USA: The effects of the Clinical Newborn Behavioral Assessment Scale (CLNBAS) on maternal representations, postpartum depression, and the quality of the mother-child relationship: Some preliminary findings
J. K. Nugent, J. Killough, J. Wides, J. Gonzalez, K. Olsen, N. Bruschweiler-Stern, D. Stern, T. B. Brazelton.

A current collaboration between the Brazelton Institute, the University of Massachusetts, Amherst and the University of Geneva, has provided a first opportunity to conduct research using the new clinical revision of the NBAS, the Clinical Version of the Neonatal Behavioral Assessment Scale (CLNBAS) (Nugent & Brazelton, 2000). The CLNBAS was designed as a tool for relationship building in the newborn period, to enable clinicians to systematically identify the unique behavioral characteristics of the newborn, and to enable them to use this information with parents, in order to make recommendations and decisions about the baby's care and development. In performing the CLNBAS in the presence of the parents the clinician has the opportunity to increase the parent's awareness of their infant's competencies, form a relationship with the parents, and thereby positively influence parent-child interactions from the beginning.

The interventive effects of the CLNBAS are being examined in a controlled, longitudinal study that is looking at the development of the mother-infant relationship over the first four months. This collaboration is taking place through the supportive cooperation of the neonatal units at Baystate Medical Center, Springfield, MA, and Cooley Dickinson Hospital, Northampton, MA. Immediately after birth, measures of mothers' perceptions of themselves and of their newborns are being collected through the Maternal Representations Questionnaire (MRQ) (Bruschweiler-Stern & Stern, 1998). These measures are collected again during subsequent home visits at three weeks and at four months, where measures of postpartum depression are also collected. (Edinburgh Postnatal Depression Scale, Cox et al., 1987). In having mothers complete a series of Lickert-like scales of polar descriptors, the MRQ provides the unique opportunity to track their perceptions over time, and to understand the impact of the CLNBAS on these perceptions. A final stage of this study provides the opportunity to collect mothers perceptions again, at four months. Also to be completed at this time are ratings of effective and sensitive mother-child interactions (CARE-Index, Crittenden, 1981, 1998), and an examination of the relationship of the MRQ measures and the earlier CLNBAS to mother-child interaction.

Though early findings of this study are largely preliminary; they do suggest some qualitative strengths that mothers have shown over the first month of their babies' lives. Results of the MRQ show that most of the participating mothers felt they were able to console their crying baby (95%), able to get their baby to look at them (81%), felt effective in their role as mother, (98%), and felt comfortable in caring for their baby (100%). Significantly more experimental mothers felt they understood their baby's needs, over controls (97% vs. 71%, p<.02). There was also a trend of experimental mothers having fewer incidences of postpartum depression (EPDS cutoff scores of less than 12).

Anecdotally, Maria Curtin-McKenna, Parent Education Coordinator at Cooley-Dickinson Hospital, and collaborator in this study, has observed, "doing the exam (CLNBAS) with the infant was actually the way to the parent". Through the infant-based information presented and the common language developed, "We (parents and examiner) end up looking at the baby in the same way". The possibility for this quickly won therapeutic alliance is an important aspect of the CLNBAS, for, as Daniel Stern stated, "Most therapeutic alliances can be made rapidly and secured solidly if the central focus of the alliance is to make the parent a better parent"(p. 114, 1995).

(References are available from the author)