We’d love to hear your feedback on the SUMMIT Implementation Toolkit! Click here to complete the Google form.
This toolkit provides information, materials, and procedures to help organizations implement the Behavioural Activation (BA) Program if funding, personnel, and resources are available. The BA program has been inspired by the findings of the SUMMIT trial, which found that “non-mental health specialists,” like nurses and midwives, could be trained to deliver BA – a brief talk therapy – either in-person or online to improve depression and/or anxiety symptoms for pregnant and postpartum people.
This toolkit is designed for healthcare administrators, mental health providers, healthcare professionals and support workers who want to provide holistic care for perinatal patients experiencing depression and/or anxiety.
Why Implement Behavioural Activation (BA) for Perinatal Depression/Anxiety?
Common conditions such as depression and anxiety in pregnant and postpartum populations is a prominent public health concern in Canada and the United States. Untreated mental health issues can negatively impact pregnant and postpartum people, as well as their children, their families, and society at large.
Depression and anxiety can be effectively treated with talk therapy, however, pregnant and postpartum people are often placed on long waitlists. This means they do not receive critical mental health care when and how they need it.
More mental health providers and avenues to deliver treatment are required to meet the needs of pregnant and postpartum people.
Fast Facts
- The perinatal period – defined as the time between pregnancy and up to one year postpartum – is a critical time when individuals are at risk of developing mental illness with long-term consequences for themselves and their families.
- 1 in 5 pregnant and postpartum individuals experience depression and anxiety symptoms during the perinatal period, but less than 10% of those have access to minimally adequate treatment.
- 20% of pregnant and postpartum individuals who experience symptoms of depression and/or anxiety will also experience suicidal thoughts or self-harm.
- Untreated mental illness during pregnancy and postpartum impacts children, which can result in low birth weight, emotional and behavioral issues in childhood, and impaired cognitive development.
- Globally, only 3% of mental health studies explicitly address women’s health, with even fewer considering perinatal populations and evaluating telemedicine platforms.
- The SUMMIT study fills a gap in mental health research for those who are pregnant and postpartum.
Parenting is a difficult job and can be even more challenging for those experiencing depression and/or anxiety.
Behavioral Activation (BA) treatment offers hope for new and expecting parents by reducing symptoms of depression and/or anxiety through straightforward, evidence-based solutions: Task-Sharing & Telemedicine.
The PCORI-funded Scaling Up for Maternal Mental healthcare by Increasing access to Treatment (SUMMIT) trial was a clinical trial conducted across three hubs in North America: Toronto, Ontario; Chicago, Illinois; and Chapel Hill, North Carolina.
1,230 pregnant and postpartum women participated in the study and almost 50% self-identified as racialized minorities (Black, Indigenous, or Persons of Color), which is more diverse than the general patient populations of each participating institution. Ensuring people from diverse backgrounds participate in clinical research is key to advancing health equity.
What We Studied
The SUMMIT study explored the straightforward questions of “how” talk therapy could be delivered and “who” can deliver talk therapy to improve access.
SUMMIT aimed to increase access to brief psychotherapy through:
1. Training and supervising non-specialist providers to deliver talk therapy to pregnant and postpartum individuals with depression and/or anxiety.
The SUMMIT study compared the outcomes of participants who received therapy from a non-specialist provider to those who received the same therapy from a mental health specialist provider (the “gold standard” of care).
2. Providing the talk therapy online via telemedicine to pregnant and postpartum individuals with depression and/or anxiety.
The SUMMIT study compared the outcomes of participants who received therapy online via telemedicine (the novel method) to those who received the same therapy in-person (the standard method).
The Treatment in SUMMIT
Perinatal participants received 6 to 8 weekly sessions of a psychotherapy (talk therapy) modality called Behavioural Activation (BA), which focuses on increasing enjoyable or fulfilling activities that are in line with one’s values. BA has been shown to reduce depressive and/or anxiety symptoms.
The Results (N=1230)
With training and supervision, the SUMMIT results show that “non-mental health specialists,” such as healthcare and support workers, can effectively deliver BA to improve their pregnant and postpartum patients’ mental health outcomes.
The SUMMIT results also show BA delivered online via telemedicine can effectively improve patients’ mental health outcomes.
For full details, please read the published results in Nature Medicine.
Who is Needed to Implement BA?
