2023 Articles

Qualitative insights from a randomized clinical trial of a mother–child emotional preparation program for preschool-aged children

Markowitz, Elizabeth S.; Maier, Malia C.; Ludwig, Robert J.; Austin, Judy; Maybach, Anna M.; Jaffe, Marc E.; Welch, Martha G.

Background
Early life stress and adversity conveys risk for emotional, behavioral, and developmental disorders. To address this risk in the preschool population, Mother–Child Emotional Preparation (MCEP) was tested as an in-school dyadic intervention for facilitating mother–child emotional connection through mother–child calming cycles. In a computer-generated block randomized controlled trial enrolling preschool-aged children and their mothers, in partnership with an early childhood learning center, we at Columbia University Irving Medical Center tested effects of MCEP across multiple domains. Within this RCT we designed a qualitative sub-study to understand how MCEP aligns with calming cycle theory and its impact on mothers and the mother–child relationship.

Methods
A qualitative researcher observed 14 group MCEP sessions consisting of nurture specialists facilitating reciprocal calming interactions through shared emotional expression between mothers and their preschool-aged children. We conducted two waves of participant interviews in English or Spanish, per participant preference. Participants (n = 8) were majority Hispanic at or below the federal poverty level. Group session observations were coded and analyzed for frequency, co-occurrence, variance by session, and alignment with calming cycle theory, incorporating demographic variables and attendance. Interview transcripts were translated from Spanish to English if needed, then coded and analyzed using thematic analysis.

Results
Qualitative analysis revealed mothers’ experiences of MCEP. Data demonstrated that calming position and emotional expression were mutually supportive, and that barriers to connection were calming cycle entry-points, not barriers. At the group level, supported by nurture specialists, fellow participants helped each other progress through calming cycles. Moreover, MCEP adapted to meet individual dyad needs, and mothers described its far-reaching impact.

Conclusions
Qualitative methods show that MCEP helps mother–child dyads emotionally connect through the calming cycle and fills a gap in early childhood education services. This study generated insights for quantitative studies and suggested implications for MCEP dissemination.

Trial registration
ClinicalTrials.gov, NCT03908268
, Registered April 9, 2019—Retrospectively registered.