A pilot randomized trial of video-based family therapy for home-visited mothers with perinatal depressive symptoms

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PROJECT SUMMARY The Maternal, Infant, and Early Childhood Home Visiting Program is a national child abuse prevention strategy that serves vulnerable families throughout the United States. Depressed mothers (pregnant and post- delivery) make up a significant portion of home visited clients. These mothers experience family conflict that precipitates or worsens their depressive symptoms. Furthermore, they infrequently get treatment due to multiple barriers. These barriers are compounded for those who live in rural areas. The proposed study will test the preliminary effectiveness of an innovative family therapy intervention, Resilience Enhancement Skills Training (REST), that aims to reduce maternal depressive symptoms and family conflict, and increase family cohesion and family cognitive reappraisal in this vulnerable population. It builds on our successful preliminary study of REST that showed it significantly reduced perinatal depressive symptoms in home visited mothers and significantly reduced family conflict, and significantly improved family cohesion and family cognitive reappraisal. The proposed study addresses a critical service need for home visited mothers with moderate to severe depressive symptoms, living in rural areas, with low access to treatment. The proposed study aligns with the NIMH Division of Services and Intervention Research high priority area in the development of innovative service delivery approaches for diverse and underserved populations. The long-term goal of the proposed study is to integrate the REST into rural home visiting agencies throughout the United States. To accomplish this goal, we must first accomplish the aims of the current application. The proposed study uses an effectiveness-implementation hybrid type 1 design with a pilot randomized trial and includes three aims: 1) Test the feasibility, acceptability, tolerability, and safety of REST conducted by community therapists; 2) Test the preliminary effectiveness of the REST compared to standard of care in reducing maternal depressive symptoms and family conflict, increasing maternal school enrollment/job attainment, and improving family cohesion and family cognitive reappraisal; and 3) Collect preliminary data on barriers and facilitators to implementation of REST. The results will be used to inform a larger randomized trial that rigorously tests the effectiveness of REST.