This project provides direction, training, technical assistance, and evaluation of the Parent-Child Assistance Program (PCAP) being implemented by 13 community agencies and 15 sites serving 20 counties and up to 1490 mothers/families in Washington State.
Patient Population: Perinatal (pregnant and new moms)
Parent-Child Assistance Program – Oklahoma
This project seeks to compare the effectiveness of the Parent-Child Assistance Program (PCAP) to services as usual in the state of Oklahoma using a randomized, controlled design.
Collaborative care for perinatal mental health – the LAMMHA project
Los Angeles Maternal Mental Health Access (LAMMHA) is a five year program (2022 – 2027) funded by The California Health Care Foundation (CHCF) to support health centers in Los Angeles to identify and treat common perinatal mental disorders (CPMD) and reduce the risk of suicide. The LAMMHA initiative is a collaboration between Community Clinic Association of Los Angeles County (CCALAC), Elevation Health Partners (EHP), Maternal Mental Health Now (MMHN), Concert Health and the Department of Psychiatry and Behavioral Sciences at the University of Washington. Co-created with Los Angeles community stakeholders, the LAMMHA program currently offers Los Angeles County providers and community clinics two different levels of support to improve perinatal mental health care.
For more information and/or to apply for the program, please visit the CCALAC LAMMHA page: https://ccalac.org/los-angeles-maternal-mental-health-access-lammha/.
Leveraging peer mentor texting to support maternal wellbeing in the perinatal period
Perinatal mood and anxiety disorders affect one in seven pregnant and postpartum women nationwide, making them the most common complication of pregnancy. Unfortunately, only one in 20 women who need treatment for these conditions actually receives it. This translates to a multigenerational issue, which can negatively affect the mother and child’s long-term physical, emotional and developmental health. It also means an estimated $14.2 billion annually in societal costs in the U.S. alone. While not every perinatal individual with mental health concerns has access to a mental health provider, cell phones and text messaging are ubiquitous. Nonjudgmental support delivered through text messaging may be a low cost approach to reaching women who need emotional support in the perinatal period.
Our project aims to evaluate a text-based mentoring program, the Nurture Program, and assess whether it is possible to support mothers through their third trimester of pregnancy and nine months postpartum and enhance their emotional well-being. The Nurture Program combines the convenience of secure text messaging with the personalization of having a trained peer mentor with whom the mother can develop a trusting relationship. This program also provides resources on child development, connections to local support agencies and suggestions for parent-child bonding and parental wellness activities. Surveyed participants of the Nurture Program consistently report their mentor helped them feel less stressed and more confident in their role as a parent. This study will allow us to measure the impact of this cost-effective approach to promoting perinatal emotional well-being.
A dyadic approach to perinatal depression treatment in primary care
Perinatal depression affects 10-20% of pregnant and postpartum individuals, impairing parenting self-efficacy and mother-infant interactions and contributing to negative maternal-child outcomes. This research will test comprehensive perinatal depression treatment, Maternal Infant and Dyadic Care (MInD), which includes a brief version of the Promoting First Relationships parenting intervention implemented within perinatal collaborative care, against perinatal collaborative care (CC) only. The aims of this study are to (1) compare the effects of MInD vs. usual perinatal CC on depression, (2) explore associations between parenting self-efficacy, dyadic interaction, and depression to inform a mediational hypothesis, and (3) examine and compare care utilization, trial feasibility, and perceived match of treatment to patient need.
Evaluating Lifelines4Moms (ELM) Study
Perinatal depression affects 10-15% of pregnant and postpartum individuals, with detrimental impacts on both parent and infant. In response to this, our department developed a perinatal consultation line for providers, PAL for Moms, to increase access to specialty perinatal psychiatric expertise and care. The purpose of the Evaluating Lifeline4Moms (ELM) is to assess comparative effectiveness of PAL for Moms and other perinatal psychiatry access and referral programs in addressing maternal depression.
