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

项目总结 母亲、婴儿和早期儿童家访计划是一项全国性的儿童虐待预防计划 服务于全美弱势家庭的战略。抑郁的母亲(怀孕和产后 送货上门)占回访客户的很大一部分。这些母亲经历了家庭冲突 加速或加重他们的抑郁症状。此外，他们很少得到治疗，因为 多重障碍。对于那些生活在农村地区的人来说，这些障碍更加严重。拟议中的研究将测试 一种创新的家庭治疗干预方法--韧性增强技巧的初步效果 培训(休息)，旨在减少产妇抑郁症状和家庭冲突，增加家庭 这一弱势群体的凝聚力和家庭认知重新评估。它建立在我们成功的初步工作基础上 对休息的研究表明，它显著减少了家访母亲和 显著减少家庭冲突，显著提高家庭凝聚力和家庭认知度 重新评估。这项拟议的研究解决了家访母亲的关键服务需求，这些母亲的中等到 严重的抑郁症状，生活在农村地区，获得治疗的机会很少。 拟议的研究与NIMH服务和干预研究部门的高度优先事项一致 在为多样化和未得到充分服务的人群制定创新的服务提供方法方面，联合国儿童基金会在这一领域发挥了重要作用。 拟议研究的长期目标是将其余部分整合到整个农村家访机构中 美国。要实现这一目标，我们必须首先实现当前应用程序的目标。这个 建议的研究使用有效性-实施混合类型1设计，并进行试点随机试验 包括三个目标：1)测试由以下人员进行的REST的可行性、可接受性、耐受性和安全性 社区治疗师；2)测试其余部分相对于标准护理的初步有效性 减少产妇抑郁症状和家庭冲突，增加产妇入学/就业 3)收集关于以下方面的初步数据： 实施REST的障碍和促进者。这一结果将用于一项更大规模的随机试验 这严格地考验了休息的有效性。

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.