The role of perinatal psychiatry access programs in advancing mental health equity.

This editorial presents: 1) a review of Perinatal Psychiatry Access Programs as an integrated care model with potential for promoting perinatal mental health equity; and 2) a summary of how the model has been and can be further adapted to help achieve perinatal mental health equity in geographically diverse settings. Within the editorial, we highlight Access Programs as a promising model for promoting perinatal mental health equity. This editorial is supported by original descriptive data on the Lifeline for Moms National Network of Perinatal Psychiatric Access Programs. Descriptive data is additionally provided on three statewide Access Programs. The Access Program model, and the accompanying Network of Access Programs, is a multi-level approach demonstrating promise in reducing perinatal mental health inequities. Access Programs demonstrate potential to implement interventions to address well-documented inequities in perinatal mental healthcare access at the patient-, clinician-, practice-, community-, and policy-levels. For Access Programs to leverage their potential to advance perinatal mental health equity, systematic efforts are needed that include partnership with impacted communities and implementation teams.

Racial inequities in emergency department wait times for pregnancy-related concerns.

OBJECTIVE: Emergency department care is common among US pregnant women. Given the increased likelihood of serious and life-threatening pregnancy-related health conditions among Black mothers, timeliness of emergency department care is vital. The objective of this study was to evaluate racial/ethnic variations in emergency department wait times for receiving obstetrical care among a nationally representative population. METHODS: The study used pooled 2016-2018 data from the National Hospital Ambulatory Medical Care Survey, a nationally representative sample of emergency department visits. Regression models were estimated to determine whether emergency department wait time was associated with the race/ethnicity of the perinatal patient. Adjusted models controlled for age, obesity status, insurance type, whether the patient arrived by ambulance, triage status, presence of a patient dashboard, and region. RESULTS: There were a total of 821 reported pregnancy-related visits in the National Hospital Ambulatory Medical Care Survey sample of emergency department visits. Of those 821 visits, 40.6% were among White women, 27.7% among Black women, and 27.5% among Hispanic women. Mean wait times differed substantially by race/ethnicity. After adjusting for potential confounders, Black women waited 46% longer than White women with emergency department visits for pregnancy problems (p < .05). Those reporting another race waited 95% longer for pregnancy problems in the emergency department than White women (p < .05). CONCLUSION: Findings from this study document significant racial/ethnic differences in wait times for perinatal emergency department care. Although inequities in wait times may emerge across the spectrum of care, documenting the factors influencing racial disparities in wait times are critical to promoting equitable perinatal health outcomes.

Patient engagement to examine perceptions of perinatal depression screening with the capabilities, opportunities, motivation, and behaviors (COM-B) model.

Background: Perinatal (during pregnancy and up until one year after birth) depression is one of the most common medical complications of pregnancy and is a major public health issue. The common early detection method to identify depression is to systematically administer depression screens to patients during their usual care clinic encounters. This study investigates how prenatal patients perceive depression screening and how screening informs their treatment to meet the specific needs of different racial and ethnic groups within both community and health care settings. Methods: Between June 2019 and August 2019, semi-structured in-depth interviews were conducted to explore participants' experiences of depression screening with the Edinburgh Postnatal Depression Scale (EPDS). Perinatal women (N = 29) consented to participate in-depth, one-on-one qualitative interviews. Trained patient-researchers (n = 6), women who had previously experienced a perinatal mental health problem, were trained as research team members and facilitated the interviews alongside a research assistant. All interviews were recorded and transcribed verbatim. Data was analyzed with the use of Nvivo12. Thematic network analysis was used to analyze the data. Results: Through the in-depth patient engaged qualitative interviews this study uncovered several specific motivators and behaviors related to perinatal depression screening. Using directed content analysis, several themes within a COM-B frame emerged and could be reduced to themes and further divided into two different stages: the depression screening stage and the post-screening stage. Conclusions: The results of this qualitative study provide information for health care providers to improve, adjust, and assess the process of conducting perinatal depression screening among women. The data also provide information for health care facilities to identify a better screening tool and develop and measure their screening process. These findings are essential to design comprehensive patient-centered screening protocols given the increase in state and federal policies urging universal depression screening.

Case Report: Implementation of a Multi-Component Behavioral Health Integration Program in Obstetrics for Perinatal Behavioral Health.

