Infant and Early Childhood Mental Health in Home Visiting

Introduction

Home visiting programs connect “expectant parents and parents of young children with a designated support person who guides them through the early stages of raising a family.”[1] While services are almost always delivered in the family’s home, programs vary in terms of program curricula and content; timing of when services begin (e.g., during pregnancy or in first year), duration, and intensity of services; and professional background and training of the home visitors. These voluntary programs are typically targeted at families experiencing risk factors such as low income, young parent age, parent with less than a high school education, and exposure to abuse or substance abuse. Common outcomes addressed by home visiting programs include maternal and child health, abuse and neglect prevention, positive parenting, and child health, development, and school readiness.[2]

In 2018, more than 286,000 families with 312,000 children were served by home visiting programs using 15 models designated as evidence-based by the Home Visiting Evidence of Effectiveness (HomVEE) project, which identifies home visiting models that demonstrate evidence of effectiveness as defined by the U.S. Department of Health and Human Services.[3] These families were served by a workforce of more than 19,500 home visitors and 3,700 supervisors.[4] The federal Maternal, Infant and Early Childhood Home Visiting Program (MIECHV) is the primary source of funding for home visiting and currently provides $400 million annually to states for the delivery of home visiting programs.[5] Other federal sources of funding for home visiting include Title V of the Maternal and Child Health Block Grant Program, Temporary Assistance for Needy Families (TANF), Project LAUNCH, Medicaid, Healthy Start, Early Head Start, the Child Abuse Prevention and Treatment Act and the Community-Based Child Abuse Prevention Program.[6] While all states use MIECHV funds for home visiting, states vary in how they use other sources of federal funds and state or local revenues to support home visiting services.[7]

Infants and young children in families served by home visiting programs face significant risk for mental health problems because of high rates of maternal depression, exposure to violence and trauma, and other maternal mental health issues, such as anxiety.[8] Maternal depression, in particular, can interfere with mothers’ responsiveness and positive parenting behavior that promote a secure parent-child relationship [see research summary on maternal depression screening for more information]. The importance of addressing maternal depression is reflected in two MIECHV performance standards that focus on maternal depression: “percent of primary caregivers enrolled in home visiting who are screened for depression using a validated tool within 3 months of enrollment” and “percent of primary caregivers referred to services for a positive screen for depression who receive one or more service contacts.”[9] National performance data indicate that 75 percent of primary caregivers are being screened and 38 percent who screen positive were referred and received at least one service contact.[10]

State Profiles that Include Infant and Early Childhood Mental Health in Home Visiting

Research Support for Infant and Early Childhood Mental Health in Home Visiting

There is evidence that home visiting programs can have positive impacts on children’s social-emotional development.[11] However, the evidence for programs’ ability to reduce child behavior problems and improve maternal depression is mixed and home visitors often encounter child and parent behavior, mental health, and relationship concerns that are challenging to address without support.[12] Home visitors themselves often express a need for additional training in mental health topics.[13] Research shows that a number of approaches used within and in conjunction with home visiting programs can address child and parent mental health concerns and improve long-term prospects for young children’s healthy development. Evidence for IECMH supports in home visiting programs has been found for:

Multiyear home visiting programs that are explicitly designed to strengthen parent-child relationships and address mental health challenges;
Shorter home visiting interventions that can be added to existing home visiting programs or delivered on their own, focusing on either
- Parent-child relationships or
- Maternal depression;
Infant-early childhood mental health consultation; and
Training for home visitors.

This evidence summary provides research findings on each of these approaches. MIECHV-eligible models are indicated with an asterisk.

