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www.piri.org.au

PARENT-INFANT RESEARCH INSTITUTE (PIRI)

Submission to the Parliamentary Inquiry into Perinatal Services

Prepared by Professor Jeannette Milgrom, Director, PIRI and

Dr. Alan Gemmill, Senior Research Fellow, PIRI

August 2017

Contact: Professor Jeannette Milgrom

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Contents

Inquiry into Perinatal Services: Submission from the Parent-Infant Research Institute ............................................................................................................................................................. 1

Good mental health throughout life begins in the womb .................................................... 1

A perinatal mental health focus is central to planning effective, comprehensive

perinatal health services ................................................................................................................... 1

Failure to detect and treat perinatal depression and anxiety incurs enormous

social and economic costs ................................................................................................................. 2

Availability, quality and safety of health services delivering services to women and their babies during the perinatal period ............................................................................. 2

Safety and quality in perinatal mental health care ............................................................ 2

Innovative e-mental health supports ....................................................................................... 2

Readily accessible interventions to support early mother-infant attachment ...... 3

Impact of loss of commonwealth funding (in particular, the National Perinatal Depression Initiative) ............................................................................................................................... 3

With the loss of NPDI funding, there remains an ongoing need .................................. 3

Access to and provision of an appropriately qualified workforce, including midwives, paediatricians, obstetricians, general practitioners, anaesthetists, maternal and child health nurses, mental health practitioners and lactation consultants across Victoria ................................................................................................................... 4

Stigma and discrimination reduction ...................................................................................... 4

The use of e-health technologies in a stepped-care model ............................................. 4

Evidence-based and effective workforce training .............................................................. 4

Disparity in outcomes between rural, regional and metropolitan locations ........... 4

The use of e-health technologies ................................................................................................ 4

Identification of best practice .............................................................................................................. 4

The best available research evidence ...................................................................................... 4

A focus on protecting the developmental prospects and future mental health of children ................................................................................................................................................. 5

Ongoing funding mechanisms for original research ......................................................... 5

The Clinical Practice Guidelines for Perinatal Mental Health .......................................... ................................................................................................................................................................... 5

About The Parent-Infant Research Institute ............................................................................... 5

Conclusion ....................................................................................................................................................... 5

References ....................................................................................................................................................... 6

1 PARENT-INFANT RESEARCH INSTITUTE 2017

Inquiry into Perinatal Services: Submission from the Parent-Infant Research

Institute

The Parent-Infant Research Institute (PIRI) welcomes the Victorian Parliament’s Inquiry

into Perinatal Services. Our organisation works specifically in the area of perinatal mental

health care and services. As such, we have commented on those items in the Inquiry’s

Terms of Reference which are most relevant to mental health care in the perinatal period.

PIRI is dedicated to tackling perinatal depression, anxiety and their consequences through

research and translating research evidence to practice. We recognise that prevention and

very early intervention, from pregnancy and throughout the postpartum period and early

infancy, is the ultimate upstream point of service delivery and key to interrupting the

intergenerational impact of mental health difficulties.

We have compiled the following brief comments and suggestions relating to achieving the

specific issue of improving perinatal mental health care.

We suggest how a stronger prevention and early intervention focus on perinatal mental

health (and on very early infant development) could contribute to the vision of all

Victorians experiencing the best possible mental health throughout life.

Good mental health throughout life begins in the womb A perinatal mental health focus is central to planning effective, comprehensive

perinatal health services. Approximately 100,000 new parents struggle with

depression or anxiety each year. There is increasing international awareness that

maternal depression in pregnancy has profound negative consequences on the

fetus and on children’s future wellbeing and development (see Science Vol 345,

August 2014, special issue on parenting; http://www.1001criticaldays.co.uk and

www.everyonesbusiness.org.uk).

