A perinatal psychiatry access program to address rural and medically underserved populations using telemedicine

Abstract

Background

Although highly prevalent, most perinatal mental health and substance use disorders often go unrecognized, undiagnosed, and untreated. Perinatal Psychiatry Access Programs have emerged as a successful model to increase the capacity of front-line maternal health care providers to address perinatal mental health conditions through education, consultation, and increased resources and referrals.

Methods

This model has been adapted in South Carolina to include direct access to mental health treatment in response to inadequate maternity care and mental health services, including a large proportion of rural, Medically Underserved Areas in Primary Care and Mental Health Healthcare Provider Shortage Areas throughout the state. Moms IMPACTT [Improving Access to Perinatal Mental Health and Substance Use Disorder Care Through Telehealth and Tele-mentoring] leverages statewide partnerships and a virtual care model to provide: 1) people who are pregnant or within 1 year postpartum with immediate access by phone or internet to a clinician trained in perinatal psychiatric care coordination to assess and refer to an appropriate level of perinatal psychiatry services; 2) communication and care coordination with the person’s healthcare provider, as appropriate; and 3) healthcare provider training and real-time psychiatric consultation for the management and treatment of perinatal mental health and substance use disorders. Adaptations to this care model have demonstrated benefit including increase access to care for patients with perinatal mental health and substance use disorders and support for frontline health providers serving this population.

Results

Within the first 12 months, the Mom’s IMPACTT program served people from 45 of the 46 counties in South Carolina. There were 938 encounters, 96% of which resulted in telehealth or teleconsultation with a care coordinator or program psychiatrist. Treatment was provided to 881 perinatal patients (54.6% White, 26.1% Black, 6.2% Hispanic) of whom 51.8% were insured by Medicaid, 89.7% resided in counties designed as fully Medically Underserved Areas, and 38.9% lived in counties designed as fully rural. Most calls were received directly from perinatal patients, with 60.7% (548/903) of patients requesting mental health support. Additionally, the program completed 22 consultations, and trainings with 443 healthcare providers throughout the state.

Conclusions

Adaptations made to psychiatry access program evident in Moms IMPACTT appear to be successful in meeting the specific needs of birthing people in the state of South Carolina. Suggestions and considerations are included to replicate the success of Moms IMPACTT program elsewhere.

Introduction

Perinatal Mood and Anxiety Disorders (PMADs), Perinatal Substance Use Disorders (PSUDs) and Intimate Partner Violence (IPV) affect at least 1 in 5 pregnant and postpartum people and are strongly associated with morbidity and mortality [1,2,3] for both patients and their children. Undetected and untreated maternal behavioral health conditions can have serious and lifelong ramifications. Children of people with untreated depression are 56% more likely to be born prematurely and 96% more likely to have a low birth weight [4]. Maternal depression is associated with fourfold increased risk of behavioral problems in children, a twofold increased risk of poor academic performance, and a sevenfold increased risk of depression [3]. PSUDs and IPV are associated with a multitude of poor obstetric outcomes including prematurity and low birth weight [5, 6], and negatively impact child development [7, 8]. Professional organizations have recommended universal screening and referral to treatment for PMADs, PSUDs, and IPV [9,10,11,12,13,14] but many will not be screened [9,10,11,12,13,14,15,16] and the vast majority will not receive treatment [17,18,19]. Reasons for widespread inadequate perinatal behavioral healthcare are multifaced and lapses occur at multiple points of care. The breadth of recommended screenings and the depth of knowledge needed to adequately assess and appropriately connect people with treatment are, in general, beyond the capability of obstetricians and other prenatal care providers within the current structure of the U.S. healthcare system [14, 17, 20]. Access to perinatal mental healthcare can be exacerbated in rural areas and healthcare deserts.