As a community-engaged research endeavor, ELM has convened patient advocates, policy experts, and perinatal clinicians, who oversee the study as partners and advisors. Over a period of three years, the research team will characterize the components, implementation timelines, and state policy contexts of access and referral programs; evaluate the reach and implementation of these programs; and examine the comparative effects on access to and quality of mental health treatment among Medicaid-insured perinatal individuals.
Washington State COVID-19 pregnancy collaborative
The objective of this proposal was to investigate the effects of a highly communicable infectious disease leading to severe pneumonia and death (COVID-19) in pregnant women in Washington State. Pregnant women are typically a highly vulnerable group to pathogenic respiratory viruses and have the highest WHO priority for influenza vaccination in a pandemic.
The team’s central hypothesis was that COVID-19 infections in pregnancy increase the risk for spontaneous abortion, preterm birth, stillbirth, intrauterine growth restriction and mental health disorders in the mother. They conducted a multi-site prospective chart review of prenatal and neonatal medical records across the majority of health systems in Western Washington (6 hospitals/hospital systems, >20 investigators). Overall, the Washington State COVID-19 in Pregnancy Collaborative sites captured approximately 61% of deliveries in Washington State during the study period.
The team successfully collected data to establish a large, population-based registry in Washington State. Analyses have been completed of the sociodemographic and clinical outcomes of 240 pregnant patients who contracted COVID-19. Work remains ongoing to calculate infection rates, disease severity, co-morbidity, symptom length and possible vascular injury that could impair fetal growth.
The team will continue working toward research to determine how COVID-19 impacts maternal-child physical and mental health. Further grants have been applied and awarded from the Center of Disease Control, Royalty Research Fund and partnerships with Washington State Department of Health.
Disseminating a user-friendly guide: Advancing the science of intervention adaptation and improving access to evidence-based psychological treatment
Adaptation of evidence-based practices and programs (EBPs) is a necessary component of the implementation process. EBPs must be adapted to function with the constraints of real-world practice settings, providers’ expertise, and patients’ needs. The science of intervention adaptation is hungry for well-defined methods of EBP adaptation to guide decision making. A how-to guide for EBP adaptation titled MODIFI: Making Optimal Decisions for Intervention Flexibility during Implementation, is under development with NIMH funding (F32 MH116623). MODIFI will be disseminated via multiple strategies locally, nationally, and internationally. Dissemination of MODIFI will improve the practice of intervention adaptation by providing practitioners with a how-to guide that is (a) evidence-based, (b) usable, and (c) supported by the expert consensus of implementation practitioners and researchers.
Moms’ Access Project ECHO: Perinatal Psychiatry Case Conference Series
Perinatal Psychiatry Case Conference Series is a CME-accredited program for providers in Washington State who want to improve the mental health of their pregnant and postpartum patients.
Facilitated by a multidisciplinary team including UW Medicine perinatal psychiatrists, obstetrician gynecologists, maternal fetal medicine experts, advanced registered nurse practitioners, therapists and social workers, the program aims to increase frontline provider capacity to address common mental disorders in pregnancy and postpartum. Program format is brief didactic followed by in depth case presentation and discussion.
Developing a tailored implementation plan for Collaborative Care of perinatal depression care in Community Health Centers in Vietnam
Perinatal depression is a common and serious disorder, with suicide representing a major cause of maternal mortality, but few women from low and middle income countries (LMICs) receive effective treatment. Effective models of care that improve perinatal depression and support suicide prevention exist but have not yet been widely implemented in routine maternal-child care services in LMICs. We plan to use a participatory approach to systematically identify and adapt key elements of evidence based models of perinatal depression care delivery to the cultural and health services context of Can Tho, Vietnam. Simultaneous exploration of potential implementation strategies to support and sustain this model in context will be identified along with the creation of a training and implementation toolkit for this setting. Using these strategies and tools we will then carry out a pilot perinatal collaborative care study in a public health center and the prenatal care practice of the Can Tho Obstetric and Gynecologic Hospital. The results of this pilot will be used to revise and enhance the treatment model and related implementation tools. These will be used in subsequent trials of effectiveness and/or implementation broadly in the health care system of Can Tho.
