhancing the quality of parent-infant interaction, and optimizing their infants’ development.

Physical and Informational Materials

The intervention was delivered as a series of audiotapes and written information, along with prescribed activities.

Setting

The intervention took place individually online and in the NICU.

Dose and Intensity

Phases I-III were delivered in the NICU, while Phase IV was delivered in the parents’ home 1 week after discharge.

Phase I occurred 2 to 4 days after the infants’ admission to the NICU. Phase II occurred 2-4 days after the first

intervention. Phase III occurred 1 to 4 days before discharge.

The number and length of sessions were not reported.

Studies that Employed this intervention: Melnyk, Feinstein, Alpert-Gillis, Fairbanks, Crean, Sinkin, Stone, Small,

Tu, Gross 109

H(=$%)*34%!M%2$&!C2$%(.&!2()!I23*%&!JHMCIK!

All information about the intervention was obtained from Pontoppidan et al. (2016)272 unless otherwise stated.

(which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

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122

Intervention Description

The Incredible Years Parents and Babies (IYPB) is a therapy intervention performed in groups of 8 families. In each

session, group leaders showed American video vignettes of real-life parent-child interactions with Danish subtitles

and facilitated group discussion following the video. Group leaders also presented information about infant neural

development and parental roles via the Incredible Years baby poster. Participants also received The Incredible

Babies book, which was translated into Danish and included ways for parents to support infant development.

Target population

Mothers and fathers with infants in Ikaste-Brande or Herning local area in Denmark.

Goal (and framework when applicable)

The goal of IYPB is to improve physical, language, and emotional development of infants via guiding parents how

to respond to their child’s needs in a shared learning space and peer-support networks. The course consisted of six

sections: “1) Getting to Know Your Baby; 2) Babies as Intelligent Learners; 3) Providing Physical, Tactile and

Visual Stimulation; 4) Parents Learning to Read Babies’ Minds; 5) Gaining Support; and 6) Babies Emerging Sense

of Self.”

Physical and Informational Materials

Parents watched American IY videos with Danish subtitles that introduced real-life vignette situations of parents and

infants. Parents also received a Danish translation of The Incredible Babies book which provided parenting advice

and a journaling section.

Setting

The intervention occurred in a group setting of 8 families and two trained group leaders. The location of group

sessions was not specified.

Dose and Intensity

Each session was approximately 120 minutes long. Sessions were offered weekly for 8 weeks. For some groups, the

weeks were interrupted by holidays or breaks. Other groups finished within 8 continuous weeks. The intervention

began after discharge from hospital but before 4 months of age (mean age of 1.59 months) and lasted for 8 weeks.

Studies that Employed this intervention: Pontoppidan, Klest, Sandoy 272

S-$.-$%!2()!C42;!JS2CK

All information about the intervention was obtained from Salo et al. (2019)95 unless otherwise stated.

Intervention Description

Theraplay is a form of child-interactive therapy that is active, adult-led, and playful. The intervention used

Theraplay-based activities, including singing, playing musical instruments, and interaction activities such as infant

massage and peek-a-boo.

During pregnancy NaP sessions, mothers are encouraged to stimulate the fetus by stroking their bellies while singing

lullabies. Pregnancy NaP sessions are also centered around reflection and discussion about maternal representation

of childhood, pregnancy, and motherhood.

Baby NaP sessions (postpartum) focused on infant massage, songs that used rhythmic movements, and holding and

rocking strategies. Additionally, sessions focused on understanding infants’ mental states. Each session includes

cognitive and affect regulation techniques with direct attention on handling depressive mood and dysregulated sleep

and eating patterns.

Discussions can also focus on coping strategies for handling stress

Homework and diaries are provided to stimulate child-directed thought. Mothers are offered relaxation techniques

and massage practices to decrease prenatal depression.

The NaP intervention is delivered by trained instructors.

Target population

Prenatally depressed mothers and their infants

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123

Goal (and framework when applicable)

The Nurture and Play intervention was based on Cognitive Behavioral Therapy and visualization/mentalization

strategies. All Theraplay-based activities were designed to promote affectionate mother-infant contact, using

physical touch, reciprocity, synchrony, and joint attention.

Physical and Informational Materials

Not reported

Setting

The first meeting was individual, followed by group sessions. All sessions were in-person.

Dose and Intensity

Pregnancy group sessions were held biweekly, while baby groups were held weekly. Sessions were 1.5 hours. The

Baby Group was invited to arrive 15-20 minutes before the session to settle in, feed, and change diapers. Mothers

were offered tea and coffee after the sessions for an additional 30-45 minutes.

There were 11 sessions, each approximately 90 minutes.

The intervention began prenatally and spanned 9 weeks.

Studies that Employed this intervention: Salo, Flykt, Makela, Biringen, Kalland, Pajulo, Punamaki 95

F#<%!H(.%$?%(.*#(!,)2'.%)!5$#<!./%!H(52(.!F%24./!2()!G%?%4#'<%(.!C$#+$2<!JHFGCK!

All information about the intervention was obtained from Schuler et al. (2000, 2002)130,273 unless otherwise stated.

Intervention Description

This home-based program adapted from the IHDP was designed to optimize infant development and consisted of

both a parent and an infant component. Specifically, this study amended the home-visiting protocol of the IHDP by

adding information about drug use and treatment.

Mothers in the intervention group received weekly home visits during the first 6 months postpartum from one of two

full-time lay visitors. The visitors were two-middle-aged African American women with previous experience

making home visits and knowledge of the community where the mothers lived. These visitors met with a

pediatrician and a psychologist weekly to track the progress of the families and to discuss concerns about the

families.

The intervention covers a range of topics, from housing, public assistance programs, partner abuse, and the effects of

drug use and drug treatment. Home visits are monitored with personal contract forms that contained information

about the content and quality of the visit, including the relationship between the mother and home visitor, the

caretaker's concern about the mother, the infant's development, and health education.

The infant-component sought to enhance mother-infant communication and provide a stimulating play environment

through games and activities. Home visitors used the HELP at Home: Hawaii Early Learning Profile, a curriculum

consisting of 650 developmental skills for children from birth to 35 months 274. Visitors would teach mothers

appropriate ways to play with their infants in order to enhance communication between mothers and infants.

Target Population

Mothers with substance use histories and their infants.

Goal (and framework when applicable)

The home intervention was developmentally oriented and was based on the program used by the IHDP 275. The goal

of the parent component was to increase maternal empowerment by enhancing the mothers’ ability to manage self-

identified problems.

The goal of the infant component was to promote infant development by using a program of games and activities.

The goal of the parent component was to help mothers use family and social support to manage self-identified

problems.

Physical and Informational Materials

Not reported.

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124

Setting

Visits are conducted in the home.

Dose and Intensity

The mean number of visits made during the first 6 months was 8.9 (SD = 5.6, range = 0–23), and the mean length

was 30.1 min (SD = 5.8). The estimated total time is 4.46 hours 130.

The average number of visits made to mothers in the intervention group in the first 18 months was 19.9 (SD=13.0,

range = 0-57), and the mean length was 28.5 minutes (SD=4.6) 273.

Studies that Employed this intervention: Schuler, Nair, Black, Kettinger 130,Schuler, Nair, Black 273

I23;!1$*'4%!C

All information about the intervention was obtained from Tsivos et al. (2015)34 unless otherwise stated.

Intervention Description

The ‘implementing parenting routines’ sessions involve active skills practice between the mother–infant dyads. The

interventionist was a triple P-accredited doctoral student who was overseen by a clinical psychologist. The

practitioner provided feedback and prompted maternal self-evaluation.

Baby Triple P consists of eight sessions:

1. Positive parenting

2. Responding to your baby

3. Survival skills

4. Partner support

5. Implementing parenting routines (1)

6. Implementing parenting routines (2)

7. Implementing parenting routines (3)

8. Implementing parenting routines (4) and maintenance and closure (see Table 1).

Target population

Mothers with postnatal depression and their infants

Goal (and framework when applicable)

The Triple P intervention has 3 specific goals276:

1. To enhance parental knowledge and resourcefulness

2. To promote nurturing, low-conflict environments for children

3. To promote children’s social, emotional, and intellectual competencies through positive parenting practices

The Triple P framework is adaptable to individual parental needs, regardless of age, gender, and socio-cultural

differences 277.

Physical and Informational Materials

The interventionist used a checklist and workbook that detailed session content 278.

Setting

Face-to-face in person, in the home.

Dose and Intensity

The intervention consists of 8 weekly sessions. The first 4 sessions lasted 60-90 minutes and the remaining 4

sessions lasted 40-60 minutes.

Infants were 6.7 months on average at baseline, and the intervention lasted 8 weeks.

Studies that Employed this intervention: Tsivos, Calam, Sanders, Wittkowski 34

"$*2(W2!1%<'$2(2

All information about the intervention was obtained from Valades et al. (2021)74 unless otherwise stated.

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125

Intervention Description

This intervention provides basic guidance and support on topics such as mother’s support network, birth process,

care of the infant, and early childhood development. Mothers are given support in caring for their infants. Mothers

are made aware of the infants’ social engagement and advised while talking and engaging in play with their infants.

The mother’s behaviors are reinforced by the facilitator when the infant exhibited a positive reaction, and the

facilitators noted how the mother’s behaviors enhanced the infant’s social engagement. The facilitator also models

and guides some behaviors for the mothers when appropriate. Other caregivers are encouraged to be present for the

sessions.

Goal (and framework when applicable)

The Thula Sana intervention was renamed ‘Crianza Temprana,’ which means ‘Early Parenting’ 279. This intervention

was based on parenting principles and early child development strategies outlined in ‘The Social Baby’ 264. This

intervention also incorporated the key ideas from the World Health Organization’s document ‘Improving the

Psychosocial Development of Children’ 280.

Physical and Informational Materials

The Neonatal Behavioral Assessment Scale (NBAS) Intervention manual was provided, as well as guidance and

support on topics such as creating a support network, birth process, care of the infant, and early childhood

development. Mothers were given support caring for their infant and behaviors were sometimes modeled for the

caregivers by the facilitator.

Setting

Face to face, individual home visits.

Dose and Intensity

This intervention included 16 sessions, approximately one hour each. Two of the visits are conducted in the late

antenatal period, and the remainder 4 of the visits are conducted weekly for the first eight weeks postnatal. After

that, every two weeks for two more months, as well as monthly visits for two more months postpartum (16 sessions,

approximately 16 total hours).

Studies that Employed this intervention: Valades, Murray, Bozicevic, De Pascalis, Barindelli, Meglioli, Cooper 74

62.%$(24!:-''#$.!5#$!I%=#<*(+!2!9*$&.i.*<%!6#./%$!J,6,"Q6C>HK

All information about the intervention was obtained from Vargas-Porras et al. (2021)19 unless otherwise stated.

Intervention Description

This intervention employs usual postnatal healthcare and the multimodal intervention, “Maternal Support for

Becoming a First‐time Mother,” (the Spanish acronym is AMACOMPRI).

