The Development of PATH, a Program to Support NICU Parent Mental Health Through the Transition from Hospital to Home

Project Summary/Abstract This application for a K08 Award includes training and research activities that support my transition to an independent mental health services researcher focused on improving services for parents with mental illness. I am a PhD-trained clinical social worker and tenure-track Assistant Professor at Portland State University, with a background in providing mental health services to parents and families. I am completing an Institutional K12 Award to study the mental health needs of parents in the neonatal intensive care unit (NICU). This K08 Award will build off my qualitative research and advance my research career by providing protected time, mentorship, and structured support to 1) learn implementation science methods, 2) increase my understanding of integrated mental health services, 3) obtain skills to conduct rigorous randomized control trials, including statistical methods necessary to analyze results, and 4) gain the skills necessary to become a leader in the field of parent mental health services research. My multidisciplinary mentorship team brings expertise in deployment-focused and participatory methods, health services research, implementation science, parent mental health research, randomized control trials, health economics, health informatics, rural health, and biostatistics. Parents of NICU-hospitalized preterm infants are at extremely high risk for mental health conditions with potentially devastating consequences. Yet, perinatal systems of care do not systematically support NICU parent mental health. The U.S. Preventive Services Task Force and state-level Maternal Mortality Review Committees have called upon perinatal systems of care to prioritize parent mental health. The objectives of this proposal are to develop and pilot test a telehealth-based mental health screening and engagement program that supports parents as they transition from the NICU to home. The program will use a stepped-care approach to screen parents for depression, anxiety, and PTSD; provide a brief behavioral intervention to those who screen as having at least a low risk of these conditions; and provide a warm hand-off to community mental health services for those at medium to high risk. We will achieve the study objectives by meeting 3 specific aims: 1) to use a RE-AIM framework to develop the program in collaboration with former NICU parents and NICU and primary care stakeholders; 2) to conduct an iterative case series to work out practical implementation details and logistics, refine the mental health screening and engagement program, and qualitatively assess purported mechanisms of action; and 3) to conduct a pilot randomized control trial to assess the program's acceptability and feasibility; to test its preliminary efficacy in targeting mental health self- efficacy and other potential mechanisms of action; and to better understand facilitators to adoption, implementation, and maintenance. The proposed activities will provide preliminary data and allow for the refinement of data collection procedures necessary for an R01 application to conduct a Type 1 hybrid effectiveness/implementation trial in multiple NICUs across the U.S.