Increasing Access To Perinatal Mental Health Care: The Perinatal Psychiatry Access Program Model.

Perinatal psychiatry access programs offer a scalable approach to building the capacity of perinatal professionals to identify, assess, and treat mental health conditions. Little is known about access programs' implementation and the relative merits of differing approaches. We conducted surveys and semistructured interviews with access program staff and reviewed policy and procedure documents from the fifteen access programs that had been implemented in the United States as of March 2021, when the study was conducted. Since then, the number of access programs has grown to thirty state, regional, or national programs. Access programs implemented up to five program components, including telephone consultation with a perinatal psychiatry expert, one-time patient-facing consultation with a perinatal psychiatry expert, resource and referral to perinatal professionals or patients, trainings for perinatal professionals, and practice-level technical assistance. Characterizing population-based intervention models, such as perinatal psychiatry access programs, that address perinatal mental health conditions is a needed step toward evaluating and improving programs' implementation, reach, and effectiveness.

Recent intimate partner violence as a prenatal predictor of maternal depression in the first year postpartum among Latinas.

The study aims to determine if recent intimate partner violence (IPV) is a prenatal risk factor for postpartum depression (PPD) among pregnant Latinas seeking prenatal care. A prospective observational study followed Latinas from pregnancy through 13 months postpartum. Prenatal predictors of PPD included depression, recent IPV exposure, remote IPV exposure, non-IPV trauma history, poverty, low social support, acculturation, high parity, and low education. Postpartum depression was measured at 3, 7, and 13 months after birth with the Beck's Depression Inventory-Fast Screen. Strength of association was evaluated using bivariate and multivariable odds ratio analysis. Subjects were predominantly low income, monolingual Spanish, and foreign-born, with mean age of 27.7. Recent IPV, prenatal depression, non-IPV trauma, and low social support were associated with greater likelihood of PPD in bivariate analyses. Recent IPV and prenatal depression continued to show significant association with PPD in multivariate analyses, with greater odds of PPD associated with recent IPV than with prenatal depression (adjusted OR = 5.38, p < 0.0001 for recent IPV and adjusted OR = 3.48, p< 0.0001 for prenatal depression). Recent IPV exposure is a strong, independent prenatal predictor of PPD among Latinas. Screening and referral for both IPV and PPD during pregnancy may help reduce postpartum mental health morbidity among Latinas.

The influence of prenatal trauma, stress, social support, and years of residency in the US on postpartum maternal health status among low-income Latinas.

This study examined the associations of prenatal psychosocial factors, including depressive symptoms, post-traumatic stress disorder symptoms, trauma exposure including intimate partner violence, perceived stress, and social support, with perceived postpartum health status. Low-income Latinas (N = 203) were recruited from two health plans within the first 12 weeks of their pregnancies and followed through 3 months after birth. Participants completed semi-structured interviews conducted in English or Spanish within the first 12 weeks of pregnancy, and again at 12 weeks postpartum. Perceived health status was measured by the SF-12. Participants with complete follow-up data (n= 193) were used in data analysis. Women were mostly foreign-born (75%) with low-incomes (59%) and reported postpartum health status in the average range (M = 102.5; SD = 12.2). Overall health status was positively associated with decreased levels of perceived stress (P < .0001), being foreign-born and having resided in the US <10 years (P = .003). Emotional well-being was positively linked with being foreign-born and having resided in the US <10 years (P = .002), increased levels of social support (P = .01), and decreased levels of perceived stress (P < .001). Exposure to non-specific IPV trauma (P = .01) and health problems experienced during pregnancy or delivery (P = .05) were negatively associated with physical health status. Prenatal psychosocial factors and length of residency in the US are differentially predictive of overall postpartum health status and emotional well-being, and have less impact on physical well-being after birth. Health professionals are encouraged to assess these factors in early pregnancy.

Intimate partner violence and maternal depression during the perinatal period: a longitudinal investigation of Latinas.

