Efficacy of a Maternal Depression Prevention Strategy in Head Start

Silverstein, Michael; Diaz-Linhart, Yaminette; Cabral, Howard; Beardslee, William R.; Hegel, Mark T.; Haile, Winta; Sander, Jenna; Patts, Gregory; Feinberg, Emily

doi:10.1001/jamapsychiatry.2017.1001

Cited by 30 publications

(39 citation statements)

References 36 publications

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“…7,8,9 Consistent with other depression interventions that have included problem-solving components, 7,12,13,48 recent work has demonstrated that PSE substantially reduces the rate of symptomatic person-time over a full year. 11 According to the present study, most of this impact appears to have been a direct effect of PSE on depressive symptoms. However, it also appears that a substantial part of PSE’s effect is mediated through a constellation of other factors, most notably the reduction of perceived stress.…”

Section: Discussionsupporting

confidence: 44%

“…Details of our trial’s methods and its adherence to the Consolidated Standards of Reporting Trials (CONSORT) reporting guideline have been reported previously. 11 The Boston University Medical Center institutional review board approved this study. All participants provided written informed consent.…”

Section: Methodsmentioning

confidence: 99%

“…We verified our main outcomes using multiple imputation techniques for missing data. 11 We conducted all analyses described with SAS statistical software version 9.3 (SAS Institute Inc).…”

Section: Methodsmentioning

confidence: 99%

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Problem-Solving Education to Prevent Depression Among Low-Income Mothers

et al. 2018

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Key Points Question What are the principal mechanisms by which problem-solving education prevents depression among low-income mothers? Findings In this mediation analysis of 230 Head Start mothers participating in a randomized clinical trial, those receiving problem-solving education experienced a reduction in depressive symptom episodes. Across an array of plausible theory-based intervention mediators, improvement in perceived stress was associated with both intervention participation and depressive symptom outcomes; however, the mechanism for much of the intervention’s impact on depression remained unexplained. Meaning Problem-solving interventions may reduce depressive symptom burden, in part, by helping recipients manage stress; successfully scaling such interventions may require expanding intervention components related to stress management and reducing components that are unrelated.

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Section: Discussionsupporting

confidence: 44%

Section: Methodsmentioning

confidence: 99%

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Problem-Solving Education to Prevent Depression Among Low-Income Mothers

et al. 2018

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“…Integrating mental health services in home visiting has been shown to reduce logistical barriers experienced by some families [8-10]. There are currently 4 individual-level psychosocial interventions that target maternal depression as a primary outcome [21,22,24]. One intervention has been delivered in a group format [23] and requires mothers to travel to the location of the group.…”

Section: Introductionmentioning

confidence: 99%

Video-Delivered Family Therapy for Home Visited Young Mothers With Perinatal Depressive Symptoms: Quasi-Experimental Implementation-Effectiveness Hybrid Trial

Cluxton-Keller

Williams

Buteau³

et al. 2018

JMIR Ment Health

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BackgroundThe Federal Maternal, Infant, and Early Childhood Home Visiting Program is a national child abuse prevention strategy that serves families at risk for child maltreatment throughout the United States. Significant portions of the clients are young mothers who screen positive for clinically significant perinatal depressive symptoms and experience relational discord that worsens their symptoms. Although home visitors refer those who screen positive for depression to community-based treatment, they infrequently obtain treatment because of multiple barriers. These barriers are compounded for home visited families in rural areas.ObjectiveThis pilot study aimed to explore the feasibility, acceptability, and effectiveness of a video-delivered family therapy intervention on reducing maternal depressive symptoms and improving family functioning and emotion regulation.MethodsA total of 13 home visited families received the video-delivered family therapy intervention. This study included a historical comparison group of mothers (N=13) who were previously enrolled in home visiting and screened positive for clinically significant perinatal depressive symptoms but refused treatment. A licensed marriage and family therapist delivered the family therapy intervention using Health Insurance Portability and Accountability Act–compliant videoconferencing technology on a computer from an office. Families participated in sessions in their homes using cell phones, tablets, and computers equipped with microphones and video cameras. Outcomes were measured following the final therapy session (post intervention) and 2 months later (follow-up). Depressive symptom scores of mothers who received the video-delivered family therapy intervention were compared with those of mothers in the historical comparison group over a 6-month period. Univariate statistics and correlations were calculated to assess measures of feasibility. Percentages and qualitative thematic analysis were used to assess acceptability. Wilcoxon signed-rank tests were used to assess changes in maternal and family outcomes.ResultsNo families dropped out of the study. All families reported that the technology was convenient and easy to use. All families reported high satisfaction with the video-delivered intervention. Nearly all families reported that they preferred video-delivered family therapy instead of clinic-based therapy. Therapeutic alliance was strong. Mothers demonstrated a statistically significant reduction in depressive symptoms (P=.001). When compared with mothers in the historical comparison group, those in the family therapy intervention showed a significant reduction in depressive symptoms (P=.001). Families demonstrated statistically significant improvements in family functioning (P=.02) and cognitive reappraisal (P=.004).ConclusionsThis pilot study yielded preliminary findings that support the feasibility, acceptability, and effectiveness of the video-delivered family therapy intervention for underserved home visited families in rural areas. Our finding...

