Nurturing Families Network Nurturing Families Network Depression Improvement Depression Improvement Study Study The Connecticut Children The Connecticut Children ’ ’ s Trust Fund, s Trust Fund, DSS DSS Center for Social Research, UofH Center for Social Research, UofH UCONN Health Center, Department of UCONN Health Center, Department of Psychiatry Psychiatry The Cincinnati Children The Cincinnati Children ’ ’ s Hospital s Hospital Medical Center Medical Center Child Health and Development Institute Child Health and Development Institute
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Nurturing Families Network Depression Improvement Study The Connecticut Children’s Trust Fund, DSS Center for Social Research, UofH UCONN Health Center,
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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
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?