Comparing the effectiveness of home visiting paraprofessionals and mental health professionals delivering a postpartum depression preventive intervention: a cluster-randomized non-inferiority clinical trial

2021 ◽  
Author(s):  
S. Darius Tandon ◽  
Jessica K. Johnson ◽  
Alicia Diebold ◽  
Melissa Segovia ◽  
Jackie K. Gollan ◽  
...  
Keyword(s):  
Mental Health ◽  
Clinical Trial ◽  
Postpartum Depression ◽  
Mental Health Professionals ◽  
Health Professionals ◽  
Home Visiting ◽  
Preventive Intervention ◽  
Cluster Randomized

scholarly journals Comparing the Effectiveness of Clinicians and Paraprofessionals to Reduce Disparities in Perinatal Depression via the Mothers and Babies Course: Protocol for a Cluster-Randomized Controlled Trial (Preprint)

2018 ◽  
Author(s):  
Jessica K Jensen ◽  
Jody D Ciolino ◽  
Alicia Diebold ◽  
Melissa Segovia ◽  
Aria Degillio ◽  
...  
Keyword(s):  
Mental Health ◽  
United States ◽  
Postpartum Depression ◽  
Low Income ◽  
Health Professionals ◽  
Group Intervention ◽  
Cluster Randomized Trial ◽  
The United States ◽  
Home Visitors ◽  
Cluster Randomized

BACKGROUND Postpartum depression is highly prevalent in low-income women and has significant health and mental health effects on mother and child. Home visiting (HV) programs provide services to large numbers of perinatal women in the United States and are a logical setting for delivering mental health services. Although there are interventions that reduce the risk of developing postpartum depression among low-income women, none have used nonhealth or nonmental health professionals as interventionists. OBJECTIVE This study aimed to outline the protocol of a cluster randomized trial funded by the Patient-Centered Outcomes Research Institute that evaluates whether the Mothers and Babies (MB) group intervention, when led by paraprofessional home visitors, is more efficacious than usual care. It will also examine if MB, when led by home visitors, is not inferior to MB delivered by mental health professionals (MHPs). MB has previously demonstrated efficacy when delivered by MHPs, and pilot work indicated promising results using home visitors to deliver the intervention. METHODS A cluster randomized trial is being conducted with 38 HV programs. Sixteen HV programs will deliver MB using MHPs, 16 will deliver MB using paraprofessional home visitors, and 6 will deliver usual HV services. The study employs a modified covariate-constrained randomization design at the site level. We anticipate recruiting 933 women aged ≥16 years enrolled in HV programs, who are 33 or more weeks’ gestation and speak either English or Spanish. Women in the 2 intervention arms will receive the 6-session MB group intervention. Baseline, postintervention, 12-week postpartum, and 24-week postpartum assessments will be conducted to assess client outcomes. The primary outcome will be the change in Quick Inventory of Depressive Symptomatology Self-Report 16 scores from baseline to 24-week follow-up. Secondary outcomes associated with core MB content will also be examined. Semistructured interviews will be conducted with home visitors and MHPs who are group facilitators and 90 study participants to gain data on intervention successes and challenges. Analyses will proceed at the participant level. Primary analyses for depressive symptoms score at 24 weeks postpartum will involve a linear mixed model, controlling for baseline symptoms and other covariates, and random effects to account for clustering. RESULTS We have recruited 838 women through the end of August 2018. Recruitment will be completed at the end of September 2018. CONCLUSIONS There is considerable potential to disseminate MB to HV programs throughout the United States. Should our results demonstrate home visitor efficacy when compared with usual care and/ noninferiority between home visitors and MHPs in improving mental health outcomes, no additional financial resources would be required for the existing HV staff to implement MB. Should this study determine that home visitors are less effective than MHPs, we will generate more wide-scale evidence on MB effectiveness when led by MHPs. CLINICALTRIAL ClinicalTrials.gov NCT02979444; https://clinicaltrials.gov/ct2/show/NCT02979444 (Archived by Webcite at http://www.webcitation.org/archive.php) INTERNATIONAL REGISTERED REPOR PRR1-10.2196/11624

scholarly journals Acceptability and Appropriateness of a Perinatal Depression Preventive Group Intervention: A Qualitative Analysis