This study assessed the course of perinatal depression among 210 Latinas who were and were not affected by intimate partner violence (IPV) and identified associated psychosocial factors. Peak depression prevalence occurred prenatally among 45.7% of IPV-exposed and 24.6% of non-IPV-exposed Latinas. At each assessment, depression was significantly higher for IPV-exposed compared to non-IPV-exposed mothers. Mastery and social support were associated with lower depression, whereas history of IPV, perceived stress, and avoidant coping behaviors were associated with higher depression. Findings support recommendations for routine depression and IPV screening of Latinas in perinatal clinical settings.

Intimate partner violence and barriers to mental health care for ethnically diverse populations of women.

Ethnically diverse populations of women, particularly survivors of intimate partner violence (IPV), experience many barriers to mental health care. The search terms ''women'' and ''domestic violence or IPV'' and ''mental health care'' were used as a means to review the literature regarding barriers to mental health care and minority women. Abstracts chosen for further review included research studies with findings on women of one or more ethnic minority groups, potential barriers to accessing mental health care, and a nonexclusive focus on IPV. Fifty-five articles were selected for this review. Identified barriers included a variety of patient, provider, and health system/community factors. Attention to the barriers to mental health care for ethnically diverse survivors of IPV can help inform the development of more effective strategies for health care practice and policy.

Child and adolescent telepsychiatry: utilization and satisfaction.

Access to psychiatric care for children and adolescents is limited outside of urban areas. Telepsychiatry provides one mechanism to bring needed services to youth. This investigation examines whether telepsychiatry could be successful in providing needed services. Using interactive video teleconferencing at 384 kilobits per second, psychiatrists based at a regional childrens hospital provided consultation and management services to patients at 4 sites across Washington State located 75150 miles from the childrens hospital. Twelve-month review of billing records provided utilization data. Surveys of parents satisfaction over 12 months examined whether parents would accept and be satisfied with the care rendered to their children. Over the study year, 387 telepsychiatry visits were provided to 172 youth 221 years old with a mean of 2.25 visits per patient. The demographic and diagnostic profile of this sample was consistent with usual outpatient mental health samples. Parents endorsed high satisfaction with their childrens telepsychiatric care, with an indication of increasing satisfaction upon return appointments. Parents demonstrated some differential satisfaction, tending to higher satisfaction with their school-aged childrens care and lower satisfaction with their adolescents care. Telepsychiatry offered through a regional childrens hospital was well utilized and parents were highly satisfied with their childrens care. The stage is now set for integrating telepsychiatry into a system of care that meets youths overall needs and for controlled studies demonstrating the efficacy of telepsychiatry with youth.

Feasibility, acceptability, and sustainability of telepsychiatry for children and adolescents.

OBJECTIVE: This study examined the feasibility, acceptability, and sustainability of a telepsychiatry service for children and adolescents living in nonmetropolitan communities. METHODS: Using high-bandwidth interactive video teleconferencing, psychiatrists at a children's hospital provided care to patients of primary care physicians at four nonmetropolitan sites. Review of one-year utilization provided feasibility data. Surveys of referring physicians examined acceptability of telepsychiatry. Reimbursement records provided sustainability data. RESULTS: Overall, 387 sessions were provided to 172 youths (mean=2.25 sessions) whose clinical profiles were representative of national samples. Referring providers endorsed high satisfaction with telepsychiatric care, although pediatricians were consistently more satisfied than family physicians. Sustainability of telepsychiatry is challenged by infrastructure costs and low reimbursement by public payers. CONCLUSIONS: Telepsychiatry is a feasible and acceptable approach to providing psychiatric services to youths in underserved communities. Sustainability will depend on developing financial alternatives to fee-for-service, especially if caseloads emphasize publicly funded programs.

The Seattle Pediatric Palliative Care Project: effects on family satisfaction and health-related quality of life.

