Keshet Ronen

Below are excerpts from this grantee’s quarterly reports.

Year 2, Quarter 1

Briefly restate the specific aims or objectives associated with this project.

Aim 1. Adapt the IMAGINE intervention in response to the COVID-19 epidemic

1a. Explore the impact of the COVID-19 epidemic on peripartum youth’s mental health

1b. Develop COVID-19-related content for inclusion in the IMAGINE pilot intervention

1c. Determine yield of respondent-driven sampling (RDS) for pilot participant recruitment

Aim 2. Develop training materials for peer facilitation of the IMAGINE intervention

Summarize what was accomplished with regard to these aims in the present quarter.

In the last quarter, we finalized the IMAGINE intervention, including adaptation of the Mothers and Babiescurriculum on which IMAGINE is based, as well as developing COVID-19 related content. Our intervention delivers the 6 Mothers and Babies modules through daily messages, interactive prompts, and reflection exercises designed to last 6-12 weeks. Adapting Mothers and Babies content involved shortening content and making it less wordy and more visual, in order to retain participants’ attention when using a remote platform and cater to their younger age.We are in the process of preparing a manuscript summarizing the adaptation process that led to development of IMAGINE.

We have created a separate channel in Slack, the intervention platform, for COVID-19 related messaging. COVID-19-related messages will be posted in a channel named “ask an expert” once per week or as requested by participants. These messages include simple messages summarizing current guidelines for prenatal care, delivery, and neonatal care to mitigate risks of COVID-19, and linking to online and social mediasources of information.

We began recruitment for the IMAGINE pilot in September 2020, and have been in contact with 10 potential participants.To date, one participant has been screened for eligibility to participate in the study.

Quarter 4

Briefly restate the specific aims or objectives associated with this project

Aim 1: To develop a social media group counseling intervention to prevent perinatal depressive symptoms in adolescents in the Seattle, WA, area.

Aim 2: To evaluate the intervention’s uptake, acceptability, and preliminary impact on mental wellness in a pilot with pregnant adolescents.

Aim 3: To characterize content and patterns of participant engagement with the intervention and identify associations between engagement, content, and mental wellness.

Briefly summarize (3-5 sentences) what was accomplished with regard to these aims in the present quarter.

In the last quarter, we analyzed data from the first round of formative interviews and began developing intervention content. Both youth and providers supported the idea of a phone-based facilitated peer group to support youth’s peripartum mental health. However, they highlighted that many aspects of youth’s lives impact their mental health, such as navigating benefits programs, getting answers to pregnancy- related medical concerns, relationship challenges – and they desire a safe, anonymous space for holistic support. This shaped our choice of delivery platform for the IMAGINE study: we are planning to use Slack, since it offers multiple channels for different topics and provides anonymity.

In what way did your project provide opportunities for training or professional development?

The PI has been able to deepen her skills in intervention development and mental healthcare provision by working collaboratively with a psychiatrist and behavioral scientist. Additionally, the logistical challenges associated with conducting this study with a marginalized population at a time of severe healthcare system disruption provided opportunities for the team to develop new community relationships and approaches to recruitment.

Quarter 3

Tell us about key learnings you’ve uncovered over the course of your project, including advice you might give to investigators conducting similar work.

We are learning a lot about the challenges of reaching youth participants through clinical settings, especially our target population which is generally underserved, vulnerable, and has historical mistrust of the medical system. Of the approaches we have explored, we’ve found old-fashioned, in-person, community-based recruitment through trusted networks (public health nurses with long-term relationships with their clients, and youth peers) to be the most successful means of recruiting. We’re also re-learning the importance of bringing youth into our study team (a value we know the TAM community embraces) – and also how challenging it is to build the connections necessary to do that in the first place.

Quarter 2

Tell us about the anticipated or real-time impact of this project.

We anticipate that completion of these aims will generate insights about young mothers’ mental health support needs and preferences with respect to use of social media platforms. It will also generate a social media intervention based on the Mothers and Babies program that can be used by others in the community. Completing the pilot will provide preliminary data on the acceptability and impact of the intervention on young women’s mental health, which will allow us to pursue larger scale funding for evaluation of efficacy.

Tell us about problems encountered, changes to your approach, and reasons behind these changes.

Three of our partner clinics have been distributing flyers to recruit youth but we have not been contacted by any youth participants so far. We are in the process of discussing this with the clinics to identify and address potential barriers and additional venues. We are also exploring recruiting through Facebook and Instagram, and plan to seek advice from our community advisory board. We welcome suggestions from SMAHRT and the TAM community to recruit young mothers.

Quarter 1

Tell us what excites you about the funded project.

Everyone on the team cares deeply about maternal mental health disparities, but this project represents a new research direction and new collaborations for us. The PI’s previous work has involved development and evaluation of social media interventions for adolescents in Kenya, and we are thrilled to combine lessons learned from that work with the expertise of the other team members to create new partnerships and projects in a new area. We especially value the opportunity to collect detailed formative data from the young women we aim to serve to deepen our understanding and drive development of a responsive intervention.

Tell us more about your team! 

Keshet Ronen, Clinical Assistant Professor, Department of Global Health, University of Washington: Keshet holds a PhD in cell and molecular biology but realized as a PhD student that her true passion lay in doing research that addresses global health disparities. Outside of work, Keshet enjoys spending time outside – hiking in the mountains of the Pacific Northwest, riding her bicycle around Seattle, and protecting her backyard chickens from hawk attacks.

Jennifer Unger, Assistant Professor, Departments of Global Health and Obstetrics and Gynecology, University of Washington: Jennifer is an obstetrician-gynecologist and clinical researcher focusing on the utilization of novel technologies and behavioral interventions to improve global maternal child health and family planning. Outside of work, Jennifer enjoys traveling, cooking, and spending time outdoors with her family.

Amritha Bhat, Assistant Professor, Department of Psychiatry and Behavioral Science, University of Washington: Amritha is a psychiatrist whose clinical practice and research focus on the mental health of pregnant and postpartum women. Outside of work, she enjoys bicycling and listening to music.

Yolanda Evans, Associate Professor, Department of Pediatrics, University of Washington and Seattle Children’s Hospital: Yolanda is an adolescent medicine physician who provides care to adolescents in the Seattle area for a variety of concerns including eating disorders, obesity, reproductive health and ADHD. Outside of work, Yolanda plays the cello, is a regular blood donor and is involved with her children’s schools.

Elise Healy, Research Assistant, Department of Global Health, University of Washington: Elise Healy is a second-year Master of Public Health student in the Department of Global Health at the University of Washington. Outside of work, Elise enjoys exploring art museums, cooking new recipes, spending time outdoors, and making block prints.