First name
Rhonda
Middle name
C
Last name
Boyd

Title

A protocol for applying health equity-informed implementation science models and frameworks to adapt a sleep intervention for adolescents at risk for suicidal thoughts and behaviors.

Year of Publication

2022

Number of Pages

971754

Date Published

12/2022

ISSN Number

2296-2565

Abstract

Background: Effective and equitable strategies to prevent youth suicidal thoughts and behaviors (STB) are an urgent public health priority. Adolescent sleep disturbances are robustly linked to STB but are rarely addressed in preventive interventions or among Black and/or Hispanic/Latinx youth for whom STB risk is increasing disproportionately. This paper describes an application of health equity-informed implementation science models and frameworks to adapt and evaluate the evidence-based Transdiagnostic Sleep and Circadian (TSC) intervention for primary care implementation with adolescents of minoritized backgrounds with depression and STB risk.

Methods: This multiphase study protocol uses the Assessment, Decision, Adaptation, Production, Topical Experts-Integration, Training, Testing (ADAPT-ITT) model to adapt and evaluate TSC for primary care implementation with adolescents who are depressed, at risk for STB, and of primarily Black and/or Hispanic/Latinx backgrounds. We integrate the Consolidated Framework for Implementation Research (CFIR) in an initial qualitative inquiry of adolescent, caregiver, and clinician perceptions of TSC. Subsequent ADAPT-ITT phases include systematically and iteratively testing adaptations based on the qualitative inquiry, with ongoing key informant input, and then evaluating the adapted TSC for feasibility, acceptability, and efficacy in a pilot randomized trial.

Anticipated results: Based on youth depression and sleep health disparities research, we expect that TSC adaptations will be needed to enhance intervention content for adolescents with depression, STB risk, and primarily Black and/or Hispanic/Latinx backgrounds. We also anticipate adaptations will be needed to align TSC delivery methods with primary care implementation.

Conclusions: Adapting evidence-based interventions with end-users and contexts in mind can help ensure that intervention strategies and delivery methods are acceptable to, and feasible with, health disparate populations. Although TSC has shown effectiveness for adolescents with sleep disturbances, we expect that additional multiphase research is necessary to optimize TSC for primary care delivery with Black and/or Hispanic/Latinx adolescents with depression and STB risk.

DOI

10.3389/fpubh.2022.971754

Alternate Title

Front Public Health

PMID

36311565

Title

Pilot RCT of a social media parenting intervention for postpartum mothers with depression symptoms.

Year of Publication

2018

Number of Pages

1-12

Date Published

2018 Dec 17

ISSN Number

0264-6838

Abstract

<p><strong>OBJECTIVE: </strong>This pilot study describes the adaptation of a parenting group intervention for social media, and examines the feasibility, acceptability and initial outcomes of the adapted intervention for mothers with postpartum depression symptoms.</p>

<p><strong>BACKGROUND: </strong>Postpartum depression can negatively affect parenting and the parent-infant relationship. Mothers with postpartum depression symptoms experience barriers to access in-person parenting interventions.</p>

<p><strong>METHODS: </strong>A small, randomised controlled trial was conducted with an adapted parenting intervention delivered via social media (Facebook) or in-person for mothers who screened positive for depression in paediatric clinics. Parenting sense of competence, depression symptoms and intervention attendance and satisfaction were assessed. Twenty-four mothers (mean age 26&nbsp;years; predominantly African American with limited economic resources) participated in the study.</p>

<p><strong>RESULTS: </strong>Linear regressions showed that the social media group had significantly improved parenting competence and decreased depression severity when compared to the in-person group. Attendance in the social media group was high (83%), but extremely poor in the in-person group (3%). The mothers rated the intervention positively and the majority of the mothers participated by posting comments on the group page on social media.</p>

<p><strong>CONCLUSION: </strong>The findings suggest the feasibility and benefit of delivering a parenting intervention through social media for postpartum mothers with high levels of depression symptoms.</p>

DOI

10.1080/02646838.2018.1556788

Alternate Title

J Reprod Infant Psychol

PMID

30556428

Title

Mothers' Mental Health Care Utilization After Screening for Postpartum Depression at Well Child Visits.

