APNA Nurses in Action: Linda Beeber earns AAN Edge Runner Award

Linda Beeber

Psychiatric-mental health nurses defy categorization. They work on the edge where mind, body, and spirit meet. Linda Beeber exemplifies this in her research, which recently merited her an American Academy of Nursing (AAN) Edge Runner Award. According to the AAN, “Edge Runners are the practical innovators who have led the way in bringing new thinking and new methods to a wide range of health care challenges.” Often, the stories of edge-runners “underscore the courage and fighting spirit of nurse leaders who have persevered despite institutional inertia or resistance.” Below, find a profile of Linda that explores her groundbreaking work that contributed to her recent accomplishment.

Linda Beeber, APNA President-Elect, has dedicated years to studying the efficacy of interventions that both reduce depressive symptoms in low-income and newly-immigrated mothers of young children and enhance their parenting. Infancy through toddlerhood is the period when the most rapid brain and neurocognitive growth occurs, and depressive symptoms in a mother can compromise maternal functions important to helping the child develop language, cognitive function, and behavioral regulation. These symptoms pose an even greater hazard to children at risk from poverty, discrimination, or pre-existing developmental disabilities.

Beeber and her collaborators were among the first to document that up to 50% of low income mothers and newly-immigrated mothers had significant levels of untreated depressive symptoms. She also led one of the first research teams to recognize that the mother-child dyad was an integral unit. The intervention developed by the team was bundled into efficient modules for psychiatric-mental health APRNs to reduce maternal depressive symptoms and capitalize on the reduction of those symptoms to improve the mothers’ parenting interactions with her child.

“These mothers are either not served or underserved in regard to their mental health needs and many experience considerable challenges such as economic hardship, resource challenges, and limited English language proficiency,” says Beeber. “The goal has been to produce, test and disseminate stigma-free, culturally tailored nursing interventions to reduce maternal depressive symptoms and enhance parenting to prevent negative child outcomes.”

Beeber recognized that the public trust of nurses, along with the existing home visiting models already in place in at-risk communities, presented a powerful opportunity to deliver mental health interventions to stigma-wary mothers. Taking inspiration from Hildegard Peplau's Interpersonal Theory of Nursing, Beeber developed an intervention which adapts an evidence-based therapy for depression (interpersonal psychotherapy) to address the mother’s stressors in the context of her life using culturally tailored and literacy-appropriate materials. In this way, the intervention meets the mother where she is and builds upon her unique strengths to promote growth. “Nurses were the key to our success and we have championed the strengths of our discipline by demonstrating how nurses effectively delivered evidence based treatment to difficult-to-reach mothers,” she says.

The outcomes speak for themselves - In randomized clinical trials of mothers with significant levels of depressive symptoms at baseline:

  • Spanish-speaking Latina mothers who received the intervention reduced their depressive symptoms below clinical threshold in less than 3 months compared to mothers receiving usual care services from Early Head Start.
  • Low-income English-speaking mothers who received the intervention demonstrated more child-directed speech, stimulating play and positive involvement with their infant/toddler compared to mothers who received equal attention and a health education intervention.
  • Six months after receiving the intervention, impoverished Spanish-speaking Latina mothers had more positive attitudes toward their child compared to mothers receiving usual care services from Early Head Start.
  • Retention rates across our intervention studies ranged from 70-100% of significantly depressed mothers remaining in the intervention long enough to receive a clinically significant dose (70%) of sessions; this was significantly higher than previous trials with the same population.

In 2010, ongoing continuous quality improvement evaluation of the Nurse Family Partnership Model (NFP) in community practice revealed that Nurse Home Visitors (NHVs) were reporting an increase in clients who had significant levels of depression and/or anxiety. The NFP is a program of pre- and post-natal nurse home visiting for first time high-risk mothers. It is currently operating in 42 US states and 8 countries outside of the US. These nurses requested augmented skills to help address the challenges in engaging and retaining these clients. As an expert in maternal depression, Beeber was called upon to head up a team to create interventions for the NHVs to administer within their scope of practice.

Throughout 2011-2012, Beeber and her team piloted the NFP innovation in four states. This version combined two in-person sessions delivered by Beeber with team-level activities that were coordinated by NFP supervisors. Beeber and the team provided support to the teams as they applied their learning to their NFP clients. Nurses reported significant increases in skill and confidence, and that they retained these gains 6 months after the last education session. The team refined the model, and in 2015 the innovation was accepted as an addition to the Nurse Family Partnership Model that will soon be launched through the NFP national education system.

As resources for mental health care are shrinking in every US state, Beeber’s mental health enhancement of the NFP model may become a national model for integrated mental health care. “We envision the mental health innovation as a powerful improvement to the NFP model that will expand access by retaining the most high-risk mothers served by NFP, thus making sure that the program benefits reach them,” says David Olds, PhD, director of the Prevention Research Center at the University of Colorado which conducts randomized controlled trials of the NFP. “The NFP has demonstrated important reductions in child abuse/neglect and injuries, in closely-spaced subsequent births, and improvements in cognitive/educational outcomes for children of mothers with cognitive and emotional challenges. Evidence from multiple studies of NFP programs indicate that for every health dollar invested in a local NFP program, communities save considerably more in return because of the prevention benefits. Dr. Beeber’s innovation will help ensure that these benefits are extended to hundreds of thousands of mothers and children as the program is expanded throughout the US and the world.”

Beeber's work to provide care to an underserved population has a ripple effect: not only does her innovative program benefit the new mothers to whom it directly provides care, but it also can improve the mental health and wellness of the new generation of children. It is clear that Beeber's research is life changing, and it is no surprise that it has earned her the distinction of the Edge Runner Award.

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