ICBT for Maternal Depression: Community Implementation in Head Start

摘要 低收入育龄妇女患抑郁症的风险不成比例，尽管 有效的干预措施，往往得不到他们所需的治疗。(1，2)我们开发了妈妈- NET，这是一种远程的、由教练协助的、基于互联网的干预，改编自一种经验支持的认知 抑郁症的行为治疗(CBT)，以满足抑郁症母亲的需求。两个随机对照 试验(3，4)表明，妈妈网在减少抑郁症状和改善育儿方面非常有效 行为和儿童适应。在拟议的项目中，我们试图研究我们是否可以扩大覆盖范围 通过在Head Start环境中实施母亲网络干预。把妈妈网搬到HS 要求我们将重点放在实施过程上，以了解各机构将如何与 采取干预措施，以便有效和可持续地实施。同样重要的是，向代理机构提供 最能满足其可用内部资源的交付方法。为了解决这些问题，我们建议 使用混合类型2，有效性-实施设计(5)来比较以下两种实施方法 妈妈网的交付，一种是利用现有的高强度训练方法，另一种是利用低强度的 强化辅导，旨在提供支持性的责任，而不是心理教育支持。我们 建议遵循探索、准备、实施和维持流程模式(EPIS(6，7))，以 引导评估。建议的研究是建基於：(A)房协认识到有需要找出和 应对产妇抑郁(8)；(B)呼吁将产妇抑郁治疗纳入幼儿服务 环境(9-11)；和(C)在干预主义者的指导下，基于网络的CBT方法的有效性的证据 未接受正式心理健康培训(12，13)。我们会(A)研究与每项计划有关的房协机构的特点 EPIS实施模式的阶段；(B)检查有效性(母亲抑郁；育儿行为； 儿童情绪和行为功能)和实施(可达性、可接受性、忠诚度和成本) 在一种设计内的结果，其中各机构将被随机分配到实施方法，母亲将 在机构内被随机分配到妈妈网或照常治疗(TAU)/等待名单的情况；以及(C)最后， 为每项执行战略审查产妇功能变化的中介影响 在母亲抑郁症状方面拥有核心的妈妈网技能。

ABSTRACT Low income women of childbearing age are at disproportionate risk for depressive syndromes and, despite the availability of efficacious interventions, often do not receive the treatment they need.(1,2) We developed Mom- Net, a remote, coach-facilitated, Internet-based intervention adapted from an empirically-supported cognitive behavioral treatment (CBT) for depression to address the needs of depressed mothers. Two randomized control trials(3,4) demonstrated Mom-Net to be highly effective in reducing depressive symptoms and improving parenting behavior and child adjustment. In the proposed project we seek to examine whether we can expand the reach of the Mom-Net intervention by implementing within the Head Start Environment. Moving Mom-Net into HS requires that we focus on implementation processes to understand how agencies would interact with the intervention in order to implement with effectiveness and sustainability. As well, it is important to offer agencies delivery approaches that can best meet their available internal resources. To address these issues, we propose using a hybrid type 2, Effectiveness-Implementation design(5) to compare two implementation approaches for the delivery of Mom-Net, one with its existing high-intensity coaching approach, and one making use of a low- intensity coaching, designed to provide supportive accountability, but not psychoeducational support. We propose to follow the Exploration, Preparation, Implementation, and Sustainment process model (EPIS(6,7)) to guide the evaluation. The proposed study is predicated on: (a) HS's awareness of the need to identify and respond to maternal depression(8); (b) calls to embed maternal depression treatment into early childhood service settings(9-11); and (c) evidence of the effectiveness of web-based CBT approaches, guided by interventionists without formal mental health training(12,13). We will (a) examine characteristics of HS agencies related to each phase of the EPIS implementation model; (b) examine effectiveness (Maternal Depression; Parenting Behavior; Child Emotional and Behavioral Functioning) and implementation (reach, acceptability, fidelity, and cost) outcomes within a design in which agencies will be randomized to implementation approach, and mothers will be randomized, within agency, to either Mom-Net or Treatment as Usual (TAU)/waitlist conditions; and (c) finally, examine for each implementation strategy, the mediating influence of changes in maternal functioning associated with core Mom-Net skills on maternal depressive symptoms.