Perinatal depression (depression during or within a year after delivery) affects 1 in 7 mothers and is the most common pregnancy complication in the United States. Left untreated, perinatal depression can negatively impact birth, mother and infant bonding, and children’s behavior and development. Pregnant and postpartum women are often seen for care in obstetric settings, making it a critical entry point for early identification and treatment of perinatal depression. However, many obstetric providers receive inadequate training in how to identify, assess, and treat the depression. Women who are Medicaid-insured experience additional barriers to care, given their social and economic disadvantage and a lack of available providers to meet their mental healthcare needs. To resolve these challenges, statewide programs are being created across the United States to build the capacity of frontline obstetric providers to treat depression themselves. Because these programs, called Perinatal Psychiatry Access Programs (PPAPs), increase access to care for all women in a given state, they are now being implemented or are under development in at least 15 of the 50 states.
Although widely adopted, programs vary in what services they offer. For example, some PPAPs aim to build workforce capacity by training obstetric providers while others provide real-time support through psychiatric consultation from perinatal experts. Other programs prioritize providing resources and referral to local mental health providers. In this study, we will examine three early PPAPs to examine which program components work best: (1) training and consultation (Washington State), (2) resources and referral (New Jersey), or (3) all three program components (Massachusetts). Our team will examine these three programs to understand each program and the state-level environment in which they occur. We will then use this information to investigate whether these programs are effective in improving access to and quality of perinatal mental health care. We selected these states so that we can learn important lessons about the relative advantage of each program’s approach in improving access to and quality of mental health care for Medicaid-insured women with perinatal depression.
In partnership with stakeholders, we designed our study to provide critical answers in how we can address the well-documented barriers that Medicaid-insured women and their families experience when accessing treatment for perinatal depression. Our research is being conducted with: (1) Postpartum Support International, an advocacy organization committed to women with lived experiences in improving the mental health care for pregnant or postpartum women; (2) the Partnership Access Line for Moms housed in Washington State; and (3) the Massachusetts Child Psychiatry Access Program for Moms. Our approach embeds research functions with teams holding longstanding relationships with each of these programs to build on local knowledge and ensure responsiveness to each program’s needs and environment. In partnership with our National and State Stakeholder Advisory Boards, we will disseminate our findings in infographics, scientific journals, and other publication venues and present at national webinars and meetings.
*All proposed projects, including requested budgets and project periods, are approved subject to a programmatic and budget review by PCORI staff and the negotiation of a formal award contract.