Perinatal Mental Health Model: Design, Implementation, and Acceptability of a Community-Based Collaborative Care Intervention
- Describe the linkages between maternal depression, intimate partner violence, substance use with maternal and child outcomes.
- Identify 2 ways of eliciting consumer and provider perspectives in developing interventions to address mental health issues in community OB/GYN settings
- Describe the design and implementation sequence of a culturally sensitive research study linking the assessment and intervention for the overlapping mental health risks of maternal depression, intimate partner violence, and substance use.
Design: Mixed method design using a staged process that led sequentially from convening (1) an advisory group, (2) key informant interviews and focus groups, and (3) finally a feasibility study with a sample of low income ethnically diverse pregnant women.
Setting: Community based Ob/GYN clinics located in a large metropolitan city in Southern California
Patients/Participants: Convenience sample of low income culturally diverse pregnant women accessing perinatal care.
Methods: Interviews & Focus groups: A transcripted interview guide included open-ended questions to learn about participants’ understanding and experiences with MD, IPV, & ATOD. Interviews were tape recorded and transcribed for analysis using a method of “Coding, Consensus, Co-occurrence, and Comparison” outlined by Willms and associates. Assessment battery including standardized measures: EPDS; Abuse Assessment Screen; TWEAK; DAST-10; and tobacco use administered to obtain information about severity of MD, IPV, and ATOD.
Results: The advisory team identified appropriate assessments for MD, IPV, & ATOD; existing community resources; and assistance in problem-solving health system related issues. From focus groups and key informant interviews recurrent themes emerged including: (a) motherhood - a time of joy, b) difficulty in talking with family, and (c) stigma. Feasibility data derived from 50 low-income mothers; approximately 88% Latina, 6% White, and 6% other race/ethnicity. Mean age = 25.2 (sd =5.76). EPDS scores ranged from 0-17 (m=3.85, sd =4.14); 14% scored positive for MD. TWEAK scores ranged from 1 to 7 (m = 4.25, sd= 1.77); 28% scored risk for harmful drinking. Eleven (22%) reported some drug use; 2 reported smoking. Maternal health advisors proactively contacted positive mothers, linked them with resources; 100% reported satisfaction with MHA contact
Conclusion/Implications for nursing practice: Assessment and treatment of perinatal depression and co-occurring mental health risks are possible in populations of women with numerous system, community, and individual barriers. Inclusion of consumer perspectives and other advisory group members helped develop enthusiasm for the project; the intervention is feasible and acceptable to our sample of low income ethnicity diverse women.
Keywords: Perinatal depression, IPV, ATOD; Community-based Collaborative Care Model
