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8 Working from the Present to the Future: Lessons Learned from Current Practice
Pages 343-384

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From page 343...
... Early efforts in the adoption, implementation, integra tion, and dissemination of various components of evidence-based depression care programs offer insight into the future development of key features of such an ideal system.
From page 344...
... Adding a Parent-Child Dimension • Adding a parent-child dimension to adult depression care requires linkages of a range of services and systems integrated across a di verse range of settings. • Existing exemplary strategies in individual service settings -- pri mary care, home visitation, early childhood and parenting training programs, schools, the criminal justice system, and community wide programs -- offer important lessons regarding the challenges faced in implementing such strategies for depressed parents and their outcomes.
From page 345...
... . Ideally, more proactive approaches to prevention and early intervention in depressed parents would also be available in multiple settings that engage young children and families, such as child care centers, home visitation programs, family support programs, and school-based programs.
From page 346...
... The chapter concludes with a set of recommendations that could advance the knowledge base associated with the design, experimentation, and implementation of different service models. QUALITY IMPROVEMENT INTERVENTIONS AND THE TREATMENT OF ADULT DEPRESSION A significant body of research has emerged demonstrating that despite the availability of evidence-based interventions and practice guidelines, the outcomes of adult patients with depression remain poor in primary care settings (Schoenbaum et al., 2001)
From page 347...
... . In all of these settings, populations, and conditions in which IMPACT has been adapted and implemented, it has been shown to be more effective in depression care than usual care (Ell et al., 2008; Grypma et al., 2006; Kinder et al., 2006; Richardson, McCauley, and Katon, 2009)
From page 348...
... Experience with the implementation of quality improvement interventions thus offers important lessons in designing new approaches that could focus on strengthening parent-child relationships as well as clinical effectiveness in treatment settings. But adding and implementing an explicit focus on parenting and parent-child relationships to different forms of screening, prevention, and treatment models for adults who struggle with depression (which we collectively term as "depression care")
From page 349...
... SPECIAL ISSUES BY SERVICE SETTING Individual service settings offer further insight and important lessons regarding the challenges that deserve systematic attention in implementing innovative strategies to strengthen, identify, treat, and prevent depression and improve parenting practices and parent-child relationships for depressed adults who are parents and their children. This section reviews the experience with exemplary strategies in such settings, including primary care, home visitation, early childhood and parent training programs, schools, the criminal justice system, and community-wide models.
From page 350...
... Financial considerations are also likely to be an inhibitory factor in the assimilation and use of depression care models by primary care physicians, since most of these models appear to add to the gross costs of practice (e.g., for an integrated care manager) (Gilbody, Bower, and Whitty, 2006; Gilbody et al., 2003; Mattke, Seid, and Ma, 2007; Simon et al., 2001)
From page 351...
... Physicians who serve as medical homes may thus develop greater interest and capacity to assimilate and use new developments in depression care. Home Visitation Home visitation programs for young families represent another possible avenue for the identification, treatment, and prevention of depression in parents.
From page 352...
... Early Head Start is actually a set of program options from which local Head Start agencies may choose: center-based care for children, home visiting for children and their families, or a combination of the two. Although initial findings from the 17-site randomized trial of Early Head Start did not show any impact on parental depression, more recent evidence suggests that the program may have had a delayed inoculatory effect (ChazanCohen et al., 2007)
From page 353...
... . Nonetheless, Head Start's 40 years of durability -- a remarkable feat among nonentitlement social programs -- makes it a credible target of opportunity for extending the reach of effective depression care.
From page 354...
... Investigations show that welldesigned parent training programs can reduce parental depression while also improving parenting skills (DeGarmo, Patterson, and Forgatch, 2004; Kaminski et al., 2008) , at least for a period of time (Barlow, Coren, and Stewart-Brown, 2003)
From page 355...
... . Schools are a challenging environment for depression care for at least three reasons.
From page 356...
... . However, among evidence-based practices, developmentally appropriate and research-supported forms of treatment appear to be the least likely for criminal justice entities to use (Henderson, Taxman, and Young, 2008)
From page 357...
... . Collaboration seems applicable to the variety of integrated depression care models that have been evaluated.
From page 358...
... Department of Health and Human Services, provide a basis for the development of more intensive and collaborative programs and policies to enhance state-based and professional responses to depression in parents and early interventions for children whose parents may be affected by this disorder. At present, federal efforts focus primarily on maternal depression that occurs during pregnancy or the postpartum period.
From page 359...
... CDC does not specifically collect data regarding the incidence or severity of depression during other stages of parenting, the identification of paternal depression, or the impact of parental depression on children; however one of the leading health indicators -- mental health -- identified in Healthy People 2010 led to a number of objectives including "increase the proportion of adults with recognized depression who receive treatment" and "increase the proportion of persons with co-occurring substance abuse and mental disorders who receive treatment for both disorders." It also contains objectives intended to increase access to quality health services, with topics including insurance, preventive and behavioral services, and competencies as well as racial and ethnic disparities for health providers (U.S. Department of Health and Human Services, 2000)
From page 360...
... At present, no systematic effort is available to coordinate the findings from NIH studies about parental depression or to integrate these research findings into programmatic and state-based programs in HRSA, AHRQ, CDC, or the Substance Abuse and Mental Health Services Administration (SAMHSA)
From page 361...
... These include • Caring for Every Child's Mental Health Campaign • Child and Adolescent Mental Health and Substance Abuse State Infrastructure Grants • Circles of Care • Comprehensive Community Mental Health Services Program for Children and Their Families • Council on Coordination and Collaboration • Partnerships for Youth Transition • Statewide Family Network Grant Program   See http://mentalhealth.samhsa.gov/publications/allpubs/KEN95-0016/default.asp.
