Outcomes of the ROSE Sustainment (ROSES) Study, a sequential multiple assignment randomized implementation trial to determine the minimum necessary intervention to sustain a postpartum depression prevention program in agencies serving low-income pregnant people
Abstract Background This Sequential Multiple Assignment Randomized Trial (SMART) was conducted to determine minimum implementation support needed for agencies serving pregnant people on public assistance to adopt and sustain the ROSE (Reach Out, Stay Strong, Essentials for mothers of newborns) postp...
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BMC
2025-02-01
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| Series: | Implementation Science |
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| Online Access: | https://doi.org/10.1186/s13012-025-01420-z |
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| author | Jennifer E. Johnson Shannon Wiltsey-Stirman Alla Sikorskii Ted Miller Ellen Poleshuck Tiffany A. Moore Simas Laura Carravallah Raven Miller Caron Zlotnick |
| author_facet | Jennifer E. Johnson Shannon Wiltsey-Stirman Alla Sikorskii Ted Miller Ellen Poleshuck Tiffany A. Moore Simas Laura Carravallah Raven Miller Caron Zlotnick |
| author_sort | Jennifer E. Johnson |
| collection | DOAJ |
| description | Abstract Background This Sequential Multiple Assignment Randomized Trial (SMART) was conducted to determine minimum implementation support needed for agencies serving pregnant people on public assistance to adopt and sustain the ROSE (Reach Out, Stay Strong, Essentials for mothers of newborns) postpartum depression (PPD) prevention program. Methods Enrolled prenatal agencies (N=98) received thorough initial implementation support (initial training + written sustainment planning). Agencies were identified as at risk for non-sustainment within the first 15 months (N=56) were randomized to: (1) no additional implementation support (N=12), or (2) quarterly implementation support (coaching and feedback; N=44). If agencies receiving quarterly implementation supports were still at risk and within the first 15 months (N=29), they were randomized to: (1) continued quarterly support (N=14), or (2) monthly implementation support (N=15). No implementation support occurred after 18 months. Follow-ups occurred quarterly and then at 18, 24, and 30 months. Outcomes included sustainment of core program elements, agency PPD rates, reach, and costs/cost-effectiveness of each sustainment step. Results Twice as many agencies as expected (41 of 98; 42%) delivered ROSE with fidelity for 15+ months after receiving thorough initial implementation support only. For agencies at risk for non-sustainment, no effects of adding quarterly implementation supports were observed. However, adding monthly supports (versus quarterly) for agencies still at risk resulted in higher monthly percent of core ROSE elements sustained and more months ROSE was sustained with fidelity with large (Cohen’s d = 0.73 and 0.80) effect sizes, and improved reach over 30 months. Many agencies did not consistently collect PPD rates, making results difficult to interpret. Mean implementation costs (including implementation support and agency staff time) per agency were $1,849 (SD $1,429) for agencies receiving initial implementation support only, $2,699 (SD $1,837) for those receiving initial and quarterly implementation support, and $4,059 (SD $1,763) for those receiving initial, quarterly, and ultimately monthly implementation support. Conclusions The cost of agency-wide ROSE implementation is far less than the cost of a single untreated case of PPD ($33,484). We suggest implementing ROSE through thorough training and written sustainment planning. For agencies not sustaining, adding monthly support can promote sustainment and improve reach. Trial registration Registered June 14, 2018 at clinicaltrials.gov, NCT03267563 ( https://clinicaltrials.gov/study/NCT03267563 ). |
| format | Article |
| id | doaj-art-b329944e8d084ced957290b5fd1d444c |
| institution | DOAJ |
| issn | 1748-5908 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | BMC |
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| series | Implementation Science |
| spelling | doaj-art-b329944e8d084ced957290b5fd1d444c2025-08-20T03:00:58ZengBMCImplementation Science1748-59082025-02-0120111710.1186/s13012-025-01420-zOutcomes of the ROSE Sustainment (ROSES) Study, a sequential multiple assignment randomized implementation trial to determine the minimum necessary intervention to sustain a postpartum depression prevention program in agencies serving low-income pregnant peopleJennifer E. Johnson0Shannon Wiltsey-Stirman1Alla Sikorskii2Ted Miller3Ellen Poleshuck4Tiffany A. Moore Simas5Laura Carravallah6Raven Miller7Caron Zlotnick8Charles Stewart Mott Department of Public Health, Michigan State UniversityNational Center for PTSD, Department of Psychiatry and Behavioral Sciences, Dissemination and Training Division and Stanford UniversityDepartment of Psychiatry, Michigan State UniversityPacific Institute for Research and EvaluationUniversity of Rochester Medical CenterUniversity of Massachusetts Chan Medical School/UMass Memorial Health, Memorial CampusDepartment of Pediatrics and Human Development, Michigan State University, Life SciencesCharles Stewart