Addressing the Maternal Mental Health Crisis Through a Novel Tech-Enabled Peer-to-Peer Driven Perinatal Collaborative Care Model

Photo by 193001056 © Yee Xin Tan on Dreamstime.com ABSTRACT Suicide and overdose, associated with perinatal mental health conditions, are the leading causes of maternal mortality in United States. Experts field using mood anxiety disorders (PMAD) as an umbrella term that includes many conditions bring to light lack screening treatment for There is a growing need equip Obstetricians Gynecologist (OB-GYN) providers better tools screen, triage, refer services equitable immediately accessible their patients. Integrating tech-enabled collaborative care model peer-to-peer coaching driver behavior change novel approach addressing crisis improving outcomes, reducing disparities, lowering costs. INTRODUCTION Over past two decades, other outcomes have worsened States disproportionately those developed countries.[1] In 2021, 1,205 pregnant women died US, representing 40 percent increase death from 2020 highest rise rates since 1960s.[2] overdose mortality.[3] Mental health-related deaths most likely occur after six weeks postpartum.[4] Despite postpartum period higher risk historically, only single visit performed between 4 6 delivery. do not attend visit.[5] Recent data Maternal Mortality Review Committees reveal 80 preventable. The represents unique ethical dilemma. For women, current healthcare system unjust. obstetricians gynecologists (OB-GYNs) patients This paper will analyze state America. It introduce Psychiatric Collaborative Care Model demonstrate its effectiveness. I highlight research obstetrics well barriers real-world implementation. Lastly, this argue integration would improve reduce lower I. Scope Problem Prior COVID-19 pandemic, prevalence depression ranged 13.2 percent, high 23.5 births US.[6] pandemic has exacerbated issue, studies revealing up 1 3 experiencing depression.[7] Although been focus it just tip iceberg. now depression, anxiety, obsessive-compulsive disorder, post-traumatic stress bipolar psychosis prenatal through first year postpartum. Socio-economically disadvantaged at increased face greater high-quality care.[8] American College Gynecologists (ACOG) recommends physicians perform screenings during pregnancy. Health Resources Services Administration provides Healthy Start Initiative Grants communities adverse outcomes. Yet, Healthcare Effectiveness Data Information Set (HEDIS) reveals both pregnancy occurs fewer than 20 patients.[9] Furthermore, if does occur, 22 who deemed positive receive care.[10] currently shortage expected worsen upcoming years.[11] Nearly half all Americans live professional desert.[12] Waitlists therapists psychiatrists average 48 days, individuals report seeking due cost or insurance coverage.[13] Given significant provider shortage, obstetric opportunity “whole patient” physical but also health. Approximately one-third consider OB-GYN primary pregnancy, over 50 OB-GYNs perceive themselves supporting primary, specialty, preventive care.[14] Medicaid covers 42 more some states, thus provide disproportionate amount poor minority compared specialties.[15] commonly feel hesitant screen address needs patients, particularly population.[16] As result, 10 adequate treatment.[17] A recent study 288 fellows revealed 84 prescribed SSRIs patients; filling gap taking ownership patients’ health.[18] ACOG’s recommendations treat period, formal training residency fellowship typically use validated such Diagnostic Statistical Manual Disorders-Forth Edition (DSM-IV) diagnosis prior prescribing antidepressants. Their standard reference can lead misdiagnoses.[19] fact, screened found later diagnosed disorder.[20] Screening further impacted trust providers. Distrust receiving Medicaid, US strongly worse self-reported outcomes.[21] Notably, coverage reported being treated unfairly disrespect because race status. They loss decision-making autonomy labor delivery less emotional practical support home.[22] Many comfortable discussing provider.[23] Connecting person shared lived experiences, known engagement coaching, may be simple solution. II. (collaborative care), University Washington 2002, integrated behavioral designed common require measurement-based follow-up chronic nature.[24] Centers Medicare issued billing codes 2016. adopted them 2017, they were widely operationalized field.[25] 2022, 19 plans.[26] facilitates manager, licensed therapist worker, setting. manager in-person virtual facilitate screenings, symptom monitoring, psychiatric consultations, coordination.[27] consultant, board-certified psychiatrist nurse practitioner, team. consultants see one one. Rather, review complex treatment-resistant cases management provider. Thus, team expanded members expertise provider, ultimately any psychoactive medications indicated.[28] tested 90 randomized clinical trials evaluating efficacy across multiple medical specialties.