Among mothers suffering either antenatal or postnatal depression and anxiety,

children followed through infancy, adolescence and early adulthood have been

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found to have substantially higher risk of enduring mental health, cognitive and/or

behavioural problems (Capron et al., 2015; Glover, 2015; Milgrom et al., 2004;

O’Donnell et al., 2014). Directly relevant to this, we have published the first

evidence that treating maternal depression in pregnancy can promote better

developmental outcomes in children (Milgrom et al., 2015).

Prevention, identification and early intervention for perinatal mental health

difficulties provides a huge opportunity to protect and optimise the trajectory of

infant development and this should be a key foundation of the wider mental

health strategy for all Victorians.

Failure to detect and treat perinatal depression and anxiety incurs enormous

social and economic costs. The London School of Economics recently reported an

£8.1 billion cost to society of perinatal mental illness for every one-year UK cohort

of births (Bauer et al., 2014). In Australia, the figures provided by Deloitte Access

Economics (Deloitte Access Economics, 2012) for the total annual cost of perinatal

depression are consistent with this on a per capita basis (but do not include the

costs of the enduring lifetime impact on children).

Availability, quality and safety of health services delivering services to

women and their babies during the perinatal period

Safety and quality in perinatal mental health care We see regular reporting on measurable indicators as central to ongoing

improvement in perinatal mental health services.

Innovative e-mental health supports tailored for particular groups and vulnerable

populations have an expanding evidence base with good results for efficacy and

cost-effectiveness. These will become an increasingly important part of future

service delivery. This is particularly relevant to the perinatal mental health area as

new parents often find it difficult to access traditional services and face-to-face

clinics due to the demands of caring for an infant and the perceived stigma of

perinatal mental health problems. The use of e-health technologies in a stepped-

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care, person-centered model lends itself to wider availability, accessibility and

better coordination of treatment services.

Readily accessible interventions to support early mother-infant attachment and

bonding are lacking in the current system. A secure attachment relationship with a

responsive caregiver is a fundamental requirement for healthy, optimal

development in human infants (Science Vol 345, August 2014, special issue on

parenting). The best scientific evidence shows that, even when maternal

depression is treated successfully, this does not redress the damage and disruption

done to early mother-infant relationships by perinatal mental health difficulties. A

specific program of mother-infant interventions and supports is required to ensure

the best start to life for infants in families affected by perinatal depression and

anxiety. Treating the maternal depression is vital and necessary, but alone it is

insufficient to protect children’s developmental prospects.

Impact of loss of commonwealth funding (in particular, the National

Perinatal Depression Initiative)

With the loss of NPDI funding, there remains an ongoing need for an evidence-

based and specific strategy to increase early identification and link this to uptake

of effective treatment of perinatal mental health and emotional problems.

Perinatal depression and anxiety are common and have devastating and costly

consequences. Most cases are not identified (60%), and the vast majority (90%)

never receive adequate treatment even when identified. Screening for perinatal

depression is Australia’s national recommendation, but many professionals lack

on-the-spot access to gold-standard guidance for interpreting, and acting on,

women’s screening results. This is a major gap that could be addressed by the

introduction of digital systems to guide professionals with on-screen prompts for

interpretation of screening results and psychosocial information adhering to

national guidelines. This would allow the user to develop a structured

management plan tailored to each client’s needs and have an electronically

produced onward referral form. PIRI has completed a pilot cluster trial of such an

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electronic clinical decision support system (PIRIMIDPIRI) with good uptake and user-

satisfaction rates. Current evidence shows that electronic perinatal depression

screening is feasible, but there has been insufficient attention to translating this

into increased treatment uptake and better mental health outcomes.

Access to and provision of an appropriately qualified workforce, including

midwives, paediatricians, obstetricians, general practitioners,

anaesthetists, maternal and child health nurses, mental health practitioners

and lactation consultants across Victoria

Stigma and discrimination reduction Stigma is one of the major reasons that men and women with mental health

problems fail to seek effective help in the perinatal period.

