To combat maternal depression, program finds novel ways of reaching poor moms most in need of help

Two months ago, The New York Times Magazine ran an illuminating cover story under the headline, “The Secret Sadness of Pregnancy with Depression.” In the piece, author Andrew Solomon eloquently tells a series of stories detailing depression’s profound effects on mothers and families, as well as the crippling isolation and stress such mothers endure.

And yet the stories told by Solomon all occurred in relatively well-to-do families. When poverty — and its correlates of trauma, abuse and addiction — are added to the mix, the challenges of raising kids while dealing with mental illness quickly escalate, as Megan Smith, a professor of psychiatry at the Yale School of Medicine, recently explained to a group of National Health Journalism Fellows. That makes depressed low-income mothers a prime target for mental health and social services, but programs targeting maternal depression have typically been unsuccessful in reaching the neediest families — or have failed to keep such moms in the fold of services for long when they did.

The stakes are high: These are families in which children are most likely to experience toxic stress and extreme adversity, which ample research has shown can deliver a lifetime of unwanted health effects and foreshortened futures. Child development experts  increasingly see the search for innovative new ways of getting mental health and other services to such mothers — “building adult capabilities” in the lingo —as key to halting the generational hand-me-downs of poverty and trauma.

Yale’s Smith said the research is clear on what can happen when maternal depression is left untreated.

“A child of a depressed mother is much more likely not to receive immunizations on time, not to receive pediatric care appropriately, more likely to use the emergency department, less likely to use safe sleeping practices and seat belts,” she said. “When you think about social, emotional and cognitive development, you’re more likely to see cognitive delays, language delays, difficulty in engaging in friendships and relationships with peers.”

But if families’ problems are addressed early enough, negative lifelong outcomes can be averted. That’s where the New Haven Mental Health Outreach for Mothers (MOMS) Partnership comes in. The collaboration between the Yale School of Medicine and a host of local agencies is notable for the novel ways in which it reaches out to low-income moms, connecting them with stress management classes, mental health care, job training and other basic services. “The MOMS Partnership was started to bridge this gap between academic research and science — psychiatry and psychology — and the actual low-income families that we really wanted to target,” said Smith, who directs the program.

In practice, that has meant building “MOMS Hubs” in busy spots such as a New Haven Stop & Shop grocery store, where staff are on hand daily to reach out to mothers (identifying undiagnosed moms is one big goal) who might need basic mental health or social services. Upstairs, eight-week stress-management group glasses take place, using a popular form of skill-building therapy. The supermarket setting lessens stigma around seeking care. Childcare is offered on site so moms can take courses, have candid conversations with staff or use the bank of computers to work on their job prospects. A ready supply of diapers, surprisingly crucial to moms’ mental well being and ability to parent, is provided as well, as 2015 National Fellow Olga Khazan recently explained in The Atlantic.

The hubs are staffed by what are called “community mental health ambassadors,” who are key to the program. These are trained lay workers — often moms themselves from similar backgrounds — who go into the community to connect with hard-to-reach families that aren’t currently connected with services.

As Smith tells it, the approach was born out of the failures of other programs targeting maternal depression. “I’d argue we still have a disconnect between some of our interventions on maternal depression and the families we’d like to reach,” she said. Meta-analyses have shown that low-income, African American single mothers are most like to drop out of home-visiting programs — one of the main interventions for moms with maternal depression.

In addition to home visits, another often-tried approach has been to systematically screen moms at hospitals and clinics and then refer those in need to mental health treatment. Smith outlined an earlier program she worked on in New Haven that recruited 365 moms and offered them child care, transportation, services in three languages and even $10 payments for coming to appointments. Despite all that, only 35 percent of depressed moms received at least one care visit over a six-month period. (That mirrors national statistics for people with a mental illness.) 

“We didn’t move the needle at all,” Smith said. “This was incredibly discouraging. We didn’t know what else to do. We know that the need for services isn't equaling service use.”

The MOMS Partnership is an ongoing attempt to get beyond those dismal rates. The program relies on community ambassadors such as Natasha Rivera-LaButhie, a mother of three. She has sought moms in need by going door to door, chatting up mothers in parks or supermarket aisles and visiting them at their homes in public housing. “Part of the work is meeting the moms where they are,” Rivera-LaButhie told fellows.

Many of the moms she encounters are dealing with overlapping crises, including addiction, abuse, trauma and chronic poverty. These are “moms that have a really traumatic history, moms that have been failed by one system or another,” Rivera-LaButhie said. “They have issues with trust for a variety of reasons.”

Placing therapy and service referrals at everyday places like the local supermarket has made the tough job of reaching these moms easier. “Being at the grocery store is a different dynamic, because now I’m not looking for them — they know where to find me,” Rivera-LaButhie said.

Early evidence from the MOMS Partnership suggests that the program’s new approach has been far more successful in reaching at-risk moms than earlier efforts. “The reason I personally continue to believe in this: In terms of attendance and retention, 89 percent of mothers have actually completed a mental health intervention with us,” Smith said. That’s compared with 35 percent of mothers in the earlier screening-based programs at hospitals and clinics. According to Smith, the data also point to decreases in depressive symptoms and increases in mothers' executive function, which is crucial for juggling jobs, parenting and long-term planning.

As a result of such early successes, the Partnership is now expanding to a dozen sites throughout Connecticut. The program is also working on getting its hubs licensed so they can receive Medicaid reimbursements, which would provide a sustainable source of funding.

Meanwhile, moms can still pick up a gallon of milk and a stress-management class at the New Haven Stop & Shop on Whalley Avenue.

“It’s not that they don’t want the services, it’s just that they didn’t know where to go to get them,” Rivera-LaButhie said. “So we made it our job to make sure they knew who we were and that we wanted to offer some kind of help and support.”

For more information about the Moms Partnership, read 2014 National Fellow Arielle Levin Becker’s piece about it in the Connecticut Mirror for her Fellowship project.

[Photo via New Haven MOMS Partnership.]