Developing an Integrated Mental Health Model for Home Visitation

开发家访综合心理健康模型

• 批准号: 8300450
• 负责人: Shiv Darius Tandon
• 金额: $ 19.38万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-05-01 至 2015-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8300450
• 关键词: Address; Affect; Anxiety; Area; Award; Baltimore; Caring; Child; Child Development; Chronic; Cities; Client; Cohort Studies; Collaborations; Communities; Comorbidity; County; Depressed mood; Development; Discipline of Nursing; Early treatment; Enrollment; Family; Funding; Goals; Health; Health Services Research; Home visitation; House Call; Intervention; Intervention Studies; Low income; Mental Depression; Mental Health; Mental Health Services; Modeling; Monitor; National Institute of Mental Health; Nurses; Outcome; Parenting behavior; Perinatal; Population; Population Heterogeneity; Post-Traumatic Stress Disorders; Prevention; Protocols documentation; Public Health; Relative (related person); Research; Screening procedure; Services; Site; Social Work; Social Workers; Societies; Symptoms; System; Testing; Training Programs; Universities; Woman; depressive symptoms; evidence base; group intervention; improved; innovation; intimate partner violence; maternal depression; pregnant; prevent; programs; randomized trial; service intervention; single episode major depressive disorder

DESCRIPTION (provided by applicant): This application for an R34 award proposes to develop and pilot test a model of mental health services integrated within home visitation (HV) programs serving pregnant and recently delivered women. There are three specific aims of this study. First, we will develop an integrated model of perinatal depression care within HV programs. This integrated model ("SCRIPT") will incorporate screening, referral, and individualized prevention and treatment services. Second, we will assess the feasibility of implementing the SCRIPT model with high fidelity in two HV programs. One HV program will use paraprofessionals as interventionists while the other program will use nurses and social workers as interventionists. Third, we will determine the impact of the SCRIPT model on depressive symptoms and major depressive episodes. To achieve Specific Aim 1, we will tailor the SCRIPT model for two HV programs, train HV staff and staff from community mental health and social service agencies on the model, and develop a fidelity monitoring system. To achieve Specific Aim 2, we will implement the SCRIPT model in two HV programs and assess the feasibility of SCRIPT implementation in these programs. To achieve Specific Aim 3, we will conduct a cohort study using a historical control. Women enrolling in the two study sites during months 1-9 will serve as historic controls (N = 108) while women enrolling in the study sites during months 12-24 will comprise the intervention group (N = 154). Assessments at enrollment in home visiting and at 3 months and 6 months after enrollment will be conducted to assess depressive symptoms, depressive episodes, anxiety, and PTSD. The public health significance of this project is substantial. Given consistent evidence that depression is a debilitating and chronic condition that has negative consequences for maternal parenting practices, interventions must attempt to prevent initial depressive episodes for occurring, treat women already depressed, and attend to comorbid conditions common to perinatal populations. The innovation of this project is also notable as it brings mental health services to home visiting programs that are being promulgated with new federal funding. Home visiting programs serve large numbers of low-income women who are not reached by existing mental health services and interventions. This project is consistent with the goal of the R34 mechanism to facilitate innovative services research that require preliminary testing or development and with a high priority area of NIMH's Division of Services and Intervention Research to develop innovative service delivery approaches and personalize them for optimal use in diverse populations. PUBLIC HEALTH RELEVANCE: Depression is a significant public health problem, with low-income pregnant and recently delivered women among the most affected. This project will develop an integrated model of screening, referral, and prevention and treatment services for women in home visiting programs. Our model may have great benefit to society as addressing depression and associated mental health problems has the potential to improve the mental health of pregnant and recently delivered women which, in turn, can promote more positive parenting.

描述（由申请人提供）：R34奖的申请建议开发和试点测试一种心理健康服务模式，该模式整合在为孕妇和最近分娩的妇女服务的家访（HV）计划中。本研究有三个具体目标。首先，我们将在HV项目中开发围产期抑郁症护理的综合模式。这一综合模式将包括筛查、转诊和个性化预防和治疗服务。第二，我们将评估在两个HV程序中以高保真度实施CIMT模型的可行性。一个HV计划将使用辅助专业人员作为干预者，而另一个计划将使用护士和社会工作者作为干预者。第三，我们将确定抑郁症模型对抑郁症状和重度抑郁发作的影响。为了实现具体目标1，我们将为两个HV项目量身定制BACT模式，培训HV员工和社区精神卫生和社会服务机构的员工，并开发保真度监测系统。为了实现具体目标2，我们将在两个HV项目中实施CRT-T模型，并评估在这些项目中实施CRT-T的可行性。为了实现具体目标3，我们将使用历史对照进行队列研究。在第1-9个月期间入组两个研究中心的女性将作为历史对照（N = 108），而在第12-24个月期间入组研究中心的女性将组成干预组（N = 154）。将在入组时进行家庭访视和入组后3个月和6个月的评估，以评估抑郁症状、抑郁发作、焦虑和PTSD。该项目的公共卫生意义重大。鉴于一致的证据表明，抑郁症是一种使人衰弱的慢性疾病，对母亲养育子女的做法有负面影响，干预措施必须试图防止最初的抑郁发作的发生，治疗已经抑郁的妇女，并注意围产期人群常见的共病状况。该项目的创新也是值得注意的，因为它将心理健康服务纳入了正在通过新的联邦资金颁布的家访方案。家访方案为大量现有心理健康服务和干预措施无法触及的低收入妇女提供服务。该项目符合R34机制的目标，即促进需要初步测试或开发的创新服务研究，并与NIMH服务和干预研究司的一个高度优先领域相一致，即开发创新服务提供方法，并使其个性化，以便在不同人群中得到最佳使用。 公共卫生关系：抑郁症是一个严重的公共卫生问题，低收入孕妇和刚分娩的妇女受影响最大。该项目将在家访方案中为妇女制定一个筛查、转诊、预防和治疗服务的综合模式。我们的模式可能对社会有很大的好处，因为解决抑郁症和相关的心理健康问题有可能改善孕妇和刚分娩的妇女的心理健康，这反过来又可以促进更积极的育儿。