The multimodal intervention aspect includes eight alternating home and telephone sessions, delivered by an

AMACOMPRI trained nurse (to ensure consistency and compliancy). The sessions focus on functional social

support, the mother-infant bond, perceived maternal self‐efficacy, and becoming a mother. The information is

provided on software that is downloaded on the participant’s phone. The participants could also access the

information on their own, the participants could write in the software and ask the nurse for advice and the nurse

could respond. A nursing care plan is then developed and implemented, according to the needs of the mother, based

on the visits.

Goal (and framework when applicable)

This intervention is based on Mercer's “Becoming a Mother Theory.” This theory encompasses a new mother’s

personal growth through the required lifetime commitment of motherhood and the challenges that this brings 281 .

The four stages of be-coming a mother according to Mercer (2004) are: “(1) commitment, attachment, and

preparation (during pregnancy); (2) acquaintance, learning, and physical restoration (first 2–6 weeks postpartum);

(3) moving toward a new normal (2 weeks–4 months); and (4) achievement of maternal identity (around 4

months)”(p. 231). Mercer also acknowledges Bronfenbrenner's Theory (1986), accounting for the three main

environments of development: family and friends, community, and society 281,282. The goal of this intervention was

to focus on the family‐and‐friends environment as well as supporting the mother during the postpartum stages, to

enhance early development and parent–infant interaction 283.

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126

Physical and Informational Materials

This intervention includes audio-visual educational and support software that was downloaded on the participant's

smartphones at the beginning of the study. Included in this software are twenty-six audio guides, conducted by an

expert, about specific postpartum issues, as well as four videos of a first‐time mother sharing her personal

experiences.

Setting

This intervention took place individually, face to face, in the participants' homes and over the phone.

Dose and Intensity

A total of eight nurse‐delivered visits, alternating between 90- to 120-minute in‐person visits and 15-minute

telephone encounters (four of each type of visit). This intervention took approximately 7 total hours.

Studies that Employed this intervention: Vargas-Porras, Roa-Diaz, Hernandez-Hincapie, Ferre-Grau, de Molina-

Fernandez 19

"-%&!

All information about the intervention was obtained from Zelkowitz et al. (2021)99 unless otherwise stated.

Intervention Description

The intervention consists of observational exercises that helped mothers learn about their infant’s behavior and

apply the knowledge they acquired during the intervention. During each session, the mother and interventionist

discuss the content of each booklet and its applications.

Sessions 1 and 2 focus on managing maternal anxiety.

Sessions 3-6 focus on infant behavioral cues, infant states, and sensitive mother-infant interaction. Session 3 focuses

on the infant’s state, session 4 focuses on infant cues, and session 5 focuses on feeding interactions. Session 6

integrates all earlier sessions.

The intervention was delivered by a nurse, a psychologist, or a nursing or psychology graduate student.

Target population

Mothers of VLBW (preterm) infants.

Goal (and framework when applicable)

The goals of the intervention were:

1. To reach mothers to recognize signs of their own anxiety and distress

2. To teach mothers to use various strategies to alleviate their distress

3. To teach mothers to read their infant’s communication cues

4. To teach mothers to respond sensitively to their infant’s cues and distress

Physical and Informational Materials

The information disseminated in the anxiety reduction and sensitivity components of the intervention was contained

in a series of five “The Keys to Caregiving” booklets.

Each booklet addressed different topics related to parent-infant interaction.

Setting

Face-to-face, individually, in the NICU and in the home

Dose and Intensity

The intervention consists of 6, 60-minute sessions. The first 5 sessions took place in the NICU, while the last session

took place in the home 2-4 weeks after discharge.

The estimated total length of the intervention was 600 minutes.

Infants were 33 days old at baseline (SD = 12). The intervention duration was 9-23 days (until the infant was 6-8

weeks corrected age).

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127

Studies that Employed this intervention: Zelkowitz, Feeley, Shrier, Stremler, Westreich, Dunkley, Steele,

Rosberger, Lefebvre, Papageorgiou 99

,..2=/<%(.EI2&%)!H(.%$?%(.*#(&!

C$*<%*$#&!\2j#&!

All information about the intervention was obtained from Alarcao et al. (2021)104 unless otherwise stated.

Intervention Description

Primeiros Laços is an individualized home visiting program. During visits, interventionists help parents develop

child-centered interactions to improve the parent-infant bond, reflect on their own attachment history and their

relationship with their parents, and help parents consider their infants’ feelings and thoughts. Interventionists used

modeling to encourage attuned, attentive, and sensitive parenting.

Interventionists are nurses specializing in maternal or mental health and were supervised weekly by senior nurses

and psychologists.

Target Population

Adolescent first-time mothers and their infants.

Goal (and framework when applicable)

Primeiros Laços is based on three theoretical frameworks, Attachment Theory, Self-Efficacy Theory, and

Bioecological Development Theory. 282,284,285The intervention was structured in five axes (healthcare, health

environment, parenting and attachment, social and family network, life project).

The goal of the intervention is to strengthen maternal capacity for warm and responsive care and to establish

positive relationships between home-visitors and the family.

Physical and Informational Materials

Not reported.

Setting

The intervention was delivered face-to-face, individually, in the mother’s home.

Dose and Intensity

The intervention began during the first 16 weeks of pregnancy and continued until the child was 24 months.

Visits were weekly (first/last month of pregnancy/puerperium), biweekly (gestation/2-20 months of child’s age), and

monthly (21-24 months of child’s age).

Mothers were expected to receive 40–42 visits by the time their infants were aged 12 months and 60–62 visits by the

time their infants were 24 months of age.

Studies that Employed this intervention: Alarcao, Shephard, Fatori, Amavel, Chiesa, Fracolli, Matijasevich,

Brentani, Nelson, Leckman, Miguel, Polanczyk 104

Healthy Families Durham (HFD)

All information about the intervention was obtained from Berlin et al. (2017)160 unless otherwise stated.

Intervention Description

Interventionists facilitate discussions on topics related to the infant-parent relationship and promoting children’s

socio-emotional development. Visits are tailored to the child’s age and developmental level as well as to the parent’s

needs. During home visits, parents are provided with handouts related to socio-emotional development and toys and

activities designed to promote parent-child interaction.

Interventionists were Healthy Families America home visitors who were mostly social workers and counseling

professionals with master's degrees.

Target population

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128

High-risk mother–infant dyads.

Goal (and framework when applicable)

The intervention is based on attachment and bio-ecological systems theories (ABC) and trauma-informed care. The

goal of the intervention was to promote healthy attachment. The intervention is credentialed as a Healthy Families

America program and drew from the Parents as Teachers curriculum, a parent education tool that seeks to promote

all aspects of child development 286,287.

Physical and Informational Materials

Home visitors brought simple toys and activities to each session to try to encourage parent-child interaction. Home

visitors also provided parents with handouts (topics included the importance of infant-parent relationships to

children’s socioemotional development).

The HFD intervention used the Parents as Teachers curriculum.

Setting

Face to face, individually, in the home.

Dose and Intensity

Visits began prenatally or during the first 3 months of birth. The interventionist continued to visit parents weekly for

1 year, and then continued to meet with families on an as needed basis. The mean number of sessions was 28.69.

The length of each session was not reported.

Studies that Employed this intervention: Berlin, Martoccio, Appleyard Carmody, Goodman, O'Donnell, Williams,

Murphy, Dodge 160

T2$4;!F%2)!:.2$.!C4-&!,..2=/<%(.!2()!I*#3%/2?*#$24!"2.=/Ek'!J,I"K

All information about the intervention was obtained from Berlin et al. (2018)136 unless otherwise stated.

Intervention Description

The intervention consists of discussion, guided practice, and watching video clips from previous sessions. Sessions

included observation and live feedback from ABC coaches on mother-infant interactions. Mothers are provided

homework outside of intervention sessions to reflect on their parenting behaviors, but this homework was not

required nor formally evaluated. Families also engaged in Early Head Start interventions.

Interventionists were two female fully bilingual (English and native Spanish) parent coaches who were accredited by

ABC/Infant-Caregiver Project staff.

Target population

Mothers and infants who were already receiving the early head start program. This included specifically low-income

Latino and Spanish speaking mothers.

Goal (and framework when applicable)

The goal of the ABC-component of the intervention was to promote the development of a secure mother-infant

attachment and improve early childhood behavioral physiological regulation. The intervention targeted three specific

aspects of sensitive caregiving behavior:

1. Providing nurturance

2. Following the child’s lead with delight

3. Avoiding intrusive and frightening behaviors

Physical and Informational Materials

The ABC manual, which was also translated into Spanish.

Setting

Face-to-face, individually, in the mother’s homes.

Dose and Intensity

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129

10 sessions, although the length of each session was not reported. At baseline, infants were within 6-20 months of

age (average of 12.7 months, SD=4.2). The intervention was delivered approximately weekly, but the reported

average was 13 weeks (SD=6.9).

Studies that Employed this intervention: Berlin, Martoccio, Jones Harden 136

Attachment and Biobehavioral Catchup (ABC)

All information about the intervention was obtained from Dozier et al. (2009), Bernard et al., (2012), Bick and

Dozier (2013), and Perrone et al., (2021)16,138,161,288 unless otherwise stated.

Intervention Description

ABC is an attachment-based intervention that seeks to help caregivers interpret children’s behaviors and provide

nurturing care. The intervention uses interactive parent discussion, videotaped feedback, and dyadic practice to teach

and solidify concepts.

Interventionists varied between studies. The intervention was delivered by professional or social workers or

psychologists with at least 5 years of clinical experience 16, parent trainers with experience with children and strong

interpersonal skills 161, and parent coaches with varying racial, ethnic, professional and educational backgrounds 138.

The intervention is standardized so that the same issues are introduced across the ten sessions, although the age and

target population vary among studies. While these themes remained constant, specific activities were tailored to the

children’s ages and family circumstances.

The focus of each session is outlined below:

1. Sessions 1 and 2: Providing nurturance when the child pushes away

2. Sessions 3, 4, and 5: Practice following the child’s lead

3. Sections 6 and 7: providing nurturance at difficult moments for the parent

4. Session 8: physical touch (holding and touching the child)

5. Session 9: reducing parent’s frightening behavior

6. Session 10: Learning to respond to the child’s negative emotions

Target population

This intervention has been used to target foster parents and their infants 16,288, infants and parents in problematic or

neglectful environments 161, and parent-infant dyads from urban community settings 138.

Goal (and framework when applicable)

ABC is based on Ainsworth’s 1976 model of attachment and construct of maternal sensitivity. It uses a multi-

pronged approach to improve parental nurturance, particularly in moments when it doesn’t come naturally. As a

result, the intervention seeks to help children develop regulatory capacities and help attachment organization (to

promote secure attachment formation).

Physical and Informational Materials

The intervention employed video feedback and manualized information16. Mothers were asked to keep an

“attachment diary” for 3 days, recording moments when the child pushes away. Video feedback was used to

consolidate skills obtained in the sessions, support maternal competence, highlight parental strengths, challenge

weaknesses, and celebrate changes in parental behaviors.