The Perinatal Psychiatry Access Program Model, based on the Massachusetts Child Psychiatry Access Project for Moms (MCPAP for Moms), has emerged as an innovative model designed to address the shortage of perinatal psychiatric care by supporting front-line obstetric providers. Key components of this model include: (1) resource and referral support with (2) psychiatric consultation for obstetrics clinicians (physicians, midwives, and nurse practitioners), and (3) provider training regarding the screening, treatment, and ongoing management of maternal behavioral health conditions. There are currently 20 states with state-wide access programs (for a list, see: https://www.postpartum.net/professionals/state-perinatal-psychiatry-access-lines/).Utilizing telehealth for perinatal psychiatry access programs can further reduce barriers to facilitate care. Byatt and colleagues showed teleconsultation that enables primary care providers to efficiently consult with psychiatrists specializing in perinatal mental health and substance use is an effective population-based means of minimizing provider and practice-level barriers to provide patients with high quality care [21]. This model has been widely disseminated in the United States and recognized by the Agency for Healthcare Research and Quality (AHRQ) as an exemplar model of collaborative care [22,23,24].

South Carolina (SC) has pervasive incidences of chronic disease, high poverty and a large percentage of medically underserved areas resulting in poor population health and significant racial disparities in health outcomes. In particular, SC has the 8th highest rate of maternal mortality in the country (26.5 per 100,000 live births vs. 17.4 per 100,000 live births nationally). Over one-third (33.7%) of the SC population lives in a rural area compared to 19.3% nationally [25]. High rates of poverty in SC result in unaddressed SDoH and SC’s long history of racism and discrimination has created significant structural determinants of health that disproportionately impact Black birthing people. Workforce distribution and access issues are also evident; of the state’s 46 counties, the Health Resources and Services Administration (HRSA) designates 43 (93.5%) as completely or partially medically underserved. Further, SC ranks 45th of the 50 states in access to mental health care [26]. Seventeen of SC's 46 counties are without a practicing psychiatrist. Currently, there are less than 5 fellowship trained reproductive psychiatrists that specialize in the treatment of peripartum mental health and substance use disorders in SC. Rural patients often lack private or public transportation, have minimal childcare options, and are required to travel > 100 miles for mental health treatment.

In response to the SC’s urgent need for access to care, the Moms IMPACTT [Improving Access to Perinatal Mental Health and Substance Use Disorder Care Through Telehealth and Tele-mentoring] program implemented a multi-prong strategy for enhancing perinatal behavioral healthcare. Using the MCPAP for Moms model as a guide, Moms IMPACTT developed and implemented a statewide Perinatal Psychiatry Access Program that aligned with the needs of South Carolina’s treatment services gaps including a large percentage of rural, low or no maternity care access and Medically Underserved Areas in Primary Care and Mental Health Healthcare Provider Shortage Areas. Moms IMPACTT intentionally integrates telemedicine into its framework to reduce barriers for perinatal populations in SC to receive mental health and substance use care. Components include phone call, text message and HIPAA compliant telehealth video appointments. The objective of this article is to describe the development of critical perinatal psychiatric teleconsultation model adaptations, implementation, and utilization outcomes of Moms IMPACTT.

Methods

Overview of Moms IMPACTT

Moms IMPACTT is a statewide program that was developed and implemented in South Carolina to respond to the critical public health problem of accessibility of perinatal mental health care. It combines a perinatal psychiatry access teleconsultation program with direct patient telehealth referral to care. Specifically, the Moms IMPACTT program has four key components and provides; 1) real-time psychiatric teleconsultation for providers to support effective management of maternal mental health and substance use disorders, 2) mental health and substance use disorder trainings tailored to the needs of the hospital and/or providers and staff in an outpatient setting, delivered virtually or in person 3) access to a care coordinator via phone and text message to assist with linking a patient to community-based resources, treatment, and support groups and 4) patient evaluation and referral to treatment for perinatal mental health and substance use disorders via telemedicine. The program is available to all perinatal people and providers located within the state of SC, regardless of the practice from which the patient receives obstetric care. The program is housed within the Women’s Reproductive Behavioral Health (WRBH) Division at the Medical University of South Carolina (MUSC). The division provides integrated behavioral health care to patients in obstetric and pediatric clinics, training to students, residents, and fellows in reproductive psychiatry and psychology, and conducts clinical research to improve the detection and treatment of PMADs and PSUDs.

