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Association of Home Visitors' and Mothers' Attachment Style with Family Engagement

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Title: Association of Home Visitors' and Mothers' Attachment Style with Family Engagement
Language: English
Authors: McFarlane, Elizabeth, Burrell, Lori, Fuddy, Loretta, Tandon, Darius, Derauf, D. Christian, Leaf, Philip, Duggan, Anne
Source: Journal of Community Psychology. Jul 2010 38(5):541-556.
Availability: John Wiley & Sons, Inc. Subscription Department, 111 River Street, Hoboken, NJ 07030-5774. Tel: 800-825-7550; Tel: 201-748-6645; Fax: 201-748-6021; e-mail: subinfo@wiley.com; Web site: http://www3.interscience.wiley.com/browse/?type=JOURNAL
Peer Reviewed: Y
Page Count: 16
Publication Date: 2010
Document Type: Journal Articles
Reports - Research
Descriptors: Child Abuse, Mental Health, Home Visits, Attachment Behavior, Parent Child Relationship, Family Relationship, Family Environment, Prevention, Questionnaires, Anxiety, Mothers, Parent Influence, Trust (Psychology)
Geographic Terms: Hawaii
DOI: 10.1002/jcop.20380
ISSN: 0090-4392
Abstract: Family engagement in home visiting (HV) is challenging. This study related attachment security of home visitors (n=48) and mothers (n=328) to family engagement in an HV program to prevent child maltreatment. Attachment security was assessed by using the Attachment Style Questionnaire to measure attachment anxiety and attachment avoidance. Family engagement was defined as receipt of a high dose of visits and home visitor response to intimate partner violence (IPV) and poor maternal mental health as measured via record review and by maternal report of trust in the home visitor. Home visitors had lower attachment anxiety and avoidance than mothers. Families were likely to receive a high dose of services if either the mother or home visitor was high on attachment anxiety. Home visitors high on attachment anxiety were less likely to respond to IPV and poor maternal mental health; home visitors high on attachment avoidance were more likely to respond to these issues. Mothers with high attachment anxiety were less trusting of highly anxious home visitors and more trusting of avoidant home visitors. HV programs should consider the influence of both home visitor and maternal attachment style on family engagement. (Contains 4 tables and 1 figure.)
Abstractor: As Provided
Number of References: 42
Entry Date: 2010
Accession Number: EJ895794
Database: ERIC
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  Value: <anid>AN0051278192;59b01jul.10;2019May30.11:53;v2.2.500</anid> <title id="AN0051278192-1">Association of home visitors' and mothers' attachment style with family engagement. </title> <p>Family engagement in home visiting (HV) is challenging. This study related attachment security of home visitors (n=48) and mothers (n=328) to family engagement in an HV program to prevent child maltreatment. Attachment security was assessed by using the Attachment Style Questionnaire to measure attachment anxiety and attachment avoidance. Family engagement was defined as receipt of a high dose of visits and home visitor response to intimate partner violence (IPV) and poor maternal mental health as measured via record review and by maternal report of trust in the home visitor. Home visitors had lower attachment anxiety and avoidance than mothers. Families were likely to receive a high dose of services if either the mother or home visitor was high on attachment anxiety. Home visitors high on attachment anxiety were less likely to respond to IPV and poor maternal mental health; home visitors high on attachment avoidance were more likely to respond to these issues. Mothers with high attachment anxiety were less trusting of highly anxious home visitors and more trusting of avoidant home visitors. HV programs should consider the influence of both home visitor and maternal attachment style on family engagement. © 2010 Wiley Periodicals, Inc.</p> <p>Home visiting is a widely used preventive intervention for families at risk for poor parenting. There are home visiting programs in all states and some states have taken specific models to scale, with programs in nearly every community (Healthy Families America, [<reflink idref="bib22" id="ref1">22</reflink>]; Nurse‐Family Partnership, [<reflink idref="bib33" id="ref2">33</reflink>]; Parents as Teachers, [<reflink idref="bib35" id="ref3">35</reflink>]). Both the private and public sectors have called for expansion of proven and promising home visiting models, concurrent with the refinement and testing of emerging models and enhancements (Isaacs, [<reflink idref="bib23" id="ref4">23</reflink>]; Office of Management and Budget, [<reflink idref="bib34" id="ref5">34</reflink>]).</p> <p>Broad adoption of home visiting has been coupled with growing appreciation of the challenges of achieving intended outcomes and of providing services with fidelity. Sweet and Applebaum's [<reflink idref="bib40" id="ref6">40</reflink>] meta‐analysis concluded that home visiting positively improves outcomes in several domains, but that effect sizes are small. Meta‐analytic research on a range of preventive interventions shows that fidelity of implementation is positively associated with effectiveness (Durlak & DuPre, [<reflink idref="bib16" id="ref7">16</reflink>]). Evidence from research across a range of home visiting models shows that actual services depart from program models (Gomby, Culross, & Behrman, [<reflink idref="bib20" id="ref8">20</reflink>]), even when outcomes are achieved (Korfmacher, Kitzman, & Olds, [<reflink idref="bib28" id="ref9">28</reflink>]). Thus, the President's 2010 Budget proposal called for investment not only in proven and promising program models, but also to provide technical assistance to ensure fidelity, and to support evaluative research on the effectiveness of models as conditions change over time (Office of Management and Budget, [<reflink idref="bib34" id="ref10">34</reflink>]).</p> <p>Carroll, Patterson, Wood, Booth, and Rick ([<reflink idref="bib8" id="ref11">8</reflink>]) have proposed a conceptual framework of organizational‐ and individual‐level factors for fidelity. Organizational factors include intervention complexity and implementation system adequacy. Many widely disseminated home visiting models are complex, incorporating family support to reduce malleable risks for poor parenting and parenting education to promote positive parent–child interaction (Gomby et al., [<reflink idref="bib20" id="ref12">20</reflink>]). This complexity calls for sophisticated implementation systems. Home visiting implementation systems, for example, include policies and procedures for staff hiring, training, and supervision; protocols for identifying and addressing family needs while building on strengths; curricula for parent training; interagency arrangements for referrals; and policies and procedures for identifying, enrolling, and retaining families.</p> <p>Individual‐level factors for fidelity include provider and recipient motivation and capacity to carry out their roles. Motivation and capacity, in turn, might be influenced by providers' and recipients' attachment security. Bowlby's attachment theory, holds that early childhood experiences with primary caregivers establish "internal working models" that guide an individual's thinking about providing and receiving emotional support in a close relationship (Bowlby, [<reflink idref="bib4" id="ref13">4</reflink>]; Bretherton & Munholland, [<reflink idref="bib6" id="ref14">6</reflink>]). Attachment security might be a factor for fidelity through its influence on the home visitor's capacity to engage a family while addressing psychosocial risks for poor parenting and the mother's willingness to share sensitive information, trust the home visitor, and act on recommendations.