Please select the eligibility criteria that correspond to the clinical trial below.
Title: Comparing the Effectiveness of Clinicians and Paraprofessionals to Reduce Disparities in Perinatal Depression
Brief Summary: There is considerable evidence that most perinatal women at risk for postpartum depression do not engage in mental health services, even when referred by home visiting (HV) programs, primary care physicians, obstetricians, or gynecologists. Thus, interventions that can be delivered via alternative settings-e.g., HV programs-are essential to prevent the onset of major depression and worsening of depressive symptoms among perinatal women. This Patient Centered Outcomes Research Institute (PCORI) funded project aims to evaluate whether the Mothers and Babies (MB) group intervention, when led by paraprofessional home visitors, is more efficacious than usual care (i.e., home visiting without the MB enhancement). It will also examine if MB, when led by paraprofessional home visitors, is not inferior to MB delivered by mental health professionals. The results of this study will inform decision-making by HV programs regarding provision of MB to perinatal women at risk for developing major depression.


Options:
A: Eligibility criteria:

For adolescent participants:

* Enrolled as a student in Grades 9-12 (corresponding to 13-20 years of age)
* Experiencing elevated mental health symptoms, based on response in the borderline or abnormal range (scores of 19 or higher for boys and 20 or higher for girls) on the self-reported SDQ Total Difficulties scale
* Experiencing significant distress and/or functional impairment, based on response in the abnormal range (scores of 2 or higher) on the self-reported SDQ Impact Supplement
* Experiencing difficulties for \>1 month, based on response to the self-reported Chronicity item from the SDQ Impact Supplement
* For adolescents under 18 years of age, able to provide informed assent to participate and supported by parental consent
* For adolescents over 18 years of age, able to provide informed consent to participate

For parent participants:

* A primary parental caregiver or guardian for the index adolescent
* Able to provide informed consent to participate, and if adolescent age 18+ years, parental involvement is supported by the index adolescent
* Proficient in spoken English or Hindi

Exclusion criteria:

For adolescent participants:

* Requiring urgent medical attention (defined as needing emergency treatment or in-patient admission)
* Unable to communicate clearly (due to a speech or hearing disability or inability to comprehend one of the program's languages)
* Already receiving intervention for mental health problems
* Received PRIDE intervention in past six months during pilot study
* Not providing assent
* Adolescent whose parents are not providing consent

For parent participants:

* Unable to communicate clearly (due to a speech or hearing disability or inability to comprehend one of the program's languages)
* Intoxicated at the point of consent or assessment
B: Inclusion Criteria:

Households that meet the following eligibility criteria will be invited to participate in the study:

1. Household meets locally defined poverty criteria (classified as an ultrapoor household);
2. Mother or female caregiver of at least one child between the ages of 10 and 15.
3. Child is between the ages of 10 and 15.
4. Male head of household provides permission for his wife and child to participate in the study;
5. Eligible child and female caregiver/parent can commit to study participation.

Exclusion Criteria:

1. Household doesn't meet locally defined poverty criteria (classified as an ultrapoor household);
2. Mother or female caregiver doesn't have at least one child between the ages of 10 and 15.
3. Child is not between the ages of 10 and 15.
4. Male head of household does not provide permission for his wife and child to participate in the study;
5. Eligible child or mother/female caregiver cannot commit to study participation.

Participants are also excluded from participation in the study if the child or the parent is assessed to have a cognitive impairment that would interfere with their ability to provide informed consent and participate in the study.
C: Inclusion Criteria:

* Caregiver must live with child at least 4 nights per week
* Child must be between 2 and 9 years old Live in Khayelitsha or Nyanga
* May include biological parents, relatives or non-kin foster caregivers, with no restrictions on biological relationship
* Participant must self-identify as the primary caretaker of the child
* Children scoring 15 or higher in the Eyberg Child Behaviour Inventory problem scale

Exclusion Criteria:

* Children scoring 14 or lower in the Eyber Child Behaviour Inventory problem scale
* Participants with child not between 2 and 9 years old
* Participants not self-identifying as the primary care take of the child
* Participants not living with the child at least 4 nights per week.
D: Inclusion Criteria:

* The investigators will enroll only pregnant women in this study, given that the Mothers and Babies Course is delivered prenatally as a postpartum depression prevention intervention. The investigators will offer participation to prenatal home visiting clients, ages 16 and older, knowing the client base for home visiting programs includes pregnant teens.

Exclusion Criteria:

* Women with high-risk medical and pregnancy conditions will be excluded since this may preclude women from regularly attending intervention sessions. The investigators will not exclude women based on race/ethnicity or based on demographic characteristics other than the ability to speak English or Spanish.

Answer: D