Innovatioins in Education and Training to Improve Perinatal Meantal Health

Innovations in Education and Training to Improve Perinatal Mental Health

Martha Zimmermann, PhDAnna R. Whelan, MD, FACOGTiffany A. Moore Simas, MD, MPH, MEd, FACOGNancy Byatt, DO, MS, MBA, DFAPA, FACLP

At her 18-week obstetric visit, Kai expresses that she feels sad and has difficulty with daily tasks. Her obstetric provider recommends that she call her insurance company for therapy, but when she does, she is faced with a four-month wait. As her symptoms worsen 24 weeks into her pregnancy, she requests medication. Her obstetric clinician,not trained in depression care, refers Kai to a psychiatrist with a five-month wait. Kai never receives treatment for depression during pregnancy. Unfortunately, experiences like this often occur in obstetric settings across the country.

One in five individuals will experience a mood or anxiety disorder during or in the year after pregnancy (the perinatal period). Mental health and substance use disorders (SUD) are the leading cause of maternal mortality in the U.S. [1]. While we have treatment that improves perinatal mood and anxiety disorders, including therapy and medication, perinatal mental health conditions are underdiagnosed and undertreated. Pregnant and postpartum individuals often face barriers to accessing care, such as long wait times to see a mental health professional. Perinatal individuals from marginalized groups, such as Black/African American, Hispanic/ Latina/o/e/x, American Indian or Alaska Native, or Native Hawaiian or other Pacific Islander are even less likely to receive adequate care [2].

Researchers at the Lifeline for Families Center at UMass Chan Medical School are working on innovative solutions to combat this lack of resources and inequities in care. By taking a “population-level” approach, the team is considering how interventions can have the greatest public health impact. Recognizing that there are not enough mental health professionals to meet the need, the team focuses on how obstetric care professionals can address perinatal mental health in the settings where they practice.

Drs. Nancy Byatt and Tiffany Moore Simas have made significant progress towards this goal. Dr. Moore Simas led the perinatal mental health conditions patient safety bundle published by the Alliance on Innovation in Maternal Health (AIM) and the clinical practice guidelines published by the American College of Obstetricians and Gynecologists (ACOG) [3,4]. The new bundle and guidelines set the standard that addressing mental health is part of obstetric care. To help obstetric clinicians meet this standard, Drs. Byatt and Moore Simas led the development of a set of resources:1) Addressing Perinatal Mental Health Conditions in Obstetric Settings E-module, 2) Perinatal Mental Health Tool Kit, and 3) Guide for Integrating Mental Health Care into Obstetric Practice. These tools are being disseminated by ACOG, reaching more than 70,000 obstetric professionals nationwide. They will be used regionally through the Perinatal-Neonatal Quality Improvement Network of Massachusetts as Dr. Moore Simas collaboratively leads AIM patient safety bundle integration across MA birthing hospitals and obstetric practices starting summer 2024.

In addition to these advances, Dr. Byatt was the founding medical director, and Dr. Moore Simas the obstetric engagement director, of the Massachusetts Child Psychiatry Access Program (MCPAP) for Moms. Funded by the Massachusetts Department of Mental Health, MCPAP for Moms empowers obstetric professionals to address mental health and SUD through training, provider consultation, one-time face-to-face psychiatric consultation, resources, and referrals. Obstetric professionals can call the MCPAP for Moms’ consultation line to request consultation regarding screening, diagnosis, treatment of perinatal mental health and SUD.

MCPAP for Moms is the flagship model for the Perinatal Psychiatry Access Program that has been adopted in 28 states across the U.S. The program is associated with improvements in symptoms of depression and nearly double the mental health treatment rates found in previous studies [5]. Since the program’s inception almost a decade ago, program staff and researchers have worked together to improve the program and expand its offerings. In partnership with Dr. Wendy Davis from Postpartum Support International and other key collaborators, Dr. Byatt was recently awarded a $21-million grant from the Patient-Centered Outcomes Research Institute (PCORI) to build on this model by comparing the impact of a health care model to the health carecommunity partnership model on patient outcomes. The study will include training Perinatal Psychiatry Access Programs across the country to implement identified models of care even after the study is complete. Provider training will include case-based interactive sessions focused on anti-racism, traumainformed care, and screening and referrals for social and structural determinants of health, or the conditions in which people work and live. The goal of trauma-informed care is to address the impact of trauma through clinical interactions and through organizational policies.

The team has increasingly focused on programs that can prevent perinatal mood and anxiety disorders before they cause harm. Dr. Anna Whelan and Dr. Martha Zimmermann are junior investigators leading studies to improve well-being in the perinatal period by adapting evidence-based interventions that have helped non-pregnant people. Dr. Whelan is developing an intervention to reduce weight stigma, which contributes to higher rates of perinatal mood and anxiety disorders among perinatal individuals in larger bodies. Dr. Zimmermann is developing a digital intervention to reduce risk for perinatal anxiety disorders.

With the support of programs like MCPAP for Moms, obstetric providers now have tools to provide depression care. If Kai sought care now, she would fill out a short questionnaire that asks about her mood that would let her provider know she is experiencing symptoms of depression. Her obstetric clinician would consult with MCPAP for Moms for a therapy referral and to prescribe medication if it was indicated. Her symptoms of depression would be more likely to improve, and the adverse consequences avoided. Continued progress in this area is needed to ensure every pregnant and postpartum person has access to high quality, culturally responsive, and trauma-informed care.

Martha Zimmermann, Ph.D.Assistant ProfessorUMass Chan Medical SchoolLifeline for Families Center & Lifeline for Moms ProgramImplementation Science and Practice Advances Research Center (iSPARC)Department of Psychiatrye-mail: martha.zimmermann1@umassmed.edu

Dr. Anna Whelan MD, FACOGAssistant ProfessorDepartment of Obstetrics & GynecologyUMass Chan Medical SchoolLifeline for Families Center & Lifeline for Moms Programe-mail: Anna.Whelan@umassmemorial.orgTiffany A. Moore Simas, MD, MPH, MEdDonna M. and Robert J. Manning Chair in Obstetrics and GynecologyChair, Department of Obstetrics & GynecologyProfessor, Obstetrics & Gynecology, Pediatrics, Psychiatry, and Population & Quantitative Health SciencesMedical Director, Lifeline for MomsObstetric Engagement Liaison, MCPAP for Momse-mail: Tiffany.MooreSimas@umassmemorial.org

Nancy Byatt, DO, MS, MBA, DFAPA, FACLPExecutive Director, Lifeline for Families Center & Lifeline for Moms ProgramProfessor with Tenure of Psychiatry, Obstetrics & Gynecology and Population & Quantitative Health SciencesMedical Director of Research and Evaluation, MCPAP for Momse-mail: Nancy.Byatt@umassmemorial.org