Project Summary

Trauma results in many negative physical and psychological health effects. One reaction that can occur after trauma is post-traumatic stress disorder (PTSD), which includes psychological symptoms like reliving 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 traumas 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 can have an impact across generations and is related to maternal morbidity and negative birth-related outcomes including risk of preterm birth and low infant birth weight. Therefore, it is necessary to screen for and treat PTSD in urban obstetrics (OB) clinics serving Black women with limited socioeconomic resources in order to improve maternal mental health, reduce maternal morbidity and negative birth outcomes and disrupt intergenerational trauma-related effects in Black communities. 

This study will help participating OB clinics to determine the best option for screening for PTSD in Black pregnant persons in their clinic during first trimester prenatal visits and will compare the effectiveness of two active screening interventions in improving PTSD symptoms, maternal perinatal care utilization, satisfaction utilization of mental healthcare services and maternal health and birth-related outcomes for Black women. The study team will examine whether Culturally Responsive Screening, Brief Intervention and Referral to Treatment (SBIRT) for OBs is more effective in reducing PTSD symptoms compared to brief screening for PTSD.  The study team will also test if Culturally Responsive SBIRT for OBs is more effective in improving perinatal care utilization, engagement in mental health care and maternal health and birth-related outcomes. 

Participants will be randomized to one of the two intervention groups. The comparators are:

  1. Culturally Responsive SBIRT for OBs, a 20- to 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 five-item screener for PTSD used in medical clinic settings to detect patients in need of referral to trauma informed behavioral health services. Eligible participants will be trauma-exposed Black pregnant women aged 18 or older who are in their first trimester, have been exposed to at least one trauma in their lifetime and are receiving services at the participating OB clinics. 

The primary outcome is change in PTSD symptoms. The secondary outcomes include change in perinatal care utilization, as measured by the Adequacy of Perinatal Care Utilization (APNCU) Index; engagement in mental health care; preterm birth; infant birth weight; and maternal morbidity. Participants will be asked about their PTSD symptoms and healthcare utilization through surveys at the start of the study, the second trimester, the third trimester and six weeks postpartum. Chart abstraction will be used for APNCU and any health- or birth-related secondary outcomes. 

Study results will provide hospital administrators, providers and payers novel information about the implementation of PTSD screening for minoritized pregnant persons in urban OB clinics and will show which intervention is best for improving PTSD symptoms, which is an important indicator of birth-related outcomes. Multiple Black mothers with lived experience as consultants and the THRIVE community action board (CAB) have been involved in the development of this project. Stakeholders will continue to be engaged in the project as lay providers and through the THRIVE CAB representing study sites in Atlanta and Kansas City. 

The THRIVE CAB will include Black mothers with lived experiences of trauma, healthcare providers, early childhood service providers, community advocates, healthcare administrators, insurance providers and current Black pregnant women patients at participating clinics. Patient and stakeholder consultants and THRIVE CAB members have already shaped the development of this project and driven its focus on pregnant women, and will continue to inform the project and how regular community engagement and dissemination occurs throughout the project.

Project Information

Abigail Powers Lott, Ph.D.
Briana Woods-Jaeger, Ph.D.
Emory University
$5,987,936 *

Key Dates

60 months *
April 2024
2024

*All proposed projects, including requested budgets and project periods, are approved subject to a programmatic and budget review by PCORI staff and the negotiation of a formal award contract.

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Last updated: April 23, 2024