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Lee K, Hough K. Racial Disparity of Mental Health Service Utilization Among Low-Income Head Start Eligible Parents. J Racial Ethn Health Disparities 2024; 11:611-620. [PMID: 36959391 DOI: 10.1007/s40615-023-01545-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 02/15/2023] [Accepted: 02/16/2023] [Indexed: 03/25/2023]
Abstract
Based on the Head Start Impact Study, 1706 parents who had mild, moderate, and severe depressive symptoms were selected to examine the following questions: (1) Are there racial disparities in mental health service utilization among low-income parents? (2) Does Head Start have an impact on mental health service utilization across white, African American, and Hispanic parents? The present research found that, compared to white parents, African American and Hispanic parents are significantly less likely to utilize mental health services. Head Start impact was found for white parents but not for African American and Hispanic parents. Furthermore, parents who spoke a language other than English had higher household risk factors, and reside in rural areas are less likely to utilize mental health services. Mental health providers should deliver patient-centered services that consider cultural and linguistic competency as well as the personal life context of their patients to remove any barriers to accessing mental health services.
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Affiliation(s)
- Kyunghee Lee
- School of Social Work, Michigan State University, 226 Baker Hall, East Lansing, MI, 48824, USA.
| | - Kerri Hough
- School of Social Work, Michigan State University, 226 Baker Hall, East Lansing, MI, 48824, USA
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Palmer Molina A, Palinkas L, Hernandez Y, Garcia I, Stuart S, Sosna T, Mennen FE. Implementation of the "Healthy Moms, Healthy Kids" Program in Head Start: An Application of the RE-AIM QuEST Framework Centering Equity. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024; 51:69-84. [PMID: 37898595 DOI: 10.1007/s10488-023-01312-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2023] [Indexed: 10/30/2023]
Abstract
BACKGROUND Marginalized mothers are disproportionately impacted by depression and face barriers in accessing mental health treatment. Recent efforts have focused on building capacity to address maternal depression in Head Start; however, it is unclear if mental health inequities can be addressed by two-generation programs in Head Start settings. Therefore, this study examined the implementation outcomes and processes of a two-generation program called "Healthy Moms, Healthy Kids" (HMHK) that provided an evidence-based depression treatment to ethnic minority Head Start mothers. METHOD Quantitative and qualitative data were collected and merged in a convergent mixed method design in accordance with the RE-AIM Qualitative Evaluation for Systematic Translation (RE-AIM QuEST) framework. Qualitative data included interviews with 52 key stakeholders, including intervention participants and staff members, and 176 sets of meeting minutes from the implementation period. Quantitative data included intervention study data and administrative data. RESULTS It was difficult for HMHK to reach the target population, with only 16.8% of eligible mothers choosing to participate. However, mothers who participated experienced reductions in depressive symptoms and parenting stress and shared a variety of positive impacts in interviews. The program was also more successful in enrolling Latinx mothers who were Spanish-speaking or bilingual rather than English-speaking and Black/African American mothers, limiting its reach. CONCLUSION Providing IPT therapy groups was effective in reducing maternal depressive symptoms and stress for those who enrolled, but additional work should focus on reducing barriers to participation, considering other delivery models to meet participants' needs, and identifying culturally relevant ways to meet the needs of Black mothers.
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Affiliation(s)
| | - Lawrence Palinkas
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Yuliana Hernandez
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Iliana Garcia
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | | | - Todd Sosna
- Optimist Youth Homes, Los Angeles, CA, USA
| | - Ferol E Mennen
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
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Harris SA, Harrison M, Hazell-Raine K, Wade C, Eapen V, Kohlhoff J. Patient navigation models for mental health of parents expecting or caring for an infant or young child: A systematic review. Infant Ment Health J 2023. [PMID: 37422890 DOI: 10.1002/imhj.22075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 04/07/2023] [Accepted: 05/11/2023] [Indexed: 07/11/2023]
Abstract
Patient navigation (PN) aims to improve timely access to healthcare by helping patients to "navigate" complex service provision landscapes. PN models have been applied in diverse healthcare settings including perinatal mental health (PMH). However, the practice models and implementation of PN programs vary widely, and their impact on engagement with PMH services has not been systematically investigated. This systematic narrative review study aimed to (1) identify and describe existing PMH PN models, (2) understand their effectiveness in improving service engagement and clinical outcomes, (3) review patient and provider perceptions, and (4) explore facilitators and barriers to program success. A systematic search of published articles/reports describing PMH PN programs/service delivery models targeting parents in the period from conception to 5 years postpartum was conducted. In total, 19 articles describing 13 programs were identified. The analysis yielded a number of commonalities and differences across program settings, target populations, and the scope of the navigator role. While there was promising evidence to support the clinical efficacy and impact on service utilization of PN programs for PMH, the current evidence base is sparse. Further research evaluating the efficacy of such services, and facilitators and barriers to their success, is warranted.
