Collaborative Model Addressing Mental Health in the Perinatal Period

描述(申请人提供)：产妇抑郁(MD)对母亲和儿童的健康和发育有负面影响，围产期的患病率从10%到50%不等，但通常在产科护理中未被发现和治疗。一项临床随机设计将用于测试一种创新的合作模式--妇女健康伙伴关系(PWH)的有效性，该模式旨在筛查产前和产后妇女的MD。威斯康星医院旨在通过与现有社区项目的合作伙伴关系，提高卫生保健提供者遵循临床指南、提供循证实践并与患者进行有效互动的能力。威尔斯亲王医院将患者与服务联系起来，这是适当和及时识别MD的结果。威尔斯亲王医院包括一名精神健康顾问，以支持提供者并主动联系抑郁症妇女，将她们联系到适当的治疗。此外，拟议的研究将阐明在保健系统内和跨保健系统筛选/转介伙伴关系的有效协作模式的关键组成部分，并追求反映对经验和临床派生知识的平衡兴趣的目标。具体目标：(1)评估威尔斯亲王医院模式与通常服务(对照)相比的有效性，以确定MD，增加服务转介和适当的精神卫生服务，在初级产科环境中为CPSP人口中的种族多样化、低收入孕妇提供服务；(2)确定威尔斯亲王医院服务转介和接受服务对母婴结局的影响；(3)研究亲密伴侣暴力和酒精、烟草和其他药物是否缓和威尔斯亲王模式对服务转介、服务接受和母婴结局的影响；(4)检查接受威尔斯亲王模式的诊所的干预实施情况和忠诚度；以及(5)对威尔斯亲王模式进行成本效益分析。我们建议采用混合方法设计，结合治疗结果的定量评估和治疗过程的定性评估，检查与计划可持续性相关的社会文化和组织背景。共有16家诊所将参加，每一家诊所都为圣地亚哥县的Medi-Cal CPSP母亲提供服务。所有在每个诊所接受产前服务的妇女都将接受MD筛查(n=6000)，筛查呈阳性的600名妇女将被纳入这项研究，并在分娩后12个月进行前瞻性跟踪。这一发现有可能通过早期干预来改善不同文化背景的抑郁母亲的妊娠结局，这将增强妇女的健康和照顾新生儿的能力。

DESCRIPTION (provided by applicant): 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.