Setting

The intervention was conducted face-to-face, individually, in the home. Intervention setting included shelters 161 and

foster parent homes 16,288.

Dose and Intensity

10 sessions, 60 minutes each, 600 minutes total.

Duration of intervention varied: 11.82 months (average), SD=4.36 138; 19.2 months (average), SD=5.2 161; 18.9

months (average), SE=1.8 16.

Age at Baseline varied: 5.64-21.48 months (m=11.82, SD=4.36) 13819.2 (SD=5.2) 161; not reported 16; 10 months

(average); SD=7.3 288.

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130

Studies that Employed this intervention: Dozier, Lindhiem, Lewis, Bick, Bernard, Peloso 16,Perrone, Imrisek,

Dash, Rodriguez, Monticciolo, Bernard 138,Bernard, Dozier, Bick, Lewis-Morrarty, Lindhiem, Carlson 161,Bick,

Dozier 288

C2$%(.EH(52(.!C&;=/#./%$2';!JCHCK

All information about the intervention was obtained from Fonagy et al. (2016) 84 unless otherwise stated.

Intervention Description

The intervention consists of parent-infant psychotherapy sessions. Parents, infants, and therapists would sit on the

floor and discuss issues such as parental mental feelings and state, the parent-infant relationship, and issues centered

around the infant. During these sessions, therapists work to observe interactions in the room, nonverbal

communication, and communication errors. The infant is present in each session. The relationship with the therapist

was viewed as an important agent of change through the sessions.

Interventionists were 6 parent-infant psychotherapists who had received 2 weeks of group supervision to discuss the

intervention and ensure model adherence before the intervention.

Target population

Parents with mental health problems and their infants.

Goal (and framework when applicable)

It was hypothesized that PIP would improve infant development, parent-infant relation outcomes, and maternal

mental health relative to the standard care group 84.

Physical and Informational Materials

The intervention model was described in a manual 289.

Setting

Face to face, individually. The PIP intervention was offered at three locations that were local and accessible to

participating families.

Dose and Intensity

The intervention consisted of 16 sessions, offered on a weekly or bimonthly basis. Psychotherapy sessions were

continued until therapists and parents mutually agreed upon an end date. The mean number of PIP sessions attended

during the 1-year study period was 16 (range= 1-49), 41% of families had completed therapy by the 6-month follow-

up. Some families continued to attend PIP sessions after the final 12-month follow-up. The length of each session

was not reported. The baseline age of infants in this study was 3.9 months (SD=3.2).

Studies that Employed this intervention: Fonagy, Sleed, Baradon 84

9#=-&%)!C2$%(.EH(52(.!C&;=/#./%$2';!J5CHCK!

All information about the intervention was obtained from Georg et al. (2021)93 unless otherwise stated.

Intervention Description

This intervention focused on strengthening the relationship between the parent and the infant, to have a positive

impact on infant development through psychodynamic interventions. The fPIP intervention explored the mother’s

own attachment experiences and related that to her current relationship with her infant. This was done using a

supportive strategy and an expressive strategy during psychotherapy sessions. Both strategies focused on

strengthening the ability of the parent to mentalize the child, as the key aspect for change.

Either one or both primary caregivers and their infant attended psychotherapy sessions. Interventionists were

postgraduate students with psychoanalytic training.

Target Population

Infants with early developmental or health impairments and their caregivers.

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131

Goal (and framework when applicable)

The intervention has several goals. Infant-related goals are to reduce sleeping, crying, and feeding problems for

infants. Caregiver-related goals include reducing caregiver’s depression and psychological distress and to increase

caregiver’s emotional availability, self-efficacy, and reflective functioning.

Physical and Informational Materials

Not reported.

Setting

Face to face, individually, at the Department for Family Therapy at Heidelberg University Hospital.

Dose and Intensity

This intervention consisted of one double, 90-minute, session and three single, 50-minute sessions. This intervention

took approximately 4 total hours.

Infants were 4 to 15 months of age at baseline (mean= 8.84), and the intervention continued for 12 weeks.

Studies that Employed this intervention: Georg, Cierpka, Schroder-Pfeifer, Kress, Taubner 93

6*()*(+!./%!I23;

All information about the intervention was obtained from Sadler et al. (2013) and Londono et al. (2022)5,290 unless

otherwise stated.

Intervention Description

Minding the Baby is an interdisciplinary intervention program that combines two early intervention approaches: The

Nurse-Family Partnership and Infant-Parent Psychotherapy. This program works to promote sensitive and reflective

parenting and improve the overall quality of the dyadic attachment relationship. The parent-clinician relationship

was the primary means of integrating this change. MTB elaborated on these two existing models, focusing on the

following topics:

(1) maternal mentalization (the mother’s reflective functioning on the baby’s and her own internal

experiences)

(2) prenatal and childcare, health, and development (delivered by the NP)

(3) contraceptive counseling (NP)

(4) ongoing assessment of the dyad and their mental health (delivered by the CSW).

Other activities include hands-on play between the dyad, recording and watching videos of play/care routines, and

maternal journaling or scrapbooking. The administration of the program is individualized to each family’s needs.

Families were recruited from prenatal groups at their primary care clinic, allowing for the clinician-parent

relationship to strengthen.

Interventionists are nurse practitioners and social workers who alternated visits such that the NP would attend one

week and the CSW would lead the following week.

Target population

First-time, young mothers and their infants

Goal (and framework when applicable)

The goal of MTB is to promote developmental, relational, and health outcomes in first-time, multiethnic young

mothers and children. In order to accomplish this, MTB used an interdisciplinary approach by combining Nurse-

Family Partnership and Infant-Parent Psychotherapy early intervention models. It is based on Fraiberg’s 1980 IPP

model as well as Ainsworth’s 1976 model of Maternal Sensitivity and Attachment 155,291.

Physical and Informational Materials

Control families received monthly informational brochures from Healthy Steps292 regarding child rearing and health.

They were also sent birthday and holiday cards.

Setting

Face-to-face home visits by trained social workers and nurse practitioners

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132

Dose and Intensity

MTB consists of weekly visits beginning in the late second or early third trimester until the child’s first birthday and

biweekly visits from the child’s first birthday until they were 24 months old. For the child’s first birthday, there was

a celebratory transition visit; at two years, there was a graduation visit in which both home visitors attended.

Mean home visits per month = 3.4 (SD = 1.5); session length ranged from 45 min to 90 min, and generally averaged

one hour.

Studies that Employed this intervention: Sadler, Slade, Close, Webb, Simpson, Fennie, Mayes 5,Londono Tobon,

Condon, Sadler, Holland, Mayes, Slade 290

:%=-$%!,..2=/<%(.!C$#<#.*#(!C$#+$2<

All information about the intervention was obtained from Santelices et al. (2011)163 unless otherwise stated.

Intervention Description

The intervention consists of prenatal lectures, group discussions, observation, and psychoeducation designed to

promote secure mother-infant attachment. During the first phase of the intervention, groups of mothers meet with an

interventionist and discussed mother-infant attachment, feelings about pregnancy, representations about motherhood

and their own experience as daughters, imaginary vs. real babies, maternity and maternal functions, and the

promotion of secure attachment.

The second, postnatal phase of the intervention are comprised of individual sessions. During these sections,

interventionists observe mother-infant interactions and provide psychoeducational feedback, including suggestions

to improve maternal sensitivity. The interventionists aim to promote secure attachment through these sessions.

Interventionists were psychology graduates.

Target population

Pregnant primipara women in Chile

Goal (and framework when applicable)

The intervention is grounded in Ainsworth’s theory of attachment. The primary goals of the intervention were to

promote maternal sensitivity, to change maternal representations of the infant, and to aid in the formation of a secure

and healthy bond between mother and infant.

Physical and Informational Materials

Researchers worked from an intervention manual that sought to observe the process by which a secure attachment is

formed.

Setting

All sessions were conducted face-to-face. Phase one consisted of prenatal group sessions of 6 women. Phase two

consisted of four individual sessions.

Most sessions were conducted in a health center, but the rest were conducted in the mother’s home.

Dose and Intensity

There were 10 sessions in total. Phase one of the intervention (conducted during pregnancy) consisted of 6, 2-hour

sessions. Phase two, conducted postpartum, consisted of 4, 1-hour sessions. These four postnatal sessions were

offered four times during the child’s first year of life, when the baby was 1, 3, 6, and 12 months old.

Studies that Employed this intervention: Santelices, Guzman, Aracena, Farkas, Armijo, Perez-Salas, Borghini 163

New Beginnings Intervention

All information about the intervention was obtained from Sleed et al. (2013)85 unless otherwise stated.

Intervention Description

The intervention is delivered by two parent-infant psychotherapists and consisted of group discussions that center

around potential triggers to the attachment relationship. Specifically, topics include the links between past and

present patterns of relating, observation, and reflection on non-conscious behaviors between mothers and babies.

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During sessions, facilitators and mothers in the group observe and note mother-infant communications and mothers’

responses to infants’ signals.

Mothers and babies in both groups had access to standard health and social care provision as provided by the prison

service. But the New Beginnings Intervention was compared to a group who only received standard care.

Target population

Incarcerated mothers and their infants

Goal (and framework when applicable)

This intervention drew on attachment theory. The goal of the intervention was to help mothers understand the

relationship between their babies’ behavior, the internal emotional world of their babies, as well as their own state of

mind.

Physical and Informational Materials

The intervention employed group discussion, handouts, individual worksheets, and homework tasks outside of

sessions.

Setting

The intervention was offered face-to-face in a group of 6 mother-baby dyads. Sessions took place In Mother and

Baby Units in the hospital. During sessions, mothers sat on the floor while babies were placed on baby mats to

facilitate active participation in intervention activities.

Dose and Intensity

There were eight, 2-hour sessions over four weeks, with two sessions per day, one day a week. The mean number of

sessions attended was 7.1 (SD = 1.6). The intended total time was 16 hours, while the average total time was

approximately 14.2 hours.

At baseline, infants ranged between birth and 23 months of age (mean of 4.9 months) and lasted for 4 weeks.

Studies that Employed this intervention: Sleed, Baradon, Fonagy 85

[$#-'!,..2=/<%(.EI2&%)!H(.%$?%(.*#(!J[,IHK!

All information about the intervention was obtained from Steele et al. (2019)86 unless otherwise stated.

Intervention Description

Each intervention session has three components. Sessions include time for parents and children to interact with one

another, a period of video filming and feedback, and a “reunion” episode between parents and children after a period

of separation while mothers are reviewing video footage of their interactions.

The intervention was delivered by trained GABI clinicians.

Target population

Families who are at risk for maltreatment and their biological infants.

Goal (and framework when applicable)

GABI is a clinical, trauma-informed approach to improving parent-child relationships. The intervention builds off of

strategies intrinsic in other attachment-based interventions, described above (Dozier 2009, Bernard 2012).