Multiyear Home Visiting Programs with a Strong Focus on Parent and Child Mental Health

Child First* targets families with young children from the prenatal period through age five who have social-emotional or developmental problems and are experiencing multiple adverse circumstances, including extreme poverty, homelessness, domestic violence, incarceration, maternal depression, and abuse and neglect. The model incorporates Child-Parent Psychotherapy dyadic treatment (see research summary on dyadic treatment) in its home-based services, as well as care coordination to connect families to community-based resources. After initial twice-weekly visits, families receive weekly visits for six to 12 months. A randomized controlled trial of Child First in Bridgeport, Connecticut, showed significant positive outcomes for participating children and families, including fewer externalizing problems for children, improved child language skills, fewer mental health symptoms for mothers, and decreased child abuse and neglect.[14] A second evaluation in Bridgeport found that 82 children exposed to violence who participated in Child First showed significant decreases in parent reports of their children’s post-traumatic stress symptoms.[15] Child First has 23 sites across three states (CT, FL, and NC). Analyses of multi-year data from Child First program sites show significant and mostly large improvements in children’s social skills and problem behaviors, caregiver depression, and parent-child relationships.

Family Spirit (FS)* was developed for young Native American mothers and focuses on strengthening parenting skills, maternal behavior and mental health, and substance abuse prevention. Paraprofessionals deliver 43 structured lessons during hourlong visits from the third trimester of pregnancy through 36 months postpartum. Three randomized controlled trials of FS have found positive impacts on parenting self-efficacy, knowledge, and involvement, and on reports of children’s externalizing, internalizing, and dysregulation problems.[16]

Minding the Baby (MTB)* is an attachment-based home visiting intervention aimed at improving developmental, health, and relationship outcomes among vulnerable young families. A nurse and clinical social worker alternate visits from the second trimester of pregnancy through age two. A randomized controlled trial of MTB found intervention children were significantly more likely to be securely attached and less likely to have disorganized attachment at 12 months, and had fewer externalizing behavior problems 1-3 years post-intervention.[17]

Home Visiting Interventions Focusing on the Parent-Child Relationship and Maternal Depression

Parent-Child Relationship-Focused Interventions

Attachment and Biobehavioral Catch-up (ABC)* is a 10-week in-home program designed to support parents’ capacity to provide nurturing care to children from 6 to 24 months old who have experienced early adversity. ABC providers coach parents during in-person sessions to engage in practices that help children develop attachment, self-regulation, and coping skills. It has been delivered as a standalone intervention, as well as an add-on to MIECHV-eligible models such as Early Head Start.[18] A systematic review of randomized control trials of ABC conducted with populations of children involved in child welfare or foster care found that the program had positive impacts across a number of child outcomes, including fewer problem behaviors, and greater positive attachment.[19]

Circle of Security-Home Visiting-4 (COS-HV4) is a four-session, in-home adaptation of Circle of Security, a group parenting program for families with children under six years that aims to strengthen the parent-child relationship by helping parents serve as a source of security for their children. While a randomized controlled trial of 220 irritable infants and their economically stressed mothers did not find an impact on attachment security for the full sample, there was a significant positive impact on attachment security among highly irritable infants.[20]

The Infant Behavior Program (IBP) is an in-home adaptation of Parent-Child Interaction Therapy (PCIT) consisting of six weekly sessions lasting 60-90 minutes. PCIT is a dyadic treatment model involving observation and coaching of parent-child interactions and is designed to address externalizing behavior problems for children from two to seven years. Among 60 infants who had screened positive for early behavior problems, a randomized controlled trial found that IBP infants displayed fewer externalizing and internalizing behaviors, and that IBP mothers displayed a significantly higher proportion of positive behaviors and lower proportion of negative behaviors with their infant during play, based on observational and parent-report measures of infant and parenting behaviors.[21]

Promoting First Relationships (PFR) is a 10-week relationship- and strengths-based home visiting program for families facing adversity. A randomized controlled trial with 210 toddlers in state supervised foster care, along with their birth or kin/foster caregivers, found significant effects on caregivers’ sensitivity and understanding of toddlers.[22] Kin/foster caregivers in the intervention group were also significantly more likely to provide stable, uninterrupted care and eventually adopt or become the toddlers’ legal guardians.[23] A second randomized controlled trial with 247 families with a toddler who had a recent, open child maltreatment investigation found significant effects on observed caregiver sensitivity and understanding of toddlers’ social-emotional needs. PFR children were significantly less likely to be placed into foster care one year post-intervention compared to control group children.[24]

