Moms for Moms
A KEY PUBLIC HEALTH ISSUE
Depression during pregnancy and the postpartum represents major public health problems. Although effective practices for screening and treating PMAD exist, few women receive such services during these important life-cycle transitions. This care gap highlights the critical need for new and innovative approaches to identify and care for pregnant women with mental health needs.
“TASK SHARING” - AN INNOVATIVE APPROACH
The paradigm of “task sharing” refers to when tasks traditionally reserved for specialist providers are redistributed to non-specialist, lay, or peer providers. This approach has been used to increase access to mental health care in low-and middle-income countries. Unfortunately, such approaches have not been tested widely in low-resource communities in the US to support maternal and infant mental health. This is surprising given that perinatal women consult informal help sources more than professionals regarding mental health concerns. Thus, peer networks provide an innovative and promising means to increase access to mental health care for mothers in the US.
BEHAVIORAL ACTIVATION – AN OPTIMAL INTERVENTION FOR TASK SHARING
Behavioral Activation (BA) is an excellent candidate intervention to disseminate broadly via peer delivery. There is a strong evidence base supporting the efficacy of BA, including meta-analytic reviews and randomized controlled trials. Our own work has demonstrated that BA is comparable in efficacy to antidepressant medication and superior in both retention and enduring effects. In our collaborative work with collaborators in low resource communities in India, we have adapted BA to be compatible with delivery by lay counselors. Other investigators in the US also have tested BA specifically with Spanish speaking populations. In our view, the time is right to test peer delivery of BA as a method to improve maternal mental health in low-resource settings in the US.
We aim to address the pressing community need for increased access to effective and acceptable perinatal mental health care by developing and testing a community-based program of peer-delivered Behavioral Activation. This work will be undertaken as an active, engaged collaboration between the University of Colorado Boulder and Kaiser Permanente. We are currently conducting Phase I of the project.
The two phases of the project are:
Phase 1: Planning and training. This phase will include the design of the curriculum, the research protocol, the implementation of the training for peer counselors. Target goals for this phase include: conducting in-depth focus groups and interviews; curriculum and training design; outreach to local community providers and key stakeholders; and development of the maternal and child evaluation protocol; and training.
Phase Two: Pilot project implementation and data analysis phase. We will train 10 peers in BA and then recruit a sample of 25 depressed pregnant and postpartum women to receive peer BA. We will provide supervision for all trained peers to ensure the quality of services provided. We will carefully evaluate the quality of BA and maternal and infant outcomes. Towards the end of Phase 2, we will focus on data analysis and presentation of findings and refining dissemination tools and platforms for sharing with other communities.