SBIR-STTR Award

Low-income mothers of young children represent a disadvantaged group who are at exceptional risk for depressive syndromes and who have increasingly limited access to mental health services. Despite the availability of efficacious treatments, most depressed persons do not receive treatment. Amongst the many barriers to treatment, several of the most substantial include lack of mental health coverage, difficulties arranging childcare, and the absence of transportation differentially affecting women of low socioeconomic status. For rural women, these difficulties may be compounded by the scarcity of providers within reasonable proximity. In our earlier work, in order to address access barriers, we developed and evaluated Mom-Net, an internet-facilitated CBT intervention for depression tailored to mothers of young children. Mom-Net was developed and evaluated in 2 NIMH-funded randomized controlled trials (R01MH091199 & R01MH070426) that demonstrated clinically significant effects on depressive symptoms. The proposed project is designed to develop and evaluate a prototype Mom-Net coach training tool for the program that will facilitate implementation within community settings. Participants in the Phase I feasibility and usability trial will include 15 trainees who will participate in the developed training and certification process. In Phase II, development of the training tool will be completed and then evaluated via a randomized controlled trial. Overall, the investigation will contribute to the evidentiary base regarding the dissemination potential of this empirically-supported intervention, adaptations to which have the potential to enable a greater proportion of the population to access and benefit from it. The proposed technology-based training tool should be highly sustainable, because it (a) relies on community setting paraprofessional personnel to deliver the intervention, (b) is likely to prove cost-effective given we will utilize a technology that can deliver training at scale, and (c) will improve fidelity by leveraging technology to provide consistent training experiences to trainees and including a computer-mediated audio recorded observation of client-coach sessions that will be reviewed and graded by an expert trainer to increase the likelihood of intervention implementation fidelity.

Public Health Relevance Statement:
Project Narrative Depression is very common in women with young children, and most women, especially those living in poverty, do not receive treatment. We have developed a paraprofessional-guided internet/mobile-delivered intervention to overcome barriers to service utilization and provide effective treatment to depressed mothers of young children. The goal of this project is to develop and evaluate a facilitator/coach training tool for the Mom-Net intervention so as to promote community use and commercialization of this empirically supported intervention.

Project Terms:
Address; Adherence; Affect; Area; barrier to care; base; Behavioral; Businesses; care providers; certificate program; Certification; Child; Child Rearing; Client; clinically significant; Cognitive; commercialization; Communities; community setting; Competence; Computers; coping; cost effective; Depressed mood; depressive symptoms; Depressive Syndromes; design; Development; Development Plans; Disadvantaged; Disease remission; Distal; Distress; Economics; effective therapy; Effectiveness; eHealth; Emotional; Evaluation; Exercise; experience; Funding; Goals; Head Start Program; Health Personnel; health training; Healthcare; high risk; high risk population; Human Resources; improved; indexing; Internet; Intervention; Investigation; Low income; low socioeconomic status; Manuals; maternal depression; Mediating; medical specialties; Mental Depression; Mental Health; Mental Health Services; Methodology; Modality; Mothers; motivational enhancement therapy; National Institute of Mental Health; Outcome; Participant; Persons; Phase; Population; postnatal period; Poverty; Process; programs; prototype; Provider; psychologic; Public Health; Randomized Controlled Trials; recruit; Risk; Rural; rural underserved; satisfaction; service utilization; Services; Site; skills; Small Business Innovation Research Grant; success; symposium; Technology; Testing; tool; Training; Training Programs; Transportation; treatment response; usability; Woman; Work

Economically disadvantaged mothers of young children experience disproportionately high rates of depressivesymptoms, yet often do not receive treatment due to instrumental and psychological barriers. Remission ofmaternal depression relates to improvements in both parenting behavior and child functioning, suggesting thattreatment of maternal depression has the potential to improve outcomes across generations. To increase accessto evidence-based depression treatment in this population, we developed Mom-Net, a coach-guided, e-healthintervention for depressed mothers of young children. Mom-Net is coach-guided, given evidence that guidedinterventions produce significantly higher levels of engagement and effectiveness than unguided interventions.Mom-Net has demonstrated effectiveness in two controlled trials with low-income depressed mothers, witheffectiveness derived from in-person coach training by a professional Mom-Net trainer. To increase Mom-Netdissemination, our Phase I SBIR efforts focused on developing and evaluating remote coach-training prototypesfor paraprofessionals, replicating the in-person training program. Remote coach training includes self-guidedonline sessions, webinar live practice sessions with a professional trainer, and a certification process. At the endof Phase I, we received funding for a Mom-Net hybrid, type II implementation-effectiveness study(R01MH120237), resulting in quick expansion of the Phase 1 prototypes into a completed remote trainingprocess as a necessary component of the trial. The current Phase II project builds upon the R01 effort and apositive evaluation and successful realization of Phase I project goals. Phase II aims to: 1) create a remote Train-the-Trainer program and Administrative Portal, allowing community settings to internally train and monitor theirown staff; 2) evaluate the Train-the-Trainer program on the primary outcomes of session completion, Mom-Netcontent and coaching skills knowledge, teaching strategy knowledge, and fidelity in observed trainer use ofteaching strategies; 3) examine effectiveness equivalence between the two Mom-Net coach training options ina randomized trial in 33 Head Start agencies. Four staff within each agency (n = 132) will serve asparaprofessional coach trainees, randomized to be trained by either the external professional coach trainer orthe trainer within the agency. Equivalency will be evaluated on session completion, Mom-Net content mastery,and fidelity in coaching skills. The proposed project, culminating in training at scale by offering two trainingoptions, will enable commercialization and broader dissemination of Mom-Net which, in turn, will contribute togreater access to a vulnerable, underserved population of mothers experiencing depressive symptoms.

Public Health Relevance Statement:
Project Narrative The negative impact of maternal depression on the livelihood of families and children cannot be understated, particularly for those living in poverty and marginalized communities who are less likely to receive treatment. We developed a paraprofessional-guided Internet-delivered depression intervention to overcome barriers to service utilization for depressed mothers of young children. Our Phase II SBIR goals serve to significantly expand access to depression intervention within the community by developing a Train-the-Trainer program that will more firmly seat training and intervention delivery in the community, by the community.

Project Terms:
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