PROJECT 1 Modified Project Summary/Abstract Section Most preventable maternal deaths occur in the intrapartum and immediate postpartum (PP) periods, as do complications from undetected/undertreated mental health (MH) conditions (e.g., suicide, overdose) and cardiovascular (CV) events. While the maternal mortality rate in New York is overall lower than nationwide, this is extremely variable by population and neighborhood, with some areas seeing rates many times higher than the national average. However, most community-based programs addressing the health of postpartum patients in high-risk populations have been narrowly focused on basic services (e.g., breastfeeding, social support), with limited focus on evidence-based care. Holistic interventions addressing physical, mental, and social health needs in the critical PP transition and moving from trauma- and “risk”-based to a strength- and empowerment-based approach are urgently needed. Many hospital, community, and governmental barriers preclude broad adoption and scaling of doula-delivered care, and it is not known how facilitators, assets, and resources can improve care continuity and community-hospital linkages to support postpartum patients at diverse sites across NYC. The impact of doula- led interventions at patient- and health-system levels have yet to be rigorously evaluated. In collaboration with the Caribbean Women’s Health Association and the Northern Manhattan Perinatal Partnership, we will address these gaps by implementing and evaluating Living Healthy for Moms (LHMoms) in three complementary settings and populations (Brooklyn, Queens, and Northern Manhattan). LHMoms is a novel integrated care intervention that focuses intensively on care continuity and community-to-healthcare linkages that starts prior to discharge and during the first 7 days post-discharge (PD) and extends into six months post-partum, as critical windows to prevent long-term physical and mental health sequelae, while also addressing key determinants of lifelong health risk. We have developed several innovative, evidence-based interventions, including an online education empowerment program (using a Patient Activated Learning System platform we developed) to build patient self- advocacy beginning in-hospital; a doula-led health emergency detection program during the critical first 7 days PD; and a trauma-informed doula-delivered cognitive behavioral phone intervention to address PP depression and cardiovascular risks for the critical six months following delivery. We propose a rigorous, mixed-methods study of LHMoms to address three specific aims. In Aim 1, we will test the effectiveness of LHMoms vs. attention control in a Hybrid Type 1 Implementation Trial with 450 randomized postpartum patients at three hospital sites in Brooklyn, Queens, and Northern Manhattan. This will include refining and tailoring the intervention to each site to maximize care quality, building capacity for doulas to deliver LHMoms, and as...