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Mamas in Waiting

This tool will provide an interactive learning experience about perinatal mental health for low-income African American pregnant women.

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Written by

Name or Organization

* MedStar Georgetown University Hospital, Department of Psychiatry Georgetown University Medical Center, Department of Psychiatry MedStar Washington Hospital Center The George Washington University *primary applicant institution

Geography

This will take place in an outpatient obstetrics (ob/gyn) clinic at MedStar Washington Hospital Center in Washington, DC.

What is your stage of development?

  • New Innovator, with less than one year of experience in ECD

Type

  • University

What is the stage of your proposal?

  • Research & Early Testing: I am exploring my idea, gathering the inspiration and information I need to test it with real users.

Describe your submission in one clear sentence

“Mamas in Waiting” is a personalized digital learning tool that will transform the OB/GYN waiting room experience by providing interactive videos and individualized learning modules on topics ranging from perinatal health and mental health to maternal-infant bonding for low-income, African American pregnant women.

Describe how your solution could be a game-changer for your selected Opportunity Area (600 characters)

Many low-income African American women are at higher risk for developing perinatal depression and anxiety due to limited access to resources and quality mental health care. “Mamas in Waiting” will transform the patient experience and take advantage of lengthy wait-times by providing short videos followed by information on a range of topics (e.g. stress, mood, parenting) relevant to perinatal women. This tool will help mothers recognize that physical and psychological health are closely intertwined and encourage them to begin to think about their relationship and bond with their babies.

Select an Innovation Target

  • Product: A new or enhanced physical product that creates value for end beneficiaries.

Tell us more about your innovation (1500 characters)

“Mamas in Waiting” is an interactive, digital learning tool that aims to address the needs of low-income African American women in DC who are at high risk for postpartum depression. This is due to many complex social factors including limited resources, low health-literacy, and poor access to quality health care. While pregnant, women tend to be more engaged in their healthcare, which presents a unique opportunity to use frequent OB/GYN appointments to enhance awareness of the importance of emotional health during the transition to motherhood. While waiting for their appointments, patients can use this tool to learn about many topics that address specific stressors while emphasizing strengths of African American women during the transition to parenthood. These topics include infant attachment, breastfeeding, interpersonal relationships, health, and how stress can affect all of these factors. Women will be able to select a topic, view a brief video that aims to stimulate conversation about the topic, and reflect on questions about the video as a way to reflect on these topics, and generate healthy strategies for themselves and their babies. The videos are based on personal experiences of African American perinatal women during their transition to motherhood. The purpose of the videos is to improve mother-infant bonding and reduce maternal depression and anxiety through information, reflection, and behavioral activation assignments.

What problem are you aiming to solve? (3 sentences)

When maternal depression and anxiety are left untreated, the impact on women and their ability to be an efficacious parent can be severe, and the infant suffers. Patients need and want varying types and amount of information and support (e.g. emotional well-being, breastfeeding, parenting, support). The tool will optimize downtime by raising awareness, promoting reflection and parenting skills-building, and emphasizing self-care, with a goal of empowering our city's most vulnerable mothers.

Explain your idea (5000 characters)

