{"edition":"los-angeles","organization":"Maternal Mental Health NOW","organizationId":"org:maternal-mental-health-now","boundaryVersion":"OMB-23-01-2023-07-21","updated":"2026-09-14","model":{"version":"la-mmhn-alpha-v1","costScope":"Full recipient program annual planning budget of $1.17m, not the $1,513 standalone pre-operation return and not former sponsor total. Modeled continuation year with current successor delivery assumed; actual full recipient expenses unverified. External clinical labor, insurer spending and participant time excluded from donor cost.","geographicAttribution":"LA MSA is Los Angeles plus Orange counties. Sana Sana eligibility is LA County, so peer g=1. Training is available beyond LA and online; training beneficiary share .8 central (.5–.95) is judgment, not trainee/HQ location evidence. No global or state-policy spillovers added.","formula":"Q_training_all=T*d*L*r*a*b*q; Q_peer_all=P*e*rP*aP*b*u*(w/52). Q_LA=k*(gT*Q_training_all+Q_peer_all)/(1.03^delay); Q_all=k*(Q_training_all+Q_peer_all)/(1.03^delay); price=10*C/Q_LA. Central T800,d.5,L30,r.1,a.5,b.5,q.002; P150,e.11,rP.25,aP.5,u.1,w12;k.9,gT.8,delay1,C1170000. Training .6 all-pop QALYs and peer .02379808 before overlap/delay; final .54506628 all-pop and .4402119119 LA.","counterfactual":"Current grants, commissioned training, other educators, clinical providers and referral services persist without the next ordinary gift. a and aP remove substitution by alternative training/support; b discounts donation-to-expanded/preserved service responsiveness. The 2022–26 LAMMHA grants and enacted screening laws are baseline, not fresh gift outcomes.","attribution":"T is an output floor, d removes duplicate/non-frontline training records, L is a subjective annual unique lower-risk postpartum caseload per effective trainee, and r scales the intensive UK training reference to heterogeneous MMHN courses. Peer rP allows lower intensity and different risk profile than the high-risk RCT. k removes cross-route overlap. No additional LAMMHA, screening, group-attendance or awareness QALYs are layered onto these pathways.","uncertainty":"Best-effort partial-health scenario, heavily judgment-driven; no empirically measured MMHN causal conversion. Positive scenarios are not confidence bounds. Reference training QALY CI includes zero; negative case retained. Full policy, anti-stigma, workforce and infant/family outcomes are unpriced, not known to be absent.","nativeOutcomes":"Central training pipeline: 800 records→400 effective unique frontline trainees→12,000 unique lower-risk postpartum care opportunities→300 reference-equivalent opportunities after transfer/additionality/funding. Peer pipeline: 150 callers→9.375 high-risk RCT-equivalent participants after transfer/additionality/funding→1.03125 fewer probable-depression cases at 12 weeks, translated with .1 utility×12/52 year. These are expected model quantities, not observed treated cases. No infant mortality or lifetime recurrence multiplier.","inputs":[{"name":"C","value":1170000,"unit":"USD/planning year","basis":"judgment","rationale":"Continuation-year full program cost anchored to reported FY25 operating budget, not actual audited expense.","sourceIds":["mmhn-impact25"]},{"name":"T","value":800,"unit":"training participant records/FY25","basis":"observed","rationale":"Published 800+ floor; not patients or unique active clinicians.","sourceIds":["mmhn-donate"]},{"name":"d","value":0.5,"unit":"effective unique frontline trainee fraction","basis":"judgment","rationale":"Allows repeat attendance and nonclinical roles.","sourceIds":["mmhn-about"]},{"name":"L","value":30,"unit":"unique lower-risk postpartum parents/trainee/year","basis":"judgment","rationale":"Plausible limited annual caseload, not published MMHN caseload; tested 5–100.","sourceIds":[]},{"name":"r","value":0.1,"unit":"clinical-effect transfer fraction","basis":"judgment","rationale":"Brief heterogeneous courses may deliver much less change than intensive health-visitor package.","sourceIds":["ponder-clinical"]},{"name":"a","value":0.5,"unit":"training additionality","basis":"judgment","rationale":"Other training and existing care reduce counterfactual effect.","sourceIds":["lammha-current"]},{"name":"b","value":0.5,"unit":"ordinary funding responsiveness","basis":"judgment","rationale":"Funding may preserve uncovered capacity or displace grants; no verified marginal