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.
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.