Improving electronic health record documentation and use to promote evidence-based pediatric care.

Objective: Electronic health records (EHRs) often lack the necessary functionalities to support the full implementation of national clinical guidelines for pediatric care outlined in the American Academy of Pediatrics Bright Futures Guidelines. Using HealthySteps (HS), an evidence-based pediatric primary care program, as an exemplar, this study aimed to enhance pediatric EHRs, identify facilitators and barriers to EHR enhancements, and improve data quality for delivering clinical care as part of HS implementation and evidence building.

Methods: Three HS sites-each differing in location, setting, number of children served, and mix of child insurance coverage-participated in the study.

An Integrative Review of Arts-Based Strategies for Addressing Pain and Substance Use Disorder During the Opioid Crisis.

In October 2017, the U.S. Department of Health & Human Services declared the opioid crisis a national public health emergency and prioritized identifying effective, evidence-based strategies for pain management and the prevention and treatment of substance use disorder (SUD).

Standardized Cost Estimates for Home Visiting: Pilot Study of the Home Visiting Budget Assistance Tool (HV-BAT).

Purpose Using a standardized approach and metrics to estimate home visiting costs across multiple evidence-based models and regions could improve the consistency and accuracy of cost estimates, allow stakeholders to observe trends in cost allocation, analyze how home visiting costs vary, and develop future program budgets. Between October 2015 and December 2018, we developed and pilot-tested the Home Visiting Budget Assistance Tool (HV-BAT) to standardize the collection of home visiting program costs and analyze costs for local implementing agencies (LIAs). Methods We recruited LIAs that implemented at least one of nine evidence-based home visiting models in 15 states implementing the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program.

Adaptation of an evidence-based postpartum depression intervention: feasibility and acceptability of mothers and babies 1-on-1.

Background: Mothers and Babies (MB) is a cognitive-behavioral intervention with demonstrated efficacy in reducing depressive symptoms and preventing depressive episodes among perinatal women when delivered in a group format by mental health professionals. Study aims were to describe the adaptation of MB into a 1-on-1 modality (MB 1-on-1) and provide data on the adapted intervention's acceptability and feasibility.

Methods: Seventy-five home visitors trained on MB 1-on-1 delivered the 15-session intervention to 1-2 clients.

Six-month outcomes from a randomized controlled trial to prevent perinatal depression in low-income home visiting clients.

Perinatal depression (PD) has negative consequences for mothers and children and is more prevalent among women of low socioeconomic status. Home visitation programs serve low-income pregnant women at risk for PD. This study tested the efficacy of a group-based cognitive behavioral intervention (Mothers and Babies Course; MB) in reducing depressive symptoms and preventing the onset of perinatal depression among low-income women enrolled in home visitation.

Associations between maternal mental health and child emotional and behavioral problems: does prenatal mental health matter?

This study examined associations between elevated symptoms of prenatal depression or anxiety and offspring emotional and behavioral problems during mid to late childhood taking into account the impact of later maternal mental health symptoms. The sample consisted of 2,891 women and their children (49 % male) from a prospective, community-based study, the Avon Longitudinal Study of Parents and Children. Women completed measures of depressive (Edinburgh Postnatal Depression Scale) and anxious (Crown Crisp Experiential Index) symptoms at regular intervals beginning in pregnancy.

Impact of a preventive intervention for perinatal depression on mood regulation, social support, and coping.

Perinatal depression prevention trials have rarely examined proximal outcomes that may be relevant for understanding long-term risk for depression. The Mothers and Babies (MB) Course is a cognitive-behavioral depression prevention intervention, which has been shown to prevent depressive symptoms among at-risk perinatal women of color. This study examined intervention impact on three proximal outcomes that are theoretically linked with the intervention's model of change and have been empirically linked with risk for depression: mood regulation expectancies, perceived social support, and coping.

Associations between depressive and anxious symptoms and prenatal alcohol use.