The specific goals of the video-feedback portion of the program include:

1. The goal of training clinicians

2. Therapeutic goal of reviewing the videos with the parents to discuss and reflect on dyadic interactions

Physical and Informational Materials

The contents of the intervention were outlined in a GABI manual. The intervention also included video recordings

of mother-child interactions.

Setting

The intervention was conducted face-to-face in multi-family groups at the New School’s Center for Attachment

Research (in a clinical context).

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Dose and Intensity

Tripartite sessions were offered three times weekly for 26 weeks. Each session lasted 120 minutes. Each session

began with a 45-minute dyadic, parent-child group psychotherapy session. Next, parents and children separate into

concurrently run, hour-long group sessions. Each session ended with a 15-minute parent-child reunion. Mothers

were offered a maximum of 72 sessions (156 hours total)

Infants and toddlers ranged in age from birth to three years old at baseline. The intervention was offered over 6

months.

A 24/7 hotline was also available to families partaking in the intervention.

Studies that Employed this intervention: Steele, Murphy, Bonuck, Meissner, Steele 86

Secure Attachment Family Education (SAFE)

All information about the intervention was obtained from Walter et al. (2019)293 unless otherwise stated.

Intervention Description

Secure Attachment Family Education (SAFE) is a multifaceted program aimed to promote secure infant-parent

attachment. The intervention involves both mothers and fathers. The program consists of both group and individual

sessions, beginning prenatally and spanning the postnatal period. Group sessions are discussion-based, with an

special focus on facilitating communication. The program consists of four elements:

1. Video-based sensitivity training to enhance parental sensitivity

The video-based component begins prenatally, is an aspect of nearly every group session. In group sessions,

participants watch video clips that show positive infant-parent interactions and are encouraged to reflect on the inner

states of the parent and infant in the video. In individual sessions, facilitators provided feedback on the mothers and

fathers (individual) interactions with the infant. Facilitators chose a single frame from the video and used it to

deliver positive reinforcement on sensitive parental behavior

2. Reflection on parents’ early and later attachment experiences and trauma

Parental psychological distress is discussed during group sessions. This included a discussion of social supports and

stabilizing exercises (such as Luise Reddemann’s “the imaginary journeys’ exercise 294.

3. Psychoeducation about attachment theory and child development

Included discussions about the benefits of secure attachment, the key factors to promote attachment security, and the

intergenerational transmission of attachment.

4. Social support from the facilitator and a group of other parents

The intervention was delivered by SAFE facilitators who were predominantly female (90.1%) professionals in

social-service fields (including physicians, midwives, psychologists, nurses, and social workers). SAFE facilitators

also received a 4-day training program prior to the intervention.

Target population

A non-clinical, low-risk, self-selected sample of mothers, fathers, and infants.

Goal (and framework when applicable)

The goal of the SAFE program is to promote parent-infant attachment and to prevent the intergenerational

transmission of trauma.

Physical and Informational Materials

The information delivered was summarized in an intervention manual, but the contents of each session were

individually tailored and deviated from the manual.

Setting

Not reported.

Dose and Intensity

The intervention began prenatally (the mean week of pregnancy at the beginning of the course was 24.34 (SD =

6.25) and spanned until the child was 1 year old.

10 group sessions and three individual sessions (13 sessions total).

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Four sessions were conducted prenatally (1 individual, 4 as a group). The remaining 6 sessions were conducted

postnatally, (2 individually, 6 as a group). Postnatal sessions were dyadic and lasted for a full day (10 am to 5pm; 7

hours). The estimated total length of the intervention was

Facilitators also established an emergency hotline that was available throughout the intervention.

Studies that Employed this intervention: Walter, Landers, Quehenberger, Carlson, Brisch 293

"-$$*=-4-<!2()!6#(*.#$*(+!:;&.%<

All information about the intervention was obtained from Badr et al. (2006)105 unless otherwise stated.

Intervention Description

The Curriculum and Monitoring System (CAMS) is a 12-month long home-based stimulation program aimed to

improve cognitive and sensorimotor skills in infants diagnosed with brain injury before discharge. Mothers are

encouraged to provide a daily 20-minute stimulation activity, and researchers logged how many total minutes the

intervention is provided to the infant. Outcome measures consisted of the following: motor and mental development,

MRI examinations, home environment assessment, parent-infant interactions, parenting stress, and satisfaction with

social support.

Target population

Infants with suspected brain injury

Goal (and framework when applicable)

CAMS is a program with over 100 activities that aim to improve motor and mental development via daily cognitive

and sensorimotor stimulation. It consists of weekly home visits by public health nurses and daily stimulation

activities. The curriculum has five sections: Cognitive, Language, Motor, Self-Help, and Social Skills. It has

previously been used for research at Utah State University. It targets children from birth to 5 years of age.

Physical and Informational Materials

Motor and mental development were measured via Bayley Scales, neurological examinations were performed at 6,

12, and 18 months via MRI, the home environment was assessed via the Caldwell HOME inventory, parent-infant

interactions were coded via the Nursing Child Assessment Feeding Scale (NCAFS) and Nursing Child Assessment

Teaching Scale (NCATS), parent stress was self-reported via the Parenting Stress Index (PSI), and social support

was assessed da the Perceived Social Support Scale (PSS).

Setting

Home visits led by public health nurses at the pediatric clinics at UCLA.

Dose and Intensity

Home visits by public health nurses occurred twice a week for the first month (following hospital discharge), then

weekly until the infant was 12 months old. The total number of visits was 36. Each home visit ranged from 60

minutes to 120 minutes. Outside of home visits, mothers were coached to provide daily stimulation activities for 20

minutes.

In total, the intervention is estimated to involve 3240 minutes of face-to-face interventionist time.

Studies that Employed this intervention: Badr, Garg, Kamath 105

C2$%(.EH(52(.!1$2(&2=.*#(!C$#+$2<!J6H1CK!

C$%<*%:.2$.!C$#+$2<!

All information about the intervention was obtained from Milgrom et al. (2013)153 unless otherwise stated.

Intervention Description

This parent-training program was adapted from the MITP. As a part of the intervention, mothers are encouraged to

implement stress-reduction strategies as early as possible. The content of the PremieStart program is based on the

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136

MITP, with the addition of certain topics (described below). Each session focused on a specific topic, but previous

topics were revisited briefly in each session.

In addition to the content of the original MITP curriculum, mothers are trained to increase their sensitivity in

recognizing signs of infant stress (shutting down mechanisms, alert-available behavior, facial expressions, quality of

motor behaviors, posture and muscle tone, graded stimulation, avoiding overwhelming infants

Four sessions included topics centered around touch, movement, and massage (kangaroo care, multi-sensory

stimulation, debriefing and normalizing parental feelings, challenging dysfunctional thoughts, and parental diary

keeping

Interventionists were psychologists (a neuropsychologist and clinical psychologist, each with extensive experience

with premature infants).

Target population

Preterm mother-infant dyads (less than 30 weeks gestational age).

Goal (and framework when applicable)

To teach mothers psychoeducational signs of infant stress.

Physical and Informational Materials

The PremieStart program adhered to a manualized protocol.

Setting

In the NICU and in the home.

Dose and Intensity

Begins in the NICU. There are 9 weekly sessions in the NICU, plus one session at home (10 sessions total;

approximately 10 weeks). Sessions lasted approximately 1 hour. The estimated total time of the intervention is 600

minutes.

Studies that Employed this intervention: Milgrom, Newnham, Martin, Anderson, Doyle, Hunt, Achenbach,

Ferretti, Holt, Inder, Gemmill 153

6#./%$EH(52(.!1$2(&2=.*#(!C$#+$2<!J6H1CK

All information about the intervention was obtained from Newnham et al. (2009)152 unless otherwise stated.

Intervention Description

The intervention followed previously described sequence, outlined below 295:

Session 1: The focus of session one is to become acquainted. Mothers are asked to describe their birthing,

hospitalization experience, and perceptions of their infant.

Sessions 2-7: These sessions focus on recognizing infant disorganization, stress, and availability, and then working

with mothers to apply that knowledge during care and play.

(i) Recognizing stress cues through homeostatic systems (respiration, skin circulation, visceral movements and

activities), the motor system (posture, tone, movement) and infant states

(ii) Engaging and sustaining infant attention without allowing disorganization

(iii) Recognizing and responding to infant cues in daily care, including massage and kangaroo care

(iv) Initiating activity (combining the earlier principles with mothers’ own ideas for alerting, responding to,

regulating the infant’s behavior and play.

Session 8: This session takes place in the home and centers on mutual enjoyment through play. Additional aspects of

the session include exploring new play ideas within sensory modalities, adjustment to home, revisiting the program

to help mothers regulate infant responses.

This iteration of the MITP differed from the original in that the hospital-based sessions were given over a 2-week

period, 2 post-discharge sessions were given, twins and single mothers were included, and a bath session was used.

This version of the intervention also included information about kangaroo dare and massage.

The intervention was delivered by a psychologist.

Target population

Preterm mother-infant dyads.

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137

Goal (and framework when applicable)

Not reported.

Physical and Informational Materials

The intervention employed verbal instruction, infant observation, practical experience in handling infants and

modeling, as well as written materials. The informational content was described in prior literature 295. Newnham

(2009) amended the intervention to include information about kangaroo care, massage, and an infant bath session.

Setting

Face to face, individually, In the NICU or nursery and in the home.

Dose and Intensity

There are 9 sessions in total, ranging from 30-60 minutes. The first 7 sessions were in the hospital, while the last two

sessions took place in the home, post-discharge. The duration of the intervention was variable and depended on the

infant’s gestational age at birth.

Studies that Employed this intervention: Newnham, Milgrom, Skouteris 152

6#./%$EH(52(.!1$2(&2=.*#(!C$#+$2<!J6H1CK

All information about the intervention was obtained from Ravn et al. (2011)137 unless otherwise stated.

Intervention Description

The first session is used to become acquainted with to explain the intervention, and to demonstrate the infant's

uniqueness and potential for self-regulation and interaction.

On the second session, the nurse introduces the mother to the behavioral indices of the homeostatic reflex systems.

During the third session the nurse introduces the mother to the concept that posture, tone, and movement can signal

disorganization. The nurse teaches the mother that her infant's progressive levels of consciousness could indicate

whether the infant is socially accessible or whether social stimulation would be disruptive.

On the fifth day, the mother learns how to engage the infant and sustain social interaction with him or her. Familiar

now with her baby's capabilities, the mother is ready to provide daily care in a more effective manner.

The 3 subsequent home visits focus on consolidation, mutual enjoyment through play, and temperament patterns.

The intervention was delivered by 10 trained neonatal nurses.

Target population

Mothers and moderately and late preterm infants.

Goal (and framework when applicable)

The intervention was influenced by Als’ study of underweight newborn fragile organization and Bromwich’s six-

stage behavior progression model to sensitize mothers to infant cues and enable mothers to adjust to relatively

poorly regulated preterm infants 295-297.

The goal of the intervention was to help parents appreciate their infant’s unique characteristics, temperament, and

developmental potential, to make the parents more sensitive and responsive to their infants’ physiological and social

cues, particularly that signal an overload of stimulus.

