Integrating Mental Health Care in Ambulatory Obstetrical Practices: Strategies and Models.

Perinatal mental health is recognized as a priority component of obstetrical care. Perinatal patients often turn to their obstetrician for help with mental health concerns as they view them as their primary health care provider. Unfortunately, obstetricians face challenges in providing adequate support due to time constraints and limited expertise. Integrated behavioral health care offers a collaborative and cost-effective solution to enhance patient care and clinician satisfaction. Integrated behavioral health clinicians possess fundamental skills to care for patients throughout the reproductive lifespan and assist obstetricians in identifying and managing common mood concerns.

Rates of Preterm Birth and Low Birth Weight in an Adolescent Obstetric Clinic: Achieving Health Equity Through Trauma-Informed Care.

Objectives: Adolescents who are pregnant and identify as Black are exposed to more societal harms that increase their and their offspring's risk for poor health outcomes. The Colorado Adolescent Maternity Program (CAMP) offers comprehensive, multidisciplinary (medical, behavioral health, nutrition, case management), trauma-informed obstetric care to pregnant adolescents to ensure the healthiest pregnancy and birth possible and pursue health equity. The present study aimed to examine ethnic and racial disparities in preterm birth and low birth weight before and after implementation of a trauma-informed model of care. Methods: Participants were 847 pregnant adolescents (ages 12-22 years; 41% self-identified as Hispanic, 32% as non-Hispanic Black, 21% as non-Hispanic white) who received prenatal treatment-as-usual (TAU) or trauma-informed treatment. Demographic information, mental health symptoms, and birth outcomes were abstracted from medical records. Results: Overall, findings provided support that implementation of a trauma-informed model of prenatal care led to equitable birth outcomes across racial and ethnic groups. Specifically, Black adolescents in the TAU group were more than twice as likely to deliver preterm or low birth weight infants compared with white and Hispanic adolescents. In the trauma-informed group, however, there were no statistical differences in birth outcomes across racial/ethnic groups, indicating an elimination of disparities in both preterm birth and low birth weight in this population. These more equitable birth outcomes occurred even in the context of adolescents of color having reported more severe depression symptoms postimplementation. Conclusions: These findings provide evidence that a health system-level intervention, herein trauma-informed obstetric care for adolescents, can play a meaningful role in the reduction of racial disparities in birth outcomes.

Connecting during COVID: The application of teleservices in two integrated perinatal settings.

Integrated perinatal behavioral healthcare provides opportunities to support women and their babies as part of their primary care medical home. The COVID-19 pandemic required significant changes to be made to medical practices to enhance safety and reduce risk, particularly for vulnerable populations, including pregnant women. Previously established modes of mental health service delivery in the HEART program, an integrated behavioral health program embedded in a primary care clinic for adolescent mothers and their babies, and the PROMISE Clinic, an integrated obstetric behavioral health program that serves pregnant women, quickly pivoted to telehealth services because of the pandemic. HEART serves a racially and ethnically diverse patient population, with over 85% of patients publicly insured. The PROMISE Clinic serves a socioeconomically, racially, and ethnically diverse patient population. Behavioral health clinicians implemented a variety of technology-based services including telephone interventions and support, virtual visits using iPads during medical visits, and video visits that patients accessed from their homes. In HEART, behavioral health visits continued at pre-COVID rates during telehealth adaptations. In the PROMISE clinic, the number of perinatal women seen doubled, the total number of patient contacts tripled, and the missed appointment rate significantly decreased during COVID. In the PROMISE clinic, significantly more White and Hispanic perinatal women were seen during COVID and telehealth adaptations, while significantly fewer Black perinatal women were seen during this period. Further research is indicated to examine patient attitudes towards telehealth services, barriers to treatment for Black women, and outcome data.

El cuidado integrado de salud perinatal y del comportamiento ofrece oportunidades para apoyar a las mujeres y sus bebés como parte central del cuidado médico primario. La pandemia del COVID-19 requirió cambios significativos en las prácticas médicas para mejorar la seguridad y reducir el riesgo, particularmente para grupos de población vulnerables, incluyendo las mujeres embarazadas. Las maneras de ofrecer el servicio de salud mental previamente establecidas en la Clínica para Madres Jóvenes (YMC), una clínica de cuidado primario para madres adolescentes y sus bebés, y la Clínica PROMESA, un equipo integrado de salud obstétrica y del comportamiento, rápidamente cambiaron a los servicios de tele-salud a causa de la pandemia. El personal clínico de salud del comportamiento implementó una variedad de servicios con base en la tecnología, incluyendo intervenciones por teléfono, visitas virtuales llevadas a cabo durante visitas médicas, así como visitas grabadas en video a las que las pacientes tenían acceso desde sus casas. En YMC, las visitas de salud del comportamiento continuaron a los niveles de pre-COVID durante las adaptaciones a la tele-salud. En la Clínica PROMESA, significativamente más mujeres blancas e hispanas perinatales fueron vistas durante las adaptaciones de tele-salud, mientras que significativamente menos mujeres negras perinatales fueron vistas durante este período. Se indica una mayor investigación para examinar las actitudes de las pacientes hacia los servicios de tele-salud, las barreras al tratamiento de mujeres negras y los datos de resultados.

