Nurturing Families Network Nurturing Families Network Depression Improvement StudyDepression Improvement Study
The Connecticut ChildrenThe Connecticut Children’’s Trust Fund, DSSs Trust Fund, DSS
Center for Social Research, UofHCenter for Social Research, UofH
UCONN Health Center, Department of PsychiatryUCONN Health Center, Department of Psychiatry
The Cincinnati ChildrenThe Cincinnati Children’’s Hospital Medical Centers Hospital Medical Center
Child Health and Development InstituteChild Health and Development Institute
44.2% are depressedin 1st year of service
88% do notget mentalhealth treatment
Ammerman, Putnam, et al., in press, Child Abuse & Neglect
Study DesignStudy DesignScreening: EPDS ≥1144 (26%) out of 167
Eligibility/Pre-treatment AssessmentSCID Diagnosis of MDD
19 (45%) out of 42 (2 refusals)
IH-CBT (n=12)15 sessions + booster
Ongoing home visitation
HVAU (n=7)Community Resources
Ongoing home visitation
Post-treatment Assessment(n=1)
3 Month Follow-Up Assessment
Inclusionary:Participants are≥16 years oldBaby 1<12 monthsEPDS ≥11MDD using SCID
Exclusionary:Non-NFN participants<16 years oldBaby <1, >12 monthsEPDS <11No MDD using SCIDSubstance dependencePsychosisCurrent suicidality
randomization
Role of Home Visitor: Our Main Partner
Screen moms using the Edinburgh
Introduce the study
Provide connection/communication to mother/family
Make engaging and identifying this subgroup possible
Nurturing Families NetworkNurturing Families Networkversusversus
Every Child SucceedsEvery Child Succeeds
Racial/Ethnic groupsRacial/Ethnic groups
Undocumented familiesUndocumented families
More variation in geographic location More variation in geographic location (inner city and rural)(inner city and rural)
What are the signs of depression? What are the signs of depression? (Focus Group Analyses, 2007)(Focus Group Analyses, 2007)
“Well, the signs are lack of interest in things. Because when I first met her she was pregnant, but she was involved in so many different programs. But now she doesn’t do much. She goes to school but she rarely goes even though she lives like in [neighborhood]. She just doesn’t do it. She doesn’t get out much. What I first brought out was like a checklist, like I did it in like a conversation manner to ask her how things were going or did she notice that she had a change in appetite or she was doing things differently. And she did. So I didn’t want to like push the subject every single home visit because then she would stop opening the door.”
What are the signs of depression? What are the signs of depression? (Focus Group Analyses, 2007)(Focus Group Analyses, 2007)
“…she is very depressed. She has panic attacks. She was a victim of child abuse. She was sexually abused when she was a child by a relative and then later on by her mother’s boyfriend. She told her mother. Her mother never paid any attention. Her father is not in the picture. She managed to start college.”
Experience of Major DepressionExperience of Major Depression Sad, depressed feelingSad, depressed feeling
Loss of interest in activitiesLoss of interest in activities
Change in appetiteChange in appetite
Insomnia; hypersomniaInsomnia; hypersomnia
Psychomotor agitation/retardationPsychomotor agitation/retardation
Fatigue/tired, all day, nearly everydayFatigue/tired, all day, nearly everyday
Feelings of worthlessness or excessive guiltFeelings of worthlessness or excessive guilt
Difficulty concentrating and/or indecisivenessDifficulty concentrating and/or indecisiveness
Suicidal ideationSuicidal ideation
Individual & Family ContextIndividual & Family Context
Past trauma: physical/sexual abusePast trauma: physical/sexual abuse
Abandonment/rejection by familyAbandonment/rejection by family
Social isolation (i.e., emotional isolation)Social isolation (i.e., emotional isolation)
Very low sense of worth (often hidden)Very low sense of worth (often hidden)
Different patterns among subgroupsDifferent patterns among subgroups
““Ineligible” MothersIneligible” Mothers History of depressionHistory of depression
Multiple, complex issuesMultiple, complex issues
Young-young moms (many changes)Young-young moms (many changes)
Have emotional supportHave emotional support
Stable home situationStable home situation
Need therapy tooNeed therapy too
Progress in therapy:Progress in therapy:SUCCESSESS AND CHALLENGESSUCCESSESS AND CHALLENGES
Moms available for sessions;flexibility of Moms available for sessions;flexibility of therapists, positive feedback from momstherapists, positive feedback from moms
Moms enjoy learning CBT skills;participate in Moms enjoy learning CBT skills;participate in home practice, i.e. Activity Schedules and home practice, i.e. Activity Schedules and Thought RecordsThought Records
Moms responding positively to progress made Moms responding positively to progress made on “ladder of success”; decrease in BDI II on “ladder of success”; decrease in BDI II scoresscores
Challenges as in all home visiting: not at home, Challenges as in all home visiting: not at home, pre-occupied, interruptionspre-occupied, interruptions
Therapeutic ThemesTherapeutic Themes Lack of entitlement (gender x depression)Lack of entitlement (gender x depression)
For help/servicesFor help/services Support/attention from othersSupport/attention from others Time/SpaceTime/Space
Ambivalence in general & impact on Ambivalence in general & impact on treatment response/approach to treatment response/approach to intervention intervention (benefit of motivational strategies, value of assessing (benefit of motivational strategies, value of assessing
“readiness”)“readiness”)
Emerging Typology of Maternal Emerging Typology of Maternal DepressionDepression
Less severe, high readiness for change, fewer complexities, rapid & Less severe, high readiness for change, fewer complexities, rapid & dramatic improvementdramatic improvement
More severe, high complexity, high trauma, intergenerational patterns, More severe, high complexity, high trauma, intergenerational patterns, slower response to treatment, challenges to engagementslower response to treatment, challenges to engagement
DISCUSSIONDISCUSSION
What do you (participating staff) think What do you (participating staff) think are successes and challenges so are successes and challenges so far? far?
What might be considered for a team What might be considered for a team model in future?model in future?