Skip to main content

Advertisement

SpringerLink
Log in

Implications of Comprehensive Mental Health Services Embedded in an Adolescent Obstetric Medical Home

  • Published:
Maternal and Child Health Journal Aims and scope Submit manuscript

Abstract

Purpose Mental health issues in perinatal adolescents are well documented and studies have shown high rates of depressive disorders among this population. Treatment is challenging because pregnant adolescents are poorly adherent with mental health services. We describe a novel integrated mental health care program for pregnant and parenting adolescent mothers and their children. Methods The Colorado Adolescent Maternity Program (CAMP) is a comprehensive, multidisciplinary teen pregnancy and parenting medical home program serving an ethnically diverse and low socioeconomic status population in the Denver metro area. We describe the Healthy Expectations Adolescent Response Team (HEART), an embedded mental health care program focused on improving identification of mental health symptoms and increasing rates mental health treatment in adolescent mothers. Results From January 1, 2011–January 16 2014, 894 pregnant adolescents were enrolled in CAMP and 885 patients were screened for mental health issues. Prior to HEART’s inception, 20 % of patients were identified as having mood symptoms in the postpartum period. Successful referrals to community mental health facilities occurred in only 5 % of identified patients. Following the creation of HEART, 41 % of patients were identified as needing mental health services. Nearly half of the identified patients (47 %) engaged in mental health treatment with the psychologist. Demographic factors including age, parity, ethnicity, and parent and partner involvement did not have a significant impact on treatment engagement. Trauma history was associated with lower treatment engagement. Conclusion Our findings suggest that an embedded mental health program in an adolescent obstetric and pediatric medical home is successful in improving identification and engagement in mental health treatment. Key components of the program include universal screening, intensive social work and case management involvement, and ready access to onsite mental health care providers. Limitations of the program are discussed as well directions for future research.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Dye, J.L. Participation of Mothers in Government Assistance of Mothers in Government Assistance Pro-grams: 2004 [Including additional detailed tables]. Current Population Reports, 71–116. Washington, DC: US Census Bureau. 2008. http://www.census.gov/hhes/fertility/data/sipp/

  2. Unpublished tabulations by the National Campaign to Prevent Teen and Unplanned Pregnancy. Data from the 2009 and 2010 Current Population Survey, Annual Social and Economic Supplement. Integrated Public Use Microdata Series, Current Population Survey: Version 3.0. [Machine-readable database]. Minneapolis MN: Minnesota Population Center. http://cps.ipums.org.

  3. Melhado, L. (2007). Teenage parents’ educational attainment is affected more by available resources than by parenthood. Perspectives on Sexual and Reproductive Health, 39(3), 184–185.

    Article  Google Scholar 

  4. Perper, K., Peterson, K., & Manlove, J. Diploma attachment among teen mothers. Washington, DC: Child Trends. 2010. http://www.childtrends.org/Files//Child_Trends-2010_01_22_FS_DiplomaAttainment.pdf

  5. Hoffman, S. D. (2006). By the numbers: The public costs of adolescent childbearing. Washington, DC: The National Campaign to Prevent Teen Pregnancy.

    Google Scholar 

  6. Manlove, J. (1998). The influence of high school dropout and school disengagement on the risk of school-age pregnancy. Journal of Research on Adolescence, 8(2), 187–220.

    Article  CAS  PubMed  Google Scholar 

  7. Unpublished tabulations by the National Campaign to Prevent Teen and Unplanned Pregnancy. (2012). The National Educational Longitudinal Study of 2002–2006 [Data File]. The National Center for Educational Statistics. http://nces.ed.gov/edat/

  8. Kirby, D., & Lepore, G. (2007). Sexual risk and protective factors: Factors affecting teen sexual behavior, pregnancy, childbearing, and sexually transmitted disease: Which are important? Which Can You Change?. Washington, DC: The National Campaign to Prevent Teen and Unplanned Pregnancy.

    Google Scholar 

  9. Saewyc, E. M., Magee, L. L., & Petingell, S. E. (2004). Teenage pregnancy and associated risk behaviors among sexually abused adolescents. Perspectives on Sexual and Reproductive Health, 36(3), 98–103.