Physical and Informational Materials

Not listed in manuscript, a detailed description of the program has been previously reported 295.

Setting

Face to face, individually, in the NICU and in the home.

Dose and Intensity

Seven sessions were carried out during the last week before NICU discharge; four sessions were given at home

during the first 3 months with the infant, with the mother and father (if possible) present. Each session lasted for 1

hour. The total estimated time is 11 hours. The intervention began as soon as possible after birth and lasted until 3

months postpartum.

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Studies that Employed this intervention: Ravn, Smith, Lindemann, Smeby, Kyno, Bunch, Sandvik 137

6#./%$_H(52(.!1$2(&2=.*#(!C$#+$2<!J6H1CK!/#<%!?*&*.&

All information about the intervention was obtained from Youn et al. (2021)22 unless otherwise stated.

Intervention Description

In this intervention RCT, the group intervention was introduced five days earlier than the original IHDP. However,

the intervention is based on the IHDP framework. Up to 12 group sessions—usually 4-5 family members attended—

occur while the infant is between 3-6 months of age. The group sessions are facilitated by a physiotherapist

specialist—specializing in infant neurodevelopment—assisted by an experienced pediatric physiotherapist.

The timing of the home visits was based on MITP framework. The families received four home visits by an

experienced NICU nurse staff member when the infant was five-days, two-weeks, one month and finally at two-

months corrected age. Education and evaluation of the of caregivers were standardized using checklists.

Goal (and framework when applicable)

This intervention was influenced by the Mother–Infant Transaction Program (MITP) as well as IHDP. The goal was

to provide the parent with a fuller understanding of their infant’s behavioral cues, temperament, satiety, sleeping

patterns, developmental milestones.

Physical and Informational Materials

Group Sessions – Information was provided to the infant’s caregiver by a physiotherapist specializing in infant

neurodevelopment, assisted by an experienced pediatric physiotherapist. The information included the following

topics: parent-infant bonding, infant’s growth and neurodevelopment, developmental milestones and various

activities to promote sensory stimulation and gross motor development. The physiotherapists also offered emotional

support to the caregivers to encourage attachment between baby and caregiver. During the visit, the caregivers and

providers observed the infant’s behaviors, and the environment was modified based on the needs of the infant. This

was to ensure that the caregivers were understanding the material that was being taught. After the meetings,

caregivers shared their experience and ideas.

Home Visits – Information was provided regarding the infant’s behavioral cues (crying, temperament, satiety,

hygiene, defecation, sleep patterns and position, feeding support, as well as what to do in case of an emergency).

Setting

Face to face, individually, in the NICU and in the home.

Dose and Intensity

Up to 12 group sessions were allowed while the infant was between 3-6 months of age. After discharge from the

NICU, the families had four home visits by a nurse when the infant was five-days, two-weeks, one month and

finally at two-months corrected age. Each home visit took approximately 90 minutes (about 1 and a half hours).

Altogether, this intervention took approximately 18+ total hours.

Studies that Employed this intervention: Youn, Shin, Kim, Jin, Jung, Heo, Jeon, Park, Sung 22

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,-)*.#$;E12=.*4%E]*&-24E]%&.*3-42$!J,1]]K

All information about the intervention was obtained from Nelson et al. (2001) and Holditch-Davis et al. (2014)90,102

unless otherwise stated.

Intervention Description

During the ATVV intervention, interventionists teach mothers how to perform a 15-minute sequence of multimodal

stimulation on their infants.

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The session begins with auditory stimulation, progresses to bimodal auditory and tactile stimulation, and eventually

visual, eye-to-eye stimulation is added as the infant becomes alert298. This combination of voice, moderate stroking

or massage, and eye contact is sustained for the first 10 minutes of the intervention. During the final 5 minutes, the

tactile component is withdrawn, and horizontal rocking is added. Tactile stimuli preceded from the least to the most

sensitive areas and included moderate stroking of the top and back of the infant’s head, back, chest, abdomen, arms,

legs, and forehead.

Mothers were that ATVV increases feeding readiness, and therefore suggested they perform ATVV before a feed.

Mothers were instructed not to perform the intervention while infants were on mechanical ventilation or continuous

positive airway pressure 102.

Mothers were also videotaped while administering the ATVV session, which was reviewed by the NICU nurse and

supervisor to guide and correct mothers 102. The interventionist was a NICU nurse 102, or a research assistant trained

to criterion for this intervention 90.

Target population

Preterm mother-infant dyads 102 Mothers and preterm infants with extreme prematurity or intraventricular

hemorrhage and/or periventricular leukomalacia 90.

Goal (and framework when applicable)

The goal of the ATVV intervention is to positively affect mothers and the mother-infant relationship.

The three modes of stimulation were chosen because the tactile and vestibular sensory pathways are well-developed

by 33 weeks postconceptional age, and are most relevant to mother-infant interaction and learning.

Physical and Informational Materials

Not reported

Setting

Hybrid; in the NICU and in the home 102 or solely in the NICU 90.

Dose and Intensity

Mothers were trained by a NICU nurse in approximately 1 hour. Mothers had an additional two contacts with NICU

nurses to videotape and review the intervention, although the timing of these contacts was not reported. Mothers

were asked to visit the NICU to perform ATVV independently as often as possible (preferably daily), but at least 3

times a week for at least 15 minutes. The intervention continued until the infants were 2 months corrected age 102.

One 15-minute training session at 33 weeks postconceptional age. The intervention continued until the infants were

2 months corrected age 90.

Studies that Employed this intervention: Nelson, White-Traut, Vasan, Silvestri, Comiskey, Meleedy-Rey, Littau,

Gu, Patel 90,Holditch-Davis, White-Traut, Levy, O'Shea, Geraldo, David 102

F#&'*.24!.#!F#<%0!Q'.*<*W*(+!./%!H(52(.&!T(?*$#(<%(.!JFEF#'%K!H(.%$?%(.*#(

All information about the intervention was obtained from White-Traut et al. (2013)91 unless otherwise stated.

Intervention Description

The H-Hope intervention combines an infant remediation intervention (ATVV) with maternal education. The goal is

to improve maternal understanding of and response to infant cues. The intervention consists of 6 sessions with

interventionists– 2 in the hospital, 2 at home, and 2 phone calls.

The intervention was delivered by a Nurse-Advocate team (NAT).

During the first hospital visit, the NAT taught the mother how to perform the ATVV component, which consisted of

10 minutes of auditory, tactile, and visual stimulation, followed by 5 minutes of vestibular stimulation (horizontal

rocking). The ATVV began when the infant reached 32 weeks PMA, or at entry to the study at 33-34 weeks. After

this training, mothers were asked to perform ATVV on their own twice a day until the infant was 1 month corrected

age. Prior to discharge, if mothers were unable to come into the hospital to perform the ATVV, they would

coordinate with their NAT team to perform the ATVV for them.

During the mother-directed component of the intervention (offered twice in the hospital, twice at home, and twice

over the phone), the NAT asked about and responded to the mother’s concerns about herself and her infant.

Interventionists referred mothers to appropriate support services as needed.

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During visit 2, the NAT taught mothers how to identify and respond to infant behavioral cues, in part by using an

instructional pamphlet titled “How to Soothe a Fussy Baby.”

During the home visits, the NAT discussed feeding, weighing, and the mother’s stressors, supports, or signs of

depression. The mothers also practiced the ATVV during home visits. The NAT also observed an infant feeding and

offered participatory guidance.

The 2 phone call sessions provided mothers another opportunity to express any questions or concerns.

Target population

Preterm mother-infant dyads

Goal (and framework when applicable)

The H-HOPE intervention was based on the transactional model and integrates infant remediation intervention

(ATVV) with maternal re-education and re-definition through participatory guidance.

The goal of the H-HOPE intervention was to establish positive interaction patterns, improve the quality of mother-

infant interactions, and target the needs of both mothers and premature infants.

Physical and Informational Materials

NATs used a pamphlet titled “How to Soothe a Fussy Baby,” which provided instruction about how to identify and

respond to infant behavioral cues. The pamphlet was adapted from materials in the medical poster parent handbook

299. Information about how to modulate infant state and use of soothing behaviors (from “Keys to Caregiving”

curriculum) was provided to mothers. Topics covered include describing the age of the newborn, what infant

behaviors mean in the context of feeding and mother-infant interaction, and teaching caregivers how to support

infant sleep and wakefulness states.

Setting

In-person before hospital discharge, then at home (in person and over the phone).

Dose and Intensity

The NAT component was provided during 2 in-hospital visits, 2 home visits and 2 phone calls after discharge.

The length of each session was not reported (although each individual ATVV session was 15 minutes).

Infants were between 32-34 weeks PMA at baseline, and the intervention lasted from enrollment to 1 month

corrected age.

Studies that Employed this intervention: White-Traut, Norr, Fabiyi, Rankin, Li, Liu 91

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"#<<-(*.;!Fk[:!J"Fk[:K

All information about the intervention was obtained from Ericksen et al. (2018)151 unless otherwise stated.

Intervention Description

This group intervention was divided into four modules.

Module 1: 3 sessions, “Let’s Play”

• Focus: group formation, play, and anxiety management

• Content: play activities, moving together with the baby in space, stress busters, and infant massage

Module 2: 3 sessions “Getting to Know Each Other”

• Focus: parenting and attachment

• Content: observation of baby in play, practice in face-to-face playful communication and

experiences in mother-infant bodily holding in seated play and movement together that

interactively engage with baby. Includes information on temperament (infant individual

differences)

Module 3: 3 sessions “Know Yourself”

• Focus: family or origin and cognitive behavioral therapy

• Content: movement for mothers and babies in group circles and individual pathways while

listening to music, with a focus on mother-infant energy levels. These sessions also included live

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141

percussion. Further content included a discussion of parenting behaviors, hopes and expectations

for infants, interpreting thoughts and feelings, and addressing balance in your life.

Module 4: 1 session “Happiness, Understanding, Giving, and Sharing”

• Focus: consolidation in thinking and movement, as well as a celebration of intervention progress.

• Content: brainstorming and sharing takeaways from CHUGS.

Interventionists were the program designers as well as newly trained facilitators. Facilitator competence was

achieved through a role play-based method.

Target population

Mothers vulnerable to postpartum depression and their infants

Goal (and framework when applicable)

Eriksen (2018) hypothesized that CHUGS would reduce stress on the infant-parent relationship while improving

mother-infant interactions, parenting skills, maternal self-efficacy, and maternal health and well-being.

Physical and Informational Materials

Not reported.

Setting

Face to face in a group of 4-8 women and their infants. Sessions took place in a comfortable play space in a public

hospital. During the intervention, mothers were encouraged to sit on the floor on a blanket.

Dose and Intensity

Participants completed four modules over 10 weekly sessions that lasted between 60-90 minutes (approximately).

The total estimated time is 10 to 15 hours. Infants were 4.94 months old at baseline (on average). The intervention

lasted for 10 weeks.