Les soins de santé périnatale intégrés offrent des occasions de soutenir les femmes et leurs bébés dans le contexte de leurs services de soin médical à domicile. La pandémie COVID-19 a exigé des changements importants pour les pratiques médicales afin de renforcer la sécurité et de réduire les risques, particulièrement pour les populations vulnérables, y compris les femmes enceintes. Des modes déjà établis de service de santé mentale dans la Clinique des Jeunes Femmes (Young Mothers Clinic, soit YMC), une clinique de soins primaires pour les mères adolescentes et leurs bébés et la Clinique PROMISE, une équipe de santé obstétrique comportementale intégrée ont vite pivoté vers des services de télésanté à cause de la pandémie. Les cliniciens de santé du comportement ont mis en place une variété de services basés sur la technologie y compris des interventions par téléphone, des visites virtuelles faites durant des visites médicales et des visites par vidéo que les parents ont regardé depuis chez eux. Pour ce qui concerne la YMC les visites de santé comportementale ont continué à des taux pré-COVID durant les adaptations de télésanté. Pour ce qui concerne la clinique PROMISE le nombre de femmes périnatales vues a doublé, le nombre total de contacts aux patientes a triplé, et le taux de rendez-vous manqués a considérablement baissé durant le COVID. A la clinique PROMISE bien plus de femmes périnatales blanches et hispaniques ont été vues durant les adaptions de télésanté, alors que bien moins de femmes périnatales noirs ont été vues durant cette période. Nous indiquons des directions de recherches supplémentaires pour examiner les attitudes de la patiente envers les services de télésanté, les barrières au traitement des femmes noires et les données des résultats.

Trauma-informed care in a patient-centered medical home for adolescent mothers and their children.

Adolescent mothers experience higher rates of trauma and abuse, as well as increased risks for mental health disorders, compared to adolescent girls who are not mothers, making them a particularly vulnerable population and contributing to them feeling less supported by or allied with their medical provider. Women with a history of childhood abuse face increased rates of obstetric complications; their infants are at increased risk for low birthweight, developmental and intellectual delays, and behavioral problems. Trauma-informed care has become widespread in mental health settings; however, this model has not been as commonly applied to other settings, such as patient-centered medical homes (PCMHs). The Colorado Adolescent Maternity Program (CAMP) is an obstetric and pediatric medical home for pregnant and parenting adolescent girls through age 22 and their children located within Children's Hospital Colorado. With the integration of behavioral health into CAMP, and given the prevalence of trauma histories among adolescent mothers reported in the literature, programmatic and operational changes to clinical care were made using the Substance Abuse and Mental Health Services Administration's six key principles of a trauma-informed approach. Data showed that nearly 30% of participants reported a history of trauma. Following the inclusion of trauma-informed principles, patients had significantly higher rates of attendance at prenatal appointments (p < .001) and significantly lower rates of low birthweight babies (p = .02). Future programmatic changes and long-term assessment outcomes of this trauma-informed approach in a PCMH are also discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Post-traumatic Stress Disorder After Sexual Abuse in Adolescent Girls.

The sexual assault of girls and women in this country is estimated at approximately 20%. The development of post-traumatic stress disorder (PTSD) after sexual abuse and assault is one of the potential lingering aftereffects. In this article we describe PTSD after sexual abuse and its effect on presenting complaints, such as sexually transmitted infections, contraception, and chronic pain, for the pediatric and adolescent gynecology (PAG) clinician. Treatment approaches, including the use of antidepressants and anxiolytics, as well as evidenced-based psychotherapies, are highlighted. In addition, this article will assist the PAG clinician in identifying trauma-related concerns during clinic visits and will cover specific screening tools to aid in identification of PTSD. A better understanding of PTSD after sexual abuse will allow PAG providers to deliver better care to their patients.