However, a small, randomized trial of a home visiting–based parenting intervention for depressed mothers demonstrated significant improvements in attachment security (as measured by the Attachment Q-Set), maternal sensitivity, and child socioemotional competence (van Doesum et al., 2008).

The Nurse-Family Partnership (NFP) has drawn a significant amount of attention and support owing to the high quality and persuasiveness of the evidence for its effectiveness on the basis of three, well-designed, randomized controlled trials and long-term findings (Isaacs, 2007; Karoly, Kilburn, and Cannon, 2005; Partnership for America’s Economic Success, 2008). In this program, nurse home visitors are trained to screen first-time mothers for depression and to make appropriate referrals for treatment. Louisiana was one of the early adopters of the NFP model and has tested a supplemented version that couples nurse visitor teams with an infant mental health specialist, usually a social worker, to help identify and treat parental, mostly maternal, mental health issues (Boris et al., 2006). A consortium of local agencies in the Cincinnati area called Every Child Succeeds, which operates both the Nurse-Family Partnership and another home visiting program, Healthy Families America, have tested, with some success, the use of cognitive behavioral therapy with participating mothers diagnosed with depression (Ammerman et al., 2005).

Early Childhood and Parent Training Programs

A system with enormous potential for reaching parents with or at risk of depression is the array of programs and services that have taken shape to support the early development of children and parenting. By far the largest and most prominent of these programs is Head Start. Like many early childhood interventions, Head Start is designed to address the needs of children and, to some extent, their parents. In recent years, federal performance standards for Head Start have heavily emphasized the program’s responsibility for readying children for school, with relatively less weight given to the program’s role in helping and engaging parents.

This has been counterbalanced to some extent by the emergence of Early Head Start, a program for children from birth to age 3 years and their families. Early Head Start is actually a set of program options from which local Head Start agencies may choose: center-based care for children, home visiting for children and their families, or a combination of the two. Although initial findings from the 17-site randomized trial of Early Head Start did not show any impact on parental depression, more recent evidence suggests that the program may have had a delayed inoculatory effect (Chazan-Cohen et al., 2007). The downstream incidence of depression (i.e., delaying the impact on maternal depression) among parents in the treatment group has been significantly lower than those in the control condition.

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