Studies that Employed this intervention: Ericksen, Loughlin, Holt, Rose, Hartley, Buultjens, Gemmill, Milgrom

151

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All information about the intervention was obtained from Holt et al. (2021)33 unless otherwise stated.

Intervention Description

This intervention consists of four mother-infant group sessions. Although HUGS was developed as a three-session

program, the suggested content was used to expand this intervention into a four-session program 300, as the

developers intended if time allowed 301. The HUGS facilitator was either a clinical psychologist or a maternal child

health nurse, trained specifically to deliver the HUGS intervention.

Sessions included psychoeducation and behavioral exercises, including interaction coaching and infant massage.

Session One: Play and Physical Contact. During this session, facilitators allowed the caregivers to interact with their

infants and alternative responses were modelled.

Session Two: Observing and Understanding Baby’s Signals. During this session, the facilitator used guided

exercises to reinforce ‘good enough’ interactions.

Session Three: Parental Responses to Infant Cues. This session worked to build up the caregiver’s cognitive

strategies that they had learned during the PND program. Specifically, separating past experiences and challenging

cognitions that had been distorted so that the caregiver could focus on the reality of the infant.

Session Four (Booster Session): Consolidating Gains. This session was a reinforcing session. The facilitator did this

by noting positive interaction cognitions and behaviors that the caregiver had toward the infant.

Target population

Mothers with postnatal depression and their infants.

Goal (and framework when applicable)

HUGS aims to ameliorate mother-infant interaction by targeting maternal communication, observation, and

responsiveness and increase maternal emotional availability by improving distorted maternal internal representations

and cognitions.

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HUGS draws on existing interventions 302, as well as theories and developmental research describing a ‘good

enough’ parent interaction. HUGS targets two key elements of mother-infant relationships: (1) maternal skills in

communication, observation, and responsiveness and (2) distorted maternal internal representations/cognitions.

By treating maternal depression first, this design aimed to allow for increased maternal emotional availability, a

basis for optimal mother-infant interactions

Physical and Informational Materials

Not reported.

Setting

Sessions took place face-to-face in a group setting at a parent-infant research institute or local community center.

Dose and Intensity

The intervention had 4, weekly sessions, each lasting 90 minutes (360 minutes total).

Infants were 3.13 months on average at baseline. The intervention lasted for 4 weeks.

Studies that Employed this intervention: Holt, Gentilleau, Gemmill, Milgrom 33

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eTable 4. Summary of Sensitivity Analysis

Removed:

High risk of Bias

Removed:

Cluster RCT not corrected

Removed:

Active Control Group

Removed:

Long-term (7+m) F/U

Outcome

Statistic

Number of

studies

(participants)

Effect

estimate

Number of

studies

(participants)

Effect

estimate

Number of

studies

(participants)

Effect

estimate

Number of

studies

(participants)

Effect

estimate

Outcome Domain: Relational Health

Bonding

(0-4m)

SMD

(95%CI)

7 (1 060)

1.21 (.46,

1.96)

N/A

Bonding

(5-12m)

SMD

(95%CI)

5 (668)

-0.07 (-.52,

.38)

N/A

Sensitivity

(0-4m)

SMD

(95%CI)

14 (1 181)

.32 (.06, .57)

15 (1 187)

0.40 (.15, .65)

N/A

Sensitivity

(5-12m)

SMD

(95%CI)

19 (2 142)

.35 (.21, .49)

22 (2 679)

.37 (.24, .50)

N/A

19 (2 124)

.41 (.26,

1.09)

Sensitivity

(13-24m)

SMD

(95%CI)

9 (553)

.48 (0.11,

0.86)

N/A

6 (483)

.38 (-.07,

.84)

Sensitivity

(25-60m)

SMD

(95%CI)

N/A

3 (1 312)

.85 (.26, 1.44)

N/A

3 (1 120)

.49 (.02, .95)

Secure

Attachment

(12-18 m)

(95%CI)

9 (944)

1.29 (0.94,

1.78)

13 (1 197)

1.42 (1.03,

1.94)

11 (1 067)

1.38 (1.01,

1.88)

10 (771)

1.63 (1.19,

2.22)

Organized

Attachment

(12-18m)

(95%CI)

3 (331)

2.23 (1.21,

4.11)

N/A

3 (341)

2.03 (.90,

4.57)

N/A

Insecure

Attachment

(12-18m)

(95%CI)

8 (816)

.74 (.47, 1.17)

N/A

9 (872)

.77 (.51, 1.15)

8 (606)

.63 (.43, .93)

Disorganized

Attachment

(12-18m)

(95%CI)

9 (1 010)

.53 (.37, .75)

N/A

9 (994)

.64 (.44, .93)

9 (796)

.57 (.39, .84)

Secure

Attachment

(21+m)

(95%CI)

1 (45)

.136 (.20,

9.02)

N/A

1 (45)

.136 (.20,

9.02)

Insecure

Attachment

(21+m)

(95%CI)

1 (45)

.73 (.22, 2.39)

N/A

1 (45)

.73 (.22,

2.39)

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144

Removed:

High risk of Bias

Removed:

Cluster RCT not corrected

Removed:

Active Control Group

Removed:

Long-term (7+m) F/U

Outcome

Statistic

Number of

studies

(participants)

Effect

estimate

Number of

studies

(participants)

Effect

estimate

Number of

studies

(participants)

Effect

estimate

Number of

studies

(participants)

Effect

estimate

Dyadic (0-

4m)

SMD

(95%CI)

11 (1 026)

0.14 (-.02,

.30)

14 (1 126)

.20 (.05, .36)

N/A

0.18 (.05, .32)

N/A

Dyadic (5-12

SMD

(95%CI)

13 (1 271)

0.17 (.06, .29)

N/A

13 (1 109)

.30 (.06, .55)

Dyadic (13-

24m

SMD

(95%CI)

7 (448)

0.16 (-.13,

.44)

N/A

5 (301)

.20 (-.23,

.64)

Dyadic (25-

60m)

SMD

(95%CI)

N/A

1 (962)

.15 (.02, .28)

N/A

Behavior

(13-24m)

SMD

(95%CI)

N/A

1 (45)

.01 (-.58,

.59)

Behavior

(25-60m)

SMD

(95%CI)

4 (336)

.01 (-.40, .43)

N/A

1 (99)

.30 (-.09,

.70)

Socio-

Emotional

(5-12m)

SMD

(95%CI)

N/A

2 (1 391)

-.04 (-.14,

.07)

Socio-

Emotional

(13-24m)

SMD

(95%CI)

N/A

Cognitive

(4-12m)

SMD

(95%CI)

4 (873)

.06 (-.08, .19)

5 (900)

.06 (-.07, .20)

N/A

4 (503)

.27 (-.05,

.59)

Cognitive

(13-24m)

SMD

(95%CI)

6 (492)

.02 (-.15, .20)

6 (492)

.02 (-.31, .20)

N/A

2 (98)

-.21 (-.70,

.29)

Language

(5-12m)

SMD

(95%CI)

N/A

2 (223)

-.01 (-.28,

.25)

Language

(13-24m)

SMD

(95%CI)

N/A

2 (98)

-.12 (-.52,

.28)

Motor

(4-12m)

SMD

(95%CI)

3 (739)

-.07 (-.22, .07)

4 (766)

-.06 (-.20, .08)

N/A

1 (96)

-.12 (-.52,

.28)

Motor

(13-24m)

SMD

(95%CI)

5 (360)

-.02 (-.23, .19)

5 (360)

-.02 (-.23, .19)

N/A

2 (98)

.00 (-.40,

.40)

Parenting

stress

SMD

(95%CI)

14 (1 363)

-.05 (-.21, .11)

13 (1 196)

-.06 (-.23, .11)

N/A

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145

Removed:

High risk of Bias

Removed:

Cluster RCT not corrected

Removed:

Active Control Group

Removed:

Long-term (7+m) F/U

Outcome

Statistic

Number of

studies

(participants)

Effect

estimate

Number of

studies

(participants)

Effect

estimate

Number of

studies

(participants)

Effect

estimate

Number of

studies

(participants)

Effect

estimate

Anxiety

SMD

(95%CI)

9 (883)

-.29 (-.56, -

.03)

10 (996)

-.25 (-.49, -

.02)

N/A

Depression

SMD

(95%CI)

29 (2 975)

-.03 (-.14, .09)

30 (3 513)

-.08 (-.19, .03)

N/A

27 (2 895)

-.11 (-.24,

.01)

Note:

No change on effect estimate

Effect estimate becomes significant

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eTable 5. GRADE Summary Table

Certainty assessment

№ of patients

Effect

Certainty

№ of

studies

Study

design

Risk of

bias

Incon-

sistency

Indirect-

ness

Impreci-

sion

Other

considera-

tions

Dyadic

interventions

Control

Relative

(95% CI)

Absolute

(95% CI)

Bonding (0-4 months)

randomised

trials

seriousa

very

seriousb

not

serious

not

serious

none

582

667

SMD

0.80 SD

higher

(0.25

higher to

1.34

higher)

⨁◯

◯◯

Very

low

Bonding (5-12 months)

randomised

trials

seriousc

very

seriousb

not

serious

not

serious

none

406

398

SMD 0.1

lower

(0.46

lower to

0.26

higher)

⨁◯

◯◯

Very

low

Sensitivity (0-4 months)

randomised

trials

seriousc

very

seriousb

not

serious

not

serious

none

747

727

SMD

0.32 SD

higher

(0.09

higher to

0.55

higher)

⨁◯

◯◯

Very

low

Sensitivity (5-12 months)

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147

Certainty assessment

№ of patients

Effect

Certainty

№ of

studies

Study

design

Risk of

bias

Incon-

sistency

Indirect-

ness

Impreci-

sion

Other

considera-

tions

Dyadic

interventions

Control

Relative

(95% CI)

Absolute

(95% CI)

randomised

trials

seriousc

seriousd

not

serious

not

serious

none

1397

1428

SMD

0.37 SD

higher

(0.25

higher to

0.49

higher)

⨁⨁

◯◯

Low

Sensitivity (13-24 months)

randomised

trials

seriousc

seriousd

not

serious

not

serious

none

384

377

SMD 0.4

higher

(0.1

higher to

0.7

higher)

⨁⨁

◯◯

Low

Sensitivity (25 months-5 years)

randomised

trials

not

serious

not

serious

not

serious

not

serious

none

707

666

SMD 0.2

higher

(0.1

higher to

0.31

higher)

⨁⨁

High

Secure attachment (12-18 months)

randomised

trials

seriousc

not

serious

not

serious

not

serious

none

434/674

(64.4%)

334/594

(56.2%)

not

estimable

⨁⨁

⨁◯

Mode

rate

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148

Certainty assessment

№ of patients

Effect

Certainty

№ of

studies

Study

design

Risk of

bias

Incon-

sistency

Indirect-

ness

Impreci-

sion

Other

considera-

tions

Dyadic

interventions

Control

Relative

(95% CI)

Absolute

(95% CI)

