Collaborative Model Addressing Mental Health in the Perinatal Period

描述（由申请人提供）：产妇抑郁症（MD）对母亲和儿童的健康和发育产生负面影响，在围产期的患病率为10-50%，但在产科护理中通常未被发现和治疗。一项随机临床设计将用于测试一种创新合作模式的有效性，即妇女健康伙伴关系（PWH），该模式旨在筛查产前和产后妇女是否患有MD。PWH旨在提高卫生保健提供者遵循临床指南的能力，提供循证实践，并通过与现有社区项目的合作伙伴关系与患者进行有效互动。在适当和及时地识别抑郁症后，PWH为患者提供服务。PWH包括一名精神健康顾问，为提供者提供支持，并主动联系抑郁症妇女，为她们提供适当的治疗。此外，拟议的研究将阐明在护理系统内部和跨系统的筛查/转诊伙伴关系的有效合作模式的关键组成部分，并追求反映经验和临床衍生知识的平衡利益的目标。具体目的：(1)评估PWH模式与常规服务（CONTROL）相比的有效性，以识别MD，增加服务转诊和服务接收到适当的精神卫生服务，在初级产科环境中为不同种族的低收入CPSP人群中的孕妇提供服务；(2)。确定转介服务和接受服务对母婴结局的影响；(3)研究亲密伴侣暴力、酒精、烟草和其他药物是否会缓和PWH模式对服务转诊、服务接受和母婴结局的影响；(4)检查接受健康护理模式的诊所的干预措施实施情况和保真度；(5)对健康护理模式进行成本效益分析。我们建议采用混合方法设计，将治疗结果的定量评估与治疗过程的定性评估结合起来，检查与项目可持续性相关的社会文化和组织背景。共有16家诊所将参与其中，每家诊所都为圣地亚哥县的加州医疗保险计划（Medi-Cal CPSP）母亲服务。所有在每家诊所接受产前服务的妇女都将接受MD筛查（n = 6000）， 600名筛查呈阳性的妇女将被纳入研究，并随访至分娩后12个月。研究结果有可能通过早期干预来改善不同文化背景的抑郁母亲的怀孕结果，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.