Translational Science Benefits
Summary
Postpartum depression affects 10-20% of women and is associated with diminished functioning, problems with interpersonal relationships, and challenges with parenting. Immigrant Latinas are up to three times more likely to develop postpartum depression compared to the general population of new mothers. While there are effective treatment options for postpartum depression, few immigrant Latinas use these services due to barriers such as lack of insurance, shortages of culturally and linguistically competent providers, competing demands at work and at home, transportation barriers, and stigma.
Early childhood programs are a unique setting to reach low-income parents who may not otherwise access mental health services. The research team is partnering with Maryland “Judy Centers,” early learning hubs designed to promote school readiness among 0-5 year olds living in Title 1 School Zones (zones serving large numbers of low-income families). By design, Judy Centers provide two-generation services (supporting parents and children). The research team worked with staff from three Baltimore City Judy Centers serving high numbers of Spanish-speaking clients to deliver Mothers and Babies, a cognitive–behavioral intervention designed to teach mood regulation skills to women at risk for postpartum depression. Originally developed for Latina women, the United States Preventive Services Task Force recognized Mothers and Babies as one of the two most effective counseling interventions for postpartum depression prevention. The research team supplemented the Mothers and Babies content with resources to address food insecurity with the aim of reducing stress and potentially allowing women to focus on programming. Following the onset of the COVID-19 pandemic, the research team converted the Mothers and Babies format to a virtual group, worked with Judy Centers to overcome technology and internet challenges for participants, and added brief health-related group discussions with a pediatric health care provider to the Mothers and Babies material. Based on encouraging results from Baltimore City, the research team worked with the Maryland State Department of Education to provide training in Mothers and Babies (including the supplemental content) to Judy Center staff across Maryland.
Significance
Results of our pilot work with Baltimore City Judy Centers were encouraging: participants on average attended approximately 70% of sessions, and reported high satisfaction with the program. Participants reported reduced depressive symptoms and parenting stress, and increased ability to manage negative emotions. Many participants noted significant practical benefits of virtual participation (e.g., reduction of transportation barriers). Several participants also reported that participating virtually minimized the amount of time parents had to take off work to participate, suggesting potential for economic benefits. Judy Center staff noted that the ability to ‘share’ groups across centers in the virtual group format could allow for efficient use of bilingual staff who are often a scarce resource. These results suggest that this may be an effective format for delivering Mothers and Babies and similar programs moving forward. Results also suggest the potential of this program as a model for expanding access to evidence-based interventions such as Mothers and Babies to immigrant Latinas as well as other populations (such as refugee families) who may face similar practical and linguistic barriers to participation in traditional interventions.
Benefits
Demonstrated benefits are those that have been observed and are verifiable.
Potential benefits are those logically expected with moderate to high confidence.
Provided Mothers and Babies, a postpartum mood regulation intervention, at Judy Centers in Baltimore, Maryland. demonstrated.
Community
Expanded access to mood regulation skills for postpartum Latinas by implementing the Mothers and Babies program at Judy Centers. demonstrated.
Community
Created a new mode of delivery for a cognitive-behavioral intervention for postpartum mothers through a virtual group format. demonstrated.
Community
Reduced depressive symptoms and parenting stress. potential.
Community
Increased perceived ability to manage negative emotions. potential.
Community
Produced potential cost savings for participants by delivering the intervention virtually, eliminating transportation costs and missed work time. potential.
Economic
Reduced the rate of postpartum depression, which could reduce the economic cost of postpartum depression on society. potential.
Economic
This research has community and economic implications. The framework for these implications was derived from the Translational Science Benefits Model created by the Institute of Clinical & Translational Sciences at Washington University in St. Louis.
Community: The project adapted Mothers and Babies – an evidence-based intervention designed to prevent postpartum depression – for delivery in a virtual group format. The project also created an intervention ‘package’ through adding supplementary material/components relevant to immigrant Latinas including assistance with nutrition resources and supplemental child health-related content.
The project increased access to the Mothers and Babies intervention for immigrant Latina women by implementing the program in partnership with Early Learning Centers (Judy Centers). Judy Centers are located at Title 1 schools (schools serving a high proportion of low-income families) and are accessible to any child and family within the residence area, regardless of insurance status. Delivering services within the school setting improves accessibility for immigrant families, who may experience barriers to receiving traditional health and mental health services, and may also be a less stigmatizing environment. The program also expanded delivery modes for postpartum depression prevention program by adding a virtual option, reducing some barriers to participation. While preliminary, results of the pilot program were promising and included decreased depressive symptoms and parenting stress, and increased emotion regulation. Program participants also reported a high degree of social connectedness with other group members in the virtual format.
Economic: Some participants described short-term economic benefits associated with attending the virtual program due to a reduction in missed work time or transportation costs compared to in-person programming. Long term, increased access to preventive interventions such as MB has the potential to decrease significant societal costs associated with postpartum depression,1 including those associated with lost work productivity, and increased costs associated with the adverse effects of postpartum depression on maternal and child health and health.
Lessons Learned
One of the most important factors contributing to the success of the pilot was the research team’s ability to be flexible and re-think and adapt programming to the new context and challenges posed by the COVID-19 pandemic. This required the team to work closely with community partners at the Judy Centers as well as with participants to understand what their needs and priorities were, given the circumstances. While they initially aimed to implement an existing, established program (Mothers and Babies) to reach a population with limited access to formal mental health services, the COVID-19 pandemic prompted the team to reconfigure the intervention as a “package” (including time with a health professional, access to a resource advocate, use of text messaging) and remain responsive to the interrelated and evolving needs of participants. The result was an intervention that was even more accessible and convenient for participants than what was originally planned. The team continues to work to ensure that programming remains responsive to participant feedback, beyond formal interviews and evaluations.
1. Maternal Depression Costs Society Billions Each Year, New Model Finds. Center For Children and Families. Published May 31, 2019. Accessed April 3, 2023.