Scattergood Foundation

Advancing Innovative Strategies for Change in Behavioral Health

The Children's Hospital of Philadelphia

Name of Innovative Program: 
Postpartum Depression Social Media-based Parenting Education
Sponsoring Organization
The Children's Hospital of Philadelphia
Name of Innovative Program Lead: 
James Guevara, MD, MPH
E-mail Address of Innovative Program Lead: 
guevara@email.chop.edu
Physical Address of Innovative Program: 
The Children's Hospital of Philadelphia, 34th & Civic Center Blvd, CHOP North, Room 1531, Philadelphia, PA 19104
Project Description: 

Postpartum depressive (PPD) symptoms are common among women following the birth of a child and adversely impact a mother’s parenting ability. We  developed a parent-coaching program for women with PPD symptoms utilizing a social media format to enhance participation. We adapted and manualized a validated parent coaching intervention, Parents Interacting With Infants (PIWI), and infused it with depression psychoeducational material, based on the Prevention Intervention Project, an empirically validated cognitive intervention for families with parental depression. We embedded the program in a social media format by creating Facebook Secret User Groups and invited women who screened positive for PPD at their child's 2-month well visit to participate. The program consisted of 8 weekly topics covering common infant parenting topics and utilized video clips , slide presentations, and exercises designed to promote responsive mother-infant bonds.

How does the innovative program work to improve behavioral health access?: 

This program provides women with PPD symptoms access to parenting knowledge and skills they may not possess. It provides content on common infant parenting topics infused with depression psychoeducation that can help women to recognize their PPD symptoms, improve parenting abilities, and manage depression and stress. Compared to traditional in-person group programs, this program utilizes a social media format (Facebook) that many women find appealing as well as convenient. This format permits participation in a validated parent-coaching program by women who may struggle to engage and attend a program outside of the comfort of their homes. In addition, use of a social media format for this program permits women flexibility to participate at times they find most convenient, encourages participants to interact with each other to promote social support, and allows administrators to provide feedback and encouragement to participants similar to traditional in-person group programs.

How does the innovative program work to improve behavioral health quality? : 

This social media-based parenting program provides parenting knowledge and encourages skill development that many women with PPD symptoms need. This program can be provided in addition to standard behavioral health treatment for women. Since PPD is a known risk factor for child maltreatment, the program can be viewed as enhancing the safety of infant care by teaching women safe parenting practices including appropriate infant feeding, safety, and sleep knowledge. The program is also timely in that it is preventive in scope and is provided to women at a time in which they need to quickly assimilate parenting knowledge and skills early in an infant's life before parenting problems arise. The program is efficient in that it can be viewed asynchronously when women have free time to engage with its content and doesn't interfere with other scheduled activities like work and behavioral health appointments.

How does the innovative program work to address behavioral health costs? : 

This social media-based parenting program is relatively inexpensive to administer. This is due to the fact that there are no associated costs for meeting space, meals, childcare, and transportation tokens or parking for participants to attend meetings like traditional group sessions. In addition, there are no costs for staff to make home visits similar to home visitation programs. The main costs associated with the program are for dedicated staff to administer the Facebook Secret User group, post weekly content, and review and respond to participant posts. This typically requires only a few hours a week. If scaled up, social media-based parenting programs can be a fairly inexpensive way to provide needed parenting knowledge and skills in a group format that enhances communication and social support.

Creativity and Innovation: 

This program allows women with PPD symptoms to access asynchronously from any location important parenting knowledge and skills to improve their parenting abilities. Access is only dependent on internet capability and doesn’t require attendance at specific locations and times as compared to traditional programs. In addition, many women find social media appealing and convenient. This social media format permits participation in a validated parent-coaching program by women who may struggle to engage and attend a program outside of the comfort of their homes. In addition, use of a social media format for this program permits women flexibility to participate at times they find most convenient, encourages participants to interact with each other to promote social support, and allows administrators to provide feedback and encouragement to participants similar to traditional programs.

Leadership: 

The leadership of this program, Drs. James Guevara and Rhonda Boyd, are currently collaborating with a community organization, Maternity Care Coalition, to develop and implement this program. This collaboration has the potential to strengthen the relevance of the program to real world agencies that might utilize it in the future. The program has been field testing at primary care practices affiliated with The Children's Hospital of Philadelphia (CHOP) and found to be feasible and satisfactory. The program is currently being evaluated through a randomized controlled trial to test its effectiveness. The leadership of this program are members of Policylab at CHOP, and plan to assist with dissemination of program results to a broad policy audience through evidence-to-action briefs, email blasts, twitter feeds, and website postings.

Sustainability: 

The costs of this program are markedly less than comparable traditional group parent-coaching programs. This is due to the fact that there are no costs for meeting space, meals, childcare, and transportation tokens or parking for participants to attend group meetings. The main costs associated with the program are for a dedicated staff person to administer the Facebook Secret User group, post weekly content, and review and respond to participant posts. In addition, the popularity of social media has grown and will provide a popular venue for participants to interact with the program. Evidence from a recent Pew Research Center Survey reported that 89% of young adults 18-29 years old regularly use social networking sites, with little difference in use by race/ethnicity or income. Therefore, the decreased expenses for this program and the growing popularity of social media enhance this program’s potential sustainability.

Replicability: 

The curriculum for this program has been manualized in terms of its content and structure, which will permit replication at other sites. In addition, the program’s specific curriculum, including video clips, slide presentations, and exercises have already been developed and can be disseminated to other organizations and community agencies via website downloads or email. The program was developed in a multicultural manner using focus groups and includes perspectives and pictures of women from different cultures, races, and ethnicities. This will permit the program to be adapted for settings different from the setting in urban Philadelphia where it was developed. The program has not been translated into other languages, which limits its use to English speaking populations. However, the curriculum is not wedded to a specific cultural milieu and has the potential to be translated into other languages to enhance its replicability.

Results/Outcomes: 

Findings from preliminary field testing have been completed. We enrolled 18 women with PPD symptoms in the social media-based program. The women were predominantly African-American (92%), single (58%), and had a high school education or less (50%).  All 18 (100%) participants viewed at least 1 session, 15 (83%) viewed half the sessions, and 14 (78%) viewed all 8 sessions. Most (94%) posted comments on at least 1 session, 12 posted comments on half the sessions, and 8 (44%) posted comments on all 8 sessions.  The mean overall satisfaction score was 4.0 (range 3.6-4.2 out of 5.0). These results demonstrate the feasibility and overall satisfaction with the program. A randomized controlled trial is currently underway to test the effectiveness of the program with results pending.

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