Home-based family recovery supports: Feasibility, acceptability, and adoption of training home visitors in "Mothering from the Inside Out"

Support for families affected by substance use disorders (SUDs) remains challenging, particularly during the postpartum period. The objective of this study was to assess the introduction of an evidence-based parenting intervention, Mothering from the Inside Out (MIO), into the early intervention (EI) home visiting setting. We conducted a mixed methods pilot study in the United States to assess the training and delivery of MIO within EI. MIO training involves didactic learning followed by MIO delivery with weekly consultation. Our primary implementation outcomes were feasibility, acceptability, and factors influencing adoption. We assessed feasibility and fidelity via quantitative measures, and acceptability and adoption via qualitative interviews with providers and parents. Two cohorts of EI providers completed the didactic training: 2019 (in-person) and 2020 (virtually). Ten providers participated in the MIO didactic training and began delivering MIO to 11 mothers; 4 of 10 providers (2 from each cohort) completed the full training. All providers that completed achieved adequate fidelity. Acceptability of MIO and perceived fit within EI was high, though challenges related to complexity limited adoption. Despite encouraging preliminary findings that EI providers achieved adequate adoption and fidelity, further adaptations are needed to address implementation challenges and improve retention of providers and parents.