Schedule:
Tuesday, May 31, 2016
Pacific D/L (Hyatt Regency San Francisco)
* noted as presenting author
Summer Rosenstock, PhD, Assistant Scientist, The Johns Hopkins University, Baltimore, MD
Anne Kenney, MPH, Research Associate, The Johns Hopkins University, Baltimore, MD
Rachel Chambers, MPH, Research Associate, The Johns Hopkins University, United States, MD
Nicole Neault, MPH, Program Manager, Johns Hopkins University, Albuquerque, NM
Crystal Kee, ., Sr. Research Program Coordinator, The Johns Hopkins University, Chinle, AZ
Jennifer Richards, MPH, Research Associate, The Johns Hopkins University, Tuba City, AZ
Novalene Goklish, BA, Senior Research Program Coordinator, The Johns Hopkins University, Whiteriver, AZ
Allison Barlow, PhD, Assistant Scientist, The Johns Hopkins University, Baltimore, MD
Introduction: Too often in low income communities mental health co-morbidities are neglected when addressing the most pressing health disparities. Psychosocial factors (e.g. depression and low quality of life) can impact health outcomes, patient compliance and substance use, especially among youth. This is accentuated in underserved populations experiencing high levels of chronic stress, emotional and economic strain. Addressing mental health is critical to the adoption of healthy behaviors and improved health outcomes. Yet, in the poorest communities there is a paucity of mental health professionals, and it is generally not feasible, affordable or culturally acceptable to grow this work force. The Johns Hopkins Center for American Indian Health has taken an integrated approach to addressing mental health risks concurrently with behavioral/physical health targets. The most successful programs have done this through intergenerational home-visiting interventions delivered by trained, local American Indian (AI) Family Health Coaches (FHCs). They have addressed health/behavioral risks among AI teen mothers and their infants (Family Spirit – FS), and prevention/management of type II diabetes (T2D) among high-risk AI youth (Together On Diabetes – TOD).
Methods: The FS and TOD interventions/study protocols were developed using a CBPR approach. They were implemented in partnership with reservation communities in the southwestern US and targeted youth (10-19 years) and a family-based support person (TOD), or teen mothers (12-19 years) and their babies (FS). Both interventions included a home-based curriculum delivered by FHCs, who also provided case management, social support and engaged with health providers. The TOD study was a pre- post- study design, and the FS study was a randomized controlled trial.
Results: There were 255 and 322 youth enrolled in the TOD and FS studies respectively, with 85% and 94% retention at 12 months. Reductions in positive depression screenings between baseline and 12 months were observed in both studies (TOD : 47.4% reduction, p=0.004, FS – Intervention: 14.2% reduction, Control: 0.0% reduction, p=0.06). Additionally, statistically significant improvements were observed in other psychosocial outcomes, such as quality of life measures (TOD), ASEBA Externalizing T-Score (FS: moms) and ITSEA scores (FS: children 0-3 years) which portend better mental and behavioral health outcomes across the life course. Both studies also showed statistically significant differences in their primary health/behavioral outcomes.
Conclusions: Home visiting programs not only have the ability to impact physical health outcomes, but contribute to improved mental health status, an important component needed to alleviate health disparities among youth.
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