My Baby, My Move+ (MBMM+, 2019-2021) is an NIH-funded peer-led wellness intervention which aimed to reduce excessive gestational weight gain (EGWG) by targeting prenatal physical activity, mood, and sleep quality. Up to 50% of pregnant women in the U.S. gain weight in excess of the Institute of Medicine guidelines. EGWG leads to poor maternal and child outcomes. It also sets the stage for long-term overweight/obesity for both mother and child.
A pilot randomized controlled two arm trial (MBMM+ intervention; Baby Basics program) was conducted. Up to 100 pregnant women (50 intervention arm, 50 control arm) were recruited from the Denver Metro and surrounding areas. Women in the intervention arm participated in the 12-week MBMM+ intervention. The intervention was completed virtually. The overall goal of the MBMM+ intervention is to instill healthy habits (e.g., physical activity, good sleep hygiene, stress management) during and beyond pregnancy. Findings from this study will be used to inform a future, larger randomized trial.
Utilizing online technology to improve provider-patient communication on prenatal mood disorders
Prenatal depression is associated with numerous, deleterious maternal and child health outcomes. Pregnant women have expressed a need for help in identifying and treating their depressive symptoms. Healthcare providers play a significant role in managing (i.e. identifying and treating/referring to care) prenatal depression as they are often the sole exposure to mental health resources for women. However, many providers may not be meeting these recommendations. Identifying women who are exhibiting depressive symptomatology and providing guidance based on evidence-based practices and/or utilizing linkages to mental health specialists are all integral to providing optimal patient-centered care. This study will conduct a pilot, randomized-controlled trial to test the preliminary effects of an online training with a diverse group of providers on the management of prenatal depression.
The present study intends to test an evidence-based, online training for a diverse group of providers on how to manage prenatal depression. Providers will be recruited from two states, Colorado and Virginia.
Our online training provides an overview of the harmful effects of prenatal depression on numerous maternal and child outcomes, as well as provides a framework that uses the 5As model (i.e. Assess, Advise, Agree, Assist and Arrange) to teach providers how to 1) assess for depression, 2) advise the patient on treatment options, 3) agree on a treatment plan, 4) assist patient in any problem solving related to obtaining treatment, and 5) arrange for supports for the patient (e.g. link patients to mental health resources in the community).
For more information, see the AHRQ study flyer.
Past research suggests that maternal depression during the pre- and post-natal periods is positively associated with obesity in early and middle childhood; however, the findings vary by timing and duration of exposure. Additionally, not all mothers suffering from depression will experience the same detrimental maternal and child health outcomes. Internal and external factors foster resilience, or positive adaptation to adversity, and can promote maternal mental health during these early critical periods.
Consideration of the determinants of obesity within a broader multi-level framework emphasize the upstream influences of maternal mental health and resilience beginning very early in the life course. The FRAME project will have significant impacts on women’s health. If accumulation of maternal depression from the prenatal period through five-years of age is more predictive of childhood development outcomes compared to exposure solely during the prenatal period, the Life Course Health Development model can be used to explicate the ways in which adversity and resilience may aggregate over time and affect the intergenerational transmission of poor mental health. Additionally, findings may strengthen and expand evidence-based research related to mental health by targeting internal and external resilience supports for mothers.
Working in early childhood education (ECE) settings is a stressful profession and formal (center-based) and informal (Family, Friend and Neighbors) ECE caregivers face significant challenges including low pay, high stress, and poor working conditions. ECE caregivers are also disproportionately impacted by mental and physical health outcomes. For example, rates of depression among ECE caregivers are three times the national average. The Fostering Resilience in Early Education (FREE) program is a two- generation, two component ECE center-and home-based intervention focused on ensuring that ECE caregivers have access to supports that improve their well-being, in turn promoting high quality relationships with the children in their care and fostering resilience. Two evidence based strategies will be implemented:
FREE Component 1: ECE Caregiver-Focused Intervention
Caregivers will have the opportunity to participate in an evidence-based strategic planning process to implement policy, system, and environment (PSE) changes that promote ECE caregiver well-being in their workplaces. An example of a systems-level change is hosting a center-specific Adverse Childhood Experiences (ACEs) training to understand the impact of caregivers’ own experiences and self-awareness on their teaching practice.
FREE Component 2: ECE Child-Focused Intervention
Follow-up coaching sessions will be adapted from the evidence-based Kindness Curriculum, which highlights the importance of ECE teachers’ well-being in the development and maintenance of supportive teacher-student relationships. Evidence suggests that implementation of this curriculum results in improvements in multiple domains of child development, thus fostering resilience among preschool-aged children.
The Colorado Department of Health and Environment (CDPHE) Positive Activities Lead to Success (PALS), and the Rocky Mountain Prevention Research Center (RMPRC) are collaborating to reduce the impact of ACEs and mental health illnesses in the San Luis Valley. PALs is a licensed after-school and summer children program for children ages 5 to 10 combating instability in their home. The mission of PALS is to provide children who have experienced trauma and ACEs a structured environment. The environment of PALS supports social-emotional learning, creativity, exploration, and nurture.
This collaboration between CDPHE, PALs, and the RMPRC aims to achieve three main goals. First, PALs will provide a modified, intense version of their program. This intensified version will provide increased one-on-one time for the children with a PALS’s staffer. Second, PALs will host monthly workshops for parents in the San Luis Valley (SLV) with each focused on different topics including parenting knowledge, skillsets, competence, and emotional regulations. Third, PALs will connect parents who experienced high ACEs/mental health illnesses to behavioral health telemedicine at The Children’s Hospital in Aurora, Colorado. While PALs will be implementing these three goals, the RMPRC will conduct a program evaluation where the team will evaluate both the intensified program and monthly workshops, as well as evaluating the impact of the behavioral telehealth medicine on the parents.