[29] setting indicate successful cost-effective usual conditions.[30] Studies show improves lowers costs, returning $6.50 every dollar spent depression. effective diverse patient populations.[31] III. Evidence Obstetrics success identifying potential savings suggest implementation feasible approach.[32] Randomized showed improvement quality care, severity, remission before birth 18 months postbaseline socioeconomically women.[33] addition, mitigating racial disparities antenatal care; equity-promoting intervention health.[34] faced limitations, including inability establish causality, researchers recommended research. warranted, programs indicated improved IV. Barriers Adoption promising results, limited, billable under states.[35] Large systems difficulty operationalizing shortages, administrative burdens. More evidence financial benefits clinics, hospitals, needed. Additionally, practices must adapt updated plans, motivated become involved issues potentially broaden scope practice.[36] major ask providers, robust lacking applied without resources infrastructure trial. V. Peer-to-Peer Engagement Peer growing. defined help people experiences give another.[37] Effective examples peer addiction, services, workforce. Regarding addiction recovery support, systematic concluded interventions beneficial effect participants positively contribute substance outcomes.[38] highly used medicine professions when attending skilled professionals train new colleagues. nursing profession uses deliver symptoms burnout.[39] described literature, differ methodology feasibility maintenance possible collaboration stakeholders.[40] Understanding foundation peers way bridge gap. coach valuable model. VI. into Currently, start-up based Boston Philadelphia, FamilyWell, piloted company strives solve close equity applying text messaging platform connect expecting newly mothers coaches. coaches trained mothers, third-trimester 12 postpartum, providing latest Coaches own stories, making relatable equipped ups downs parenthood.[41] Increased education, screening, co-occur connections made texting visits On demand ensures no mother feels alone safe space questions process emotions. If needed, enrolled moms request longer sessions minutes certified coaches, how move forward better, accomplished cognitive techniques.[42] schedules automated messages containing educational content. Individual plans individual’s OB include monthly post-pregnancy. three-week sent Edinburg postnatal scale (EPDS-3) via messages.[43] three national six-weeks recommendation focuses antepartum which factor depression.[44] individual therapy available platform, giving access therapist, specializing extensive waitlist. Therapists medication FamilyWell CEO founder, Jessica Gaulton, preliminary collected company’s launch, limited PA region 24 consented program. total 3,000 texts exchanged, 44.2 came coaches.[45] expediates appropriate referrals, creates individualized wellness serves resource navigating system. VII. Providing Justice System well-being bellwether society; injustice our society shows health.[46] Earlier, broader, frequent combined direct essential rate. care. yet begins tech-based platform’s broader critical. Limiting illness fails serve adequately. Expanding criteria indicators future simple, proactive step. critical helping openly problems facing beginning conversations otherwise occurring visit. Companies like Having outside organization peer-coaches building championing reduces burden overworked obstetricians. organize interprofessional communications, rarely take place system.[47] telehealth brings compassion, contact directly patient, demographic properly accessing now. coordinator make referrals align mother’s coverage, might know where begin performing knowing CONCLUSION significant. Women trust, effective, proven setting, conclude obstetrics, exist. eliminate build needed model, financially sustainable revenue-generating hospitals departments. However, step generate save lives. - [1] Collier, A. R. Y., & Molina, L. (2019). States: updates trends, causes, solutions. Neoreviews, 20(10), e561-e574. [2] Hoyert, D. (2023). Rates States, 2021.Health E-Stats. National Center Statistics. Disease Control. https://dx.doi.org/10.15620/cdc:124678 [3] Miller, E. S., Grobman, W. A., Ciolino, J. D., Zumpf, K., Sakowicz, Gollan, J., Wisner, K. (2021). Services, 72(11), 1268-1275. [4] Trost, S. L., Beauregard, Smoots, N., Ko, Haight, C., Moore Simas, T. ... Goodman, Preventing Pregnancy-Related Deaths: Insights From 14 Committees, 2008–17: Study examines Affairs, 40(10), 1551-1559. [5] Blenning, C. E., Paladine, H. (2005). An office Family Physician, 72(12), 2491-2496; ACOG Committee Opinion No. 736: Optimizing Postpartum Care. gynecology, 132(3), 784–785. https://doi.org/10.1097/AOG.0000000000002849 [6]Bauman, B. Cox, D'Angelo Mph, V., Warner, Folger, Tevendale, Coy, Harrison, Barfield, (2020). Vital Signs: Depressive Symptoms Provider Discussions About