T- BOOM Teens--Building Options and Opportunities for Moms
T- BOOM Teens--Building Options and Opportunities for Moms
Postpartum depression (PPD) is depression that occurs shortly after the mother delivers her
 baby. Mothers with postpartum depression may feel sad mood, low motivation or stress; some
 may have problems caring for their new baby. Successful depression treatment involves early
 screening and detection of postpartum depression and early access to treatment services.

 The purpose of this study is to evaluate the effectiveness of a telephone-based depression
 screening and care management program for postpartum women. We will evaluate the: 1) how
 often (frequency) young mothers develop symptoms of depression 4 to 6 weeks after birth, 2)
 how quickly (timeliness) young mother receive treatment and how effective (adequacy) are the
 treatments for the symptoms of postpartum depression, 3) the effects of depression care
 support on young mothers' symptoms and their ability to function at 3, 6 and 12 months after
 entering the study, 4) visits to the pediatrician or nurse practitioner (preventive health
 services) during their baby's first year of life, and 5) cost and cost savings associated
 with depression care management.
Depression during the perinatal period is a major public health concern. Postpartum
 depression (PPD) causes personal and family suffering at a time when adaptation to parenthood
 is critical. Successful interventions for treating depression in medical settings have been
 framed by a chronic disease management model. The key ingredient to success is a dedicated
 care manager who provides education and support to patients, actively coordinates care, and
 thereby improves treatment outcomes for patients. Compared to interventions in medical office
 settings, telephone care management positioned at the level of the health plan offers a
 systematic and efficient mechanism for ongoing treatment support of women with PPD,
 particularly in a geographically dispersed population.

 We propose to conduct a comprehensive project to improve treatment outcomes for depressed
 postpartum women through adaptation of the depression care management model used in primary
 care settings. The major components are: 1) depression screening in a population of
 postpartum adolescents, 2) depression education for all who screen positive, 3) a diagnostic
 interview to evaluate for depressive disorders in mothers who score above and below a defined
 threshold on the screening instrument, 4) telephone-based care management intervention, and
 5) longitudinal evaluation across the first year post-birth for depression and maternal and
 child public health outcomes. Focus groups will precede the major study components. A focus
 group of adolescent mothers will inform the investigators about the barriers to depression
 care management that encompass resource needs, acceptability of interventions to cope with
 stress or depression, and access to care. A separate focus group of community professionals
 of representatives from agencies or groups that provide community supports and health
 services will be used to explore the perceptions of barriers to care for new adolescent
 mothers. All participants in this project will be eligible for mental health services through
 their health plans that serve Medicaid and commercial members.

 We plan to identify 125 child or adolescent new mothers with PPD. The child or adolescent new
 mothers will be assigned to depression care management. They will be supported in making
 choices about depression treatment (after receiving education about options), encouraged to
 access their preferred treatment (through the direct discussion of barriers and solutions),
 counseled to comply with treatment recommendations, and assisted to problem-solve if failure
 to respond occurs. All participants will have systematic evaluations at 3, 6, and 12 months
 post-birth. Outcomes include not only maternal depressive symptom levels but also functional
 and public health outcomes for mothers, families, and infants. We have developed a
 multi-disciplinary team with expertise in clinical research with depressed and minority women
 and health services to address these needs.
Inclusion Criteria:

 -  Adolescent mothers age < 17 years 364 days at birth of index infant

 -  Live born infants

 -  Parents/guardian of the young mother must be available and competent to provide
 consent to the enrollment of the young mother

 -  The young mother may provide assent for her own enrollment.

 -  Ethical need for awareness of the possible risks, benefits and alternatives to
 enrollment in this study.

 -  Mothers with an EPDS>/=10 or CES-D>/=16 (suggest increased risk for major depression)

 -  Mothers with major depressive disorder (MDD) regardless of their EPDS or CES-D scores.
 These are patients with high risk for severe recurrence of depressive symptoms in the
 postpartum. We will assess their outcomes in this study.

 -  Adolescent mothers with an EPDS<10 OR CES-D<16 (screen negative) without MDD will be
 interviewed by phone with the KIDDIE-SADS mood screen to screen for all categories of
 major diagnoses AND the Mood Disorders Module

 Exclusion Criteria:

 -  No access to a telephone Screening and depression care management are accomplished by
 phone; mothers with no phone are referred to Magee social work for other services

 -  NON-English-speaking Measures are in English

 -  The multiple questionnaires and measures are in English