Evidence-Based, Telehealth-Enabled, Perinatal Collaborative Care Model (TE-PCoCM)

Background

The purpose of this project is to implement, sustain, expand, and disseminate TE-PCoCM, an evidence-based and integrated care approach, to improve behavioral health outcomes for perinatal individuals residing in the rural and medically underserved region of Chautauqua County, NY. Three Originating Sites (one OB/GYN office, one primary care office, and one behavioral health clinic) and one Distant Site (telepsychiatry/TE-PCoCM provider) will be the first cohort of practices in which TE-PCoCM will be initially implemented. The team will utilize the Collaborative Care Model, an evidence-based, integrated care approach that addresses mental and substance use conditions in primary care settings through the collaboration between medical and behavioral health (BH) providers.

Healthcare challenge

Perinatal behavioral health (BH) conditions, including mood and anxiety disorders, are prevalent among individuals during pregnancy and the postpartum period. These conditions can have adverse effects for mothers, children, and families. Nationally, approximately 20% of perinatal individuals experience depression, with rates rising to 23% for those living in rural areas.¹ During pregnancy, heightened depression and anxiety symptoms may lead to unhealthy behaviors such as alcohol, drug, and tobacco use, poor dietary choices, and insufficient physical activity—all of which are tied to long-lasting negative health consequences for both mother and child.^2,3 Screening rates, receipt of treatment, and remission rates for depression remain alarmingly low, particularly among rural and low-income populations. Engaging in BH treatment, which may involve psychotropic medications or therapeutic interventions like cognitive behavioral therapy, can significantly alleviate BH symptoms during pregnancy and the postpartum period. Unfortunately, despite these persistent perinatal health needs, Chautauqua County lacks an adequate number of providers to address them. Consequently, the county has been identified as a HRSA-designated Mental Health Professional Shortage Area (HPSA). This funding opportunity will help in rectifying this situation by expanding access to high-quality perinatal BH care.

Goals

1. Optimize the readiness of Cohort 1 (the three initial Originating Sites) and the project team to implement and evaluate the impact of TE-PCoCM.
2.  Implement and evaluate the effectiveness of TE-PCoCM in improving Cohort 1 site outcomes.
3.  Optimize the ability for Cohort 1, as well as other interested entities, to sustain TE-PCoCM implementation. Identify strategies that consider diverse contextual factors (i.e., patient, provider, financial, policy, logistical, data capabilities) to sustain TE-PCoCM.
4.  Identify opportunities to scale TE-PCoCM and expand this care approach to address the needs of additional perinatal individuals and other underserved patient populations.
5.  Use varied strategies to provide diverse audiences (i.e., patients, providers, payers, policy makers, community organizations, health systems) with information about TE-PCoCM and contribute to the evidence base surrounding this approach to telebehavioral health-enabled integrated care.
   
   

Implementation Approach

• Population: The target population for this project is the nearly 900 perinatal individuals with BH conditions eligible to receive TE-PCoCM services during the five-year funding period.
• Methodology: TE-PCoCM leverages a team-based approach to guide the provision of BH services within obstetrics and primary care settings. Perinatal patients will be referred to receive TE-PCoCM services if they have a positive PHQ-9 (Patient Health Questionnaire-9) screen or if BH concerns are identified during a conversation between the patient and provider during an appointment. For patients with an identified BH need, the OB/primary care provider puts an order for TE-PCoCM, using UPMC’s integrated electronic health record system. Once an order is placed, the patient is scheduled to meet with the Patient Coordinator for enrollment in TE-PCoCM. The Patient Coordinator meets virtually with the Perinatal Telepsychiatry Consultant periodically to review enrolled patients’ progress to help ensure their BH issues are improving as expected. If necessary, additional care planning and consultation with the patient and/or referring provider are coordinated. Multiple sources of routinely collected clinical data will be available to support program evaluation and the scaling of this program in other practices.
  

Citations

1. Nidey N, Tabb KM, Carter KD, et al. Rurality and Risk of Perinatal Depression Among Women in the United States. The Journal of Rural Health. 2020;36(1):9-16. doi:https://doi.org/10.1111/jrh.12401

2. Alhusen JL, Ayres L, DePriest K. Effects of Maternal Mental Health on Engagement in Favorable Health Practices During Pregnancy. J Midwifery Womens Health. Mar-Apr 2016;61(2):210-6. doi:10.1111/jmwh.12407

3. Tong VT, Farr SL, Bombard J, DʼAngelo D, Ko JY, England LJ. Smoking Before and During Pregnancy Among Women Reporting Depression or Anxiety. Obstet Gynecol. Sep 2016;128(3):562-70. doi:10.1097/aog.0000000000001595