Perinatal Depression 2018. MMWR. Morbidity weekly report, 69(19), 575–581. https://doi.org/10.15585/mmwr.mm6919a2 [7] Shuman, C.J., Peahl, A.F., Pareddy, N. (2022) factors pandemic. BMC Res Notes 15, 102. https://doi.org/10.1186/s13104-022-05991-8 [8] Grote, Katon, Russo, Lohr, M. Curran, M., Galvin, Carson, (2015). women: Anxiety, 32(11), 821-834. [9] HESI Annual Report. HESI. (2022, November). Retrieved April 30, 2023, Special-Report-Nov-2022-Results-for-Measures-Leveraging-Electronic-Clinical-Data-for-HEDIS.pdf (ncqa.org) [10] Byatt, Levin, Ziedonis, Allison, Enhancing Participation Outpatient Settings: Systematic Review. Gynecology, 126(5), 1048–1058. https://doi.org/10.1097/AOG.0000000000001067 [11] Satiani, Niedermier, B., Svendsen, P. (2018). Projected Workforce Psychiatrists Population Analysis. (Washington, D.C.), 69(6), 710–713. https://doi.org/10.1176/appi.ps.201700344 [12] Bureau (HRSA) U.S. Department Human Services. (April 27, 2023) Designated Professional Shortage Areas Statistics, Second Quarter Fiscal Year 2023 HPSA Quarterly Summary. https://data.hrsa.gov/Default/GenerateHPSAQuarterlyReport [13] Coward, New CCBHCs access, wait times. Behavioral Business. https://bhbusiness.com/2021/05/25/new-data-shows-ccbhcs-improve-behavioral-health-access-reduce-wait-times; Government. June 17). Reducing economic unmet CEA. White House. https://www.whitehouse.gov/cea/written-materials/2022/05/31/reducing-the-economic-burden-of-unmet-mental-health-needs/ [14] LaRocco-Cockburn, Reed, Melville, Croicu, Inspektor, (2013). Improving integrating Contemporary trials, 36(2), 362-370. [15] Raney, Cracking codes: State approaches reimbursing Oakland, California Foundation. [16] Hansen, Tobón, Haider, U. Newsome, Finelli, role psychiatry advancing equity. General Hospital Psychiatry. [17] Q., Sowa, Meltzer-Brody, Gaynes, (2016). cascade: baby steps toward Journal psychiatry, 77(9), 20901. [18] Taouk, H., Matteson, Stark, Schulkin, Prenatal antidepressant prescription: obstetrician-gynecologists' practices, opinions, interpretation evidence. Archives women's health, 21(1), 85–91. https://doi.org/10.1007/s00737-017-0760-7 [19] Garbarino, Kohn, R., Coverdale, Kilpatrick, Current Trends Education Among Gynecology Residency Programs. Academic psychiatry: journal Association Directors Training Psychiatry, 43(3), 294–299. https://doi.org/10.1007/s40596-019-01018-w ; [20] Sit, McShea, Rizzo, Zoretich, Hughes, L.,& Hanusa, Onset timing, thoughts self-harm, diagnoses screen-positive findings. JAMA 70(5), 490-498 [21] Armstrong, Rose, Peters, Long, McMurphy, Shea, (2006). general internal medicine, 21(4), 292–297. https://doi.org/10.1111/j.1525-1497.2006.00396.x [22] Declercq, Zephyrin, Primer. Commonwealth Fund. https://www.commonwealthfund.org/publications/issue-brief-report/2020/dec/maternal-mortality-united-states-primer [23] Scholle, Kelleher, (2003). Preferences advice among low-income women. child journal, 7(2), 95–102. https://doi.org/10.1023/a:1023864810207https://doi.org/10.1023/a:1023864810207 [24] AIMS Center. (n.d.). https://aims.uw.edu/collaborative-care [25] Press, Howe, Schoenbaum, Cavanaugh, Marshall, Baldwin, Conway, (2017). payment integration. n Engl j Med, 376(5), 405-407. [26] Chang, Morrison, Bowen, Harris, Dusic, Velasquez, Ratzliff, Making Sustainability: Evaluating Billing Strategies appips20220596. Advance online publication. https://doi.org/10.1176/appi.ps.20220596 [27] Jensen, Hoffman, Osborne, McEvoy, Moses-Kolko, Implementation care: Primary development, 21, e30. [28] [29] Unützer, W., Callahan, Williams, Jr, Hunkeler, Harpole, Hoffing, Della Penna, Noël, Lin, Areán, Hegel, T., Tang, Belin, Oishi, Langston, IMPACT Investigators. Mood-Promoting Access Treatment (2002). late-life setting: controlled JAMA, 288(22), 2836–2845. https://doi.org/10.1001/jama.288.22.2836 [30] [31] Harbin, Druss, model: homes. Home Resource Center, 1-13. [32] [33] 821-834 [34] 1268-1275; Snowber, Clark, (2022). Associations Between Disparities 140(2), 204-211. [35] Percent People Covered By Medicaid/CHIP, 2022. Fact Sheets. KFF. May 1, https://www.kff.org/interactive/medicaid-state-fact-sheets/ [36] [37] Shalaby, Agyapong, health: literature review. JMIR 7(6), e15572. [38] Bassuk, Hanson, Greene, Richard, Laudet, Peer-delivered addictions abuse treatment, 63, 1-9. [39] Eastburg, Williamson, Gorsuch, Ridley, (1994). Social personality, burnout nurses. Applied Psychology, 24(14), 1233-1250. [41] FamilyWell. (2023.). https://familywellhealth.com/ [42] Patients, Well https://familywellhealth.com/patients [43] Providers, https://familywellhealth.com/providers [44] [45] Author interview (2023) [46] Maven “If unwell, unwell.” Recapping Q&A Dr. Neel Shah. Maven. https://www.mavenclinic.com/post/if-moms-are-unwell-society-is-unwell-recapping-our-q-a-with-dr-neel-shah#! [47] Klatter, van Ravesteyn, Stekelenburg, Is key component treating (and additional psychosocial problems)? Women's Health, 25(6), 1029-1039.