Bridging the gap: A university-community partnership for addressing depression and family functioning among teenage mothers
By Julia L. Mendez, PhD, Holly Paymon, MA, Doré R. LaForett, PhD, Kari M. Eddington, PhD, Susan P. Keane, PhD, and Susan Cupito, MA
Dual generation intervention models are designed to promote mental health within programs such as Head Start.1 Common elements of this approach include a developmentally appropriate early childhood program, parent education and parent services, including occupational training and mental health treatment. Unfortunately, the full potential of dual generation models is often unrealized due to numerous barriers preventing low-income families from accessing services, including lack of child care, parenting stress and the demands of economic self-sufficiency.2
There are multiple reasons to target parental depression with secondary prevention efforts. First, the societal burden created by depression is well known, with an estimated economic impact of tens of billions of dollars per year. Second, because depression co-occurs with economic stressors, depression among socioeconomically disadvantaged parents occurs at higher rates. Prevalence estimates suggest that 33-40 percent of low-income parents endorse moderate to severe levels of depressive symptoms.3 Third, treatment of depression can translate into improvements at the family and child level, which can foster resilience for low-income children and parents.4
However, symptoms of depression — such as attention/concentration difficulties, anhedonia and lack of motivation — make it difficult for new mothers to acquire positive parenting skills. Mothers with depression report difficulty attending to the needs of young children and struggle with building a strong bond with their infants. Thus, efforts to teach parenting skills without first reducing depression may result in limited, difficult to maintain gains. Conversely, focusing on depression alone, while effective in relieving symptoms, may be inadequate for reversing dysfunctional parenting behaviors or helping mothers thrive with their infants.
New, interdisciplinary approaches to the problem of depression are needed. Expanding treatment services for mothers with mental health challenges has been recommended as one mechanism for supporting young children’s social-emotional development and mental health.5 Unfortunately, few mothers who would benefit from mental health services access treatment, even when treatment is explicitly recommended and offered.6
Solution: The Importance of Co-locating Services and Prevention Efforts
Models of culturally competent care seek to address the high rates of untreated psychological difficulties, supporting families from a wide range of cultural and linguistic backgrounds in accessing care. Co-location of mental health services and delivery in non-traditional locations (e.g., faith-based communities, schools and public health departments) is emphasized. With funding from the Health Resources Services Administration, several faculty members at our university administer a training grant called the Graduate Psychology in Education Program (GPEP). This federal grant provides clinical psychology graduate trainees with experiences in community settings where individuals often have difficulty accessing mental health services. One target “underserved population” for our trainees is teen mothers.
Our local YWCA involves women who are pregnant, parenting or at-risk for becoming pregnant in mentoring and educational services. Each year, approximately 750,000 women between the ages of 15 and 19 become pregnant in the United States. The Teen Parent Mentor Program is a long-term, relationship-based program that matches teen mothers with adult female mentors who are a source of positive support. The goal is to help teens prevent subsequent teen pregnancies, experience healthy deliveries, establish secure bonds with their children and succeed in school and workplace endeavors. Program components include home visitation, peer group sessions at the YWCA and in local schools, childbirth and prenatal classes, teen family literacy services, doula interventions, mentoring, individual interventions and parent or child activities.
We partner with the YWCA and provide on-site screenings for depression. GPEP-supported trainees also provide individual therapy, developing their competencies in working with teen mothers and their children. Moreover, we consult with program staff about other dual generation needs, such as parenting classes and child-directed play.
Outcomes from an evaluation reported by the YWCA suggest that co-locating service delivery makes a significant impact. Recent data show that 91 percent of teen moms reconnected with or remained in school (vs. 38 percent nationally); 98 percent postponed subsequent teen childbearing (vs. 72 percent in NC); 98 percent delivered above average birth weight babies (vs. 90 percent nationally); and 75 percent are still involved with their mentors after one year (vs. 50 percent for other mentoring programs). Targeting these risk factors associated with the development of depression is essential in reducing the impact of mental illness for this population. The GPEP training grant has supported 12 trainees over a four-year period. This HRSA-supported dual generation approach has trained future mental health professionals to address the workforce shortage while also addressing depression among teens and new mothers.
Implications for Policy and Future Research
Targeted prevention and early intervention services for families with young children can reduce the need for costly inpatient care later in the parent or child’s life.7 Moreover, dual generation programs, such as YWCA Teen Parent Mentor Program that are effective with culturally diverse populations need to be supported and further studied given depression’s significant impact on these populations.
1LaForett, D.R. & Mendez, J.L. (2010). Parent involvement, parental depression, and program satisfaction among low-income parents participating in a two-generation early childhood education program. Early Education and Development, 21(4), 517-535.
2Mendez, J.L. (2010). How can parents get involved in preschool? Barriers and engagement in education by ethnic minority parents of children attending Head Start programs. Cultural Diversity and Ethnic Minority Psychology, 16(1), 26-36. doi: 10.1037/a0016258
3D’Elio, M. A., O’Brien, R. W., & Vaden-Kiernan, M. (2003). Relationship of family and parental characteristics to children’s cognitive and social development in Head Start. Meeting for the Society for Research in Child Development, Tampa, FL.
4Riley, A.W., Valdez, C.R., Barrueco, S., Mills, C., Beardslee, W., Sandler, I. & Rawal, P. (2008). Development of a family-based program to reduce risk and promote resilience among families affected by maternal depression: Theoretical basis and program description. Clinical Child and Family Psychology Review, 11:12–29. DOI 10.1007/s10567-008-0030-3
5North Carolina Institute of Medicine. (2012). Growing up well: Supporting young children’s social-emotional development and mental health in North Carolina.
6Horowitz, J., & Cousins, A. (2006). Postpartum depression treatment rates for at-risk women. Nursing Research, 55(2), S23-SS27.
7Wang, P.S., Simon, G. & Kessler, R.C. (2008). The economic burden of depression and the cost-effectiveness of treatment. Journal of Methods of Psychiatric Research, 12, 22-33.