Patient Navigation for Depressed Mothers in Head Start - An Engagement Strategy

为抑郁母亲提供耐心导航——一种参与策略

• 批准号: 8358339
• 负责人: Michael Silverstein
• 金额: $ 25.15万
• 依托单位: BOSTON MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-07-01 至 2014-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8358339
• 关键词: Address; Adult; Affect; Award; Cancer Patient; Caring; Case Management; Child; Client; Collection; Communities; Consent; Control Groups; Data; Development; Diagnostic Services; Enrollment; Family; Funding; Future; Goals; Grant; Head Start Program; Health Services Accessibility; Healthcare; Hour; Institute of Medicine (U.S.); Insurance; Intervention; Intervention Trial; Interview; Interviewer; Knowledge; Language; Learning; Life Experience; Link; Logistics; Low income; Massachusetts; Mechanics; Medicaid; Mental Depression; Mental Health; Mental Health Services; Methods; Minority; Modeling; Monitor; Mothers; Motivation; Nursery Schools; Outcome; Outcome Measure; Parenting behavior; Parents; Participant; Patients; Persons; Pilot Projects; Prevention; Preventive Intervention; Programmed Learning; Publishing; Randomized; Reporting; Research; Research Design; Risk; Screening procedure; Services; Techniques; Testing; Time; Training; Transportation; Woman; Work; arm; base; beneficiary; care seeking; follow-up; improved; maternal depression; programs; psychologic; randomized trial; shared decision making; single episode major depressive disorder; theories; treatment planning; willingness

DESCRIPTION (provided by applicant): Maternal depression disproportionately affects low-income and minority women and has substantial negative impacts on their children. Among these women, myriad cultural, psychological and logistic barriers impede engagement with mental health services, resulting in disparities in access to care. In 2009, the Institute of Medicine (IOM) published a landmark report, Depression in Parents, Parenting, and Children, in which it recognized engagement with care to be a substantial hurdle to better outcomes, and called for interventions that link screening efforts to treatment plans, and that take place in community-based, family-focused venues. Consistent with this report, our research group obtained an R01 award (R01MH091871) in 2010 to conduct a randomized trial of a maternal depression prevention intervention in Head Start - a federally funded preschool program that provides services for ~1 million children of low-income families across the US. In this ongoing study, Head Start mothers are enrolled based on their risk for developing major depressive episode (MDE); those in MDE are deliberately excluded and referred to more definitive care. This R21 proposes to enroll those women excluded from the prevention trial in an adjunct pilot study - the principal goal of which is to develop Patient Navigation as a model to promote engagement with depression care. Patient Navigation is a lay-delivered case management approach that focuses on overcoming logistical hurdles to care, such as transportation, language barriers or insurance complexities, during a defined episode. However, because engaging with mental health care requires addressing additional cultural and psychological barriers, we believe that traditional Navigation models will be insufficient for this purpose. We will thus train our navigators in the 'Engagement Interview,' an empirically-supported technique, in which interviewers facilitate client-focused exploration of life experiences, shared decision making, and goal setting as a way to build motivation to seek treatment. We propose a two-arm, 60-subject pilot study, within which we will: field test study mechanics, including the acceptabiliy of randomization among Head Start mothers in MDE; use quality improvement methods to optimize intervention delivery; and obtain empiric estimates of study parameters to inform the planning of an appropriately powered RCT. Although Patient Navigation has emerging evidence among adult cancer patients for promoting timely use of diagnostic services, it has yet to be studied as a mechanism to promote engagement with mental health care. Studying engagement in the child-focused Head Start setting offers the further possibility of learning how such a community-based setting - with its emphasis on children and family - can be leveraged to help mothers in MDE seek care. Such knowledge will inform the development of a subsequent trial of the intervention model. Our ultimate goal is model dissemination at the national level through Head Start and a reduction in disparities in access to mental health care. PUBLIC HEALTH RELEVANCE: Maternal depression disproportionately affects low-income and minority women and has substantial negative impacts on their children. Among these women, myriad cultural, psychological and logistic barriers impede engagement with mental health services, resulting in disparities in access to care. This R21 application proposes to explore Patient Navigation as a mechanism to promote engagement with care for depressed mothers in Head Start - a federally funded early learning program for children of low-income families. By embedding theory-based engagement strategies in the navigation model, we aim to improve engagement with mental health services, and thereby improve outcomes for both depressed mothers and their children.

描述（由申请人提供）：孕产妇抑郁症不成比例地影响低收入和少数族裔妇女，并对其子女产生重大负面影响。在这些妇女中，无数的文化，心理和后勤障碍阻碍了对心理健康服务的参与，从而导致获得护理的差异。 2009年，医学研究所（IOM）发表了具有里程碑意义的报告，《父母，育儿和子女的抑郁症》，在该报告中，它认识到，它认识到与谨慎的互动是一个实质性的障碍，并呼吁采取干预措施，将筛查工作与治疗计划联系起来，并在社区以社区为基础的家庭，以家庭为中心的地方进行。与本报告一致，我们的研究小组在2010年获得了R01奖项（R01MH091871），以对孕产妇抑郁症进行预防干预的随机试验 - 一项联邦资助的学前班计划，为美国各地低收入家庭的约100万儿童提供服务。在这项正在进行的研究中，头开始母亲是根据发展重大抑郁发作（MDE）的风险而招募的。 MDE中的那些被故意排除在外，并提及更明确的护理。该R21建议在一项辅助试点研究中招募那些被排除在预防试验之外的妇女 - 其主要目标是开发患者导航作为促进抑郁症护理参与的模型。患者导航是一种额外交付的病例管理方法，侧重于克服后勤障碍，例如在定义的情节中，例如运输，语言障碍或保险复杂性。但是，由于参与精神保健需要解决其他文化和心理障碍，因此我们认为传统导航模型将不足以实现此目的。因此，我们将在一种经验支持的技术“参与面试”中训练我们的导航员，访调员在其中促进了以客户为中心的生活经验，共同的决策和目标设定的探索，以此作为建立寻求治疗动机的方式。我们提出了一项两臂，60个主体的试点研究，我们将在其中：现场测试研究机制，包括MDE中的头开始母亲的随机分解；使用质量改进方法来优化干预措施；并获得研究参数的经验性估计，以告知适当动力的RCT的计划。尽管患者导航在成年癌症患者中有新的证据来促进及时使用诊断服务，但尚未将其作为促进精神卫生保健参与的机制进行研究。研究以儿童为中心的头部开始环境的参与提供了学习的进一步可能性，即可以利用这种基于社区的环境（重点是儿童和家庭）如何帮助MDE寻求护理的母亲。这些知识将为干预模型的后续试验提供信息。我们的最终目标是通过头部开始在国家一级的模型传播，并减少获得心理保健的差异。 公共卫生相关性：孕产妇抑郁症不成比例地影响低收入和少数族裔妇女，并对其子女产生重大负面影响。在这些妇女中，无数的文化，心理和后勤障碍阻碍了对心理健康服务的参与，从而导致获得护理的差异。该R21申请提议探索患者导航，以此作为促进与沮丧母亲的关怀的机制，这是一项针对低收入家庭儿童的联邦资助的早期学习计划。通过将基于理论的参与策略嵌入导航模型中，我们旨在改善对心理健康服务的参与，从而改善沮丧的母亲及其子女的成果。