Symptoms of depression and anxiety are prevalent during pregnancy and may influence women's health behaviors. The impact of women's mental health on alcohol use may be particularly important to consider as prenatal alcohol use is common and may have serious negative consequences for the developing fetus. The objectives of this study were to investigate the relationships between elevated symptoms of depression and anxiety and subsequent likelihood of any alcohol use and binge drinking during pregnancy.

A comparison of three screening tools to identify perinatal depression among low-income African American women.

Background: The purpose of the current study was to determine the sensitivity, specificity, and positive predictive value of three depression screening tools among a low-income African American population of pregnant and recently delivered women enrolled in home visitation programs in a low-income urban community.

Methods: Ninety-five women enrolled in home visitation programs-32 who were pregnant and 63 with a child <6 months comprise the study sample. Each woman completed a structured clinical interview and three depression screening tools-the Edinburgh Postnatal Depression Scale (EPDS), Center for Epidemiologic Studies Depression Scale (CES-D), and Beck Depression Inventory II (BDI-II).

Preventing perinatal depression in low-income home visiting clients: a randomized controlled trial.

Objective: To assess the efficacy of a 6-week cognitive-behavioral intervention in preventing the onset of perinatal depression and reducing depressive symptoms among low-income women in home visitation programs.

Method: Sixty-one women who were pregnant or who had a child less than 6 months of age and who were assessed as at risk for perinatal depression were randomized to a 6-week, group-based cognitive-behavioral intervention or usual home visiting services. Study participants were predominately African American, unmarried, and unemployed.

Perceptions of mental health services among low-income, perinatal African-American women.

Introduction: The objective of this qualitative study was to explore perceptions of mental health services as a barrier to service use among low-income, urban, perinatal African-American clients of home visiting programs.

Methods: Inductive thematic analysis procedures were used to analyze data collected from focus groups conducted with clients (n = 38) and staff (n = 26) of two paraprofessional home visiting programs.

Findings: Four complementary themes were identified: Perceptions of mental health care providers, concerns about confidentiality, beliefs about the effectiveness of psychotherapy, and perceptions of psychotropic medication.

A Pilot Study of a Family-Focused Intervention for Children and Families Affected by Maternal Depression.

A non-experimental pilot study examined child, mother, and family outcomes of a 10-session multi-family group intervention designed to reduce risk and promote resilience for mothers with depression and their families. Positive changes following the Keeping Families Strong intervention included mother-reported decreases in child behavior and emotional problems, improvements in the quality of family interactions and routines, and improvements in their own well being and support from others. Children (9-16 years) reported decreased internalizing symptoms, improved coping, increased maternal warmth and acceptance, and decreased stressful family events.

Intergenerational transmission of psychopathology: minor versus major parental depression.

This study used data from the National Comorbidity Survey to investigate associations between: (1) maternal and paternal depression and young adult offspring psychopathology, and (2) major and minor parental depression and offspring psychopathology. Offspring of a depressed parent were significantly more likely to experience a psychiatric disorder by young adulthood than offspring of nondepressed parents. Major and minor maternal and paternal depression were associated with comparable increases in risk for offspring 12-month mood, anxiety, and substance use disorders and lifetime substance use disorder.

A systematic review of home-based interventions to prevent and treat postpartum depression.

This systematic review evaluated randomized controlled trials assessing home-based psychological interventions to prevent and treat postpartum depression (PPD). Six studies meeting inclusion criteria were identified, five assessing treatments for PPD and one assessing a preventive intervention for PPD. Interventions used cognitive behavioral, psychodynamic, and non-directive counseling approaches.

Change in prevalence of psychiatric disorders from ages 21 to 30 in a community sample.

The authors examined change and demonstrated variation in the prevalence of psychiatric disorders from ages 21 to 30 in a prospective community study (n = 352) using generalized estimating equations and investigated effects of past and recent psychiatric disorder on emerging adult functioning (at age 30). Results revealed significant declines in 12-month prevalence of phobia and substance use disorders from ages 21 to 30 but not in depression or posttraumatic stress disorder. Males were at significantly higher risk for lifetime substance use disorders; females were at higher risk for lifetime depression, phobia, and PTSD.