2020 ◽  
Author(s):  
Alicia Diebold ◽  
Melissa Segovia ◽  
Jessica K. Johnson ◽  
Aria Degillio ◽  
Dana Zakieh ◽  
...  
Keyword(s):  
Mental Health ◽  
Pregnant Women ◽  
Mental Health Professionals ◽  
Health Professionals ◽  
Group Intervention ◽  
Home Visiting ◽  
Perinatal Depression ◽  
The United States ◽  
Health Concern ◽  
Preventive Interventions

Abstract Background: Perinatal depression is a prevalent public health concern. Although preventive interventions exist, there is limited literature on the acceptability and appropriateness of these interventions, especially those delivered by paraprofessionals. The Mothers and Babies Program (MB) is a group-based perinatal depression preventive intervention delivered prenatally. A current cluster-randomized controlled trial is examining the acceptability, appropriateness, and effectiveness of MB delivered by mental health professionals compared to paraprofessional staff from home visiting programs. Methods: The full study enrolled 874 pregnant women. Fifty-three facilitators were trained and delivered the MB intervention to women in one of seven states in the United States. Semi-structured interviews were attempted with a randomly-selected subset of the full sample of pregnant women who received the MB intervention and with all facilitators. Specifically, interviews were conducted with 88 women who received the MB group intervention (45 in the paraprofessional-led arm and 43 in the mental health professional-led arm) and 46 women who facilitated the groups (27 home visiting staff and 19 mental health professionals). Interviews were conducted over the phone in English or Spanish and audio recorded. The recordings were translated into English, as needed, and transcribed. Thematic analysis was conducted using NVIVO to identify key themes related to intervention acceptability and appropriateness. Similarities and differences between study arms were explored. Results: Clients and facilitators found the MB content and group format acceptable. Challenges included maintaining group attendance, transportation issues, and managing group discussion. Overall, facilitators found the intervention appropriate for pregnant clients with some challenges presented for clients in crisis situations, experiencing housing instability, and with literacy and learning challenges. Participants provided suggestions for improvement, both for the course content and implementation. There were no significant differences found between study arms. Conclusions: Overall, clients and facilitators enjoyed MB irrespective of study arm, and facilitators found the intervention appropriate for the population. These findings add to the qualitative literature on perinatal depression preventive interventions, specifically those delivered by paraprofessionals. Trial Registration: This trial is registered on ClinicalTrials.gov (Initial post: December 1, 2016; identifier: NCT02979444; https://clinicaltrials.gov/ct2/show/NCT02979444).

Home visit in mental health care: the “italian way”

2011 ◽  
Vol 26 (S2) ◽  
pp. 531-531
Author(s):  
S. Ferrari ◽  
L. Malavolta ◽  
M.R. Laghezzi Ortolani ◽  
S. Mimmi ◽  
M. Rigatelli
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Community Mental Health ◽  
Mental Health Care ◽  
Mental Health Professionals ◽  
Health Professionals ◽  
Home Visit ◽  
Home Visiting ◽  
Health Centre ◽  
Home Visits

IntroductionHome visits are an essential component of community mental health care for their potentials in prevention and rehabilitative interventions. In the tradition of the Italian organisation, home visits are commonly carried out by psychiatric nurses, usually case managers for patients receiving them. Poor training and scarce integration to other clinical activities are common problems addressed by mental health professionals.MethodsA written survey on attitudes, beliefs and reality of home visiting was submitted to all 95 mental health professionals working in the community mental health centres of the Modena District, North of Italy. The survey included the following sections: general information (including seniority of service); personal experience and emotions; description of “what actually happens”; opinions on training; comparison between reality and ideals.ResultsNinety-eight percent of contacted professionals responded to the questionnaire. Home visiting should be improved and better integrated according to 55% of respondents. Good integration with social services but poor planning and lack of periodical assessments of effectiveness were emphasized by respondents. Seniority of service was significantly associated to different opinions on aim (p = .043) and numbers of home visits (p = .02) as well as the specific mental health centre was strongly associated to different perceptions on quantitative load of home visits (p < .0001). Almost no perception of danger was addressed by respondents, particularly if older.ConclusionsHome visit is a powerful tool for assertive community treatments in psychiatry and should be a focus for training and research.