Program adaptations

The MCPAP for Moms model was examined and adapted in the development phase of Moms IMPACTT. Specific program adaptations include a virtual care model to provide: 1) perinatal patients with access to a trained clinician within 30 min by phone who can provide care coordination, assessment and referral to treatment or resources; 2) communication and care coordination with the patient’s healthcare provider, as appropriate; and 3) healthcare provider training and real-time psychiatric teleconsultation for the management and treatment of perinatal mental health and substance use disorders. The program provides open access to both patients and providers, without prerequisites for utilization. Moms IMPACTT also adopted a broader definition of front-line health care providers compared to other Perinatal Psychiatry Access Programs, defined as anyone that cares for pregnant and postpartum persons including traditional roles such as obstetricians and gynecologist (Ob/Gyns), midwives, pediatricians, family medicine practitioners and primary care providers (PCPs) but also includes nurses, social workers, case managers, community health workers, doulas, and peer support specialists. Finally, the availability of specialized perinatal psychiatric providers in MUSC’s WRBH clinic to receive referrals from Moms IMPACTT and provide clinical care may be a unique component to Moms IMPACTT, although this was not an intentional adaptation during conception.

Funding/support

Two awards, including philanthropic support (The Duke Endowment) and a state agency (South Carolina Department of Alcohol and Other Drug Abuse Services), provided funds to develop and implement Moms IMPACTT over a 3-year period, beginning in January 2022. Subsequent funding was secured in collaboration with The South Carolina Department of Alcohol and Other Drug Abuse Services via SAMHSA to expand the program with an emphasis on perinatal Opioid Use Disorders (2022–2025). In addition, the program is supported by the MUSC Center for Telehealth infrastructure, including equipment and technical support needed for virtual care and provider effort to deliver trainings and provider-to-provider consultations.

Outreach and engagement

While the program is available to all providers and peripartum people in SC, program outreach specifically focused on agencies serving birthing people in counties designated as fully rural, fully Medically Underserved Areas and fully Mental Health, and Health Professional Shortage Areas. To map this outreach strategy, counties in South Carolina were designated as first, second and third priority to target implementation within the counties designated as rural and/or medically underserved, and with high rates of maternal morbidity and mortality including significant racial disparities in outcomes. Key agencies working with these rural populations assisted with informing their networks and communities about the proposed program and assisted with connecting program trainers with healthcare providers for trainings.

Active outreach and engagement included didactic educational sessions, presentations at staff meetings and professional organizations, as well as features in health system and association newsletters. On March 1, 2022, the Moms IMPACTT team began to advertise access to the program, prioritizing outreach efforts to key stakeholders using a targeted strategy to reach priority areas in the state. During this pre-launch period, we had a total of 77 outreach encounters (email, phone call), of which of 71% resulted in an informational meeting with program staff. We completed 25 key stakeholder meetings, reaching a total of 288 stakeholders. The program officially launched, ahead of schedule, on May 2, 2022, and began providing direct services to patients via telemedicine and consultations to providers by phone.

Partnerships with key stakeholders

Moms IMPACTT collaborated with several stakeholders throughout the state during the development and implementation phases. Stakeholders include Addiction Professionals of South Carolina (APSC), American College of Obstetricians and Gynecologists, Center for Community Health Alignment, Department of Health and Human Services (DHHS), Department of Health and Environmental Control (DHEC) Bureau of Maternal and Child Health, South Carolina Birth Outcome Initiative (SCBOI), SC Hospital Association, Department of Mental Health (DMH), obstetric, pediatric and primary care providers and practices. Program outreach to rural, Medically Underserved Areas and HPSA areas was supported by agencies serving women in counties. Examples of key agencies working with these rural communities include the SCBOI, SC Office of Rural Health, Nurse Family Partnership, Healthy Start, Help Me Grow South Carolina and Federally Qualified Health Centers. Education and training efforts are supported by 3 State Project ECHOs [SC Pregnancy Wellness, Opioid Use Disorder, Peer Recovery for Substance Use Disorders].

