Reproductive Life Planning for Women Veterans with Mental Illness

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Project Background: Many women Veterans are of reproductive age and, of those, a substantial number experience mental health concerns. Women Veterans with mental illness are at greater risk for unplanned pregnancy and adverse pregnancy outcomes due to factors unique to mental illness and mental health treatment. In addition, mental health and mental health-related concerns associated with pregnancy (e.g. impact of pregnancy on mental health, psychiatric medication use during pregnancy) often affect reproductive life decisions and health outcomes. For these reasons, reproductive life planning (RLP), setting personal goals and plans regarding reproductive intentions, that incorporates considerations and addresses concerns specific to mental health conditions is particularly important for women with mental illness. Despite this need, women Veterans with mental illness rarely receive RLP, and current tools do not adequately consider or address the unique reproductive health considerations women with mental illness often experience. Gaps Addressed: Research on the efficacy of RLP in improving reproductive outcomes in and tailoring for women with mental illness is limited. Use of RLP in routine care and RLP interventions that specifically address the unique needs of women Veterans with mental illness are even more lacking. Both represents significant gaps that hamper the VHA’s ability to provide quality comprehensive health care for women Veterans—gaps highlighted by the identification of reproductive mental health as a priority goal in the VHA’s Strategic Plan for Enhancing Delivery of Reproductive Health Services and in the Women’s Health Research Agenda. The current study attempts to address these gaps by examining the feasibility, acceptability, and potential efficacy of a mental health-informed facilitated RLP/RLP goal setting intervention specifically designed for women Veterans with mental illness (Reproductive Life Plan for Mental Health; RLP-MH). Innovativeness: We adapted existing RLP materials to create an interactive, client-centered RLP intervention specifically designed to address mental health considerations that can influence RLP decisions and outcomes in women Veterans with mental illness. Women Veterans work with a facilitator to explore pregnancy intentions and RLP goals; consider important factors that impact those goals (e.g. medical, mental health or psychosocial concerns); and identify steps to address their RLP goals. As such, the RLP-MH intervention may empower women Veterans with mental illness to take an active role in their reproductive health and engage in behaviors that may improve reproductive outcomes. Thus, this project has the potential to provide important services and improve reproductive outcomes for a group at risk for unplanned pregnancy and poor reproductive outcomes. Specific Aims: The specific aims of this study are to examine the: 1) feasibility, 2) acceptability, and 3) the potential efficacy of the RLP-MH intervention when compared to the provision of written materials on RLP. Project Methods: This study is a pilot randomized trial of 40 women Veterans with a diagnosis of mental illness, of reproductive age (18-40), and receiving outpatient mental health services at the VA Maryland Health Care System. Participants will be randomly assigned to receive either: 1) the facilitated RLP-MH intervention or 2) receipt of written RLP information/materials. All participants will complete a baseline and a 2-month follow-up assessment. Participants in the RLP-MH condition will also complete a brief assessment at immediate post-intervention. Feasibility and acceptability will be assessed via rates of recruitment, retention, and participant reported acceptability. Potential outcomes that will be explored include: Veterans’ self-efficacy for and attitudes towards RLP/RLP goals, RLP behavioral intentions, and engagement in behaviors aimed at addressing RLP goals. Next steps will include using the results of this pilot to inform the design of a larger scale randomized controlled trial of the RLP-MH intervention.