1. • This poster proposes using existing staff at a
maternal wellness clinic with an integrative care
model to provide doulas with training and
consultation in CBT principles.
Objectives
• New care models for maternal health clinics such
as the proposed offer an opportunity to
incorporate doulas into standard practice while
offering doulas the opportunity to access and
adequately support a broad base of clients.
• CBT has been successfully incorporated into
task-shifting models for maternal mental health
internationally (Patel & Kirkwood 2008; Rahman
et al., 2008). The current model considers a task-
shifting approach for the American reproductive
and mental health care systems.
• Successful implementation of this model could
offer insight into training for other types of
doulas (e.g., abortion, postpartum, bereavement)
in CBT principles.
• Limitations of this model include the
implementation challenges of any novel
intervention, such as feasibility and sustainability
(e.g., protected psychologist and/or social worker
time for consultation), funding, monitoring, and
standardization of workshop training. The
model also assumes a co-located care model with
a CBT expert therapist on staff. Additionally, the
model assumes a well-managed doula collective
that adheres to practice guidelines outlined by
professional accrediting organizations.
Discussion
• Doulas are persons trained and experienced in
childbirth who provide continuous
physical, emotional, and informational support to
mother and family before, during and just after
birth.
• Benefits of doulas are well-documented, including
decreased cesarean section and epidural
rates, decreased instrumental and pharmacological
interventions, increased initiation of
breastfeeding, maternal-infant bonding, and patient
satisfaction (Hodnett et al., 2012). There are
emerging calls for doulas to be integrated into
standard maternal health care (Kozhimannil et
al., 2013).
• Despite these benefits and the growing presence
of doulas in clinical settings, there remains a
perceived tension between the medical model and
the doula care model (Hunter, 2012).
• Empirical research suggests pregnancy and the
postpartum period account for the highest
prevalence of mental health problems (e.g., anxiety
and depression) in a woman's life (Botega &
Dias, 2006). Cognitive-behavioral therapy (CBT) is
an evidence-based practice (EBP) for these
disorders but a research-to-practice gap remains
(Beidas et al., 2012). Suggestions for addressing
this gap include utilizing paraprofessionals
(Rotheram-Borus et al., 2012). Doulas are a
potential paraprofessional cohort to increase the
implementation of EBPs in maternal health.
Background
Doulas to fill the gap: a proposed model of doula delivery of
cognitive-behavioral therapy principles for maternal
internalizing disorders
Margaret Mary Downey, BA; and Rinad Beidas, PhD
University of Pennsylvania Perelman School of Medicine, Center for Mental Health Policy and Services Research
Doula
Collective
Hospitals
Maternal
Wellness
Clinics
Birth
Centers
Home
Births
Maternal Health
Clinic
OngoingConsultation
• Co-located care
model
• Expert therapist
Patients
Outreach
Thanks to Rinad Beidas, PhD; and to Delane Casiano; PhD; Jabina Coleman, MSW, CLC; Sara Kornfield, PhD;
and all staff at the Helen O. Dickens Center for Women’s Health at the University of Pennsylvania
Hires a
Provides CBT informed care