Journal Article

    Substance Use and Depression in Home Visiting Clients: Home Visitor Perspectives on Addressing Clients' Needs

    Journal of Community Psychology

    Published: April 2017

    Abstract

    The Maternal, Infant, and Early Childhood Home Visiting Program (MIECHV) under the Affordable Care Act has significantly expanded evidence-based home visiting services for pregnant women and new mothers at risk for child maltreatment (Health Resources and Services Administration, 2015). Home visiting (HV) is the most widely used child maltreatment prevention strategy across the country, and typical models provide high-risk parents with education about child development and effective parenting, as well as linkages to childcare, medical, and early intervention services (Azzi-Lessing, 2013). In line with their primary goal of child maltreatment prevention, most HV programs target pregnant women and new mothers with significant behavioral health risks known to be associated with impaired parenting such as substance use and mental health problems. However, the HV workforce is comprised of a wide range of professional and educational backgrounds, with many programs staffed largely by paraprofessionals who lack the necessary clinical training and skills to address challenging behavioral health risks (Paulsell, Del Grosso, & Supplee, 2014). While this discrepancy between client need and workforce qualification has long been recognized, the MIECHV legislation provided new impetus for action to address this mismatch by requiring state HV systems to demonstrate improvement on benchmark outcomes related specifically to maternal mental health (U.S. Department of Health and Human Services, 2014). Consequently, initiatives to bolster HV capacity to address maternal behavioral health have begun to emerge within HV networks.

    Much of the work to date in this area has focused on maternal depression (MD), and has included mandated depression screening within HV, providing mental health consultation to home visitors, and integrating mental health treatment into home visits (Ammerman, Putnam, Teeters, & van Ginkel, 2014; Le, Perry, Mendelson, Tandon, & Munoz, 2015; Price, Gray, & Thacker, 2015; Rowan, Duckett, & Wang, 2015; Segre, O’Hara, Brock, & Taylor, 2012; Segre, Stasik, O’Hara, & Arndt, 2010; Tandon, Leis, Mendelson, Perry, & Kemp, 2014; Yonkers et al., 2009). In contrast, maternal substance use (SU) has received comparatively little attention within HV behavioral health initiatives, and is often an exclusion criterion from studies examining the impact of depression interventions (e.g., (Ammerman et al., 2011; Segre et al., 2010)). Maternal SU is a significant risk factor for child maltreatment (Dubowitz et al., 2011), is often co-morbid with depression (Connelly, Hazen, Baker-Ericzen, Landsverk, & McCue Horwitz, 2013), and is prevalent among pregnant and parenting women (Substance Abuse and Mental Health Services Administration, 2014), the population served by HV programs. Expansion of existing behavioral health initiatives within HV to include SU is sorely needed. In order to inform the development of an enhancement to HV aimed at addressing both SU and MD, the current study presents the results of a survey that asked home visitors to report on their current practices, knowledge and perceived self-efficacy, perceived barriers, and training needs regarding SU and MD in their clients. This research emanates from one state network’s interest in advancing its practice in addressing maternal behavioral health within HV, and is aligned with the national HV research priorities of supporting the development of a competent workforce and strengthening HV effectiveness (Home Visiting Research Network, 2013).

    J Community Psychol. 2017 Apr. doi: 10.1002/jcop.21855.

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