The Bronx has been hit disproportionally by COVID-19. For caregivers in the borough, the pandemic has caused unprecedented psychological distress. In addition to existing health disparities, these families now face greater financial insecurity and challenges related to their school-aged children.
Now, the National Institutes of Health (NIH) has awarded researchers at Montefiore Health System and Albert Einstein College of Medicine a five-year, $4.1 million grant to study interventions to reduce symptoms of depression and anxiety among Bronx caregivers and healthcare workers.
“As a psychiatrist and mom, I want caregivers in the Bronx to have the tools to be confident in tough parenting situations and tackle stress and uncertainty in a healthy way,” said Dr. Vilma Gabbay, principal investigator on the grant, co-director of the Psychiatry Research Institute at Montefiore Einstein, and associate professor of psychiatry and behavioral sciences in the Dominick P. Purpura Department of Neuroscience at Einstein.
Supporting Parents With High Stress
The Montefiore-Einstein study will enroll 360 Bronx parents and other primary caregivers for kids and teens. The participants, who will receive psychological support, will be selected from among three groups who face unique vulnerabilities during the ongoing COVID-19 pandemic:
- Parents and caregivers of children who have autoimmune illnesses like lupus and juvenile arthritis, and may develop serious illness following COVID-19 infection.
- Parents and caregivers of children who have existing psychiatric conditions and are at higher risk for pandemic-related anxiety and depression.
- Frontline healthcare workers at Montefiore who are parents under increased stress during the pandemic.
Group Therapy vs. Parental Education vs. Combined Approach
The randomized trial will evaluate three approaches. One-third of the participants will receive 12 weeks of group telehealth therapy, expanding on the work of the Connecting and Reflecting Experience (CARE), a group-based program at Montefiore and Einstein. In these telehealth sessions, a group leader helps caregivers “mentalize” by encouraging them to recognize and understand what motivates their children’s behavior, while examining their own thoughts and feelings. The CARE program is adapted from the work of Nancy Suchman, Ph.D., the late mentor of Dr. Amanda Zayde, assistant professor of psychiatry and behavioral sciences at Einstein. Suchman was a researcher at the Yale School of Medicine and a pioneer of this approach for fostering the connection between mothers and young children.
“In the group sessions, parents have the opportunity to connect with other caregivers and share common experiences, normalizing challenges,” Zayde said. “For example, they might wonder about and discuss why a child would spend hours online during the pandemic. Additionally, participants support each other and share community resources.”
The CARE program was developed seven years ago for caregivers, often recent immigrants, who face health disparities and who are raising children with a range of mental health conditions. In previous research, people who completed the program reported decreased symptoms of anxiety and depression plus decreases in parenting stress.
Another third of the participants will receive 12 weeks of parenting education supported by the Valera Health app, with a focus on teaching caregivers problem-solving, communication and coping skills.
“We want to help Bronx residents lower anxiety and depression symptoms by building skills to support their children and manage distress,” said Dr. Jonathan Alpert, professor and chair of psychiatry and behavioral sciences and co-principal investigator on the grant. Alpert is also professor in the Dominick P. Purpura Department of Neuroscience, and of pediatrics, and the Dorothy and Marty Silverman Chair in Psychiatry at Einstein.
Participants in this part of the study will have upgraded resources in the Valera Health app, including articles on addressing children’s emotions and behaviors, created with input from Sandra S. Pimentel, Ph.D., associate professor of psychiatry and behavioral sciences at Einstein. Additionally, parents will be able to use the app to communicate with their children’s care teams.
The last third of participants will receive both programs: parental education via the Valera Health app and the online CARE program.
Using Technology to Improve Outcomes
All participants who are not healthcare workers will be provided with smartphones to use the basic functions of the Valera Health app, including messaging, which has been shown to increase communication with health care teams — a significant issue for Bronx residents.
Researchers will use machine learning approaches to explore complex patterns in the data to identify factors — COVID-19 illness, psychiatric diagnoses, housing, poverty and trauma, for example — that can help predict psychological and health outcomes.
The grant, titled “A Multimodal Parent-focused Intervention for Vulnerable Populations in the Bronx,” is supported by the National Institute for Mental Health, part of the NIH (R01MH126821).