Enhanced Engagement: An Intervention Pilot for Mental Health Promotion among Low-Income Women in a Community Home Visiting Program

Headnote

Background:

Enhanced engagement is a brief, evidence-informed emerging practice model integrating mental health promotion and community service enhancements into maternal and child health home visiting.

Methods:

This mixed-methods, quasi-experimental pilot study (N = 25) was implemented in routine practice by existing community providers trained by study staff.

Results:

Quantitative data suggest significant decreases, relative to usual community care, in depressive symptoms [Patient Health Questionnaire (PHQ-9); t = -3.24, p = 0.0036], as well as an increase in perceived social support [Sarason's Social Support Questionnaire-Revised (SSQ-R); t = 3.35, p = 0.0027] associated with enhanced engagement. Narrative responses reveal solid recall of intervention content in the intervention group, as well as perceived individual benefit and satisfaction with the intervention.

Implications:

Quantitative, qualitative, and cost-benefit outcomes from this pilot study offer a promising foundation for future research and replication of enhanced engagement, particularly in communities where service utilization barriers preclude or delay traditional mental health treatment.

Key words: home visiting; mental health promotion; perinatal depression

Public awareness of the importance of women's mental health during and around the time of pregnancy has increased in the past decade. An estimated 15 to 20 percent of all women experience depression during pregnancy or postpartum (Gaynes et al., 2005). Higher prevalence estimates for perinatal depression have been reported in community samples of low-income and ethnic minority women, groups that are also less likely to utilize traditional public or private sector mental health services (Beeghly et al., 2003; Leis, Mendelson, Perry, & Tandon, 2011; Rafferty, Griffin, & Robokos, 2010). In addition to the impact of perinatal depression on maternal mental health and well-being, studies consistently demonstrate the generational impact of untreated perinatal depression on the health, development, and emotional well-being of infants and children (Field, 2010; Grote et al., 2010; Satyanarayana, Lukose, & Srinivasan, 2011).

Public-health-supported maternal and child health home visiting programs provide extensive parenting education as well as health promotion for pregnant and postpartum women and families. The current practice within many home visiting programs is to screen and immediately refer women who screen positive for perinatal depression to community mental health treatment (Segre, O'Hara, Brock, & Taylor, 2012). Unfortunately, studies also suggest that an estimated 60 percent of women with elevated perinatal depression symptoms at screening do...