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).

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).

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.

scholarly journals VitalSign6: A Primary Care First (PCP-First) Model for Universal Screening and Measurement-Based Care for Depression

2019 ◽  
Vol 12 (2) ◽  
pp. 71 ◽  
Author(s):  
Madhukar Trivedi ◽  
Manish Jha ◽  
Farra Kahalnik ◽  
Ronny Pipes ◽  
Sara Levinson ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Health Professionals ◽  
Health Professionals ◽  
Universal Screening ◽  
Primary Care Providers ◽  
The United States ◽  
Care Providers ◽  
Similar Treatment ◽  
Measurement Based Care

Major depressive disorder affects one in five adults in the United States. While practice guidelines recommend universal screening for depression in primary care settings, clinical outcomes suffer in the absence of optimal models to manage those who screen positive for depression. The current practice of employing additional mental health professionals perpetuates the assumption that primary care providers (PCP) cannot effectively manage depression, which is not feasible, due to the added costs and shortage of mental health professionals. We have extended our previous work, which demonstrated similar treatment outcomes for depression in primary care and psychiatric settings, using measurement-based care (MBC) by developing a model, called Primary Care First (PCP-First), that empowers PCPs to effectively manage depression in their patients. This model incorporates health information technology tools, through an electronic health records (EHR) integrated web-application and facilitates the following five components: (1) Screening (2) diagnosis (3) treatment selection (4) treatment implementation and (5) treatment revision. We have implemented this model as part of a quality improvement project, called VitalSign6, and will measure its success using the Reach, Efficacy, Adoption, Implementation, and Maintenance (RE-AIM) framework. In this report, we provide the background and rationale of the PCP-First model and the operationalization of VitalSign6 project.

scholarly journals Optimal Well-Being After Major Depression

2019 ◽  
Vol 7 (3) ◽  
pp. 621-627 ◽  
Author(s):  
Jonathan Rottenberg ◽  
Andrew R. Devendorf ◽  
Vanessa Panaite ◽  
David J. Disabato ◽  
Todd B. Kashdan
Keyword(s):  
Mental Health ◽  
United States ◽  
Major Depression ◽  
Mental Health Professionals ◽  
Health Professionals ◽  
Well Being ◽  
The United States ◽  
Global Burden ◽  
Leverage Points ◽  
Midlife Development

Can people achieve optimal well-being and thrive after major depression? Contemporary epidemiology dismisses this possibility, viewing depression as a recurrent, burdensome condition with a bleak prognosis. To estimate the prevalence of thriving after depression in United States adults, we used data from the Midlife Development in the United States study. To count as thriving after depression, a person had to exhibit no evidence of major depression and had to exceed cutoffs across nine facets of psychological well-being that characterize the top 25% of U.S. nondepressed adults. Overall, nearly 10% of adults with study-documented depression were thriving 10 years later. The phenomenon of thriving after depression has implications for how the prognosis of depression is conceptualized and for how mental health professionals communicate with patients. Knowing what makes thriving outcomes possible offers new leverage points to help reduce the global burden of depression.

scholarly journals Clinical Training with Undocumented Latinx Immigrant Minors: Case Examples and Reflections using the Multicultural Developmental Supervisory Model (MDSM) as a Framework.

2020 ◽  
Vol 9 (3) ◽  
pp. 127-141
Author(s):  
B.E. Galicia ◽  
C.A. Bailey ◽  
M. Briones ◽  
K.Z. Salinas ◽  
A,C. Venta
Keyword(s):  
Mental Health ◽  
Mental Health Professionals ◽  
Health Professionals ◽  
Clinical Training ◽  
Developmental Stages ◽  
Clinical Work ◽  
The United States ◽  
Multicultural Competency ◽  
Case Examples ◽  
Clinical Interviews

As of 2017, the number of international immigrants worldwide increased from 220 million to 248 million, and will continue to rise [16]. Growing diversity worldwide requires a stronger emphasis on multicultural competency among mental health professionals. Learning multicultural competency skills is a career-long commitment that begins in practicum training and is modeled and reinforced through supervision. The Multicultural Developmental Supervisory Model (MDSM) is an evidence-based model that focuses on supervisory dyads and multicultural competence [12]. Using the MDSM [12] as a guide reflective of our training, four graduate supervisees share their supervision experiences in learning to conduct clinical interviews in Spanish with undocumented Latinx immigrant minors in government custody in the United States, a rising population with unique clinical considerations. Our supervisor includes her experience in training and fortifying beginning mental health professionals’ skills in conducting these evaluations. In this contribution, we illustrate our trajectory from different training developmental stages, including the process of conceptualizing clinical cases, and transitioning languages in conducting clinical interviews, as well as considering our own cultural identities in clinical work. While our experience focuses on bicultural and bilingual training in the U.S., this aspect of clinical training is growing increasingly relevant around the world, especially in Europe where 54% of tчёёhe population is multilingual [10]. Although we used the MDSM model as a helpful framework in guiding our multicultural development, empirical research is needed to examine the utility of this model.

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

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