The PRogram In Support of Moms (PRISM): Increasing obstetric practice capacity to implement the depression care...

Area of Science:

• Perinatal mental health
• Healthcare implementation science
• Maternal-child health

Background:

• Perinatal depression is a prevalent yet undertreated condition affecting maternal and child well-being.
• The Massachusetts Child Psychiatry Access Program (MCPAP) for Moms aims to improve perinatal depression care access through training and consultation.
• The PRogram In Support of Moms (PRISM) builds upon MCPAP for Moms by adding practice-level implementation support.

Purpose of the Study:

• To compare the effectiveness of MCPAP for Moms versus PRISM in implementing a comprehensive perinatal depression care pathway.
• To evaluate the impact of practice-level support on the adoption of perinatal depression screening, assessment, treatment, and care transition protocols.

Main Methods:

• A cluster randomized controlled trial involving ten obstetric practices.
• Medical record data abstraction for 294 perinatal individuals with elevated depression symptoms.
• Generalized linear mixed-effects models and practice leadership surveys to assess implementation outcomes.

Main Results:

• PRISM practices demonstrated significantly higher rates of bipolar disorder screening, documented treatment engagement, follow-up monitoring, and transition of care plans.
• Patients in PRISM practices were more likely to be identified with perinatal depression.
• Practice leadership reported a greater increase in capacity to address perinatal depression in PRISM-supported practices.

Conclusions:

• The PRogram In Support of Moms (PRISM) significantly enhanced the implementation of the perinatal depression care pathway compared to MCPAP for Moms alone.
• Practice-level implementation support is crucial for integrating new initiatives, such as bipolar disorder screening, into perinatal care.
• PRISM shows promise for improving identification and management of perinatal depression.