Video-Delivered Family Therapy for Home Visited Young Mothers With Perinatal Depressive Symptoms: Quasi-Experimental Implementation-Effectiveness Hybrid Trial

Abstract

BackgroundThe Federal Maternal, Infant, and Early Childhood Home Visiting Program is a national child abuse prevention strategy that serves families at risk for child maltreatment throughout the United States. Significant portions of the clients are young mothers who screen positive for clinically significant perinatal depressive symptoms and experience relational discord that worsens their symptoms. Although home visitors refer those who screen positive for depression to community-based treatment, they infrequently obtain treatment because of multiple barriers. These barriers are compounded for home visited families in rural areas.ObjectiveThis pilot study aimed to explore the feasibility, acceptability, and effectiveness of a video-delivered family therapy intervention on reducing maternal depressive symptoms and improving family functioning and emotion regulation.MethodsA total of 13 home visited families received the video-delivered family therapy intervention. This study included a historical comparison group of mothers (N=13) who were previously enrolled in home visiting and screened positive for clinically significant perinatal depressive symptoms but refused treatment. A licensed marriage and family therapist delivered the family therapy intervention using Health Insurance Portability and Accountability Act–compliant videoconferencing technology on a computer from an office. Families participated in sessions in their homes using cell phones, tablets, and computers equipped with microphones and video cameras. Outcomes were measured following the final therapy session (post intervention) and 2 months later (follow-up). Depressive symptom scores of mothers who received the video-delivered family therapy intervention were compared with those of mothers in the historical comparison group over a 6-month period. Univariate statistics and correlations were calculated to assess measures of feasibility. Percentages and qualitative thematic analysis were used to assess acceptability. Wilcoxon signed-rank tests were used to assess changes in maternal and family outcomes.ResultsNo families dropped out of the study. All families reported that the technology was convenient and easy to use. All families reported high satisfaction with the video-delivered intervention. Nearly all families reported that they preferred video-delivered family therapy instead of clinic-based therapy. Therapeutic alliance was strong. Mothers demonstrated a statistically significant reduction in depressive symptoms (P=.001). When compared with mothers in the historical comparison group, those in the family therapy intervention showed a significant reduction in depressive symptoms (P=.001). Families demonstrated statistically significant improvements in family functioning (P=.02) and cognitive reappraisal (P=.004).ConclusionsThis pilot study yielded preliminary findings that support the feasibility, acceptability, and effectiveness of the video-delivered family therapy intervention for underserved home visited families in rural areas. Our finding...

Engaging rural young mothers in a technology-based intervention for depression

“…In summary, home visitors had to be fluent in English and were eligible for the study if they intended to remain in their current jobs for at least a year (Cluxton-Keller et al, 2017). Mothers, ages 13–25 and fluent in English, in the first trimester of pregnancy through eighteen months postpartum with Edinburgh Postnatal Depression Scale ( EPDS ) (Cox, Holden, & Sagovsky, 1987) scores of ≥8 were recruited for study participation (Cluxton-Keller, Williams, Buteau, Donnelly, Stolte, Monroe-Cassel, & Bruce, 2018). The EPDS is commonly used by home visiting program agencies to routinely screen mothers for depression.…”

“…At least one of the mother’s family members had to be willing and available to participate in eight of the 10 video-based family therapy sessions (Cluxton-Keller et al, 2018). All families had consistent internet access (i.e., subscribed to an internet service provider and did not experience weekly disruptions in service) on a cell phone or computer equipped with a camera and microphone (Cluxton-Keller et al, 2018). No families were removed from the study for inconsistent Internet access (Cluxton-Keller et al, 2018).…”

“…All families had consistent internet access (i.e., subscribed to an internet service provider and did not experience weekly disruptions in service) on a cell phone or computer equipped with a camera and microphone (Cluxton-Keller et al, 2018). No families were removed from the study for inconsistent Internet access (Cluxton-Keller et al, 2018).…”

Maternal Mental Health MATTERS

“…Telepsychiatry is a component of MATTERS to increase access to perinatal mental health specialists, and this may be adapted to provide access to telepsychotherapy. Preliminary findings also support the use of video-delivered family therapy integrated with home visiting to address perinatal depression symptoms [27]. As such, the MATTERS model, in conjunction with programs such as Family Connects, could provide a comprehensive approach to maternal mental health where providers and patients feel supported, increasing efficacy in meeting mental health needs in a number of ways, including for those in more rural areas through telehealth approaches.…”

mHealth and Perinatal Depression in Low-and Middle-Income Countries: A Scoping Review of the Literature

“…Mobile phones have been used to access self-help tools and emotional support for women with postpartum depression [ 29 ], as well as patient decision tools for making treatment choices [ 26 ]. mHealth has also been used to deliver counseling therapy via text messages [ 30 ], family therapy for young mothers with perinatal depressive symptoms [ 31 ], cognitive behavioral therapy for antenatal depression [ 32 ] and even to address the mental health concerns of fathers to be [ 33 ]. However, it is important to understand how the use of mHealth is developing in low- and middle-income countries where the potential for impact, in terms of improving perinatal outcomes, is high.…”