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Currently Skimming:

10 Opportunities for Innovative Reforms and Knowledge Development
Pages 409-430

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From page 409...
... ____________________ In earlier chapters the committee described the extensive literature on the relationship of parental depression, parenting practices, and the healthy 409
From page 410...
... developing a research agenda that highlights priorities for new knowledge development and (2) creating policy and learning environments that contribute to successful dissemination and implementation of effective practices for improving the quality of care for depressed parents and their children.
From page 411...
... Interaction of Depression, Parenting, and Child Health and Development Although strong evidence now supports the breadth and extent of associations between depression in parents and adverse outcomes in children, there remain many unanswered questions. In particular, many questions remain regarding mediation and moderation of those associations.
From page 412...
... The committee also noted several gaps in the literature related to physical health of the children of depressed parents. More tracking is needed of health care utilization, missed school days, and other aspects of daily functioning in association with depression in parents.
From page 413...
... More specifically, studies are needed that measure depression in parents with both diagnostic interviews and symptom scales that examine differences in parenting and in child functioning that might be related to measurement approach, severity, impairment, and other clinical characteristics of depression. In terms of outcomes, research is lacking on the outcomes of screening parents as part of a two-generation, comprehensive, depression care program that addresses issues for both parent and child.
From page 414...
... Prevention More research is needed on the prevention of adverse outcomes in families with depressed parents. Although there is preliminary support for interventions that prevent adverse effects for depressed parents and their children, most of these approaches need further evaluation, replication, and longitudinal studies before widespread implementation is warranted.
From page 415...
... Although these targeted approaches are likely to be most promising, more evidence is also needed to determine whether universal programs focused on wellness and mental health promotion can lead to reductions in depression in parents and the subsequent adverse effects in children. The following types of programs need more research with attention to depression in parents: • programs targeted at preventing depression in parents with chil dren at all developmental stages; • prevention programs targeted at improving parenting; • prevention programs targeted at enhancing protective factors and reducing risk in children; • multigenerational and multicomponent programs; • prevention programs in settings in which families with depression and their children are readily accessed, such as schools and com munity settings; and • policy and social welfare interventions and other broad-based pro grams that target vulnerable families and children.
From page 416...
... Given the considerable evidence about the social determinants of health in general and its effects on parental depression in particular, it is important that intervention research to address depression in parents should assess relative effectiveness in families with low income, families in high-risk neighborhoods, families with unstable housing, and families from varied cultural and linguistic backgrounds, as well as adaptations or enhancements to target these vulnerable populations. This research will help to elucidate the need to address these interrelated factors to successfully intervene to improve depression, parenting, and child outcomes as well as the need to address depression in order to make other interventions for these vulnerable families more successful.
From page 417...
... Trials are also needed of specific ways to offer identification, outreach, engagement, and treatment and prevention services to vulnerable families who face multiple risks. Specifically, research is needed on culturally and linguistically competently evidenced-based models as well as models that integrate treatment of co-occurring conditions, such as marital conflict, domestic violence, and exposure to trauma and co-existing mental and substance abuse disorders.
From page 418...
... 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 419...
... The application of evidence-based knowledge requires explicit attention to dissemination, implementation, and the creation of an organizational culture, often termed a "learning organization," which is intentionally receptive to new research. The next section explores the features associated with learning organizations that may foster the use of science in the prevention and treatment of parental depression and in calling attention to children who may be affected by this disorder.
From page 420...
... The section concludes with a research agenda to help support innovation, dissemination, and implementation of evidence-based depression care programs for depressed parents and their children across a wide range of venues. The Mechanisms of Learning Dissemination and implementation of promising models draw explicit attention to the mechanisms of learning, such as assimilation and use.
From page 421...
... . Research in health care quality improvement suggests that organizational leaders must demonstrate commitment and persistence for their messages about quality to motivate and to be observed by hospital staff (Rousseau and Tijoriwalla, 1999)
From page 422...
... . In 2009 the American Recovery and Reinvestment Act included a health information technology extension agent function that could be broadened as a method for clinical practice quality improvement and research dissemination (Rural Health Resource Center, 2009)
From page 423...
... The guide is organized around four core questions, features active links to websites that contain in-depth information on related topics, and provides a hyperlinked index of public domain implementation tools and an appendix of four case studies. The first core question potential adopters need to consider is "Does the innovation fit?
From page 424...
... However, the generic nature of such guidelines means that potential adopters must creatively interpret their application to specific programs and settings. Indeed, most evidence-based and promising depression care programs lack detailed implementation manu
From page 425...
... Future research involving the replication of a specific program in multiple settings should devote resources to identifying common and unique implementation issues and tasks raised across different sites. A Research Agenda for Dissemination and Implementation of Innovative Strategies The scope and compelling nature of depression in parents and its effects on their family calls for experimentation with programs that have not yet met the highest standard of evidence -- that is, longitudinal randomized controlled clinical trials, efficacy and effectiveness studies, effects on clinical depression compared with effects on depressive symptoms, and cultural considerations and generalizability.
From page 426...
... However, the dissemination and implementation research literature points to no simple paths for extending the reach of effective forms of depression care. Although general guidelines exist to help potential adopters ask pertinent questions, the answers required for the implementation of complex, multidisciplinary, two-generation, large-scale prevention care programs must be drawn by inference from a limited body of research largely focused on other health care and business areas.
From page 427...
... This research agenda should include the development and evaluation of empirically based strategies for screening, treatment, and prevention of depressed parents and the effects on their children and improve widespread dis semination and implementation of these strategies in different services settings for diverse populations of children and their families. In carrying out this recommendation, these federal agencies should consider partnerships with private organizations, employers, and payers to support this research agenda.
From page 428...
... Clinical Psychology: Science and Practice, 13, 73–89. Jansen, J.P., Van den Bosch, F.A.J., and Volderba, H.W.
From page 429...
... . Assessing the impact of total quality management and organizational culture on multiple outcomes of care for coro nary artery bypass graft surgery patients.
From page 430...
... . Does changing behavioral intentions engender behavior change?


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