Can an Integrated Mental Health Model Improve Engagement Among Pregnant Youth?

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A young pregnant woman and her counselor.

Implications of Comprehensive Mental Health Services Embedded in an Adolescent Obstetric Medical Home” (abstract). Bethany Ashby, Nikhil Ranadive, Veronica Alaniz, Celeste St. John-Larkin, and Stephen Scott. Maternal and Child Health Journal, Vol. 20, No. 3 (2016).

What it’s about: Researchers wanted to see if an integrated mental health care program called Healthy Expectations Adolescent Response Team (HEART) was effectively identfying young mothers with mental health care needs and engaging them in treatment. They surveyed 885 ethnically diverse pregnant (and later parenting) young women ages 22 and under, who were referred to HEART via the Colorado Adolescent Maternity Program.

Why read it: Ashby et al. state that young moms are more likely to experience mental health issues, such as anxiety, depression, and postpartum depression, compared to their peers. These mental health challenges can negatively impact both moms and their children as they learn to bond and as they interact with others. Unfortunately, the authors say, many young moms do not follow through on mental health referrals for a variety of reasons, including stigma, insurance concerns, transportation challenges, and lack of trust. By studying an integrated model of mental health care delivered in a medical facility, the researchers aim to shed light on the program elements that encourage young moms to continue pursuing treatment.

Biggest takeaways from the research: Of the 885 study participants, 41% were identified as needing mental health services. Among this group, 48% were diagnosed with mood disorders, 36% with Major Depressive Disorder, 28% with Anxiety Disorder, and 20% with Adjustment Disorder. In terms of referrals, 68% of participants successfully initiated treatment if a HEART appointment was scheduled during their screening visit. Only 38% went on to make a mental health appointment on their own if such an appointment was recommended, but not scheduled onsite.

Smilarly, the authors found that moms were more likely to stay engaged in services in the HEART model compared to their participation in other programs providing only screening and referrals. They identified the following elements of the HEART program that may contribute to this finding:

  • Open-ended timeline. HEART participants can start and stop mental health treatment at any time, do not need to complete a specified number of visits, and can enage in a variety of therapeutic techniques.
  • Social supports and continuity of care. Each young mom sees the same mental health staff member at each visit to help develop and maintain relationships. Additionally, the HEART program provides support during pregnancy and after delivery to account for behavioral health concerns at various stages of motherhood. 
  • Emphasis on minimizing barriers. The HEART team seeks to simplify the process for seeking care by coordinating mental health appointments with medical visits, offering a range of appointment times, facilitating transportation (in some cases), and welcoming children to the office.

In addition to this study, the authors are now exploring HEART's long-term effects on participants' (and their children's) developmental outcomes and its potential impact on reducing rapid repeat pregnancies.

Additional references: Look for more articles about pregnancy and mental health or adolescent pregnancy in our digital library.

Read about ways to address postpartum depression among teen moms.

Learn what research says about the importance of social support for teen moms.

Publications discussed here do not necessarily reflect the views of the National Clearinghouse on Families and Youth, the Family and Youth Services Bureau, or the Administration for Children and Families.

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