Maternal Depression Screening in Head Start: Pitfalls and Solutions

Background and Purpose:  The negative consequences of maternal depression on children’s cognitive and behavioral functioning and subsequent school performance is well documented.   The high rates of depression among low income minority mothers introduce an additional risk for their children’s school readiness. These concerns lead to a joint venture of a school of social work and a large community agency operating Head Start centers in largely Latino and African American communities to test whether a depression intervention would remediate mother’s depression and lead to better performance for their children in Head Start classrooms.  

Screening for the intervention was introduced by the agency’s family service workers (FSWs).  The first screens came back with no mothers scoring in the clinical range although the workers’ suspected that a number of these mothers were depressed.  Previous studies have revealed depression rates of over 50% in similar populations. 

This paper describes the qualitative study instituted to develop a more sensitive and appropriate way to screen mothers for depression and the screening protocol developed from the data.

Methods: Focus groups of mothers in both English and Spanish were held: one for mothers who participated in the screening and another for mothers who had not been screened.  Thirty three mothers participated, 7 who had been part of the screening, and 26 who had not; 17 in Spanish and 16 in English. Interviews were transcribed, coded, and analyzed to reveal themes. We developed questions from the literature and from interviews with the FSWs who had done the initial screening.

Findings: Themes emerging from the interviews were fears about what admitting depression might mean in the program: being reported to child protection or stigmatized as mentally ill.  There was ambivalence about whether they could trust giving this information to the family service workers. The need for confidentiality and privacy in the screening process was seen as essential.   Depression was conceptualized as something happening in the past or to others rather than a current problem. If participants felt depressed, they talked about coping methods they used.  They saw depression as being caused by isolation, money problems, being overwhelmed with family demands.  In addition, mothers who had been screened felt targeted by the process and worried about what would happen to the information. Mothers enjoyed the focus groups and liked being able to get together and talk to other mothers.  They welcomed an opportunity to participate in further groups.

Conclusions and Implications: Depression is difficult for these low income mothers to admit and they worry about the negative repercussions of admitting depression in the context of their children’s school setting. Confidentiality, trust, and privacy are essential.  Results from the interviews were used to develop a more appropriate screening process which included a change in the screening instrument, an inclusion of a life event checklist, imbedding the screening in a more general needs assessment at enrollment, training the FSWs in Motivational Interviewing and depression, and informational meetings on depression in the setting.