We plan to develop an interactive, personalized digital learning tool, which will be utilized by low-income African American pregnant women in the waiting room at an OB/GYN clinic in Washington, DC. While spending time in the waiting room, patients will have access to “Mamas in Waiting”, a personalized platform aimed at building skills to help women become the best mother they can to their baby. The patient will be provided with a tablet, which will ask her what she would like to learn about today. Based on information previously gathered through surveys and interviews with patients in the clinic, a variety of topics will be created to address specific stressors and strengths of African American women during the transition to parenthood -- including promoting mother-infant attachment and bonding, increasing awareness of how mood and anxiety can affect pregnancy and postpartum, breastfeeding, and relationships with partner and father of the baby and others. After the woman makes her selection, a short (one- to three-minute) video clip will play. The content of the clip will vary depending on the topic area, but will show a new mom or soon-to-be mom in a situation that relates to the selected topic area. Following the video, she will be asked a question about what she watched and will be given several response options. After choosing a response, the woman will be linked to a screen with educational materials that are tailored to her selection. She will continue to move through the course, which will adapt to each of her responses. The digital tool will save her responses so that she can resume at her next prenatal visit. An example would be a video showing a mother discussing her hopes for her baby. After viewing this video, the patient will be asked to describe her own hopes for her baby when s/he is born and what she thinks her baby will be like. Suggestions for activities may include writing a letter to her baby or making a recording of her wishes for her baby. The goal is to promote attachment to the baby during pregnancy as they start of their lives together. At the end of each topic, the mother will be able to text or email herself any content that she is interested in taking home with her. There will also be a link to websites, mobile apps, and other resources related to the selected topic. This will provide low-income pregnant women with useful information that has been developed to meet their distinct needs when they otherwise may not have had access to psychoeducation materials. We hope that this tool normalizes the universal experience of pregnancy, which can be stressful as well as joyous for all women. This tool will provide a space and time for these women to prioritize self care, reflect on the ways that they want to parent their children, and have access to community resources to obtain more information on the topic of interest. If partners and mothers are present in the waiting room, they can also participate in this tool by watching the videos and helping the patient respond to the questions, thereby enabling the entire family to reflect on the parenting journey. Finally, this tool also has the potential to change the culture at the clinic level by increasing staff and providers’ recognition that “there is no health without mental health,” and recognizing that stress, mood, and anxiety can negatively impact pregnancy and postpartum outcomes for mothers and babies.

Who benefits? (1500 characters)

“Mamas in Waiting” is intended to benefit low-income, African American pregnant women who are receiving OB/GYN care at MedStar Washington Hospital Center in Washington, DC. Preliminary clinic data suggest that women attend their prenatal care visits, but many do not return postpartum. The clinic has a waiting room with a television and limited reading materials, however, these materials are not tailored to perinatal women’s needs. Therefore, clinic patients can capitalize their time in the waiting room to address their own needs by using the “Mamas in Waiting” personalized learning tool. Over the past year, our team has been working to develop an integrated model of mental health support in the clinic. Through this process, we have extensive formal and informal contact with African American perinatal women who obtain healthcare in this clinic. Integral to our team, Ms. Ruthie Arbit, a licensed mental health clinician, has been working in the clinic for approximately eight months. Ms. Arbit has spent these months observing the clinic flow, building buy-in with clinic providers and staff, and interacting with patients. She conducted an informal patient needs assessment and semi-structured, in-depth interviews with patients - all of whom are African American. These experiences have led us to consider how to increase awareness of the relationship between physical and psychological health and integrate technology in a relevant way for this population.

What kind of impact will your idea have? (1500 characters)

Women from all socioeconomic and ethnic backgrounds are more likely to seek medical services during pregnancy than at other times in their lives. Thus, a personalized learning tool for low-income African American pregnant women to utilize in the waiting room of a busy OB/GYN clinic has the potential for long-lasting impact not only for this population but potentially for all pregnant women and their babies. Waiting times for prenatal appointments can be long and unpredictable, sometimes up to 1.5 or 2 hours. “Mamas in Waiting” will provide an opportunity for pregnant women to reflect on their well-being and their babies’ well-being starting during pregnancy. It offers an interactive format to deliver psychoeducational materials relevant to the needs of low-income African American pregnant women, which could serve to decrease social isolation and stigma, and increase understanding about the ways stress and distress impact maternal and infant outcomes. This tool has the potential to increase help-seeking and utilization of local community resources, as well as increase utilization of services that women may not have been aware of. It may also enhance communication with their own healthcare providers at the clinic. If successful, this tool could be adapted for use with newly postpartum women, as a way to engage and retain women in the postpartum period, increase postpartum visits, and enhance maternal and infant well-being.

How does or how could your idea impact low-income children? (1500 characters)

The “Mamas in Waiting” development team are part of a multidisciplinary group focusing on health and wellbeing in early childhood, the Early Childhood Innovation Network (ECIN). ECIN is a local collaborative of health and education providers, community-based organizations, researchers, and advocates promoting resilience in families and children from pregnancy through age 5 in Washington, DC. During this critical period of brain development, children are deeply affected by their experiences and environment. ECIN’s approach affirms the tremendous opportunity to promote and ensure healthy development of young children. Part of our team recognizes that early childhood development begins in the the womb, with a focus starting on pregnancy. This personalized learning tool provides an opportunity for low-income African American pregnant women to start thinking about the kinds of parents they want to be - learn about what to expect for parenting, become aware of the detrimental impact of stress, depression, and anxiety on infant and child outcomes, and utilize existing community resources to increase support for mothers and babies. The tool will increase the patient’s awareness of both her and her baby’s mood, promote ways to manage stress, and improve mother-infant bonding. The tool may help patients feel more comfortable discussing these topics with their provider, beginning during pregnancy and extending into parenthood.

