Service Coordination for Mothers Experiencing Depression in Home Visiting: Client and Staff Perspectives

Background and Purpose: Children of mothers experiencing depression are at greater risk for social-emotional, cognitive, and physical health problems (Baird et al., 2023; Goodman et al., 2011; Kingston & Tough, 2014; Sutherland et al., 2021; Thompson et al., 2018). Home visiting (HV) programs that serve young children and families in the United States are highly impacted by maternal depression, with positive screening rates ranging from 35.5 to 57.2% (Ammerman et al., 2010; Easterbrooks et al., 2016). Research shows that maternal depression can limit the effectiveness of HV programs (Ammerman et al., 2010) and that HV services alone are not sufficient to improve depressive symptoms (Leonard et al., 2020). Many HV programs have implemented universal screening procedures to identify mothers with depression for additional services, but only a small proportion of mothers who screen positive are then referred to services or initiate services (Tandon et al., 2020). This study gathered qualitative from mothers and staff in the Parents as Teachers (PAT) HV program to understand the referral process and identify barriers and facilitators mothers encounter when accessing mental health services.

Methods: Semi-structured qualitative interviews were conducted with 15 mothers who participated in depression screening and 16 parent educators (PEs) and supervisors who conducted screenings. Interviews were conducted across four PAT sites in the United States (in CA, NC, LA, and PA) that were chosen to maximize ethnic/racial and geographic diversity. A third of staff identified as Black, a third identified as White, and a third identified as Hispanic/Latino. Almost half of mothers identified as Hispanic/Latino, a quarter identified as White, just under a quarter identified as Black, and one mother identified as biracial. Three mothers were interviewed in Spanish. Qualitative data were analyzed using a team-based approach.

Results: Staff used several strategies to facilitate the referral process, including verifying that a mental health resource was available, providing information about what the client would encounter when reaching out for help, making the initial call with the client if needed, reminding the client before the appointment, and following up afterwards. Respondents also shared barriers mothers faced in accessing mental health services, including financial concerns, difficulty qualifying due to documentation status, child care needs, lack of fit with providers, language barriers, lack of time, transportation challenges, anxiety about accessing services, and a lack of mental health services in their region, which was the most commonly cited challenge, particularly in rural areas. Several respondents recommended that PAT provide virtual mental health services to overcome these challenges.

Conclusions and Implications: Findings indicate the importance of intensive PE involvement in facilitating access to mental health services for mothers experiencing depression and suggest that HV visiting programs would benefit from building staff capacity to support mothers in this process. HV programs may also want to consider providing mental health services directly due to the lack of services available in the community. Currently the research team is partnering with PAT to develop briefs and trainings for PAT home visitors, supervisors, and the broader HV community to share these findings.