Healthy Start Healthy Families A Program of Marys Center for Maternal and Child Care, Inc'

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Healthy Start Healthy FamiliesA Program of
Marys Center for Maternal and Child Care, Inc.

• An Overview
• Multi-disciplinary Approach
• Maternal Depression
• August 2007

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Marys Centerfor Maternal Child Care, Inc.

• Mary's Center was established in 1988 with
  joint funding from the DC Mayor's Office on
  Latino Affairs and the DC Commission of Public
  Health to address the demand for Spanish-speaking
  maternal and pediatric services in the
  predominately Latino areas of Ward One.

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• Today, the Center serves a multicultural
  population residing in every Ward of the city,
  with a focus on families who work in jobs where
  health insurance is not available.

The mission of Mary's Center is to build better
futures through the delivery of health care,
education and social services. We embrace our
culturally diverse community and provide the
highest quality care regardless of ability to pay.
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Healthy Families America

• A national initiative for all new parents to
  support them in getting their children off to a
  healthy start.
• One of over 420 sites across the country, Canada
  and the Philippines.

Healthy Start

• A national initiative to reduce infant mortality
• One of 97 federally-funded Healthy Start Projects
  in 37 States, the District of Columbia, and
  Puerto Rico.

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Healthy Start Healthy Families Mission

• HSHFs mission is to partner with families to
  ensure children are healthy, safe, and ready for
  school through home visitation, and linkages with
  community resources.

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Healthy Start Healthy Families Goals

• To systematically assess parents
• To promote optimal birth outcomes, child health,
  child development, and school readiness
• To foster positive parenting and enriching
  parent-child interaction
• To promote optimal family functioning and life
  outcomes
• To prevent child abuse and neglect

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Population Served

• Healthy Start funding supports services to
  Families in Wards 1, 2 and 4 of the District of
  Columbia. Additional sources support services to
  Wards 3, 5, 6, 7 and 8.
• Enroll parent who is pregnant or with a child
  under 3 months old
• Families identified as overburdened
• All services are voluntary

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Service Description

• Family Assessment to identify appropriate
  services for families
• Voluntary home visiting services prenatally up to
  the childs 5th year of life.
• Weekly home visiting
• Child Development Screens
• Mental Health Counseling in the Home
• Nurse Home Visits
• Linkages to health insurance and medical home
  Community Referrals
• Case Management
• Family Goal Planning

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History Overview

• Existing Healthy Families and Healthy Start
  program
• Identification of mental health concerns
• Lack of services in the District of Columbia
• Population isolated, at-risk and fearful of
  agency services
• Need for supports for FSWs confronting mental
  health and substance abuse needs

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SAMHSAs Starting Early Starting Smart (SESS)

• research initiative
• child- and family-centered programs
• behavioral health services
• settings regularly used by families.

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HSHF Approach to SESS

• Population families and children at risk for
  substance abuse and mental health concerns
  prenatal up to age 3.
• Families enter through Home Visiting Assessment.
  They receive existing HSHF plus behavioral health
  services.

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Healthy Start Healthy Families Logic Model

• INPUTS CRITICAL ELEMENTS PROGRAM
  ACTIVITIES INTERMEDIATE
  ULTIMATE
• OUTCOMES OUTCOMES

? Teen Parents ? Family Risks ? Family Culture
/ Demographics ? Staff Characteristics ? Staff
Training ? Marys Center Infrastructure ?
Marys Center FQHC Educational/ Social Service
Programs ? Interagency Partnerships ? Unmet
community needs

• Enroll Prenatally or at Birth
• Voluntary
• Standard Assessment
• Weekly Home Visits
• Culturally Appropriate
• Focus on Child Development Parent-Child
  Interaction Parent Support
• Link to Community Services as needed
• Limited caseloads for quality
• Selection of FSW with special characteristics
• Broad Training
• Intensive Training
• Regular, intensive supervision

• Parenting
• Parents as Teachers
• Role modeling
• Support groups

• Parenting
• Positive Parent-Child Interaction
• Increased Parenting Knowledge, Skills
• Decreased child abuse neglect
• Increased father involvement

DECREASED REPEAT TEEN BIRTHS CHILDREN CURRENT
WITH IMMUNIZATIONS IMPROVED EDUCATIONAL/
VOCATIONAL SKILLS MENTALLY HEALTHY
FAMILIES HEALTHY BIRTH OUTCOMES HEALTHY
PARENTING