The Moms IMPACTT program serves as an initial access point to PMADs and PSUD assessment and referral to treatment and provides care coordination as needed throughout treatment. To facilitate on-going care, the program also works closely with statewide partners, such as the SC Department of Alcohol and other Drug Abuse Services (DAODAS) and DMH, that provide MH and SUD treatment, recovery support, and community resources and education. For example, DAODAS provides treatment services within each county for adults with SUD, including pregnant and postpartum people. DHM serves as a key partner and referral resource for longer-term mental health treatment and crisis intervention for mental health emergencies which is available 24 h per day, 7 days per week, 365 days per year.

Staffing

Moms IMPACTT serves all of South Carolina with 1 full-time equivalent (FTE) care coordinator and 0.3 FTE reproductive psychiatrist. Care Coordinators are master’s level mental health providers licensed in the state of SC (ex: Licensed Clinical Social Worker). Reproductive psychiatrists fulfilled requests for a provider consultation. The leadership team consists of a Medical Director (Guille) and a Program Director (King) who lead program development, implementation, and operations. Project activities were further supported by division research program coordinators. Prior to program launch (months 0–4), efforts were focused on 1) creating culturally diverse and inclusive marketing materials including patient and provider flyers, promotional videos, magnets, QR scan cards and program website, 2) developing and testing a database to capture key outcomes and analytics, 3) operationalizing program processes and 4) finalized training and educational materials. Post-launch, effort shifted to managing day-to day operations, updating area-specific resource and referral sources, and continued outreach, education, and partnership development. Telehealth services in compliance with HIPAA regulations for the patient care component were available through infrastructure already in place within MUSC.

Process

Patients and providers can access the program by calling a statewide toll-free number during regular business hours (8am – 5 pm) Monday through Friday, or by filling out an online form on the program’s website (muschealth.org/momsimpactt). All program contacts made during regular business hours are returned within 30 min via telephone. Interpreter services for non-English speaking patients are available as needed to facilitate all virtual contacts, including phone calls. Requests made outside of business hours are returned the next business day. The care coordinator is alerted of a program contact through the website by a text message and email automatically generated by the system. Because contacts to the Moms IMPACTT program can be made for several reasons, the care coordinator triages the initial request. Primary reasons for a program contact align with the program’s goals, described above, and include (1) referral for resources or treatment for a pregnant or postpartum person, (2) provider training and/or (3) provider-to-provider consultation.

When a patient is referred to the program, either through self-referral or provider-referral, the care coordinator contacts the patient directly. During this phone call, the care coordinator collects basic information and employs a brief intervention (BI) using Motivational Interviewing (MI) techniques to support positive health behaviors and a shared decision-making process to provide patient-centered referrals to an appropriate level of care. If a request is made for community resource information, the coordinator can provide this information without involvement of a reproductive psychiatrist. If the contact request requires involvement of a reproductive psychiatrist, for example to complete a provider-to-provider consultation, the care coordinator contacts the Mom’s IMPACTT psychiatrist via text message and email to schedule a consultation or training request.

Following triage by the care coordinator, patients may be referred to treatment provided by the WRBH clinic or to a community provider. When a person is referred to treatment and scheduled for an appointment, care coordinators seek to reduce barriers to care because of financial-related factors by scheduling an appointment with a provider aligned with a patient’s insurance coverage. Patients are also offered the option of completing a virtual or in person appointment. If clinically indicated, the Moms IMPACTT psychiatrist can see the patient via telehealth within 24 h of the patient contacting the care coordinator. This critical program component does not require a healthcare provider to initiate access to the program, and it provides direct access to care for perinatal people, which is often not available or accessible in most communities.