Maternal Depression-Focused Interventions

Moving Beyond Depression, an in-home adaptation of Cognitive Behavioral Therapy (IH-CBT), was delivered by licensed, master’s-level social workers to mothers in Healthy Families American and Nurse-Family Partnership programs. Ninety-three mothers who had received a diagnosis of major depressive disorder were randomly assigned to a control group or to IH-CBT, consisting of 15 weekly hourlong, in-home sessions and a final booster session. Compared to the control group, mothers who received IH-CBT showed significantly greater improvements in depression, psychological distress, and social functioning post-treatment and three months later.[25] There was no significant difference between the two groups in parenting or child adjustment outcomes.[26]

An in-home adaptation of Interpersonal Therapy (IH-IPT) was delivered by teams consisting of a psychiatric nurse and an interpreter to Latina mothers during home visits in Early Head Start. Nurses received 20-30 hours of classroom and supervised field training. Eighty mothers who had positive screens for depression were randomly assigned to IH-IPT, consisting of 11 in-home sessions interspersed with five booster visits from the interpreter alone, or to a control group. Depressive symptoms of mothers who received IH-IPT showed significantly greater reductions than those of control group mothers, and intervention mothers’ reports of child aggression also showed significantly greater reductions.[27]

Mothers and Babies (MB) is a cognitive behavioral, group-based home visiting enhancement delivered by licensed clinical social workers or clinical psychologists as six weekly, two-hour group sessions with reinforcement provided by the home visitor. One randomized controlled trial of MB with women who were assessed as at risk for perinatal depression, found significantly greater declines in depressive symptoms in treatment mothers compared to control group mothers at one week, three months, and six months post-intervention.[28] Another randomized controlled trial found significant positive impacts of MB on coping, stress, and depression post-intervention, though not at six months. However, at six months, there were significant positive impacts on two of five aspects of a parent-child interaction quality, based on an observational measure.[29]

Infant-Early Childhood Mental Health (IECMH) Consultation and Ongoing Supports

IECMH consultation is “a prevention-based service that pairs a mental health consultant with families and adults who work with families with young children in the different settings where they learn and grow, such as child care, preschool, and their home. The aim is to build adults’ capacity to strengthen and support the healthy social and emotional development of children.”[30] In the context of home visiting, consultants work with home visitors and their supervisors to recognize and appropriately respond to the mental health needs of the families they serve. Consultation can involve activities such as group or individual reflective supervision, case conferences, group trainings, and accompanying staff on home visits.[31]

Randomized-controlled trials on consultation in early care and education settings have found positive impacts on children’s hyperactivity and problem behaviors.[32] To date, research on consultation in home visiting has not employed random-assignment designs, nor has it collected data on child and family mental health outcomes. However, evaluations have examined implementation of consultation in home visiting, along with outcomes related to home visitors’ attitudes and knowledge.

In Illinois, home visiting consultants provide reflective supervision, case consultation, training, and joint home visits. In focus groups and surveys, home visitors reported positive impacts from consultation on: “understanding behavior in the context of a relationship, focusing on the parent-child relationship, understanding the impacts of trauma, improving the quality of their intervention skills, improving assessment skills, and increased referrals to other agencies.”[33]
In Louisiana, consultants supported Nurse-Family Partnership home visitors through ongoing group case conferences. Home visitor feedback indicated they “perceived the MHC [mental health consultant] as having expertise and providing useful conceptualizations for understanding clients.”[34]
In Multnomah County, Oregon, a consultant provided training, reflective supervision, and case consultation to Healthy Families America home visitors. Home visitors “reported significant increases in knowledge of children’s mental health, knowledge of adult mental health, confidence in involving parents as partners, and program leadership around addressing early childhood mental health issues.”[35]

