Integrated perinatal mental health care: a national model of perinatal primary care in vulnerable populations
Open accessAbstract
Introduction: Perinatal mood and anxiety disorders (PMADs) are the most common complication of pregnancy and have been found to have long-term implications for both mother and child. In vulnerable patient populations such as those served at Denver Health, a federally qualified health center the prevalence of PMADs is nearly double the nationally reported rate of 15–20%. Nearly 17% of women will be diagnosed with major depression at some point in their lives and those numbers are twice as high in women who live in poverty. Women also appear to be at higher risk for depression in the child-bearing years. In order to better address these issues, an Integrated Perinatal Mental Health program was created to screen, assess, and treat PMADs in alignment with national recommendations to improve maternal–child health and wellness. This program was built upon a national model of Integrated Behavioral Health already in place at Denver Health. Methods: A multidisciplinary team of physicians, behavioral health providers, public health, and administrators was assembled at Denver Health, an integrated hospital and community health care system that serves as the safety net hospital to the city and county of Denver, CO. This team was brought together to create a universal screen-to-treat process for PMAD’s in perinatal clinics and to adapt the existing Integrated Behavioral Health (IBH) model into a program better suited to the health system’s obstetric population. Universal prenatal and postnatal depression screening was implemented at the obstetric intake visit, a third trimester prenatal care visit, and at the postpartum visit across the clinical system. At the same time, IBH services were implemented across our health system’s perinatal care system in a stepwise fashion. This included our women’s care clinics as well as the family medicine and pediatric clinics. These efforts occurred in tandem to support all patients and staff enabling a specially trained behavioral health provider (psychologists and L.C.S.W.’s) to respond immediately to any positive screen during or after pregnancy. Results: In August 2014 behavioral health providers were integrated into the women’s care clinics. In January 2015 universal screening for PMADs was implemented throughout the perinatal care system. Screening has improved from 0% of women screened at the obstetric care intake visit in August 2014 to >75% of women screened in August 2016. IBH coverage by a licensed psychologist or licensed clinical social worker exists in 100% of perinatal clinics as of January 2016. As well, in order to gain sustainability, the ability to bill same day visits as well as to bill, and be reimbursed for screening and assessment visits, continues to improve and provide for a model that is self-sustaining for the future. Conclusion: Implementation of a universal screening process for PMADs alongside the development of an IBH model in perinatal care has led to the creation of a program that is feasible and has the capacity to serve as a national model for improving perinatal mental health in vulnerable populations.
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Models of collaborative care that integrate behavioral health providers into medical practice may improve screening rates and provide increased access to accurate, sensitive assessment and timely implementation of evidence-based interventions.
“Models of collaborative care that integrate behavioral health providers (e.g., social workers, psychiatric nurse practitioners, and psychologists) into medical practice may offer unique advantages by not only improving screening rates [90] but also providing increased access to accurate, sensitive assessment and the timely implementation of evidence-based interventions [91].”
From Trajectories of Maternal and Paternal Internalizing Symptoms from Pregnancy to 2 Years Postpartum: Identifying Modifiable Risk and Protective Factors (2024) · cites this paper as [90]
In the context of structural racism and discrimination, rates of perinatal mental health conditions are nearly double for women of color and those experiencing poverty.