Data collection

Data were collected from all birthing people and providers who utilized Moms IMPACTT from May 2, 2022 (start of program) through April 30, 2023. Each individual inquiry to the program made via phone call or online form is considered an encounter. Multiple calls or inquiries relating to the same birthing person or provider referral, or consultation request, are recorded as a single encounter. Encounter information is collected by survey and stored within an Electronic Data Capture system, REDCap. REDCap provides secure, web-based interface for users to enter data and have real time validation rules at the time of entry, uses strong encryption for protection of data in transit and at rest, as well as a high-end firewall and daily data backup. REDCap is HIPAA and HITECH compliant. All demographic, referral, and intake information is collected and stored in REDCap. Mom’s IMPACTT utilization was assessed by the number of care coordinator encounters.

Measures

Information was collected from both referring providers and their patient, when applicable. Referring provider demographics, provider type, highest degree earned, primary area of practice and practice setting is collected by care coordinators during triage. Data is collected for each discrete encounter and includes the following: date and time, referring provider name, primary area of practice and zip code from which the encounter was originating. Further data was collected on reason for contact (medication or diagnostic question, community resource, etc.), patient's reported symptoms, providers' diagnostic concerns, and current psychiatric medications. Patient demographics include county, patient status (pregnant, postpartum, perinatal loss, etc.), race, ethnicity, insurance coverage, and reason for contact. This work did not meet criteria for human subject research by the institutional review board at the Medical University of South Carolina.

Results

From May 2, 2022, through April 30, 2023, there were a total of 938 encounters, with 903 (96%) resulting in teleconsultation with a care coordinator or telehealth appointment with a program psychiatrist. Twenty-two were same-day consultation requests by frontline healthcare providers. Treatment was provided to 881 patients. Of these, 548 were self-referred or patient initiated and 333 were provider referred. Program inquiries were received from forty-five of the forty-six (97.8%) counties in South Carolina. Additionally, the IMPACTT team completed 10 provider trainings, serving a total of 443 frontline healthcare providers. See Fig. 1 for work-flow.

Fig. 1

Visual flow of Moms IMPACTT

Most provider encounters (referrals and consult requests) were made by healthcare providers in Obstetrics (173 [52%] provider referrals, 9 [40.9%] on-demand consultations). Provider consultations were also requested by 4 providers (18.2%) in mental health, 3 (13.6%) in pediatrics, 1 (4.5%) healthcare provider in addiction medicine, 1 (4.5%) serving in community health work, and 4 (18.2%) providers who identified multiple affiliations. Provider referrals were made by 137 (41.1%) registered nurses (RN, LPN or equivalent), 63 (18.9%) physicians, 52 (15.6%) social workers (MSW), 49 (14.7%) advanced practice registered nurses (APRN, CNM), 5 (1.5%) physician assistants (PA), 5 (1.5%) psychiatrists, and 22 (6.6%) providers that identified as “Other”. “Others” included peer support specialists, Department of Social Service (DSS) workers, and case managers for insurance payers (Medicaid, Blue Cross Blue Shield). The total number of provider encounters, listed by provider type and provider affiliation are listed in Table 1.

Table 1 Encounters according to services provided, provider type and provider affiliation from May 2, 2022 to April 30, 2023

Of the 881 patients served, 279 (43.3%) were pregnant and 345 (52.2%) were postpartum. Of the remaining encounters, 6 (0.9%) addressed preconception, 2 (0.3) were received from patients post-adoption, and 26 (3.4%) focused on perinatal loss. Of postpartum patients, 116 (33.6%) were lactating. Consistent with demographics of South Carolina’s reproductive age population, 359 (54.5%) were of patients served were White, 172 (26.1%) were Black, and 41(6.2%) patients self-identified as Hispanic. A total of 341 (51.8%) of patients were insured by Medicaid, 307 (46.7%) were covered by private insurance and 10 (1.5%) were uninsured. Most patients contacting the program resided in counties designated Fully Medically Underserved Areas (n = 590 [89.7%]), and over one-third were in counties designated as Fully Rural (n = 256 [38.9%]). Patient demographic information can be found in Table 2.

