Developing an Integrated Mental Health Model for Home Visitation

开发家访综合心理健康模型

• 批准号: 8462687
• 负责人: Shiv Darius Tandon
• 金额: $ 18.26万
• 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 2014-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8462687
• 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 Intervention; 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; 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; screening; 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.

描述（由申请人提供）：这项R34奖的申请提议开发和试点测试一种整合在为孕妇和刚分娩的妇女服务的家访（HV）项目中的心理健康服务模式。本研究有三个具体目的。首先，我们将在hiv项目中开发一个围产期抑郁症护理的综合模型。这种综合模式（“SCRIPT”）将包括筛查、转诊和个性化的预防和治疗服务。其次，我们将评估在两个HV程序中高保真度实现SCRIPT模型的可行性。一个hiv项目将使用辅助专业人员作为干预人员，而另一个项目将使用护士和社会工作者作为干预人员。第三，我们将确定SCRIPT模型对抑郁症状和重度抑郁发作的影响。为实现具体目标1，我们将为两个艾滋病项目量身定制SCRIPT模式，对艾滋病工作人员以及社区精神卫生和社会服务机构的工作人员进行该模式的培训，并开发一个保真度监测系统。为了实现具体目标2，我们将在两个HV项目中实施SCRIPT模型，并评估SCRIPT在这些项目中实施的可行性。为了实现特定目标3，我们将使用历史对照进行队列研究。在1-9个月期间在两个研究地点注册的妇女将作为历史对照（N = 108），而在12-24个月期间注册的妇女将组成干预组（N = 154）。在入组时家访以及入组后3个月和6个月进行评估，以评估抑郁症状、抑郁发作、焦虑和创伤后应激障碍。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，干预措施必须试图预防最初的抑郁症发作，治疗已经患有抑郁症的妇女，并注意围产期人群常见的合并症。这个项目的创新也值得注意，因为它将心理健康服务引入了正在由新的联邦资金颁布的家访项目中。家访项目为大量低收入妇女提供服务，她们没有得到现有的精神卫生服务和干预措施。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，并符合NIMH服务和干预研究部的高度优先领域，即开发创新的服务提供方法，并使其个性化，以便在不同人群中获得最佳使用。