Year of Publication

2018

Date Published

2018 Nov 26

ISSN Number

1876-2867

Abstract

<p><strong>OBJECTIVES: </strong>The American Academy of Pediatrics recommends postpartum depression (PPD) screening. It is unknown if pediatricians are effective in linking mothers to mental health services. The objectives of the current study are to determine: 1) mental health care utilization among women with Medicaid insurance after a positive PPD screen and 2) maternal and infant factors that predict the likelihood of mental health care utilization.</p>

<p><strong>METHODS: </strong>Retrospective cohort design of mothers attending their infants' 2-month well child visit at one of five urban primary care practices between 2011-2014. A linked dataset of the child's electronic health records, maternal Medicaid claims, and birth certificates was used. The primary outcome was mental health care utilization within six months of a positive PPD screen. Multivariate logistic regression was used to estimate maternal and infant clinical and sociodemographic factors that predict service use.</p>

<p><strong>RESULTS: </strong>3,052 mothers met study criteria, 1,986 (65.1%) completed the PPD screen, and 263 (13.2%) screened positive for PPD of whom 195 (74.1%%) were referred for services. Twenty-three women (11.8%) had at least one Medicaid claim for depression within six months of screening. In multivariate modeling, mothers with a history of depression in the prior year (OR=3.80, 1.20-12.11) were more likely to receive mental health services after a positive screen.</p>

<p><strong>CONCLUSIONS: </strong>Few mothers who screened positive for PPD received mental health services. Mothers without a recent history of depression treatment may be especially at risk for inadequate care. Additional mechanisms to improve access to mental health services following PPD screening are needed.</p>

DOI

10.1016/j.acap.2018.11.013

Alternate Title

Acad Pediatr

PMID

30496869

Title

A Toddler Parenting Intervention in Primary Care for Caregivers With Depression Symptoms.

Year of Publication

2017

Number of Pages

465-480

Date Published

2017 Oct

ISSN Number

1573-6547

Abstract

<p>Caregiver depression impacts parenting behaviors and has deleterious effects on child behavior. Evidence-based interventions to address parenting have not been adapted for use with depressed caregivers in pediatric primary care settings. Our study examined the feasibility and explored outcomes of an evidence-based parenting program implemented in primary care and adapted for caregivers with depressive symptoms caring for toddlers. We conducted a randomized controlled trial with a wait-list control. Participants were caregivers who screened positive for depressive symptoms in pediatric settings with a toddler. Our study was implemented from July 2011 to June 2012. We adapted the Incredible Years Parents, Babies and Toddlers program with the addition of depression psychoeducation (12 weekly sessions), and assessed caregivers at baseline and immediately post-intervention. We assessed participation rates, depressive symptoms, parenting discipline practices, social support, and parenting stress. Our results revealed that 32 caregivers participating in the intervention group had significantly greater improvement in self-reported parenting discipline practices compared to the 29 wait-list control group caregivers. We found no differences between groups in depressive symptoms, social support, or parenting stress. Our study demonstrated that the average attendance was poor (mean attendance&nbsp;=&nbsp;3.7 sessions). We adapted an evidence-based parenting intervention for caregivers with depressive symptoms and toddlers in primary care; however, participation was challenging. Alternative intervention strategies are needed to reach and retain low-income caregivers with depression symptoms as they face multiple barriers to participation in groups within center-based services. Trial Registration Clinical Trials.gov identifier NCT01464619.</p>

DOI

10.1007/s10935-017-0481-8

Alternate Title

J Prim Prev

PMID

28733799

Title

SScreening for Parental Depression in Urban Primary Care Practices: A Mixed Methods Study.

Year of Publication

2016

Number of Pages

1858-1871

Date Published

2016

ISSN Number

1548-6869

Abstract

<p>We sought to determine feasibility and acceptability of parental depression screening in urban pediatric practices. We recruited seven practices to participate. Patient Health Questionnaire-2, a validated two-item screening tool, was used to screen for depressive symptoms at 1-3 year old well visits. We conducted semi-structured interviews with clinicians to identify barriers and facilitators to screening. Of 8,621 eligible parents, 21.1% completed screening with site-specific rates ranging from 10.1% to 48.5%. Among those screened, 8.1% screened positive for depressive symptoms with site-specific rates ranging from 1.2% to 16.9%. Electronic alerts improved screening rates from 45 / month to 170 / month. Fifteen clinicians completed interviews and endorsed screening to provide help for families, build stronger ties with parents, and improve outcomes for children. However, insufficient time, need to complete activities with higher priority, lack of mental health availability, few resources for parents with limited English proficiency, and discomfort addressing depression were thought to limit screening.</p>

DOI

10.1353/hpu.2016.0167

Alternate Title

J Health Care Poor Underserved

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