Home Visiting and Maternal Depression: Seizing the Opportunities to Help Mothers and Young Children

Abstract

This guide offers practical insights about how home visiting programs can better serve depressed mothers and their young children. Results reveal no single source of help, formal or informal, is universally trusted by mothers, who look for someone with whom they have a trusting relationship over time. Home visiting programs have great potential to help these families. However, programs need strong mental health connections, staff training, and capacity to transition depressed mothers to follow-up treatment, among other enhancements. The Doris Duke Charitable Foundation funded this research as part of an Urban Institute project identifying effective service approaches for depressed mothers.

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Executive Summary

Undetected and untreated parental depression places millions of children in the United States at risk each day. Parental depression can be especially damaging for the growth and healthy development of very young children, who depend heavily on their parents for nurture and care. Treating parental depression and addressing its negative effects early in a child’s life could improve that child’s development. Several safe and effective depression treatments are available, but the delivery of these services, especially to low‐income families, requires new and innovative approaches.

This guide looks at one promising approach: using home visiting programs to identify depressed mothers and connect them and their families to services. Home visiting programs generally involve regular visits to pregnant women and mothers of young children over several months to several years by a paraprofessional or professional (such as a nurse or social worker), with goals that may include enhanced parenting skills, better maternal and child health, achievement of maternal education and employment goals, postponement of subsequent births, and enhanced child development. Researchers have identified different home visiting programs that are backed by solid evidence of improved results, and new funding to expand the programs is included in the Patient Protection and Affordable Care Act (or ACA).

However, despite these programs’ promise, the evidence about their current success specifically for depressed mothers and their children is mixed, leading researchers to call for better information about how to redesign or supplement services. This guide helps fill that information gap. By drawing on research as well as new interviews with low‐income mothers, home visitors, and other service providers, this guide offers practical insights about how home visiting programs can enhance their own work and their links to other programs in the community—such as mental health treatment—to better serve depressed mothers and their young children.

Low‐income mothers of young children, as well as home visitors themselves and other service providers, agree with researchers on the tremendous potential of home visiting services to reach mothers, build a trusting relationship, and enable moms to get help with depression. The mothers interviewed believe that depression is widespread in their communities among mothers of young children, and many would advise a depressed friend to seek help somewhere. While they do not agree on a single institution or person to go to for help with depression, they do articulate the kind of relationship they look for: one where the other person—whether neighbor, family member, or service provider—has earned their trust through consistency over time.

Yet, interviews and research evidence also make clear the large challenges that face home visit programs in responding to maternal depression—and the practical options that exist for addressing each challenge.

1. Reaching the mothers who most need help. As programs expand with new ACA funding, communities should seize the opportunity to use data to learn about and target services to depressed mothers of young children, develop effective referral and recruitment paths that connect depressed mothers with home visiting, and offer many such paths for mothers with young children of different ages.
2. Helping home visitors identify depression and talk to mothers about its implications and treatment. Home visiting programs should consider depression screening as part of a more comprehensive approach to engaging and helping depressed mothers. Programs should explain to staff how identifying and treating a mother’s depression connects to the core home visiting mission, consider training home visitors to speak honestly to a mother’s concerns about child protective services, complement one‐on‐one attention during home visits with group or community strategies that are not stigmatized, and seek out resources to overcome some of the mothers’ practical barriers while also connecting mothers to depression treatment.
3. Connecting to, supporting, and providing high‐quality treatment. Researchers are studying two promising approaches to this challenge: developing home‐based mental health services that partner with home visit programs, and providing skilled mental health consultation and supervision. Programs should consider combining the two approaches to reach the most families.
4. Attending to young children’s development as well as mothers’ treatment. Keeping a genuine focus on both the child’s and the mother’s needs is not easy or automatic. Programs should consider partnering (for example, between Nurse‐Family Partnership and Early Head Start), multidisciplinary collaborative teams, and cross‐training as potential strategies.
5. Offering ongoing help after home visiting. Programs should consider an explicit transition plan for mothers with depression leaving home visiting programs.

Researchers have clearly demonstrated the widespread prevalence of maternal depression and the risks to young children who grow up with mothers with untreated depression. Studies have also shown the clinical effectiveness of treatment once depression is identified. The challenge for policymakers and program leaders is to translate this clear research evidence into service delivery approaches that make a difference. Today, the visibility of home visiting and the opportunity for additional resources offer an opportunity to build on innovations from the field and significantly improve young children’s life chances.

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