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Beeber LS, Gasbarro M, Knudtson M, Ledford A, Sprinkle S, Leeman J, McMichael G, Zeanah P, Mosqueda A. A Mental Health Innovation for Nurse Home Visiting Program Shows Effectiveness in Reducing Depressive Symptoms and Anxiety. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2024; 25:126-136. [PMID: 37552380 DOI: 10.1007/s11121-023-01574-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2023] [Indexed: 08/09/2023]
Abstract
The objective of this paper is to report on the effectiveness of a mental health addition to a national nurse-delivered home visiting program. The methods are as follows: analysis of pre/post-launch of the standard Mental Health Intervention and comparison of 356 teams randomized to standard versus enhanced implementation. Stepwise regression controlled for significant client characteristics that were related to relevant outcomes. These characteristics were used in generalized mixed effect models comparing pre/post implementation and intervention and control groups. Pre/post analysis showed that only clients with no elevated mental health screening scores or mental health diagnoses at enrollment showed a significant decrease in depressive symptoms. Clients enrolled with and without mental health needs at enrollment significantly decreased on anxiety scores while referrals to mental health care increased. Teams receiving enhanced implementation enrolled more clients with mental health needs and clients completed more well-child visits and use of safe sleep practices. By integrating mental health care into maternal, infant, and early childhood home visiting programs, a new equitable model of primary mental health care can reach populations in need. This example provides a new paradigm of accessible and equitable mental health care for the future that can be implemented in a variety of home visiting programs.
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Affiliation(s)
- Linda S Beeber
- University of North Carolina at Chapel Hill School of Nursing, Carrington Hall, CB #7460, Chapel Hill, NC, 27599-7460, USA
| | - Mariarosa Gasbarro
- Prevention Research Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Michael Knudtson
- Prevention Research Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Alasia Ledford
- University of North Carolina at Chapel Hill School of Nursing, Carrington Hall, CB #7460, Chapel Hill, NC, 27599-7460, USA.
| | - Sharon Sprinkle
- Nurse-Family Partnership National Service Office, Denver, CO, USA
| | - Jennifer Leeman
- University of North Carolina at Chapel Hill School of Nursing, Carrington Hall, CB #7460, Chapel Hill, NC, 27599-7460, USA
| | | | - Paula Zeanah
- College of Nursing and Allied Health Professions and Picard Center for Child Development and Lifelong Learning, University of Louisiana at Lafayette, Lafayette, LA, USA
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Baggett KM, Davis B, Olwit C, Feil EG. Pre-intervention child maltreatment risks, intervention engagement, and effects on child maltreatment risk within an RCT of MHealth and parenting intervention. Front Digit Health 2023; 5:1211651. [PMID: 37497187 PMCID: PMC10367099 DOI: 10.3389/fdgth.2023.1211651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 06/21/2023] [Indexed: 07/28/2023] Open
Abstract
Introduction Evidence-based mental health and parenting support services for mothers postpartum can reduce risk for child maltreatment. However, women suffering economic and cultural stressors disproportionately shoulder the burden of infant caregiving while experiencing profound barriers to accessing mental health and parenting services. This article reports on an MHealth and parenting intervention targeting maternal mood and positive parent practices within a randomized controlled trial, which provided a unique opportunity to view pre-intervention child maltreatment risk, its relationship to subsequent intervention engagement, and intervention engagement effects on pre-post child maltreatment risk reduction. Method Principal component factor analysis was conducted to identify a modifiable pre-intervention child maltreatment risk construct within a combined MHealth and parenting intervention sample of 184 primarily Black mothers and their infants. An independent t-test was conducted to compare pre-intervention child maltreatment risk levels between mothers who went on to complete at least two-thirds of the intervention and those who did not. A GLM repeated measures analysis of variance was conducted to determine effects of intervention engagement on child maltreatment risk reduction. Results Pre-intervention child maltreatment risk did not differentiate subsequent maternal intervention completion patterns. Mothers who completed two-thirds of the intervention, compared to those who did not, demonstrated significant reductions in pre-post child maltreatment risk. Discussion Findings underscore the potential of MHealth parenting interventions to reduce substantial child maltreatment risk through service delivery addressing a range of positive parenting and behavioral health needs postpartum, a particularly vulnerable developmental period for maternal depression and child maltreatment risk.
