ICBT for Maternal Depression: Community Implementation in Head Start

ICBT 治疗孕产妇抑郁症：社区实施抢先一步

• 批准号: 10370417
• 负责人: EDWARD GUSTAV FEIL
• 金额: $ 101.63万
• 依托单位: OREGON RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-04-01 至 2026-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10370417
• 关键词: Accountability; Address; Adoption; Awareness; Behavior; Behavioral; Belief; Characteristics; Child; Child Rearing; Cognitive; Cognitive Therapy; Communities; Depressed mood; Depressive Syndromes; Depressive disorder; Disease remission; Distress; Economically Deprived Population; Economics; Effectiveness; Emotional; Environment; Evaluation; Exploration Preparation Implementation and Sustainment; Female of child bearing age; Funding Agency; Generations; Head Start Program; Health Services Accessibility; Hybrids; Internet; Intervention; Investigation; Investigational Therapies; Leadership; Low income; Mediating; Mediator of activation protein; Mental Depression; Mental Health; Modeling; Moods; Mothers; Online Systems; Outcome; Patient Self-Report; Phase; Poverty; Preparation; Preventive service; Process; Public Health; Randomized; Randomized Controlled Trials; Research; Resources; Risk; Service setting; Social support; Training; Waiting Lists; Wit; Woman; base; behavioral outcome; burden of illness; community setting; coping; cost; cost outcomes; depressive symptoms; design; disability; early childhood; effectiveness implementation design; effectiveness outcome; effectiveness study; effectiveness trial; efficacious intervention; evidence base; health training; high risk; implementation evaluation; implementation outcomes; implementation process; implementation strategy; implementation study; improved; maternal depression; practice setting; primary outcome; recruit; secondary outcome; skills; symptomatology; telecoaching; therapeutic evaluation; treatment as usual; treatment response; web-based intervention

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.

抽象的 低收入育龄妇女患抑郁症的风险不成比例，尽管 有效干预措施的可用性，往往得不到他们需要的治疗。(1,2) 我们开发了妈妈- Net，一种由教练协助、基于互联网的远程干预，改编自经验支持的认知 抑郁症行为治疗（CBT），以满足抑郁症母亲的需求。两组随机对照 试验（3,4）证明 Mom-Net 在减少抑郁症状和改善育儿方面非常有效 行为和孩子的调整。在拟议的项目中，我们寻求研究是否可以扩大覆盖范围 通过在 Head Start 环境中实施 Mom-Net 干预。将 Mom-Net 移至 HS 要求我们关注实施过程，以了解各机构如何与 干预，以便有效和可持续地实施。同样，向代理机构提供服务也很重要 最能满足其可用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、有效性-实施设计(5) 来比较两种实施方法 Mom-Net 的交付，一种采用现有的高强度辅导方法，另一种利用低强度辅导方法 强度辅导，旨在提供支持性责任，但不是心理教育支持。我们 建议遵循探索、准备、实施和维持过程模型 (EPIS(6,7)) 指导评价。拟议的研究基于： (a) HS 意识到需要确定和 应对母亲抑郁症(8)； (b) 呼吁将孕产妇抑郁症治疗纳入幼儿服务 设置（9-11）； (c) 在干预主义者的指导下基于网络的 CBT 方法有效性的证据 没有接受正规的心理健康培训(12,13)​​。我们将 (a) 检查与每个相关的 HS 机构的特征 EPIS实施模型的阶段； (b) 检查有效性（母亲抑郁症；养育行为； 儿童情绪和行为功能）和实​​施（影响范围、可接受性、保真度和成本） 设计中的结果，机构将被随机分配实施方法，母亲将 在机构内随机分配至 Mom-Net 或照常治疗 (TAU)/候补名单条件； (c) 最后， 检查每项实施策略与相关孕产妇功能变化的中介影响 拥有关于孕产妇抑郁症状的核心妈妈网技能。