Maternal depression disproportionately affects low-income and minority women and has profound negative impacts on their children. Among these women, access to mental health services is known to be poor. In 2009, the Institute of Medicine (IOM) published a landmark report, Depression in Parents, Parenting, and Children, in which it called for the development of innovative, community-based initiatives to reduce barriers to care through identification, treatment, and prevention of depression in parents. Pursuant to the IOM's report, this application to the NIMH BRAINS program continues a trajectory of research devoted to studying a systems approach to identifying mothers with depressive symptoms in Head Start - a federally funded early learning program for children of low-income families - and providing an on-site intervention to prevent or alleviate depressive symptoms;improve functioning;and, where appropriate, proactively link mothers to more definitive mental health services. We propose a 5-year, randomized controlled efficacy trial of a Head Start-based intervention model developed as part of the applicant's K23-award (K23MH074079). The model represents an integrated identification and intervention system, based on the evidence-based construct of screening, brief intervention, and referral to treatment. Within the comprehensive case management services of Head Start, 230 mothers at increased risk for depressive disorder will be randomized to receive either usual care or a Head Start-based problem-solving intervention, plus 'activated'referral to more definitive services using principles of motivational enhancement. Measured over a 12-month follow up period, we aim to: 1) improve mothers'problem solving skills;2) decrease the incident rate of episodes in which mothers experience moderate to severe depressive symptoms;3) reduce depressive symptoms over time;4) increase mothers'likelihood of engaging with primary care or specialty mental health services when referred;and 5) improve parental functioning, as measured both by valid and reliable scales and by assessing children's missed Head Start school days. We hypothesize that through our intervention, mothers at risk for depression will develop stronger problem solving skills;and that such skills will serve as a buffer again depression. Subjects, therefore, will experience a decreased incidence of moderate to severe symptomatic episodes over the study's follow-up period, as well as a reduction in symptoms over time. When referral is necessary, subjects in the intervention arm will be more apt to engage with mental health services. We hypothesize that intervention mothers will also experience an improvement in functioning, and become more involved in their children's Head Start activities, leading to fewer missed days of Head Start. Results of the applicant's K23 award led directly to the research described herein. The results of this efficacy trial, in turn, will set the stage for a larger multisite effectiveness trial. Our ultimate goal is dissemination of the model at the national level through Head Start. PUBLIC HEALTH RELEVANCE: Maternal depression disproportionately affects low-income and minority women, and has profound negative impacts on their children. This application to the NIMH BRAINS program proposes a randomized trial of a systems approach to identify mothers at risk for depression in Head Start - a federally funded early learning program for children of low-income families - and to provide an on-site intervention to prevent or alleviate depressive symptoms;improve functioning;and, where appropriate, proactively link mothers to more definitive mental health services. Through an innovative, accessible, and scalable community-based intervention model, we aim to improve mental health outcomes for both at risk mothers and their children.