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: 10083218
• 负责人: EMILY FEINBERG
• 金额: $ 64.44万
• 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 2021-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10083218
• 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; 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 study; 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.

项目摘要 低收入家庭的孩子面临着无数的社会风险，这些风险会干扰健康的发展，行为和 学术成就。这些孩子的母亲经历了高度的抑郁率，本身与 对儿童的持久影响。 2009年，美国国家医学院发表了具有里程碑意义的报告， 父母，育儿和孩子的抑郁症，要求采取基于社区的干预措施以防止 父母的抑郁症并帮助沮丧的父母接受治疗。与本报告一致 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 有头脑抑郁的风险 - 一项由联邦资助的学前班计划，可为约100万 低收入美国家庭。 在本项目中，我们旨在通过部署阶梯护理来改善头启动儿童的成果 干预措施，在这种干预措施中，为基于抑郁症状的母亲提供了基于预防计划 解决问题的教育模式以及症状更大的母亲提供参与会议 将它们与正式的心理健康服务联系起来。模型的两个组成部分均具有强大的随机试验 证据;但是它们尚未在协调的干预措施中合成和测试，适用于 广泛的人口基础。利用马萨诸塞州的Head Start中心的研究网络，我们提出了 该阶梯护理模型的有效试验（n = 388）。 我们的主要目的是确定该模型在降低头开始母亲的速度方面的效率 经历抑郁症状发作；母亲在接受心理健康服务的可能性 转介;父母的功能；和儿童旷工从头开始。我们的第二个目标是确定 改善母校福祉的作用机制可促进儿童的弹性。为此，我们将 评估母亲对压力，家庭冲突和母子互动模式的看法；我们将评估 情感，人际和认知领域的儿童结果。最后，为随后的 有效性试验，我们将在另外20位母亲中进行一项单臂试验研究，以评估 将干预交付纳入通常的头开始工作流程的可行性。 我们的建议代表了NICHD的高优先研究领域，因为它解决了社会和 影响儿童适应行为和学校准备的环境因素。我们的学习计划 增强了先前研究的严格性，因为它测试了全面抑郁管理的效率 模型，并且因为我们的设计使我们能够研究母亲和儿童的结果 - 以及机制 将它们联系起来 - 在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 低收入母亲的差异，并改善他们和他们的孩子的成果。