Collaborative Perinatal Mental Health and Parenting Support in Primary Care
Collaborative Perinatal Mental Health and Parenting Support in Primary Care
Treating mothers' perinatal depressive and other mental health symptoms alone does not
 prevent impaired parenting quality and adverse infant outcomes. The goal of this research is
 to conduct a randomized controlled trial to evaluate the effectiveness of adding a
 research-based 10-week home visiting parenting program to evidence-based mental health
 treatment, to counter the pernicious effects of mothers' symptoms on parenting quality and
 infant development. Participants will be English and Spanish-speaking low-income mothers who
 began publicly funded mental/behavioral health treatment in pregnancy at their primary care
 community health centers.
Infants exposed to impaired parenting as a result of their mothers' major depression and
 other mental health disorders in the perinatal period are at risk for compromised social
 interaction and affective and behavioral regulation. Depression is the most frequently
 reported mental health condition during the perinatal period; about 9% of infants under one
 year have mothers who experience a major depressive episode. That rate nearly triples to 25%
 for infants of mothers below 200% of the federal poverty level. In addition to poverty, young
 maternal age, lack of social support, low education, and adverse childhood experiences are
 all risk factors for depression, anxiety, and other mental health conditions. Two strands of
 research point to the need for effective parenting support for mothers following treatment
 for mental health conditions in pregnancy. First, depressed mothers frequently fail to
 accurately notice, interpret, or respond sensitively to infant cues. Alarmingly, mothers'
 impaired parenting of their infants continues even after their depression has been
 successfully treated. Second, newborns of prenatally depressed women are physiologically
 dysregulated and hence more challenging to nurture. With the passage of the Affordable Care
 Act and Maternal, Infant, and Early Childhood Home Visiting, the federal government is
 supporting states to implement high-quality home visiting programs as part of a comprehensive
 early childhood system for vulnerable families experiencing the risk factors associated with
 maternal depression and other mental health symptoms. But two important limitations of home
 visiting have been identified: child development home visitors are not trained to deal
 meaningfully with maternal depression and other mental health conditions, and they are often
 not sufficiently trained to support infant-mother relationships. Our study has the potential
 to inform intervention programs nationwide by testing the effectiveness of adding a short,
 attachment-based, home-visiting parenting program to an existing, evidence-based mental
 health treatment program delivered via community primary care clinics serving pregnant and
 parenting women from vulnerable populations. The goal of this research is to conduct a
 randomized controlled trial to evaluate the effectiveness of Promoting First Relationships®
 for English and Spanish-speaking low-income mothers who were treated for depression or other
 mental health conditions beginning in pregnancy and as needed in the perinatal year.
 Treatment will be coordinated through the publicly funded, evidenced-based Mental Health
 Integration Program for High-Risk Pregnant and Parenting Women (MHIP Moms) in primary care
 community health centers that target safety-net populations in King County, Washington.
 Promoting First Relationships® is a research-based, 10-week home visiting program that uses
 video feedback and strengths-based consultation strategies to increase mothers' parenting
 competence and confidence. Bilingual community providers will deliver Promoting First
 Relationships® after a baseline assessment and random assignment at infant age three months.
 Post tests will occur at infant age six and twelve months. The primary specific aims are to
 test the effectiveness of PFR to improve parenting quality for low income, English and
 Spanish speaking mothers who began mental/behavioral health treatment during pregnancy, and
 to improve social and regulatory outcomes for their infants.
Inclusion Criteria:

 -  Mothers with infants 6 weeks - 3 months old

 -  English or Spanish speaking

 -  Access to a telephone

 -  Currently or at some point during pregnancy received treatment for a mental health
 condition (counseling and/or medications) at a participating community health center
 in the Seattle, Washington area

 Exclusion Criteria:

 -  Currently experiencing an acute crisis (e.g., severe domestic violence, homelessness,
 hospitalization, imprisonment)