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Elevating Voices, Addressing Depression, Toxic Stress and Equity in Group Prenatal Care (EleVATE GC)

提高声音、解决抑郁症、有毒压力和团体产前护理中的公平性 (EleVATE GC)

基本信息

批准号：
10458076
负责人：
Ebony Boyce Carter
金额：
$ 55.21万
依托单位：
WASHINGTON UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-09-21 至 2025-06-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10458076
关键词：
Address Adverse event Affect African American Anxiety Anxiety Disorders Appointment Area Birth Rate Caring Chronic Disease Clinic Collaborations Data Diagnosis Discipline of obstetrics Disease Management Enrollment Event Exposure to Face Health High Risk Woman Individual Infant Insurance Coverage Intervention Life Low Birth Weight Infant Low income Medicaid Mental Depression Mental Health Mental Health Services Minority Women Modeling Mood Disorders Neonatal Outcome Patients Perinatal Population Postpartum Depression Practical Robust Implementation and Sustainability Model Pregnancy Pregnant Women Premature Birth Prenatal care Provider Psyche structure Psychosocial Stress Recording of previous events Research Personnel Resources Risk Site Stigmatization Stress System Testing Time Trauma Underserved Population United States Voice Woman adverse pregnancy outcome antepartum depression base behavioral health intervention disparity reduction effectiveness evaluation effectiveness testing effectiveness-implementation RCT evidence base experience high risk implementation determinants implementation strategy improved improved outcome maternal risk novel parity peripartum depression pilot trial prenatal primary outcome programs psychological distress psychosocial racism secondary outcome therapy design treatment services trial comparing women of color

项目摘要

Project Summary Although 21% of pregnant women experience perinatal mood and anxiety disorders, the burden is especially heavy for low-income and minority women. For example, African-American women have a higher risk of psychosocial stress (e.g., exposure to adversity, racism, and traumatic life events) throughout life than white women. Moreover, African-American women are at significantly higher risk for maternal and neonatal adverse events resulting from psychological distress, such as preterm birth (17% vs. 10%) and low birthweight (13% vs. 7%). However, African-American women are the least likely group to receive mental health interventions that could reduce these disparate outcomes. A cross-system collaboration between researchers, clinicians, and patients is working to overcome these barriers by developing, testing, and implementing a novel model: Elevating Voices, Addressing Depression, Toxic Stress and Equity in Group Prenatal Care (EleVATE GC). EleVATE GC is based on group prenatal care and has embedded within it a trauma-informed, evidence-based behavioral health intervention grounded in anti-oppressive principles. The objectives of this proposal are to rigorously assess the effectiveness of EleVATE GC and to determine the feasibility, sustainability, and barriers to implementing EleVATE GC in real-world care settings. These objectives will be achieved by conducting a pragmatic effectiveness-implementation randomized controlled trial comparing EleVATE GC (n=563) to individual prenatal care (n=282) for pregnant women at high risk for depression. This trial will be conducted at eight diverse prenatal clinics in the St. Louis region that serve a population with a high preterm birth rate (~16% vs. 11% nationally). Additionally, 80% of women served by these sites have a history of depression, anxiety, trauma, or another mental health diagnosis. Within this trial, Aim 1 is to determine the effectiveness of EleVATE GC to reduce perinatal depression and adverse pregnancy outcomes among low-income, predominantly African-American women. This aim tests the hypothesis that, compared to women receiving individual care, those in EleVATE GC will have lower perinatal depression (primary) and lower risk of preterm birth and low birthweight infants (secondary). Aim 2 is to identify strategies and contextual implementation factors to enhance implementation of EleVATE GC. An adaptation of the Practical Robust Implementation and Sustainability Model will be used across three of the four domains (intervention design, recipient, implementation and sustainability) at three levels (prenatal care clinic, clinician, and patient). This project is directly responsive to the call of RFA-MH-20-400 to "test the effectiveness of strategies for implementation and sustainable delivery of evidence-based mental health treatments and services to improve mental health outcomes for underserved populations in under-resourced settings in the United States".

项目总结