Background: Black women experience a higher prevalence of maternal mental health conditions, particularly postpartum depression and anxiety.  These issues, to which toxic stress due to structural racism is a major contributor, can also lead to serious complications of pregnancy and adverse outcomes for the mother and/or child, and are largely underreported and often go unaddressed. 

Proposed Solution to the Problem: To mitigate the impact of toxic stress due to structural racism on maternal health among expectant Black mothers, the Alliance of Community Health Plans (ACHP) proposes convening a diverse set of stakeholders using the community-based participatory research (CBPR) model to establish a research agenda to provide insight into reducing health disparities in adverse maternal health outcomes. ACHP proposes to develop an agenda that highlights key pathways that can potentially expand access to equitable and anti-discriminatory maternal health care.

Objectives:

Aim #1:  Recruit Stakeholders

• ACHP will leverage its reach within community health plans in the recruitment of mental health providers, maternal health providers, community groups, and Black women to participate. 

Aim #2: Convene Meeting

• ACHP will convene a cross-stakeholder meeting to prioritize topics for the development of patient-centered outcomes research (PCOR)/comparative clinical effectiveness research (CER) projects, including opportunities to compare different types of community engagement and investment on maternal health outcomes.

Aim #3: Disseminate Findings

• ACHP will communicate and disseminate a fully developed research agenda created by an extensive network of community-based organizations and individuals with lived experience that identifies and prioritizes PCOR projects that can identify and test potential interventions to reduce toxic stress and mitigate structural racism.

Activities: ACHP will convene a one-day research meeting to develop and prioritize research topics that are centered around the experiences of structural racism and toxic stress of Black birthing people and its impact on their mental health. The research topics and areas of exploration will examine the effectiveness of approaches to mitigate and/or eliminate disparities in maternal health. 

Projected Outcomes and Outputs:

For the short-term (PCORI-project funding period) outcomes, it is expected that ACHP will provide the following:

• A fully developed health research agenda that identifies and prioritizes PCOR research projects that address potential interventions to mitigate structural racism and reduce toxic stress to lessen the impact on maternal health among pregnant Black women.

Within the medium-term (0-2 years post-project period), the organizations that participated in the meeting will advance the topics described within the research agenda and will acquire funding to begin research to advance these topics. 

The long-term outcomes (3+ years post-project period) include an expanded evidence-base of concepts, tools, and resources for use by the maternal and mental health workforce to better support expectant Black birthing people and additional ways of providing culturally congruent, trauma-informed care.

Patient and Stakeholder Engagement Plan: ACHP will leverage the principles of CBPR and PCOR strategies to engage community groups, providers, community health plans, researchers, and Black women in conversation about the lived experience of toxic stress and racism within the healthcare system and its impact on maternal health.

Project Collaborators: ACHP will collaborate with its member plans’ affiliated research institutes, along with Black maternal health groups, and community-based maternal health providers.