Developing an Integrated Mental Health Model for Home Visitation

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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.