The use of e-health technologies in a stepped-care model lends itself to

expanding access to evidence-based treatment services.

Evidence-based and effective workforce training, such as that delivered by our

institute to every Maternal & Child Health Service in Victoria, is essential to the

provision of adequate perinatal mental health care.

Disparity in outcomes between rural, regional and metropolitan locations The use of e-health technologies in a stepped-care model lends itself to expanding

access to evidence-based treatment services irrespective of geography. Perinatal

women living in regional, rural and remote communities often lack access to

coordinated specialist services and trained mental health workers and this along

with fear of stigma can contribute to disappointingly low rates of treatment

Identification of best practice The best available research evidence emphasizes the need for

identification/screening programs that are integrated with pathways to care and

coordinated with workforce training (Milgrom & Gemmill, 2014; Milgrom &

Gemmill, 2015).

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A focus on protecting the developmental prospects and future mental health of

children: there is a need to better emphasize the need to act as early as possible,

not only from childhood but in pregnancy and early infancy, as the key to

interrupting intergenerational transmission.

Ongoing funding mechanisms for original research into the improvement of

perinatal mental health services, especially translational research, are key to

identifying best practice, evidence-based approaches and bringing them into real-

world services.

The soon-to-be updated Clinical Practice Guidelines for Perinatal Mental Health

offer the best evidence-based guidance available in the Australian context.

Adherence to the national guidelines should be a key consideration in the delivery

of perinatal mental health services.

Conclusion We urge the Inquiry to include a specific focus on improving perinatal mental health

services, and integrated identification and intervention programs in this most crucial of

areas. A focus on the more specific issues outlined above, which if successfully addressed

would do much to underpin an efficient and effective perinatal mental health policy into

the future. As perinatal mental health specialists, we would again emphasize that in

planning for the good mental health of all Victorians throughout life, the critical

importance of perinatal care along with prevention and early intervention in the very

earliest stages of life (conception to 2 years) must take a central place.

About The Parent-Infant Research Institute At the Parent-Infant Research Institute, we have completed a substantial body of work

addressing the above issues. Attached is an overview of our work in developing cost-

effective screening and evidence-based treatment approaches and evaluations

(Attachment 1: Transforming the Lives of Parents and Infants; Attachment 2: PIRI

Programs). We have been engaged in perinatal mental health research for 15 years,

including a close collaboration with beyondblue. During that period we have screened tens

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of thousands of perinatal women and developed new e-systems for screening, integrated

with e-treatment, in a model suitable for widespread dissemination for self care and

community based care. For example, our evidence-based online Mum Mood Booster

program has been validated as an effective treatment for postnatal depression (Danaher

et al., 2013) and an antenatal version, Mum 2B Mood Booster, has been developed. We

believe that developments in e-health point the way for the future in terms of cost-

effective, accessible treatment options. Our focus is on building resilience in families with

targeted treatments (including recognition of the importance of not only mothers and

babies, but father’s mental health) and assessment of very early risk situations (maternal

suicide or preventing trauma and maltreatment in infancy). We have developed

interventions using a range of delivery modes (individual, group, telephone, self-help, e-

health) working closely with GPs and maternal and child health nurses. For example,

Towards Parenthood is an evaluated, universal program addressing transition to

parenthood that also helps to reduces emotional difficulties (Milgrom, Schembri et al.,

2011). We also have a strong focus on prevention and workplace training.

References Bauer, A., Parsonage, M., Knapp, M., Iemmi, V., & Adelaja, B. (2014). The costs of perinatal mental

health problems. London: London School of Economics and the Centre for Mental Health.

Capron, L. E., Glover, V., Pearson, R. M., Evans, J., O'Connor, T. G., Stein, A., . . . Ramchandani, P. G.

(2015). Associations of maternal and paternal antenatal mood with offspring anxiety

disorder at age 18 years. J Affect Disord, 187, 20-26.