“In the context of structural racism and discrimination, the rates are nearly double for women of color and those experiencing poverty.33,34”
From The transition to parenthood in obstetrics: enhancing prenatal care for 2-generation impact (2022) · cites this paper as [34]
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Cites
Detection of Postnatal Depression: Development of the 10-item Edinburgh Postnatal Depression Scale
Cox, J. L., Holden, J. M., & Sagovsky, R. (1987) · British Journal of Psychiatry · doi:10.1192/bjp.150.6.782 · Cited by 14,183 · see citing works
Effects of perinatal mental disorders on the fetus and child
Stein, A., Pearson, R. M., Goodman, S. H., Rapa, E., Rahman, A., McCallum, M., Howard, L. M., & Pariante, C. M. (2014) · The Lancet · doi:10.1016/s0140-6736(14)61277-0 · Cited by 2,166 · see citing works
Screening for Depression in Adults: US Preventive Services Task Force Recommendation Statement
Siu, A. L., and the US Preventive Services Task Force (USPSTF), Bibbins-Domingo, K., Grossman, D. C., Baumann, L. C., Davidson, K. W., Ebell, M., García, F. A. R., Gillman, M., Herzstein, J., et al. (2016) · JAMA · doi:10.1001/jama.2015.18392 · Cited by 1,407 · see citing works
Non-psychotic mental disorders in the perinatal period
Howard, L. M., Molyneaux, E., Dennis, C.-L., Rochat, T., Stein, A., & Milgrom, J. (2014) · The Lancet · doi:10.1016/s0140-6736(14)61276-9 · Cited by 1,328 · see citing works
Gaynes, B. N., Gavin, N., Meltzer-Brody, S., Lohr, K. N., Swinson, T., Gartlehner, G., Brody, S., & Miller, W. C. (2005) · PsycEXTRA Dataset · doi:10.1037/e439372005-001 · Cited by 1,211 · see citing works
Wisner, K. L., Sit, D. K. Y., McShea, M. C., Rizzo, D. M., Zoretich, R. A., Hughes, C. L., Eng, H. F., Luther, J. F., Wisniewski, S. R., Costantino, M. L., et al. (2013) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2013.87 · Cited by 1,091 · see citing works
(2015) · Obstetrics and Gynecology · doi:10.1097/01.aog.0000465192.34779.dc · Cited by 424 · see citing works
Pregnant women with posttraumatic stress disorder and risk of preterm birth
Yonkers, K. A., Smith, M. V., Forray, A., Epperson, C. N., Costello, D., Lin, H., & Belanger, K. (2014) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2014.558 · Cited by 331 · see citing works
Maternal Deaths From Suicide and Overdose in Colorado, 2004–2012
Metz, T. D., Rovner, P., Hoffman, M. C., Allshouse, A. A., Beckwith, K. M., & Binswanger, I. A. (2016) · Obstetrics and Gynecology · doi:10.1097/aog.0000000000001695 · Cited by 204 · see citing works
Self-citationEngaging Women Who Are Depressed and Economically Disadvantaged in Mental Health Treatment
Grote, N. K., Zuckoff, A., Swartz, H., Bledsoe, S. E., & Geibel, S. (2007) · Social Work · doi:10.1093/sw/52.4.295 · Cited by 171 · see citing works
Measures of maternal stress and mood in relation to preterm birth
Hoffman, M. C., Mazzoni, S. E., Wagner, B. D., Laudenslager, M. L., & Ross, R. G. (2016) · Obstetrics & Gynecology · doi:10.1097/aog.0000000000001287 · Cited by 168 · see citing works
Self-citationMbuagbaw, L., Medley, N., Darzi, A. J., Richardson, M., Habiba Garga, K., & Ongolo-Zogo, P. (2015) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd010994.pub2 · Cited by 156 · see citing works
Consensus Bundle on Maternal Mental Health: Perinatal Depression and Anxiety
Kendig, S. M., Keats, J. P., Hoffman, M. C., Kay, L. B., Miller, E. S., Simas, T. A. M., Frieder, A., Hackley, B. K., Indman, P., Raines, C., et al. (2017) · Journal of Obstetric, Gynecologic & Neonatal Nursing · doi:10.1016/j.jogn.2017.01.001 · Cited by 144 · see citing works
Self-citationImproving Care for Depression in Obstetrics and Gynecology: A Randomized Controlled Trial
Melville, J. L., Reed, S. D., Russo, J., Croicu, C. A., Ludman, E., LaRocco-Cockburn, A., & Katon, W. (2014) · Obstetrics & Gynecology · doi:10.1097/aog.0000000000000231 · Cited by 132 · see citing works
Symptoms of Posttraumatic Stress Disorder in a Community Sample of Low-Income Pregnant Women
Smith, M. V., Poschman, K., Cavaleri, M. A., Howell, H. B., & Yonkers, K. A. (2006) · American Journal of Psychiatry · doi:10.1176/ajp.2006.163.5.881 · Cited by 121 · see citing works
Perinatal depression: implications for child mental health.
