Dr. Kathleen M. Baggett, Associate Professor of Health Promotion & Behavior at the School of Public Health at Georgia State University, gave an invited plenary address at the Science of Caregiving: Bringing Voices Together Summit presented by the National Institute of Nursing Research and Partners. The talk took place in August 2017 at the Bethesda, MD campus of the National Institutes of Health and was on research innovation in the area of “Strengthening Caregiver Practices that Build Infant Social Emotional and Social Communication Development.”

1. Strengthening Caregiver Practices that Build Infant Social-Emotional
and Social Communication Competencies
Kathleen M. Baggett, Ph.D.
Associate Professor & Director of Early Childhood Social-Emotional Health Promotion Research
Mark Chaffin Center for Healthy Development
Division of Health Promotion and Behavior, School of Public Health
Georgia State University
Prepared for the National Institute of Nursing Research Summit on the Science of Caregiving
August 8, 2017
Bethesda, MD
Contact: Kbaggett@gsu.edu

2. Infant-Net/Baby-Net Research Team
Kathleen M. Baggett, Ph.D., Georgia State University
Edward G. Feil
Betsy Davis
Lisa Sheeber
Susan H. Landry
Ursula Johnson
Kathleen M. Baggett
Edward G. Feil, Ph.D., Oregon Research Institute
Betsy Davis, Ph.D., Oregon Research Institute
Lisa Sheeber, Ph.D., Oregon Research Institute
Susan H. Landry, Ph.D., University of Texas, Houston
Ursula Johnson, Ph.D., University of Texas, Houston

3. Grant Participants Design
1-NIMH R34 MH073756 (2006-2008)
2-NICHD R01 HD1R01 HD064870 (2010-2014)
40 low-income mothers and thieir infants
159 low income mothers and their infants
RCT
2-CDC R18CE001705 (2009-2012) 13 Healthy Families home their mother infant caseloads Implement.
3- USDE, IES R324A100041 (2010-2013)
4- NICHD R21 HD06287 (2010-2012)
19 Early Head Start teachers and infants
21 Community Child Care teachers and infants
Feasibility
Pilot
5-HRSA R40MC26822 RCT (2014-2017) 36 Low income mothers and their infants exiting inner
urban NICUs
RCT
A Decade of Research: Acknowledgments and Disclosure
*Disclosure: This information or content and conclusions are those of the author and should not be construed as the
official position or policy of, nor should any endorsements be inferred by any of the entities above. Dr. Baggett is a
developer of the InfantNet/Baby-Net program.

4. Epigenetic toxic stress contributes to early infant vulnerability, which challenges
caregiving and leads to practices that further compromise health and developent
outcomes across the life course
• Prematurity and low birth weight
• Neurodevelopmental and behavioral challenges
• Developmental delays
Evidence Based Intervention 20 Year Lag
https://www.whatisepigenetics.com/what-is-epigenetics/
Community Implementation
Research Gap

6. Key Opportunities
Ø Deploy interventions
with the strongest
evidence of
effectiveness for
improving caregiving
practices demonstrated
to promote infant
social-emotional and
social- communication
competencies
Ø Make them accessible
to all caregivers-
especially the most
vulnerable
Ø Rigorously evaluate and
refine them to bring
them to scale while
maximizing
engagement for all
caregivers- especially
the most vulnerable

7. Baby-Net (ePALS) is a mobile web-based adaptation of the
evidence-based Play & Learning Strategies Home Visiting Program

8. Baby-Net goals are to:
Strengthen caregiving practices that build infant social-emotional health and
development
Improve access for vulnerable caregivers and infants to:
• Skills-based intervention: Practice – Observe – Reflect –Build Interaction Skills
• 24-hour mobile access
• Supportive coaching relationship

9. Weekly post-session remote coaching calls engage parents in
co-viewing their own videos to notice, celebrate and plan for
success

10. Sequenced Intervention Structure
Program Features
• Secure log in
• Discovery: Video-based teaching of new content
• Check-In Questions with immediate corrective feedback
• Session Review
• Guided Action Plan
• Self-Created Video of parent-infant interaction skill practice
• Remote Practice-Based Coach Call
• Administrative reports to monitor participant progress
• Secure email, text for coach-participant communication
Session Structure
Step 1
Discover
Step 2
Check In
Step 3
Guided
Action
Plan
Step 4
Video
Creation
Step 5
Coach Call
10-12 Weekly Skill-Based Sessions
1-2 Caregiver learning motivation 7 Linking words & actions
3 Recognizing signals 8 Reading with baby
4 Sensitive responding 9 1-2 Alternate caregiver sessions
5 Maintaining focus 10 Being your own coach
6 Introducing for engagement

11. Sample Demographics
Mothers
• =/<130% fed poverty
• 66% <$20,000/year
• 42% Non-White
• 38% Hispanic
• 46% high school/less
• Mean PDSS > clinical cut
Other
Caregivers/Providers
• Community child
care providers
• Early intervention
center based
teachers
• Healthy Families
home visitors
Infants
• Mean age = 4 months
• NICU; VLBW
• Identified disability
• Developmental delays
• Child maltreatment risk

12. Results

13. Results

14. Conclusions
• Program completion rates for mothers and child care providers were high
• Effects of the Internet, remote coaching adaptation of the PALS program
are encouraging
• Considerations for scalability:
• Given the continued digital divide for computer Internet access, future efforts
should focus on more ubiquitous technologies such as smart phone delivery
• Future efforts should include brief on-line multi-gating screening procedures that
assist families and child care providers in accessing tiered intervention best
matched to their need
• Opportunities for intentional imbedding of caregiver mental health focused
intervention: e.g., reducing maternal depression