A Call to Action for Funders & Policymakers
Key Points
- Perinatal mood disorders, such as depression and/or anxiety, place significant cost burdens on healthcare systems in both Canada and the United States.
- The SUMMIT study demonstrated that behavioural activation therapy by non-mental health specialists (task-sharing) and through telemedicine was as effective as the current standard of care in treating perinatal depression and/or anxiety.
- Task-sharing and telemedicine offer scalable, cost-effective solutions to expand the mental healthcare workforce and improve access to effective mental healthcare.
- If implemented in real-world settings and supported by appropriate resources, Behavioural Activation delivered by non-specialists via telemedicine can meet the demand for effective mental healthcare.
Policymakers and insurers can support transforming perinatal mental healthcare and improve access to talk therapy services for pregnant and postpartum individuals by:
- Integrating Behavioural Activation into standard perinatal healthcare practices.
- Funding non-specialist providers’ training and supervision to deliver care.
- Covering patient therapy costs.
- Expanding coverage to virtual healthcare.
To get in touch about how you can get involved, please contact [email protected]
Healthcare Administrators
Key Responsibilities
- Administrators will need to ensure they have funding for mental health specialists for training and consultation fees.
- Learn what types of providers are covered to deliver “psychotherapy” or “behavioural interventions” in your region. E.g. in Ontario, Canada, psychotherapy can be delivered by registered psychotherapists, nurses (RNs & RPNs), physicians, social workers, and occupational therapists.
- Seek trainees such as individuals with a background working with perinatal people. E.g. nurses, midwives, and doulas are ideal candidates for delivering BA because they are already experienced in supporting perinatal patients.
1. Organize BA Training
- Schedule BA training, which will be completed in a two-day workshop either in-person or online.
- Training must be scheduled by administrators, and when possible:
- Train at least two people per group which allows for role-play practice between trainees.
- Two trainers enables role-playing to be observed by trainees.
- Standardized patient (e.g. a paid actor) interactions with trainees are a beneficial addition to training.
2. Best Practices for Working with Perinatal Populations
- For those who have delivered different types of therapy, but are not familiar with perinatal populations, administrators may require they take PSI training to become comfortable with specific needs of perinatal individuals.
3. Screening Patients
- Patients with depressive symptoms as identified with these screening tools:
- EPDS (Edinburgh Postnatal Depression Scale)
- PHQ-9 (Patient Health Questionnaire-9)
- Note: The recommended cut-off score for a positive screen using either tool is 10.
- Exclusion Criteria:
- Active suicidal intent (ideation and plan), active symptoms of psychosis or mania.
- Note: Severe fetal anomalies, stillbirth, or infant death may also require alternative mental health treatments.
4. Organize Clinical Consultations
- During training, set expectations for successful clinical consultations (sometimes called clinical supervision).
- To get the most out of clinical consultations administrators must ensure group consultations are scheduled for new BA providers and consultants in the first 6 weeks.
- Ensure clinical consultants are available for emergencies and to support new BA providers as they navigate treatment with their clients.
- Other recommendations for administrators:
- Providing consultants with structure and probing questions for effective discussions.
- Inform consultants of the new BA providers’ professional background and level of experience.
5. Stepped-Care
What is a stepped care model?
Benefits of a Stepped-Care Process:
- Reduces delays in treatment by providing immediate, structured BA support.
- Leverages existing providers (nurses/midwives) to offer evidence-based care without requiring specialized mental health training.
- Improves symptom management and may prevent worsening of perinatal depression/anxiety.
- Supports individuals in a low-intensity, accessible way while waiting for more specialized intervention.
BA Trainers & Clinical Consultants
Key Responsibilities
- Deliver training and/or clinical consultations to new BA providers.
- Note: this could be filled by one mental health specialist able to deliver training and consultations.
Materials you will need
Symptoms of depression and anxiety during pregnancy and postpartum are common and can be effectively treated with talk therapy. If you or someone you love are experiencing symptoms of depression or anxiety, reach out to your healthcare provider or someone you trust.
Why Your Mental Health Matters?
The mental health of pregnant and postpartum individuals is a prominent public health concern in Canada and the United States. Untreated mental health issues negatively impact pregnant and postpartum individuals, as well as their children, their families, and society at large.
