"When Your Village Is on Speed Dial": Parent-Centered Mental Health Screening & Response in Home Visiting Services

BACKGROUND/PURPOSE: Maternal mental health has been increasingly acknowledged as a significant public health concern that adversely impacts the well-being of mothers, children and families. Research has suggested 7-9% of mothers experience symptoms of depression during pregnancy and post-partum depression is experienced in approximately 8% to 23% of all mothers. In addition to providing an array of services aimed at improving developmental and health outcomes for children, and families, federally funded home visiting programs (Maternal, Infant and Early Childhood Home Visiting-MIECHV) and their staff are required to screen and respond to the mental health needs of their parenting clients. While required, home visiting screening practices vary across programs and agencies, limiting impact. Understanding the client's perspective is essential for tailoring effective screening practices and ensuring that maternal mental health support adequately addresses their needs and challenges. Most of the research to improve screening practice has focused on home visiting staff, and not client perspectives, illustrating a gap in our understanding of how to improve practices.

METHODS: This study is part of a multi-year state evaluation, conducted in Texas, focused on examining maternal mental health screening, response, and intervention in MIECHV-funded home visiting services. Qualitative data were collected through semi-structured interviews with mothers (n = 32) utilizing home visiting services from Texas agencies. Three home visiting models were represented in the data. Data were analyzed using a thematic approach in which transcripts were read and coded to themes guided by the following research aim: What are parent-centered practices for mental health screening in home visiting services?

RESULTS: Thematic analysis findings indicate that parent-centered practices include 1). Building a non-judgmental connection before screening in which the client felt emotionally supported and allowed them to the home visitor as a credible source of information about mental health; 2). Use of culturally responsive and relatable practices around parenting approaches lead to more positive experiences in screening; 3). Using formal screening and informal check-ins to assess mental health concerns connected to postpartum depression, depression, and anxiety as well as additional economic stressors that impacted client overall well-being.; and 4). Assistance accessing low-barrier mental health supports. Home visiting clients reported greater success securing connection to the referral when home visitors were able to be ‘hands on’ in the process, such as there being a warm handoff, the home visitor asking the referrals to contact the client directly, and making sure the referrals were culturally appropriate. A lack of understanding of parenting individual health needs, and a narrow focus on children, rather than the whole family, limits connection.

CONCLUSIONS/IMPLICATIONS: Screening helps to identify mental health needs among parents but works best when conducted in tandem with a supportive response to help address mental health issues. Study findings indicate the importance of relationship building, seeing the home visitor as knowledgeable, cultural sensitivity, and help accessing resources to build a strong screening response.