Executive Director, Vermont Child Health Improvement Program Robert Larner, M.D., College of Medicine at the University of Vermont Burlington, Vermont, United States
Background: Perinatal mood and anxiety disorders (PMAD) impact not only pregnant and postpartum people but also children’s health and wellbeing. In 2019, Vermont implemented a 5-year effort to address rising rates of PMADs that included the pediatric community to find comprehensive solutions to address this public health issue. Objective: This qualitative study assesses the role of pediatric health care practitioners in improving the state of PMAD screening, referral, and treatment systems and outlines ongoing challenges to their involvement in this policy area. Design/Methods: We conducted semi-structured interviews in Spring 2023 with 28 people working in perinatal health across the state. Participants represented diverse experience, geographic regions, practice settings, and patients and included front-line clinicians, community workers, and state/county employees working in obstetric, pediatric, mental health, or other community settings serving pregnant people or new parents. Interviews were coded by multiple team members, first using preliminary analysis to develop codes and then using NVivo to apply codes and identify themes. Results: Respondents noted several advantages to leveraging pediatric visits to conduct PMAD screening, including workflows that already include screenings; frequent touches with families during the postnatal period; lower no-show rates than postpartum obstetric visits; ongoing positive family relationships to support screening beyond the immediate postpartum period; and connections to family-focused services. Successful efforts by pediatricians drew on team-based care models that include embedded social workers, in-network adult providers and existing referral networks. Challenges to pediatric PMAD efforts included logistical issues in charting, billing, and other office visit mechanics for parents that are not patients at the practice; limited connections to adult resources or providers; and limited contact during the prenatal period to support early diagnosis. Practices that had targeted initiatives to incorporate PMAD screening into their workflow, often as part of larger efforts to address whole-family wellness and health-related social needs, reported fewer challenges. There was variation in provider comfort level with PMAD screening, indicating a need for ongoing education and training.
Conclusion(s): In this single-state study, targeted efforts to engage pediatric providers showed the important role this group can play in addressing PMAD and highlighted areas for continued focus to address ongoing challenges.