Early Intervention is Key
Many individuals experience depression and anxiety during the perinatal period. Due to a lack of mental healthcare providers, individuals find themselves on long waitlists without access to the critical mental healthcare they require. More mental health providers are required to meet the needs of pregnant and postpartum individuals.
Behavioural Activation (BA) treatment offers hope by increasing access through task-sharing and telemedicine. This approach offers a new pathway to reduce individuals’ symptoms of depression and anxiety through straightforward, evidence-based solutions.
Disclaimer: BA talk therapy is an effective treatment for perinatal depression and anxiety but may not be appropriate or sufficient for all patients depending on their needs and mental health concerns. Mental healthcare is not one-size-fits-all. Consult with your trusted healthcare provider to determine the best steps for you moving forward.
What is Behavioural Activation (BA) & How Can It Support Your Patients?
Why is BA so Effective?
Behavioural Activation (BA) treatment for perinatal depression and/or anxiety was developed in collaboration with clinical experts and perinatal patients. The treatment is designed to support those who are struggling with feeling depressed, down, stressed, or isolated. BA offers hope for new and expecting parents by reducing patients’ symptoms of depression and/or anxiety. BA has been proven to be an effective treatment in reducing depression and/or anxiety.
In a short period of time (6-8 weeks) patients learn to…
- Acknowledge & Recognize: Track daily activities to understand their impact on mood.
- Identify: Clarify personal values and strengthen meaningful social connections.
- Prioritize: Focus on activities that enhance well-being and boost mood.
- Reconnect: Rediscover joy and fulfillment from before this life transition.
- Develop Skills & Strategies: Navigate daily challenges and enhance communication.
- Overcome Avoidance & Social Withdrawal: Re-engage with life and relationships.
- Reduce Rumination: Break free from repetitive negative thoughts.
- Enhance Self-Efficacy & Control: Build confidence in managing emotions and life demands.
What to Expect from BA Training?
In a short training (10 hours over 2 days) trainees learn:
Learning the Foundations
- Theoretical foundations of the behavioural model of depression (i.e., how avoidance and inactivity contribute to low mood).
- The difference between BA & other types of psychotherapy (e.g. CBT).
Core components of BA
- Assessment skills: Identifying patterns of avoidance and inactivity in clients.
- Activity monitoring: Teaching clients to track daily activities and mood connections.
- Activity scheduling: Creating structured, goal-oriented plans to increase engagement.
- Values-based planning: Helping clients select meaningful activities aligned with personal values.
- Graded task assignment: Encouraging small, manageable steps to build momentum.
- Overcoming barriers: Addressing common challenges like fatigue, low motivation, and anxiety.
Clinical Skills Development
- Motivational interviewing techniques to encourage engagement.
- Psychoeducation strategies to help clients understand BA’s benefits.
- Problem-solving approaches to address obstacles to activity engagement.
- Measuring progress using mood tracking and behavioural assessments.
Role-Playing & Supervision
- Practice BA techniques through role-plays with peers or trainers.
- Receive constructive feedback on session delivery and client interactions.
- Supervision with experienced clinicians to refine skills.
Case Conceptualization & Adaptation
- Applying BA to different client populations, including perinatal individuals, those with comorbid anxiety, and those with physical health limitations.
- Modifying BA for low motivation, cultural considerations, or time constraints.
Practical Experience & Application
- Working with real clients under supervision.
- Use BA in individual or group therapy settings.
- Learning to document progress and adjust interventions based on client feedback.
Ethical & Professional Considerations
- Understand the scope of practice as a new provider.
- Navigate client resistance and dropout prevention.
- Identify clients may require additional or different support (e.g. medication, other psychotherapies, etc.).
- Knowing when to seek expert consultation and activate safety protocols.
What to Expect from BA Sessions?
The BA workbook guides both the provider and the patient through each of the 6-8 hour-long sessions.
Step-by-Step Guide to Implementing
Organize Funding & Materials
- Who: Administrators & mental health providers.
- What: SUMMIT Implementation Toolkit.
- How: Use materials to collaborate.
Identify Key Groups
- Who: Administrators.
- What: Identify (1) healthcare providers who can be trained to provide BA & (2) mental health providers to lead training & consultation.
- How: Engagement across health teams.
Conduct BA Training
- Who: BA trainers & trainees.
- What: 2-day training.
- How: Online or in-person.
Identify Patients
- Who: Administrators.
- What: Screen patients.
