Helping nurse family partnership clients cope with depressive symptoms and anxiety

First-time, high-risk mothers who are exposed to repeated stressors, economic hardship and other risks show a high prevalence of depressive symptoms and anxiety that compromise sensitive, developmentally supportive parenting. High-risk mothers have had difficulty accessing traditional treatments for depression and anxiety symptoms because of instrumental barriers (cost, transportation, childcare) and stigma. These symptoms also limit engagement in enrichment services such as the Nurse-Family Partnership (NFP). NFP is a trusted entity that positively impacts maternal health, educational achievement and maternal role acquisition, and child safety and health outcomes. Integrating mental health approaches into NFP activities is a model approach that can reduce mothers' symptoms and enhance child outcomes. This paper presents the process by which a development team has created an enhancement to NFP services that is undergoing pilot testing. Following a year of discussion and analysis of NFP client and nurse home visitor (NFPHVs) data, a team was formed representing NFP thought leaders, mental health researchers and clinicians, evaluation and implementation experts and field consultants. A consensus-building approach was used to integrate evidence-based interventions into existing NFP materials and design skill-building and supports for NFPHVs and NFP supervisors. An educational program spanning 9 months was designed along with pre-and posttest evaluations. The education was offered to NFPHVs and supervisors in 3 states. Anecdotally, preliminary results are positive. Long-range post-education evaluation data are being gathered and analyzed. Key issues in the process of introducing appropriately leveled mental health intervention, support and referral will be presented.