A Pilot Study of a Sequential Multiple Assignment Randomized Trial Aimed at Reducing Depressive Symptoms among Home Visiting Clients

This study will examine the use of a sequential, multiple assignment, randomized trial (SMART) design for testing the effects of a perinatal depression preventive intervention—Mothers and Babies (MB)—when delivered to pregnant women and new mothers enrolled in home visiting (HV). The pilot study will allow our research team to conduct preliminary research necessary to establish the feasibility and acceptability of delivering different permeations of the MB intervention to perinatal women in HV programs. In doing so, our goal is to move from a “one size fits all” model to an adaptive intervention that is tailored to HV clients. Moreover, an adaptive trial design will allow our research team to determine how to deliver MB in ways that will reduce costs and burden on HV providers and clients. Because perinatal depression has been shown to attenuate HV program effects and impede delivery of HV services (Ammerman et al., 2010), this study has considerable potential to positively affect HV program impact on maternal and child health outcomes. The specific objectives of our HARC Pilot Study are to: 1. Pilot test the use of ecological momentary assessment with HV clients to obtain real-time data on mood and stress 2. Pilot test randomization procedures for our SMART design with 12 low-income HV clients 3. Develop and pilot test the delivery of additional mindfulness content in response to HV clients’ self-reported mood and/or stress 4. Translate MB text messages, ecological momentary assessment text messages, and MB mindfulness content into Spanish and assess the acceptability and usefulness of MB text messages and mindfulness content among Spanish-speaking HV clients