ICBT for Maternal Depression: Community Implementation in Head Start

摘要 低收入育龄妇女患抑郁综合征的风险不成比例，尽管 由于缺乏有效的干预措施，他们往往得不到所需的治疗。（1，2）我们开发了妈妈- Net，一种远程的，教练促进的，基于互联网的干预，改编自一个由医疗支持的认知 针对抑郁症的行为治疗（CBT），以满足抑郁母亲的需求。双随机对照 试验（3，4）表明，Mom-Net在减少抑郁症状和改善育儿方面非常有效 行为和儿童适应。在拟议的项目中，我们试图研究我们是否可以扩大覆盖面 通过在领先环境中实施Mom-Net干预。将Mom-Net迁移到HS 要求我们专注于执行过程，以了解各机构将如何与 干预，以便有效和可持续地实施。同样，重要的是提供机构 能够最好地满足其现有内部资源的交付方法。为了解决这些问题，我们建议 使用混合类型2，重复性-实现设计（5）来比较两种实现方法， Mom-Net的交付，一个是现有的高强度教练方法，另一个是使用低强度教练方法， 强度辅导，旨在提供支持性的问责制，但不是心理教育支持。我们 建议遵循勘探、准备、实施和维持过程模型（EPIS（6，7））， 引导评价。建议进行的研究是基于：（a）房协认识到有需要找出 对产妇抑郁症作出反应（8）;（B）呼吁将产妇抑郁症治疗纳入幼儿服务 （9-11）;（c）在干预者指导下，基于网络的CBT方法的有效性证据 没有接受过正规的心理健康培训（12，13）。我们将（a）研究与每一个项目有关的房协机构的特点， （B）检查有效性（母亲抑郁;父母行为; 儿童情绪和行为功能）和实施（范围，可接受性，忠诚度和成本） 在一个设计中，各机构将被随机分配到实施方法，母亲将 在机构内随机分配到Mom-Net或治疗作为治疗（TAU）/等待名单条件;以及（c）最后， 检查每一项实施战略，产妇功能变化的中介影响， 拥有针对孕产妇抑郁症状的核心Mom-Net技能。

ABSTRACT Low income women of childbearing age are at disproportionate risk for depressive syndromes and, despite the availability of efficacious interventions, often do not receive the treatment they need.(1,2) We developed Mom- Net, a remote, coach-facilitated, Internet-based intervention adapted from an empirically-supported cognitive behavioral treatment (CBT) for depression to address the needs of depressed mothers. Two randomized control trials(3,4) demonstrated Mom-Net to be highly effective in reducing depressive symptoms and improving parenting behavior and child adjustment. In the proposed project we seek to examine whether we can expand the reach of the Mom-Net intervention by implementing within the Head Start Environment. Moving Mom-Net into HS requires that we focus on implementation processes to understand how agencies would interact with the intervention in order to implement with effectiveness and sustainability. As well, it is important to offer agencies delivery approaches that can best meet their available internal resources. To address these issues, we propose using a hybrid type 2, Effectiveness-Implementation design(5) to compare two implementation approaches for the delivery of Mom-Net, one with its existing high-intensity coaching approach, and one making use of a low- intensity coaching, designed to provide supportive accountability, but not psychoeducational support. We propose to follow the Exploration, Preparation, Implementation, and Sustainment process model (EPIS(6,7)) to guide the evaluation. The proposed study is predicated on: (a) HS's awareness of the need to identify and respond to maternal depression(8); (b) calls to embed maternal depression treatment into early childhood service settings(9-11); and (c) evidence of the effectiveness of web-based CBT approaches, guided by interventionists without formal mental health training(12,13). We will (a) examine characteristics of HS agencies related to each phase of the EPIS implementation model; (b) examine effectiveness (Maternal Depression; Parenting Behavior; Child Emotional and Behavioral Functioning) and implementation (reach, acceptability, fidelity, and cost) outcomes within a design in which agencies will be randomized to implementation approach, and mothers will be randomized, within agency, to either Mom-Net or Treatment as Usual (TAU)/waitlist conditions; and (c) finally, examine for each implementation strategy, the mediating influence of changes in maternal functioning associated with core Mom-Net skills on maternal depressive symptoms.