Danaher, B.G., Milgrom, J., Seeley, J.R., Stuart, S., Schembri, C., Tyler, M.S., Ericksen, J., Lester, W.,

Gemmill, A.W., Kosty, D. & Lewinsohn, P. (2013). MumMoodBooster Web-Based

Intervention for Postpartum Depression: Feasibility Trial Results. Journal of Medical

Internet Research, 15(11), e242

Deloitte Access Economics. 2012. The cost of perinatal depression in Australia. Report to the Post-

and Antenatal Depression Association.

Glover, V. (2015). Prenatal stress and its effects on the fetus and child: possible underlying

biological mechanisms. Advances in Neurobiology, 10, 269-283.

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Milgrom, J., Westley, D. & Gemmill, A.W. (2004). The mediating role of maternal responsiveness in

some longer-term effects of postnatal depression on infant development. Infant Behavior

& Development, 27, 443-454.

Milgrom, J., Schembri, C., Ericksen, J., Ross, J., & Gemmill, A. W. (2011). Towards parenthood: An

antenatal intervention to reduce depression, anxiety and parenting difficulties. Journal of

Affective Disorders, 130(3), 385-394.

Milgrom, J., Holt, C., Holt, C., Ross, J., Ericksen, J., & Gemmill, A.W. (2015). A Feasibility Study and

Pilot Randomised Trial of an Antenatal Depression Treatment with Infant Follow-up.

Archives of Women's Mental Health. E-Publication ahead of print DOI: 10.1007 /s007 37 -

015-0512-5

Milgrom, J., & Gemmill, A.W. (Eds.). (2015). Identifying Perinatal Depression and Anxiety: Evidence-

based Practice in Screening, Psychosocial Assessment and Management. Chichester:

Wiley-Blackwell.

Milgrom, J. & Gemmill, A.W. (2014). Screening for Perinatal Depression. Best Practice & Research:

Clinical Obstetrics & Gynaecology, 28(1), 13-23.

O'Donnell, K. J., Glover, V., Barker, E. D., & O'Connor, T. G. (2014). The persisting effect of

maternal mood in pregnancy on childhood psychopathology. Development and

Psychopathology, 26(2), 393-403.

Science, Volume 345, August 2014, Special Issue on Parenting.

We Are Passionate About Tackling

Perinatal Depression and AnxietyPerinatal depression and anxiety are the leading cause of maternal death and disability. They affect the development of many infants and unborn children and disrupt the rela�onship between mother and child. The long-term impacts on educa�onal a�ainment and health incur enormous costs into adulthood. Meanwhile, the s�gma associated with perinatal mental health problems means that women and men are frequently forced to hide their symptoms and avoid seeking treatment and care. Fewer than 50% of women seek or accept help, even when iden�fied as depressed and only 10% receive adequate, effec�ve treatment.

We believe this is unacceptable and we are determined to change it.

Who We Are & What We DoThe Parent-Infant Research Ins�tute (PIRI) is staffed by a team of researchers and expert clinicians. We are dedicated to tackling perinatal depression, anxiety and their consequences through research and transla�ng evidence into prac�ce.

We recognise that preven�on and very early interven�on, from pregnancy and throughout early infancy, are the keys to breaking the cycle of mental health difficul�es.

We have been engaged in perinatal mental health research and working with mothers, fathers and infants across two decades to successfully deliver large screening and treatment projects and public health ini�a�ves in close collabora�on with key stakeholders across the sector.

Find Out Today How You Can Work With

PIRI To Transform The FuturePIRI is a leader in developing and evalua�ng treatment programs to help parents and to support the early parent-infant rela�onship. We are now seeking your support, collabora�on and partnership for the essen�al work of transla�ng solid research evidence into a brighter future for all of Australia's mothers, fathers and babies. Ÿ PIRI’s researchers and clinicians are commi�ed to inves�ng in

strong, produc�ve research collabora�ons. Partner with us to deliver cu�ng-edge research.

