Studies have shown that poor mental health reduces work attendance, performance, and economic opportunities. The disability associated with maternal depression, in particular, can affect engagement with children, which can lead to development deficits that create a powerful process for the perpetuation of poverty within and between generations.
Women’s Health Research at Yale and Elevate, the university’s health policy lab, are expanding their partnership to meet the urgent health needs of under-resourced and overburdened pregnant and parenting women. Their shared mission: to harness the science of sex and gender for policy change that can overcome the potentially devastating impact of economic inequality on women’s health.
“We have learned the importance of starting with children in fostering resilience, and that means addressing the needs of adults who care for them,” said Dr. Megan Smith, the founder of Elevate and the Mental health Outreach for MotherS (MOMS) Partnership. “If we can improve mental health for caregivers and their relationships with their children starting as early as possible, we have an opportunity to promote economic mobility that can persist into the future.”
Recognizing the value of the intersection of economic status and health, Elevate has launched a new, unique clinical research collaboration with The Tobin Center for Economic Policy at Yale.
In the 1970s and 80s, many studies on fighting poverty through interventions in the adult labor market, such as job training, showed limited success. Individuals might experience a marginal improvement in their circumstances but little that proved life-changing for themselves and their children.
However, studies also found that lower-income individuals with prior achievements tended to respond better to interventions than peers with fewer achievements in their past. This was true both for vocational and other educational interventions. These findings, as well as evidence from efficacy trials in the United States, Jamaica, and Bangladesh, led economists, such as Dr. Costas Meghir and Dr. Orazio Attanasio, to think about interventions that began in early childhood. They started collaborations with pediatricians, psychologists, and psychiatrists.
“The burden of thinking about the next day’s food availability and survival can prevent a mother struggling with poverty from thinking about the longer arc of life and making plans,” said Meghir, Douglas A. Warner III Professor of Economics affiliated with The Tobin Center. “We started working across disciplines to think of how to design, scale, and reproduce interventions that would actually work to change this.”
Research has shown that 42 percent of children born into a family earning an income that places it in the bottom 20 percent of American families will remain in that lowest-earning group as an adult. People whose income, education, and occupations place them in a category defined by researchers as low socioeconomic status (SES) face a risk of meeting the criteria for a mental health disorder 2.6 times greater than those living in higher SES categories.
With guidance from WHRY, Elevate and The Tobin Center are now conducting a large, randomized controlled trial of a scalable program called 1-2-3 MOMS, offering three sequential interventions to women beginning in their second trimester of pregnancy and ending about one year after giving birth. Dr. Smith, along with Dr. Meghir and Dr. Attanasio, Cowles Professor of Economics, will measure the interventions’ capacity for improving maternal mental health, child cognitive and language development, parenting quality, access to and use of welfare programs and other public services, and data on maternal employment and earnings.
The study, conducted in partnership with Dr. Rachel Ebling, Director of Research and Evaluation of the Yale Parent and Family Development Program, is the first of its type for The Tobin Center. With additional funding, the researchers plan to track this group of families and measure the longer-term effects of these interventions for both the children and the mothers.
“Our study is unique in that it starts before the child is born and combines interventions to get at a root cause of poverty across generations and the many interlinked problems we see with people living in poverty,” Meghir said. “The goal is to create a dynamic effect, making mothers feel more secure so they engage better with their children. Then, when mothers see their kids doing better, that’s uplifting. Their minds will be less occupied with survival and more able to make longer-term investments in themselves and their families, improving both their own opportunities as well as the development and future opportunities of their children.”
In addition, The Tobin Center and Elevate are collaborating to develop and evaluate clear public health communications and a robust contact tracing plan for COVID-19 in lower-income populations, including Black women, who have been underrepresented in many such efforts to contain the disease.
“As we have seen in the COVID-19 pandemic, it is more important than ever to marshal resources behind scientifically proven and cost-effective methods for helping the people most vulnerable to disease and its economic consequences,” said WHRY Director Carolyn M. Mazure, Ph.D. “We work with Elevate because together we can leverage existing and new scientific findings, identify the most urgent needs, and test practical remedies that can be implemented as widely as possible.”
Dr. Smith expressed enthusiasm for Elevate’s direction, momentum, and enhanced partnership with The Tobin Center and WHRY.
“This is the time to effect real change,” she said. “In so many ways, we are having a bigger, broader impact on communities.”