Innovation: What makes your concept innovative? (1500 characters)

“Mamas in Waiting” is an innovative approach to providing psychoeducation to low-income, minority ethnic women. This tool will be developed specifically to meet the needs and interests of this population and takes advantage of lengthy-clinic wait times, which are typically spent reading magazines, playing games on a phone, watching the television, or just sitting in the waiting area. Instead, patients will be able to use this digital learning tool to enhance awareness of the importance of emotional health during the transition to motherhood. This tool also has the potential to increase communication with their OB/GYN clinic healthcare providers, increase help-seeking of local community resources as well as increase access to mental health evaluation and treatment, services many women may not be aware of.

Scale: Describe how your idea could reach a significant number of end-users. (1500 characters)

MedStar Washington Hospital Center (MWHC) delivers approximately half of the 9,000 babies born each year in Washington, DC. After development and pilot testing, “Mamas in Waiting” could be implemented in all clinics at MWHC and have the potential to reach approximately half of all mothers in Washington, DC. In the long term, this digital learning tool could be adapted for use in OB/GYN clinics across the nation who serve low-income African American pregnant women. The tool can be adapted for other pregnant populations (e.g., Latinas), who may have unique needs, and eventually expand this tool for postpartum women.

Feasibility: Where are you with understanding the feasibility of your idea? Describe what you’ve done so far and your plans. (3000 characters)

We believe that our personalized learning tool will be feasible to implement at Medstar Washington Hospital Center’s OB/GYN clinic for several reasons. First, our team has established an excellent and collaborative working relationship with the staff and providers at the OB/GYN clinic at MedStar Washington Hospital Center. We are working to develop a model of integrated care in the clinic that promotes the importance of mental health during pregnancy and postpartum, recognizing the symbiotic relationship between physical and psychological health. Through multiple conversations, the OB providers and staff understand the importance of perinatal mood and anxiety disorders, infant attachment, and early childhood development, and have expressed interest in having more culturally relevant educational materials for patients. Second, results from both the patient and provider surveys indicate that more needs to be done for this low resourced population. Specifically, results from our needs assessment survey and interviews with patients indicate more desire to learn about topics during pregnancy. The survey results from OB providers, residents, and staff indicate a desire to learn more about resources to refer and treatment perinatal mood and anxiety disorders. Third, the technology is available as proposed. There are several programs that our team can use to build content for the digital learning tool, including Adobe Captivate Prime, Litmos Learning Management System, or WizIQ.

Business Viability: How viable is your business model? (1500 characters)

MedStar Washington Hospital Center is one of ten MedStar hospitals across Washington, DC and Maryland. In 2008, Dr. Aimee Danielson founded the Women’s Mental Health Program at MedStar Georgetown, which has been the only program of its kind in the region providing specialized psychiatric evaluation and treatment for perinatal women with mood and anxiety disorders. She is a founding member of the DC Women’s Reproductive Mental Health Consortium and an active member of the DC Collaborative for Mental Health in Pediatric Primary Care. Through this work, she has trained local mental health clinicians to grow the capacity of perinatal mental health(PMH)-trained mental health providers in DC, been a PMH educator for medical providers at MedStar, and an advocate for PMH awareness and services in and around the District of Columbia. Dr. Danielson has been working in DC to improve perinatal mental health for over ten years and has established working relationships with obstetrical providers across every major birthing hospital in Washington, DC. These relationships as well as her prominent role in the perinatal mental health community would be beneficial to any effort to bring this tool to market. If successful, after development and pilot testing, this tool has the potential to be implemented in OB/GYN clinics serving low-income, minority ethnic women across the DMV area.