Organized attachment (12-18 months)

randomised

trials

seriousc

seriousd

not

serious

not

serious

none

198/246

(80.5%)

131/189

(69.3%)

not

estimable

⨁⨁

◯◯

Low

Insecure attachment (12-18 months)

randomised

trials

seriousc

not

serious

not

serious

not

serious

none

165/527

(31.3%)

173/465

(37.2%)

not

estimable

⨁⨁

⨁◯

Mode

rate

Disorganized attachment (12-18 months)

randomised

trials

seriousc

not

serious

not

serious

not

serious

none

90/579

(15.5%)

120/535

(22.4%)

not

estimable

⨁⨁

⨁◯

Mode

rate

Secure (21+ months)

randomised

trials

seriousc

seriousd

not

serious

not

serious

none

9/47 (19.1%)

2/46

(4.3%)

not

estimable

⨁⨁

◯◯

Low

Insecure (21+ months)

randomised

trials

seriousc

not

serious

not

serious

not

serious

none

23/47

(48.9%)

22/46

(47.8%)

not

estimable

⨁⨁

⨁◯

Mode

rate

Dyadic interactions (0-4 months)

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149

Certainty assessment

№ of patients

Effect

Certainty

№ of

studies

Study

design

Risk of

bias

Incon-

sistency

Indirect-

ness

Impreci-

sion

Other

considera-

tions

Dyadic

interventions

Control

Relative

(95% CI)

Absolute

(95% CI)

randomised

trials

seriousc

seriousd

not

serious

not

serious

none

529

560

SMD

0.19 SD

higher

(0.01

higher to

0.36

higher)

⨁⨁

◯◯

Low

Dyadic interactions (5-12 months)

randomised

trials

seriousc

seriousd

not

serious

not

serious

none

761

666

SMD

0.30 SD

higher

(0.11

higher to

0.49

higher)

⨁⨁

◯◯

Low

Dyadic interactions (13-24 months)

randomised

trials

seriousc

seriousd

not

serious

not

serious

none

360

305

SMD

0.14 SD

higher

(0.06

lower to

0.34

higher)

⨁⨁

◯◯

Low

Dyadic interactions (25 months-5 years)

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150

Certainty assessment

№ of patients

Effect

Certainty

№ of

studies

Study

design

Risk of

bias

Incon-

sistency

Indirect-

ness

Impreci-

sion

Other

considera-

tions

Dyadic

interventions

Control

Relative

(95% CI)

Absolute

(95% CI)

randomised

trials

seriousc

very

seriousb

not

serious

not

serious

none

539

501

SMD

0.39 SD

higher

(0.16

lower to

0.93

higher)

⨁◯

◯◯

Very

low

Parenting Stress

randomised

trials

seriousc

seriousd

not

serious

not

serious

none

778

655

SMD

0.05 SD

lower

(0.21

lower to

0.11

higher)

⨁⨁

◯◯

Low

Anxiety

randomised

trials

seriousc

seriousd

not

serious

not

serious

none

585

557

SMD

0.27 SD

lower

(0.49

lower to

0.06

lower)

⨁⨁

◯◯

Low

Depression

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151

Certainty assessment

№ of patients

Effect

Certainty

№ of

studies

Study

design

Risk of

bias

Incon-

sistency

Indirect-

ness

Impreci-

sion

Other

considera-

tions

Dyadic

interventions

Control

Relative

(95% CI)

Absolute

(95% CI)

randomised

trials

seriousc

seriousd

not

serious

not

serious

none

1995

1886

SMD

0.09 SD

lower

(0.19

lower to

0.02

higher)

⨁⨁

◯◯

Low

Child Behavior (13-24 months)

randomised

trials

seriousc

seriousd

not

serious

not

serious

none

439

444

SMD

0.22 SD

higher

(0.07

lower to

0.51

higher)

⨁⨁

◯◯

Low

Child Behavior (3-5 months)

randomised

trials

seriousc

seriousd

not

serious

not

serious

none

193

196

SMD

0.07 SD

higher

(0.28

lower to

0.42

higher)

⨁⨁

◯◯

Low

Child Socio-Emotional Functioning (5-12 months)

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152

Certainty assessment

№ of patients

Effect

Certainty

№ of

studies

Study

design

Risk of

bias

Incon-

sistency

Indirect-

ness

Impreci-

sion

Other

considera-

tions

Dyadic

interventions

Control

Relative

(95% CI)

Absolute

(95% CI)

randomised

trials

seriousc

not

serious

not

serious

not

serious

none

778

668

SMD

0.03 SD

lower

(0.13

lower to

0.07

higher)

⨁⨁

⨁◯

Mode

rate

Child Socio-Emotional Functioning (13-24 months)

randomised

trials

seriousc

not

serious

not

serious

not

serious

none

SMD

0.18 SD

higher

(0.22

lower to

0.58

higher)

⨁⨁

⨁◯

Mode

rate

Child Cognitive Development (4-12 months)

randomised

trials

seriousc

seriousd

not

serious

not

serious

none

519

527

SMD

0.14 SD

higher

(0.10

lower to

0.38

higher)

⨁⨁

◯◯

Low

Child Cognitive Development (13-24 months)

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153

Certainty assessment

№ of patients

Effect

Certainty

№ of

studies

Study

design

Risk of

bias

Incon-

sistency

Indirect-

ness

Impreci-

sion

Other

considera-

tions

Dyadic

interventions

Control

Relative

(95% CI)

Absolute

(95% CI)

randomised

trials

not

serious

seriousd

not

serious

not

serious

none

330

308

SMD

0.11 SD

higher

(0.08

lower to

0.30

higher)

⨁⨁

⨁◯

Mode

rate

Child Language Development (5-12 months)

randomised

trials

not

serious

not

serious

not

serious

not

serious

none

366

373

SMD

0.07 SD

lower

(0.22

lower to

0.07

higher)

⨁⨁

High

Child Language Development (13-24 months)

randomised

trials

not

serious

not

serious

not

serious

not

serious

none

253

233

SMD

0.01 SD

lower

(0.19

lower to

0.17

higher)

⨁⨁

High

Child Motor Development (4-12 months)

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154

Certainty assessment

№ of patients

Effect

Certainty

№ of

studies

Study

design

Risk of

bias

Incon-

sistency

Indirect-

ness

Impreci-

sion

Other

considera-

tions

Dyadic

interventions

Control

Relative

(95% CI)

Absolute

(95% CI)

randomised

trials

seriousc

not

serious

not

serious

not

serious

none

498

502

SMD

0.10 SD

lower

(0.23

lower to

0.02

higher)

⨁⨁

⨁◯

Mode

rate

Child Motor Development (13-24)

randomised

trials

not

serious

not

serious

not

serious

not

serious

none

306

282

SMD

0.21 SD

lower

(0.56

lower to

0.14

higher)

⨁⨁

High

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eFigure 1. RCT Risk of Bias Summary

eFigure 2. Cluster RCT Risk of Bias Summary

0% 25% 50% 75% 100%

Overall risk of bias

Bias arising from the randomization process

Bias arising from the timing of identification and recruitment of

individual participants in re lation to timing of randomization

Bias due to deviations from intended interventions

Bias due to missing outcome data

Bias in measurement of the outcome

Bias in selection of the reported result

Low Risk Some Concerns High Risk

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156

eFigure 3. RoB (RCT) – Bonding (0-4 months)

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157

eFigure 4. RoB (RCT) – Bonding (5-12 months)

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158

eFigure 5. RoB (RCT) – Sensitivity (0-4 months)

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159

eFigure 6. RoB (cluster RCT) – Sensitivity (0-4 months)

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160

eFigure 7. RoB (RCT) – Sensitivity (5-12 months)

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eFigure 8. RoB (cluster RCT) – Sensitivity (5-12 months)

eFigure 9. RoB (RCT) – Sensitivity (13-24 months)

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eFigure 10. RoB (RCT) – Sensitivity (25-60 months)

eFigure 11. RoB (cluster RCT) – Sensitivity (25-60 months)

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eFigure 12. RoB (RCT) – Secure Attachment (12-18 months)

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eFigure 13. RoB (cluster RCT) – Secure Attachment (12-18 months)

eFigure 14. RoB (RCT) – Insecure Attachment (12-18 months)

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eFigure 15. RoB (RCT) – Organized Attachment (12-18 months)

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eFigure 16. RoB (RCT) – Disorganized Attachment (12-18 months)

eFigure 17. RoB (cluster RCT) – Disorganized Attachment (12-18 months)

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eFigure 18. RoB (RCT) – Secure Attachment (21+ months)

eFigure 19. RoB (RCT) – Insecure Attachment (21+ months)

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eFigure 20. RoB (RCT) – Dyadic Interactions (0-4 months)

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eFigure 21. RoB (cluster RCT) – Dyadic Interactions (0-4 months)

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eFigure 22. RoB (RCT) – Dyadic Interactions (5-12 months)

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eFigure 23. RoB (cluster RCT) – Dyadic Interactions (5-12 months)

eFigure 24. RoB (RCT) – Dyadic Interactions (13-24 months)

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eFigure 25. RoB (RCT) – Dyadic Interactions (25-60 months)

eFigure 26. RoB (cluster RCT) – Dyadic Interactions (25-60 months)

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eFigure 27. RoB (RCT) – Child Behaviors (13-24 months)

eFigure 28. RoB (RCT) – Child Behaviors (25-60 months)

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eFigure 29. RoB (cluster RCT) – Child Behaviors (25-60 months)

eFigure 30. RoB (RCT) – Socio-Emotional Functioning (5-12 months)

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eFigure 31. RoB (cluster RCT) – Socio-Emotional Functioning (5-12 months)

eFigure 32. RoB (RCT) – Socio-Emotional Functioning (13-24 months)

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eFigure 33. RoB (RCT) – Child Cognitive Development (4-12 months)

eFigure 34. RoB (cluster RCT) – Child Cognitive Development (4-12 months)

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eFigure 35. RoB (RCT) – Child Cognitive Development (13-24 months)

eFigure 36. RoB (cluster RCT) – Child Cognitive Development (13-24 months)

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eFigure 37. RoB (RCT) – Child Language Development (5-12 months)

eFigure 38. RoB (RCT) – Child Language Development (13-24 months)

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eFigure 39. RoB (RCT) – Child Motor Development (5-12 months)

eFigure 40. RoB (cluster RCT) – Child Motor Development (5-12 months)

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eFigure 41. RoB (RCT) – Child Motor Development (13-24 months)

eFigure 42. RoB (cluster RCT) – Child Motor Development (13-24 months)

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eFigure 43. RoB (RCT) – Parent/Caregiver Parenting Stress

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eFigure 44. RoB (cluster RCT) – Parent/Caregiver Parenting Stress

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eFigure 45. RoB (RCT) – Parent/Caregiver Anxiety

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eFigure 46. RoB (RCT) – Parent/Caregiver Depression

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eFigure 47. RoB (cluster RCT) – Parent/Caregiver Depression

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Centering pediatric research, advocacy, and clinical care around early relational health

Article

Mar 2024

Advancing early relational health: a collaborative exploration of a research agenda

Article

Full-text available

Dec 2023

Here, we introduce the Early Relational Health (ERH) Learning Community's bold, large-scale, collaborative, data-driven and practice-informed research agenda focused on furthering our mechanistic understanding of ERH and identifying feasible and effective practices for making ERH promotion a routine and integrated component of pediatric primary care. The ERH Learning Community, formed by a team of parent/caregiver leaders, pediatric care clinicians, researchers, and early childhood development specialists, is a workgroup of Nurture Connection—a hub geared toward promoting ERH, i.e., the positive and nurturing relationship between young children and their parent(s)/caregiver(s), in families and communities nationwide. In response to the current child mental health crisis and the American Academy of Pediatrics (AAP) policy statement promoting ERH, the ERH Learning Community held an in-person meeting at the AAP national headquarters in December 2022 where members collaboratively designed an integrated research agenda to advance ERH. This agenda weaves together community partners, clinicians, and academics, melding the principles of participatory engagement and human-centered design, such as early engagement, co-design, iterative feedback, and cultural humility. Here, we present gaps in the ERH literature that prompted this initiative and the co-design activity that led to this novel and iterative community-focused research agenda, with parents/caregivers at the core, and in close collaboration with pediatric clinicians for real-world promotion of ERH in the pediatric primary care setting.