</p> <p>The traditions of social and developmental psychology have approached the measurement of attachment security in adults from different perspectives and with different terminology, but with substantial concordance in empirical findings. From the perspective of social psychology, attachment is typically conceptualized and measured on two dimensions—attachment anxiety and attachment avoidance—using an adult attachment questionnaire (Mikulincer & Shaver, [<reflink idref="bib32" id="ref15">32</reflink>]). The anxiety dimension reflects an individual's degree of worry that close others are not sufficiently invested in relationships with them. Individuals high on attachment anxiety have a strong desire for interpersonal closeness; they view others as being less interested in engaging in a close relationship than they would like. The avoidance dimension reflects the degree of discomfort with interpersonal closeness. Individuals high on attachment avoidance express discomfort with such closeness and with trusting and depending on others.</p> <p>From the perspective of developmental psychology, adult attachment security is typically measured as attachment <emph>state of mind</emph> via instruments such as the Adult Attachment Interview (AAI; George, Kaplan, & Main, [<reflink idref="bib19" id="ref16">19</reflink>]). Using traditional coding of the AAI, individuals are broadly categorized as either secure or insecure, and those who are insecure are subcategorized as preoccupied (anxious), dismissive (avoidant), or disorganized (unresolved) with regard to relationships. Kobak ([<reflink idref="bib24" id="ref17">24</reflink>]) developed a Q set for coding the AAI that generates continuous measures of attachment strategies along two dimensions: secure versus insecure and dismissive versus preoccupied. Secure individuals tend not to be influenced by defensive processes. Numerous studies have shown them to have better emotion regulation than individuals who are insecure (e.g., Kobak, Cole, Ferenz‐Gillies, Fleming, & Gamble, [<reflink idref="bib25" id="ref18">25</reflink>]). Individuals scoring high on dismissiveness tend to be avoidant of trusting relationships; those scoring high on preoccupation tend to be anxious about relationships.</p> <p>Several studies using the AAI provide empirical support for recipients' attachment security as a factor for how services are used. Korfmacher, Adam, Ogawa, and Egeland ([<reflink idref="bib27" id="ref19">27</reflink>]) found that mothers categorized as secure engaged more deeply in home visiting and accepted a wider range of treatments than mothers categorized as dismissive or unresolved. Dismissive mothers were less emotionally engaged in the program than other mothers; services for unresolved mothers tended to be crisis‐oriented.</p> <p>Dozier ([<reflink idref="bib9" id="ref20">9</reflink>]) found that, among individuals treated for serious psychopathological disorders, those who were secure were more compliant with treatment than those who were insecure. Furthermore, avoidant individuals were more likely to reject providers, less likely to self‐disclose, and more likely to use treatment poorly than individuals with preoccupied strategies (Dozier, [<reflink idref="bib9" id="ref21">9</reflink>]).</p> <p>Dozier, Cue, and Barnett ([<reflink idref="bib10" id="ref22">10</reflink>]) have also examined how provider and recipient attachment security interact as influences on service delivery. In a study of case managers of clients with severe psychopathological disorders, they found that insecure case managers, compared to secure case managers, attended to more dependency needs and intervened in greater depth with preoccupied clients than they did with dismissing clients. Tyrell, Dozier, Teague, and Fallot ([<reflink idref="bib41" id="ref23">41</reflink>]) found that case managers who were low on dismissiveness developed stronger alliances with dismissive clients, whereas case managers who were high on dismissiveness developed stronger alliances with clients low on this attribute (Dozier et al., [<reflink idref="bib10" id="ref24">10</reflink>]).</p> <p>Attachment security might influence how home visitors interact with their supervisors and the families they serve. Those high on attachment anxiety might be more eager to comply with program policy and supervision, but less comfortable discussing sensitive issues with parents for fear it will jeopardize their relationship with them. Evidence from the studies cited above would suggest that mothers high on attachment anxiety would be more receptive to home visiting and to addressing sensitive issues.</p> <p>We conducted two statewide randomized trials of the Healthy Families America (HFA) home visiting model. The first study focused on Hawaii's Healthy Start Program (HSP), the prototype for HFA (Duggan, Fuddy, et al., [<reflink idref="bib12" id="ref25">12</reflink>]; Duggan, McFarlane, et al., [<reflink idref="bib14" id="ref26">14</reflink>]; Duggan, et al., [<reflink idref="bib15" id="ref27">15</reflink>]). The second study focused on Healthy Families Alaska programs (Duggan et al., [<reflink idref="bib11" id="ref28">11</reflink>]). Both studies identified departures from fidelity for all sites combined as well as variations in fidelity across home visiting sites within each state. Elements of the implementation system partially explained variations in fidelity. For example, program sites with an assertive outreach policy had substantially higher family retention rates than sites with a nonassertive policy (Duggan et al., [<reflink idref="bib15" id="ref29">15</reflink>]); however, individual‐level fidelity factors were not assessed.</p> <p>The present study uses data from the HSP study to investigate the influence of individual‐level factors for fidelity, specifically, home visitor and maternal attachment security. The first objective is to describe and compare home visitors' and mothers' attachment anxiety and avoidance. The second objective is to determine how attachment anxiety and avoidance influence three indicators of fidelity: receipt of a high dose of service, home visitor response to psychosocial risks for poor parenting, and maternal trust in the home visitor. The findings have implications for the design of program models and implementation systems.</p> <hd id="AN0051278192-2">METHOD</hd> <p></p> <hd id="AN0051278192-3">Healthy Start Program Model</hd> <p>The HSP has been described elsewhere (Duggan et al., [<reflink idref="bib15" id="ref30">15</reflink>]; Duggan, Fuddy, et al., [<reflink idref="bib12" id="ref31">12</reflink>]; Duggan, McFarlane, et al., [<reflink idref="bib14" id="ref32">14</reflink>]). It targets at‐risk families of newborns through population‐based screening and assessment using the Family Stress Checklist (Korfmacher, [<reflink idref="bib26" id="ref33">26</reflink>]). Home visiting is voluntary, with weekly visits for the first 6–9 months and less frequent visits as family functioning improves. Home visitors are expected to establish a trusting relationship with families. With supervisory support, they encourage parents to seek professional help for psychosocial risks (e.g., poor maternal mental health, IPV) for poor parenting. They promote positive parenting through education, role modeling, reinforcement, and referral to community resources. Supervisors use the home visit record in weekly reflective one‐on‐one supervision, reviewing the home visitor's observations and actions and guiding the home visitor in planning next steps.