Literature Collection

INTRODUCTION: Perinatal mental health conditions are common yet frequently undertreated. Perinatal collaborative care models improve access to evidence-based care but face implementation challenges related to workflow efficiency and scalability. Digital innovations may enhance care delivery and sustainability within perinatal collaborative care models. This study evaluated whether a technology-enabled service, designed to support and streamline care manager workflow in a perinatal collaborative care model, improves depression and anxiety symptoms, patient satisfaction, and engagement compared with the collaborative care model without digital support tools. METHODS: This randomized controlled trial was conducted from October 2022 through January 2024 within a perinatal collaborative care program serving five obstetric clinics in Chicago, Illinois. Participants included 75 pregnant or postpartum individuals enrolled in collaborative care with symptoms of depression (Patient Health Questionnaire-9 [PHQ-9] ≥ 5) or anxiety (Generalized Anxiety Disorder-7 [GAD-7] ≥ 5). Participants were randomized either to a technology-enabled service incorporating a cognitive behavioral therapy mobile application with text-based coaching and a care manager-facing dashboard or to usual perinatal collaborative care without digital tools. Depression and anxiety symptoms were assessed biweekly for 12 weeks using the PHQ-9 and GAD-7. Score results were analyzed using generalized linear mixed models. Additional outcomes included symptom response (≥50% reduction from baseline), symptom remission (PHQ-9 and GAD-7 < 5), stepped care utilization, patient satisfaction, and engagement. RESULTS: A total of 75 individuals were enrolled with 38 randomized to the technology-enabled service. Depression (β = -0.24; 95% CI, -0.45 to -0.03) and anxiety (β = -0.24; 95% CI, -0.46 to -0.03) symptoms improved over time in both groups. There were no significant differences between the technology-enabled service and usual care groups for depression (β = -0.06; 95% CI, -0.06 to 0.17) or anxiety (β = -0.06; 95% CI, -0.30 to 0.19). Response and remission rates did not differ between groups for depression (43% vs. 53%, p = 0.4; 46% vs. 32%, p = 0.2) or anxiety (35% vs. 55%, p = 0.08; 32% vs. 32%, p = 0.9). Stepped care occurred in 21% of participants in the technology-enabled service group and 20% in the usual care group (p > 0.9). Engagement at the study midpoint was higher in the technology-enabled service group, while satisfaction was comparable across groups. CONCLUSIONS: Although symptom improvement was similar between groups, the technology-enabled service improved patient engagement within perinatal collaborative care. These findings suggest that while digital tools may not directly benefit clinical care, they may enhance operational efficiency and support the scalability and sustainability of perinatal collaborative care models. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT05525689.

Traditional medical care accounts for 10% of health outcomes, whereas SDOH account for over 60%. Optimal care of older adults with chronic illnesses requires integration of medical and social service providers. Such partnerships remain uncommon. The authors describe a successful health system/Area Agency on Aging (AAA) integrated team model that meets weekly to discuss challenging community-dwelling older adults and generate care recommendations back to the primary care providers. As part of a quality improvement project, outcomes measured over 6 months during 1 year show a statistically significant decline in the number of important threats to independent living related to the 4Ms (ie, lower fall risk, fewer high-risk medication issues, less behavioral health concerns, and less frequent health care utilization). AAA care managers expressed high satisfaction with the team process and indicated that it helped them address important issues. This model is easily replicated and modifiable to differing local needs. If replicable in rigorously designed research studies, these results would argue for changes in Medicare and Medicaid reimbursement policies to support this interagency integrated model of collaborative care.

Substance use disorder (SUD) during pregnancy and the postpartum period presents unique clinical and structural challenges that require integrated, evidence-based care. The intensity of perinatal care visits creates a critical opportunity to embed treatment for SUD within routine medical services. While many models of perinatal SUD (PSUD) care exist, they vary widely in structure and scope. A foundational and adaptable framework is needed to support implementation, promote consistency, and evaluate care quality across diverse health care settings. This manuscript presents a tiered framework for outpatient PSUD care, adapted from the SAMHSA-HRSA Integrated Behavioral Health model. The framework outlines 3 core domains: (1) Team Scope of Services, (2) Systematic Communication, and (3) Degree of Coordination stratified across 3 tiers that reflect increasing levels of integration and service maturity. By defining the components of integrated PSUD care, this model provides a shared language for clinical teams, researchers, and policymakers. The framework is illustrated through examples from established PSUD programs in Virginia and North Carolina, highlighting real-world application. Common challenges and regional considerations, including the unique needs of Appalachian populations and financial sustainability, are also discussed. This framework serves as a beginning tool for quality improvement, research, and health system planning. It prioritizes patient-centered care and scalability, supporting risk-appropriate models of PSUD treatment. By promoting consistency in service delivery, this approach aimed to improve mother-baby dyad outcomes and reduce overdose-related mortality.