Family Connections provides a consultant who works with teachers, children, and parents, with a primary focus on teachers’ concerns to address depression and related adversities. This consultation is paired with staff group trainings about key issues in mental health: how to build resilience in the face of depression, what is depression, how to engage difficult parents, how to build resilience in parents and children in the face of depression, and the importance of self-reflection both for parents and teachers. The trainings are conducted by the consultant, who works in the center and is therefore able to address any concerns that a parent, teacher, or child may have and to apply the content of the trainings to everyday challenges. A set of materials for parents, teachers, and workshop leaders has been developed and includes brief documents for parents and teachers about the key issues as well as a workshop leader’s guide to how to conduct trainings and lessons learned. These materials are available on the Head Start website to all Head Start centers (Avery et al., 2008). Initial evaluation of the approach shows that teachers value the training and consultation and report that it influences their practice; parents also report positive responses (Beardslee et al., in press-a).

In addition to Head Start, a variety of other evidence-based, family-focused programs have slowly been gaining wider application and are able to connect directly with vulnerable parents. Investigations show that well-designed parent training programs can reduce parental depression while also improving parenting skills (DeGarmo, Patterson, and Forgatch, 2004; Kaminski et al., 2008), at least for a period of time (Barlow, Coren, and Stewart-Brown, 2003). Even when such programs do not directly affect depression, they may still enable gains in parenting knowledge and ability (Baydar, Reid, and Webster-Stratton, 2003; Olds et al., 2003). Parent training is also part of the responsibility of the public child welfare system at the state and local levels. However, the quality of the training programs used by child welfare agencies varies widely, and there is little evidence on how effective even the higher quality programs are in practice (Barth et al., 2005).

School-Based Services

Schools offer the potential to provide integrated parent-child depression services, especially for teenage parents. Many schools have school nurses or nurse aids who could be trained to screen for depression (Centers for Disease Control and Prevention, 2006), but these and other school employees (i.e., school counselors) have a range of other duties. However, only a minority of schools have a school-based health clinic where additional capacity might be situated to deal with a range of identified mental health needs. Less than a fifth of these clinics report offering mental health

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