Understanding the impact of newborn touch upon mothers of hospitalized preterm neonates

Article

Full-text available

Jun 2022

Introduction: Many interventions have been designed to support the development of the preterm baby and minimise the complications of prematurity. However, there is limited evidence of the possible psychological benefits of touch to the mother when she is the one performing the support programme during the hospitalisation of her newborn. Objective: This study explored whether the type of touch provided to preterm neonates had an impact on maternal self-efficacy, self-esteem and maternal-to-infant attachment, as-well-as newborn weight gain. Methods: Using a randomised cluster trial, forty babies and their mothers were allocated to one of two groups receiving either a touch-based intervention (TAC-TIC; Touching And Caressing; Tender In Caring) or spontaneous touch. Results: Mothers who provided the touch-based intervention demonstrated greater increases in self-efficacy, self-esteem and attachment, and babies gained more weight than those using spontaneous touch. Conclusion: The results indicate that systematic touch interventions may be used to facilitate the mother-baby relationship as well as to promote newborn weight gain.

Parent-child Relationship Outcomes of the Incredible Years Parents and Babies Program: A Pilot Randomized Controlled Trial

Article

Full-text available

Jun 2022
SJCAPP

Background A warm, sensitive, and responsive relationship to a caregiver is essential for healthy child development. Objective This paper examines the effects of the Incredible Years Parents and Babies (IYPB) program on the parent-child relationship at post-intervention when offered as a universal parenting intervention to parents with newborn infants. Method We conducted a pragmatic, two-arm, parallel pilot randomized controlled trial; 112 families with newborns were randomized to IYPB intervention (76) or usual care (36). The IYPB program is a group intervention with eight two-hour sessions. In addition to parent-reported questionnaires, we collected a six-minute-long video at post-intervention from 97 families to assess the parent-child relationship, which was then coded with the Coding Interactive Behavior system. Results There were no significant intervention effects on either the total score or any of the seven subscales at post-intervention when the children were around 5.5 months old. For parental sensitivity, results were significant at the 10% level, favoring the IYPB group. When examining the lowest-functioning mothers in moderator analyses, we also found no significant differences between the two groups. Conclusion In line with parent-report outcomes, we did not find any statistically significant differences between the IYPB program and usual care on parent-child relationship when offered as a universal intervention for a relatively well-functioning group of parents with infants in a setting with a high standard of usual care. However, there was a positive trend for the total score, parental sensitivity and reciprocity with effect sizes in the range of .41-.51. It is possible that a larger sample would have resulted in significant differences for these outcomes. Trial registration ClinicalTrials.gov NCT01931917 (registration date August 27, 2013)

Short-term Music Therapy for Families With Preterm Infants: A Randomized Trial

Article

Full-text available

Jan 2022

OBJECTIVES To evaluate short-term effects of music therapy (MT) for premature infants and their caregivers on mother-infant bonding, parental anxiety, and maternal depression. METHODS Parallel, pragmatic, randomized controlled-trial conducted in 7 level III NICUs and 1 level IV NICU in 5 countries enrolling premature infants (<35 weeks gestational age at birth) and their parents. MT included 3 sessions per week with parent-led, infant-directed singing supported by a music therapist. Primary outcome was mother-infant bonding as measured by the Postpartum Bonding Questionnaire (PBQ) at discharge from NICU. Secondary outcomes were parents’ symptoms of anxiety measured by General Anxiety Disorder-7 (GAD-7) and maternal depression measured by Edinburgh Postpartum Depression Scale (EPDS). Group differences at the assessment timepoint of discharge from hospital were tested by linear mixed effect models (ANCOVA). RESULTS From August 2018 to April 2020, 213 families were enrolled in the study, of whom 108 were randomly assigned to standard care and 105 to MT. Of the participants, 208 of 213 (98%) completed treatment and assessments. Participants in the MT group received a mean (SD) of 10 sessions (5.95), and 87 of 105 participants (83%) received the minimum of 6 sessions. The estimated group effect (95% confidence interval) for PBQ was −0.61 (−1.82 to 0.59). No significant differences between groups were found (P = .32). No significant effects for secondary outcomes or subgroups were found. CONCLUSIONS Parent-led, infant-directed singing supported by a music therapist resulted in no significant differences between groups in mother-infant bonding, parental anxiety, or maternal depression at discharge.

Version française du Postpartum Bonding Questionnaire

Article

Full-text available

Dec 2021

Le bonding est l’un des processus les plus importants dans les pre- mières interactions entre la mère et le nouveau-né (Brockington, 2004). Il décrit la qualité du lien de la mère à son nouveau-né dans les pre- mières semaines et mois du post-partum. À ce jour, on dispose en France de très peu d’outils validés permettant d’évaluer la qualité de ce lien dont on connaît pourtant l’importance pour la relation qui s’ins- taure avec l’enfant et le développement de ce dernier. Dans cet article, nous présentons l’étude de validation française du Postpartum Bonding Questionnaire (PBQ) (Brockington, et al., 2001), un outil conçu pour le dépistage des troubles du bonding.

Randomized Trial of Promoting First Relationships for New Mothers Who Received Community Mental Health Services in Pregnancy

Article

Full-text available

Aug 2021

The effectiveness of Promoting First Relationships (PFR), a 10-week home visiting program with video feedback, was tested in a randomized controlled trial involving 252 mothers and their 8- to 12-week-old infants. Mothers were eligible if they initiated treatment after mental health screening (depression, anxiety, posttraumatic stress disorder [PTSD]) at a community or public health primary care center in pregnancy. At baseline, 51% had mild to severe depression symptoms, 54% had mild to severe anxiety, and 35% had PTSD. Their ages ranged from 18 to 42 years. Mothers were 66% White, 18% Black, and 16% other races. Forty-seven percent identified as Hispanic, and 33% preferred to read and speak in Spanish. The median family annual income was less than $20,000. The PFR program or receipt of a resource packet (control condition) followed the baseline assessment and randomization; we assessed outcomes when infants were age 6 and 12 months. Compared to mothers in the control condition, mothers in the PFR condition had significantly (ps < .05) higher observed sensitivity scores at both follow-up time points (d = .25, d = .26), had improved understanding of infant-toddler social-emotional needs at both time points (d = .21, d = .45), and reported less infant externalizing behavior at age 12 months (d = .28). This study is the fourth completed randomized controlled trial of the PFR program, all involving populations experiencing adversity.

Treating postnatal depression: A psychological approach for health care practitioners

Book

Jan 1999

Acceptability and feasibility of a nursing intervention to promote sensitive mother-infant interactions in the NICU

Article

Sep 2022
J Neonatal Nurs

Objective The primary objective of this study was to evaluate the feasibility and acceptability of the study design of a randomized controlled trial, and an experimental neonatal nursing intervention. Design and Setting A pilot parallel randomized controlled trial was conducted in a level-III NICU. Participants Dyads of mothers and very preterm infants 27–32 weeks of gestational age. Methods Twenty mother-preterm infant dyads were enrolled and randomized in a 1:1 ratio to the experimental group (n = 10) or standard care group (n = 10). The intervention encompassed weekly individual sessions where nurses guided mothers in interacting with sensitivity with their infant while providing care and positioning. Results Results show that the intervention was acceptable for mothers and feasible for intervention neonatal nurses, but some challenges related to recruitment and data collection were noted. Conclusion A second pilot study to test adapted recruitment and data collection procedures should be conducted before a large-scale study. Trial registration clinicaltrial.gov (NCT03677752). Registered on September 19, 2018.

The Emotional Availability (EA) Scales and EA Zones Evaluation: Infancy/early childhood version; middle childhood/youth versions (4th ed.), Boulder, CO: emotionalavailability.com.

Research

Aug 2008

Zeynep Biringen

This manual is the 4th edition of the Emotional Availability (EA) Scales.

Effects of skin‐to‐skin contact on full‐term infants’ stress reactivity and quality of mother–infant interactions

Article

Nov 2022

Skin‐to‐skin contact (SSC) between mothers and their infants has beneficial effects in both preterm and full‐term infants. Underlying mechanisms are largely unknown. This randomized controlled trial assessed whether daily SSC in full‐term mother–infant dyads: (1) decreases infants’ cortisol and behavioral reactivity to a mild naturalistic stressor, and (2) facilitates interaction quality between infants and mothers (i.e., improved maternal caregiving behavior and mother–infant adrenocortical synchrony). Pregnant Dutch women (N = 116) were recruited and randomly allocated to an SSC or care‐as‐usual condition. The SSC condition performed 1 h of SSC daily, from birth until postnatal week 5. In week 5, mothers bathed the infant (known mild stressor). Infant and maternal cortisol was sampled at baseline, 25 and 40 min after bathing, and infant and maternal behavior was rated. Results did not indicate effects of SSC on infant behavioral and cortisol reactivity to the bathing session. Similarly, no effect of SSC was found on maternal caregiving behavior and mother–infant adrenocortical synchrony. In conclusion, the findings provide no evidence that daily mother–infant SSC is associated with full‐term infants’ behavioral and adrenocortical stress reactivity or mother–infant interaction quality. Future studies should replicate these findings and unveil other potential mechanisms underlying beneficial effects of SSC.

Early Interventions for Infants of Depressed Mothers

Article

Nov 1998

Tiffany Field

Infants of mothers who remain depressed for 1 year after birth have a distinct profile of behavioral, physiologic, and biochemical dysregulation. Their mothers also have a distinct profile that can be used to target those in need of intervention. These interventions may include mood induction, massage therapy, interaction coaching, and natural buffers such as nondepressed fathers and caregivers.

Early Dyadic Parent/Caregiver-Infant Interventions to Support Early Relational Health: A Meta-Analysis

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