Project LAUNCH (Linking Actions for Unmet Needs in Children’s Health), a federal initiative that promotes the behavioral health and prevention of future mental health problems among young children, requires grantees to implement five strategies, two of which are: enhanced home visitation and IECMH consultation. Eight grantees funded from 2009-2011 chose to implement IECMH consultation within home visiting. Evaluation findings from home visitors’ self-reports suggest they increased their knowledge of children’s social-emotional development and of available mental health services where they could refer families.[36]

Training for Home Visitors

While most of the approaches discussed above have a training component, the following trainings are intended to build the IECMH- and maternal depression-related knowledge and skills of home visitors delivering models and interventions without an explicit focus on IECMH. In addition, states often include training on parent-child relationships and IECMH in universal home visitor training, but formal evaluations of these training efforts are lacking.

Home Visitation Enhancing Linkages Project (HELP) promotes screening and referral for maternal depression, substance use, and intimate partner violence. In addition to formal screening, HELP incorporates motivational interviewing and case management to help connect mothers to treatment. Home visitors receive training via webinars and an in-person workshop. Healthy Families America (HFA) home visitors trained on HELP were more likely to discuss maternal depression, substance use, and intimate partner violence than a comparison group of HFA home visitors.[37] However, there were no significant differences between the two groups in identifying families at risk or referring them to services, a finding that is possibly due to low fidelity to the HELP protocol.

The Listening Visits (LV) intervention is delivered by trained home visitors or physician assistants (PAs) when the intervention occurs at a health care site. During LV sessions conducted in homes, the home visitors engage in reflective listening and collaborative problem solving with mothers. Healthy Start in Des Moines, Iowa, conducted a randomized-controlled trial of LV. Healthy Start is a federally-funded maternal and infant health program with a home visiting component that offers case-management to families with infants and toddlers to help them access needed services. Home visitors and PAs received two seven-hour LV training workshops. Women with positive depression screens were randomly assigned to a control group or the LV intervention, which consists of six 30-50-minute sessions delivered over eight weeks. Depressive severity, depressive symptoms, and quality of life showed significant improvements among LV women compared to the control group, and these improvements were maintained up to eight-weeks post-intervention.[38]

Fourteen home visiting programs in eight states participated in a federally-funded Home Visiting Collaborative Improvement and Innovation Network (HV CoIIN). The HV CoIIN targeted postpartum depression screening, receipt of evidence-based services, and reductions in depressive symptoms among clients over a 12-15 month period. Programs adopted strategies, including “specific policies and protocols for depression screening and home visitor response to screening results; home visitor training and supervision; delivery of prevention and treatment interventions; and tracking systems for screening, referral, and follow-up.”[39] Among programs in the HV CoIIN, maternal depression screening rates increased from 83 to 96 percent, the percentage of women with a positive screen who accessed evidence-based services increased from 41 to 65 percent, and the percentage of women who saw a 25 percent reduction in depressive symptoms within three months of accessing services grew from 51 to 59 percent.[40]

Last updated February 2021

References

[1] National Home Visiting Resource Center (2019). 2019 home visiting yearbook: An overview. Arlington, VA: Author. Retrieved from https://live-nhvrc.pantheonsite.io/wp-content/uploads/NHVRC_Yearbook_Summary_2019_FINAL.pdf

[2] Ammerman, R. T., Putnam, F. W., Bosse, N. R., Teeters, A. R., & Van Ginkel, J. B. (2010). Maternal depression in home visitation: A systematic review. Aggression and Violent Behavior, 15(3), 191-200.

Zeanah, P. D., & Korfmacher, J. (2018). Infant mental health and home visiting: Needs, approaches, opportunities, and cautions. In C. H. Zeanah, Jr., (Ed.), Handbook of infant mental health (4^th ed., pp. 610-625). New York, NY: Guildford Press.