queue.","sourceIds":["mmhn-impact25","mmhn-whitepaper"]},{"name":"q","value":0.002,"unit":"QALY/lower-risk postpartum parent over 6 months","basis":"observed","rationale":"Published adjusted randomized economic estimate,95%CI−.001 to .004; not MMHN efficacy.","sourceIds":["ponder"]},{"name":"P","value":150,"unit":"warmline callers/FY25","basis":"observed","rationale":"Currentdonationpage; no added group participants or repeatcalls.","sourceIds":["mmhn-donate"]},{"name":"e","value":0.11,"unit":"absolute reduction in probable depression at 12 weeks","basis":"observed","rationale":"External high-risk RCT rounded 25%−14%; not measured MMHN outcome.","sourceIds":["peer-rct"]},{"name":"rP","value":0.25,"unit":"peer-effect transfer fraction","basis":"judgment","rationale":"Different baseline risk, intensity and population.","sourceIds":["peer-rct","mmhn-whitepaper"]},{"name":"aP","value":0.5,"unit":"peer counterfactual additionality","basis":"judgment","rationale":"Support or treatment may otherwise be available.","sourceIds":["mmhn-sana"]},{"name":"u","value":0.1,"unit":"utility gain per incremental case","basis":"judgment","rationale":"Conservative illustrative mapping of probable-depression change; not a measured SF-6D result.","sourceIds":[]},{"name":"w","value":12,"unit":"weeks of benefit","basis":"judgment","rationale":"Subjective 12-week benefit-area assumption, not a measured duration inferred from endpoint prevalence. No significant 24-week group difference supports finite extrapolation but does not establish this benefit area.","sourceIds":["peer-rct"]},{"name":"k","value":0.9,"unit":"cross-route nonoverlap factor","basis":"judgment","rationale":"No linked participant identifiers; prevents full addition of overlapping benefits.","sourceIds":[]},{"name":"gT","value":0.8,"unit":"LA+Orange training beneficiary fraction","basis":"judgment","rationale":"Missionlocal but trainings canextendbeyondregion; no measuredresidence distribution.","sourceIds":["mmhn-about"]},{"name":"delay","value":1,"unit":"years to mean benefit realization","basis":"judgment","rationale":"Discount future annual delivery and follow-up at 3%; no added lifetime multiplier.","sourceIds":[]}],"scenarios":[{"id":"central","label":"Training/peer health component; planned full cost","costUSD":1170000,"allPopulationQalys":0.545066280806572,"editionQalys":0.44021191187453323,"assumptions":"{\"d\":0.5,\"L\":30,\"r\":0.1,\"a\":0.5,\"b\":0.5,\"g\":0.8,\"q\":0.002,\"rP\":0.25,\"aP\":0.5,\"k\":0.9,\"u\":0.1,\"w\":12,\"C\":1170000} All non-reference clinical conversions are judgment; no statistical interpretation of combined bounds."},{"id":"low","label":"low stress scenario","costUSD":1500000,"allPopulationQalys":0.00009867438386855863,"editionQalys":0.0000816840926064227,"assumptions":"{\"d\":0.25,\"L\":5,\"r\":0.01,\"a\":0.1,\"b\":0.1,\"g\":0.5,\"q\":0.0005,\"rP\":0.1,\"aP\":0.1,\"k\":0.7,\"u\":0.05,\"w\":6,\"C\":1500000} All non-reference clinical conversions are judgment; no statistical interpretation of combined bounds."},{"id":"high","label":"high stress scenario","costUSD":1000000,"allPopulationQalys":89.74189693801344,"editionQalys":85.26811053024645,"assumptions":"{\"d\":0.9,\"L\":100,\"r\":0.5,\"a\":0.8,\"b\":0.8,\"g\":0.95,\"q\":0.004,\"rP\":0.75,\"aP\":0.8,\"k\":1,\"u\":0.15,\"w\":12,\"C\":1000000} All non-reference clinical conversions are judgment; no statistical interpretation of combined bounds."},{"id":"zero","label":"zero stress scenario","costUSD":1170000,"allPopulationQalys":0,"editionQalys":0,"assumptions":"{\"d\":0.5,\"L\":30,\"r\":0.1,\"a\":0.5,\"b\":0,\"g\":0.8,\"q\":0.002,\"rP\":0.25,\"aP\":0.5,\"k\":0.9,\"u\":0.1,\"w\":12,\"C\":1170000} All non-reference clinical conversions are judgment; no statistical interpretation of combined bounds."},{"id":"downside","label":"downside stress scenario","costUSD":1170000,"allPopulationQalys":-0.2621359223300971,"editionQalys":-0.20970873786407765,"assumptions":"{\"d\":0.5,\"L\":30,\"r\":0.1,\"a\":0.5,\"b\":0.5,\"g\":0.8,\"q\":-0.001,\"rP\":0,\"aP\":0.5,\"k\":0.9,\"u\":0.1,\"w\":12,\"C\":1170000} All non-reference clinical conversions are judgment; no statistical interpretation of combined bounds."