A pilot randomized trial of video-based family therapy for home-visited mothers with perinatal depressive symptoms

项目摘要 母婴和幼儿家访计划是一项全国性的防止虐待儿童的计划。 这是一项为美国各地的弱势家庭服务的战略。抑郁的母亲（怀孕和产后） 送货）占上门客户的很大一部分。这些母亲经历的家庭冲突， 加重或减轻他们的抑郁症状。此外，他们很少得到治疗， 多重障碍。对于生活在农村地区的人来说，这些障碍更加严重。这项研究将测试 创新的家庭治疗干预措施的初步效果，增强韧性技能 培训（REST），旨在减少产妇抑郁症状和家庭冲突，并增加家庭 凝聚力和家庭认知的重新评价。它建立在我们成功的初步 REST的研究表明，它显着减少了家庭访问的母亲围产期抑郁症状， 显著减少家庭冲突，显著提高家庭凝聚力和家庭认知 重新评估拟议的研究解决了一个关键的服务需要，家访的母亲与中度至 严重的抑郁症状，生活在农村地区，获得治疗的机会很少。 拟议的研究符合NIMH服务和干预研究部的高度优先事项 在这方面，教科文组织在为不同的和得不到充分服务的人口制定创新的服务提供办法方面发挥了重要作用。 拟议研究的长期目标是将REST整合到整个农村家访机构中 美国的为了实现这个目标，我们必须首先实现当前应用程序的目标。的 拟议的研究采用了有效性-实施混合1型设计，并进行了初步随机试验， 包括三个目标：1）测试REST的可行性，可接受性，耐受性和安全性， 社区治疗师; 2）测试REST与标准护理相比的初步有效性， 减少母亲抑郁症状和家庭冲突，增加母亲入学率/工作 成绩，提高家庭凝聚力和家庭认知的重新评价;和3）收集初步数据， 实现REST的障碍和促进因素。研究结果将用于一项更大规模的随机试验 严格测试REST的有效性。

PROJECT SUMMARY The Maternal, Infant, and Early Childhood Home Visiting Program is a national child abuse prevention strategy that serves vulnerable families throughout the United States. Depressed mothers (pregnant and post- delivery) make up a significant portion of home visited clients. These mothers experience family conflict that precipitates or worsens their depressive symptoms. Furthermore, they infrequently get treatment due to multiple barriers. These barriers are compounded for those who live in rural areas. The proposed study will test the preliminary effectiveness of an innovative family therapy intervention, Resilience Enhancement Skills Training (REST), that aims to reduce maternal depressive symptoms and family conflict, and increase family cohesion and family cognitive reappraisal in this vulnerable population. It builds on our successful preliminary study of REST that showed it significantly reduced perinatal depressive symptoms in home visited mothers and significantly reduced family conflict, and significantly improved family cohesion and family cognitive reappraisal. The proposed study addresses a critical service need for home visited mothers with moderate to severe depressive symptoms, living in rural areas, with low access to treatment. The proposed study aligns with the NIMH Division of Services and Intervention Research high priority area in the development of innovative service delivery approaches for diverse and underserved populations. The long-term goal of the proposed study is to integrate the REST into rural home visiting agencies throughout the United States. To accomplish this goal, we must first accomplish the aims of the current application. The proposed study uses an effectiveness-implementation hybrid type 1 design with a pilot randomized trial and includes three aims: 1) Test the feasibility, acceptability, tolerability, and safety of REST conducted by community therapists; 2) Test the preliminary effectiveness of the REST compared to standard of care in reducing maternal depressive symptoms and family conflict, increasing maternal school enrollment/job attainment, and improving family cohesion and family cognitive reappraisal; and 3) Collect preliminary data on barriers and facilitators to implementation of REST. The results will be used to inform a larger randomized trial that rigorously tests the effectiveness of REST.