Mental Health Assessment, Counseling and Navigation for First-Time Mothers

Program Description

Philadelphia Nurse-Family Partnership (NFP) serves low-income families throughout the city of Philadelphia. Our team of public health nurses takes a strengths-based approach to maternal-child health and development, encouraging women to build their own strengths to become the best mothers they can be. Research has shown that pregnant women and new mothers are uniquely open to receiving advice and making positive changes during this transformative period of their lives. Philadelphia NFP works with new mothers to set goals and establish positive patterns that resonate for decades beyond the initial visit. Approximately half of all clients screen positive for depression at intake. However, home visiting nurses report widespread reluctance among clients to follow through with mental health referrals. Mothers cite concerns about not trusting external providers and feeling uncomfortable seeking help. Since 2015, our Mental Health Assessment, Counseling and Navigation initiative brings a certified therapist to meet new mothers in the privacy of their homes, and build bridges to more intensive services in the community. Having earned their trust over time, home visiting nurses are able to link new mothers to mental health services and reiterate the importance of seeking professional counseling in the weeks and months surrounding childbirth.

Creativity

Over the past decade, we have seen mothers enter our program with increasingly acute needs. About 90% of Philadelphia NFP mothers report prior exposure to multiple Adverse Childhood Experiences (ACEs), including physical, sexual and verbal abuse. More and more pregnant women come to us in crisis. Our nurses knew that we needed to find a way to address the root causes of family instability and stress in our community. By integrating a basic mental health therapy intervention into the daily operations of an evidence-based home visiting program, we have developed a system to proactively bring assessment and short-term counseling services to clients. This capitalizes on home visiting nurses’ status as trusted advisers and successfully linked clients to mental health services in the community. When our nursing team works with therapists across professional boundaries, we find that we can more effectively address the negative impacts of poverty on children and families.

Leadership

Philadelphia NFP has envisioned a way to link and coordinate a variety of health, social and mental health support services to meet the diverse needs of the families we serve. We are committed to sharing lessons learned with our colleagues and our community, through presentations, papers and community outreach. Most recently, Philadelphia NFP Nurse Administrator Dr. Kinsey presented on program outcomes at the 2016 American Public Health Association Annual Meeting in Denver, CO. Because of nursing’s emphasis on holistic, preventative care, nurses naturally operate at the intersection of health and social services. When we break down the walls between health care, education, and social services, we can change the entire trajectory of both mothers’ and babies’ lives. What we do today is our legacy for tomorrow’s families.

Sustainability

Evidence-based nurse home visiting services are at the heart of our work. NFP is among the most well-researched and compelling anti-poverty programs in the United States. Each client receives between 30-50 visits from their nurse over the course of the program. Over time, a special relationship evolves between mother and nurse. In addition to home visits, we have developed new approaches that go beyond the core home visiting curriculum to better meet the complex needs of families living in deep poverty. We are currently working to develop a sustainable financial model for integrated parenting support and holistic wraparound services, including mental health assessment, counseling and navigation. With this goal in mind, we work with professional evaluators to measure our impact on family health and well-being in a variety of domains, as well as return on investment. We also advocate for sustainable payment streams to scale our solution.

Replicability

Like all evidence-based NFP program sites throughout the country (now operating in 42 states), Philadelphia NFP nurses use validated screening tools (Patient Health Questionnaire [PHQ-9] and Edinburgh Postnatal Depression Scale [EPDS]) at five intervals over the course of program enrollment for all clients. We have worked closely with home visiting nurses to ensure that any additional mental health services and/or evaluation assessments do not create an undue administrative burden, thereby increasing the likelihood of replication at other home visiting program sites nationwide. Preliminary findings indicate positive results with regard to overcoming stigma and other barriers to mental health care among Philadelphia NFP’s low-income, predominantly African-American client population. A mental health therapist who accompanies public health nurses on scheduled home visits and provides assessment, short-term counseling, and navigation services may offer a cost-effective way to link vulnerable mothers to mental health services during the perinatal period.

Results/Outcomes

Participating mothers reported a number of social-emotional and environmental stressors influencing mental health functioning on a daily basis. Preliminary findings indicate that pregnancy itself is not the overriding stressor in many clients’ lives. Reported stressors are endemic and persistent, and often linked to conditions of poverty. Among the new mothers referred for additional follow-up and assessment, the most commonly reported symptoms were stress, depression, anxiety, and sleep changes. Preliminary data analyses of pilot outcomes indicate that over 50% of referred clients follow-through with scheduled therapy appointments.