Perinatal Mental Health Coordination and Monitoring Pilot Program for Veterans

Abstract:

Intro

The proportion of female Veterans has increased over the past 20 years. Currently 11%, it is expected to reach 14.6% by 2035. Approximately half of all Veterans are of child-bearing age, making perinatal mental health a growing priority for VA. Previous authors have described perinatal mental health monitoring programs, but none specifically focused on the unique needs of female Veterans.



Method

This program was designed using collaborative care principles to address the needs of perinatal Veterans. Patients may be referred by PCPs, the VA Maternity Care Coordinator, or their mental health clinician. Nurse Care Managers manage the perinatal patient registry and are the main point of contact for Veterans. They check in at least once per trimester, at 2 weeks post-partum, then every 2 months up to 1-year post-partum. Standardized outcome measures are completed at each contact and reviewed at weekly interprofessional consultation meetings. Nurse Care Managers can schedule patients with a perinatal psychologist and/or psychiatrist for further consultation and treatment. Satisfaction surveys at the end of care assess patients’ overall satisfaction with the program and their satisfaction with specific elements of the program, including periodic check-in calls, access to psychotherapy and psychiatry, having coordinated mental health care, having an established mental health provider, having a single point of contact for mental health, and program participation. Possible scores ranged from 0 (not helpful) to 3 (extremely helpful).



Results

Female Veterans involved in the pilot program expressed high satisfaction. To date, 196 Veterans have enrolled. Data collection is ongoing as the program transitions out of pilot phase. Current results demonstrated overall satisfaction score 2.7, satisfaction with the program 2.5, and satisfaction score 2.6 for check-in calls, access to psychiatry and therapy, continuation of mental health care, screening process, and having a point of contact for their mental health. Future analysis will evaluate whether standardized outcome measure scores improve during program participation.



Discussion

Women Veterans have unique mental health needs during the perinatal period. To our knowledge, this perinatal mental health monitoring program is the first of its kind to focus specifically on Veterans. Participants were highly satisfied with the program. We anticipate that mental health symptom monitoring and care management in the peripartum period will improve clinical outcomes during this crucial phase for Veterans.



Conclusion/Implications

This perinatal mental health monitoring program was feasible and holds promise for implementation in other collaborative care settings. Veterans are overall satisfied with the program and were grateful to be a part of it.





References:

Women Veterans Report: The Past, Present, and Future of Women Veterans. National Center for Veterans Analysis and Statistics, Dept Veterans Affairs, 2017

National Survey of Veterans (NSV9503), Department of Veterans Affairs, National Center for Veteran Analysis and Statistics, April 1995