PURPOSE: This paper presents the components of a pediatric palliative care demonstration program implemented in Seattle during the period 1999-2001. It reports findings from the evaluation of quality of life and family satisfaction among enrolled participants. The program was designed to enhance patient-provider communication using the Decision-making Tool (DMT) and experimented with co-management by clinicians and insurers to support decision making in advanced serious pediatric illness. DESIGN: The project design consisted of ethical decision-making, provider education, and flexible administration of health benefits through co-case management between insurers and care providers. The evaluation study design is a non-experimental pretest, posttest design comparison of pediatric quality of life and family satisfaction at program entry with repeated measures at 3 months post-program entry. Quality of life was measured with parent proxy reports of health-related quality of life using the PedsQL() Version 4.0, and family satisfaction was measured with a 31-item self-administered questionnaire designed by project staff. RESULTS: Forty-one patients ranging in age from infancy to 22 years old were enrolled in the program over a 2-year period. Parents consented to participate in the evaluation study. Thirty one specific diagnoses were represented in the patient population; 34% were some form of cancer. Improvements in health-related quality of life over baseline were observed for 21 matched pairs available for analysis in each domain of health-related quality of life; positive changes in reports of emotional well-being were statistically significant. Improvements over baseline in 14 of 31 family satisfaction items were statistically significant. CONCLUSIONS: Pediatric palliative care services that focus on effective communication, decision support, and co-case management with insurers can improve aspects of quality of life and family satisfaction.

Telepsychiatry with incarcerated youth.

PURPOSE: Incarcerated adolescents have a high prevalence of psychiatric disorders but lack psychiatrists to provide ongoing care. Telepsychiatry may provide one solution to treating this underserved population. METHODS: Interactive video conferencing was used to connect a minimum security correctional facility with a regional telemedicine program. Clinical records were reviewed to examine utilization, demographics, diagnoses, pharmacotherapy, and patient satisfaction. RESULTS: During the 29-month study period, 115 youth were treated using 275 telepsychiatry visits. Substance-use, behavioral, and emotional disorders were highly prevalent. Eighty percent (80%) of the youth were successfully prescribed medications. Youth expressed confidence with the psychiatrist's recommendations but expressed concerns about privacy. CONCLUSIONS: Telepsychiatry can successfully deliver services to incarcerated adolescents with a wide range of psychiatric needs. A patient-centered approach that directly assesses adolescents' satisfaction is recommended to ensure youths' optimal involvement in needed services.

Trends in pediatric hospitalizations of children in washington state by insurance and chronic condition status, 1991-1998.

OBJECTIVE: To examine the possible impact of changes in the organization and management of the Medicaid program on hospitalization patterns for children with chronic and nonchronic conditions between January 1, 1991, and December 31, 1998. DESIGN: Longitudinal retrospective study of hospitalization patterns of children in 4 strata: Medicaid, non-Medicaid, chronic conditions, and nonchronic conditions. SETTING: Washington State. PATIENTS: Hospital discharge abstract records for all children aged 0 to 17 years profiled into those with and without a chronic condition, Medicaid, and non-Medicaid using a diagnosis-based classification system. MAIN OUTCOME MEASURES: Hospitalization and multiple hospitalization rates and length of hospital stay. RESULTS: In 1991, hospitalization and multiple hospitalization rates were higher for all Medicaid vs non-Medicaid children. From 1991 to 1998, there was a decrease in the hospitalization and multiple hospitalization rates for Medicaid children only. By 1998, rates for Medicaid children approximated those for non-Medicaid children. This decrease was greater for nonchronically ill children than for chronically ill children. Total hospitalizations in Medicaid children decreased by 4.5%. The mean length of stay in 1991 for all Medicaid hospitalized children was higher than that for non-Medicaid children (6.1 vs 5.1 days). By 1998, the length of stay decreased for both groups (5.7 vs 4.9 days). CONCLUSION: The declines in hospitalization and multiple hospitalization rates observed in Washington State Medicaid children from 1991 to 1998 may be the result of many statewide efforts to increase access and improve management for this population.