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11/12/2021 | 2:45 PM to 3:45 PM
The Role of the C-L Psychiatrist in Perinatal Collaborative Care: A Mixed Methods Analysis
Background:
The Collaborative Care Model (CoCM) is an effective primary care-based intervention for depression which has had slow adoption into widespread practice. A psychiatric consultant is a key member of CoCM teams, and in perinatal CoCM this role is often filled by a Consultation Liaison trained psychiatrist with interest or expertise in women’s mental health. Psychiatrists do not always receive in depth training in integrated care or women’s mental health and this may pose a barrier to practicing in the perinatal CoCM. We plan to assess psychiatric consultants’ experiences of practicing in the perinatal CoCM. We conducted a qualitative analysis of data from 20 clinics within a clinical trial comparing the Longitudinal Remote Consultation strategy to standard implementation (trials.gov NCT02976025).
Methods:
We used data from our documentation of team members in each clinic, and from in depth interviews with psychiatric consultants and care managers. We conducted a content analysis of interview responses in six categories (team based practice, remote practice, need for additional training/technical assistance, comfort prescribing in the perinatal population, and perceptions about the CoCM).
Results:
Of the 20 participating clinics, 50% (n=10) had a psychiatric practitioner within the organization who became part of the CoCM team, 20% had (n=4) had a psychiatric practitioner who did not participate in CoCM, 15% (n=3) could not hire a psychiatric consultant and 15% (n=3) hired a psychiatric consultant to build the CoCM team.
We will report on content analysis of 10 psychiatric consultant interviews from eight different clinical sites and 39 care manager interviews from 17 sites, at different points in implementation and sustainment of perinatal collaborative care.
Conclusions:
Challenges to high fidelity implementation of the CoCM model include the ability to recruit psychiatric consultants to the CoCM team, and once recruited their comfort and interest in practicing in this role. Our analysis will help elucidate barriers to implementation that are specific to the psychiatric consultant role and inform future efforts to implement perinatal collaborative care.
The Collaborative Care Model (CoCM) is an effective primary care-based intervention for depression which has had slow adoption into widespread practice. A psychiatric consultant is a key member of CoCM teams, and in perinatal CoCM this role is often filled by a Consultation Liaison trained psychiatrist with interest or expertise in women’s mental health. Psychiatrists do not always receive in depth training in integrated care or women’s mental health and this may pose a barrier to practicing in the perinatal CoCM. We plan to assess psychiatric consultants’ experiences of practicing in the perinatal CoCM. We conducted a qualitative analysis of data from 20 clinics within a clinical trial comparing the Longitudinal Remote Consultation strategy to standard implementation (trials.gov NCT02976025).
Methods:
We used data from our documentation of team members in each clinic, and from in depth interviews with psychiatric consultants and care managers. We conducted a content analysis of interview responses in six categories (team based practice, remote practice, need for additional training/technical assistance, comfort prescribing in the perinatal population, and perceptions about the CoCM).
Results:
Of the 20 participating clinics, 50% (n=10) had a psychiatric practitioner within the organization who became part of the CoCM team, 20% had (n=4) had a psychiatric practitioner who did not participate in CoCM, 15% (n=3) could not hire a psychiatric consultant and 15% (n=3) hired a psychiatric consultant to build the CoCM team.
We will report on content analysis of 10 psychiatric consultant interviews from eight different clinical sites and 39 care manager interviews from 17 sites, at different points in implementation and sustainment of perinatal collaborative care.
Conclusions:
Challenges to high fidelity implementation of the CoCM model include the ability to recruit psychiatric consultants to the CoCM team, and once recruited their comfort and interest in practicing in this role. Our analysis will help elucidate barriers to implementation that are specific to the psychiatric consultant role and inform future efforts to implement perinatal collaborative care.
