The Maternal, Infant, and Early Childhood Home Visiting Program is a national child abuse prevention
strategy that serves vulnerable families throughout the United States. Depressed mothers (pregnant and post-
delivery) make up a significant portion of home visited clients. These mothers experience family conflict that
precipitates or worsens their depressive symptoms. Furthermore, they infrequently get treatment due to
multiple barriers. These barriers are compounded for those who live in rural areas. The proposed study will test
the preliminary effectiveness of an innovative family therapy intervention, Resilience Enhancement Skills
Training (REST), that aims to reduce maternal depressive symptoms and family conflict, and increase family
cohesion and family cognitive reappraisal in this vulnerable population. It builds on our successful preliminary
study of REST that showed it significantly reduced perinatal depressive symptoms in home visited mothers and
significantly reduced family conflict, and significantly improved family cohesion and family cognitive
reappraisal. The proposed study addresses a critical service need for home visited mothers with moderate to
severe depressive symptoms, living in rural areas, with low access to treatment.
The proposed study aligns with the NIMH Division of Services and Intervention Research high priority
area in the development of innovative service delivery approaches for diverse and underserved populations.
The long-term goal of the proposed study is to integrate the REST into rural home visiting agencies throughout
the United States. To accomplish this goal, we must first accomplish the aims of the current application. The
proposed study uses an effectiveness-implementation hybrid type 1 design with a pilot randomized trial and
includes three aims: 1) Test the feasibility, acceptability, tolerability, and safety of REST conducted by
community therapists; 2) Test the preliminary effectiveness of the REST compared to standard of care in
reducing maternal depressive symptoms and family conflict, increasing maternal school enrollment/job
attainment, and improving family cohesion and family cognitive reappraisal; and 3) Collect preliminary data on
barriers and facilitators to implementation of REST. The results will be used to inform a larger randomized trial
that rigorously tests the effectiveness of REST.