Literature Collection

Perinatal psychological health conditions (eg, perinatal depression, anxiety) are some of the leading causes of maternal mortality in the United States and are associated with adverse pregnancy outcomes, long-term cardiovascular outcomes, and intergenerational effects on offspring neurodevelopment. These risks underscore the importance of addressing maternal psychological health as a key determinant of perinatal cardiovascular health. Thus, it is vital to recognize the spectrum of perinatal psychological health and to provide guidance for both patients and clinicians on screening and management options across the perinatal period. In this scientific statement from the American Heart Association, we redefine maternal cardiovascular health to include psychological health, provide robust evidence on the association of psychological health with cardiovascular outcomes, highlight the social and environmental underpinnings, and finally, offer guidance about how to integrate psychological health into maternal cardiovascular health with a specific focus on the perinatal period (ie, pregnancy through 1 year postpartum). We also describe opportunities for creating care delivery models that recurrently address perinatal psychological health in cardio-obstetric care, using behavioral and pharmacological interventions, with an emphasis on better integration of psychological health care, longer postpartum follow-up, and opportunities for evaluating the comparative effectiveness of these models with stakeholder partners.

BACKGROUND: Social care integration in health systems is on the rise in the United States, particularly since the National Committee for Quality Assurance introduced screening and intervention as HEDIS metrics. These policy levers outpace empirical knowledge to guide how best to operationalize social care. This study reports results from a quality improvement initiative to implement social care in an integrated health system. METHODS: A quantitative effectiveness evaluation was conducted across 32 clinics in Kaiser Permanente Washington, which had recently embedded Community Resource Specialists (CRS) in their primary care teams and integrated a social health screener into their electronic health record. Using a pragmatic design with propensity score matched comparison group (PSC), we compared two intervention arms (both of whom completed a social health screener): (1) CRS-S who engaged in only a single CRS visit and (2) CRS-M who engaged in at least two CRS visits. Patients completed a survey shortly after their qualifying primary care encounter and approximately three months later that assessed the following domains: social health, patient experience with the care team, and health and functioning; healthcare utilization was obtained from the electronic health record. Patients from each arm were then purposefully sampled for qualitative interviews. RESULTS: Quantitative results suggest that CRS-M patients experienced exacerbated social risk severity and food insecurity over three months, but improved financial risk. For the majority of domains, no differences were observed between arms, though CRS-M demonstrated poorer coping over time whereas PSC patients showed higher use of instrumental and emotional support coping strategies. CRS-M reported worse health and need for more help with activities of daily living, but improvements in trust in their care team. Qualitative results showcased, by design, the positive potential impact of working with a CRS across all domains of interest, especially social and mental health. CONCLUSION: This quality improvement evaluation of social care integration using the CRS illustrates a potential pathway for activating social support and healthcare relationships in primary care, but more rigorous designs and longer-term follow up are needed to explore if this pathway leads to improvements in patient or population health and healthcare utilization.

INTRODUCTION: This study implemented a single-session oral health education and referral program in behavioral health settings serving people with psychiatric disabilities. The program was led by peer specialists ("peers")-lay community behavioral health workers with personal experience of mental health challenges who are trained and certified to support others. METHODS: Investigators collaborated with peers, state government, and clinical leadership to design and implement the program. Randomized parallel assignment was used to compare 2 arms: (1) group viewing of an oral health educational video (VC) and (2) a peer-led 1-time class providing education and motivation to access dental care (the Oral Health Recovery Group; OHRG). In both arms, peers followed up with participants to encourage accessing dental care and reinforce at-home care goals. Oral health knowledge, at-home care, motivation, appointment scheduling, and utilization were assessed at baseline, postintervention, and 2 mo. Qualitative interviews assessed barriers and facilitators. RESULTS: More than half of participants reported oral pain in the previous year. Pre-/postintervention survey results did not significantly improve in either arm or differ between arms. At follow-up, 25 (68%) in OHRG and 14 (56%) in VC reported meeting a dental at-home care goal because of the program. Ten (27%) in OHRG and 9 (36%) in VC reported making a dental appointment because of the program. Most were satisfied with the program. Interviewed participants were comfortable with peers in this role, yet access barriers remained. CONCLUSIONS: Single-session oral health interventions were implemented in behavioral health settings. The fact that surveys did not significantly improve suggests that more intensive interventions may be needed. Nevertheless, peers successfully scheduled dental appointments for vulnerable patients. Given that dental appointments were scheduled after only a 1-time class and light-touch peer navigation, oral health integration in behavioral health settings shows promise as a financially sustainable approach that merits further research. KNOWLEDGE TRANSFER STATEMENT: The results of this study can be used by staff in behavioral health settings who wish to consider peer-led financially sustainable approaches to providing oral health education and linkages to dental care for their clients.