- How: Using validated tools (EPDS, PHQ-9).
Begin Delivering BA
- Who: New BA providers.
- What: 8 Weeks of 1 hour sessions.
- How: Apply training with guidance from the BA Manual & clinical consultation.
Clinical Consultations
- Who: Clinical experts & new BA providers.
- What: Discuss challenges, ask questions, & continue learning.
- How: Online with other new providers.
Organize Funding & Materials
- Who: Administrators & mental health providers.
- What: SUMMIT Implementation Toolkit.
- How: Use materials to collaborate.
Identify Key Groups
- Who: Administrators.
- What: Identify (1) healthcare providers who can be trained to provide BA & (2) mental health providers to lead training & consultation.
- How: Engagement across health teams.
Conduct BA Training
- Who: BA trainers & trainees.
- What: 2-day training.
- How: Online or in-person.
Identify Patients
- Who: Administrators.
- What: Screen patients.
- How: Using validated tools (EPDS, PHQ-9).
Begin Delivering BA
- Who: New BA providers.
- What: 8 Weeks of 1 hour sessions.
- How: Apply training with guidance from the BA Manual & clinical consultation.
Clinical Consultations
- Who: Clinical experts & new BA providers.
- What: Discuss challenges, ask questions, & continue learning.
- How: Online with other new providers.
Emergency Supports
If you are thinking about suicide, or you’re worried about someone else: Call or text 9-8-8 toll free, any time — lines are open 24/7/365 for the 9-8-8 Suicide Crisis Helpline (Canada & US)
Non-Emergency Supports
Postpartum Support International (Canada, US, International)
Postpartum Support International HelpLine: The PSI HelpLine is a toll-free telephone number anyone can call to get basic information, support, and resources. It is not a crisis hotline and does not handle emergencies:
- Text en Español 971-203-7773
- Call 1-800-944-4773 (4PPD) #1 En Español or #2 English
- Text “Help” to 800-944-4773 (English)
Additional Perinatal Mental Health Resources
SUMMIT Resources, Publications, and Press
We’d love to hear your feedback on the SUMMIT Implementation Toolkit! Click here to complete the Google form.
This toolkit provides information, materials, and procedures to help organizations implement the Behavioural Activation (BA) Program if funding, personnel, and resources are available. The BA program has been inspired by the findings of the SUMMIT trial, which found that “non-mental health specialists,” like nurses and midwives, could be trained to deliver BA – a brief talk therapy – either in-person or online to improve depression and/or anxiety symptoms for pregnant and postpartum people.
This toolkit is designed for healthcare administrators, mental health providers, healthcare professionals and support workers who want to provide holistic care for perinatal patients experiencing depression and/or anxiety.
Why Implement Behavioural Activation (BA) for Perinatal Depression/Anxiety?
The Problem
Common conditions such as depression and anxiety in pregnant and postpartum populations is a prominent public health concern in Canada and the United States. Untreated mental health issues can negatively impact pregnant and postpartum people, as well as their children, their families, and society at large.
Depression and anxiety can be effectively treated with talk therapy, however, pregnant and postpartum people are often placed on long waitlists. This means they do not receive critical mental health care when and how they need it.
More mental health providers and avenues to deliver treatment are required to meet the needs of pregnant and postpartum people.
Fast Facts
- The perinatal period – defined as the time between pregnancy and up to one year postpartum – is a critical time when individuals are at risk of developing mental illness with long-term consequences for themselves and their families.
- 1 in 5 pregnant and postpartum individuals experience depression and anxiety symptoms during the perinatal period, but less than 10% of those have access to minimally adequate treatment.
- 20% of pregnant and postpartum individuals who experience symptoms of depression and/or anxiety will also experience suicidal thoughts or self-harm.
- Untreated mental illness during pregnancy and postpartum impacts children, which can result in low birth weight, emotional and behavioral issues in childhood, and impaired cognitive development.
- Globally, only 3% of mental health studies explicitly address women’s health, with even fewer considering perinatal populations and evaluating telemedicine platforms.
- The SUMMIT study fills a gap in mental health research for those who are pregnant and postpartum.
The SUMMIT Trial
Parenting is a difficult job and can be even more challenging for those experiencing depression and/or anxiety.
Behavioral Activation (BA) treatment offers hope for new and expecting parents by reducing symptoms of depression and/or anxiety through straightforward, evidence-based solutions: Task-Sharing & Telemedicine.
