Home Visitation Enhancing Linkages Project (HELP)

A small pilot randomized controlled trial (RCT) will be conducted to test the impact of an electronic screening and brief intervention (e-SBI) on reduction in substance use (measured via self-report), associated symptoms (depression and parenting stress), and improvement in home visiting retention and substance use treatment engagement.

The purpose of this clinical trial is to pilot test an electronic screening and brief intervention (e-SBI) that will be adapted for use with pregnant and postpartum women in home visiting (HV) programs. The e-SBI will be tested in a small randomized trial in two home visiting sites, with 10 home visitors and 40 clients. Home visitors will be randomized to the control intervention or the e-SBI. Clients will be surveyed at baseline, and 3- and 6- month follow-up to track e-SBI impacts on reduction in substance use (measured via self-report), associated symptoms (depression and parenting stress), and improvement in home visiting retention and substance use treatment engagement.

A two-session (20 minutes each) computer-delivered screening and brief motivational intervention targeting alcohol and drug use. Computerized screening is conducted using the ASSIST. Session 1 of the BI includes personalized feedback, readiness to change interventions, and goal setting around substance use. Session 2 will contain motivational content reinforcing engagement in home visiting and information around other challenges mothers may experience including tobacco use, postpartum depression, and intimate partner violence.

The control group will receive a similar 2-session brief motivational intervention. Session 1 focuses on nutrition and healthy eating, session 2 focuses on exercising while pregnant or in the postpartum period.

Computer-delivered screening and brief motivational intervention targeting alcohol and drug use + goal-setting and content reinforcement

Computer-delivered screening and brief motivational intervention targeting healthy eating and exercise

10-item scale measuring perinatal depressive symptoms. Total score range is 0-30, with depression possible with a score of 10 or higher.

36-item measure of stress associated with parenting. Subscales include parental distress, parent-child dysfunctional interaction, and difficult child, leading to a total stress indicator. Scores are calculated as percentiles: 15-80 are typical percentiles, with clinically significant levels starting at 85 for the parent-child dysfunctional interaction subscale and 90 for all other subscales. Defensive responding is defined as a raw score below ten.

The number of home visits attended in the home visiting program will be mined from the home visiting program's management information system.

Will use the Treatment Services Review to gather client report on attendance at any substance use treatment during the study period.

Inclusion Criteria: English-speaking, 18 years or older, pregnant or up to 3 months postpartum, newly enrolling in home visiting with a participating home visitor, not currently attending substance use treatment Exclusion Criteria: