694 - Effects of the Family Check-Up 4 Health on Parental Depression: a Randomized Clinical Trial in Primary Care

Publication Number: 694.4920

Meera Nagarajan, University of Utah School of Medicine, Salt Lake City, UT, United States; Justin Smith, University of Utah School of Medicine, Salt Lake City, UT, United States; Cady Berkel, Arizona State University, Tempe, AZ, United States; Jeremiah Kaplan, ASU, Phoenix, AZ, United States; Matt L. Miller, REACH Institute, Arizona State University, Tempe, AZ, United States; Alejandro B. Hernandez, Arizona State University, Glendale, AZ, United States

Background: There is robust literature on the association between child development and parental depression. Health-related social needs (HRSN) not only affect depression and other mental health conditions, but disproportionately affect under-resourced communities, further contributing to children’s health disparities. The evidence-based Family Check-Up 4 Health (FCU4Health) is an adaptation of the Family Check-Up (FCU) for delivery in primary care settings, focusing on promoting child health by addressing HRSN and promoting the use of effective parenting strategies. While previous work has demonstrated significant effects of the FCU4Health on parenting and child health outcomes, effects on parental depression and HRSN has not been examined.

Objective: This study sought to examine program effects and the role of food insecurity and parenting behaviors on parent depression among FCU4Health recipients.

Design/Methods: This type 2 hybrid effectiveness-implementation study, conducted from June 2017-September 2019, involved family-level randomization to FCU4Health (n = 141) or primary care as usual (n = 99). Enrolled families (n = 240) were identified at well-child visits (46%), sick visits (31%), and weight-checks (5%) while the remainder were identified via electronic health record search with mail/phone recruitment. The core components of the FCU4Health included an ecological assessment of the family, a feedback and motivation session, and follow-up services and resources individually tailored based on identified needs. Follow-ups were arranged at 3 months (wave 1), 6 months (wave 2), and 12 months post-intervention (wave 3). Structural equation modeling was used to examine the direct effects of FCU4Health on parent depression, and if this was mediated by food insecurity and parenting behaviors.

Results: Random assignment to FCU4Health was associated with improvement in parenting (β = 0.19, p < .05) and parental depression (β = -.17, p < .05). The FCU4Health was also associated with decreases in food insecurity (β = -.11, p < .05). Food insecurity at Wave 2 was associated with increases in parental depression at Wave 3 (β = 0.19, p < .01). The link between Wave 2 parenting and Wave 3 parental depression was not significant. A moderational pathway was included to determine whether baseline food insecurity interfered with improvement in parenting. This was not a significant predictor, suggesting families are able to benefit regardless of food access.

Conclusion(s): Results of these analyses suggest that incorporating HRSN coordination into a parenting program can address food insecurity and parental depression.