Ÿ Many more families need access to evidence-based programs like those developed by PIRI. Partner with us to make it happen in your community.

Ÿ Our work depends on con�nued funding. Become a PIRI Sponsor

Parent-Infant Research Institute (PIRI)

Transforming the lives of parents and infants

Our MissionOriginal research into preven�ng, allevia�ng and reducing the consequences of perinatal mental health difficul�es

Transla�on of research into evidence based prac�ce.

Programs for mothers, fathers and babies

A stepped care approach to interven�on using digital technology

Training and skills building for health professionals

PIRI has developed a substan�al body of high quality applied research. Founded in 2001 to provide world class research and develop interven�ons, PIRI is part of Aus�n Life Sciences and is affiliated with the University of Melbourne through its Execu�ve Director, Professor Jeanne�e Milgrom. PIRI's team has an interna�onal reputa�on in the iden�fica�on and treatment of depression and anxiety for new parents, and how to protect and nurture parent-infant rela�onships in difficulty.

Every day, our programs are tackling the problems caused by perinatal mental health difficul�es.

Our Research Is Changing Perinatal

Mental Health CareMumMoodBooster (MMB): A new evidence-based online program for perinatal depression and anxiety. ⁽¹⁾

Bea�ng the Blues Before Birth (BBB): Antenatal CBT treatment to protect maternal mental health and neurodevelopment of unborn children and infants. ⁽²⁾

Happiness, Understanding, Giving and Sharing (HUGS): An interven�on to enhance the rela�onship between mother and infant. ⁽³⁾

Towards Parenthood: Preparing for the challenges of parenthood – A Workbook (e-book coming soon) ⁽⁴⁾ www.towardsparenthood.org.au

1. Milgrom et al. (2016). Internet Cogni�ve Behavioural Therapy for Women with Postnatal Depression: a randomised controlled trial of MumMoodBooster. Journal of Medical Internet Research, 18(3), e54.2. Milgrom et al., (2015). Feasibility study and pilot randomised trial of an antenatal depression treatment with infant follow-up. Archives of Women's Mental Health, 18(5), 717-730. 3. Milgrom, J., & Holt, C. (2014). Early interven�on to protect the mother-infant rela�onship following postnatal depression. Trials, 15, 385.4. Milgrom, J., Schembri, C., Ericksen, J., Ross, J., & Gemmill, A. (2011). Towards Parenthood: An Antenatal Interven�on to Reduce Depression, Anxiety and Paren�ng Difficul�es. Journal of Affec�ve Disorders, 130 (3), 385-394.

www.piri.org.au

Contact

Us Today!

Parent-Infant Research Ins�tute (PIRI)Aus�n HealthHeidelberg VIC 3084 Australia+613 9496 4009

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The Parent-Infant Research Institute (PIRI) supports all parents and their babies (prenatal to 2 years) to have the best possible start to life by creating a Centre of Excellence whose activities are designed to improve emotional wellbeing and optimise infant development. Visit us at www.piri.org.au.

PIRI was incorporated in 2001 to provide world class research and services to mothers, fathers and babies, health professionals and researchers. PIRI is part of Austin Life Sciences, a strategic partnership of research institutes at Austin Health, affiliated with the University of Melbourne through its Executive Director, Professor Jeannette Milgrom.

Intervention

Research

TrainingPublic health

OBJECTIVES: PIRI’s core activity is the conduct of basic and applied RESEARCH. In addition, translating knowledge to practice occurs through the development of parent-infant INTERVENTIONS and PUBLIC HEALTH initiatives. Education and TRAINING of professionals (online and face-to-face) is provided through workshops, study days and conferences.

