The Integrative Child and Adolescent Psychiatrist: Novel Models of Perinatal Mental Health Care to Improve Maternal–Infant Outcomes

Objectives: Maternal depression and anxiety occur in 10-20 percent of pregnancies and have implications for the mother, the parent-child relationship, and long-term outcomes in infants. We discuss the evolution of care delivery to perinatal women with mental health issues across the United States and present a framework for child psychiatry involvement based on impact of maternal distress on child development. Methods: Each presenter will review the development, challenges, and opportunities for models of perinatal mental health care in a variety of settings, with the goal of improving outcomes for women, infants, and families. Data were collected on numbers of patients or providers served, staffing of programs, demographics, diagnostics, and outcomes when available. Results: In approximately 1 year, Illinois DocAssist has provided 33 consultations, responded to six inquiries, and trained 138 healthcare professionals through eight workshops. Postpartum depression was the most common concern, followed by anxiety, bipolar disorder, and prenatal depression. In New Mexico, a perinatal psychiatric clinic emerged from increased screening on inpatient pediatrics. Forty clients were assessed in the first 3 months. Increased collaboration between multiple disciplines has continued, and a new clinic embedded in the University Women's Health Clinic has been opened. In a primary care adolescent maternity medical home in Colorado, 41 percent of patients were identified as needing mental health services during routine screening, and 47 percent presented for mental health treatment with an integrated psychologist; 36.4 percent of patients were diagnosed with MDD, and 27.9 percent had primary diagnoses of anxiety disorders; 43.4 percent of patients met criteria for at least two disorders, and the most commonly occurring comorbidity was PTSD and a mood disorder (21.3 percent). In the Healthy Expectations Perinatal Mental Health Clinic for adult mothers, patient feedback demonstrates positive impact on mother's treatment goals, competence in mother role, symptoms of depression, and relationship with their child. There also was a decrease in mothers' symptoms of depression. The use of medications was also monitored. Conclusions: Child psychiatrists are in an optimal position to address the need for identification and care of women with perinatal mood disorders and their infants.