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Affiliation(s)
- Kathleen M. Baggett
- Mark Chaffin Center for Healthy Development, School of Public Health, Georgia State University, Atlanta, GA, United States
| | - Betsy Davis
- Oregon Research Institute, Eugene, OR, United States
| | - Connie Olwit
- Mark Chaffin Center for Healthy Development, School of Public Health, Georgia State University, Atlanta, GA, United States
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Ingalls A, Rebman P, Martin L, Kushman E, Leonard A, Cisler A, Gschwind I, Brayak A, Amsler AM, Haroz EE. Towards precision home visiting: results at six months postpartum from a randomized pilot implementation trial to assess the feasibility of a precision approach to Family Spirit. BMC Pregnancy Childbirth 2022; 22:725. [PMID: 36151535 PMCID: PMC9502904 DOI: 10.1186/s12884-022-05057-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 09/12/2022] [Indexed: 11/25/2022] Open
Abstract
Background Shared implementation challenges at scale in early childhood home visiting have led researchers to explore precision home visiting as a promising service delivery mechanism to better address families’ unique needs and build greater program efficiencies. This randomized controlled pilot study aimed to assess the acceptability of a precision approach to one home visiting model, Family Spirit® and explore potential differences between Precision Family Spirit (PFS) and Standard Family Spirit (Standard FS) on participant-home visitor relationship and maternal outcomes. Methods Participants (N = 60) were at least 14 years old, pregnant or within 2 months postpartum, and enrolled in Family Spirit. Four sites in Michigan were randomized 1:1 to deliver PFS (up to 17 core lessons plus up to 13 additional lessons as needed) or Standard FS (home visiting services as usual). Primary (program acceptability, participant satisfaction, home visitor-participant relationship quality, retention, adherence) and secondary (knowledge, quality of life, difficulty with parenting problems, substance use, depression, stress) outcomes at 6 months postpartum are presented. PFS participants also self-reported on quality of life, difficulty with parenting problems, stress, substance use, and concerns with sexual and reproductive health and self and child’s nutrition status at each home visit. This informed which lessons they should receive. Results Mothers in both groups reported positive program acceptability, satisfaction, and home visitor-participant relationships at 6 months postpartum. However, open-ended feedback from Standard FS participants indicates that some lesson content may not be applicable to all participants. At 6 months, retention was 82.3% for PFS and 66.7% for Standard FS, and adherence was 30.1% for PFS and 20.6% for Standard FS. Conclusions Preliminary findings indicate that precision home visiting may be acceptable and feasible. A definitive trial is needed to build on this pilot data, assess outcomes for mothers and children participating in a precision approach to home visiting as compared to standard home visiting, and ready this approach for scale. Trial registration ClinicalTrials.govNCT03975530 (first posted on 05/06/2019).
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Affiliation(s)
- Allison Ingalls
- Johns Hopkins University, Bloomberg School of Public Health, International Health Department, Center for American Indian Health, Allison Ingalls, 415 N. Washington St., 4th Floor Room 439, Baltimore, MD, 21231, USA.
| | - Paul Rebman
- Johns Hopkins University, Bloomberg School of Public Health, International Health Department, Center for American Indian Health, Allison Ingalls, 415 N. Washington St., 4th Floor Room 439, Baltimore, MD, 21231, USA
| | - Lisa Martin
- Inter-Tribal Council of Michigan, Inc, Sault Ste. Marie, MI, USA
| | | | - Amanda Leonard
- Inter-Tribal Council of Michigan, Inc, Sault Ste. Marie, MI, USA
| | - Aimee Cisler
- American Indian Health and Family Services, Detroit, MI, USA
| | | | | | | | - Emily E Haroz
- Johns Hopkins University, Bloomberg School of Public Health, International Health Department, Center for American Indian Health, Allison Ingalls, 415 N. Washington St., 4th Floor Room 439, Baltimore, MD, 21231, USA
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