Transcript Home Visitation in Connecticut and Clinical Trial on In

Nurturing Families Network
Depression Improvement Study
The Connecticut Children’s Trust Fund, DSS
Center for Social Research, UofH
UCONN Health Center, Department of Psychiatry
The Cincinnati Children’s Hospital Medical Center
Child Health and Development Institute
88% do not
get mental
health treatment
44.2% are depressed
in 1st year of service
Ammerman, Putnam, et al., in press, Child Abuse & Neglect
Inclusionary:
Participants are
≥16 years old
Baby 1<12 months
EPDS ≥11
MDD using SCID
Study Design
Screening: EPDS ≥11
44 (26%) out of 167
Eligibility/Pre-treatment Assessment
SCID Diagnosis of MDD
19 (45%) out of 42 (2 refusals)
Exclusionary:
Non-NFN participants
<16 years old
Baby <1, >12 months
EPDS <11
No MDD using SCID
Substance dependence
Psychosis
Current suicidality
randomization
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
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 Network
versus
Every Child Succeeds
 Racial/Ethnic
groups
 Undocumented
 More
families
variation in geographic location
(inner city and rural)
What are the signs of depression?
(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?
(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 Depression

Sad, depressed feeling

Loss of interest in activities

Change in appetite

Insomnia; hypersomnia

Psychomotor agitation/retardation

Fatigue/tired, all day, nearly everyday

Feelings of worthlessness or excessive guilt

Difficulty concentrating and/or indecisiveness

Suicidal ideation
Individual & Family Context

Past trauma: physical/sexual abuse

Abandonment/rejection by family

Social isolation (i.e., emotional isolation)

Very low sense of worth (often hidden)

Different patterns among subgroups
“Ineligible” Mothers

History of depression

Multiple, complex issues

Young-young moms (many changes)

Have emotional support

Stable home situation

Need therapy too
Progress in therapy:
SUCCESSESS AND CHALLENGES
 Moms
available for sessions;flexibility of
therapists, positive feedback from moms
 Moms enjoy learning CBT skills;participate
in home practice, i.e. Activity Schedules
and Thought Records
 Moms responding positively to progress
made on “ladder of success”; decrease in
BDI II scores
 Challenges as in all home visiting: not at
home, pre-occupied, interruptions
 Lack



Therapeutic Themes
of entitlement (gender x depression)
For help/services
Support/attention from others
Time/Space
 Ambivalence
in general & impact on
treatment response/approach to
intervention (benefit of motivational strategies, value of assessing
“readiness”)
 Emerging
Typology of Maternal
Depression


Less severe, high readiness for change, fewer complexities, rapid &
dramatic improvement
More severe, high complexity, high trauma, intergenerational patterns,
slower response to treatment, challenges to engagement
DISCUSSION
 What
do you (participating staff) think
are successes and challenges so
far?
 What
might be considered for a team
model in future?