PRogram In Support of Moms: An Innovative Stepped-Care Approach for Obstetrics and Gynecology Clinics
Condition: Depression
MeSH terms: Depression
Study type: Interventional

Summary: 
      The primary goal of this study is to develop, evaluate, and share a new low-cost program for
      Obstetrics/Gynecology (Ob/Gyn) practices which will help to improve depression treatment for
      women during pregnancy and after childbirth.
    

Detailed description: 
      Upwards of 1 in 5 women suffer from depression during pregnancy or within a year after giving
      birth. It has negative effects on birth outcomes, infant attachment, and children's
      behavior/development. Maternal suicide causes 20% of postpartum deaths in depressed women.
      Although the vast majority of perinatal women are amenable to being screened for depression,
      screening alone does not improve treatment rates or patient outcomes. Ob/Gyn practices need
      supports in place to adequately address depression in their patient populations. Thus, the
      Investigators developed and pilot tested the PRogram In Support of Moms (PRISM), to create a
      comprehensive intervention that is proactive, multifaceted, and practical. PRSIM aims to
      improve perinatal depression treatment and treatment response rates through: (1) access to
      immediate resource provision/referrals and psychiatric telephone consultation for Ob/Gyn
      providers; (2) clinic-specific implementation of stepped care, including training support and
      toolkits; and, (3) proactive treatment engagement, patient monitoring, and stepped treatment
      response to depression screening/assessment. PRISM builds on a low-cost and widely
      disseminated population-based model for delivering psychiatric care in primary care settings
      developed by our team. Because it uses existing infrastructure and resources, PRISM, has the
      potential to be feasible, sustainable and transportable to other practice settings. The
      Investigators will compare PRISM vs. enhanced usual care (access to resource
      provision/referrals and psychiatric telephone consultation) in a clinical trial in which
      Investigators will randomize 12 Ob/Gyn practices to either PRISM or enhanced usual care
      intervention. Provider and staff participants will participate in either PRISM or enhanced
      usual care, depending on what intervention their practice is assigned to. The Investigators
      will compare the effectiveness of PRISM vs. enhanced usual care to improve depression
      severity and treatment participation in pregnancy through 12 months postpartum among 300
      patients (n=150/group, 25 per clinic). The Investigators will also determine change in
      knowledge, attitudes, and practices toward depression screening and treatment in the PRISM
      group compared to enhanced usual care group.
    

Intervention name(s): PRogram In Support of Moms (PRISM); Enhanced Usual Care group (Access to MCPAP for Moms)
Intervention type(s): Behavioral; Behavioral
Intervention description(s): PRogram In Support of Moms Toolkit with Stepped Care Algorithms
Support clinic specific implementation using the Addressing Problems Through Organizational Change (APTOC) platform
Customization of depression screening for each practice
Proactively engage and track all women who screen +ve on the Edinburgh Postnatal Depression Scale(EPDS)
Employ psychoeducation and Motivational Interviewing to engage patients with depression
medical assistant champion and psychiatrist contact bi-weekly to review cases
Stepped care treatment to depression screening/assessment; 30-60 minute presentation on perinatal depression
Access to telephonic psychiatric consultation with MCPAP for Moms perinatal psychiatrist for Ob/Gyns
Access to Ob/Gyn provider assessment and treatment recommendations via one-time face-face MCPAP for Moms psychiatrist patient evaluation
Access to assessment and treatment protocols in Provider Toolkit
Resource provision/referrals
Other intervention name(s): Rapid Access to Perinatal Psychiatric care in Depression
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Health Services Research
Keywords: Depression