Community Based Participatory Intervention Development for Maternal Depression: Towards a Responsive Tier of Mental Health Services

Background and Purpose

Using the lens of community-based participatory research (Israel et al., 2003), the authors partnered with a community-based home visiting program for low-income parents to inform the creation of an approachable, innovative and culturally relevant continuum of interventions to address the voiced concern that depressed mothers were “falling through the cracks” of the current service delivery system. The goals and objectives of this study were to: 1) garner community definitions and experiences of maternal depression, 2) identify perspectives of mothers and agency staff regarding the meaning of, and preferences for, mental health services, and 3) create sustainable and replicable models for community-based interventions that expand services beyond the specialty care sector.

Methods

This interpretive, qualitative study used both focus groups and individual interviews to elicit community voice. Three focus groups (N=14) were conducted initially to identify definitions and experiences of depression among low-income mothers. Subsequently, semi-structured interviews (N=20) detailed individual perspectives of both mothers and staff regarding preferred components of home visiting where maternal depression could be integrated: initial conversation, family education, screening, assessment, and intervention. We specifically examined differences and similarities in perceptions between mothers and staff. Analyses were completed using digital recordings of focus groups and interviews, with the first wave of thematic analysis conducted by the researchers and thematic interpretation occurring within the community-research team.

Results

From Stigma to Strengths: Mothers voiced a desire to overcome the “bad mom stigma” surrounding maternal depression through an understanding of symptoms as a continuum (rather than a diagnosis) and integrating services through already trusted providers rather than referral “out” to specialty mental health. The consumer-informed continuum of services presented “starts with stress” addressed through peer support, builds in evidence-based interventions delivered by familiar, trusted providers at increasing levels of symptom severity and finally adds specialty providers to the team as needed. The community-based organization's strengths also emerge across the continuum, starting as a resource for information and family support and building capacity to provide psychosocial support across the continuum of services through training and strategic partnerships.

From Strengths to Sustainable Services: Thematic analysis of individual interviews provided specific recommendations for dialogue, education, screening, and interventions culturally relevant to low-income, urban mothers. Fiscal sustainability is enhanced through the tiered service delivery model with future research to examine cost-efficacy and outcomes across tiers. Programmatic sustainability is generated through the capacity-building process, augmented by consumer-staff “buy in” from initial conceptualization through implementation.

Conclusions and Implications

This participatory research generated a relevant and responsive model for a tier of services for low-income, depressed mothers who are underserved in the current arena of mental health services. The sustainability of the proposed intervention will be enhanced by cost-efficacy and mental health services research that focuses on capacity-building within existing maternal and child health home visiting programs. The next phase of community-based research will pilot-test the tiered service delivery model, examining stakeholder outcomes and experiences while building capacity for both services and research that are relevant and responsive to the community.