</p> <hd id="AN0051278192-4">Setting and Sample</hd> <p>The study was carried out in six HSP communities. The HSP programs in these communities were operated by three different agencies through contracts with the Hawaii Department of Health. Contract specifications were the same across agencies and staff completed the same core training. The study was approved by institutional review boards of The Johns Hopkins University School of Medicine, the Hawaii Department of Health, and the hospitals where families were recruited.</p> <p>At risk families were identified using the usual HSP protocol and randomly assigned to HSP and control groups; 373 families were assigned to the HSP group, with sixty‐one home visitors providing services to these families during their first year in the program. Details of the HSP protocol are described elsewhere (Duggan et al., [<reflink idref="bib13" id="ref34">13</reflink>], [<reflink idref="bib15" id="ref35">15</reflink>]; Hawaii Family Stress Center, [<reflink idref="bib21" id="ref36">21</reflink>]).</p> <hd id="AN0051278192-5">Data Collection</hd> <p>Home visitors completed a self‐administered structured questionnaire at the start of the study and annually for 3 years to measure demographics and attachment security. Questionnaire data on attachment security were available for 48 of the 61 home visitors serving study families.</p> <p>Research staff unaware of family group assignment interviewed mothers at HSP enrollment and one year later. The enrollment interview measured demographics, maternal mental health, and IPV. The interview at one year measured these variables, maternal attachment security, and maternal ratings of the home visitor. Separate research staff reviewed HSP records to measure duration of HSP enrollment, visit frequency, and visit content. Research staff were trained and monitored to prevent measurement bias and drift. Data on maternal attachment status were available for 328 (88%) of the mothers assigned to HSP.</p> <hd id="AN0051278192-6">Measures</hd> <p></p> <hd id="AN0051278192-7">Attachment anxiety and avoidance</hd> <p>Home visitors and mothers completed the Attachment Style Questionnaire (Feeney, Noller, & Hanrahan, [<reflink idref="bib18" id="ref37">18</reflink>]). The ASQ consists of 40 items rated on a scale of 1 (<emph>totally disagree</emph>) to 6 (<emph>totally agree</emph>). Items include, "I find it hard to trust people" and "I worry a lot about my relationships." The instrument's measures of attachment anxiety and avoidance have been linked in theoretically predicted ways to maternal depression, stress, and readiness to end abusive relationships (Feeney, Alexander, Noller, & Hohaus, [<reflink idref="bib17" id="ref38">17</reflink>]; Meredith, Strong, & Feeney, [<reflink idref="bib31" id="ref39">31</reflink>]; Shurman & Rodriguez, [<reflink idref="bib37" id="ref40">37</reflink>]). We opted to measure attachment style because instruments for measuring attachment state of mind required substantially more resources than were available for this aspect of the study. We selected the ASQ because it was designed to tap attachment security for relationships in general (rather than many alternative instruments, which focused on romantic relationships) and because its developer had reported good test‐retest reliability <emph>(r</emph>s=.75 to.80) and good internal consistency (Feeney et al., [<reflink idref="bib18" id="ref41">18</reflink>]). In the current study, we used the 34 items from four of the ASQ's original subscales: discomfort with closeness, confidence in self, need for approval, and preoccupation with relationships. We omitted the subscale, relationships as secondary to accomplishments, to reduce respondent burden<emph>.</emph></p> <p>Confirmatory factor analysis revealed that the original ASQ subscale structure was not a good fit for this sample, according to four indices of fit: the chi‐square statistic, root‐mean‐square error of approximation, comparative fit index, and the Tucker‐Lewis Index. Because of the compelling evidence of two major dimensions of attachment insecurity (Mikulincer & Shaver, [<reflink idref="bib32" id="ref42">32</reflink>]), we conducted exploratory factor analysis using a maximum likelihood algorithm and a 2‐factor solution. All items were included in the first step; those with factor loadings ≥.40 were retained. The model was rerun, again retaining only items with factor loadings ≥.40, until the loadings of all remaining items were ≥.40. Items with equal loadings ≥.40 on both factors were dropped. Varimax orthogonal rotation and promax (oblique) rotation generated similar factor structures; we report the promax rotation results.</p> <p>The final factor analysis resulted in an attachment anxiety factor of 16 items (nearly all from the original preoccupation with closeness and need for approval subscales) with loadings from.46 to.72 and an attachment avoidance factor of four items (all from the discomfort with closeness subscales) with loadings from.40 to.74. Reliability analyses revealed high internal consistency for mothers on both the attachment anxiety factor (<emph>α</emph>=.80) and the attachment avoidance factor (<emph>α</emph> =.88). Reliability analyses revealed similarly high internal consistency for home visitors (Cronbach's <emph>α</emph>=.89 for attachment anxiety and.81 for attachment avoidance). Items in the anxiety dimension indicate anxiety about others not being available (e.g., "I worry that others won't care about me as much as I care about them" and "I wonder how I would cope without someone to love"). The attachment avoidance dimension includes items indicating discomfort being close with others (e.g., "I find it difficult to depend on others").</p> <hd id="AN0051278192-8">Maternal mental health</hd> <p>Maternal mental health was assessed using three instruments. The Center for Epidemiological Studies‐Depression Scale (CES‐D; Radloff, [<reflink idref="bib36" id="ref43">36</reflink>]) was used to measure maternal depressive symptoms at follow‐up. This 20‐item, self‐report instrument asks respondents how often in the past week they experienced specific symptoms (e.g., "I was bothered by things that usually don't bother me") on a 4‐point scale. Concurrent and construct validity, high internal consistency (<emph>α</emph>s.85 to.90) and test‐retest reliability have been reported (Radloff, [<reflink idref="bib36" id="ref44">36</reflink>]). A commonly used cutoff is a score ≥16 (McDowell & Newell, [<reflink idref="bib29" id="ref45">29</reflink>]; Radloff, [<reflink idref="bib36" id="ref46">36</reflink>]). Because higher cut points have been recommended to reduce false positives (McDowell & Newell, [<reflink idref="bib29" id="ref47">29</reflink>]), we used a cutoff of ≥24 as indicative of clinically significant depression.