Executive Summary

Improving the identification and treatment of maternal depression among low-income women, particularly mothers of young children, would be an extraordinary public health success. Untreated maternal depression can interfere with a parent’s capacity to help a child develop, place children’s safety and cognitive and emotional development at risk, and stymy families’ efforts to escape poverty.

Seizing New Policy Opportunities to Help Low-Income Mothers with Depression: Current Landscape, Innovations, and Next Steps offers practical, timely ideas for state and federal action to do just that. The brief contends that federal and state decision-makers and advocates in the early childhood, anti-poverty, health, and mental health worlds, along with the world of philanthropy, should seize this moment of opportunity for young children and their families.

The proposed next steps are grounded in a first-ever scan of federal, state, and local efforts in selected states (Connecticut, Minnesota, Ohio, and Virginia) to realize this public health opportunity at a large scale.  The brief is timely because of the new policy opportunities available through the Patient Protection and Affordable Care Act (ACA) and through recent federal decisions and guidance, as well as local and state innovations emerging at the same time.

The brief—written by Stephanie Schmit and Christina Walker—highlights two broad lessons learned:

1. While the provisions of the ACA offer important new routes to finance, expand, and systematize maternal depression identification and treatment, major efforts to take advantage of these positive policy changes are still very rare; and
2. Many innovative ideas for improving identification and treatment of maternal depression are surfacing from the local and state levels and from recent federal decisions and guidance

Therefore, the brief finds that this is the moment to bring together the policy opportunities and the local innovations to speed movement towards largescale change.  CLASP’s recommendations combine immediate steps for early successes, the development of infrastructure to sustain the effort, and the creation of a clear policy framework to make it far easier for states to avoid reinventing the wheel.

The brief also proposes that the best way to seize these positive policy opportunities is for decision-makers, advocates, and other stakeholders to come together across the relevant policy fields:  health, mental health, early childhood education, and family services. Even though many obstacles stand in the way of connecting these worlds, there are clear advantages to families—and to stakeholders—in a collaborative approach to designing new policies.

The brief features about half a dozen local and state innovations that offer lessons for largescale policy choices, among them:

• The Mental Health Outreach for Mothers (MOMS) Partnership in New Haven, Connecticut—a collaborative of agencies working to improve the wellbeing of mothers and children— supports local mothers serving as Community Mental Health Ambassadors to deliver screening, brief intervention, and referral and linkage to clinical treatment. The Partnership is exploring Medicaid reimbursement for this new outreach model with the state.
• An evidence-based maternal depression treatment for mothers participating in home visiting programs in Ohio is provided by mental health clinicians working in partnership with home visitors. The model, Moving Beyond DepressionTM, has expanded to home visiting programs in 10 states, and in 4 of those states, Medicaid is paying for the program.
• In all states, stakeholders had ideas and possible solutions to help create the conditions for policy reform, such as: bringing stakeholders together to design or implement better approaches to addressing maternal depression, improving cross-training, better integrating primary and behavioral health care, collecting data to understand the state’s needs, and exploring quality and outcome measures for maternal depression.

At the same time, the brief explains how steps taken by the federal government in 2016 could galvanize additional state and local activity. For example, state decision-makers and advocates should drive further action by using guidance from HHS that authorizes states to cover a mother’s depression screening and parent-child treatment under a child’s Medicaid benefit because of the scientifically established importance to young children’s wellbeing. In addition, states should use the finding by the U.S. Preventive Services Task Force that depression screening is solidly supported by the research—which in turn provides state Medicaid programs with a financial incentive to cover it. 

Identifying and treating low-income mothers with depression is an important opportunity to take on a major challenge that faces low-income families: promoting children’s learning and successful development and families’ economic stability.