Improving Health Outcomes through PTSD Screening for Expectant Black Mothers
(I-HOPE)
Principal Investigators:
Abigail Powers Lott, PhD, ABPP &
Briana Woods-Jaeger, PhD
I-HOPE: A program collaboration between our teams at the Grady Trauma Project and the THRIVE (Together promoting Health and Resilience through Interventions, Voice & Equity) lab
Trauma and Posttraumatic Stress Can Lead to Adverse Health Outcomes in Expecting Mothers
Trauma results in many negative physical and psychological health effects. One reaction that can occur after trauma is posttraumatic stress disorder (PTSD), which includes psychological symptoms like re-experiencing of the trauma, avoidance of trauma reminders, changes in mood or views of self and others, and being on edge or easily startled. Although anyone can develop PTSD following trauma, some people are at greater risk than others. Individuals who are exposed to more trauma are more likely to develop PTSD and women are at greater risk than men. People with fewer socioeconomic resources and from Black communities show particularly high rates of PTSD. Pregnancy may be a particularly important time to intervene because PTSD is related to maternal morbidity and negative birth-related outcomes and can have an impact across generations.
Our Study: Comparing PTSD Screening Approaches for Black Pregnant Women
Screening for PTSD in urban OB clinics serving Black women with limited socioeconomic resources can help improve maternal mental health and reduce maternal morbidity and negative birth outcomes by helping to identify women in need and connect them to mental health resources. This study will help OB clinics to determine the best option for screening for PTSD with Black patients in their clinic by comparing the effectiveness of two active screening interventions on:
· reducing PTSD symptoms
· improving maternal perinatal care utilization (attending OB visits)
· increasing utilization of mental healthcare services
· improving maternal health and birth-related outcomes
Participants will be recruited prior to their initial prenatal care visit in the 1st trimester at sites in Atlanta, GA (Grady Memorial Hospital) and Kansas City, MO (Truman Medical Center) and randomized to one of the two intervention groups:
(1) Culturally Responsive SBIRT for OB, a 20-30 minute intervention led by a trained lay provider that includes standardized screening with validated measures, psychoeducation, motivational interviewing strategy components to promote awareness of psychological symptoms and engagement in relevant resources, and coping skills training.
(2) Brief Screening for PTSD, a 5-item screener for PTSD used in medical clinic settings to detect patients in need of referral to trauma-informed behavioral health services.
Who are our participants?
Eligible participants will be Black pregnant women aged 18 or older, who are in their first trimester, who have been exposed to at least one trauma in their lifetime, and are receiving services at the participating OB clinics screening.
What are we measuring and how?
At each study time point (1 visit each trimester + ~6 weeks postpartum), a study team member will do an interview asking about psychological symptoms (e.g., PTSD, depression), stressful and positive life experiences, and healthcare utilization. After delivery, information regarding prenatal care visit attendance and birth outcomes will also be taken directly from the medical chart.
Inclusion of Stakeholders and Mothers with Lived Experience
Stakeholder consultants (Black mothers with lived experience) and THRIVE community action board (CAB), led by Dr. Briana Woods-Jaeger, have shaped the development of this project and driven our focus on pregnant women. They will continue to inform the project and how regular community engagement and dissemination occurs throughout the project. Stakeholders will stay engaged in the project as lay providers and through the THRIVE CAB representing our sites in Atlanta and Kansas City. Our THRIVE CAB will include Black mothers with lived experiences of trauma, health care providers, early childhood service providers, community advocates, health care administrators, insurance providers, and current Black pregnant women patients at participating clinics.