}],"sensitivity":["The positive low/high scenarios are stress tests, not calibrated probability quantiles; training caseload and clinical implementation dominate. Zero additional funding response yields zero benefit.","The original training Table 5 QALY difference is .002 with 95% CI−.001 to .004. Cost-saving probability is not a 99% probability of improved health; NHS cost savings are not subtracted from this donor numerator.","Training benefit ends at six-month follow-up for each modeled parent, with only one annual cohort. Peer benefit is .1 utility for 12 weeks per incremental probable-depression case; no persistence beyond 24 weeks assumed. The peer benefit area is a subjective scenario, not the trial's measured duration of improvement.","At the central $1.17m budget, $1m/10 requires 11.7 LA QALYs; $100k/10 requires 117. Central modeled component=.44021. With other factors fixed, training caseload would need about 835 lower-risk parents per effective trainee to approach $1m/10; do not treat that threshold as observed capacity.","Cost should be updated from reconciled current recipient accounts; $1,513 is not a cheaper valid scenario. Paid clinical follow-through is a necessary complementary resource and could materially raise societal costs."],"missingInputs":["Successor full-year actual accounts, sponsor assets/liabilities transferred, and whether $1.17m includes all sponsorship/transition overhead.","Unique trainees by role, course completion, baseline competence, LA+Orange beneficiary residence and eligible annual caseload.","Controlled or credible comparison of training-induced screening, treatment engagement and patient-reported health outcomes.","Unique warmline and group participants, overlap, dose, baseline clinical risk, attrition and controlled outcomes.","Marginal staffing/service plan, contractual grant commitments, billing actually collected, and donor substitution."]},"sources":[{"id":"mmhn-about","title":"Mission and model","url":"https://maternalmentalhealthnow.org/about-us/","publisher":"Maternal Mental Health NOW","published":null,"retrieved":"2026-09-14"},{"id":"mmhn-impact25","title":"FY25 impact report and operating budget","url":"https://maternalmentalhealthnow.org/wp-content/uploads/2025/11/MMHN-Impact-Report-FY25.pdf","publisher":"Maternal Mental Health NOW","published":null,"retrieved":"2026-09-14"},{"id":"mmhn-99025","title":"Original standalone FY2025 Form 990-EZ","url":"https://projects.propublica.org/nonprofits/organizations/991790214/202600839349201225/full","publisher":"Maternal Mental Health NOW / IRS; ProPublica host","published":"2026-03-23","retrieved":"2026-09-14"},{"id":"mmhn-donate","title":"Current donation and output page","url":"https://maternalmentalhealthnow.org/donate/","publisher":"Maternal Mental Health NOW","published":null,"retrieved":"2026-09-14"},{"id":"mmhn-sana","title":"Sana Sana current service eligibility","url":"https://maternalmentalhealthnow.org/sana/","publisher":"Maternal Mental Health NOW","published":null,"retrieved":"2026-09-14"},{"id":"mmhn-whitepaper","title":"Sana Sana white paper, December 2025","url":"https://maternalmentalhealthnow.org/wp-content/uploads/2025/12/MMHN-whitepaper-Dec2025-1.pdf","publisher":"Maternal Mental Health NOW","published":null,"retrieved":"2026-09-14"},{"id":"ponder","title":"PoNDER training economic analysis; Table5","url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC6518383/","publisher":"Henderson et al., Psychological Medicine","published":null,"retrieved":"2026-09-14"},{"id":"ponder-clinical","title":"Randomized health-visitor training clinical trial","url":"https://pubmed.ncbi.nlm.nih.gov/19147636/","publisher":"Morrell et al., BMJ","published":"2009-01-15","retrieved":"2026-09-14"},{"id":"peer-rct","title":"Postpartum peer-support randomized trial","url":"https://www.bmj.com/content/338/bmj.a3064","publisher":"Dennis et al., BMJ","published":"2009-01-15","retrieved":"2026-09-14"},{"id":"lammha-current","title":"LAMMHA current coalition and funding","url":"https://ccalac.org/los-angeles-maternal-mental-health-access-lammha/","publisher":"Community Clinic Association of Los Angeles County","published":null,"retrieved":"2026-09-14"},{"id":"lammha-primary","title":"LAMMHA implementation, roles and findings","url":"https://www.chcf.org/wp-content/uploads/2025/10/CollaborativeCareModelImprovesMaternalMentalHealth.pdf","publisher":"Bennett, Grover and Vredevoogd / CHCF","published":"2025-10-23","retrieved":"2026-09-14"},{"id":"dhcs-peer","title":"Medi-Cal peer-support benefit","url":"https://www.dhcs.ca.gov/services/medi-cal-peer-support-services/","publisher":"California DHCS","published":null,"retrieved":"2026-09-14"}]}