Collaborative Model Addressing Mental Health in the Perinatal Period

描述（由申请人提供）：孕产妇抑郁症（MD）对母亲和儿童的健康和发育产生负面影响，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。一个随机的诊所设计将被用来测试一个创新的合作模式，妇女健康伙伴关系（PWH），旨在筛选产前和产后妇女MD的有效性。PWH旨在提高医疗保健提供者遵循临床指南的能力，提供基于证据的实践，并通过与现有社区计划的合作伙伴关系与患者进行有效互动。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。威尔斯亲王医院设有一名心理健康顾问，为服务提供者提供支持，并主动与抑郁妇女联系，为她们提供适当的治疗。此外，拟议的研究将阐明有效的合作模式的关键组成部分，筛选/转介的合作伙伴关系内和跨系统的护理，并追求的目标，反映了经验和临床派生知识的平衡利益。具体目标：（1）评估PWH模式与常规服务（对照）相比的有效性，以识别MD，增加服务转介和接受适当的精神卫生服务，在初级产科环境中为CPSP人群中的种族多样性，低收入孕妇提供服务;（2）。（3）探讨亲密伴侣暴力、酒精、烟草及其他药物是否会调节威尔斯亲王医院模式对服务转介、服务接受及母婴成效的影响;（4）研究接受威尔斯亲王医院模式的诊所的介入措施的实施情况和忠诚度;及（5）对威尔斯亲王医院模式进行成本效益分析。我们建议采用一种混合方法的设计相结合的治疗结果的定量评估与治疗过程中的定性评估，检查社会文化和组织背景下的可持续发展计划。共有16个诊所将参与，每个服务Medi-Cal CPSP母亲在整个圣地亚哥县。在每个诊所接受产前服务的所有妇女都将接受MD筛查（n = 6000），600名筛查阳性的妇女将入选本研究，并在分娩后12个月进行前瞻性随访。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症母亲的怀孕结果，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.