Transcript PolicyLab

Enhancing Parenting for
Depressed Caregivers
Research Coordinator
Brooke Rothman, MSSP
October 20, 2011
Addressing Barriers to Mental Health
Treatment
• Few depressed parents seek MH treatment (20-57%)
• Barriers to accessing mental health treatment
– Stigma associated with mental health agencies
– Denial of depression
– Lack of payment or insurance for services
– Need for childcare
– Lack of time or transportation
– Lack of social support
– Other issues perceived as priorities (e.g. housing issues, pregnancy,
marital, etc.)
– Confusing to navigate options of treatment
• Personalized MH referrals needed to address barriers
Identification of Depressed Caregivers:
Depression Screening in the Primary Care
Setting
• Screening Tool: Patient Health Questionnaire-2 (PHQ-2)
• Caregivers screened at 1 and 2 year old well child visits at 7
participating primary care pediatric practices in Philadelphia
• Healthcare providers trained on screening procedure
• Language provided on how to address positive screens
• Mental health resource packet
• Lists emergency phone numbers, crisis centers, and
community mental health centers in Philadelphia
• Explanation of study and consent for contact
Study Design
• If caregiver (CG) interested/eligible,
set up first study visit (3 total)
• Study visits conducted at home
and in primary care center
• Both groups provided
individualized enhanced mental
health referrals for 6 to 7
months
• Role as an “Access
Navigator” – facilitating
mental health service
utilization
Access Navigator: In-Person Contact
• Review of mental health resource list at
study visits
• Highlight crisis centers and
emergency numbers
• Indicate mental health centers
near residency
• Identify agencies that are
convenient for caregiver’s needs
• Assure follow-up with caregiver about
outcome of referrals
Access Navigator: Problem-Solving
• To problem-solve, motivate to make appointments, and navigate
the mental health system in Philadelphia
• Find caregiver the best place to seek treatment based on health
insurance status, location, schedule, and situational needs
• Make appointment with caregiver through three-way calling or
• Make appointment for caregiver with appropriate information
(Social Security number, type of health insurance, phone
number, address, DOB)
• Partnership with Philadelphia’s Office of Mental Health- Community
Behavioral Health Member Services Department to identify
referrals
Follow-Up Phone Calls
• Questions asked:
• Stress status
• Whether sought help for stress
• Social support
• Professional support
•
•
If did seek help:
Gather details (agency, frequency
of appointments, satisfaction with
services)
• If did not seek help:
• Acknowledge difficulty of
seeking appointments as a busy
parent
• Reiterate ability to assist CG
• Encourage to make
appointment during phone call
if interested
•
• If did not seek help:
If appointment made,
reminder phone calls/text
messages before appointment
Access Navigator: Build Relationships
• Home visits and frequent phone calls gains trust and allows assistance to
be more personalized for effective problem-solving
• Frequent contact by phone or text messaging to follow-up
• Call caregivers AT LEAST once per month
• Call an average 2-3 times per month
• Each phone call takes 5 – 30 min.
• Caregivers often difficult to reach (phone numbers changed
frequently, phones out of service, voicemails not returned)
• To reestablish contact, send reminder postcards, do drive-bys to
homes, text message
• “It’s okay that you call me so much, I’ve come to think of you as a friend.”
– Caregiver over the phone
Accessing Services
- 31 (53%) caregivers took action towards mental health treatment
Implications
• Enhanced mental health referrals do not guarantee caregiver will
utilize services, however, it may be the guidance and support
needed to access services in the future.
• To effectively refer caregivers with depression, access navigators
must cultivate relationships with the often fragmented mental
health resources and services in the area to gather a
comprehensive, customized, and centralized list of services
available.
• Access navigators can feasibly assist caregivers with depression to
access services, however it requires a lot of time and attention and
relationship building with caregivers and mental health service
providers.
Feedback
• “I couldn’t have done this
• “I was skeptical at first, but now
without you. I’ve been trying to
I like going each week. [My
do this for so long, but I usually
therapist] really makes me
can’t focus and I needed
think.” – Study Participant
someone like you to help me
figure this out.”
– Study Participant
• “My visits [to the therapist] are
lifesavers. She really
understands what I’m going
through. Ever since I started
going, it feels less stressful to
be with my [four] children.
- Study Participant
Acknowledgements
Principal Investigator: Jim Guevara, MD, MPH
Study Team:
Marsha Gerdes, PhD
Russell Localio, JD, MA, MPH, MS, PhD
Rhonda Boyd, PhD
Susan Dougherty, PhD
Denise Actie, MSW