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Affiliation(s)
- Sophia A Harris
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, Australia
| | - Michelle Harrison
- Parenting Research Centre, Melbourne, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Karen Hazell-Raine
- Faculty of Health, Charles Darwin University, Darwin, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | | | - Valsamma Eapen
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, Australia
- South Western Sydney Local Health District, Liverpool, Australia
| | - Jane Kohlhoff
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Harries MD, Xu N, Bertenthal MS, Luna V, Akel MJ, Volerman A. Community Health Workers in Schools: A Systematic Review. Acad Pediatr 2023; 23:14-23. [PMID: 36223871 PMCID: PMC9951773 DOI: 10.1016/j.acap.2022.08.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 07/28/2022] [Accepted: 08/21/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Community health workers (CHWs) are trusted community members who provide health education and care. However, no consensus exists regarding whether community health worker-based interventions are effective within the school setting. OBJECTIVE To determine outcomes and best practices of school-based community health worker interventions. DATA SOURCES PubMed, CINAHL, and SCOPUS databases. STUDY ELIGIBILITY CRITERIA This systematic literature review examined articles that described an intervention led by community health workers, targeted children and/or parents, and took place primarily within a Kindergarten-12th grade school setting. Articles were excluded if they described an intervention outside the United States. PARTICIPANTS Community health workers, children, and/or their parents INTERVENTIONS: School-based community health worker programs RESULTS: Of 1875 articles identified, 13 met inclusion criteria and were included in the final analysis. Of these, 5 described a statistically significant primary outcome. Seven articles provided details regarding community health worker recruitment, training, and roles that would enable reproduction of the intervention. LIMITATIONS This review focused on interventions in the United States. Bias of individual studies had a wide range of scores (9-21). Heterogeneity of studies also precluded a meta-analysis of primary outcomes. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS The utilization of Community health workers in school-based interventions for children and/or parents is promising. This review identified a lack of detail and uniformity in program presentation, specifically with Community health worker recruitment, training, and roles. A standardized reporting mechanism for Community health worker interventions in schools would better allow for reproducibility and scalability of existing studies.
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Affiliation(s)
- Michael D Harries
- Department of Pediatrics (MD Harries, M Bertenthal, A Volerman), University of Chicago, Chicago, Ill.
| | - Nuo Xu
- Department of Medicine (N Xu, V Luna, MJ Akel, A Volerman), University of Chicago, Chicago, Ill
| | - Michael S Bertenthal
- Department of Pediatrics (MD Harries, M Bertenthal, A Volerman), University of Chicago, Chicago, Ill
| | - Viridiana Luna
- Department of Medicine (N Xu, V Luna, MJ Akel, A Volerman), University of Chicago, Chicago, Ill
| | - Mary J Akel
- Department of Medicine (N Xu, V Luna, MJ Akel, A Volerman), University of Chicago, Chicago, Ill
| | - Anna Volerman
- Department of Pediatrics (MD Harries, M Bertenthal, A Volerman), University of Chicago, Chicago, Ill; Department of Medicine (N Xu, V Luna, MJ Akel, A Volerman), University of Chicago, Chicago, Ill
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Broder-Fingert S, Kuhn J, Sheldrick RC, Chu A, Fortuna L, Jordan M, Rubin D, Feinberg E. Using the Multiphase Optimization Strategy (MOST) framework to test intervention delivery strategies: a study protocol. Trials 2019; 20:728. [PMID: 31842963 PMCID: PMC6915979 DOI: 10.1186/s13063-019-3853-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Accepted: 10/25/2019] [Indexed: 12/11/2022] Open
Abstract
Background Delivery of behavioral interventions is complex, as the majority of interventions consist of multiple components used either simultaneously, sequentially, or both. The importance of clearly delineating delivery strategies within these complex interventions—and furthermore understanding the impact of each strategy on effectiveness—has recently emerged as an important facet of intervention research. Yet, few methodologies exist to prospectively test the effectiveness of delivery strategies and how they impact implementation. In the current paper, we describe a study protocol for a large randomized controlled trial in which we will use the Multiphase Optimization Strategy (MOST), a novel framework developed to optimize interventions, i.e., to test the effectiveness of intervention delivery strategies using a factorial design. We apply this framework to delivery of Family Navigation (FN), an evidence-based care management strategy designed to reduce disparities and improve access to behavioral health services, and test four components related to its implementation. Methods/design The MOST framework contains three distinct phases: Preparation, Optimization, and Evaluation. The Preparation phase for this study occurred previously. The current study consists of the Optimization and Evaluation phases. Children aged 3-to-12 years old who are detected as “at-risk” for behavioral health disorders (n = 304) at a large, urban federally qualified community health center will be referred to a Family Partner—a bicultural, bilingual member of the community with training in behavioral health and systems navigation—who will perform FN. Families will then be randomized to one of 16 possible combinations of FN delivery strategies (2 × 2 × 2× 2 factorial design). The primary outcome measure will be achieving a family-centered goal related to behavioral health services within 90 days of randomization. Implementation data on the fidelity, acceptability, feasibility, and cost of each strategy will also be collected. Results from the primary and secondary outcomes will be reviewed by our team of stakeholders to optimize FN delivery for implementation and dissemination based on effectiveness, efficiency, and cost. Discussion In this protocol paper, we describe how the MOST framework can be used to improve intervention delivery. These methods will be useful for future studies testing intervention delivery strategies and their impact on implementation. Trial registration ClinicalTrials.gov, NCT03569449. Registered on 26 June 2018.
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Affiliation(s)
- Sarabeth Broder-Fingert
- Boston Medical Center, 801 Albany Street, Boston, MA, 02114, USA. .,Boston University School of Medicine, Boston, MA, USA.
| | - Jocelyn Kuhn
- Boston Medical Center, 801 Albany Street, Boston, MA, 02114, USA
| | | | - Andrea Chu
- Boston Medical Center, 801 Albany Street, Boston, MA, 02114, USA.,Boston University School of Public Health, Boston, MA, USA
| | - Lisa Fortuna
- Boston Medical Center, 801 Albany Street, Boston, MA, 02114, USA.,Boston University School of Medicine, Boston, MA, USA
| | | | - Dana Rubin
- Boston University School of Medicine, Boston, MA, USA.,DotHouse Health Center, Dorchester, MA, USA
| | - Emily Feinberg
- Boston Medical Center, 801 Albany Street, Boston, MA, 02114, USA.,Boston University School of Medicine, Boston, MA, USA.,Boston University School of Public Health, Boston, MA, USA.,DotHouse Health Center, Dorchester, MA, USA
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