Maternal Depression and Early Head Start

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DESCRIPTION (provided by candidate): Maternal depression is a source for substantial morbidity for both mother and child. This K23 application outlines a mentored 5-year education and research plan, devoted to developing and studying a self- management support system for maternal depression in Early Head Start (EHS), a federally funded early child development program for low income families. The intervention, based on the Chronic Care Model, will involve the identification of mothers with depressive symptoms through standardized instruments, and a case-management system that involves motivational enhancement and problem solving therapy. Through these strategies-the latter of which is an evidence-based treatment for depression in and of itself-EHS caseworkers will link mothers to further evidence-based mental health services, such cognitive behavioral therapy and medication management, and provide subsequent ongoing support and reassessment. The specific aims of the research plan are to: 1. conduct qualitative interviews with EHS mothers to determine the range of attitudes to having their own mental health addressed as part of their children's preschool experience; 2. conduct focus groups with EHS caseworkers to learn the personal and institutional barriers to participating in this type of case-management system; 3. develop, through a 9-month pilot intervention, the details of the case-management protocol; 4. conduct a quasi-experimental study of the system to test its effect on EHS mothers' receipt of services for depression, depressive symptoms, social functioning, quality of maternal teaching interactions with their children, and child health care utilization. The candidate will gain experience in qualitative and quantitative research methods, behavioral intervention design, systems approaches to mental health promotion, and analysis of parent-child interaction. Information and experience gained from this project will be used to design a longitudinal randomized controlled trial to study the effect of this system on both mothers' depressive symptoms and their children's developmental outcomes.