</p> <p>The Mental Health Index 5‐item short form (MHI‐5; McHorney & Ware, [<reflink idref="bib30" id="ref48">30</reflink>]), which gives an overall measure of anxiety and depressive symptoms, was administered at baseline and follow‐up. Respondents indicate how often in the past month they have felt each way (e.g., "How much of the time during the last month have you been a very nervous person") on a 6‐point scale. Items were summed and scores standardized to a scale of 0–100, with high scores indicating better general mental health. Internal‐consistency reliability coefficients range from 0.67 to 0.95 (Ware, Snow, Kosinski, & Gandek, [<reflink idref="bib42" id="ref49">42</reflink>]). A cutoff of <67 was used to define poor mental health (Berwick et al., [<reflink idref="bib3" id="ref50">3</reflink>]).</p> <p>The Parenting Stress Index Short Form (PSI‐SF; Abidin, [<reflink idref="bib1" id="ref51">1</reflink>]) was administered at follow‐up to measure parenting stress. The PSI‐SF is a self‐report measure in which respondents indicate agreement with each of 36 items (sample item, "My child rarely does things for me that make me feel good") on a 5‐point scale (1=<emph>strongly agree</emph>, 5=<emph>strongly disagree</emph>). A mother was considered positive for severe parenting stress if she scored positive for personal adjustment problems, child abuse potential, or high child abuse potential as defined by Abidin ([<reflink idref="bib1" id="ref52">1</reflink>]).</p> <p>In the present study, a mother was classified as having a mental health problem in the child's first year of life if she scored positive on the CES‐D, the MHI‐5, or the PSI‐SF.</p> <hd id="AN0051278192-9">Intimate partner violence</hd> <p>Partner violence was measured using the Revised Conflict Tactics Scale (CTS2; Straus, [<reflink idref="bib39" id="ref53">39</reflink>]). The CTS2 is a 39‐item, fixed response, self‐report measure of the frequency of specific behaviors in the past year. The instrument has strong evidence of validity (Straus, [<reflink idref="bib39" id="ref54">39</reflink>]), internal consistency (subscale <emph>α</emph>s=.79–.95; Straus, [<reflink idref="bib38" id="ref55">38</reflink>]), and subscale test‐retest reliability (correlations of.49 to.90; Straus, [<reflink idref="bib39" id="ref56">39</reflink>]). We created a binary partner violence variable, defined as positive if the mother reported at follow‐up that (<reflink idref="bib1" id="ref57">1</reflink>) she or her partner had sustained an injury requiring medical care in the preceding year as a result of a violent act by the other, or (<reflink idref="bib2" id="ref58">2</reflink>) she or her partner had committed acts of physical violence toward the other on three or more occasions in the preceding year. Mothers without a partner were considered negative for IPV.</p> <hd id="AN0051278192-10">Dose of services</hd> <p>A family was classified as receiving a high dose of service in the first year if the family met three criteria: (<reflink idref="bib1" id="ref59">1</reflink>) active in the program at the end of year one, (<reflink idref="bib2" id="ref60">2</reflink>) had ≥75% of expected visits, and (<reflink idref="bib3" id="ref61">3</reflink>) on creative outreach for ≤3 months. The percentage of expected visits achieved was the actual number of visits divided by the number expected based on the number of months a family was on each level of service (e.g., Level 1 weekly visits, Level 2 bimonthly visits). Per HSP protocol, programs assigned families to creative outreach (intensive positive engagement) when family circumstances or a protracted period of disengagement precluded even monthly visits.</p> <hd id="AN0051278192-11">Home visitor response to maternal risks for poor parenting</hd> <p>Home visiting programs maintain detailed records of all visits to families. Research staff reviewed each family's HSP record, abstracting information on the date and content of each visit. A home visitor was considered to have responded to poor maternal mental health or partner violence if there was any documentation of any form of response ranging, for example, from talking about the issue with the mother or another family member to arranging a family's receipt of services to address the issue. The present study focuses on response in the first year of program enrollment. Any home visitor notation in the home visit record of any type of response to poor mental health or IPV was counted.</p> <hd id="AN0051278192-12">Maternal trust of the home visitor</hd> <p>Mothers rated home visitors on a self‐administered questionnaire at one year. Items were adapted from a similar unpublished ratings instrument developed by David Olds, PhD, at the Kempe Prevention Research Center for Family and Child Health, University of Colorado Health Sciences Center, Denver. In this study, we focus on the three items rating the mother's trust in the home visitor ("I feel I can confide in her and say how I really feel," "I can confide in her and say what I want," and "I trust her to look after my best interests"). Response choices ranged from 1 (<emph>strongly disagree</emph>) to 5 (<emph>strongly agree</emph>). Responses were summed to create a trust score that could range from 3 to 15; higher scores indicate greater trust. The scale had high internal consistency (Cronbach's <emph>α</emph>=.89).</p> <hd id="AN0051278192-13">RESULTS</hd> <p></p> <hd id="AN0051278192-14">Sample Characteristics</hd> <p>The home visitors (<emph>n</emph> diverse in age (range 23 to 63 years, <emph>M</emph>=40.3, <emph>SD</emph>=8.9) and ethnicity (42% Asian, 25% Native Hawaiian or Other Pacific Islander, 29% White, 4% other). All were female, 74% were married, and 93% had children. Half had an educational degree beyond high school and half had been in their position at least 3 years.</p> <p>Home‐visited mothers (<emph>n</emph>=373) had a mean age of 24 years at baseline and were racially diverse (34% Native Hawaiian or Other Pacific Islander, 28% Asian, 10% White and 27% multiracial with no primary affiliation per self report). Two thirds had household incomes below the poverty level, 43% were first‐time mothers, and 55% lived with or were married to the child's father. Overall, 43% of mothers had poor general mental health at baseline and 43% reported three or more incidents of partner violence in the preceding year.</p> <hd id="AN0051278192-15">Home visitors' and mothers' attachment anxiety and avoidance</hd> <p>Home visitors' attachment anxiety scores ranged from 16 to 58 (<emph>M</emph>±<emph>SD</emph> 28.8±8.8). Their attachment avoidance scores ranged from 4 to 22 (<emph>M</emph>±<emph>SD</emph> 10.4±3.9). These scores were moderately correlated (<emph>r</emph>=0.41, <emph>p</emph><.01). As reported elsewhere, home visitor attachment anxiety and avoidance were not related to demographic attributes (e.g., race, marital status), but were related to psychological and work attributes (Burrell et al., [<reflink idref="bib7" id="ref62">7</reflink>]).</p> <p>Overall, 332 (89%) of the mothers completed a follow‐up interview at one year; of these, 328 provided data on attachment security. Mothers with versus without attachment measures did not differ on any baseline variable (all <emph>p</emph>>.66). Maternal attachment anxiety scores ranged from 16 to 88 (<emph>M</emph>±<emph>SD</emph> 51.4±11.2) and attachment avoidance scores ranged from 6 to 24 (<emph>M</emph>±<emph>SD</emph> 15.0±3.2). These scores were moderately correlated (<emph>r</emph>=0.33, <emph>p</emph><.001). The scores were very similar to those of mothers in the control group (<emph>n</emph>=228); for anxiety, home visited 51.4±11.2 vs. control 50.9±11.0, <emph>t</emph>(<reflink idref="bib551" id="ref63">551</reflink>)=0.52, <emph>p</emph>=.60; for avoidance, home visited 15.0±3.2 vs. control 15.0±3.3, <emph>t</emph>(<reflink idref="bib554" id="ref64">554</reflink>)=0.15, <emph>p</emph>=.88.