The Solution
The PCORI-funded Scaling Up for Maternal Mental healthcare by Increasing access to Treatment (SUMMIT) trial was a clinical trial conducted across three hubs in North America: Toronto, Ontario; Chicago, Illinois; and Chapel Hill, North Carolina.
1,230 pregnant and postpartum women participated in the study and almost 50% self-identified as racialized minorities (Black, Indigenous, or Persons of Color), which is more diverse than the general patient populations of each participating institution. Ensuring people from diverse backgrounds participate in clinical research is key to advancing health equity.
What We Studied
The SUMMIT study explored the straightforward questions of “how” talk therapy could be delivered and “who” can deliver talk therapy to improve access.
SUMMIT aimed to increase access to brief psychotherapy through:
1. Training and supervising non-specialist providers to deliver talk therapy to pregnant and postpartum individuals with depression and/or anxiety.
The SUMMIT study compared the outcomes of participants who received therapy from a non-specialist provider to those who received the same therapy from a mental health specialist provider (the “gold standard” of care).
2. Providing the talk therapy online via telemedicine to pregnant and postpartum individuals with depression and/or anxiety.
The SUMMIT study compared the outcomes of participants who received therapy online via telemedicine (the novel method) to those who received the same therapy in-person (the standard method).
The Treatment in SUMMIT
Perinatal participants received 6 to 8 weekly sessions of a psychotherapy (talk therapy) modality called Behavioural Activation (BA), which focuses on increasing enjoyable or fulfilling activities that are in line with one’s values. BA has been shown to reduce depressive and/or anxiety symptoms.
The Results (N=1230)
With training and supervision, the SUMMIT results show that “non-mental health specialists,” such as healthcare and support workers, can effectively deliver BA to improve their pregnant and postpartum patients’ mental health outcomes.
The SUMMIT results also show BA delivered online via telemedicine can effectively improve patients’ mental health outcomes.
For full details, please read the published results in Nature Medicine.
Who is Needed to Implement BA?
Funders & Policymakers
A Call to Action for Funders & Policymakers
Key Points
- Perinatal mood disorders, such as depression and/or anxiety, place significant cost burdens on healthcare systems in both Canada and the United States.
- The SUMMIT study demonstrated that behavioural activation therapy by non-mental health specialists (task-sharing) and through telemedicine was as effective as the current standard of care in treating perinatal depression and/or anxiety.
- Task-sharing and telemedicine offer scalable, cost-effective solutions to expand the mental healthcare workforce and improve access to effective mental healthcare.
- If implemented in real-world settings and supported by appropriate resources, Behavioural Activation delivered by non-specialists via telemedicine can meet the demand for effective mental healthcare.
Policymakers and insurers can support transforming perinatal mental healthcare and improve access to talk therapy services for pregnant and postpartum individuals by:
- Integrating Behavioural Activation into standard perinatal healthcare practices.
- Funding non-specialist providers’ training and supervision to deliver care.
- Covering patient therapy costs.
- Expanding coverage to virtual healthcare.
To get in touch about how you can get involved, please contact [email protected]
Healthcare Administrators
Healthcare Administrators
Key Responsibilities
- Administrators will need to ensure they have funding for mental health specialists for training and consultation fees.
- Learn what types of providers are covered to deliver “psychotherapy” or “behavioural interventions” in your region. E.g. in Ontario, Canada, psychotherapy can be delivered by registered psychotherapists, nurses (RNs & RPNs), physicians, social workers, and occupational therapists.
- Seek trainees such as individuals with a background working with perinatal people. E.g. nurses, midwives, and doulas are ideal candidates for delivering BA because they are already experienced in supporting perinatal patients.
1. Organize BA Training
- Schedule BA training, which will be completed in a two-day workshop either in-person or online.
- Training must be scheduled by administrators, and when possible:
- Train at least two people per group which allows for role-play practice between trainees.
- Two trainers enables role-playing to be observed by trainees.
- Standardized patient (e.g. a paid actor) interactions with trainees are a beneficial addition to training.
2. Best Practices for Working with Perinatal Populations
- For those who have delivered different types of therapy, but are not familiar with perinatal populations, administrators may require they take PSI training to become comfortable with specific needs of perinatal individuals.
