Implementing Mental Health Programs Across Communities in Iowa & Indiana for Transformation (IMPACT)

Hackensack Meridian Health

Status: Not yet enrolling

Conditions: Mental Health Disorder

Treatments: Behavioral: Standard Implementation; Behavioral: Adapted Facilitation

Study type: Interventional

Funder types: Other; NIH

Identifiers

NCT06575894

Pro2025-0522 (Other Identifier)

202312148

28141 (Other Identifier)

1R01MH134474-01A1 (U.S. NIH Grant/Contract)

Details and patient eligibility

About

Depression and anxiety during and after pregnancy are common medical complications contributing to a rising maternal mortality rate. Home visiting programs can offer evidence-based interventions to improve mental health outcomes for a vulnerable pregnant population; however, barriers remain to achieving the full potential of these interventions. Our work will explore the impact of context on the implementation of a mental health intervention to provide action-based and impactful data that focuses on the lived experiences of the diverse populations served by home visiting programs in Iowa and Indiana.

Full description

Perinatal mental health conditions are the most common complication of pregnancy and childbirth (1 in 8 women). When left untreated, perinatal depression and anxiety adversely affects the entire family with pregnancy complications and negative outcomes including preterm birth, impaired mother-infant bonding, impaired lactation, substance abuse, divorce, suicide, and infanticide. Despite this, significant gaps persist in the diagnosis and treatment of perinatal depression and anxiety. Preliminary research with stakeholders including community advisory boards, underrepresented groups, and state departments of health, demonstrates the importance of social support as a mechanism for improving perinatal depression, particularly in rural geographies. Home visiting programs (HVPs) can provide the social support needed to improve mental health outcomes in pregnant and postpartum women.

Using the strategy of implementation facilitation, our proposed study will engage multilevel stakeholders (e.g., policymakers, front-line implementers, and intervention recipients) to adapt facilitation to integrate a maternal mental health intervention across two midwestern, rural states (Iowa and Indiana) with multiple HVP models. Given the complexity and heterogeneity of the contexts in which Mothers and Babies will be integrated, a three variable hybrid implementation-effectiveness-context trial will test the adapted facilitation strategy compared with implementation as usual (i.e., standard education) and will assess contextual factors related to the outcomes. Using an evidence-based implementation strategy that tailors implementation delivery to the needs of the specific populations and context may improve fidelity and adoption, particularly in rural states where residents have limited access to care.

The immediate impact of this research will be to show whether adapted facilitation can improve the uptake and fidelity of a maternal mental health intervention like Mothers and Babies across multiple HVP models and thus positively affect depressive symptoms and perceived stress of recipients. Further, our implementation protocol can be used by other states to better integrate other evidence-based interventions into public health programs, leading to further improvements in maternal mental health, better access, and further reductions in adverse outcomes for mothers, children, and families.

Enrollment: 1,750 estimated patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Affiliated as staff or volunteer with a home visiting program in Iowa or Indiana at the time of enrollment
• Aged 18 years or older

Exclusion criteria

- No exclusion criteria.

Trial design

Primary purpose: Health Services Research

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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1,750 participants in 3 patient groups

HV Supervisor Refused

No Intervention group

Description:

Home visitors outside the trial will receive no implementation support from their supervisors with respect to the Mothers and Babies intervention.

Standard Implementation

Active Comparator group

Description:

Control arm home visitors will receive standard Mothers and Babies implementation support from their supervisors.

Treatment:

Behavioral: Standard Implementation

Adapted Facilitation

Experimental group

Description:

Home visitors in the adapted facilitation group will receive standard Mothers and Babies support plus adapted facilitation delivered by home visiting supervisors trained in adapted implementation facilitation.

Treatment:

Behavioral: Adapted Facilitation