Dr. Sarah Wakefield is the Chair of the Department of Psychiatry at Texas Tech University School of Medicine. She also serves as the Medical Director of the Texas Perinatal Psychiatry Access Network (TX PeriPAN), which supports clinicians serving pregnant women and new mothers experiencing mental health challenges. The program facilitates real-time access for PCPs to a network of mental health experts, including reproductive psychiatrists, through peer-to-peer consults by phone, vetted and personalized referrals and resources, and behavioral health CMEs.
Trayt’s multifactorial data platform helps PeriPAN improve care coordination and clinician productivity through better workflows while also providing data and analytics tools that empower leaders to evaluate key patient and program insights. Trayt is committed to helping programs like PeriPAN achieve better patient outcomes through measurement-based care.
PeriPAN was founded in 2022 with Dr. Wakefield serving as the inaugural medical director. Trayt spoke with Dr. Wakefield for Maternal Mental Health Month about the importance of mental health resources in this space, and what has made PeriPAN successful so far.
Q: How pervasive are maternal mental health illnesses?
Maternal mental health conditions are the most common complications of pregnancy and childbirth. They affect 1 in 5 perinatal women and are the leading underlying cause of pregnancy-related death in the United States. Depression during this time is twice as common as gestational diabetes. Women who get treatment can and do recover.
Q: What challenges are Access Programs in general trying to address?
So little training has been provided to our frontline clinicians when it comes to mental health, despite the known prevalence. Access Programs like PeriPAN increase health care professionals’ confidence and capacity to provide perinatal mental health support, services, and interventions.
Q: Could you share how you developed the approach being used by PeriPAN?
Lots of hours and thought went into the development of our model. I have been following what Massachusetts Child Psychiatry Access Program (MCPAP) for Moms has been doing for many years. I have stalked their website and referred people to their model. When we had the opportunity to launch in Texas, we joined a collaboration of Perinatal Psychiatry Access Programs from around the country that is facilitated by Lifeline for Moms and listened intently. We visited one on one with multiple state access projects to better understand the potential variations in the model and developed an approach that was a conglomeration of all we learned as we thought it could best apply to our mission in Texas.
Q: From a policy standpoint, what is happening at the state and federal level in relation to perinatal mental health programs?
I’m certain I won’t capture everything happening at the policy level in a state as big as Texas, but we know that Texas is supporting the infrastructure for PeriPAN and its sister program Child Psychiatry Access Network (CPAN) to support clinicians providing care to moms, children, and families. Texas’ Health and Human Services Commission is also facilitating a rollout of the Alliance for Innovation on Maternal Health (AIM) bundles to enhance the standard of care for women in the perinatal period of their lives. These bundles cover a multitude of diagnoses from diabetes and postpartum hemorrhage to substance use and mental health diagnoses. Texas has also extended Medicaid and Children’s Health Insurance Program (CHIP) post-partum coverage from 2- to 12-months. Anyone enrolled in Medicaid or CHIP who is pregnant or becomes pregnant is eligible for extended coverage. Texas Department of State Health Services (DSHS) facilitates the Maternal Mortality and Morbidity Review Committee to review every postpartum death in Texas in order to better understand what is happening to women in Texas and how best to intervene.
Q: Have we begun moving from treatment to prevention?
We must always be thinking of both, but we are still mostly in a treatment mindset. Mental health distress is hard to see until it is on the more severe end of the spectrum. We seem more willing to talk about it then. However, plenty of clinicians and patients could catch things much earlier, which would likely necessitate a smaller intervention comparatively, if we didn’t feel quite so stigmatized about it. Because Access Programs are increasing conversations and education around mental health, we are reducing the stigma. This will drive us toward a world where we can prevent more and more severe illness presentations, and maybe prevent illness all together.
Q: What are policy changes that can be implemented to ensure programs and strategies are proactive around perinatal mental health rather than reactive?
Any policy that promotes mental health education and screening even for those who appear symptomless, will drive us toward a proactive rather than reactive system. When our system learns to recognize early signs and not to over-pathologize but to promote wellness, we will be walking away from the sick/crisis system that exists for mental health care now, and toward a wellness and recovery-oriented system.
Q: What role does the technology provided by companies like Trayt Health play in improving care delivery from both the patient and provider perspective?
Trayt allows us to connect experts across the state with a single platform to facilitate collaboration for the care of patients. Having a secure platform to coordinate treatment is key to the movement of knowledge and in improving patient outcomes. Having a shared platform can also help us capture metrics to review the performance of our clinicians: How many people are we helping? With what are we helping them? How was their satisfaction?
Q: Can you describe how clinical expertise and technology can work together to achieve better measurement-based care?
Measurement-based care gives us more concrete data we can track over time. In mental health care, we use scales and screeners to help us qualify the severity of a person’s symptoms and to see if the treatment we have recommended is improving their state. Technology allows us to better track the outcomes of care and utilize that information to deliver better outcomes for patients. Utilizing measurement-based care by implementing technology can allow us to build algorithms for improved care. We can also review the severity of referred cases to see how clinicians are using our services and for what. This helps us tailor educational modules and materials to the current needs of clinicians.
Q: What can people do for Maternal Mental Health Month to begin discussing or implementing perinatal mental health programs in their own communities?
Talk about PeriPAN, attend our free educational modules, call us with a question if you are a provider in the state of Texas. Talk about moms and maternal mental health. Reduce the stigma. Shout it to the rooftops that this occurs in 1 in 5 new mommas. It is not rare, but it is rarely acknowledged.
To learn more about how Trayt can support your state Access Program, schedule time here.
Read more from our Leaders in Maternal Mental Health series below, dedicated to Maternal Mental Health Month in May 2024 and celebrating the voices and perspectives of those at the forefront of maternal mental health policies and programs.
Explore profile of Dr. Nancy Byatt, leading perinatal mental health researcher and clinician
Get to know Abby Koch, Director of Population Health and Analytics at Trayt Health
Dig into policy with Jamie Zahlaway Belsito, founder of the Maternal Mental Health Leadership Alliance