3. Screening Patients
- Patients with depressive symptoms as identified with these screening tools:
- EPDS (Edinburgh Postnatal Depression Scale)
- PHQ-9 (Patient Health Questionnaire-9)
- Note: The recommended cut-off score for a positive screen using either tool is 10.
- Exclusion Criteria:
- Active suicidal intent (ideation and plan), active symptoms of psychosis or mania.
- Note: Severe fetal anomalies, stillbirth, or infant death may also require alternative mental health treatments.
4. Organize Clinical Consultations
- During training, set expectations for successful clinical consultations (sometimes called clinical supervision).
- To get the most out of clinical consultations administrators must ensure group consultations are scheduled for new BA providers and consultants in the first 6 weeks.
- Ensure clinical consultants are available for emergencies and to support new BA providers as they navigate treatment with their clients.
- Other recommendations for administrators:
- Providing consultants with structure and probing questions for effective discussions.
- Inform consultants of the new BA providers’ professional background and level of experience.
5. Stepped-Care
What is a stepped care model?
Benefits of a Stepped-Care Process:
- Reduces delays in treatment by providing immediate, structured BA support.
- Leverages existing providers (nurses/midwives) to offer evidence-based care without requiring specialized mental health training.
- Improves symptom management and may prevent worsening of perinatal depression/anxiety.
- Supports individuals in a low-intensity, accessible way while waiting for more specialized intervention.
Non-Mental Health Specialist Providers
BA Trainers & Clinical Consultants
BA Trainers & Clinical Consultants
Key Responsibilities
- Deliver training and/or clinical consultations to new BA providers.
- Note: this could be filled by one mental health specialist able to deliver training and consultations.
Materials you will need
Patients
Symptoms of depression and anxiety during pregnancy and postpartum are common and can be effectively treated with talk therapy. If you or someone you love are experiencing symptoms of depression or anxiety, reach out to your healthcare provider or someone you trust.
Why Your Mental Health Matters?
The mental health of pregnant and postpartum individuals is a prominent public health concern in Canada and the United States. Untreated mental health issues negatively impact pregnant and postpartum individuals, as well as their children, their families, and society at large.
Early Intervention is Key
Many individuals experience depression and anxiety during the perinatal period. Due to a lack of mental healthcare providers, individuals find themselves on long waitlists without access to the critical mental healthcare they require. More mental health providers are required to meet the needs of pregnant and postpartum individuals.
Behavioural Activation (BA) treatment offers hope by increasing access through task-sharing and telemedicine. This approach offers a new pathway to reduce individuals’ symptoms of depression and anxiety through straightforward, evidence-based solutions.
Disclaimer: BA talk therapy is an effective treatment for perinatal depression and anxiety but may not be appropriate or sufficient for all patients depending on their needs and mental health concerns. Mental healthcare is not one-size-fits-all. Consult with your trusted healthcare provider to determine the best steps for you moving forward.
What is Behavioural Activation (BA) & How Can It Support Your Patients?
Why is BA so Effective?
Why is BA so Effective?
Behavioural Activation (BA) treatment for perinatal depression and/or anxiety was developed in collaboration with clinical experts and perinatal patients. The treatment is designed to support those who are struggling with feeling depressed, down, stressed, or isolated. BA offers hope for new and expecting parents by reducing patients’ symptoms of depression and/or anxiety. BA has been proven to be an effective treatment in reducing depression and/or anxiety.
In a short period of time (6-8 weeks) patients learn to…
- Acknowledge & Recognize: Track daily activities to understand their impact on mood.
- Identify: Clarify personal values and strengthen meaningful social connections.
- Prioritize: Focus on activities that enhance well-being and boost mood.
- Reconnect: Rediscover joy and fulfillment from before this life transition.
- Develop Skills & Strategies: Navigate daily challenges and enhance communication.
- Overcome Avoidance & Social Withdrawal: Re-engage with life and relationships.
- Reduce Rumination: Break free from repetitive negative thoughts.
- Enhance Self-Efficacy & Control: Build confidence in managing emotions and life demands.
What to Expect from BA Training?
What to Expect from BA Training?
In a short training (10 hours over 2 days) trainees learn:
Learning the Foundations
- Theoretical foundations of the behavioural model of depression (i.e., how avoidance and inactivity contribute to low mood).
- The difference between BA & other types of psychotherapy (e.g. CBT).