</p> <p>Maternal attachment anxiety and avoidance were not associated with any demographic attributes (all <emph>p</emph> >.30). Mothers with poor mental health scored higher for attachment anxiety, 54.3±9.8 vs. 49.2±11.7, <emph>t</emph>(<reflink idref="bib325" id="ref65">325</reflink>)=4.2, <emph>p</emph><.001, and avoidance, 15.7±3.1 <emph>vs</emph>. 14.5±3.2, <emph>t</emph>(<reflink idref="bib326" id="ref66">326</reflink>)=3.5, <emph>p</emph><.01. Mothers in a violent relationship scored higher for attachment avoidance, 15.4±3.2 <emph>vs</emph>. 14.6±3.1, <emph>t</emph>(<reflink idref="bib326" id="ref67">326</reflink>)=2.3, <emph>p</emph><.05.</p> <p>Home visitors scored significantly lower than home visited mothers on both attachment anxiety, <emph>t</emph>(<reflink idref="bib371" id="ref68">371</reflink>)=13.1, <emph>p</emph><.001, and avoidance, <emph>t</emph>(<reflink idref="bib373" id="ref69">373</reflink>)=8.9, <emph>p</emph><.001.</p> <hd id="AN0051278192-16">Factors for family receipt of a high dose of services</hd> <p>At one year, 181 families (49%) were still active in HSP, 131 (35%) had chosen to leave, and 61 (16%) had left for unavoidable reasons such as moving out of state. We focused on the 312 families who remained in the program or had chosen to leave. Within this group, analysis was further limited to families who had a single home visitor (<emph>n</emph>=235). Of these families, 27% had a high dose of service.</p> <p>To test the influence of home visitors' and mothers' attachment security on receipt of a high dose of service, we began by testing a fully specified multiple logistic regression model with four 2‐way interactions: Home Visitor Anxiety×Maternal Anxiety, Home Visitor Anxiety×Maternal Avoidance, Home Visitor Avoidance×Maternal Anxiety, and Home Visitor Avoidance×Maternal Avoidance, and all main effects. We used a step‐down approach (Aiken & West, [<reflink idref="bib2" id="ref70">2</reflink>]) to identify the most parsimonious model, dropping nonsignificant (<emph>p</emph>>.05) interactions and then dropping nonsignificant main effects. All models clustered on home visitor to adjust standard errors to account for the possible nonindependence of observations within home visitor.</p> <p>The final model retained a significant interaction of home visitor anxiety and maternal anxiety (Table 1). As shown in Figure 1, Panel A, families were likely to have a high dose of service if either the mother or the home visitor had high attachment anxiety. Thus, among mothers with high anxiety, over a third had a high dose of service even if the home visitor had low attachment anxiety. However, among mothers with low attachment anxiety, the likelihood of receiving a high dose of service increased as home visitor anxiety increased.</p> <p>Graph: 1 Panel A: Percentage of families with a high dose of service by maternal and home visitor attachment anxiety. Solid lines represent high dose of services for mothers with low attachment anxiety at varying levels of home visitor anxiety. Dashed lines represent receipt of high dose of services for mothers with high attachment anxiety at varying levels of home visitor anxiety. Low attachment anxiety is defined as one standard deviation below the mean; high attachment anxiety is defined as one standard deviation above the mean. Panel B: Percentage of families with home visitor response to intimate partner violence (IPV), by home visitor attachment anxiety and avoidance. Solid, dashed, and dotted lines represent response to IPV by home visitors with low, moderate, and high levels of attachment anxiety, respectively, at varying levels of home visitor attachment avoidance. Low attachment anxiety is defined as one standard deviation below the mean; high attachment anxiety is defined as one standard deviation above the mean. Panel C: Home visitor trust rating. Maternal ratings of trust in the home visitor by maternal anxiety, home visitor attachment avoidance, and home visitor attachment anxiety. Solid lines represent trust ratings for mothers with low attachment anxiety and dashed lines represent trust ratings for mothers with high attachment anxiety, at varying levels of home visitor anxiety (left panel) and avoidance (right panel). Low attachment anxiety is defined as one standard deviation below the mean; high attachment anxiety is defined as one standard deviation above the mean.</p> <p>1 Regression of High Doseaof Service on Maternal and Home Visitor Attachment Security (AOR)</p> <p> <ephtml> <table><thead valign="bottom"><tr><th align="left" /><th align="left"><italic>AOR</italic></th><th align="center"><italic>p</italic></th></tr></thead><tbody valign="top"><tr><td align="left">Home visitor attachment anxiety (A)</td><td align="char" char=".">1.03</td><td align="char" char=".">.17</td></tr><tr><td align="left">Maternal attachment anxiety (B)</td><td align="char" char=".">1.02</td><td align="char" char=".">.21</td></tr><tr><td align="left">A×B</td><td align="char" char=".">0.99</td><td align="char" char=".">.03</td></tr></tbody></table> </ephtml> </p> <p>1 <emph>Note. n</emph>=198 mothers; 38 home visitors.</p> <p>2 a <sups>a</sups>Active Year 1, 75% expected visits, <3 months creative outreach.</p> <hd id="AN0051278192-17">Factors for home visitor response to IPV</hd> <p>Overall, 48 (39%) of mothers with a single home visitor and still in the program at one year experienced IPV and 41 (85%) of these 48 mothers also had poor mental health. There was evidence that the home visitor responded to IPV for 9 (19%) of these mothers. Response rates for IPV were not associated with the presence of poor maternal mental health (<emph>p</emph>=.60) and there were very few mothers with IPV in the absence of poor mental health. Thus, we did not test maternal mental health as a moderator of home visitor response to IPV.</p> <p>Multiple logistic regression was used to test for the influence of home visitors' and mothers' attachment security on home visitor response to IPV. We began with a model containing all four attachment security variables and clustered on home visitor, and used backward elimination to drop nonsignificant terms systematically. Interaction terms were not tested because of small sample size.</p> <p>The final model retained home visitor attachment anxiety (AOR=0.89, <emph>p</emph>=.01) and avoidance (AOR 1.25, <emph>p</emph>=.02; Table 2). Home visitor rates of response to IPV varied substantially, e.g., from 2% for home visitors with low attachment avoidance and high anxiety to 46% for home visitors with high avoidance and low anxiety (Fig. 1, Panel B).</p> <p>2 Regression of Home Visitor Response to Intimate Partner Violence on Home Visitor Attachment Security (AOR)</p> <p> <ephtml> <table><thead valign="bottom"><tr><th align="left" /><th align="left"><italic>AOR</italic></th><th align="center"><italic>p</italic></th></tr></thead><tbody valign="top"><tr><td align="left">Home visitor attachment anxiety</td><td align="char" char=".">0.89</td><td align="char" char=".">.01</td></tr><tr><td align="left">Home visitor attachment avoidance</td><td align="char" char=".">1.26</td><td align="char" char=".">.02</td></tr></tbody></table> </ephtml> </p> <p>3 <emph>Note. n</emph>=43 mothers; 24 home visitors.