scholarly journals Acceptability and Appropriateness of a Perinatal Depression Preventive Group Intervention: A Qualitative Analysis

2020 ◽  
Author(s):  
Alicia Diebold ◽  
Melissa Segovia ◽  
Jessica K. Johnson ◽  
Aria Degillio ◽  
Dana Zakieh ◽  
...  
Keyword(s):  
Mental Health ◽  
Pregnant Women ◽  
Mental Health Professionals ◽  
Health Professionals ◽  
Group Intervention ◽  
Home Visiting ◽  
Perinatal Depression ◽  
The United States ◽  
Health Concern ◽  
Preventive Interventions

Abstract Background: Perinatal depression is a prevalent public health concern. Although preventive interventions exist, there is limited literature on the acceptability and appropriateness of these interventions, especially those delivered by paraprofessionals. The Mothers and Babies Program (MB) is a group-based perinatal depression preventive intervention delivered prenatally. A cluster-randomized controlled trial examined the acceptability, appropriateness, and effectiveness of MB delivered by mental health professionals compared to paraprofessional staff from home visiting programs.Methods: The full study enrolled 874 pregnant women. Fifty-three facilitators were trained and delivered the MB intervention to women in one of seven states in the United States. Semi-structured interviews were attempted with a randomly-selected subset of the full sample of pregnant women who received the MB intervention and with all facilitators. Specifically, interviews were conducted with 88 women who received the MB group intervention (45 in the paraprofessional-led arm and 43 in the mental health professional-led arm) and 46 women who facilitated the groups (27 home visiting staff and 19 mental health professionals). Interviews were conducted over the phone in English or Spanish and audio recorded. The recordings were translated into English, as needed, and transcribed. Thematic analysis was conducted using NVIVO to identify key themes related to intervention acceptability and appropriateness. Similarities and differences between study arms were explored.Results: Clients and facilitators found the MB content and group format acceptable. Challenges included maintaining group attendance, transportation issues, and managing group discussion. Overall, facilitators found the intervention appropriate for pregnant clients with some challenges presented for clients in crisis situations, experiencing housing instability, and with literacy and learning challenges. Participants provided suggestions for improvement, both for the course content and implementation. There were no significant differences found between study arms. Conclusions: Overall, clients and facilitators enjoyed MB irrespective of study arm, and facilitators found the intervention appropriate for the population. These findings add to the qualitative literature on perinatal depression preventive interventions, specifically those delivered by paraprofessionals. Trial Registration: This trial is registered on ClinicalTrials.gov (Initial post: December 1, 2016; identifier: NCT02979444; https://clinicaltrials.gov/ct2/show/NCT02979444).

The effects of bereavement in childhood

2012 ◽  
pp. 1758-1760
Author(s):  
Dora Black ◽  
David Trickey
Keyword(s):  
Mental Health ◽  
High Risk ◽  
Mental Health Professionals ◽  
Health Professionals ◽  
Preventive Intervention ◽  
Post Traumatic Stress ◽  
Treatment Needs ◽  
Bereaved Children ◽  
Post Traumatic ◽  
Loss Of A Parent

Bereavement in childhood, particularly the loss of a parent, represents a significant adversity, although the majority of bereaved children do not develop anything other than transient symptoms. Nevertheless, there is evidence that a brief preventive intervention can reduce subsequent morbidity. Children, who lose a parent through suicide, homicide, accident, or disaster, especially if they have witnessed the death, are at high risk of developing post-traumatic stress disorder and other psychiatric disorders and their treatment needs should be assessed by mental health professionals.

scholarly journals Acceptability and Appropriateness of a Perinatal Depression Preventive Group Intervention: A Qualitative Analysis

2019 ◽  
Author(s):  
Alicia Diebold ◽  
Melissa Segovia ◽  
Jessica K. Johnson ◽  
Aria Degillio ◽  
Dana Zakieh ◽  
...  
Keyword(s):  
Mental Health ◽  
Pregnant Women ◽  
Mental Health Professionals ◽  
Health Professionals ◽  
Group Intervention ◽  
Home Visiting ◽  
Perinatal Depression ◽  
The United States ◽  
Health Concern ◽  
Preventive Interventions

