In California, one in five people experience perinatal mood and anxiety disorders (PMAD) and many women are under identified or undertreated despite available effective treatments. The Los Angeles Maternal Mental Health Access (LAMMHA) program is working to change that by helping LA County community health centers implement the evidence-based Collaborative Care Model (CoCM) for perinatal mental health. Implementing a complex new model takes interdisciplinary collaboration, training, and ongoing listening, learning, and real-time adjustments.

A new study under peer review from the LAMMHA evaluation team examined what the program learned using a rapid audit-feedback method from its first cohort of four federally qualified health centers (FQHCs) in relationship to the process of implementation. Guided by the Consolidated Framework for Implementation Research 2.0 (CFIR) and Woodward Health Equity domains1, the Stages of Implementation (SIC) tool was used to track ...

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Los Angeles County Maternal Mental Health Access (LAMMHA) is a five-year program funded by the California Health Care Foundation (CHCF) to support community health centers in identifying and treating perinatal mental disorders in primary and prenatal care. Affecting at least one in seven childbearing persons in the U.S., perinatal depression is one of the most common complications of pregnancy and the postpartum period. Having clinical protocols and workflows for early detection and management is critical in achieving the best care and outcomes for both parent and infant.

The Plan-Do-Study-Act (PDSA) cycle

The Plan-Do-Study-Act (PDSA) cycle is a structured approach to implementing quality improvement initiatives in healthcare settings. PDSA cycles are used to improve patient safety, quality of care, and efficiency by testing changes on a small scale before making them standard practice. PDSA’s are continuous and iterative, and follow the ...

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Los Angeles County Maternal Mental Health Access (LAMMHA) is a five-year program funded by the California Health Care Foundation (CHCF) to support community health centers in identifying and treating perinatal mental disorders in primary and prenatal care. Depression is one of the most common complications of pregnancy and the postpartum period, affecting at least one in seven childbearing persons in the U.S. Early identification is essential to prevent suffering, reduce family impact, and improve outcomes for both parent and infant.

To reflect on the experience of depression screening and linkage to care, we spoke with Dr. Ian Bennett, a family physician providing prenatal, postpartum, and pediatric care in a community health center and Dr. Amritha Bhat, a perinatal psychiatrist and associate professor in the Department of Psychiatry and Behavioral Sciences at the University of Washington. Drs. Bennett ...

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With the goal of improving perinatal mental health care, the Los Angeles County Maternal Mental Health Access (LAMMHA) program is funded by The California Health Care Foundation (CHCF) to support Los Angeles County community health centers in the identification and treatment of common perinatal mental disorders. TCC Family Health (TCC) and St. John’s Community Health (St. John’s) joined LAMMHA as part of the second cohort. During their two-year participation, they received intensive on-going support and training to implement and sustain the evidence-based collaborative care model (CoCM) used to treat common mental health conditions in primary care.  As they near the end of their LAMMHA support period, their clinical teams reflect on the experience and impact of implementing CoCM with their perinatal patient populations.

Why did your organization join the LAMMHA project? What were some of the benefits of your participation?

St. John’s: LAMMHA gave ...

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The Los Angeles County Maternal Mental Health Access (LAMMHA) program is a five-year program funded by The California Health Care Foundation (CHCF) to support community health centers in the identification and treatment of urgent but common perinatal mental disorders in primary care. Participating organizations are provided training and support to implement the evidence-based Collaborative Care Model (CoCM) for their perinatal population.

Context within LA County

Los Angeles County is home to nearly 10 million people living in 88 cities and unincorporated areas. Unfortunately, it also has the biggest gap between the supply and demand for perinatal mental health specialists. Within Los Angeles County, one in five women experience perinatal depression, yet the County is simply too big, with too many births a year, to provide individual perinatal mental health care to all the patients who may need it. PROMISE offers one solution. PROMISE is ...

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The Los Angeles County Maternal Mental Health Access (LAMMHA) program is a five-year program funded by The California Health Care Foundation (CHCF) to support community health centers in the identification and treatment of urgent but common perinatal mental disorders in primary care. The first cohort of clinical teams from AltaMed Health Services and Eisner Health shared their experiences as they near completion of their two-year experience in implementing the evidence-based collaborative care model (CoCM).

Why did your organization join the LAMMHA project? What were some of the big benefits of your participation?

Eisner: Our primary reason for joining the project was to increase mental health access to our prenatal and postpartum patients. We believe we have met these goals, as we were able to reach these patients and more often provide them with in-house services versus having to refer them out. ...

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Nationally, approximately 700 women die each year from complications related to pregnancy and childbirth with perinatal depression being the most common postpartum complication (CDC). Within Los Angeles County, one in five women experience perinatal depression, and often those who are identified as having depression have difficulty finding appropriate care due to various social and economic factors, including material poverty, housing instability, and lack of social support (CDPH). Addressing social drivers (determinants) of health (SDOH) – defined as non-medical factors that affect health outcomes – can improve overall care and perinatal mental health outcomes.

A recent study in LA county, Social Determinants Among Pregnant Clients With Perinatal Depression, Anxiety, Or Serious Mental Illness (Health Affairs, April 2024), takes a close look at the linkages between SDOH and clients experiencing perinatal anxiety and depression. Co-author Dr. Bridgette Blebu, shared some of the ...

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Los Angeles County Maternal Mental Health Access (LAMMHA) is a five-year program funded by The California Health Care Foundation (CHCF) to support Los Angeles County community health centers in the identification and treatment of common perinatal mental disorders in primary care. At least one in five childbearing persons in the U.S. will experience a mental health or substance use disorder (SUD) during pregnancy or in the first year postpartum1. To reflect on the experience of perinatal SUD treatment, we spoke with Dr. Nadejda Bespalova, a perinatal and addiction psychiatrist and Acting Assistant Professor in the Department of Psychiatry and Behavioral Sciences at the University of Washington. During our conversation, Dr. Bespalova shared her reflections on a case of a pregnant patient who had a history of substance use. “Some things went well, and some things didn’t go well – for a ...

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Six months after the launch of a collaborative to improve perinatal health, a new cohort of Los Angeles health centers will implement the innovative program. 

TCC Family Health (TCC) and St. John’s Community Health (St. John’s) joined the Los Angeles County Maternal Mental Health Access (LAMMHA) program as part of a second cohort implementing the evidence-based collaborative care model (CoCM) to treat common mental health conditions in primary care. Six months after training an initial cohort, the LAMMHA partners* chose TCC and St. John’s to join cohort 2 with two clinic sites each. During the two-year program, they will receive intensive on-going support and training to implement and sustain CoCM at their sites. Care teams from the four cohort 2 clinical sites attended an in-person training in Los Angeles on October 19, 2023 to build key perinatal CoCM skills. The session provided interactive education for behavioral health care managers, psychiatric consultants, medical ...

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Providers need support when presented with a pregnant or postpartum patient with a complicated history, symptoms, or situation. Luckily, there is someone they can turn to who can troubleshoot with them, through the Los Angeles Maternal Mental Health Access (LAMMHA) ECHO Perinatal Case Conference Series. The monthly LAMMHA webinar, based on the successful ECHO Model, brings together doctors, nurses, behavioral health clinicians, and other staff working to support new families in Los Angeles County during their pregnancy and postpartum journeys and provides them an opportunity to learn from one another. Each webinar features a brief presentation on a unique topic related to perinatal mental health delivered by an expert in the field. Following the presentation, attendees are invited (and strongly encouraged!) to bring challenging cases that they have encountered to the group for discussion and troubleshooting. Through this interactive ...

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