Transforming Systems for Parental Depression and Early Childhood Developmental Delays

Findings and Lessons Learned from the Helping Families Raise Healthy Children Initiative

by Dana Schultz, Kerry Reynolds, Lisa Sontag-Padilla, Susan L. Lovejoy, Ray Firth, Harold Alan Pincus

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Research Questions

  1. What are the rates of co-occurrence for parental depression and childhood early developmental delays?
  2. What is the best way to improve cross-system collaboration and coordinate care for these co-occurring challenges?
  3. How can health professionals be trained to screen for depression and have confidence in their abilities?
  4. What are some ways to ensure a high rate of follow-through upon referral for care?

Many families experience the often co-occurring challenges of parental depression and early childhood developmental delays. The Helping Families Raise Healthy Children initiative, implemented in Allegheny County, Pennsylvania, addressed these challenges by mobilizing and aligning the early intervention and behavioral health systems. The initiative focused on three components of service delivery: (1) screening and identification of families at risk for parental depression, (2) referrals for those identified as being at risk, and (3) engagement in relationship-based services provided by both the early intervention and behavioral health systems that addressed the needs of parents and young children in a parent-child relationship context. More than 4,000 caregivers (primarily mothers) received formal screening for depression through the initiative, representing a screening rate of 63 percent. In addition to formal screening, some self-identified or were identified by community partners as being at risk for depression. In total, nearly 700 caregivers at risk for depression were identified. Among these, the referral rate was 62 percent; 71 percent of those referred engaged in services. These high rates of referral and engagement likely reflect several important components of the initiative that were designed to reduce barriers to obtaining services, including the provision of mobile services, an emphasis on the parent-child relationship in both early intervention and behavioral health settings, and improvement of cross-system communication and collaboration. The Helping Families Raise Healthy Children initiative demonstrates the potential gains associated with improved cross-system care, and could serve as a model for similar initiatives in a variety of domains.

Key Findings

Effective Approaches Overcome Barriers to Care

  • With its focus on parent-child relationship-based approaches, the Helping Families Raise Healthy Children initiative improved cross-system care for families at risk for parental depression and early childhood developmental delays.
  • Providers and agencies from the early intervention and behavioral health systems collaborated to achieve high rates of screening, referral, and engagement in services by using extensive outreach as well as in-home screening and mobile care.
  • Through cross-system training and support, the initiative helped build system capacity for sustaining these improvements and improved outcomes for parents and children.

Cross-System Support Improves Understanding of Family Needs

  • Caregivers in both the early development and behavioral health systems gained a greater understanding of the related issues faced by families at risk for parental depression and early childhood developmental delays.

Recommendations

  • Mandate universal screening for depression in early intervention system.
  • Add parental mental health challenges as a qualifying risk factor for early intervention at-risk tracking services statewide.
  • Add depression as a tracking category for early intervention services.
  • Develop protocols for depression screening using a validated tool.
  • Facilitate cross-system collaboration and communication among the early intervention, behavioral health, and parent and child health care systems.
  • Develop cross-system referral protocols for families identified as needing behavioral health services and other supports.
  • Provide initial training and ongoing support on cross-system referral protocols.
  • Provide initial training and ongoing support on depression screening.
  • Implement training for providers from both systems on the interconnectedness of parental depression and early childhood developmental delays.
  • Support referral of infants and toddlers in families with a parent at risk for depression to early intervention for developmental screening.
  • Facilitate cross-system collaboration and communication among the early intervention, behavioral health, and parent and child health care systems.
  • Develop cross-system referral protocols for families identified as needing behavioral health services and other supports.

Table of Contents

  • Chapter One

    Introduction

  • Chapter Two

    Methods

  • Chapter Three

    Results

  • Chapter Four

    Discussion

  • Chapter Five

    Conclusions, Recommendations, and Next Steps

  • Appendix A

    Training Assessments

  • Appendix B

    Data Collection Tools

  • Appendix C

    Outcome Measure Linkages

  • Appendix D

    Reference Studies

Research conducted by

The research described in this report was prepared for the Community Care Behavioral Health Organization and was conducted within RAND Health, a division of the RAND Corporation.

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