The overarching goal of this NIMH Mentored Patient-Oriented Research Career Development Award (K23) is to provide me with the skills and advanced training necessary to establish an independent program of research focused on the development and testing two-generational service delivery models in pediatric primary care to reduce mental health treatment disparities. To facilitate my long-term career goal, I have developed specific short-term training goals including: 1) Obtain advanced skills in applied, multimethod qualitative research; 2) Gain expertise in cultural psychiatry and cross-cultural research; 3) Develop a core knowledge base in group psychotherapeutic interventions including their mechanism(s) of benefit and evaluation; and 4) Develop core skills in mental health services intervention development and implementation in primary care settings. During the award period, I will conduct a series of inter-related studies which will serve as vehicles for pragmatic learning of the training goals complementing formal training and mentorship. The studies seek to characterize and subsequently enhance a novel and increasingly utilized form of pediatric well-child care, group pediatric well-child visits, to address disparities in identification, initial management, and subsequent treatment engagement of immigrant Latinas with postpartum depressive symptoms.
The aims will be achieved through (1) a case study of two purposively sampled clinics currently delivering group well-child visits with immigrant Latino families, triangulating data from direct observations; in-depth and semi-structured interviews and surveys with parents participating and electing not to participate in group visits, group visit facilitators and other key informants at two purposively sampled clinics; (2) development of enhanced group visits using Intervention Mapping and Human-Centered Design methods and procedures; and (3) a single-arm pre-post pilot of the enhanced visit with one cohort of patients/families at each of the sites studied in Aim 1. We anticipate that the enhancements incorporate elements from interventions that have previously shown acceptability and/or effectiveness with this patient population including screening, brief intervention and referral to treatment procedures, provider communication skill- building to address cultural barriers to problem identification and treatment-seeking and facilitate a cohesive group process, and psychoeducation and self-management strategies.
Postpartum depression disproportionately affects Latinas, who also have low rates of mental health treatment engagement. While the pediatric primary care setting offers an important opportunity to identify and engage perinatal Latinas, several barriers, including low rates of detection, lack of trust, and stigma, limit detection and management of depressive symptoms in this setting. This project will explore and subsequently enhance a new model of pediatric care, group well-child visits, as a setting in which to address these barriers and increase detection, initial management, and subsequent treatment engagement of Latinas with postpartum depressive symptoms.
