MCH Leads Health Equity Edition – In order to advance health equity for MCH populations, beginning January 2023, MCH Leads will feature trainees’ health equity-focused work. We look forward to highlighting trainees’ experiences supporting the health and well-being of vulnerable and underserved populations and communities. Also, their work assessing and addressing the underlying causes of health disparities–and their efforts to promote diversity, equity, and inclusion–ultimately improving MCH outcomes. In addition, we encourage trainees to reflect on how the MCH Leadership Competencies are applicable to their health equity-focused stories.
Kristin Roadman (she/her) graduated from the Drexel University Dornsife School of Public Health in December 2023 with her Master of Public Health, majoring in Urban Health with a minor in Maternal and Child Health (MCH). Dornsife’s MCH Program is funded by the Health Resources and Services Administration through its MCH Public Health Catalyst Program. Kristin’s interest in MCH stems from a desire to improve health outcomes for women and increase access to reproductive services to achieve greater health equity. Having lived in several cities across the U.S., Kristin felt compelled to shift her career focus to advocate for policies and programs that address health disparities in urban areas and remove barriers to help people live their healthiest lives. Prior to obtaining her MPH, Kristin completed her Master of Public Administration at the University of Illinois Chicago (UIC) and was selected to serve as a Presidential Management Fellow (PMF). The PMF program is the Federal Government’s competitive flagship leadership development initiative where approximately half of finalists obtain two-year appointments. Kristin has worked in agencies focused on emergency management, environment, and immigration, which has broadened her understanding of how prevalent public health issues are in our society. Currently, she works for UIC, where she manages programs designed to support faculty and students, including the Community Health Advocacy program, which uses a multidisciplinary approach to address health disparities in urban areas through health innovation. Kristin also holds a Bachelor of Arts in Communication from Drexel University. While pursuing her MPH at Drexel’s Dornsife School of Public Health, Kristin completed her Applied Practical Experience with the Campaign for Trauma-Informed Policy and Practice and her Integrated Learning Experience (ILE) with Maternity Care Coalition (MCC) and Pennsylvania Partnerships for Children where she produced a brief for Thriving PA. The work she completed highlighted how MCH programs can improve health outcomes for the perinatal population and their families, address health inequities, and reach more pregnant people and new mothers who need support. Connect with Kristin on LinkedIn!
Background
This past summer (2023), I worked with the Maternity Care Coalition (MCC), the Pennsylvania Partnerships for Children, and Thriving PA to support advocacy efforts to start a Perinatal Psychiatry Access Program in Pennsylvania. The goal of the project was to develop a technical policy brief to be shared with relevant stakeholders summarizing research on the design, implementation, sustainability, and feasibility of a perinatal psychiatry access pilot program and to provide a pathway forward for implementing the program in Pennsylvania. The Access Program model, which was initially designed and launched in Massachusetts in 2014 to address gaps in mental health support and improve access to care, has proven to be an effective mechanism in the U.S. for reducing perinatal mental health inequities and building primary provider care capacity (Byatt et al., 2020). As part of my efforts, I reached out to program managers, directors, and subject matter experts and conducted interviews with 12 different state program teams to understand the varying program designs, challenges they had encountered during implementation, and recommendations for program sustainability. Using knowledge gained from my interviews and research, I composed a brief that strategically highlighted how perinatal psychiatry access programs can help to achieve perinatal mental health equity.
Competency 1 – MCH Knowledge Base/Context
It was important for me to understand how and why Access Programs have been an effective tool in addressing perinatal mental health conditions, especially in states with demographics and political landscapes like Pennsylvania. My maternal and child health (MCH) training prepared me to think critically about who is disproportionately impacted by certain MCH issues and how evidence-based practices, interventions, and policies can help to address them. I gained knowledge through my classwork of barriers that exist for treating mental health conditions during the perinatal period, including the inequitable treatment rates that are present across racial and ethnic groups (Deichen Hansen et al., 2023). Despite affecting one in five women during pregnancy and up to one-year postpartum, mental health conditions remain widely untreated (Byatt et al., 2020). When left untreated, mental health conditions increase the risk for pregnancy-related deaths for perinatal individuals (Flynn et al., 2021). Considering the alarming maternal mortality rate in the U.S., which is even higher for individuals of color (CDC, 2022), advocating for programs that improve screening, referral, and treatment options for perinatal mental health conditions is critical for improving health outcomes for individuals and their families.
The evidence-based Access Program is an effective model that uses three pillars to build the capacity of medical professionals to address perinatal mental health and substance use disorders: training and education, perinatal psychiatric consultation, and resources and referrals to community-based mental health resources (Byatt et al., 2020). I learned through my research that there are currently 21 state-based Access Programs in the U.S. that provide perinatal mental health support services, with several more planned (Byatt et al., 2020). Modeled after the Massachusetts Child Psychiatry Access Programs for Moms (MCPAP for Moms), these programs have the potential to impact nearly 54% of yearly births in the U.S. (Deichen Hansen et al., 2023).
