The role of doulas in supporting perinatal mental health - a qualitative study.

Objective: The perinatal period presents several opportunities to identify and treat perinatal mental health and substance use disorders by integrating into existing care pathways. We aimed to examine the role of birth doulas in supporting their clients' perinatal mental health. Methods: Thematic content analysis of focus groups with doulas, and interviews with doula clients was used to characterize the doula-client relationship, investigate whether and how doulas provide mental health and substance use support, and identify barriers and recommendations for doulas to support their clients' mental health. Participants were doula clients from communities underserved due to race, income, language and culture. Results: Doulas and clients reported positive relationships, supported by congruence in culture, language, and lived experiences. Doulas varied in their confidence in identifying perinatal mental health problems, though most agreed that doulas could support their clients' mental health to different degrees. Barriers to engaging in perinatal mental health treatments included low perceived need and socio-economic burden. Conclusions: With adequate support and training, doulas can play an important role in supporting their client's emotional well-being.

Project ECHO in Psychiatric Workforce Development: the Example of a Perinatal Mental Health ECHO.

OBJECTIVE: Perinatal mental health and substance use disorders (PMHSUD) often go unrecognized and untreated. This study examined the use of the Project ECHO model to teach obstetric, primary care, and mental health clinicians about screening, diagnosis, and treatment of PMHSUD. METHODS: Participants in 3 years of the University of Washington's Moms' Access Project (MAP) ECHO program (2019-2022) completed pre- and post-program surveys. Nine participants in year 1 completed qualitative interviews. Dedoose was used for qualitative analysis of interviews. RESULTS: Of 136 participants, 62.5% (15/24) completed both pre- and post-surveys in year 1, 56% (28/50) in year 2, and 32.2% (20/62) in year 3. Most respondents agreed or strongly agreed that they were glad to have participated (96.8%; 60/62) and that they had used information learned in the program in treating a patient (95.1%; 58/61). In all years, respondents endorsed increased confidence regarding learning objectives of the program. Qualitative interviews following year 1 yielded themes of hierarchy of competence, motivation versus results of participation, connection, and politics of change: position and practice type. CONCLUSIONS: Findings supported the feasibility, acceptability, and self-reported effectiveness of the ECHO model for workforce development in PMHSUD.

Facilitators of and barriers to perinatal telepsychiatry care: a qualitative study.

OBJECTIVES: Perinatal mental health disorders such as anxiety, depression and bipolar disorder can negatively impact the health of women and their children without appropriate detection and treatment. Due to increases in mental health symptoms and transmission risks associated with in-person appointments, many clinics transitioned to providing telepsychiatry care during the COVID-19 pandemic. This study sought to identify the facilitators and barriers to receiving perinatal telepsychiatry care from the perspective of patients, clinic staff and psychiatrists. DESIGN: Qualitative study based on analysis of in depth semistructured interviews. SETTING: The study was conducted in a virtual specialty mental health clinic in an academic setting. PARTICIPANTS: Eight patients who had been scheduled for an appointment with the perinatal telepsychiatry clinic between 14 May 2021 and 1 August 2021, seven of whom had attended their scheduled appointment with the clinic and one of whom had not, and five staff members including psychiatrists, navigators and clinic managers, participated in in-depth interviews. RESULTS: Telepsychiatry was perceived by most as preferable to in-person care and easy to attend and navigate. Alternatively, technological difficulties, personal preference for in-person care and scheduling conflicts related to the perinatal period were identified as barriers by some. Participants identified communication between care staff and patients, online patient portals, and appointment reminders as important for facilitating appointment preparedness and attendance. CONCLUSIONS: The findings from this study suggest that telepsychiatry services are perceived positively by patients and care staff and have the potential to improve access to mental healthcare for perinatal patients.

A national survey on adaptations by perinatal psychiatry access programs to promote perinatal mental healthcare equity.

OBJECTIVE: Perinatal Psychiatry Access Programs ("Access Programs") are system-level interventions that aim to build the capacity of perinatal healthcare professionals to address mental health, and thereby improve access to perinatal mental healthcare. Access Programs are widely implemented and positioned to promote health equity in perinatal mental healthcare, but little is known about the adaptations being made to the model in response to calls to promote health equity. METHODS: One respondent from each of the 14 Access Programs (n = 14) completed an online survey that queried on adaptations made to promote perinatal mental healthcare equity. RESULTS: Twelve of the 14 Access Program team members (86%) indicated implementation of at least one new equity initiative. The average number of initiatives that a single Access Program implemented was 3.5 (range 0-10). Two Access Programs (14%) implemented 8.5 initiatives (range: 7-10), indicating that a small cohort is leading promotion of equity among Access Programs. CONCLUSION: Efforts to further expand the capacity and services of Access Programs to address perinatal mental healthcare inequities are needed. These adaptations may provide a robust opportunity for implementation initiatives to promote health equity through a system-level intervention.

Participant perspectives on a seminar-based research career development program and its role in career independence.

Health science researchers need training and support to effectively pursue independence in their research careers. Little data exist regarding the specific resources that faculty researchers have found or would find useful. In this study, we aimed to better understand the needs of health science researchers to develop recommendations for effective career development programming. The authors conducted a multi-method evaluation of early-career researcher faculty needs beginning by using post-session satisfaction surveys to assess the value of a long-standing "K-Club" seminar, which educates and supports those pursuing NIH Career Development (K) awards or similar. The authors then collected in-depth views on career development needs through a series of focus groups conducted with health science researchers at three career stages: early career, award-seeking junior faculty; mid-career faculty who have obtained some extramural funding; senior faculty who serve as mentors for early/mid-career faculty. Participants who attended the existing K-Club strongly endorse the program in supporting their career goals. Focus group participants described specific areas for program expansion that would add value across career stages: more flexible training options, conducted in smaller group settings with immediate feedback provided; more formalized training and resources for senior research mentors; in-depth guidance on individualized grantsmanship. The authors propose program development guidelines for helping researchers achieve research independence and success. Findings indicate that a broad-reaching K-Club style educational seminar can serve as a valuable foundation supporting professional development. The addition of tailored programs delivered across diverse platforms are predicted to heighten career development success.