Core components of BA
- Assessment skills: Identifying patterns of avoidance and inactivity in clients.
- Activity monitoring: Teaching clients to track daily activities and mood connections.
- Activity scheduling: Creating structured, goal-oriented plans to increase engagement.
- Values-based planning: Helping clients select meaningful activities aligned with personal values.
- Graded task assignment: Encouraging small, manageable steps to build momentum.
- Overcoming barriers: Addressing common challenges like fatigue, low motivation, and anxiety.
Clinical Skills Development
- Motivational interviewing techniques to encourage engagement.
- Psychoeducation strategies to help clients understand BA’s benefits.
- Problem-solving approaches to address obstacles to activity engagement.
- Measuring progress using mood tracking and behavioural assessments.
Role-Playing & Supervision
- Practice BA techniques through role-plays with peers or trainers.
- Receive constructive feedback on session delivery and client interactions.
- Supervision with experienced clinicians to refine skills.
Case Conceptualization & Adaptation
- Applying BA to different client populations, including perinatal individuals, those with comorbid anxiety, and those with physical health limitations.
- Modifying BA for low motivation, cultural considerations, or time constraints.
Practical Experience & Application
- Working with real clients under supervision.
- Use BA in individual or group therapy settings.
- Learning to document progress and adjust interventions based on client feedback.
Ethical & Professional Considerations
- Understand the scope of practice as a new provider.
- Navigate client resistance and dropout prevention.
- Identify clients may require additional or different support (e.g. medication, other psychotherapies, etc.).
- Knowing when to seek expert consultation and activate safety protocols.
What to Expect from BA Sessions?
What to Expect from BA Sessions?
The BA workbook guides both the provider and the patient through each of the 6-8 hour-long sessions.
Step-by-Step Guide to Implementing
Organize Funding & Materials
- Who: Administrators & mental health providers.
- What: SUMMIT Implementation Toolkit.
- How: Use materials to collaborate.
Identify Key Groups
- Who: Administrators.
- What: Identify (1) healthcare providers who can be trained to provide BA & (2) mental health providers to lead training & consultation.
- How: Engagement across health teams.
Conduct BA Training
- Who: BA trainers & trainees.
- What: 2-day training.
- How: Online or in-person.
Identify Patients
- Who: Administrators.
- What: Screen patients.
- How: Using validated tools (EPDS, PHQ-9).
Begin Delivering BA
- Who: New BA providers.
- What: 8 Weeks of 1 hour sessions.
- How: Apply training with guidance from the BA Manual & clinical consultation.
Clinical Consultations
- Who: Clinical experts & new BA providers.
- What: Discuss challenges, ask questions, & continue learning.
- How: Online with other new providers.
Organize Funding & Materials
- Who: Administrators & mental health providers.
- What: SUMMIT Implementation Toolkit.
- How: Use materials to collaborate.
Identify Key Groups
- Who: Administrators.
- What: Identify (1) healthcare providers who can be trained to provide BA & (2) mental health providers to lead training & consultation.
- How: Engagement across health teams.
Conduct BA Training
- Who: BA trainers & trainees.
- What: 2-day training.
- How: Online or in-person.
Identify Patients
- Who: Administrators.
- What: Screen patients.
- How: Using validated tools (EPDS, PHQ-9).
Begin Delivering BA
- Who: New BA providers.
- What: 8 Weeks of 1 hour sessions.
- How: Apply training with guidance from the BA Manual & clinical consultation.
Clinical Consultations
- Who: Clinical experts & new BA providers.
- What: Discuss challenges, ask questions, & continue learning.
- How: Online with other new providers.
Emergency Supports
If you are thinking about suicide, or you’re worried about someone else: Call or text 9-8-8 toll free, any time — lines are open 24/7/365 for the 9-8-8 Suicide Crisis Helpline (Canada & US)
Non-Emergency Supports
Postpartum Support International (Canada, US, International)
Postpartum Support International HelpLine: The PSI HelpLine is a toll-free telephone number anyone can call to get basic information, support, and resources. It is not a crisis hotline and does not handle emergencies:
- Text en Español 971-203-7773
- Call 1-800-944-4773 (4PPD) #1 En Español or #2 English
- Text “Help” to 800-944-4773 (English)
Additional Perinatal Mental Health Resources
SUMMIT Resources, Publications, and Press