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: 9884948
• 负责人: EMILY FEINBERG
• 金额: $ 77万
• 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 2024-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9884948
• 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; Effectiveness; 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 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.

项目概要 低收入家庭的儿童面临着无数的社会风险，这些风险会干扰他们的健康发展、行为和健康。 这些孩子的母亲患抑郁症的比例很高，而抑郁症本身与学业成就有关。 2009年，美国国家医学院发表了一份具有里程碑意义的报告， 父母、养育子女和儿童的抑郁症，其中呼吁采取基于社区的干预措施来预防 与本报告一致，我们的研究旨在帮助抑郁症父母接受治疗。 研究小组进行了一系列由 NIH 资助的研究，旨在减轻母亲的症状 Head Start 是一项联邦资助的学前教育计划，为约 100 万人提供服务，有患抑郁症的风险 美国低收入家庭。 在本项目中，我们的目标是通过部署分级护理来改善 Head Start 儿童的成果 干预，其中为患有轻度抑郁症状的母亲提供基于以下基础的预防计划： 问题解决教育模式，为症状较严重的母亲提供参与课程 将它们与正式的心理健康服务联系起来 该模型的两个组成部分都经过了强有力的随机试验。 证据；但它们尚未在协调的干预措施中进行综合和测试，适用于 我们建议利用马萨诸塞州的启蒙中心研究网络。 这种分级护理模式的功效试验（n=388）。 我们的主要目标是确定该模型在降低 Head Start 母亲死亡率方面的功效 经历抑郁症状发作时，母亲参与心理健康服务的可能性； 我们的第二个目标是确定家长的功能；以及儿童缺勤情况。 改善孕产妇福祉促进儿童复原力的行动机制 为此，我们将采取行动。 评估母亲对压力、家庭冲突和母子互动模式的看法，我们将进行评估； 最后，为后续的学习做好准备。 有效性试验，我们将在另外 20 名母亲中进行单臂试点研究，以评估效果 将干预实施纳入通常的 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，因为它涉及社会和 影响儿童适应行为和入学准备的环境因素。 提高了先前研究的严谨性，因为它测试了全面抑郁症管理的有效性 模型，因为我们的设计使我们能够研究孕产妇和儿童的结果以及机制 将它们联系起来——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。 低收入母亲的差距，并改善她们及其子女的成果。