Walk with Me (WWM) for Perinatal Grief

7. PROJECT SUMMARY Pregnancy and infant loss (perinatal loss) impact approximately one in four families in the United States. Three out of five mental health related perinatal deaths are caused by suicide. Parents who have a perinatal loss are often not the focus of suicide prevention. Additionally, posttraumatic stress disorder is more common among birthing people who have a perinatal loss compared to birthing people who do not. This reflects the acute, somatic, distressing, and often disenfranchised (e.g., dismissed or ignored) experiences of bereaved parents. Compounding the heightened distress experienced by many parents after the death of their baby, there are few resources and those that do exist are often inconsistent and do not provide evidence-based therapeutic content. Approximately half of Americans live in an area with a mental health professional shortage. Even when counseling services are available, there are few providers specifically trained to support bereaved parents. In Phase I, we developed a functional prototype of Along With Me for perinatal grief (AWM), a web- based application that combines therapeutic content for bereaved parents and healthcare professional training. Our clinical trial yielded moderate effect sizes for improving grief self-efficacy and reducing post-traumatic stress avoidance symptoms. These findings were in line with our theory of change and study developed application modules. Our successful Phase I results suggest we can confidently move to Phase II to build additional cognitive behavioral therapy modules to support bereaved parents, tailor content for parents who speak Spanish and those who have experienced miscarriage, complete a randomized controlled trial to establish the evidence base for AWM, and enhance the product for adoption. Phase II development and evaluation of the dual-language tool will allow us to create a commercially-viable product for adoption by healthcare organizations. To accomplish this goal, we will achieve three specific aims: (Aim 1) Complete development of an enhanced AWM application informed by the formative, usability, and outcome data generated from Phase I, by a diverse bereaved parent community board (n = 12), and by healthcare administrators. (Aim 2) Pilot and assess the usability of the AWM mobile app with English- and Spanish- speaking bereaved parents (n = 20) and healthcare professionals (n = 10) and make necessary revisions. Testing and feedback will occur in 3 waves to prepare the prototype for evaluation. (Aim 3) Conduct a clinical trial to evaluate the efficacy, acceptability, and usability of the AWM app with 300 recently bereaved parents randomly allocated to (a) services as usual (n = 100), (b) AWM alone (n = 100), or (c) AWM plus a peer guide (n = 100). Our primary outcomes will be posttraumatic stress symptoms and suicidal ideation. We hope to establish that AWM can prevent and address posttraumatic stress and suicidal ideation to improve outcomes for bereaved parents. Without dedicated resources toward intervention, bereaved parents, especially Black, Indigenous, and rural residing parents, will continue to have suboptimal access to evidence-based care.