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Comparing the effectiveness of clinicians and paraprofessionals to reduce disparities in perinatal depression
Investigator (PI): Tandon, Darius
Performing Organization (PO): (Current): Northwestern University, Feinberg School of Medicine, Department of Medical Social Sciences / (312) 503-1725
Supporting Agency (SA): Patient-Centered Outcomes Research Institute (PCORI)
Initial Year: 2016
Final Year: 2020
Record Source/Award ID: PCORI/AD-1507-31473
Funding: Total Award Amount: $2,033,617
Award Type: Contract
Award Information: PCORI: More information and project results (when completed)
Abstract: Postpartum depression is a serious public health problem for low-income women of all races and ethnic groups, as it has the potential to create two generations of suffering, for the mother and her children. Unfortunately, most women experiencing postpartum depression symptoms do not access mental health treatment. Over 500,000 low-income pregnant women and new mothers receive home visiting (HV) services across the United States, making it one of the largest avenues for reaching women experiencing postpartum depression. Most HV programs use paraprofessional home visitors to deliver services. Currently, there are no interventions led by non-health or non-mental health professionals that have been shown to be effective in preventing the onset and worsening of postpartum depression among low-income women. Over the past five years, researchers and community stakeholders have worked closely to conduct research that has shown that one intervention--the Mothers and Babies Course (MB)--is effective in preventing new cases of major depression and reducing depressive symptoms when led by mental health clinicians. In this PCORI project, we will determine whether paraprofessional home visitors can achieve similar reductions in depressive symptoms and prevention of new cases of major depression when delivering MB as mental health clinicians do. We are also interested in other patient-centered outcomes, such as quality of life, parenting practices, engagement in pleasant activities, and relationship with one's partner. This project focuses on a critical issue for HV programs, because these programs could use their home visitors to deliver MB if we find similar results in mental health outcomes for women receiving MB from home visitors versus clinicians. This project addresses a critical issue for patients affected by postpartum depression, as most low-income women experiencing postpartum depression symptoms do not access mental health services via other settings (e.g., community mental health centers, primary care) and are seeking mental health services provided in a non-stigmatizing fashion. Eighteen HV programs in Illinois will implement MB with mental health clinicians and 18 will implement MB with paraprofessional home visitors. Eight programs will serve as control sites, where HV clients receive only usual care. Control sites will allow us to examine whether MB led by paraprofessionals leads to better mental health outcomes than usual HV services. MB is an eight-session intervention (six prenatal, two postpartum) delivered in a group format to 6 to 10 women. Core content focuses on increasing pleasant activities, reframing harmful thought patterns, and establishing and accessing social support networks. An Operations Team of researchers, policy makers, clinicians, community organizations, and patients has guided the development of this project and will continue to provide governance during implementation and dissemination of study findings.
MeSH Terms:
  • Allied Health Personnel
  • Comparative Effectiveness Research
  • Depression /complications
  • /therapy
  • Depression, Postpartum /*therapy
  • Female
  • Health Status Disparities
  • Healthcare Disparities
  • Home Care Services
  • Humans
  • Illinois
  • Mental Health Services /organization & administration
  • Outcome Assessment, Health Care
  • Parenting
  • Patient-Centered Care
  • Perinatal Care
  • Poverty
  • Pregnancy
  • Prenatal Care /organization & administration
  • Psychotherapy, Group
  • Quality of Life
  • Social Support
Country: United States
State: Illinois
Zip Code: 60611
UI: 20163006
CTgovId: NCT02979444
Project Status: Completed
Record History: ('2019: Project extended to 2020',)