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

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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".