I found the workforce development and training aspects of Access Programs to be critical when considering the shortages of mental health providers and frontline providers in rural areas. The most common component of the model is the telephonic consultation line, which generally operates during regular business hours and offers a guaranteed response timeframe to connect a provider to a perinatal psychiatrist. The consultation that occurs between the provider and the perinatal psychiatrist also allows providers such as OBYGNs to become more comfortable with treating mental health conditions. As providers gain new knowledge, they can share this information with their colleagues to help address disparities in screening and treating perinatal mental health conditions. Other primary providers like pediatricians who regularly engage with postpartum individuals may benefit from Access Programs by using consultation lines for referral services. Program outreach that includes physician assistants, nurse practitioners, and non-prescribers, such as doulas, lactation specialists, and home visitors, is also essential. Building an inclusive community of healthcare professionals who have access to resources and education and feel empowered to promote perinatal mental health screening, referral, and treatment options improves community wellbeing.
Additional tools exist to support the establishment of Access Programs, such as Lifeline for Moms, which is a national network led by UMass Chan Medical School to support Perinatal Psychiatry Access Lines. The team at Lifeline for Moms works to improve the quality, impact, and durability of Access Programs throughout the country. They offer training, services, and resources, which help to increase access to perinatal mental health care, promote engagement in treatment and services, and build the capacity of healthcare professionals (Lifeline for Moms, n.d.). They also support the creation of new lines through consultation services and develop and test interventions and resources to improve existing care models and address gaps in care. Regular convening opportunities led by Lifeline for Moms further bolster the community of Access Program leaders by providing a space to share best practices and lessons learned.T he team at Lifeline for Moms was instrumental in providing me with information about Access Programs and helping to connect me with experts throughout the country.
Competency 7 – Diversity, Equity, Inclusion, and Accessibility
It is critical that policies and programs designed to improve the diagnosis and treatment of perinatal mental health conditions are culturally competent and use a health equity lens to reduce racial and ethnic health disparities. Stress due to systemic and structural factors such as racism and classism disproportionately impacts individuals of color, which contributes to higher rates of perinatal mental health conditions in pregnant and postpartum people (Deichen Hansen et al., 2023). Black mothers are also nearly twice as likely to experience postpartum depression as compared to white mothers but are significantly less likely to be screened and referred for treatment (Iyer, 2021). Unfortunately, mental health conditions, including suicide and overdoses related to substance use disorder are among the leading causes of pregnancy-related deaths, of which 80% are considered preventable (CDC, 2022). Designing culturally competent programs that consider these factors and remove barriers to improve access to quality healthcare services for those who need it most will help to reduce unnecessary deaths and protect pregnant and postpartum individuals.
The range of available providers, including non-prescribers, can help to build inclusivity in addressing mental health inequities. Research shows that more individuals of color are relying on doulas, who often provide services ranging from prenatal information and care to delivery room coaching and postpartum support (Thomas, 2022). Frontline providers such as doulas, lactation specialists, and home visitors are in a unique position to educate pregnant and postpartum individuals and conduct regular perinatal mental health condition screenings. Designing innovative programs that include resources and education can further enable these providers to recognize the signs of perinatal mental health conditions and refer their clients for treatment. Doing so will help to achieve perinatal mental health equity and improve health outcomes for pregnant and postpartum people throughout the U.S.
The process of creating the brief was rewarding, offering me invaluable opportunities to engage with and learn from numerous experts in the field of perinatal mental health. I deepened my understanding of perinatal psychiatry access programs and honed my research and interview skills. This experience helped me further realize how I can use my passion and interest in writing as a tool to advocate for critical policies aimed at promoting health equity and enhancing quality of life for individuals. The brief, which has been published by Thriving PA, will be used to support advocacy efforts to encourage Pennsylvania government officials and relevant stakeholders to establish a Perinatal Psychiatry Access Line in the state.
References
Byatt, Bergman, A., Maslin, M. C. T., Straus, J., Forkey, H., Griffin, J. L., Griffen, A., & Moore Simas, T. (2020). Promoting the Health of Parents & Children: Addressing Perinatal Mental Health by Building Medical Provider Capacity Through Perinatal Psychiatry Access Programs. Psychiatry Issue Briefs, 17(19). https://doi.org/10.7191/pib.1159
Centers for Disease Control and Prevention. (2022, Sept. 19). Four in 5 pregnancy related deaths in the U.S. are preventable. U.S. Department of Health and Human Services. https://www.cdc.gov/media/releases/2022/p0919-pregnancy-related-deaths.html
Deichen Hansen, Londoño Tobón, A., Kamal Haider, U., Moore Simas, T. A., Newsome, M., Finelli, J., Boama-Nyarko, E., Mittal, L., Tabb, K. M., Nápoles, A. M., Schaefer, A. J., Davis, W. N., Mackie, T. I., Flynn, H. A., & Byatt, N. (2023). The role of perinatal psychiatry access programs in advancing mental health equity. General Hospital Psychiatry, 82, 75–85. https://doi.org/10.1016/j.genhosppsych.2023.03.001
Iyer, P. (2021, March 30). Racial Disparities Have Been Found in Screening for Postpartum Mood Disorders. Scientific American. https://www.scientificamerican.com/article/racial- disparities-have-been-found-in-screening-for-postpartum-mood-disorders.
Lifeline for Moms. (n.d.). Our National Network of Perinatal Psychiatry Access Programs. UMass Chan Medical School. https://www.umassmed.edu/lifeline4moms/Access-Programs/
Thomas, T. (2022, May 5). Concerns over Black maternal mortality increase demand for doulas in Philadelphia. WPVI-TV Philadelphia. https://6abc.com/philadelphia-pregnancy-child-birth-black-maternal-mortality-death-during/11821272/