PIRI PARENT-INFANT PROGRAMS

PIRI is a leader in developing and evaluating treatment programs to help parents make the transition to parenthood and to support the early parent-infant relationship. PIRI’s programs are brief and cost-effective. All programs have detailed manuals and have been evaluated as effective (or are in the process of evaluation). We are still recruiting to our latest programs! To make a referral or enquire about our programs and training, contact PIRI Infant Clinic: (03) 9496 4496; piri@austin.org.au.

PIRI PROGRAMSParent-Infant Research Institute

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OUR LATEST PROGRAMS

Motivational Interviewing: Promoting Motivation, Empowerment and Readiness (PRIMER)©

Substantial numbers of women with postnatal depression (PND) do not accept help. Our brief motivational interviewing intervention delivered by nurses prepares and motivates postnatal

women to take action for their own emotional health needs. Funding by Australian Rotary Health (ARH) for a cluster randomised trial.

Beating the Blues Before Birth©

Designed to treat depression and anxiety during pregnancy, 8 CBT sessions help women manage their mood with one couple session providing information and support to partners.

Evaluated in a RCT with benefits for mothers and infants. Funded by Bupa Health Foundation and ARF.

Mum Mood Booster Internet Treatment©

This internet treatment for postnatal depression (MumMoodBooster) addresses the unique needs of depressed postnatal women, including infant and partner relationships. MumMoodBooster consists of 6 interactive cognitive behavioural therapy (CBT) sessions as well as a library of companion articles on communication skills, problem solving, stress management, getting support, time management, sleep and caring for baby, baby’s needs and the couple relationship. There is also a web forum, telephone support and a partner support website. Funded by NIH, beyondblue, Windermere and NHMRC. Developed in collaboration with ORI, USA. Additional details about this innovative program are found in the Appendix.

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OUR WELL ESTABLISHED SIGNATURE PROGRAMS

OUR SPECIALIST MOTHER-INFANT ATTACHMENT PROGRAMS

BabyHUGS©

BabyHUGS is the most well established of our mother-infant relationship programs, and was developed to be implemented following treatment of maternal PND.

BabyHUGS consists of 4 sessions which assist mothers to become more fully engaged and attuned to their infant. Feasibility studies have demonstrated a rapid decline in parenting stress; BabyHUGS has just been successfully evaluated in RCT and developed also as an e-HUGS program. Funded by beyondblue.

Intuitive Mothering©, CommunityHUGS© and PremieStart©

Intuitive Mothering is an innovative 8-week programusing naturalmovement,holding patternsand imaginativeplay that occursbetween mother

and infant. It incorporates movement and dance with music and discussion with mothers about what they noticed in their baby’s play. CommunityHUGS is a 10 session playgroup designed for delivery in community settings and incorporates aspects of BabyHUGS, cognitive behaviour therapy, attachment theory and the Intuitive Mothering program. Its evaluation has demonstrated improvements in interaction, maternal anxiety, depression and stress. Funded by DSS.

PremieStart is an intervention that teaches parents about preterm infant behavioural responses, how to protect infants from stress whilst still in the Neonatal Intensive Care Unit and encourages sensitive involvement from the earliest point. This intervention improves parent-infant interactions and early developmental milestones. Funded by NHMRC.

Getting Ahead of Postnatal Depression Group Program©

This highly successful 12-week CBT group program is designed specifically for postnatal women to learn coping strategies to help manage their moods. 9 sessions cover understanding and managing moods; pleasant activities; relaxation on the run; assertiveness and self-esteem; unrealistic expectations of parenting and developing a more helpful thinking style. In addition, 3 couple sessions are held recognising the important role of fathers and the couple relationship. Evaluated in randomised controlled trials and rolled-out internationally.

Overcoming Depression©

This 7-week program is designed for primary care professionals as a counselling intervention informed by CBT. It has been evaluated in a randomised controlled trial and found to be a helpful supplement to GP practice and delivered effectively by nurses and psychologists.

