A randomized trial of a video-based family intervention for home visited mothers with perinatal depressive symptoms

PROJECT SUMMARY The Maternal, Infant, and Early Childhood Home Visiting Program is a national child abuse prevention strategy that facilitates evidence-based home visiting for vulnerable families throughout the U.S. Mothers (pregnant and postpartum) with clinically significant depressive symptoms make up a significant portion of home visited clients. These mothers experience family conflict that precipitates and exacerbates their depressive symptoms. They infrequently get treatment due to multiple barriers that are compounded for those who live in rural areas. The proposed study addresses a critical service need for home visited mothers with moderate to severe depressive symptoms, including those with co-occurring moderate to severe anxiety symptoms, in rural areas with low access to treatment. The proposed study builds on the success of our NIMH- funded R34 that assessed the feasibility, acceptability, safety, tolerability and preliminary effectiveness of an innovative video-based family therapy intervention (Resilience Enhancement Skills Training, REST) for home visited mothers with moderate to severe depressive symptoms and moderate to high family conflict. Our R01 application aligns with NIMH’s high priority area (NOT-MH-21-270) to test the effectiveness of REST compared to standard of care (Video-based Problem Solving individual Therapy, V-PST) for treatment of home visited mothers with moderate to severe depressive symptoms, including those with co-occurring moderate to severe anxiety symptoms, and moderate to high family conflict. The proposed study uses an effectiveness- implementation hybrid type 1 design with a randomized trial and includes three Specific Aims: 1) Determine REST’s sustained impacts on outcomes (family conflict, family cohesion, maternal depressive symptom severity, co-occurring maternal anxiety symptom severity, and maternal job attainment/school enrollment) at post-intervention, 3-month, 6-month, 12-month, and 18-month follow-ups; 2) Identify family-level mechanisms of change on treatment response at 12-month and 18-month follow-ups; and 3) Investigate implementation strategies preferred by home visiting agency affiliated therapists to sustain high fidelity to REST. Successful completion of the aims is the initial step to accomplish our long-term goal to disseminate REST to home visiting agency affiliated therapists who serve home visited families in rural regions of the U.S.