Despite growing research and policy attention, perinatal behavioral health conditions (i.e., mental health and substance use disorders) remain prevalent, burdensome for families, and largely untreated in the US. Researchers have documented an array of barriers to accurate detection, linkage with effective treatment, and improved outcomes for perinatal women with behavioral health disorders. It is clear that a multi-component approach that integrates evidence-based detection and management of perinatal behavioral health in the context of obstetrics care can be effective. This paper presents the initial development of a clinical quality improvement program that includes evidence-based components of behavioral health integration in obstetrics in the state of Florida in the US. The FL BH Impact (Improving Maternal and Pediatric Access, Care and Treatment for Behavioral Health) program, guided by the RE-AIM model for program implementation, has been developed over the past 2 years. Program components, initial implementation, and preliminary findings are presented. Following the implementation phase, the program has enrolled 12 obstetrics practices and 122 obstetrics providers in program engagement and training activities. The primary program component allows for obstetrics clinician telephone access to a statewide listing of behavioral health referral resources for patients and access to consultation with psychiatry. Since program implementation, the program has received a total of 122 calls to this line, with an expected increasing trajectory of calls over time. Results suggest this program is feasible to implement across a large geographic area. Challenges to implementation and future directions are discussed. These types of multi-component approaches to improved management and outcomes for perinatal behavioral health are promising and must be expanded and sustained in the US.

Predictors of preterm birth and low birth weight: A person-centered approach.

OBJECTIVE: Profound disparities exist among Black and White families who experience adverse infant health outcomes, yet much is unclear regarding factors that predict disparate outcomes. In order to address this gap, this study applied a person-centered, intersectional analysis to determine ways that women's typological risk profiles inform risk for preterm birth and low birth weight. MATERIALS AND METHODS: In order to examine the role that social determinants play in predicting risk, this study implemented a latent class mixture modeling analysis of data from the Pregnancy Risk Assessment Monitoring System (PRAMS). Data were extracted from Pennsylvania and Illinois PRAMS surveys from 2012 to 2015 (n = 4336). RESULTS: Results of the study indicate three distinct risk types among women in the sample: low-, moderate- and high-risk. Three latent classes were identified: (1) low risk for PTB/LBW (44%); (2) moderate risk (19%); and (3) high risk (36%). Compared to class one, the likelihood of experiencing PTB were significantly higher for class three (x 2 PTB = 9.54, p < .001; x 2 LBW = 35.51, p < .001). The likelihood of experiencing LBW were significantly higher for class three, compared to class two (x 2 PTB = 9.21, p < .05; x 2 LBW = 21.17, p < .001).Within the three risk groups, racial disparities are particularly notable, with 76% of the sample's African American mothers falling into the "high-risk" category. CONCLUSION: Public and perinatal health researchers, organizations, and funders are increasingly recognizing the need to identify methods that will best support health-promoting interventions that have the potential to close the racial disparity in PTB and LBW. Although racial disparities have long been noted, the findings from this study's analysis help to better understand how determinants of health intersect to create an overarching risk profile, which can be used to inform health interventions and services that may reduce the current Black-White gap in infant health outcomes.

Traversing Traditions: Prenatal Care and Birthing Practice Preferences Among Black Women in North Florida.

Objective: Our goal was to explore prenatal practices and birthing experiences among Black women living in an urban North Florida community. Design: Non-random qualitative study. Setting: Private spaces at a convenient location selected by the participant. Participants: Eleven Black women, aged 25-36 years, who were either pregnant or had given birth at least once in the past five years in North Florida. Methods: Semi-structured interviews were completed in July 2017, followed by thematic analysis of interview transcripts. Results: Four main themes emerged: a) decision-making strategies for employing alternative childbirth preparation (ie, midwives, birthing centers, and doulas); b) having access to formal community resources to support their desired approaches to perinatal care; c) seeking advice from women with similar perspectives on birthing and parenting; and d) being confident in one's decisions. Despite seeking to incorporate "alternative" methods into their birthing plans, the majority of our participants ultimately delivered in-hospital. Conclusions: Preliminary results suggest that culturally relevant and patient-centered decision-making might enhance Black women's perinatal experience although further research is needed to see if these findings are generalizable to a heterogenous US Black population. Implications for childbirth educators and health care professionals include: 1) recognizing the importance of racially and professionally diverse staffing in obstetric care practices; 2) empowering patients to communicate and achieve their childbirth desires; 3) ensuring an environment that is not only free of discrimination and disrespect, but that embodies respect (as perceived by patients of varied racial backgrounds) and cultural competence; and, 4) providing access to education and care outside of traditional work hours.

A Comparison of Professional Views on Research-Supported Parenting Interventions in A Community-Based System of Care.

PURPOSE: This qualitative study examined views of research-supported parenting interventions across three stakeholder groups that have critical roles in child welfare-case managers, clinicians, and judicial representatives in one rural community. METHOD: Semi-structured interviews were conducted with members in each stakeholder group. Two analytic approaches were used. First, views on the selection of research-supported interventions, strengths and weaknesses, and professional collaboration in implementation were examined. Second, several factors in the literature impacting research-supported interventions were used to compare views. RESULTS: All stakeholder groups supported the use of research-supported therapies while agreeing that the overriding importance in selecting any therapy was to ensure the best "fit" with a client. Professional collaboration was considered essential in a variety of forms and combinations by all groups. DISCUSSION AND CONCLUSION: The results highlight important considerations in selecting and implementing research-supported parent therapies. Recommendations to continue and expand this line of research are articulated.