Towards Parenthood©

The Towards Parenthood Program© for pregnant women and their partners prepares parents for the challenges of parenthood. The workbook and online version includes 9 chapters – 8 antenatal and one postnatal.Each chapter contains informationand activities to generate thoughtand reflection, conversation andcommunication between couples.It has been found to reduceparenting stress and enhance mood(www.towardsparenthood.org.au).

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APPENDIX

MUMMOODBOOSTER: INTERNET TREATMENT FOR POSTNATAL DEPRESSION

MumMoodBooster (MMB) is a secure, private Internet intervention that provides an important treatment option for women who are experiencing postnatal depression (PND). It is particularly helpful for women who might otherwise not seek treatment because of perceived stigma, cost, and logistical difficulties in scheduling clinic visits.

MMB was developed with assistance from a grant from the US National Institutes of Mental Health that was awarded to a multi-national team composed of researchers based in three organizations: Oregon Research Institute, Parent-Infant Research Institute (PIRI) in Melbourne, Australia, and the Iowa Depression and Clinical Research Center. The content of MMB was adapted from the pioneering Cognitive Behavioral Therapy (CBT) group treatment program (developed by PIRI) that proved to be helpful for hundreds of women suffering from PND. Over the past 4 years, MMB has been tested both in a feasibility study as well as in a randomized controlled trial that have established its effectiveness in reducing depression and its acceptability to women who have used it both in Australia and the United States (where it is called MomMoodBooster- the Australian version has its own Australian videos of a welcoming health professional and mothers describing their experiences). It is now also adapted for antenatal use (Mum2BMoodBooster).

Once a participant is enrolled in the MMB program, she is able to access each of the 6 sessions — one session per week. Session topics including psychoeducational information about PPD and practical strategies for managing moods, increasing pleasant activities, managing negative thoughts, increasing positive thoughts, and preventing a relapse. Sessions use text, interactions, animations, and videos to engage user interest and encourage follow-through practice of the skills. The program includes online tools to track and chart daily mood ratings and pleasant activities. MMB users can personalize their program content by typing in personal lists, by setting personal goals, and by performing practice change activities in their everyday routines. They can also visit the always-available library of relevant articles on communication skills, getting support, managing stress, managing time, solving problems, sleep and caring for baby, baby’s needs, and partner support.

Since depressed mothers of newborn babies often experience social isolation and Since depressed mothers of newborn babies often experience social isolation and stigma, the MMB program also provides access to a private peer-based Web forum in which mothers can post a message as well as read and interact with the messages of other participants.

MMB participants also receive phone calls from a Personal Coach that are designed to provide support, encourage program engagement, and clarify how best to use the online program. Personal Coaches can view an online digital dashboard describing the extent that each participant has used the program. The program also includes a Partner Support website and an Administration website.

MMB details can be reviewed in the following publications:

Danaher, B. G., Milgrom, J., Seeley, J. R., Stuart, S., Schembri, C., Tyler, M. S., . . . Lewinsohn, P. (2012). Web-based Intervention for postpartum depression: Formative research and design of the MomMoodBooster program. JMIR Research Protocols, 1(2), e18. DOI: 10.2196/resprot.2329 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3626158/

Danaher, B. G., Milgrom, J., Seeley, J. R., Stuart, S., Schembri, C., Tyler, M. S., . . . Lewinsohn, P. (2013). MomMoodBooster web-based intervention for postpartum depression: feasibility trial results. Journal of Medical Internet Research, 15(11), e242. DOI: 10.2196/jmir.2876 http://www.jmir.org/2013/11/e242/

Milgrom, J., Danaher, B.G., Holt, C., Holt, C.J., Seeley, J., Tyler, M.S., Ross J., Ericksen J. & Gemmill A.W., (2015) Internet cognitive behavioural therapy for women with postnatal depression: a randomised controlled trial of MumMoodBooster. Journal of Medical Internet Research (under Review)

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Parent-Infant Research Institute www.piri.org.au