• Self Sufficiency
• Family Empowerment
• Enrollment into educ., employment, vocational,
  housing, literacy, ESOL, etc. services
• Mental Health services
• Linkages to Substance Abuse Services

• Self Sufficiency
• Reduced Parental Stress, Maternal Depression, and
  Social Isolation
• Improved Education, and Vocational Status

• Health
• Pre/Post-natal Care (pregnancy testing maternity
  counseling)
• Nutrition/ATOD education
• Linkage to HIV/STD screening/ education
• Linkage to pediatric health care
• Education related to repeat births

• Health
• Prenatal Visits
• Healthy Birthweights
• Healthy Lifestyle
• Well-care Visits

• Child Development
• Positive Parent-Child Bonding
• Enrollment in Quality Child Care
• Early Identification of Developmental Delay

• Child Development
• Early Literacy
• Screening/Referral for Developmental Delays
• Partners for a Healthy Baby Curriculum

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Method and Measures

• Quasi-experimental with comparison group
• Process and Outcome Measures
• Standardized Outcome Measures
• Parent Child Interaction (HOME)
• Parenting Knowledge (KIDI)
• Depression (CES-D)
• Social Isolation (CPSS)
• Substance Abuse (GPRA)
• Child Developmental Delay (ASQ)
• Measures collected at enrollment
  (prenatal/postnatal) and annually thereafter,
  except GPRA every 6-months

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Center for Epidemiologic Studies - Depression

• Developed by the National Institute of Mental
  Health
• Designed to assess symptoms of depression in
  general population
• Screening tool, NOT clinical diagnosis
• May be administered in interview formal or as
  self-report
• Looks at 4 Separate Factors
• Depressive Affect
• Somatic Symptoms
• Positive Affect
• Interpersonal Relations
• Parent reports how frequently in last 7 days they
  have experienced each of 20 events
• 4 positive events, scored in reverse order
• Score range from 0-60 with higher scores
  indicating greater levels of depression
• Scores greater than or equal to 16 indicate
  possible depression
• Validated across some cultures

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CES-D Continued

• Additional Questions Added
• Have you ever had a period of depression that
  lasted 2 weeks or more, in which you felt sad,
  had little energy, and/or did not feel like doing
  anything?
• Have you ever had a period of depression or
  irritability AND a period of unusually elevated
  mood, like a high, with out-of-control behavior
  (risky sex, little need for sleep), that led to
  difficulties with others?
• Have you ever had any close blood relative
  (parent, child, sister, brother) with depression,
  alcohol abuse, or who was psychiatrically
  hospitalized?
• Have you ever had any thoughts of killing or
  harming yourself?

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Overall OutcomesDemonstrated Significant
Differences

• Improvement in Parent Child Interaction from
  baseline to 12 months
• Decrease in Maternal Depression baseline to 6
  months consistent through 12 months
• Reduction in depression to prenatal enrollees at
  time of babys birth, continued through 6 months
  and at 12 months
• Increase in parenting knowledge from baseline to
  12 months
• Increase in Social Support from baseline to 6
  months and increase again at 12 months

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Interconceptional Mental Health Supports

• Adult evaluation - brief assessment of mental
  status, emotional or somatic symptoms, formal
  diagnosis, history of or current suicidal
  thoughts and actions and current level of
  functioning.
• Young children -- early, routine developmental
  screening.
• Training to staff on adult and child mental
  health.

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Interconceptional Mental Health Supports

• Continued
• Have adult mental health provider to provide
  support at center or in the home -- also to
  provide early identification of child mental
  health issues.
• Referral to more intensive services as needed.
• Education to families in the areas of soothing
  techniques, crisis management, non-violent
  problem solving, conflict resolution, domestic
  violence, awareness of communication skills,
  recognizing and coping with depression and
  womens health.

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Implications

• Interventions of FSWs and impact on depression
  vs. medication only approach
• Need for and impact of prevention/ intervention
  prenatally
• Identification of need for ongoing supports
  interconcpetionally
• Continuum of services to address level of need
• Impact on self-sufficiency/employment
• Duration of mental health services

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• Thank You
• to
• Health Resources and Services Administration
• Maternal Child Health Bureau
• National Healthy Start Association
• Healthy Families America

Joan Yengo jyengo_at_maryscenter.org
Laura Charles-Horne lcharlesh_at_maryscenter.org