From page 362...
... Currently, these include disease prevention, eliminating health disparities, public health preparedness, and improving health literacy. Those specifically related to improving the quality of care for depressed parents and their children include eliminating health disparities and public health preparedness.
From page 363...
... State-Led Comprehensive Initiatives Illinois Illinois has several initiatives that are primarily directed at improving outcomes for pregnant women and young children. These include • The Perinatal Mental Health Consultation Service, operated by the University of Illinois at Chicago and the state, in partnership with the Illinois Chapter of the Academy of Pediatrics and the Acad emy of Family Physicians, offers provider consultative services and education and training to clinicians across disciplines to develop competencies in assessment and treatment of maternal depression.
From page 364...
... It contains a consultation com ponent and is designed to enhance the state's capacity in primary care to appropriately identify and treat perinatal depression. • The state also produced a pocket guide for health care profession als, that is, a reference book that includes information on treat ment, coding, and billing.
From page 365...
... Through the state's e-birth certificate program, mandated screenings for maternal depression can be tracked (between 80–85 percent of the screenings are now in the database)
From page 366...
... Ohio The Ohio Departments of Health and Mental Health have launched a statewide, county-based home visitation program. This program, titled Help-Me-Grow, includes an emphasis on screening and referrals for parental depression among the participating mothers in collaboration with local mental health agencies.
From page 367...
... State-Led Specific Public Awareness Activities In addition to the more comprehensive initiatives highlighted above, several states also have made efforts to promote public awareness and to reduce the stigma attached to parental depression. In both Washington and New Jersey, Speak Up When You Are Down is a multilingual public education campaign to increase awareness of postpartum depression funded through a legislative appropriation.
From page 368...
... Preventionists have a specific role and title, and many have been educated in Dutch academic and training programs that feature a particular focus on prevention, health education, and health promotion. The work is part of a national health policy, and about 5–10 percent of the budgets of community mental health centers are spent on prevention of mental disorders, much of it to support the work of prevention experts, although it also supports the part-time involvement of mental health professionals.
From page 369...
... Over the past 15 years, a comprehensive array of services for children of mentally ill parents have been developed, including play and talk groups, information support groups, online work websites, brochures, videos, school-based education, and a buddy system for children and for parents, home-based mother-baby interventions, parent training, and others. This is accompanied by extensive postgraduate training.
From page 370...
... A 3-day meeting is held annually in which those countries developing programs for children of the mentally ill meet together in mutual support. Iceland, Norway, and Sweden have chosen to include the Family Talk Intervention as part of their regular array of services, and both Norway and Sweden are in the process of developing national programs.
From page 371...
... For widespread implementation of programs that are shown to be effective for families with depression, there is a need for more work on issues of engagement and barriers to access to services as most families with depressed parents do not receive adequate intervention. Research on depression care models should therefore identify characteristics of individuals who accept services and individuals who decline them to determine how well a given model fits with the cultural and socioeconomic characteristics of the relevant community.
From page 372...
... It is important to note as well that each setting frequently has difficulty in establishing strong linkages with mental health services. Some of the most successful depression care programs have been implemented in quality improvement efforts in primary care settings.
From page 373...
... Home visitation programs provide a service setting in which high-risk parents and families can be readily screened for depression in the comfort of their own homes. In addition to screening and mental health referrals, home visitors can provide parenting interventions to depressed parents and screen for developmental delays and emotional problems in their children.
From page 374...
... Although the current system of care is far from being ready to implement this ideal, a variety of initiatives for improving the quality of services for depressed parents and their children have emerged at the community, state, and federal level, as well as internationally in a variety of service settings. Based on the opportunities (and challenges)
From page 375...
... These activities and materials should specifically target the public and individuals who make decisions about care for a diverse population of depressed parents and their children in a variety of settings (e.g., state and county leadership, state health directors, state mental health agencies, and state maternal and child health services)
From page 376...
... who are at risk because their parents are depressed; • could include the Healthy Start Program, the Head Start Program, the Nurse-Family Partnership, home visiting, schools, primary care, mental health and substance abuse treatment settings, and other programs that offer early childhood interventions; • would ideally use more than one strategy and could use funds to test state-based efforts that experiment with different service strate gies and service settings and to strengthen the relationship between mental health services and parental support programs; • could test ways to reduce the stigma and biases frequently as sociated with depression, address cultural and racial barriers and disparities in the mental health services system, and explore op portunities to strengthen formal and informal supports for families that are consistent with cultural traditions and resources; and • should include state mental health agencies and local government (e.g., counties) , at least in an advisory capacity.
From page 377...
... SAMHSA could identify an interagency committee to pool information about programs that are affected by parents with depression, programs that offer opportunities to engage parents and children in the treatment and prevention of this disorder, and research and evaluation studies that offer insight into effective interventions. SAMHSA could develop opportunities to introduce effective interventions in both community-based systems of care frameworks and in integrated behavioral and mental health services in a variety of settings, including primary care and substance abuse treatment settings.
From page 378...
... . It takes time: Impacts of Early Head Start that lead to reductions in maternal depression two years later.
From page 379...
... . Can quality improvement programs for depression in primary care address patient preferences for treatment?
From page 380...
... . Taking an evidence-based model of depression care from research to practice: Making lemonade out of depression.
From page 381...
... . Improving depression care in patients with diabetes and multiple complications.
From page 382...
... . Primary care pediatricians' roles and perceived responsibilities in the identifica tion and management of maternal depression.
From page 383...
... . Cost-effectiveness of practice-ini tiated quality improvement for depression: Results of a randomized controlled trial.
From page 384...
... . Collaborative care management of late life depression in the primary care setting: A randomized controlled trial.


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