Integrating the Prevention of Postpartum Depression within the Home Visitation Context

Recent years have witnessed a rapid growth in home visiting (HV) services, with an estimated 400,000-500,000 low-income perinatal women in at least 40 states currently receiving such services. Exposed to chronic stressors associated with poverty, HV clients are significantly more likely to develop postpartum depression (PPD) than the general U.S. perinatal population. Our team initiated a research program aimed at embedding a cognitive behavioral group intervention for prevention of PPD--the Mothers and Babies (MB) Course--within the HV context. This research program is the first to integrate PPD prevention into the context of HV, despite the large numbers of HV clients at risk for PPD.  The research involved several components.  Initially, focus groups were conducted to elicit the perspectives of HV supervisors, home visitors, and clients on how to integrate the MB Course into HV.  These qualitative data guided the adaptation of the MB Course to better fit the HV setting, including modification of curriculum content and activities.  This adaptation was done while working with MB Course developers to ensure fidelity to core intervention elements.  We will provide specific examples of how our qualitative data provided data on the (a) implementation climate for integrating the MB Course into HV, (b) readiness for implementation among HV programs.  Subsequently, a pilot randomized trial was conducted with four home visiting programs, using post-intervention and 3- and 6-month follow up assessments to evaluate intervention feasibility and mental health outcomes.  Our feasibility and mental health findings suggest HV is a promising context in which to embed PPD prevention efforts. This presentation will provide an overview of our research, highlighting the challenges and opportunities of the HV setting, and the process of translating the MB Course into a new setting (HV). We will also describe the next steps in our work, including an NIMH-funded study aimed at expanding the ability of HV programs to address clients’ mental health needs in a more comprehensive fashion.