</p> <hd id="AN0051278192-18">Factors for home visitor response to poor maternal mental health</hd> <p>Overall, 82 (67%) of mothers with a single home visitor and enrolled in the program at one year experienced poor mental health; 50% of these 82 mothers were also in a violent relationship. Program records showed that home visitors responded to poor maternal mental health for 12 (15%) of the 82 mothers overall. Home visitors responded to poor maternal mental health for 20% of mothers in a violent relationship and 8% of those not in a violent relationship (<emph>p</emph>=.16).</p> <p>Multiple logistic regression was used to test home visitors' and mothers' attachment security as factors for home visitor response to poor maternal mental health. The initial model contained all four attachment security variables, IPV, and interaction terms for each attachment security variable by IPV. The model clustered on home visitor. Backward elimination was used to determine the most parsimonious model, first by dropping nonsignificant interaction terms and then by dropping main effects that were not a part of remaining interaction terms.</p> <p>The final model retained main effects for maternal attachment anxiety and home visitor attachment anxiety (Table 3). As maternal attachment anxiety increased, so too did the odds of home visitor response to poor maternal mental health (AOR=1.17, <emph>p</emph><.001); as home visitor attachment anxiety increased, the odds of responding to poor maternal mental health decreased (AOR=0.92, <emph>p</emph><.05).</p> <p>3 Regression of Home Visitor Response to Poor Maternal Mental Health on Intimate Partner Violence and Home Visitor Attachment Security (AOR)</p> <p> <ephtml> <table><thead valign="bottom"><tr><th align="left" /><th align="center"><italic>Nonviolent families are reference</italic></th><th align="left"><italic>Violent families are reference</italic></th></tr><tr><th align="left" /><th align="center"><italic>AOR</italic></th><th align="center"><italic>p</italic></th><th align="center"><italic>AOR</italic></th><th align="center"><italic>p</italic></th></tr></thead><tbody valign="top"><tr><td align="left">Intimate partner violence (A)</td><td align="char" char=".">15.22</td><td align="char" char=".">.02</td><td align="char" char=".">0.06</td><td align="char" char=".">.02</td></tr><tr><td align="left">Maternal attachment anxiety</td><td align="char" char=".">1.17</td><td align="char" char="."><.001</td><td align="char" char=".">1.17</td><td align="char" char="."><.001</td></tr><tr><td align="left">Home visitor attachment anxiety</td><td align="char" char=".">0.92</td><td align="char" char=".">.04</td><td align="char" char=".">0.92</td><td align="char" char=".">.04</td></tr><tr><td align="left">Home visitor attachment avoidance (B)</td><td align="char" char=".">0.81</td><td align="char" char=".">.33</td><td align="char" char=".">1.18</td><td align="char" char=".">.02</td></tr><tr><td align="left">A×B</td><td align="char" char=".">1.47</td><td align="char" char=".">.06</td><td align="char" char=".">0.69</td><td align="char" char=".">.06</td></tr></tbody></table> </ephtml> </p> <p>4 <emph>Note. n</emph>=72 mothers; 30 home visitors.</p> <p>The final model also contained an interaction term for home visitor attachment avoidance by IPV. In families without IPV, home visitor attachment avoidance was not associated with recognition of poor maternal mental health (AOR=0.81, <emph>p</emph>=.33); in families with IPV, as home visitor attachment avoidance increased, the odds of recognizing and responding to poor maternal mental health also increased (AOR=1.18, <emph>p</emph>=.02).</p> <hd id="AN0051278192-19">Factors moderating mothers' ratings of trust in the home visitor</hd> <p>Of mothers who stayed in the program for a full year and had a single home visitor, 92% recalled having a home visitor. Overall, their ratings of trust in the home visitor were high (<emph>M</emph>±<emph>SD</emph> 13.2±1.9).</p> <p>We began by testing a fully specified multiple linear regression model with four 2‐way interactions: Home Visitor Anxiety×Maternal Anxiety; Home Visitor Anxiety×Maternal Avoidance; Home Visitor Avoidance×Maternal Anxiety; and Home Visitor Avoidance×Maternal Avoidance, and all main effects. We used the step‐down approach recommended by Aiken and West ([<reflink idref="bib2" id="ref71">2</reflink>]) to identify the most parsimonious model. All models clustered on home visitor.</p> <p>The final model retained significant interactions of maternal attachment anxiety with home visitor anxiety and avoidance (Table 4). Mothers with low attachment anxiety had high levels of trust in the home visitor, regardless of the home visitor's level of attachment anxiety (Fig. 1, left side of Panel C) or attachment avoidance (right side of Panel C). Mothers with high attachment anxiety had low trust in home visitors who were high on attachment anxiety (Fig. 1, left side of Panel C) or low on attachment avoidance (Fig. 1, right side of Panel C).</p> <p>4 Regression of Maternal Ratings of Trust of the Home Visitor on Home Visitor Attachment Security</p> <p> <ephtml> <table><thead valign="bottom"><tr><th align="left" /><th align="center"><italic>B</italic></th><th align="center"><italic>p</italic></th></tr></thead><tbody valign="top"><tr><td align="left">Maternal attachment anxiety (A)</td><td align="char" char=".">−0.03</td><td align="char" char=".">.06</td></tr><tr><td align="left">Home visitor attachment anxiety (B)</td><td align="char" char=".">−0.04</td><td align="char" char=".">.08</td></tr><tr><td align="left">Home visitor attachment avoidance (C)</td><td align="char" char=".">0.13</td><td align="char" char=".">.02</td></tr><tr><td align="left">A×B</td><td align="center">−0.003</td><td align="char" char=".">.06</td></tr><tr><td align="left">A×C</td><td align="char" char=".">0.01</td><td align="char" char=".">.03</td></tr><tr><td align="left">Constant</td><td align="char" char=".">13.23</td><td align="left" /></tr><tr><td align="left"><italic>R</italic><sup>2</sup></td><td align="char" char=".">0.15</td><td align="left" /></tr></tbody></table> </ephtml> </p> <p>5 <emph>Note. n</emph>=103 mothers; 29 home visitors.</p> <hd id="AN0051278192-20">DISCUSSION</hd> <p>This study described attachment security of the main recipients and providers of a home visiting program targeted to families with multiple psychosocial risks for harsh and neglectful parenting. Mothers varied widely on both attachment anxiety and avoidance. Their scores spanned nearly the full possible range for each construct. This demonstrates the heterogeneity of at risk mothers on factors that might influence their engagement in home visiting, their parenting behavior, and the impact of home visiting impact on parenting behavior and related outcomes.</p> <p>Home visitors also varied on attachment anxiety and avoidance. They varied as much as mothers in attachment avoidance, but less so in attachment anxiety. Mothers' attachment anxiety scores spanned nearly the full possible range, but home visitors' scores fell in the bottom half of the possible range. Still, there was enough variability to test home visitor attachment anxiety and avoidance as possible factors for family engagement.</p> <p>Mothers' mean attachment anxiety score was slightly less than the midpoint of the possible range; their mean avoidance score was slightly above the midpoint of the range. Home visitors had significantly lower scores than mothers for both anxiety and avoidance. Thus, HSP hiring practices yielded a workforce with greater attachment security than that of the mothers served. Even so, there appears to be more variability among these home visitors than among the case managers in the research of Tyrrell et al. ([<reflink idref="bib41" id="ref72">41</reflink>]), who reported highly selective hiring and retention practices based in part on staff comfort and competence in discussing relational issues.