Imagine a rural area where health care resources, particularly for mental health, are limited. Now, imagine a woman, a mother, who is struggling. Imagine that her first language is not English. The challenge many of us face in getting mental health care is even greater for her.
While we may imagine this scenario, many women are living it. That’s the reason for the Alma program in Garfield County, Colorado. (Alma was previously known as Una Madre a Otra, during its development phase. Alma, which means “soul” in Spanish and in English comes from the Latin word for “nourishing” and “kind,” was chosen for the program’s permanent name.)
The current pilot program is training mothers who have personally experienced post-partum or perinatal depression in what’s known as behavioral activation (BA), a component of cognitive behavioral therapy. Training the mothers is an example of task-shifting, an important strategy in increasing mental health services by having laypeople provide assistance that mental health providers are simply not available to do. Once trained, these mentors can help their peers – other mothers in need of support as they struggle with depression.
Sona Dimidjian, an associate professor in the Department of Psychology and Neuroscience at the University of Colorado Boulder, who leads the Alma team, previously worked on teams in low- and middle-income countries (e.g., India), adapting the BA approach to be compatible with delivery by lay counselors. However, this approach has never been evaluated as an intervention specifically designed to improve maternal or child outcomes using peers in low-resource settings in the United States.
“Working with the NMHIC team has been one of the great pleasures and potentiators of the last year. Their combination of big-picture vision and practical wisdom has helped to accelerate the pace of the research I do and expand the impact on the lives of people who need it most, more than I could have every imagined.” — Sona Dimidjian, Ph.D.
Alma provides greater accessibility to mental health services for Latino women in the area. The Latino community is a tight knit one, so while our partners at the Valley Settlement Project in Carbondale, Colorado, promote the services, we expect word-of- mouth to be an important catalyst for the program. In addition to providing greater accessibility to mental health care, the Alma program, by its nature of peer-to- peer help, is designed to reduce stigma.
NMHIC staff are collaborating on the intervention’s design and providing the training. Longer-term, Dimidjian’s team plans to conduct a larger randomized-controlled trial to scientifically assess how behavioral activation performs in reducing depressions when laypeople deliver the intervention.
Ultimately, the program has potential to scale in many communities with significant immigrant populations.