[3] National Home Visiting Resource Center (2019). 2019 home visiting yearbook: An overview. Arlington, VA: Author. Retrieved from https://live-nhvrc.pantheonsite.io/wp-content/uploads/NHVRC_Yearbook_Summary_2019_FINAL.pdf

[4] National Home Visiting Resource Center (2019). 2019 home visiting yearbook: An overview. Arlington, VA: Author. Retrieved from https://live-nhvrc.pantheonsite.io/wp-content/uploads/NHVRC_Yearbook_Summary_2019_FINAL.pdf

[5] May, A., & Poppe, J. (2019). Early childhood home visiting: What legislators need to know. Denver, CO: National Conference of State Legislatures. Retrieved from https://web.archive.org/web/20220122154713/https://www.ncsl.org/research/human-services/early-childhood-home-visiting-what-legislators-need-to-know.aspx

[6] May, A., & Poppe, J. (2019). Early childhood home visiting: What legislators need to know. Denver, CO: National Conference of State Legislatures. Retrieved from https://web.archive.org/web/20220122154713/https://www.ncsl.org/research/human-services/early-childhood-home-visiting-what-legislators-need-to-know.aspx

[7] Johnson, K. (2009). State-based home visiting: Strengthening programs through state leadership. New York, NY: National Center for Children in Poverty. Retrieved from http://www.nccp.org/wp-content/uploads/2009/03/text_862.pdf

[8] Zeanah, P. D., & Korfmacher, J. (2018). Infant mental health and home visiting: Needs, approaches, opportunities, and cautions. In C. H. Zeanah, Jr., (Ed.), Handbook of infant mental health (4^th ed., pp. 610-625). New York, NY: Guildford Press.

[9] U.S. Maternal and Child Health Bureau. (n. d.). Maternal, Infant, and Early Childhood Home Visiting Program. Washington, DC: Author. Retrieved from https://mchb.hrsa.gov/sites/default/files/mchb/MaternalChildHealthInitiatives/HomeVisiting/Federal_Home_Visiting_Program_Performance_Indicators_and_Systems_Outcomes_Summary.pdf

[10] Tandon, D., Mackrain, M., Beeber, L., Topping-Tailby, N., Raska, M., & Arbour, M. (2020). Addressing maternal depression in home visiting: Findings from the Home Visiting Collaborative Improvement and Innovation Network. PLoS ONE, 15(4).

[11] Ammerman, R. T., Putnam, F. W., Bosse, N. R., Teeters, A. R., & Van Ginkel, J. B. (2010). Maternal depression in home visitation: A systematic review. Aggression and Violent Behavior, 15(3), 191-200.

[12] Ammerman, R. T., Putnam, F. W., Bosse, N. R., Teeters, A. R., & Van Ginkel, J. B. (2010). Maternal depression in home visitation: A systematic review. Aggression and Violent Behavior, 15(3), 191-200.

[13] Schultz, D. A., Schacht, R. L., Shanty, L. M., Dahlquist, L. M., Barry, R. A., Wiprovnick, A. E., Groth, E. C., Gaultney, W. M., Hunter, B. A., & DiClemente, C. C. (2019). The development and evaluation of a statewide training center for home visitors and supervisors. American Journal of Community Psychology, 63(3-4), 418-429.

[14] Lowell, D. I., Carter, A. S., Godoy, L., Paulicin, B., & Briggs-Gowan, M. J. (2011). A randomized controlled trial of Child FIRST: A comprehensive home-based intervention translating research into early childhood practice. Child Development, 82(1), 193-208.

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Barlow, A., Varipatis-Baker, E., Speakman, K., Ginsburg, G., Friburg, I., Goklish, N., et al. (2006). Home-visiting intervention to improve child care among American Indian adolescent mothers: A randomized trial. Archives of Pediatrics and Adolescent Medicine, 160(11), 1101-1107.