Table 2 Patient characteristics. Demographic information collected from patients contacting the psychiatry access program from May 2, 2022 to April 30, 2023

There were a wide range of concerns stated as the reason for accessing the IMPACTT program (see Table 3). Mental health concerns were identified as the primary reason for contacting the program (n = 861, 95.3%), whereas 42 (4.7%) identified substance use disorder concerns, 9 (1%) identified IPV and 26 (2.9%) contacted the program for safety concerns. Other reasons included diagnostic questions (0.2%), risk/benefit of medication use (during pregnancy, 10.8% and lactation, 3.7%), medication questions (4.1%), preconception questions (0.4%), resources for psychotherapy (4.1%) and resources for social determinants of health (5.5%). Interestingly, 589 (65.1%) contacted the program for peer and community support resources.

Table 3 Reasons for access program encounter initiation. Reasons for contacting access program for all 903 encounters from May 2, 2022 to April 30, 2023

Of the patients served, 658 (72.9%) patients were referred to and scheduled for mental health appointments within WRBH clinic, 67 (7.4%) were not scheduled for appointment but received care coordination, 50 (5.6%) received additional supports or information and 85 (9.4%) could not be reached. Among the 658 patients were scheduled for an appointment with WRBH clinic, 19 (2.9%) patients received immediate direct care for mental health related concerns via telemedicine by the Moms IMPACTT psychiatrist, 13 (2.1%) patients received immediate direct care for substance use disorder related concerns via telemedicine by the Moms IMPACTT psychiatrist, and 579 (88%) were scheduled to see a WRBH clinic provider. The majority of services were delivered by telemedicine to the patient’s home (n = 629, 95.7%), however, 18 (2.7%) were delivered by telemedicine to a practice/office, and 11 (1.6%) were in-person appointments. Of the 35 requests for IPV or safety information, all were given community resources by a Care Coordinator. Care coordinators worked to facilitate access to shelter or safe-house facilitates, as needed.

Discussion

The state of South Carolina has approximately 57,000 births each year [27]. As such, an estimated 11,400 South Carolinians will experience a perinatal mood, anxiety, or substance use disorder, based prevalence rates [28]. During the first year of program implementation, the Mom’s IMPACTT team served roughly 8.7% of women in the state who are predicted to have experienced a perinatal mental health or substance use disorder, almost all of whom resided in rural and/or medically underserved areas. The success achieved during the program’s inaugural year can be attributed to several key components, including partnerships with community and state organizations, infrastructure within MUSC Center for Telehealth to support telemedicine visits and MUSC to serve Medicaid beneficiaries, availability of specialized behavioral health providers within the WRBH clinic, and utilization of care coordinators trained in perinatal mental health to provide brief interventions and facilitate direct, and sometimes immediate, access to care. Consideration of these factors for future work and sustainability efforts is imperative.

Enacting a direct-referral line staffed by care coordinators to facilitate referral to WRBH clinic providers reduced initial barriers to accessing mental health care. Changes to care delivery during the COVID-19 pandemic response allowed treatment delivery and reimbursement for telemedicine services to patient’s homes, which further reduced barriers to accessing care for all people, particularly those living in rural communities. Further, partnerships were leveraged with MUSC satellite clinics across the state to provide access to telemedicine technology for birthing people who did not have internet, computer, smart-phone or tablet access to complete a telemedicine visit. Grant-funded psychiatry fellows and supervised master’s level psychotherapy interns in the WRBH clinic were able to receive referrals for patients without insurance. Ongoing work towards sustainability of these types of programs must consider access (internet, smart devices), reimbursement and partnerships with community organizations. One goal of Moms IMPACTT was to increase ease of patient and provider access to assessment and referral to treatment for peripartum mental health and substance use disorders, as such the availability of WRBH clinic providers were not an initial component of the Moms IMPACTT conceptualization. The availability of WRBH clinic providers to act as a referral source for patients likely played a significant role in the program’s success. Future iterations of similar programs should consider the network of providers available to receive treatment referrals, and increase treatment provider infrastructure when needed, when aiming to improve access to assessment and referral to treatment for birthing people.