Authors
Speakers
Amritha Bhat
Assistant Professor University of Washington
Amritha Bhat, MBBS, MD, MPH is a perinatal psychiatrist and Assistant Professor in the Department of Psychiatry and Behavioral Sciences at the University of Washington. A psychiatrist trained in both India and the USA, she also completed the Psychiatry in Primary Care Fellowship Program at the University of Washington. She established the perinatal psychiatry clinic at the University of Washington Medical Center. She leads and is involved in several projects that make perinatal mental health treatments available to women in primary care and obstetric settings, including collaborative care and telephone consultation. She leads the Perinatal Psychiatry interest pathway in the University of Washington’s Psychiatry residency pathway and is faculty on the Women’s Mental Health Fellowship. She has created educational modules regarding postpartum depression for NICU nurses, and compiled training material for care managers working with women with perinatal depression. Her research interests include developing sustainable primary care based models of maternal mental health care that also include attention to the mother – infant dyad.
Whitney Eriksen
Senior Researcher University of Pennsylvania
.
Frances Barg
Professor Perelman School of Medicine, University of Pennsylvania
Dr. Fran Barg is a medical anthropologist, a professor in the Department of Family Medicine and Community Health, a professor of Epidemiology, a senior fellow in the Center for Public Health Initiatives at the University of Pennsylvania School of Medicine, a senior scholar in the Center for Clinical Epidemiology and Biostatistics, associated faculty in the Department of Anesthesia and Critical Care and a Professor in the Department of Anthropology at the University of Pennsylvania. She developed and directs the Mixed Methods Research Lab. She is a collaborator for mixed methods and qualitative research with interdisciplinary research teams across six schools at the University of Pennsylvania. Her research focuses on stakeholder perspectives on managing health and health care.
Ian Bennett
Professor Departments of Family Medicine, Psychiatry and Behavioral Sciences, and Global Health, University of Washington
Dr. Bennett is a physician scientist who has focused his scholarly and clinical career on the delivery of primary health services to vulnerable populations in the US and in developing countries. His research expertise is in the area of Implementation Science and he focuses on the implementation and dissemination of adaptations of the evidence based Collaborative Care Model (CoCM) of integrated and team based behavioral health care focused on perinatal mental health and risk of suicide. He is on the leadership team of the IMPLICIT Quality Improvement and Practice Based Research Network that focuses on perinatal health. He is a family physician providing full spectrum primary care including obstetric, family planning, pediatric and general adult health care. Dr. Bennett has expertise in the use of health information and communications technologies to support the delivery of mental health care in the non-specialty mental health setting. He makes use of participatory design strategies to bring end-users into the process of agile technology development and reduce the risk of designs that are unacceptable to target users. He is the PI of NIH funded national and international implementation trials of the implementation of collaborative care for perinatal depression in community health centers. He has also been funded to study mHealth strategies to extend the reach of services for women from vulnerable populations in pregnancy in the US, Vietnam, Nigeria, and Peru.
Outpatient Consultation Brief Oral Papers
Category
General Sessions
Description
CE Hours
Presenting Author
Amritha Bhat
Assistant Professor | University of Washington
Amritha Bhat, MBBS, MD, MPH is a perinatal psychiatrist and Assistant Professor in the Department of Psychiatry and Behavioral Sciences at the University of Washington. A psychiatrist trained in both India and the USA, she also completed the Psychiatry in Primary Care Fellowship Program at the University of Washington. She established the perinatal psychiatry clinic at the University of Washington Medical Center. She leads and is involved in several projects that make perinatal mental health treatments available to women in primary care and obstetric settings, including collaborative care and telephone consultation. She leads the Perinatal Psychiatry interest pathway in the University of Washington’s Psychiatry residency pathway and is faculty on the Women’s Mental Health Fellowship. She has created educational modules regarding postpartum depression for NICU nurses, and compiled training material for care managers working with women with perinatal depression. Her research interests include developing sustainable primary care based models of maternal mental health care that also include attention to the mother – infant dyad.
