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1777 Exposition Drive
Boulder, CO 80309

(303) 492-7378

Online Learning & Practice Community

Colorado CARES

Colorado Communities to Advance Referral and Effective Services

for Mood and Anxiety Disorders during Pregnancy



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.


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 (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 the Valley Settlement Project. The Valley Settlement Project, located in rural Colorado, is a two-generation approach to increase school readiness and elementary school achievement and family economic stability among approximately 300 Latino families in the area (see for more information about The Valley Settlement Project history and programs).

The Valley Settlement Project relies on community organizing strategies that develop trusting relationships within the community based on formative research that was conducted in the homes of the underserved. Few referral options for mental health services are available to Spanish-speaking individuals in this area.  The Valley Settlement has established a foundation of effective peer network interventions, initially focused on increasing preschool readiness of children and then expanded to support parent wellbeing. The proven track record of the Valley Settlement Project makes it an ideal partner within which to examine the effectiveness of a peer-delivered mental health intervention, such as BA.

We will address five aims in two phases for this project. The key aims are to:    

  1. Assess healthcare professionals’ and other stakeholders’, including potential participants and peer volunteers, judgments of the capacity of trained peer volunteers, likelihood of referring to or seeking care from peer volunteers, and the feasibility of integrating the peer-led BA program into current health care and social service systems and referral networks.
  2. Develop and pilot test an online curriculum and learning environment designed to provide training to community-based peer volunteers to deliver BA via telephone for pregnant and postpartum women with elevated mood and anxiety symptoms.
  3.  Assess peer volunteers’ satisfaction with the training as well as their confidence and competency in providing BA.
  4. Assess the feasibility and safety of BA as provided by peer volunteers
  5. Assess clinical outcomes associated with receiving peer-led BA, including women’s satisfaction and depression and anxiety symptoms, and assess potential mechanisms of change.

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, and six Valley Settlement program managerial staff and the clinical supervisor. 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.