# Improving Preschool Outcomes by Addressing Maternal Depression in Head Start

> **NIH NIH R01** · BOSTON MEDICAL CENTER · 2020 · $770,035

## Abstract

PROJECT SUMMARY
Children of low-income families face myriad social risks that interfere with healthy development, behavior, and
academic achievement. Mothers of these children experience a high rate of depression, itself associated with
lasting effects on children. In 2009, the National Academy of Medicine published a landmark report,
Depression in Parents, Parenting, and Children, in which it called for community-based interventions to prevent
parental depression and to help engage depressed parents in treatment. Consistent with this report, our
research group has conducted a series of NIH-funded studies aimed at alleviating symptoms among mothers
at risk for depression in Head Start – a federally funded preschool program that provides services for ~1 million
low-income US families.
 In the present project, we aim to improve outcomes for Head Start children by deploying a stepped-care
intervention, in which mothers with low level depressive symptoms are offered a prevention program based on
the Problem Solving Education model, and mothers with greater symptoms are offered Engagement Sessions
to link them with formal mental health services. Both components of the model have strong randomized trial
evidence; but they have yet to be synthesized and tested within a coordinated intervention, applicable to a
broad population base. Harnessing a research network of Head Start centers in Massachusetts, we propose
an efficacy trial (n=388) of this stepped-care model.
 Our primary aim is to determine the model’s efficacy in decreasing the rate at which Head Start mothers
experience depressive symptom episodes; mothers’ likelihood of engaging with mental health services when
referred; parental functioning; and child absenteeism from Head Start. Our second aim is to determine
mechanisms of action by which improved maternal wellbeing promotes child resiliency. To do this, we will
assess mothers’ perceptions of stress, family conflict, and mother-child interaction patterns; and we will assess
child outcomes in the affective, interpersonal and cognitive domains. Finally, to prepare for a subsequent
effectiveness trial, we will conduct a single arm pilot study among 20 additional mothers to assess the
feasibility of incorporating intervention delivery into usual Head Start workflow.
 Our proposal represents a high-priority research area for NICHD because it addresses social and
environmental factors that impact children’s adaptive behaviors and school readiness. Our study plan
enhances the rigor of prior research because it tests the efficacy of a comprehensive depression management
model, and because our design allows us to study both maternal and child outcomes – and the mechanisms
that link them – among a true community-based sample. Our ultimate goal is to reduce mental health
disparities for low-income mothers and to improve outcomes for them and their children.

## Key facts

- **NIH application ID:** 9884948
- **Project number:** 1R01HD092456-01A1
- **Recipient organization:** BOSTON MEDICAL CENTER
- **Principal Investigator:** EMILY FEINBERG
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $770,035
- **Award type:** 1
- **Project period:** 2020-01-13 → 2024-12-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9884948

## Citation

> US National Institutes of Health, RePORTER application 9884948, Improving Preschool Outcomes by Addressing Maternal Depression in Head Start (1R01HD092456-01A1). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/9884948. Licensed CC0.

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