Muzik, M., & Morgan, S. B. (2010) · PubMed Central · Cited by 113 · see citing works
Byatt, N., Biebel, K., Friedman, L., Debordes-Jackson, G., Ziedonis, D. M., & Pbert, L. A. (2013) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2013.07.011 · Cited by 110 · see citing works
Primary care mental health: a new frontier for psychology
Gunn, W. B., & Blount, A. (2009) · Journal of Clinical Psychology · doi:10.1002/jclp.20499 · Cited by 90 · see citing works
Psychological treatments for perinatal depression
Stuart, S. P., & Koleva, H. K. (2013) · Best Practice & Research Clinical Obstetrics & Gynaecology · doi:10.1016/j.bpobgyn.2013.09.004 · Cited by 80 · see citing works
Dimidjian, S., & Goodman, S. H. (2014) · Behaviour Research and Therapy · doi:10.1016/j.brat.2013.11.008 · Cited by 75 · see citing works
Katon, W. J., Russo, J. E., Reed, S. D., Croicu, C., Ludman, E. J., LaRocco–Cockburn, A., & Melville, J. (2014) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2014.14020258 · Cited by 56 · see citing works
Poleshuck, E. L., & Woods, J. R. (2014) · American Psychologist · doi:10.1037/a0036044 · Cited by 52 · see citing works
Consensus Bundle on Maternal Mental Health: Perinatal Depression and Anxiety
Kendig, S. M., Keats, J. P., Hoffman, M. C., Kay, L. B., Miller, E. S., Simas, T. A. M., Frieder, A., Hackley, B. K., Indman, P., Raines, C., et al. (2017) · Journal of Midwifery & Women s Health · doi:10.1111/jmwh.12603 · Cited by 41 · see citing works
Self-citationBest Practices: An Emerging Best Practice Model for Perinatal Depression Care
Sit, D. K. Y., Flint, C. S., Svidergol, D., White, J., Wimer, M., Bish, B., & Wisner, K. L. (2009) · Psychiatric Services · doi:10.1176/appi.ps.60.11.1429 · Cited by 33 · see citing works
Kwee, J., & McBride, H. L. (2015) · Journal of Health Psychology · doi:10.1177/1359105315586211 · Cited by 26 · see citing works
Best Practices: An Emerging Best Practice Model for Perinatal Depression Care
Sit, D. K. Y., Flint, C. S., Svidergol, D., et al. (2009) · Psychiatric Services · doi:10.1176/ps.2009.60.11.1429 · Cited by 21 · see citing works
Getting mental health care where it is needed.
Blount, A. (2013) · Families Systems & Health · doi:10.1037/a0032496 · Cited by 5 · see citing works
210: Maternal deaths from suicide and drug overdose in Colorado
Metz, T. D., Rovner, P., Allshouse, A. A., et al. (2015) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2015.10.247 · Cited by 3 · see citing works
Denver Health. Transforming care across the continuum.
Gabow, P. A. (2010) · PubMed · Cited by 3 · see citing works
Flagged first, then by citations
Research works printed but not linked: 1
- National Institute for Health and Care Excellence (2017) Antenatal and postnatal mental health: clinical management and service guidance, [website], 2017, https://www.nice.org.uk/guidance/cg192/chapter/1-recommendations. 31990493
Cited by
Sorted by citations
The transition to parenthood in obstetrics: enhancing prenatal care for 2-generation impact
Monk, C., Dimidjian, S., Galinsky, E., Gregory, K. D., Hoffman, M. C., Howell, E. A., Miller, E. S., Osborne, C., Rogers, C. E., Saxbe, D. E., et al. (2022) · American Journal of Obstetrics & Gynecology MFM · doi:10.1016/j.ajogmf.2022.100678 · Cited by 19 · see citing works
Self-citationEmotion regulation strategies and perceived stress during pregnancy in expectant mothers and fathers
Penner, F., Bunderson, M., Bartz, C., Brooker, R. J., & Rutherford, H. J. (2024) · Journal of Reproductive and Infant Psychology · doi:10.1080/02646838.2022.2110224 · Cited by 14 · see citing works
Laifer, L. M., DiLillo, D., & Brock, R. L. (2023) · Development and Psychopathology · doi:10.1017/s0954579421000894 · Cited by 9 · see citing works
Laifer, L. M., Ramsdell, E. L., Stasik-O’Brien, S. M., Martin, R. C. B., & Brock, R. L. (2024) · Depression and Anxiety · doi:10.1155/2024/5164261
- Authors
- Lomonaco-Haycraft, K. C., Hyer, J., Tibbits, B., Grote, J., Stainback-Tracy, K., Ulrickson, C., Lieberman, A., van Bekkum, L., & Hoffman, M. C.
- Affiliations
- Denver Health Medical Center (US)
- Denver Public Health (US)
- Corresponding author
- Lomonaco-Haycraft, Kimberly C.
- Venue
- Primary Health Care Research & Development
- Publisher
- Cambridge University Press (CUP)
- Published
- 2018-06-18
- Volume
- 20
- Pages
- e77-e77
- ISSN
- 1463-4236 (ISSN-L)
- 1477-1128
- PMC
- PMC6567896
- OpenAlex
- W2809195722
- Cited by
- 59
- References
- 29
- Citations by year
- 2026: 6 · 2025: 7 · 2024: 12 · 2023: 8 · 2022: 17 · 2021: 6 · 2020: 2 · 2019: 1
- FWCI
- 2.15
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Primary Health Care Research & Development (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- Walton Family Foundation
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Health Sciences › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
- Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
- Keywords
- perinatal mood and anxiety disorders, behavioral health integration, perinatal depression screening, universal screening, safety net health care, federally qualified health centers, vulnerable populations, maternal mental health, integrated care model, postpartum depression, antenatal depression, multidisciplinary team, Denver Health, health care access disparities, maternal and child health
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