The Florida BH Impact Project: Integrated Perinatal Care As a Vehicle for Promoting Behavioral Health Equity

Background: One in five women in the US experience perinatal mental health conditions (including depression, anxiety, and substance use disorders). Despite the high prevalence of perinatal mental health conditions, as few as 25-50% of women are properly diagnosed and 10-20% receive treatment. This combination of under-detected and under-treated perinatal mental health conditions has led to dramatic and dangerous outcomes for perinatal women. Most seriously, perinatal mental health conditions are now the leading cause of maternal mortality within the United States, causing as many as 23% of deaths.

While awareness regarding perinatal treatment needs is well-documented, barriers to care remain complex. Treament barriers often occur across multiple levels, including at the patient-, provider-, practice-, and community levels. Critically, barriers to care are considered intersectional in nature, meaning that patients may experience numerous barriers to care simultaneously, creating multiplicative disadvantages in obtaining appropriate care. Research has documented that improvements to the perinatal care system are needed in order to better serve patients and democratize the knowledge of evidence-based perinatal mental health care.

In response, the FL BH IMPACT (Improving Maternal and Pediatric Behavioral Health Access, Care, and Treatment) Program emerged as an evidence-based strategy for reducing barriers to care. Modeled after Massachusetts’ successful perinatal telepsychiatric access progam, MCPAP for Moms, FL BH IMPACT initially began as a regional approach to enhancing provider capacity to address perinatal mental health care gaps. Now statewide, this Progam includes integrated care services within high-need, under-resourced communities.

Purpose: The FL BH IMPACT Program is a federally funded partnership between the Florida Department of Health and Florida State University to address the unacceptably low rate at which Florida women receive professional care for maternal behavioral health conditions. This presentation will highlight strategies for implementing evidence-based perinatal behavioral health screening and treatment in a large and diverse state, with the goal of reducing disparate outcomes and promoting quality perinatal behavioral healthcare. Particular emphasis will be placed on strategies for promoting equitable perinatal mental health care services.

Methods: The Program was established in 2019 to enhance maternal health providers’ identification and treatment of childbearing women who experience behavioral health conditions. Utilizing the RE-AIM model as an implementation guide, FL BH IMPACT builds health care providers’ capacity to address new and expectant mothers’ health needs through professional development, expert consultation and support, and dissemination of best practices.

Results: The Project has developed a comprehensive database documenting all relevant health and social service providers; engaged in outreach and clinical quality improvement trainings across the state of Florida; and is currently accepting calls for resource and referral support as well as psychiatric consultation. 28 obstetrics clinics have been enrolled and trained.

Conclusions: Since its inception, FL BH IMPACT has introduced strategies for enhancing and streamlining treatment for depression, anxiety, and substance use across a variety of perinatal health sites. Through this enhanced and streamlined approach to behavioral healthcare, the Program aids in combating structural and interpersonal determinants of health in order to enhance perinatal health equity within the state.