Promoting infant mental health through relationship-based interventions: STEEP™ and Seeing Is Believing®

Martha Farrell Erickson, Ph.D. & Byron Egeland, Ph.D.

The STEEP™ program (Steps Toward Effective, Enjoyable Parenting) aims to promote healthy parenting and prevent social-emotional problems among babies in families facing risk factors such as poverty, social isolation, or a history of troubled relationships.

Attachment theory provides a framework for the program, and longitudinal research on factors that underlie healthy parent-child relationships informs the program’s broad goals (Egeland & Erickson, 2003; Suess, G., Erickson, M.F., Egeland, B., Scheuerer-Englisch, H., Hartmann, H-P, in press).

STEEP program structure

Participants typically are recruited through obstetric clinics during pregnancy. Biweekly home visits, tailored to the needs and strengths of each family, continue until the child’s second birthday. Shortly after the babies are born, mothers begin attending biweekly group sessions. Reflecting the relationship-based approach of STEEP, each group is led by the person who conducts the home visits for those eight to 10 families.

Group sessions begin with mother-child activities geared to the babies’ stage of development. Then, following a casual meal, mothers gather for “momtalk,” focused on their own personal growth and life goals. Although group meetings are for mothers and babies, fathers and other family members are included in home visits and periodic family events.

Grounded in attachment theory and research

The primary pathway to a secure attachment and the foundation of infant mental health is parental sensitivity to baby’s cues and signals. With that in mind, STEEP promotes sensitivity and addresses factors that can undermine sensitive care.

The primary pathway to a secure attachment and the foundation of infant mental health is parental sensitivity to baby’s cues and signals.

A centerpiece of the program is Seeing Is Believing®, video-recording parent-infant interaction, then engaging parents in self-observation and discovery as they watch the video with their home visitor (Erickson, 2005). Through open-ended questions, the facilitator encourages parents to focus on what their baby is telling them and to recognize their own skills in adapting to their baby’s needs.

Video-recording helps to keep the parent-child relationship at the center of the intervention, provides a permanent record for monitoring progress, and is a valuable aid when facilitators seek supervision or consultation. The video becomes a treasured keepsake for the family and, according to many participants, a powerful incentive to participate in the program.

Babies know what they experience — whether mom and dad can be counted on to offer comfort when they cry, play with them when they’re feeling sociable, and respect their privacy when they’d rather sleep than be tickled. Many factors underlie a parent’s ability to sustain sensitive, responsive care. Although each family has unique strengths and challenges, some major factors deserve special attention in a program designed to promote sensitivity:

Knowledge and understanding of child development

Sensitive care is grounded in knowledge about child development and understanding of the developmental meaning of key behaviors such as separation protest or toddler negativism. When parents lack that understanding, they often hold unrealistic expectations and get caught in a cycle of frustration and anger, attributing negative qualities to their child just because he or she is doing what kids naturally do.

Social support

For parents to respond sensitively to their children’s needs, their own needs must be addressed. Many parents are socially isolated; they lack supportive friends or family members, and/or lack the skills or confidence to access supportive resources. Barriers to getting support also may include lack of transportation and money. Sometimes parents are surrounded by family and friends, but those networks do not support good parenting and the best interest of the child. This is dramatically evident, for example, in families living in a culture of drug abuse. STEEP helps parents identify potential sources of support and develop the skills to use support effectively.

Looking back, moving forward

Consistent with attachment theory and research on intergenerational transmission of parenting, an important part of STEEP is to help parents reflect on what they learned in their own early relationships and how that influences their responses to their children. Both in home visits and group, STEEP creates a supportive environment in which parents reflect on their history, confront painful memories, and identify positive experiences to pass on to their children.

Understanding that no one is a perfect parent, the focus is on leaving hurtful patterns behind and mustering all available resources to become a “good enough” parent. As described in the STEEP facilitators’ guide (Erickson, Egeland, Simon & Rose, 2002), group activities give parents permission to begin looking back so they can move forward. Home visits afford an opportunity for more individualized encouragement, support, and reflection.

Broad dissemination and adoption

Since STEEP and Seeing Is Believing first were developed and evaluated at the University of Minnesota, they have been used in varied settings throughout North America, Australia, and Europe. The approaches have been used effectively with several special populations, including indigenous families, women identified as substance abusing during pregnancy, teen parents, mothers who are depressed, families identified as abusive or neglectful, and families of pre-term, medically fragile infants. Most recently, STEEP has been implemented and evaluated across several locations throughout Germany (Suess, et al, in press).

For further information about this work, or to inquire about training tailored to the strengths and needs of staff in your organization, contact the authors in care of Dr. Erickson,


Egeland, B., Erickson, M. F. (2003). Lessons from STEEP™: Linking theory, research and practice for the well-being of infants and parents. In A. Sameroff, S. McDonough & K., Rosenblum (Eds.), Treating Parent-infant Relationship Problems: Strategies for Intervention. New York: Guilford, Publications, p. 213–242.

Erickson, M. F. (2005). Seeing is Believing® Training DVD. Minneapolis, MN: Irving B. Harris Training Programs, Center for Early Education & Development, University of Minnesota.

Erickson, M. F., Egeland, B., Simon, J., Rose, T. (2002). STEEP™ Facilitator’s Guide. Minneapolis, MN: Irving B. Harris Training Programs, Center for Early Education & Development, University of Minnesota.

Suess, G., Erickson, M. F., Egeland, B. Scheuerer-Englisch, H., Hartmann, H-P. (In press). Attachment-based preventive intervention: Lessons from 30 years of implementing, adapting and evaluating the STEEP™ program. In H. Steele & M. Steele (Eds.), Handbook of Attachment-based Interventions. New York, NY: Guilford Publications.

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