</p> <p>Maternal attachment anxiety was associated with engagement in home visiting in ways that are consistent with theory and empirical research. Maternal attachment anxiety was positively associated with receiving a high dose of service and with the likelihood that the home visitor would recognize and respond to poor maternal mental health. This is consistent with the research of Egeland and colleagues (Bosquet & Egeland, [<reflink idref="bib5" id="ref73">5</reflink>]; Korfmacher et al., [<reflink idref="bib27" id="ref74">27</reflink>]), who found that preoccupied (anxious) mothers were more engaged in home visiting and accepted a wider range of services than dismissive (avoidant) mothers. The association of maternal attachment anxiety with trust in the home visitor was contingent on the home visitor's attachment security. Highly anxious mothers reported low levels of trust in home visitors who also were high on attachment anxiety; they reported high levels of trust in home visitors who were high on avoidance. This is concordant with the findings of Dozier et al. ([<reflink idref="bib10" id="ref75">10</reflink>]) and Tyrrell et al. ([<reflink idref="bib41" id="ref76">41</reflink>]), who also found that recipients worked more effectively with case managers who were less similar to them in attachment security.</p> <p>Home visitor attachment anxiety was positively associated with family receipt of a high dose of service among mothers with low attachment anxiety. This would suggest that higher levels of home visitor attachment anxiety are an asset. However, highly anxious home visitors were less likely to respond to IPV and poor maternal mental health. In addition, they received low ratings of trust by mothers with high attachment anxiety. Thus, although highly anxious home visitors achieved a high dose of service for some families, this did not translate to greater success in addressing risks for maltreatment or in earning trust.</p> <p>Home visitors with higher levels of attachment avoidance, on the other hand, were more likely to respond to family IPV and to poor maternal mental health in families with IPV. In addition, they earned higher levels of trust among highly anxious mothers.</p> <hd id="AN0051278192-21">Methodological Considerations</hd> <p>Findings must be interpreted in light of limitations and strengths in sample selection, measurement, and study design. The samples were limited to home visitors and enrolled families in Hawaii and thus were largely Asian and Pacific Islander. We do not know how generalizable the findings are to home visiting providers and recipients of other racial and ethnic groups. Two other features of sample selection enhance generalizability. First, families were identified through population‐based screening and assessment as routinely carried out by the HSP. Second, the study focused on sites in a scaled‐up, statewide program. Thus, the samples of home visitors and mothers are more likely to be representative of providers and recipients of scaled‐up programs nationally than would be samples derived in a demonstration project.</p> <p>A limitation of measurement is our use of a self‐report measure of attachment security, which is likely to be more vulnerable to social desirability reporting bias than the AAI. This might have been an issue especially for home visitors. Such bias would have the effect of attenuating associations of attachment status with engagement in home visiting. A related limitation is that the subscale for attachment avoidance had only four items related specifically to discomfort with trusting and dependence on others. The content validity of these items as a measure of attachment avoidance is uncertain and might have contributed to our failure to detect associations between maternal attachment avoidance and engagement in home visiting.</p> <p>A weakness of study design was that maternal attachment security was measured at one year rather than at baseline, precluding temporal sequence as evidence of causality. However, attachment security is theorized to be a stable construct and results of our prior research are consistent with this. Specifically, we found strong correlations of home visitors' attachment security scores over 4 years of annual administration of the Attachment Style Questionnaire and no significant changes in mean score over time (Burrell et al., [<reflink idref="bib7" id="ref77">7</reflink>]). Similar results for maternal attachment scores at baseline and 2 years later were obtained in our study of Healthy Families Alaska. Thus, our findings suggest that the maternal attachment scores obtained at the one‐year follow‐up are a reliable indicator of their scores at the time of program enrollment.</p> <p>A strength of the study design was that both provider and recipient attachment security were assessed. Thus, we could test the influence of these attributes for both members of the service dyad and, for selected outcomes, their interactive effects as well.</p> <hd id="AN0051278192-22">Implications for Policy and Practice</hd> <p>Mothers—the primary recipient of home visiting targeted in at risk families—were heterogeneous in terms of attachment anxiety and avoidance and these attributes influenced important indicators of their engagement in program services. Our findings, like those of Korfmacher et al. ([<reflink idref="bib27" id="ref78">27</reflink>]), indicate that these factors should be considered in the targeting and tailoring of home visiting. Our prior research in Alaska also showed mothers to vary on attachment security and for this variation to moderate program impacts (Duggan et al., 2009). Given these associations with engagement and outcomes, we feel it is important for programs to assess attachment security as part of family screening and assessment. Comparative research is needed on the feasibility and utility of available approaches.</p> <p>Paraprofessional home visitors—the primary providers in this model of home‐based family support services—were also heterogeneous in attachment anxiety and avoidance. This heterogeneity helped explain variations in several simple measures of family engagement. Research is needed to assess whether and how home visitor attachment style influences the quality of their interactions with parents and how this, in turn, influences program impacts.</p> <p>Our findings suggest the importance of considering individuals' attachment security in policies for hiring, training and supervising staff. Tools such as the AAI or the Attachment Style Questionnaire might be effective in identifying individuals particularly well suited to engaging at risk families and to addressing sensitive issues such as IPV and mental health. Training and supervisory practices to build reflective capacity might be effective in improving home visitors' ability to carry out aspects of their role that they find challenging. Research is needed to test the feasibility and utility of such practices.</p> <p>Home visiting programs aim to improve a range of complex psychosocial outcomes. Success depends not only on how long families remain in service and whether important issues are addressed, but also on the <emph>quality</emph> of home visitor interactions with families. Implementation science and the move to invest in evidence‐based models of prevention are bringing the issue of fidelity as a moderator of program impact to the fore. We believe that provider and recipient attachment style are key attributes to consider in home visiting research, policy, and practice to promote fidelity and to broaden and deepen program impact for at risk families.</p> <ref id="AN0051278192-23"> <title> REFERENCES </title> <blist> <bibl id="bib1" idref="ref51" type="bt">1</bibl> <bibtext> Abidin, R.R. (1990). Parenting Stress Index Short Form Test Manual. Charlottesville, VA : Pediatric Psychology Press.</bibtext> </blist> <blist> <bibl id="bib2" idref="ref58" type="bt">2</bibl> <bibtext> Aiken, L.S., & West, S.G. (1991). Multiple regression: Testing and interpreting interactions. 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Items – Name: Title
