Maternal-fetal specialist Marika Toscano has been awarded a $250,000 grant from the Hearst Foundations to implement a collaborative care approach to providing mental health care to patients during and after their pregnancies.

Mental health disorders, including postpartum depression and substance use disorder, are the leading cause of mortality for new mothers in the year after giving birth, both nationally and in Maryland, says Toscano, adding that marginalized communities are at particular risk.

Yet care barriers remain high, she says, and include stigmas attached to seeking mental health treatment, long wait times for therapists and psychiatrists, insurance challenges, and the logistics, costs and hassles associated with additional medical appointments.

To address these challenges, Toscano and colleagues across nursing, behavioral health, clinical operations and health system leadership will use the new three-year grant to pilot a model of perinatal mental health care called the collaborative care model at The Johns Hopkins Hospital.

Under the collaborative care model, patients receive mental health treatment as part of their existing obstetric care rather than being referred into a separate mental health system. A behavioral health care manager helps coordinate treatment and follows patients over time, while a reproductive psychiatrist provides consultation to the care team. Symptoms are measured regularly so treatment can be adjusted as needed.

For a patient, the clinic could provide a much simpler path to care. In the traditional model, a patient who screens positive for depression during a prenatal visit might leave with a referral and then need to find a mental health provider, determine whether that provider accepts her insurance, and potentially wait weeks or months for an appointment.

The team now being assembled includes a reproductive psychiatrist and a behavioral health care manager, working alongside the clinic’s current obstetric clinicians, nurses and administrative team. 
This sort of collaborative care model has proven successful in primary and pediatric practices, she says, but the model has not been widely integrated into routine obstetric care. It serve as a pilot and training resource to guide future expansion at Johns Hopkins Medicine, says Toscano, assistant professor in the Department of Gynecology and Obstetrics.

Patients identified by depression screenings at prenatal and postpartum clinic visits will be eligible for referral to the collaborative care model. The team will evaluate whether the model successfully connects patients with treatment, how quickly patients are able to begin care, whether they remain engaged in treatment and whether their depression symptoms improve or remit over time.

“The issues that arise in pregnancy and postpartum are unique,” Toscano says. “The goal is to make access to reproductive-specific mental health care easier. Patients won’t need to go to another location or make an appointment with another doctor. They can use their current insurance. They can get into treatment much faster.”

Medically reviewed by Marika Toscano, M.D.