Improving Preschool Outcomes by Addressing Maternal Depression in Head Start

通过提前解决母亲抑郁症问题来改善学前教育成果

• 批准号: 10083218
• 负责人: EMILY FEINBERG
• 金额: $ 64.44万
• 依托单位: BOSTON MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-01-13 至 2021-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10083218
• 关键词: Absenteeism; Academic achievement; Academy; Adaptive Behaviors; Address; Adherence; Affect; Affective; Area; Award; Behavior; Behavioral; Caring; Child; Child Rearing; Cognitive; Communities; Conflict (Psychology); Depressed mood; Development; Education; Employee; Environmental Risk Factor; Face; Family; Feasibility Studies; Funding; Goals; Head Start Program; Healthcare; Intervention; Link; Low income; Massachusetts; Measures; Medicine; Mental Depression; Mental Health; Mental Health Services; Minority; Modeling; Mother-Child Relations; Mothers; National Institute of Child Health and Human Development; Nursery Schools; Outcome; Parents; Pattern; Perception; Personal Satisfaction; Pilot Projects; Population; Prevention; Prevention program; Prevention strategy; Problem Solving; Process; Protocols documentation; Provider; Public Health; Publishing; Randomized; Readiness; Reporting; Research; Research Priority; Risk; Sampling; Schools; Series; Services; Site; Social Work; Stress; Symptoms; Testing; United States National Institutes of Health; Woman; arm; base; coping; depressive symptoms; design; effectiveness study; effectiveness trial; efficacy testing; efficacy trial; experience; health disparity; improved; improved outcome; intervention effect; lower income families; maternal depression; multi-component intervention; pilot trial; population based; prevent; programs; randomized trial; reduce symptoms; resilience; skills; social; social factors; social skills; stress management; symptomatology

PROJECT SUMMARY Children of low-income families face myriad social risks that interfere with healthy development, behavior, and academic achievement. Mothers of these children experience a high rate of depression, itself associated with lasting effects on children. In 2009, the National Academy of Medicine published a landmark report, Depression in Parents, Parenting, and Children, in which it called for community-based interventions to prevent parental depression and to help engage depressed parents in treatment. Consistent with this report, our research group has conducted a series of NIH-funded studies aimed at alleviating symptoms among mothers at risk for depression in Head Start – a federally funded preschool program that provides services for ~1 million low-income US families. In the present project, we aim to improve outcomes for Head Start children by deploying a stepped-care intervention, in which mothers with low level depressive symptoms are offered a prevention program based on the Problem Solving Education model, and mothers with greater symptoms are offered Engagement Sessions to link them with formal mental health services. Both components of the model have strong randomized trial evidence; but they have yet to be synthesized and tested within a coordinated intervention, applicable to a broad population base. Harnessing a research network of Head Start centers in Massachusetts, we propose an efficacy trial (n=388) of this stepped-care model. Our primary aim is to determine the model’s efficacy in decreasing the rate at which Head Start mothers experience depressive symptom episodes; mothers’ likelihood of engaging with mental health services when referred; parental functioning; and child absenteeism from Head Start. Our second aim is to determine mechanisms of action by which improved maternal wellbeing promotes child resiliency. To do this, we will assess mothers’ perceptions of stress, family conflict, and mother-child interaction patterns; and we will assess child outcomes in the affective, interpersonal and cognitive domains. Finally, to prepare for a subsequent effectiveness trial, we will conduct a single arm pilot study among 20 additional mothers to assess the feasibility of incorporating intervention delivery into usual Head Start workflow. Our proposal represents a high-priority research area for NICHD because it addresses social and environmental factors that impact children’s adaptive behaviors and school readiness. Our study plan enhances the rigor of prior research because it tests the efficacy of a comprehensive depression management model, and because our design allows us to study both maternal and child outcomes – and the mechanisms that link them – among a true community-based sample. Our ultimate goal is to reduce mental health disparities for low-income mothers and to improve outcomes for them and their children.

项目总结 低收入家庭的孩子面临着无数的社会风险，这些风险干扰了健康的发展、行为和 学术成就。这些孩子的母亲经历了高抑郁的比率，这本身与 对儿童的持久影响。2009年，美国国家医学科学院发表了一份里程碑式的报告， 《父母、养育和儿童中的抑郁》，其中呼吁以社区为基础的干预措施来预防 父母抑郁，并帮助抑郁的父母参与治疗。与这份报告一致，我们的 研究小组进行了一系列由美国国立卫生研究院资助的旨在缓解母亲症状的研究 Head Start面临抑郁的风险--这是一个由联邦政府资助的学前教育项目，提供约100万英镑的服务 低收入的美国家庭。 在目前的项目中，我们的目标是通过部署分级护理来改善Head Start儿童的结局 干预，向患有轻度抑郁症状的母亲提供基于以下方面的预防计划 问题解决教育模式，症状较重的母亲被提供参与会议 将他们与正式的精神健康服务联系起来。模型的两个组成部分都有很强的随机试验 证据；但它们尚未在协调的干预措施中进行合成和测试，适用于 广泛的人口基础。利用马萨诸塞州Head Start中心的研究网络，我们建议 这种阶梯式护理模式的有效性试验(n=388)。 我们的主要目标是确定该模型在降低母婴出生率方面的有效性 经历抑郁症状发作；母亲在以下情况下接受心理健康服务的可能性 被转介；父母职能；儿童从Head Start缺勤。我们的第二个目标是确定 改善产妇福祉促进儿童复原力的行动机制。要做到这一点，我们将 评估母亲对压力、家庭冲突和母子互动模式的看法；我们将评估 儿童在情感、人际和认知领域的结果。最后，为后续的 有效性试验，我们将在另外20名母亲中进行一项单一ARM试点研究，以评估 将干预交付纳入常规Head Start工作流程的可行性。 我们的提案代表了NICHD的一个高度优先的研究领域，因为它解决了社会和 影响儿童适应行为和入学准备的环境因素。我们的学习计划 增强了先前研究的严谨性，因为它测试了综合抑郁症管理的有效性 模型，因为我们的设计允许我们研究母亲和儿童的结果-以及机制 这将他们联系在一起--在一个真正的基于社区的样本中。我们的最终目标是减少心理健康 低收入母亲的收入差距，并改善她们及其子女的结果。