  Label: Title
  Group: Ti
  Data: Association of Home Visitors' and Mothers' Attachment Style with Family Engagement
– Name: Language
  Label: Language
  Group: Lang
  Data: English
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22McFarlane%2C+Elizabeth%22">McFarlane, Elizabeth</searchLink><br /><searchLink fieldCode="AR" term="%22Burrell%2C+Lori%22">Burrell, Lori</searchLink><br /><searchLink fieldCode="AR" term="%22Fuddy%2C+Loretta%22">Fuddy, Loretta</searchLink><br /><searchLink fieldCode="AR" term="%22Tandon%2C+Darius%22">Tandon, Darius</searchLink><br /><searchLink fieldCode="AR" term="%22Derauf%2C+D%2E+Christian%22">Derauf, D. Christian</searchLink><br /><searchLink fieldCode="AR" term="%22Leaf%2C+Philip%22">Leaf, Philip</searchLink><br /><searchLink fieldCode="AR" term="%22Duggan%2C+Anne%22">Duggan, Anne</searchLink>
– Name: TitleSource
  Label: Source
  Group: Src
  Data: <searchLink fieldCode="SO" term="%22Journal+of+Community+Psychology%22"><i>Journal of Community Psychology</i></searchLink>. Jul 2010 38(5):541-556.
– Name: Avail
  Label: Availability
  Group: Avail
  Data: John Wiley & Sons, Inc. Subscription Department, 111 River Street, Hoboken, NJ 07030-5774. Tel: 800-825-7550; Tel: 201-748-6645; Fax: 201-748-6021; e-mail: subinfo@wiley.com; Web site: http://www3.interscience.wiley.com/browse/?type=JOURNAL
– Name: PeerReviewed
  Label: Peer Reviewed
  Group: SrcInfo
  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 16
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2010
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Research
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Child+Abuse%22">Child Abuse</searchLink><br /><searchLink fieldCode="DE" term="%22Mental+Health%22">Mental Health</searchLink><br /><searchLink fieldCode="DE" term="%22Home+Visits%22">Home Visits</searchLink><br /><searchLink fieldCode="DE" term="%22Attachment+Behavior%22">Attachment Behavior</searchLink><br /><searchLink fieldCode="DE" term="%22Parent+Child+Relationship%22">Parent Child Relationship</searchLink><br /><searchLink fieldCode="DE" term="%22Family+Relationship%22">Family Relationship</searchLink><br /><searchLink fieldCode="DE" term="%22Family+Environment%22">Family Environment</searchLink><br /><searchLink fieldCode="DE" term="%22Prevention%22">Prevention</searchLink><br /><searchLink fieldCode="DE" term="%22Questionnaires%22">Questionnaires</searchLink><br /><searchLink fieldCode="DE" term="%22Anxiety%22">Anxiety</searchLink><br /><searchLink fieldCode="DE" term="%22Mothers%22">Mothers</searchLink><br /><searchLink fieldCode="DE" term="%22Parent+Influence%22">Parent Influence</searchLink><br /><searchLink fieldCode="DE" term="%22Trust+%28Psychology%29%22">Trust (Psychology)</searchLink>
– Name: Subject
  Label: Geographic Terms
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Hawaii%22">Hawaii</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1002/jcop.20380
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 0090-4392
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Family engagement in home visiting (HV) is challenging. This study related attachment security of home visitors (n=48) and mothers (n=328) to family engagement in an HV program to prevent child maltreatment. Attachment security was assessed by using the Attachment Style Questionnaire to measure attachment anxiety and attachment avoidance. Family engagement was defined as receipt of a high dose of visits and home visitor response to intimate partner violence (IPV) and poor maternal mental health as measured via record review and by maternal report of trust in the home visitor. Home visitors had lower attachment anxiety and avoidance than mothers. Families were likely to receive a high dose of services if either the mother or home visitor was high on attachment anxiety. Home visitors high on attachment anxiety were less likely to respond to IPV and poor maternal mental health; home visitors high on attachment avoidance were more likely to respond to these issues. Mothers with high attachment anxiety were less trusting of highly anxious home visitors and more trusting of avoidant home visitors. HV programs should consider the influence of both home visitor and maternal attachment style on family engagement. (Contains 4 tables and 1 figure.)
– Name: AbstractInfo
  Label: Abstractor
  Group: Ab
  Data: As Provided
– Name: Ref
  Label: Number of References
  Group: RefInfo
  Data: 42
– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2010
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ895794
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ895794
RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1002/jcop.20380
    Languages:
      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 16
        StartPage: 541
    Subjects:
      – SubjectFull: Child Abuse
        Type: general
      – SubjectFull: Mental Health
        Type: general
      – SubjectFull: Home Visits
        Type: general
      – SubjectFull: Attachment Behavior
        Type: general
      – SubjectFull: Parent Child Relationship
        Type: general
      – SubjectFull: Family Relationship
        Type: general
      – SubjectFull: Family Environment
        Type: general
      – SubjectFull: Prevention
        Type: general
      – SubjectFull: Questionnaires
        Type: general
      – SubjectFull: Anxiety
        Type: general
      – SubjectFull: Mothers
        Type: general
      – SubjectFull: Parent Influence
        Type: general
      – SubjectFull: Trust (Psychology)
        Type: general
      – SubjectFull: Hawaii
        Type: general
    Titles:
      – TitleFull: Association of Home Visitors' and Mothers' Attachment Style with Family Engagement
        Type: main
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    HasContributorRelationships:
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            NameFull: McFarlane, Elizabeth
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            NameFull: Burrell, Lori
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            NameFull: Tandon, Darius
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            NameFull: Derauf, D. Christian
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            NameFull: Leaf, Philip
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            NameFull: Duggan, Anne
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              Y: 2010
          Identifiers:
            – Type: issn-print
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            – TitleFull: Journal of Community Psychology
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