Intervention description {11a}
depression
The intervention has been pilot tested with pregnant individuals and is comprised of a BA therapy module, a short workbook, and informal peer support from study entry until 6 weeks postpartum. The intervention will be primarily administered through the secure and encrypted Zoom for Healthcare by trained peer counsellors (below); peer counsellors will also connect with participants over the telephone as needed (e.g. check-ins) or based on barriers to videoconference (e.g. technical issues, no internet or camera). The counselling module is aligned with the BA treatment manual, adapted from the Alma BA peer-mentorship intervention [Peer counsellors, defined as individuals with previous lived experience of antenatal or postpartum depression, who are stable and recovered, will be recruited from Calgary, Alberta using social media and advertising on post-secondary campuses. Interested peers will be screened for eligibility and suitability, following provision of a separate informed consent to research assistants, the criteria for which include: completion of a minimum of some post-secondary education, demonstrated basic understanding of mental health, and openness to evidence-based treatments for depression. After providing informed consent, peer counsellors will complete a 4-week training program adapted from a previous pilot-tested BA training program. BA training consists of weekly asynchronous learning through online training videos and written content, weekly practice of skills as guided by the online content, and weekly virtual group meetings with other peer counsellors to review training content. These meetings will be facilitated by a supervising clinical psychologist certified in the Alma BA program and graduate trainees in clinical psychology (peer supervisors). Weekly training commitment is estimated at 3 h total on average, with options for additional training support as requested or deemed necessary. The weekly virtual meetings will consist of brief didactic review of the weekly content led by supervisors (i.e., graduate students or clinical psychologist), opportunity for questions and discussions of the weekly content, and live skill practice with other peer counsellors and supervisors. Supervisors will have a minimum of one hour of virtual face-to-face contact with peer counsellors (e.g. during weekly virtual group sessions or one-on-one check-in if absent) during the training to provide feedback on skill development and connect with peers requiring additional training support. Peer counsellors will engage in mock-counselling role plays with trainers and other peers (observed by trainers) throughout training to ensure their proficiency in applying the therapeutic skillset developed from the training modules. Trainers will meet following training sessions to discuss the ongoing evaluation of peer counsellors using a standardized scoring system (Additional file SPIRIT schedule of enrolment, intervention, and assessmentsOnce the peer counsellors have obtained their competency approval, they will be paired with a single randomized participant and will establish contact with them to initiate and administer the intervention. The peer-delivered intervention will be conducted through Zoom for Healthcare and telephone contact between the peer counsellors and participants. Zoom sessions will be recorded for the purposes of supervision, which is intended for both clinical oversight and continued refinement of peer counsellor’s competencies and therapeutic skillset. In addition to between 6 and 8 structured BA therapy sessions, peer counsellors will also provide informal and unstructured peer support via telephone and/or text. This will include both participant-initiated and peer counsellor-initiated check-ins, sharing of information, and peer guidance. The peer support component will be available to participants up to 6 weeks postpartum, for a total possible length of time of 12 weeks. Peer counsellors may opt to be paired with subsequent participants following completion of the intervention and peer support components. All peer counsellors will receive weekly mandatory clinical supervision via 60-min remote group meetings provided by a clinical psychology graduate trainee, and additional individual supervision meetings as needed, to ensure patient safety and treatment fidelity, and peer counsellor adherence to the protocol. All trainee peer supervisors will be supervised by a registered clinical psychologist through regular virtual group supervision and one-on-one supervision as needed. Fidelity will be addressed with the weekly supervision sessions with the peer counsellors. During the weekly supervision sessions, it will be emphasized that external resources outside of what we provide them cannot be recommended. We will also request that peer counsellors keep an informal record of peer support that they deliver, which will be reviewed during supervision. Peer counsellors will be offered a stipend of $250 for each intervention cycle administered to a single participant, to acknowledge their time and contribution to the study. Following their final intervention cycle in the current study, peers will be invited to complete a qualitative individual in-depth interview, conducted by a trained research assistant under the supervision of the PIs (Chaput, Tomfohr-Madsen). Interviews will elicit reflective conversation around the experiences of peers in delivering the intervention, and any perceived positive or negative impacts the experience may have on their well-being. We will also explore their thoughts and opinions on strengths and weaknesses of the intervention and its delivery (including the training experience) and whether they have suggestions for improvement in the future.The control group will receive standard of care, including receiving routine obstetric care and referral to community mental health resources, and will also complete all study assessments.