Know What’s at Stake: Utilizing the Collaborative Care Model to Improve Maternal Health Outcomes
January 23rd is maternal health awareness day, and this year the American College of Obstetricians and Gynecologists has selected the theme “Know What’s at Stake.” Over the past several years, the United States has repeatedly reported exceptionally high rates of maternal mortality, with Black birthing persons being disproportionately affected. Data from the CDC suggests that mental health conditions account for 23% of all maternal mortality cases. As we near maternal health awareness day, it is an opportunity for us to reflect on the intersectionality of mental health and maternal well-being, and to reiterate our commitment to improving maternal health outcomes.
Perinatal mood and anxiety disorders (PMADs), like anxiety and depression, are common during pregnancy and postpartum. However, gaps in addressing social determinants of health and structural racism and discrimination present barriers to treating PMADs. The collaborative care model is an integrated care intervention with proven effectiveness in treating mental health conditions in primary care. At the center of the model is a care manager who is a licensed mental health provider. It is built on five equity-centered core principles:
1) patient-centered team care
2) population-based care
3) measurement-based treatment
4) evidence-based care
5) accountable care
Though widely implemented in primary care, the collaborative care model remains underutilized in perinatal settings. However, prior research suggests that implementation of the perinatal collaborative care model can increase screening for mental health concerns and patients with a positive screen are significantly more likely to receive a recommendation for mental health treatment after implementation of the model.
In the perinatal collaborative care model, obstetric clinicians screen every patient for mental health symptoms. For those with symptoms, the care manager collaborates with the patient, obstetric provider, and a supervising perinatal psychiatrist to develop a treatment plan based on the patient’s preferences. This may include medication, short-term therapy, or providing referrals to community resources. The care manager utilizes a patient registry to send monthly mental health surveys to patients and monitor their symptoms. The care manager meets weekly with the psychiatrist to talk through modifications to treatment plans for patients whose symptoms may not be improving. Patients remain enrolled in the program throughout pregnancy and up to 1 year postpartum. The role of the care manager is sustainable via the use of the collaborative care billing codes.
COMPASS-PLUS (Collaborative Care Model for Perinatal Wellness Support Services - Population-Level Equity-Centered Solutions) is a grant-funded initiative in Rhode Island that aims to partner with community to enhance the collaborative care model’s equity-centered principles and then implement the model in 6 perinatal clinics in Rhode Island. It is being led by Dr. Emily Miller at Women and Infants Hospital of Rhode Island.
The collaborative care model is being co-adapted in COMPASS+ with the input of two parallel community action and advisory boards: one comprised of individuals with lived experiences of PMADs and another comprised of birth workers and mental health therapists. The community action and advisory boards have provided their input on the care manager job description, questions asked by the care manager during initial contact with a patient, structure of the weekly supervision meetings, and integration of a health equity advocate role to advise the care teams when issues of structural racism and discrimination are in play.
Because addressing social determinants of health is instrumental in improving mental health outcomes, care managers in COMPASS+ will also collaborate with community health workers that will be integrated in participating sites through a funded program called Rhode Island Community-based Maternal Support Services Bundle for Advancing Perinatal Health Equity (RI-COMSS). Together, the care managers and community health workers will address both the emotional and social needs of patients.
COMPASS+ and the collaborative care model are just one solution to addressing the mental health needs of pregnant patients to help improve maternal outcomes. We must not forget the families that do not have access to reproductive health services, the families who suffer unimaginable losses during pregnancy, and the trauma that ensues from experiencing mental and physical complications during pregnancy and afterwards. On maternal health awareness day, we must not forget what’s at stake: the lives and well-bring of birthing persons and their children.