HCD: How have you used human centered design to build or refine your concept? (1500 characters)

The Early Childhood Innovation Network strongly believes in the importance of co-creation with the community. We incorporate a human centered perspective into the design and development of all of our pilot projects, by obtaining feedback from parents, caregivers, community members, and participants throughout the duration of the project period. During the development of this tool, we will survey patients about the design, utility, content, and interest in using the tool. Then, we will incorporate their feedback into the next iteration of the tool.

Tell us more about you (3000 characters)

The idea of a personalized learning tool was refined from a conversation our team had with Dr. Barry Zuckerman, a pediatrician who developed the Small Moments, Big Impact videos for use in pediatric primary care. These videos were developed to help pediatricians start conversations around parenting and child development with low-income, African American parents and caregivers. Our team really liked this idea, but given the OB providers’ limited time with their patients, felt it would be best to take advantage of lengthy clinic wait-times and develop a tool that could be implemented in the waiting room. From our formative work, we learned that there were more pregnant women in the clinic than return postpartum mothers, leading us to first focus on pregnant women. We also knew that the OB clinic where we began working did not have psychoeducation materials that focused on African American women. Thus, inspired by these videos, we wanted to see if we could explore ways to better reach this population, validate their experiences during pregnancy, and provide psychoeducation and resources that will benefit this population. Inspired by the Small Moments, Big Impacts videos, we came up with the “Mamas in Waiting” personalized learning tool. We hope that our videos will be conversation starters - a way to enable and empower African American pregnant women to discuss their stories about pregnancy, stress, and the impact of stress, mood, and anxiety on their own well-being but also on their baby’s well-being (during pregnancy and when they are born). The “Mamas in Waiting” development team are part of a multidisciplinary group focusing on health and wellbeing in early childhood, the Early Childhood Innovation Network (ECIN). ECIN is a local collaborative of health and education providers, community-based organizations, researchers, and advocates promoting resilience in families and children from pregnancy through age 5 in Washington, DC. During this critical period of brain development, children are deeply affected by their experiences and environment. ECIN’s approach affirms the tremendous opportunity to promote and ensure healthy development of young children. Our approach is multi-modal, stemming from three goals. First, we want to keep parents well, through enhancing parent’s psychological as well as physical well-being. Second, we want to build healthy brains, by building resources to optimize early childhood developmental outcomes. Third, we aim to prepare children to be ready for school at age 5, by promoting multiple domains. Part of our team follows the first goal, recognizing that mothers need support starting during pregnancy, and that early childhood development begins in the the womb.

Do you have the people and partners you need to do what you’ve described? (500 characters)

We have an established relationship with the providers and staff at the OB clinic at MedStar Washington Hospital Center. However, we would like to work with the clinic to identify one or two provider and staff champions to help lead the effort around this initiative and promote the use of the tool within the clinic.

As you consider your next steps, what kinds of help could you use? Is there a type of expertise that would be most helpful? (1800 characters)

As we move forward with the development of the digital learning tool, we could benefit from technological consultation with someone who is skilled at developing these types of tools, such as web-developers, programmers, etc. We could also benefit from someone who can record the professional quality videos and engage in the editing process to finalize the content of the videos, such as producers, videographers, etc.

Would you like mentoring support? [Relevant only for Early Submission Deadline]

  • Yes

If so, what type of mentoring support do you think you need? (1200 characters) [Relevant only for Early Submission Deadline]

Mentoring of how to take an idea from conception to implementation, with long term dissemination would be ideal. This is a new area for us, and mentoring in thinking through such a potentially large scale project would be immensely useful.

Are you willing to share your email contact information submitted on OpenIDEO with Gary Community Investments?

  • Yes, share my contact information

[Optional] Biography: Upload your biography. Please include links to relevant information (portfolio, LinkedIn profile, organization website, etc).

Relevant Links: 1. www.ecin.org 2. https://www.medstargeorgetown.org/our-services/psychiatry/treatments/womens-mental-health/#q={} 3. https://www.medstarhealth.org/doctor/dr-aimee-l-danielson-phd/#q={} 4. https://psychology.columbian.gwu.edu/huynh-nhu-mimi-le 5. https://www.researchgate.net/profile/Hillary_Robertson-GU 6. http://arbitcounseling.weebly.com/

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