Early on, Wyandotte County MIECHV program partners identified struggles serving families with mental health concerns such as limited access to mental health services or clinicians that serve families with very young children, affordability, poor parent motivation, and the stigma associated with accessing these types of services.  These challenges make the delivery of home visiting services difficult. Addressing mental health issues often consume a home visitor's time, ability, and capacity and compromise the achievement of program activities and objectives.  Specifically, maternal depression can significantly interfere with the efficacy of home visiting.  Research has demonstrated that depression in the postpartum period occurs in about 26% of high risk mothers and, in populations served by home visitation, prevalence is up to 50%.  Maternal depression seriously undermines crucial aspects of parenting and has been linked to a number of poor child health and developmental outcomes. Detecting and treating depression in prenatal and parenting families can have profound effects on promoting the mental wellness of all family members, especially young children.

The good news is that maternal depression can be treated and in an accessible manner for mothers in home visiting programs. To provide enhanced services to Wyandotte County MIECHV program participants experiencing depression, Moving Beyond Depression In-Home Cognitive Behavioral Therapy (MBD) was selected.  MBD is an intervention program developed by Dr. Bob Ammerman and other researchers at Every Child Succeeds and Cincinnati Children's Hospital which provides an evidence-based treatment for depression adapted for home visitation in order to optimize outcomes.  MBD provides mothers identified through screening by their home visitor as experiencing depression with 15 weekly, in-home therapy visits by a trained therapist. During the treatment program, mothers continue to receive their regular home visiting program as well. 

In Wyandotte County, The Family Conservancy (TFC) is providing the MBD intervention.  In spring 2013, two TFC therapists and the home visiting programs received training by Dr. Ammerman and his staff and colleagues.  Since MBD officially launched in June 2013, at least 14 mothers have received MBD services and several have completed the intervention. The MIECHV development project funding the MBD implementation includes an evaluation component.  Preliminary data, as well as anecdotal reports from mothers and their home visitors, are indicating MBD is having a positive effect.  Previous research studies of MBD have shown positive results such as decreased major depressive symptoms and improvements in parenting stress, mother-child relationships, nurturing parenting, and continued engagement in home visits.  More information about MBD is available at: http://www.movingbeyonddepression.org/

Although evidence-based home visiting models have individually been found to produce some positive effects, there are many remaining gaps in knowledge about home visiting programs.  The federal MIECHV Program funding to support the scale up of evidence-based programs provides an unprecedented, critical opportunity for program and research collaboration at the federal, state, and community levels. The Mother and Infant Home Visiting Program Evaluation (MIHOPE) is a legislatively mandated, national cross-site evaluation designed to build knowledge of the effectiveness of home visiting programs funded by MIECHV, specifically the evidence-based Early Head Start, Healthy Families America, Parents as Teachers, and Nurse Family Partnership models. The national evaluation includes an effectiveness study to measure what difference home visiting programs make for the at-risk families they serve in areas of prenatal, maternal and newborn health, child development, parenting, domestic violence and referrals and service coordination.  The study also includes an implementation analysis to examine how program models operate in their local and state contexts and describe the families who participate, and an economic analysis of the financial costs of operating the programs.

Kansas was one of 12 states selected to participate in MIHOPE.  Eight MIECHV program sites along with 77 program sites in other states are actively involved in the study.  This has required much additional work by the involved program sites, yet there is excitement about the significant contribution the Kansas programs and families will make to this extraordinary national opportunity.  The study was launched in Kansas in late May 2013 and will continue through approximately early 2015.  An initial report to Congress is due in 2015. 

For more information on MIHOPE click this link:

MIHOPE Website

Both the Wyandotte County and Southeast Kansas MIECHV teams have identified a need for new community outreach and marketing strategies and materials that will more effectively engage their local populations.  Materials will focus on the benefit of home visiting programs in general and will be previewed by families/parents to ensure effectiveness.  Both Spanish and English resources will be developed.   Both teams continue to refine their coordinated outreach and referral processes in partnership with Connections in Wyandotte County and My Family in Cherokee, Labette, and Montgomery counties.

Dr. Kathy Bigelow is an Assistant Research Professor and Dr. Dale Walker is an Associate Research Professor at Juniper Gardens Children's Project, University of Kansas, based at the Children's Campus in Kansas City, KS.  For the MIECHV Program, they provide expertise in Continuous Quality Improvement (CQI) and implementation fidelity.  Kathy and Dale are supporting individual programs to incorporate CQI procedures into their work processes and are working on the collection of implementation fidelity data across the MIECHV partner programs. The initial CQI focus is to assure substance use, depression, and domestic violence screening tools are effectively administered to all mothers and primary caregivers, provide assistance with tools to collect and assess data in a timely manner, and use data to improve program practices. They appreciate the efforts that programs are making toward quality improvement and look forward to expanding these efforts to additional goals and priorities of the partner programs.   We are grateful they are on our state team as well!