Developing an Integrated Mental Health Model for Home Visitation

开发家访综合心理健康模型

• 批准号: 8824815
• 负责人: Shiv Darius Tandon
• 金额: $ 20.18万
• 依托单位: NORTHWESTERN UNIVERSITY AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-03-19 至 2016-10-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8824815
• 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）：本 R34 奖项申请建议开发并试点测试一种整合到为孕妇和刚分娩的妇女提供服务的家访 (HV) 计划中的心理健康服务模式。这项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型。这种综合模式（“SCRIPT”）将纳入筛查、转诊以及个性化预防和治疗服务。其次，我们将评估在两个 HV 项目中实现高保真 SCRIPT 模型的可行性。一个 HV 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。为了实现具体目标 1，我们将为两个 HV 项目定制 SCRIPT 模型，对 HV 工作人员以及社区心理健康和社会服务机构的工作人员进行该模型的培训，并开发保真度监控系统。为了实现具体目标 2，我们将在两个 HV 项目中实施 SCRIPT 模型，并评估在这些项目中实施 SCRIPT 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 个月期间在两个研究中心注册的女性将作为历史对照 (N = 108)，而在第 12-24 个月期间在两个研究中心注册的女性将构成干预组 (N = 154)。入组时、家访时以及入组后 3 个月和 6 个月时将进行评估，以评估抑郁症状、抑郁发作、焦虑和 PTSD。该项目对公共卫生具有重大意义。鉴于一致的证据表明抑郁症是一种使人衰弱的慢性疾病，会对母亲的养育方式产生负面影响，因此干预措施必须尝试预防最初的抑郁发作，治疗已经抑郁的妇女，并处理围产期人群常见的共病。该项目的创新也很引人注目，因为它将心理健康服务引入了新的联邦资金颁布的家访计划中。家访计划为大量现有心理健康服务和干预措施无法覆盖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，并且符合 NIMH 服务和干预研究部门的高度优先领域，即开发创新服务提供方法并对其进行个性化，以便在不同人群中得到最佳使用。