Collaborative Model Addressing Mental Health in the Perinatal Period

6.项目总结/摘要 母亲抑郁症（MD）的患病率高，严重影响母婴健康和发育 围产期的发病率为10-50%，但在产科护理中一般不被发现和治疗。 临床随机设计将用于测试创新合作模式的有效性， 妇女健康伙伴关系（PWH），旨在筛查产前和产后妇女的MD。PWH是 旨在提高卫生保健提供者遵循临床指南的能力， 实践，并通过与现有社区的合作伙伴关系与患者进行有效互动 程序.威尔斯亲王医院能适时及适当地识别MD，从而将病人与服务联系起来。PWH 包括一名心理健康顾问，以支持提供者，并主动联系与他们联系的抑郁妇女 接受适当的治疗此外，拟议的研究将阐明有效的关键成分 在护理系统内部和之间建立筛查/转诊伙伴关系的合作模式，并追求目标 这反映了对经验和临床知识的平衡兴趣。 具体目的：（1）评估威尔斯亲王医院模式与一般服务的成效 （控制）识别MD，增加服务转介和接受适当的精神健康服务 在初级产科环境中为CPSP中不同种族、低收入孕妇提供服务 人口;（2）.确定威尔斯亲王医院转介服务及接受服务对母婴的影响 结果;（3）检查亲密伴侣暴力和酒精，烟草，其他药物是否会调节 威尔斯亲王医院模式对服务转介、服务接受及母婴健康成效的影响;（4） 研究接受威尔斯亲王医院模式的诊所的干预措施的实施情况和忠诚度;及（5）进行一项 PWH模型的成本效益分析。我们建议采用混合方法设计， 对治疗结果进行定量评估，对治疗过程进行定性评估， 与方案可持续性有关的社会文化和组织背景。共有16家诊所将参加， 每一个服务于整个圣地亚哥县的Medi-Cal CPSP母亲。所有接受产前服务的妇女， 每个诊所都将进行MD筛查（n = 6000），并将600名筛查阳性的妇女作为样本， 入组研究并前瞻性随访至分娩后12个月。发现有可能 通过早期干预改善不同文化背景的抑郁母亲的妊娠结局， 提高妇女的健康和照顾新生儿的能力。7.项目叙述 早期识别和治疗孕产妇抑郁症（MD）是公共卫生的优先事项。MD是一个严重的， 影响美国10-20%妇女的潜在破坏性疾病;严重影响孕产妇和儿童 健康虽然治疗是有效的，帮助60%-90%的母亲，MD是治疗在只有10%的人， 影响。产前检查是进行初步筛查和干预的理想场所，因为围产期是一个非常重要的时期。 出现抑郁症状的高危时间。研究已开始解决种族问题， 对MD的影响;然而，科学的状态是不发达的。文化敏感的必要性 干预是尖锐的。一项随机（按诊所）临床试验被提议用于测试 创新的合作模式，以改善提供者筛选，转介和治疗MD 低收入的多元文化女性。利用标准化的工具和集中的心理健康 顾问（MHA），以支持供应商和积极联系抑郁症妇女，早期识别和治疗 MD将使妇女、她们的家庭和整个社会受益。

6. Project Summary/Abstract Maternal depression (MD) negatively affects the mother and child's health and development with prevalence rates ranging from 10-50% in the perinatal period, but is generally undetected and untreated in obstetric care. A randomized by clinic design will be used to test the effectiveness of an innovative collaborative model, Partnership for Women's Health (PWH), designed to screen prenatal and postpartum women for MD. PWH is aimed to increase the ability of health care providers to follow clinical guidelines, offer evidence-based practices, and productively interact with patients through a collaborative partnership with existing community programs. PWH links patients to services as a result of appropriate and timely identification of MD. PWH includes a Mental Health Advisor to support providers and proactively contact depressed women linking them to appropriate treatment. In addition, the proposed study will elucidate the critical components of effective collaborative models for screening/referral partnerships within and across systems of care, and pursues aims that reflect balanced interest in empirically and clinically derived knowledge. Specific Aims: (1) To evaluate the effectiveness of the PWH model compared to usual services (CONTROL) to identify MD, increase service referrals and service receipt to appropriate mental health services, within primary obstetric settings serving ethnically diverse, low income pregnant women in CPSP populations; (2). To determine the impact of PWH service referrals and service receipt on maternal and child outcomes; (3) To examine whether intimate partner violence and alcohol, tobacco, other drugs moderate the effects of the PWH model on service referrals, service receipt, and maternal and child outcomes; (4) To examine intervention implementation and fidelity across clinics receiving the PWH model and (5) To conduct a cost effectiveness analysis of the PWH model. We propose to adopt a mixed-method design combining the quantitative assessment of treatment outcome with a qualitative assessment of treatment process examining sociocultural and organizational context related to program sustainability. A total of 16 clinics will participate, each serving Medi-Cal CPSP mothers throughout San Diego County. All women receiving prenatal services at each of the clinics will be screened for MD (n = 6000), and a sample of 600 women who screen positive will be enrolled in the study and prospectively followed up to 12 months post delivery. Findings have the potential to improve pregnancy outcomes among culturally diverse depressed mothers by intervening early, which will enhance the women's health and ability to care for their newborns. 7. Project Narrative Early recognition and treatment of maternal depression (MD) is a public health priority. MD is a serious and potentially devastating condition affecting 10-20% of women in the US; severely impacting maternal and child health. Although treatment is effective, helping 60%-90% of mothers, MD is treated in as few as 10% of those affected. Antenatal visits are an ideal venue for initial screening and intervention, as the perinatal period is a high-risk time for the emergence of depressive symptoms. Research has begun to address issues of ethnic influences on MD; however, the state of the science is underdeveloped. The need for culturally sensitive interventions is acute. A randomized (by clinic) clinical trial is proposed to test the effectiveness of an innovative collaborative model on improvement in provider screening, referral, and treatment for MD among low-income culturally diverse women. Utilizing a standardized instrument and a centralized Mental Health Advisor (MHA) to support providers and proactively contact depressed women, early recognition and treatment of MD will benefit women, their families, and society at large.