QING LI, MD, DrPH
University of Colorado

Our study aims to evaluate the effectiveness of a nurse home visiting program augmented with relationship education on maternal depression (MD), intimate partner violence (IPV), and substance use (SU). Relationship education (RE) from family psychology has addressed marital distress, dating violence, and IPV. Through modeling and monitoring a vision of commitment, teaching skills, and empowering future-oriented decision-making (self-efficacy), RE programs (Hawkins, 2018; Stanley et al., 2020) address precursors of relationship instability, reduce antecedents and triggers of IPV, and thus can disrupt the occurrence of IPV and prevent MD. However, gaps remain in implementing RE in home visiting. One trial (Feder et al., 2018) was the first attempt to integrate RE into home visiting workflows to prevent IPV but the effectiveness on MD and SU were not evaluated. Although the Home Visiting Collaborative Improvement & Innovation Network increased RE service from 41% to 58%, RE was not comprehensive or standardized across models.

We performed secondary data analyses of a longitudinal randomized controlled trial at three waves from 2005 to 2011. In the NFP program in Oregon, 238 first-time, low-income mothers were randomized to a standard or augmented program when nurses delivered Within My Reach relationship education curriculum during pregnancy.

During pregnancy, and 1- year and 2-year follow-up, research assistants interviewed mothers with the Edinburgh Depression Inventory, Alcohol Use Disorder Identification Test and Drug Abuse Screening Test, and the Revised Conflict Tactics Scale. IPV was a count of victimization and/or perpetration of physical assault, sexual coercion, and physical injury. Multilevel zero-inflated negative binomial regression models and mediation analyses (using PROC NLMIXED and CAUSALMED) were performed, adjusting for race, age, education, and nativity status.

At baseline, participants in the augmented (n=133) and standard (n=105) programs did not differ in maternal age or nativity status (p>0.05). However, more Hispanic mothers (56%) were in the augmented program (p=0.03), and more White mothers (36%) in the standard program (p=0.04). The augmented program did not reduce MD, IPV, or SU at the 1-year or 2-year follow-up points. It affected MD at 2-year follow-up through IPV as a mediator at 1-year follow-up.

The NFP program augmented with relationship education did not affect MD, IPV, or SU, but IPV was a mediator to reduce MD. Study findings inform hypothesis generating in future trials. Meanwhile, other evidence-based interventions need to be included, for example engaging fathers in mother-father dyads. This study extended nursing’s role of caring for abused women to include relationship education. Large trans-disciplinary studies are needed to perform mediation analyses to delineate mechanisms of change and improve home visiting models to prevent MD, IPV,

DAVID SOMMERFELD, PhD, MSW
University of California, San Diego

Peripartum depression affects many women and has significant negative consequences for women and their children when left untreated. The recently developed Sleep and Light Intervention (SALI) has been assessed in research contexts to be effective for treating peripartum depression. SALI is a non-pharmacological, rapid-acting and low-cost peripartum depression home treatment that entails one night of adjusted sleep followed by two weeks of using a portable bright white lightbox for 30 minutes daily, with differential timing based upon whether pregnant or postpartum. To ensure that SALI is a viable treatment option for women with limited resources and/or access to care, we are now building upon an existing collaboration between academics, government, and community-based service providers to inform the transition of SALI into community settings by training clinicians from the Accessible Depression and Anxiety Peripartum Treatment (ADAPT) program to integrate SALI into their treatment services.

An existing collaboration engaged in transitioning SALI from research settings into community programs that treat peripartum depression among low-income, historically underserved women.

UCSD investigators developed materials and conducted trainings to teach ADAPT clinicians how to administer both the pregnant and postpartum versions of SALI. UCSD collected qualitative and quantitative feedback from ADAPT clinicians regarding the trainings and utilization of SALI and from patients about their perceptions of SALI feasibility, acceptability and effectiveness.

Preliminary data from the ongoing pilot study indicated that SALI was perceived by ADAPT staff to have high levels of: 1) appropriateness for patients and 2) clinician feasibility for administering SALI. While there was greater than expected initial hesitancy to try SALI (which has informed revised training materials and patient communication), patient assessments indicated that participating in SALI was a positive experience and associated with improved wellbeing. Additionally, ADAPT staff requested that SALI implementation be expanded to include monolingual Spanish speaking patients.

The findings indicate SALI has potential for widespread adoption and implementation by clinicians to treat peripartum depression in community settings. This study is guiding the development and refinement of materials to support clinician and patient utilization of SALI with a specific emphasis on addressing health inequities by ensuring feasibility of SALI in low resource settings. This study also highlights the importance of developing ongoing partnerships between academics, the public sector, and community-based organizations to facilitate the research-to-practice pipeline and promote development and sustainable implementation of treatments that can address health inequities.

BRYAN GARNER, PhD
Ohio State University

As part of the Substance Abuse Treatment to HIV Care (SAT2HIV) Project, Garner and colleagues (2020) found empirical support for the project’s Implementation and Sustainment Facilitation (ISF) Strategy, as well as the project’s motivational interviewing-based brief intervention (MIBI) for substance use disorders. Building on the SAT2HIV Project and our prior research supporting pay-for-performance (P4P) as an effective (Garner et al., 2011, 2012) and cost-effective (Garner et al., 2018) strategy, the SAT2HIV-II Project was funded (R01-DA052294) to test the incremental effectiveness and cost-effectiveness of P4P as a strategy to improve MIBI integration by HIV service organizations (HSOs) and their staff. The current presentation will provide an overview of the SAT2HIV-II Project (i.e., a type 3 hybrid design), as well as present findings from the project’s initial cohort.

U.S.-based HSOs, HSO staff prepared to implement a motivational interviewing-based brief intervention for SUDs, and HSO clients with a comorbid SUD.

As part of this three-cohort, cluster-randomized, type 3 implementation-effectiveness hybrid trial, an initial cohort of 12 HSOs and their staff (n = 45) were randomized to one of two conditions. In the control condition, HSOs and their participating staff received the team-focused ISF Strategy, with the HSO’s MIBI staff also receiving a 4-hour online introductory training in motivational interviewing, a 11.5-hour live virtual training workshop in the project’s MIBI protocol, ongoing fidelity feedback, and monthly virtual group MIBI consultation meetings with a MIBI expert. In addition to these strategies, MIBI staff working in HSOs randomized to the project’s experimental condition had the opportunity to earn P4P bonuses (i.e., $10 per MIBI implemented and $10 per MIBI rated as having high-fidelity). Current analyses focused on the time (post-training, mid-implementation, end-of-implementation) by condition interaction for each of the three implementation outcome measures developed by Weiner and colleagues (2017; acceptability, appropriateness, feasibility), as well as a single-item assessing intentions to implement the MIBI (0 = not at all to 6 = highest intentions possible).

Consistent with prior research (Garner et al., 2011), P4P significantly increased implementation intentions.