Abstract Background Perinatal depression is a prevalent public health concern. Although preventive interventions exist, there is limited literature on the acceptability and appropriateness of these interventions, especially those delivered by paraprofessionals. The Mothers and Babies Program (MB) is a group-based perinatal depression preventive intervention delivered prenatally. A current cluster-randomized controlled trial is examining the acceptability, appropriateness, and effectiveness of MB delivered by mental health professionals compared to paraprofessional staff from home visiting programs. Methods The full study enrolled 874 pregnant women. Fifty-three facilitators were trained and delivered the MB intervention to women in one of seven states in the United States. Semi-structured interviews were attempted with a randomly-selected subset of the full sample of pregnant women who received the MB intervention and with all facilitators. Specifically, interviews were conducted with 88 women who received the MB group intervention (45 in the paraprofessional-led arm and 43 in the mental health professional-led arm) and 46 women who facilitated the groups (27 home visiting staff and 19 mental health professionals). Interviews were conducted over the phone in English or Spanish and audio recorded. The recordings were translated into English, as needed, and transcribed. Thematic analysis was conducted using NVIVO to identify key themes related to intervention acceptability and appropriateness. Similarities and differences between study arms were explored. Results Clients and facilitators found the MB content and group format acceptable. Challenges included maintaining group attendance, transportation issues, and managing group discussion. Overall, facilitators found the intervention appropriate for pregnant clients with some challenges presented for clients in crisis situations, experiencing housing instability, and with literacy and learning challenges. Participants provided suggestions for improvement, both for the course content and implementation. There were no significant differences found between study arms. Conclusions Overall, clients and facilitators enjoyed MB irrespective of study arm, and facilitators found the intervention appropriate for the population. These findings add to the qualitative literature on perinatal depression preventive interventions, specifically those delivered by paraprofessionals.

scholarly journals Acceptability and Appropriateness of a Perinatal Depression Preventive Group Intervention: A Qualitative Analysis

2019 ◽  
Author(s):  
Alicia Diebold ◽  
Melissa Segovia ◽  
Jessica K. Johnson ◽  
Aria Degillio ◽  
Dana Zakieh ◽  
...  
Keyword(s):  
Mental Health ◽  
Pregnant Women ◽  
Mental Health Professionals ◽  
Health Professionals ◽  
Group Intervention ◽  
Home Visiting ◽  
Perinatal Depression ◽  
Controlled Trial ◽  
Health Concern ◽  
Preventive Interventions

Abstract Background Perinatal depression is a prevalent public health concern. Although preventive interventions exist, there is limited literature on the acceptability and appropriateness of these interventions, especially those delivered by paraprofessionals. The Mothers and Babies Program (MB) is a group-based perinatal depression preventive intervention delivered prenatally. A current cluster-randomized controlled trial is examining the acceptability, appropriateness, and effectiveness of MB delivered by mental health professionals compared to paraprofessional staff from home visiting programs. Methods The full study enrolled 874 pregnant women. Fifty-three facilitators were trained and delivered the MB intervention. Semi-structured interviews were attempted with a randomly-selected subset of the full sample of pregnant women who received the MB intervention and with all facilitators. Specifically, interviews were conducted with 88 women who received the MB group intervention (45 in the paraprofessional-led arm and 43 in the mental health professional-led arm) and 46 women who facilitated the groups (27 home visiting staff and 19 mental health professionals). Interviews were conducted over the phone in English or Spanish and audio recorded. The recordings were translated into English, as needed, and transcribed. Thematic analysis was conducted using NVIVO to identify key themes related to intervention acceptability and appropriateness. Similarities and differences between study arms were explored. Results Clients and facilitators found the MB content and group format acceptable. Challenges included maintaining group attendance, transportation issues, and managing group discussion. Overall, facilitators found the intervention appropriate for pregnant clients with some challenges presented for clients in crisis situations, experiencing housing instability, and with literacy and learning challenges. Participants provided suggestions for improvement, both for the course content and implementation. There were no significant differences found between study arms. Conclusions Overall, clients and facilitators enjoyed MB irrespective of study arm, and facilitators found the intervention appropriate for the population. These findings add to the qualitative literature on perinatal depression preventive interventions, specifically those delivered by paraprofessionals.

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