Background: In New Hampshire, one in five birthing people experience depression during or after pregnancy, and overdose and suicide account for over half of pregnancy‐associated deaths. The need for high-quality perinatal mental health care is clear, yet access to care in New Hampshire is limited by patients’ insurance status, rurality, race, and ethnicity, contributing to disparities in care and outcomes. This project will build partnerships to make evidence-based mental health services accessible to all postpartum people in New Hampshire.
Proposed Solution to the Problem: Historically, perinatal quality improvement work in New Hampshire has focused on birth hospital settings, with less attention paid to what happens after birth and hospital discharge. However, poor mental health outcomes occur after patients have gone home, and often when they are no longer receiving postpartum care. Therefore, community-based postpartum care providers, as well as patients, families, and communities, must be part of quality-improvement strategies to expand access to effective, culturally appropriate mental health care. Involving key stakeholders outside of the traditional maternity care system is critical to reducing the burden of adverse mental health outcomes in New Hampshire. This project is a critical step toward ensuring the best research-based mental healthcare practices are optimally disseminated across New Hampshire’s diverse birthing communities.
Objectives: This project will bring together an existing loose network of stakeholders—patients, community health workers, nurses, midwives, physicians, mental health professionals, language interpreters—to develop a sustainable, community‐focused infrastructure for disseminating research‐based innovations across New Hampshire’s diverse birthing communities.
Activities: This community-based project will begin with Emotional Journey Mapping sessions (EJM), exploring patients’ needs and preferences regarding postpartum mental healthcare. EJM will be used as a basis for Community Engagement Studios (CES) bringing community experts and professionals together to generate strategies for culturally appropriate dissemination of research knowledge about effective models of postpartum mental healthcare. EJM and CES will be accessible virtually and in person, and barriers minimized by providing access to technology, childcare, and help with transportation. To ensure the ability to track the progress of future dissemination, statewide data on postpartum care utilization will be analyzed at the birth hospital level through the creation of postpartum care dashboards stratified by payor, rurality, and race/ethnicity to identify opportunities and gaps in postpartum care for their patients.
Project Outputs and Outcomes: Primary outputs for the PCORI-funded period include the creation of a Strategic Plan and creation of Data Dashboards. Primary outcomes include:
- Short-term (during the project period): establishment of a sustained patient-professional network engaging key stakeholders
- Medium-term (0-2 years post-project period): improved community knowledge of PCOR/CER research findings, increased access to and utilization of research-based mental health care
- Long-term (3+ years post-project period): decreased maternal morbidity and mortality from mental health conditions, decreased disparities in perinatal mental health outcomes.
Patient and Stakeholder Engagement Plan: The project team includes representation from community leaders (Trinidad Tellez, MD), maternity care stakeholder (DaisyGoodman, MPH, DNP), and health equity researchers (Alka Dev, DrPH). Community engagement efforts will be guided by three Community Advisors with lived experience of childbirth representing diverse geographical and cultural communities in the state, and by partnerships with key stakeholder organizations.
Project Collaborators: Partners in this work include key stakeholder organizations, including New Hampshire’s perinatal quality collaborative, representing all 16 birth hospitals in the state; and the Bi-state Primary Care Association, representing community-based maternity care providers from New Hampshire’s 14 Community Health Centers.