Walkup, J. T., Barlow, A., Mullany, B.C., Pan, W., Goklish, N., Hastings, R., et al. (2009). Randomized controlled trial of a paraprofessional-delivered in-home intervention for young reservation-based American Indian mothers. Journal of the American Academy of Child and Adolescent Psychiatry, 48(6), 591-601.

[17] Ordway, M. R., Sadler, L. S., Dixon, J., Close, N., Mayes, L., & Slade, A. (2014). Lasting effects of an interdisciplinary home visiting program on child behavior: Preliminary follow-up results of a randomized trial. Journal of Pediatric Nursing, 29(1), 3-13.

Sadler, L. S., Slade, A., Close, N., Webb, D. L., Simpson, T., Fennie, K., et al. (2013). Minding the Baby: Enhancing reflectiveness to improve early health and relationship outcomes in an interdisciplinary home visiting program. Infant Mental Health Journal, 34(5), 391-405.

[18] West, A. L., Aparicio, E. M., Berlin, L. J., & Harden, B. J. (2017). Implementing an attachment-based parenting intervention within home-based Early Head Start: Home-visitors’ perceptions and experiences. Infant Mental Health Journal, 38(4), 514-522.

[19] Grube, W. A., & Liming, K. W. (2018). Attachment and Biobehavioral Catch-up: A systematic review. Infant Mental Health Journal, 39(6), 656-673.

[20] Cassidy, J., Woodhouse, S. S., Sherman, L. J., Stupica, B., & Lejuez, C. W. (2011). Enhancing infant attachment security: An examination of treatment efficacy and differential susceptibility. Development and Psychopathology, 23(1), 131-148.

[21] Bagner, D. M., Coxe, S., Hungerford, G. M., Garcia, D., Barroso, N. E., Hernandez, J., & Rosa-Olivares, J. (2016). Behavioral parent training in infancy: A window of opportunity for high-risk families. Journal of Abnormal Child Psychology, 44(5), 901-12.

[22] Spieker, S. J., Oxford, M. L., Kelly, J. F., Nelson, E. M., & Fleming, C. B. (2012). Promoting First Relationships: Randomized trial of a relationship-based intervention for toddlers in child welfare. Child Maltreatment, 17(4), 271-286.

[23] Spieker, S. J., Oxford, M. L., & Fleming, C. B. (2014). Permanency outcomes for toddlers in child welfare two years after a randomized trial of a parenting intervention. Children and Youth Services Review, 44, 201-206.

[24] Oxford, M. L., Spieker, S. J., Lohr, M. J., & Fleming, C. B. (2016). Promoting First Relationships: Randomized trial of a 10-week home visiting program with families referred to child protective services. Child maltreatment, 21(4), 267-277.

[25] Ammerman, R. T., Putnam, F. W., Altaye, M., Teeters, A. R., Stevens, J., & Van Ginkel, J. B. (2013). Treatment of depressed mothers in home visiting: Impact on psychological distress and social functioning. Child Abuse & Neglect, 37(8), 544-554.

Ammerman, R. T., Putnam, F. W., Altaye, M., Stevens, J., Teeters, A. R., & Van Ginkel, J. B. (2013). A clinical trial of in-home CBT for depressed mothers in home visitation. Behavior Therapy, 44(3), 359-372.

[26] Ammerman, R. T., Altaye, M., Putnam, F. W., Teeters, A. R., Zou, Y., & Van Ginkel, J. B. (2015). Depression improvement and parenting in low-income mothers in home visiting. Archives of Women’s Mental Health, 18(3), 555-563.

[27] Beeber, L. S., Holditch-Davis, D., Perreira, K., Schwartz, T. A., Lewis, V., Blanchard, H., Canuso, R., & Goldman, B. D. (2010). Short-term in-home intervention reduces depressive symptoms in Early Head Start Latina mothers of infants and toddlers. Research in Nursing & Health, 33(1), 60-76.

