TARGETING DETERMINANTS AND TAILORING STRATEGIES: A JOURNEY TO ADDRESS MENTAL HEALTH DISPARITIES THROUGH PERINATAL HOME VISITING PROGRAMS

Perinatal home visiting programs provide a conduit for addressing maternal mental health. Effectively integrating evidence-based mental health interventions into these programs requires researchers to study and document not only the effectiveness of mental health evidence-based interventions in these settings but the implementation planning, process, and outcomes. The purpose of this dissertation is three-fold: (a) to evaluate through a systematic review, the current state of knowledge around the implementation of mental health interventions within perinatal home visiting programs; (b) to explore through qualitative methods nurses’ adoption of a mental health innovation for Nurse-Family Partnership and; (c) to understand through qualitative methods the extent to which implementation strategies within the mental health innovation targeted the determinants they were designed to target and what remaining determinants need to be considered in the future. Most studies included in the systematic review reported effectiveness of mental health interventions at reducing symptoms of depression and a limited number reported effectiveness at reducing anxiety. Very few studies reported on implementation processes or outcomes. Looking across studies, implementation outcomes and strategies were poorly or inconsistently defined. Determinants were identified in studies, but strategies to address those determinants were not. Findings from the qualitative studies presented here indicated that while providing resources and education increased awareness and potential adoption of MHI content, nurses reported having peer support and an opportunity to talk through specific scenarios they saw in the field with mental health experts increased active adoption and application of MHI content. Nurse home visitors and supervisors from teams who received consultation were more likely to report they adopted team meeting education modules and clinical resources. Study findings also revealed many determinants were successfully targeted, and nurse home visitors reported challenges with adapting MHI content for specific populations such as refugee and immigrant populations. Certain determinants outside the scope of the MHI implementation strategies continued to create barriers to addressing the mental health concerns of clients, such as lack of transportation to follow up with a mental health referral, lack of insurance, lack of mental health providers and long waiting periods.