nurturing families network depression improvement study the connecticut children’s trust fund, dss...

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?