[28] Tandon, S. D., Leis, J. A., Mendelson, T., Perry, D. F., & Kemp, K. (2014). Six-month outcomes from a randomized controlled trial to prevent perinatal depression in low-income home visiting clients. Maternal and Child Health Journal, 18(4), 873–881.

[29] McFarlane, E., Burrell, L., Duggan, A., & Tandon, D. (2017). Outcomes of a randomized trial of a cognitive behavioral enhancement to address maternal distress in home visited mothers. Maternal and Child Health Journal, 21(3), 475-484.

[30] Center of Excellence for Infant and Early Childhood Mental Health Consultation (n. d.). About infant and early childhood mental health consultation. Washington, DC: Author. Retrieved from https://www.samhsa.gov/sites/default/files/programs_campaigns/IECMHC/about-infant-and-early-childhood-mental-health-consultation.pdf

[31] Goodson, B. D., Mackrain, M., Perry, D. F., O’Brien, K., & Gwaltney, M. K. (2013). Enhancing home visiting with mental health consultation. Pediatrics, 132(Supplement 2), S180-190.

[32] Gilliam, W. S., Maupin, A. N., & Reyes, C. R. (2016). Early childhood mental health consultation: Results of a statewide random-controlled evaluation. Journal of the American Academy of Child & Adolescent Psychiatry, 55(9), 754-761.

Gilliam, W. S. (2007). IMPACT: Reducing behavior problems in early care and education programs: An evaluation of Connecticut’s Early Childhood Consultation Partnership. Farmington, CT: Child Health and Development Institute of Connecticut.

[33] Illinois Children’s Mental Health Partnership. (n. d.). Early childhood mental health consultation to home visiting programs: Addressing the unmet mental health needs of families with young children. Chicago, IL: Author. Retrieved from http://icmhp.org/wordpress/wp-content/uploads/2016/01/EarlyChildhoodConsultHomeVisitProg.pdf

[34] Boris, N. W., Larrieu, J. A., Zeanah, P. D., Nagle, G. A., Steier, A., & McNeill, P. (2006). The process and promise of mental health augmentation of nurse home-visiting programs: Data from the Louisiana Nurse-Family Partnership. Infant Mental Health Journal, 27(1), 26-40.

[35] Lambarth, C. H., & Green, B. L. (2019). Exploring a model for infant and early childhood mental health consultation in early childhood home visiting. Infant Mental Health Journal 40(6), 874-888.

[36] Goodson, B. D., Mackrain, M., Perry, D. F., O’Brien, K., & Gwaltney, M. K. (2013). Enhancing home visiting with mental health consultation. Pediatrics, 132(Supplement 2), S180-190.

[37] Dauber, S., Hogue, A., Henderson, C. E., Nugent, J., & Hernandez, G. Addressing maternal depression, substance use, and intimate partner violence in home visiting: A quasi-experimental pilot test of a screen-and-refer approach. Prevention Science, 20(8), 1233-1243.

[38] Brock, R. L., O’Hara, M. W., & Segre, L. S. (2017). Depression treatment by non-mental-health providers: Incremental evidence for the effectiveness of Listening Visits. American Journal of Community Psychology, 59(1-2), 172183.

Segre, L. S., Brock, R. L., & O’Hara, M. W. (2015). Depression treatment for impoverished mothers by point-of-care providers: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 83(2), 314-324.

[39] Tandon, D., Mackrain, M., Beeber, L., Topping-Tailby, N., Raska, M., & Arbour, M. (2020). Addressing maternal depression in home visiting: Findings from the Home Visiting Collaborative Improvement and Innovation Network. PLoS ONE, 15(4).

[40] Tandon, D., Mackrain, M., Beeber, L., Topping-Tailby, N., Raska, M., & Arbour, M. (2020). Addressing maternal depression in home visiting: Findings from the Home Visiting Collaborative Improvement and Innovation Network. PLoS ONE, 15(4).