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“…FN is a care management strategy designed to reduce disparities in care (12). Traditional models utilize trained community health workers who assist families in overcoming systems and patient barriers to services over a time-limited period.FN is rooted in the Chronic Care Model (13) and has evidence in multiple diseases as a means to reduce disparities by shortening the interval between discovery of risk (e.g., a positive screening mammogram for breast cancer) and diagnostic ascertainment (14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25).…”

Section: Optimizing Intervention Delivery For Scale: Family Navigatiomentioning

confidence: 99%

Using the Multiphase Optimization Strategy (MOST) Framework to Test Intervention Delivery Strategies: A Study Protocol

Broder‐Fingert¹,

Kuhn

Sheldrick

et al. 2019

Preprint

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Background Delivery of behavioral interventions is complex, as the majority of interventions consist of multiple components used either simultaneously, sequentially, or both. The importance of clearly delineating delivery strategies within these complex interventions - and furthermore understanding the impact of each strategy on effectiveness - has recently emerged as an important facet of intervention research. Yet, few methodologies exist to prospectively test the effectiveness of delivery strategies and how they impact implementation. In the current paper, we describe a study protocol for a large randomized controlled trial in which we will use the Multiphase Optimization Strategy (MOST) – a novel framework developed to optimize interventions - to test the effectiveness of intervention delivery strategies using a factorial design. We apply this framework to delivery of Family Navigation (FN), an evidence-based care management strategy designed to reduce disparities and improve access to behavioral health services, and test four components related to its implementation. Methods/Design The MOST framework contains three distinct phases: Preparation, Optimization, and Evaluation. The preparation phase for this study occurred previously. The current study consists of the optimization and evaluation phases. Children ages three-to-twelve years-old who are detected as “at-risk” for behavioral health disorders (n=304) at a large, urban federally qualified community health center will be referred to a Family Partner – a bi-cultural, bi-lingual member of the community with training in behavioral health and systems navigation – who will perform FN. Families will then be randomized to one of 16 possible combinations of FN delivery strategies (2x2x2x2 factorial design). The primary outcome measure will be achieving a family-centered goal related to behavioral health services within 90 days of randomization. Implementation data on fidelity, acceptability, feasibility, and cost of each strategy will also be collected. Results from the primary and secondary outcomes will be reviewed by our team of stakeholders to optimize FN delivery for implementation and dissemination based on effectiveness, efficiency, and cost. Discussion In this protocol paper, we describe how the MOST Framework can be used to improve intervention delivery. These methods will be useful for future studies testing intervention delivery strategies and their impact on implementation.

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Efficacy of a Maternal Depression Prevention Strategy in Head Start

Abstract: clinicaltrials.gov Identifier: NCT01298804.

Cited by 30 publications

References 36 publications

Problem-Solving Education to Prevent Depression Among Low-Income Mothers

Problem-Solving Education to Prevent Depression Among Low-Income Mothers

Video-Delivered Family Therapy for Home Visited Young Mothers With Perinatal Depressive Symptoms: Quasi-Experimental Implementation-Effectiveness Hybrid Trial

Using the Multiphase Optimization Strategy (MOST) Framework to Test Intervention Delivery Strategies: A Study Protocol

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