Influential factor combinations leading to language outcomes following a home visiting intervention: A qualitative comparative analysis (QCA).

Mothers' antenatal psychological resources were a flag for future language concerns which can be used to improve the precision of the MECSH intervention. They were highly influential to their children's Good and Poor language outcomes by 5 years, when over time they were combined with characteristics such as early childhood education, poor maternal responsivity and/or the number of children in the home. Knowledge of early conditions associated with later Poor language can help clinicians identify and respond in preventative and promoting ways to improve language skills. What this paper adds What is already known on the subject Children experiencing adversity are more vulnerable to language difficulties. Both risk for language difficulties and protection against them in this group are via a complex combination of factors. It is unknown how intervention works with these complex factors to result in Good and Poor language outcomes. What this paper adds to existing knowledge There are multiple paths to both Good and Poor language outcomes for children experiencing adversity. Mothers' psychological resources antenatally in combination with other key factors were particularly influential to Good and Poor language outcomes. What are the clinical implications of this work? In this study, maternal antenatal distress together with poor maternal responsivity were present in children's paths to Poor language outcomes at school entry. An extra focus on responsivity is required in antenatally distressed mothers of children experiencing adversity in early interventions. Children of mothers with good psychological resources antenatally who received home visiting intervention had Good language outcomes at 5 years when combined with 3 years or more of early childhood education and if there were one to two children in the home. Knowledge of these influences on language development can improve the precision of home visiting interventions and help clinicians tailor their visits to individual families' needs.