Remote Supervision for Implementing Collaborative Care for Perinatal Depression

Depression is a common and serious disorder among pregnant women but few from low income
groups receive effective treatment. The highly evidence based collaborative care (CC) model
for depression has been shown to work for women in pregnancy but has not been widely
implemented in this population. The proposed study targets improving dissemination of the
evidence based CC treatment model for pregnant and postpartum women with depression, a common
disorder of the perinatal period (pregnancy and the first year following birth). Longitudinal
remote consultation (LRC) is an implementation strategy that has been have shown to improve
fidelity to evidence-based practices and patient outcomes for mental health innovations. The
investigators believe LRC can be used with equal benefit for complex interventions such as
CC.

The purpose of this study is to compare two implementation strategies for Collaborative Care
depression treatment: 1) standard implementation and 2) standard implementation +
Longitudinal Remote Consultation (LRC). This research is being done in order to assess
implementation and patient outcomes in sites receiving a standard implementation approach
with and without LRC. The results of the proposed study will provide information on the
benefits and relative value of ongoing consultation, such as LRC, for implementation of
complex interventions like collaborative care.

The proposed study will involve twenty health centers providing prenatal care which are part
of the national OCHIN Network or other health center network. All sites will receive a
standard implementation approach. After pre-implementation training ten of the sites will be
randomly selected to receive LRC. Implementation and clinical outcomes as well as costs will
be compared between the study conditions after a 12 month implementation period and a 13-21
month sustainment period. The results of the proposed study will provide critical
generalizable knowledge regarding the benefits of ongoing consultation for implementation of
complex interventions like collaborative care.

Patient Participants:

Inclusion: Patient participants must be perinatal women, age 18-45, receiving care at one
of the 20 OCHIN health centers or other health center network participating in the study
and have major depression defined by ≥10 on the PHQ-9.

Exclusion: age <18 or >45, male

Health Center Participating Sites:

Inclusion: Must be part of the OCHIN network or other health network with perinatal patient
population