Comparing the effectiveness of home visiting paraprofessionals and mental health professionals delivering a postpartum depression preventive intervention: a cluster-randomized non-inferiority clinical trial

Tandon, Darius; Johnson, Jessica K.; Diebold, Alicia; Segovia, Melissa; Gollan, Jackie K.; Degillio, Aria; Zakieh, Dana; Chen, Yeh; Solano-Martinez, Jesus; Ciolino, Jody D.

doi:10.1007/s00737-021-01112-9

Cited by 20 publications

(15 citation statements)

References 48 publications

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“…The EPIC longitudinal study builds on a completed CRT that enrolled 874 pregnant women from home visiting (HV) programs to examine the effects of MB on maternal mental health through 6 months postpartum [29]. The parent study was conducted with 37 HV programs across seven states (Illinois, Minnesota, Ohio, Michigan, Iowa, Missouri, and West Virginia).…”

Section: Methodsmentioning

confidence: 99%

“…Of these 37 HV programs, 16 implemented MB using mental health professionals (e.g., licensed clinical social workers), 15 implemented MB using paraprofessional home visitors, and six were control sites delivering usual HV. The parent study's primary outcome was maternal depressive symptoms as measured by the Quick Inventory of Depressive Symptomatology (QIDS), with secondary outcomes related to core CBT skills-specifically, mood regulation, behavioral activation, modification of harmful thought patterns, and utilization of social support [28,29]. The EPIC study, a long-term observational cohort study, will re-consent the same cohort of women enrolled in the CRT and recruit women from 10 additional HV programs to serve as additional control participants (receiving usual HV).…”

Section: Methodsmentioning

confidence: 99%

“…Women in the intervention arms had a varying degree of intervention receipt (0-6 sessions) [29]. While the parent study involved MB delivered in a group setting either via trained mental health professional or a home visiting paraprofessional, we will group all participants receiving intervention into one exposure group, regardless of the deliverer (home visitor vs. mental health professional).…”

Section: Intervention Conditionsmentioning

confidence: 99%

“…The Effects of a Prenatal Depression Preventive Intervention on parenting and young children's Self-Regulation and Functioning (EPIC) study examines the effect of an evidence-based perinatal depression prevention program-Mothers and Babies (MB)-on parenting and child development in the preschool years (2.5-4.5 years of age). Building on a completed cluster-randomized trial (CRT) [28,29] that delivered the MB intervention prenatally to low-income women, the study will examine whether targeting depression symptoms prenatally can prevent the kinds of negative parenting and child development outcomes that so often affect families of depressed mothers. As shown in Fig.…”

Section: Introductionmentioning

confidence: 99%

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Testing the effects of a prenatal depression preventive intervention on parenting and young children’s self-regulation and functioning (EPIC): protocol for a longitudinal observational study

et al. 2021

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Background Perinatal depression is a pervasive public health concern that disproportionately affects low-income women and can have negative impacts on parenting and child developmental outcomes. Few interventions focus on preventing perinatal depression. Previous studies suggest that Mothers and Babies is efficacious in preventing the worsening of depressive symptoms and the onset of postpartum depression. This manuscript presents the protocol of the EPIC study (Effects of a Prenatal Depression Preventive Intervention on parenting and young children’s Self-Regulation and Functioning) to test the effects of Mothers and Babies on parenting and child developmental outcomes through 54 months postpartum. EPIC is an observational study that builds on a completed cluster-randomized trial (CRT). Innovations of this study are direct observations of a subsample of mother-child dyads and the inclusion of fathers/caregivers’ variables as moderators of maternal mental health. Methods For this study, we plan to enroll 738 women with children under 30 months old, ≥18 years old, and who speak English or Spanish. Additionally, 429 fathers, partners, or other adult caregivers will be recruited through women participating in the study. Women will be recruited through the parent study (intervention and control participants) or through one of 10 home visiting programs in Illinois (control participants). Data collection will take place through maternal self-report at five time points (when the child is 30, 36, 42, 48, and 54 months), paternal self-report at three time points (when the child is 30, 42, and 54 months), and through mother-child observations at three time points (when the child is 36, 42, and 48 months). Outcome domains include maternal mental health, cognitive-behavioral and parenting skills, and child self-regulation and functioning. Moderators include the contributions of fathers/caregivers, race-ethnicity, and socioeconomic disadvantage. Power and sample size were calculated assuming a two-sided 5% type I error rate and assumed analyses on the individual level. Discussion This study has several key strengths and innovations, as well as great potential significance to influence the long-term trajectories of parenting and child development via prenatal intervention. Trial registration The study was retrospectively registered at ClinicalTrials.gov (Identifier: NCT04296734) on March 5, 2020.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Intervention Conditionsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Testing the effects of a prenatal depression preventive intervention on parenting and young children’s self-regulation and functioning (EPIC): protocol for a longitudinal observational study

et al. 2021

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“…Though findings from LMICs are promising on LHWdelivered EBPs, minimal research has investigated if there are differences in clinical outcomes depending on provider experience and education level (Barnett, Gonzalez, et al, 2018). One recent study found similar levels of fidelity and effectiveness between LHW and professional delivery of a perinatal depression preventive intervention (Diebold et al, 2020;Tandon et al, 2021), but few other studies have made these comparisons. If LHWs are less effective at delivering EBPs than mental health professionals or their roles in auxiliary care diminishes effectiveness, disparities could be exacerbated for marginalized populations.…”

Section: Effectiveness: Are Lhw Models Of Care Effective?mentioning

confidence: 99%

Future Directions in Lay Health Worker Involvement in Children’s Mental Health Services in the U.S.

Barnett

Sanchez

Rosas

et al. 2021

Journal of Clinical Child & Adolescent Psychology

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Nearly half of children meeting criteria for a mental health disorder in the United States (U.S.) do not receive the treatment they need. Unfortunately, lack of access to and engagement in mental health services can be seen at even higher rates for historically marginalized groups, including low-income, racial, and ethnic minority youth. Lay Health Workers (LHWs) represent a valuable workforce that has been identified as a promising solution to address mental health disparities. LHWs are individuals without formal mental health training who oftentimes share lived experiences with the communities that they serve. A growing body of research has supported the mobilization of LHWs to address service disparities around the globe; however, challenges persist in how to scale-up and sustain LHW models of care, with specific barriers in the U.S. In this paper, we describe LHWs' different roles and involvement in the mental health field as well as the current state of the literature around LHW implementation. We integrate the RE-AIM Framework with a conceptual model of how LHWs address disparities to outline future directions in research and practice to enhance equity in the reach, effectiveness, adoption, implementation, and maintenance of LHW models of care and evidencebased practices for historically marginalized communities within the U.S.

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Leading the charge toward a world without depression: perinatal depression can be prevented

Muñoz

Barrera

et al. 2021

Arch Womens Ment Health

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Comparing the effectiveness of home visiting paraprofessionals and mental health professionals delivering a postpartum depression preventive intervention: a cluster-randomized non-inferiority clinical trial

Cited by 20 publications

References 48 publications

Testing the effects of a prenatal depression preventive intervention on parenting and young children’s self-regulation and functioning (EPIC): protocol for a longitudinal observational study

Testing the effects of a prenatal depression preventive intervention on parenting and young children’s self-regulation and functioning (EPIC): protocol for a longitudinal observational study

Future Directions in Lay Health Worker Involvement in Children’s Mental Health Services in the U.S.

Leading the charge toward a world without depression: perinatal depression can be prevented

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