title: Using Prenatal Advocates to Implement a Psychosocial Education Intervention for Posttraumatic Stress Disorder during Pregnancy: Feasibility, Care Engagement, and Predelivery Behavioral Outcomes.
abstract: Pregnant women with posttraumatic stress disorder (PTSD) engage in more high-risk behavior and use less prenatal care. Although treating depression in pregnancy is becoming widespread, options for addressing PTSD are few. This study was designed to test the feasibility of implementing a manualized psychosocial PTSD intervention, Seeking Safety, delivered by prenatal advocates.
  
  
  
  All women entering prenatal care at two federally qualified health centers were screened for current symptoms of PTSD. One site was selected randomly to have prenatal care advocates deliver eight Seeking Safety topics for women that indicated clinical or subclinical PTSD symptoms. Baseline and pre-delivery interviews were conducted, which collected background characteristics and assessed PTSD severity and coping skills. Medical records were collected to document care visits. Documentation of participation rates, fidelity to the treatment, and qualitative feedback from advocates and participants was collected.
  
  
  
  More than one-half (57.3%) of the intervention women received all Seeking Safety sessions and fidelity ratings of the session showed acceptable quality. Using an intent-to-treat analysis, intervention women participated in significantly more prenatal care visits (M = 11.7 versus 8.9; p < .001), and had a significantly higher rate of achieving adequate prenatal care (72.4% vs. 42.9%; p < .001). Although not significant when accounting for baseline differences, intervention women also reduced negative coping skills but not PTSD symptoms.
  
  
  
  Using prenatal care advocates to deliver Seeking Safety sessions to women screening positive for PTSD symptoms at entry to prenatal care is a promising intervention that seems to increase prenatal care participation and may reduce negative coping strategies.
authors.affiliation: Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, Massachusetts. Electronic address: carole.upshur@umassmed.edu.
authors.forename: Carole C
authors.initials: CC
authors.lastname: Upshur
authors.affiliation: Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, Massachusetts.
authors.forename: Melodie
authors.initials: M
authors.lastname: Wenz-Gross
authors.affiliation: Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, Massachusetts.
authors.forename: Linda
authors.initials: L
authors.lastname: Weinreb
authors.affiliation: Department of Family Medicine and Community Health and Family Health Center of Worcester, Worcester, Massachusetts.
authors.forename: Jennifer Jo Averill
authors.initials: JJ
authors.lastname: Moffitt
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003266:Continuity of Patient Care; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D010043:Outcome and Process Assessment, Health Care; D010342:Patient Acceptance of Health Care; D010353:Patient Education as Topic / Q000379:methods*; D011247:Pregnancy; D011295:Prenatal Care / Q000379:methods* / Q000458:organization & administration; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000628:therapy*