What's your secret sauce?
1. Co-location of depression and trauma-related services in neighborhoods of the people we serve and in agencies serving families;
2. Community Mental Health Ambassadors (CMHAs): Trained mothers from the local community who focus on target population outreach, retention, and treatment (alongside traditional licensed, skilled, and local mental health clinicians). These ambassadors are highly valued given both their understanding of the unique struggles faced by these mothers and their unparalleled ability to develop authentic partnerships; and
3. Core Mental Health Treatments: Evidence-based, mental health, parenting and job readiness interventions derived from Cognitive Behavioral Therapy (CBT) to decrease the symptoms of trauma and depression and increase family social and economic mobility.
I see MOMS Partnership™ talking about the results the program has achieved. Which ones come from randomized controlled trials?
The data on adherence / utilization, depressive symptoms, and lease compliance (e.g. a mother's compliance with public housing authority policies) come from a cluster, randomized controlled trial in public housing. The treatment condition was the MOMS Partnership™ -- specifically the Stress Management and job readiness courses, co-delivered by Community Mental Health Ambassadors and clinicians, as well as a facilitated connection to other social services and government benefits. The control condition was CBT alone. The findings showed that mothers receiving the MOMS Partnership™ interventions for depression had lower depressive symptoms, better lease compliance, and higher adherence to the intervention than mothers in the control cohort.
- Participants of the MOMS Partnership™ adhered to 75% of the intervention, whereas members of the control group had an adherence rate of 57%.
- Participation in the MOMS Partnership™ decreased depressive symptoms for about 75% of the women served as compared to about 30% of the control group.
- Among women who experienced a decrease in depressive symptoms, participation in the MOMS Partnership™ decreased depressive symptoms by 47% on average, compared to an average decrease of 29% in the control group.
Specific findings on lease compliance will be published in Spring 2018. Other data on the MOMS Partnership™ are derived from a matched design where we compare data on mothers in MOMS and mothers not in MOMS, who share similar demographic characteristics.
What are you trying to learn now as you currently implement the MOMS Partnership™?
We are trying to better understand for which populations the MOMS Partnership™ works best, where the MOMS Partnership™ works well, and how MOMS can best integrate into extant social service systems such that families can achieve breakthrough outcomes in economic and social mobility.
Where do you get your funding?
We have received funding from the State of Connecticut, the federal government in the form of grants, and philanthropic sources. We also currently bill Medicaid for certain components of the MOMS Partnership™ program.
Is MOMS Partnership™ a program of Yale? What is Yale's role?
The MOMS Partnership™ was started as a collaboration between Dr. Smith at the Yale School of Medicine, and community and state agencies in Connecticut. Currently, as we replicate the MOMS Partnership™, Yale provides extensive training, extensive technical and legal assistance, human subjects approvals, and research infrastructure and services to the MOMS Partnership™. The MOMS Partnership™ core staff are employed by Yale, but Yale does not pay for the MOMS Partnership™ to provide programmatic services.
Is the MOMS Partnership™ just for moms? What about pregnant women or teens?
Pregnant women are eligible for the MOMS Partnership™. We know from some of our data that the MOMS Partnership™ does not work well for women under the age of 17 who have children or are pregnant. Instead mothers and pregnant women younger than 17 may be best served by more targeted and tailored programming for young adolescent parents.
Why don't you serve dads too?
The MOMS Partnership™ began with the belief that a gender-transformative approach would be necessary to address women's mental health and economic mobility. This was based on many stressors and specific traumas that mothers described that were unique to being a woman, parenting, and working or looking for work. Additionally, demographics of the initial target population for MOMS were such that the majority of the population of low-income women with children was single, female-headed households. The MOMS Partnership™ has partnered closely with organizations that served fathers and often referred male partners of women served by the MOMS Partnership™ to community partners, highlighting again the benefit of a community collaborative approach!
Does a woman need to have a clinical diagnosis of depression or of an anxiety disorder in order to be eligible for a program?
No, a woman does not need a clinical diagnosis to participate. Instead, a woman must have a minimal level of depressive symptoms to participate in the MOMS Partnership™. Depressive symptoms are assessed with a self-report depression screening instrument. Unfortunately, we have found that over 70% of low-income women we have screened have this minimal level of depressive symptoms.
What if a woman needs an anti-depressant or other psychiatric medication?
The MOMS Partnership™ is designed to be a "no wrong door" entry point to mental health services for women with depressive symptoms. Thus, if a woman starts in a MOMS Partnership™ program and has not improved by the end of the program, referral systems would ensure a mother gets appropriate care whether it be a psychiatric medication or additional treatment for addiction. We encourage all locations that implement the MOMS Partnership™ to have strong collaborations and even written Memorandums of Understanding with mental health providers to assist with these referrals. Also, Community Mental Health Ambassadors (CMHAs) can assist in referring mothers and coaching them to attend additional appointments. We have found that mothers are more likely to continue to engage in their own mental health care once they have completed a MOMS Partnership™ program component.
Does the MOMS Partnership™ turn away women who are suicidal or have other severe psychiatric needs? This program doesn't seem suited for them.
The MOMS Partnership™ is not a good match for women who are actively suicidal or psychotic. Instead, we refer these women to more acute forms of care.
Aren't you concerned about confidentiality when you are delivering mental health services in public places like grocery stores? And in group settings?
The MOMS Partnership™ holds confidentiality in the highest regard. The convenience and reduction of stigma that provision of services in a grocery store offers does come with the need for additional precautions to guard confidentiality of participants. Staff are well-trained in methods to minimize breaches of confidentiality and ensure that group participants understand and adhere to strict confidentiality requirements. For example, the supermarket space is designed such that while mothers initially engage with Community Mental Health Ambassadors in the front of the grocery store, actual programmatic work is provided in a discreet and private room in the upstairs or back of the store.
How much does it cost to implement the MOMS Partnership™?
Actual implementation costs vary by local market, reflecting differences in cost of labor, space, and materials. Costs also vary by number of women served and the design of the program, reflecting differences across sites in the adoption of optional elements in the model. As a rough estimate, however, annual implementation costs in 2017 dollars may amount to just over $2 million to serve 1,040 participants - or under $2,000 per participant.