Increasing training to support effective and evidence-based management of mental health concerns in pregnancy and during breastfeeding for front-line providers is a crucial step to addressing the maternal mental health crisis in SC and across the U.S. Increasing outreach for provider trainings and consultations is an ongoing target area for Mom’s IMPACTT and is being more explicitly targeted in subsequent years of the program. One of the biggest challenges with the implementation of behavioral health integration programs in obstetrics or other primary care settings is engagement and participation [29]. The IMPACTT team has conducted numerous types of clinician outreach efforts in the past year, however, it can be challenging to realize full uptake of training and consultation opportunities while clinicians face a multitude of demands on their time. Offering CE’s for completing trainings or expanding billing reimbursement from insurance providers for provider-to-provider consultations can help incentivize engagement in training and consultation for providers.

A critical challenge for these multi-component care models is sustaining the programs in the absence of grant funds. Although the Mom’s IMPACTT program has support through MUSC’s infrastructure and revenue generated through clinical services, a mechanism for long-term funding is crucial. McPAP for Mom’s has sustained their program through lobbying their state legislature, resulting in congress creating a permeant line item in the state annual budget to support the McPAP for Mom’s program. To achieve this in South Carolina, program leadership will work closely with key stakeholders to educate lobbyist and state legislature about the morbidity, mortality and high financial cost of untreated PMADs and PSUDs. It is vital that insurance providers such as Medicaid and other private insurance providers recognize the significant economic impact data, including costs per patient of the programs along with the return on investment. Many states in the US already have reimbursement codes for behavioral health screening, chronic care management and reimburse for provider-to-provider psychiatric consultation. These reimbursement and payment models must account for all evidence-based components in order to realize the impact on clinical and functioning outcomes for perinatal patients and families.

Ongoing work by the Mom’s IMPACTT team is responding to the growth edges outlined using data and lessons learned during the first year of implementation. The ultimate goal is a model that supports perinatal healthcare, including mental health and substance use disorder care, to improve outcomes for both birthing people and their families. This cannot be achieved by individual providers or organizations alone. Through collaborative efforts from multiple avenues, we can begin to close the gaps in access to maternal healthcare for all individuals, including those in rural and medically underserved areas.

Conclusion

The goal of MOMs IMPACTT is to increase access to mental health and substance use disorder treatment for birthing people across South Carolina. This was achieved through a three-pronged strategy; (1) provider-to-provider consultation, (2) provider training, and (3) direct access to assessment and referral to treatment or resources by a care coordinator. In its inaugural year, 10 provider-to-provider consultations were completed, 10 provider trainings, serving a total of 443 frontline healthcare providers were facilitated, and 881 birthing people received screening and referral to treatment by a care coordinator. Future work by the Moms IMPACTT team will focus on increasing trainings delivered to frontline providers, provider-to-provider referrals, and maintaining sustainability of referral practices for patients requiring treatment.

To replicate the success of Moms IMPACTT, organizations should consider their resources and partnerships with community agencies and organizations. Without these partnerships, it could be hard for a perinatal access program with direct patient care access to be successful. This includes funding and referral options for those requiring treatment, and community resource options available for those in need of SDoH support. The inclusion of telehealth infrastructure will likely increase success of a perinatal access program, particularly for birthing people residing in rural or medically underserved areas, or those facing barriers such as transportation or childcare when attempting to access behavioral health treatment.