PROJECT SUMMARY Children of low-income families face myriad social risks that interfere with healthy development, behavior, and academic achievement. Mothers of these children experience a high rate of depression, itself associated with lasting effects on children. In 2009, the National Academy of Medicine published a landmark report, Depression in Parents, Parenting, and Children, in which it called for community-based interventions to prevent parental depression and to help engage depressed parents in treatment. Consistent with this report, our research group has conducted a series of NIH-funded studies aimed at alleviating symptoms among mothers at risk for depression in Head Start – a federally funded preschool program that provides services for ~1 million low-income US families. In the present project, we aim to improve outcomes for Head Start children by deploying a stepped-care intervention, in which mothers with low level depressive symptoms are offered a prevention program based on the Problem Solving Education model, and mothers with greater symptoms are offered Engagement Sessions to link them with formal mental health services. Both components of the model have strong randomized trial evidence; but they have yet to be synthesized and tested within a coordinated intervention, applicable to a broad population base. Harnessing a research network of Head Start centers in Massachusetts, we propose an efficacy trial (n=388) of this stepped-care model. Our primary aim is to determine the model’s efficacy in decreasing the rate at which Head Start mothers experience depressive symptom episodes; mothers’ likelihood of engaging with mental health services when referred; parental functioning; and child absenteeism from Head Start. Our second aim is to determine mechanisms of action by which improved maternal wellbeing promotes child resiliency. To do this, we will assess mothers’ perceptions of stress, family conflict, and mother-child interaction patterns; and we will assess child outcomes in the affective, interpersonal and cognitive domains. Finally, to prepare for a subsequent effectiveness trial, we will conduct a single arm pilot study among 20 additional mothers to assess the feasibility of incorporating intervention delivery into usual Head Start workflow. Our proposal represents a high-priority research area for NICHD because it addresses social and environmental factors that impact children’s adaptive behaviors and school readiness. Our study plan enhances the rigor of prior research because it tests the efficacy of a comprehensive depression management model, and because our design allows us to study both maternal and child outcomes – and the mechanisms that link them – among a true community-based sample. Our ultimate goal is to reduce mental health disparities for low-income mothers and to improve outcomes for them and their children.

PROJECT NARRATIVE Maternal depression disproportionately affects low-income and minority women and has negative impacts on their children. In the present proposal, we aim to improve outcomes for Head Start children by deploying a stepped-care intervention, in which mothers with low level depressive symptoms are offered a prevention program based on the Problem Solving Education model, and mothers with greater symptoms are offered Engagement Sessions to link them with formal mental health services. We propose to test the efficacy of this model among both mothers and children, and determine mechanisms of action by which improved maternal wellbeing promotes child resiliency.