Advancing a New System of Care
A major barrier to addressing perinatal mood and anxiety disorders is the fragmented behavioral health and medical health care systems that serve women and their children. Maternal Mental Health NOW partners with healthcare facilities in order to address these barriers and increase access to depression screening and treatment services for medically underserved pregnant and postpartum women. In partnership with clinic staff, we work to develop collaborative care models that treat the medical and mental health needs of the mother, her infant, and her family under one roof. In these integrated systems of care we emphasize universal screening for perinatal mental health, an informed and empathic behavioral health intervention on site, a registry for tracking patient screening and outcomes over time, and collaboration between medical and behavioral health providers as part of a unified team.
Our Demonstration Project
In 2013, Maternal Mental Health NOW launched a pilot project that integrated perinatal mental health care into one primary care setting at USC-Eisner Family Medicine Clinic, a Federally Qualified Health Clinic (FQHC) in Los Angeles serving 13,000 high-risk, uninsured, under-insured and otherwise medically underserved women and their infants. Early findings from the pilot concluded that 33% of pregnant and postpartum women who were screened as part of the project were assessed as being high risk and received follow up care. In the absence of the program, the mental health issues ofthese women would not have been systematically detected or responded to.
Expanding Our Reach
Since our 2013 pilot, Maternal Mental Health NOW has worked with many medical sites throughout L.A. County, including the following.
- Harbor-UCLA Pediatric Group - Attending physicians and case managers regularly screen parents of pediatric patients for maternal mental health disorders. When parents screen positive, they are referred to a case manager who provides patients with self-care recommendations and referrals to informed care using our online Maternal Mental Health Resource Directory.
- UCLA Westwood Pediatric Group – Attending physicians, residents and social work staff screen parents of pediatric patients for maternal mental health disorders using the Edinburgh Postnatal Depression Scale. Referrals to informed care are made using our online Maternal Mental Health Resource Directory.
- Harbor Community Clinic – Physicians, psychologists and medical assistants screen pregnant and postpartum parents (throughout the first year of well child visits) for maternal mental health disorders using the PHQ-9 and Edinburgh-3 screening tools. When a patient screens positive, the psychologist provides an array of psychosocial interventions including CBT, the case manager also works to provide additional referrals as needed. Physicians prescribe medication if needed and also make referrals using our online Maternal Mental Health Resource Directory as necessary.
- Los Angeles County + University of Southern California Family Wellness Clinic – This novel clinic integrates maternal mental health care, pediatric well-child care and mother-infant attachment interventions in one comprehensive clinic.
Our Newest Project
In 2016, Maternal Mental Health NOW received a grant from the California Health Care Foundation to further expand our integration efforts in L.A. County. The goal of the new initiative is to spread our model of perinatal collaborative care in medical settings by improving the recognition and response to maternal mood and anxiety disorders during the perinatal period in medical clinics that serve as a safety net. This project will include training, collaborative learning, and data analysis at each location and will result in a Best Practice Resource Guide on integrating perinatal mental health care into medical settings. In this way we hope to facilitate the spread of this exciting model. Dr Jurgen Unutzer from the University of Washington AIMS Center is the advisor to this project.