Mott Department of Public Health, Michigan State UniversityButler Hospital and Brown UniversityAbstract Background This Sequential Multiple Assignment Randomized Trial (SMART) was conducted to determine minimum implementation support needed for agencies serving pregnant people on public assistance to adopt and sustain the ROSE (Reach Out, Stay Strong, Essentials for mothers of newborns) postpartum depression (PPD) prevention program. Methods Enrolled prenatal agencies (N=98) received thorough initial implementation support (initial training + written sustainment planning). Agencies were identified as at risk for non-sustainment within the first 15 months (N=56) were randomized to: (1) no additional implementation support (N=12), or (2) quarterly implementation support (coaching and feedback; N=44). If agencies receiving quarterly implementation supports were still at risk and within the first 15 months (N=29), they were randomized to: (1) continued quarterly support (N=14), or (2) monthly implementation support (N=15). No implementation support occurred after 18 months. Follow-ups occurred quarterly and then at 18, 24, and 30 months. Outcomes included sustainment of core program elements, agency PPD rates, reach, and costs/cost-effectiveness of each sustainment step. Results Twice as many agencies as expected (41 of 98; 42%) delivered ROSE with fidelity for 15+ months after receiving thorough initial implementation support only. For agencies at risk for non-sustainment, no effects of adding quarterly implementation supports were observed. However, adding monthly supports (versus quarterly) for agencies still at risk resulted in higher monthly percent of core ROSE elements sustained and more months ROSE was sustained with fidelity with large (Cohen’s d = 0.73 and 0.80) effect sizes, and improved reach over 30 months. Many agencies did not consistently collect PPD rates, making results difficult to interpret. Mean implementation costs (including implementation support and agency staff time) per agency were $1,849 (SD $1,429) for agencies receiving initial implementation support only, $2,699 (SD $1,837) for those receiving initial and quarterly implementation support, and $4,059 (SD $1,763) for those receiving initial, quarterly, and ultimately monthly implementation support. Conclusions The cost of agency-wide ROSE implementation is far less than the cost of a single untreated case of PPD ($33,484). We suggest implementing ROSE through thorough training and written sustainment planning. For agencies not sustaining, adding monthly support can promote sustainment and improve reach. Trial registration Registered June 14, 2018 at clinicaltrials.gov, NCT03267563 ( https://clinicaltrials.gov/study/NCT03267563 ).https://doi.org/10.1186/s13012-025-01420-zImplementationSustainmentCost-effectivenessPostpartum depressionPreventionPublic assistance |
| spellingShingle | Jennifer E. Johnson Shannon Wiltsey-Stirman Alla Sikorskii Ted Miller Ellen Poleshuck Tiffany A. Moore Simas Laura Carravallah Raven Miller Caron Zlotnick Outcomes of the ROSE Sustainment (ROSES) Study, a sequential multiple assignment randomized implementation trial to determine the minimum necessary intervention to sustain a postpartum depression prevention program in agencies serving low-income pregnant people Implementation Science Implementation Sustainment Cost-effectiveness Postpartum depression Prevention Public assistance |
| title | Outcomes of the ROSE Sustainment (ROSES) Study, a sequential multiple assignment randomized implementation trial to determine the minimum necessary intervention to sustain a postpartum depression prevention program in agencies serving low-income pregnant people |
| title_full | Outcomes of the ROSE Sustainment (ROSES) Study, a sequential multiple assignment randomized implementation trial to determine the minimum necessary intervention to sustain a postpartum depression prevention program in agencies serving low-income pregnant people |
| title_fullStr | Outcomes of the ROSE Sustainment (ROSES) Study, a sequential multiple assignment randomized implementation trial to determine the minimum necessary intervention to sustain a postpartum depression prevention program in agencies serving low-income pregnant people |
| title_full_unstemmed | Outcomes of the ROSE Sustainment (ROSES) Study, a sequential multiple assignment randomized implementation trial to determine the minimum necessary intervention to sustain a postpartum depression prevention program in agencies serving low-income pregnant people |
| title_short | Outcomes of the ROSE Sustainment (ROSES) Study, a sequential multiple assignment randomized implementation trial to determine the minimum necessary intervention to sustain a postpartum depression prevention program in agencies serving low-income pregnant people |
| title_sort | outcomes of the rose sustainment roses study a sequential multiple assignment randomized implementation trial to determine the minimum necessary intervention to sustain a postpartum depression prevention program in agencies serving low income pregnant people |
| topic | Implementation Sustainment Cost-effectiveness Postpartum depression Prevention Public assistance |
| url | https://doi.org/10.1186/s13012-025-01420-z |
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