    Article  PubMed  Google Scholar 

  10. Noll, J. G., Shenk, C. E., & Putnam, K. T. (2009). Childhood sexual abuse and adolescent pregnancy: A meta-analytic update. Journal of Pediatric Psychology, 34(4), 366–378.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Carpenter, S. C., Clyman, R. B., Davidson, A. J., et al. (2001). The association of foster care or kinship care with adolescent sexual behavior and first pregnancy. Pediatrics, 208(3), 46–52.

    Article  Google Scholar 

  12. Gest, S. D., Mahoney, J. L., & Cairns, R. B. (1999). A developmental approach to prevention research: Configural antecedents of early parenthood. American Journal of Community Psychology, 27(4), 543–565.

    Article  CAS  PubMed  Google Scholar 

  13. Herrenkohl, E., Herrenkohl, R., Egolf, B., et al. (1998). The relationship between early maltreatment and teenage parenthood. Journal of Adolescence, 21(3), 291–303.

    Article  CAS  PubMed  Google Scholar 

  14. Quinlivan, J., Tan, H., Steele, A., et al. (2004). Impact of demographic factors, early family relationships, and depressive symptomatology in teenage pregnancy. Australian and New Zealand Journal of Psychiatry, 38(4), 197–203.

    Article  PubMed  Google Scholar 

  15. Woodward, L., Fergusson, D. M., & Horwood, L. J. (2001). Risk factors and life processes associated with teenage pregnancy: Results of a prospective study from birth to 20 years. Journal of Marriage and Family, 63, 1170–1184.

    Article  Google Scholar 

  16. Clare, C. A., & Yeh, J. (2012). Postpartum depression in special populations: A review. Obstetrical and Gynecological Survey, 67(5), 313–323.

    Article  PubMed  Google Scholar 

  17. Kingston, et al. (2012). Comparison of adolescent, young adult, and adult women’s maternity experiences and practices. Pediatrics, 129(5), e1228–e1237.

    Article  PubMed  Google Scholar 

  18. Yoziak, J. A. (2010). Postpartum depression and adolescent mothers: A review of assessment and treatment approaches. Journal of Pediatric and Adolescent Gynecology, 23(3), 172–178.

    Article  Google Scholar 

  19. Sheeder, J., Kabir, K., & Stafford, B. (2009). Screening for postpartum depression at well-child visits: Is once enough during the first 6 months of life? Pediatrics, 123(6), e982–e988.

    Article  PubMed  Google Scholar 

  20. Corcoran, J. (1998). Consequences of adolescent pregnancy/parenting: A review of the literature. Social Work in Health Care, 27(2), 49–67.

    Article  CAS  PubMed  Google Scholar 

  21. Kalmuss, D. S., & Namerow, P. B. (1994). Subsequent childbearing among teenage mothers: The determinants of a closely spaced second birth. Family Planning Perspectives, 26(4), 149–159.

    Article  CAS  PubMed  Google Scholar 

  22. McAnarney, E. R., & Stevens-Simon, C. (1990). Maternal psychological stress/depression and low birth weight. Is there are relationship? American Journal of Diseases of Children, 144, 789–792.

    Article  CAS  PubMed  Google Scholar 

  23. Orr, S. T., & Miller, C. A. (1995). Maternal depressive symptoms and the risk of poor pregnancy outcome. Review of the literature and preliminary findings. Epidemiologic Reviews, 17(1), 165–171.

    CAS  PubMed  Google Scholar 

  24. Chung, T. K. H., Lau, T. K., Yip, A. S. K., et al. (2001). Antepartum depressive symptomatology is associated with adverse obstetric and neonatal outcomes. Psychosomatic Medicine, 63(5), 830–834.

    Article  CAS  PubMed  Google Scholar 

  25. Orr, S. T., James, S. A., & Prince, C. B. (2002). Maternal prenatal depressive symptoms and spontaneous preterm births among African-American women in Baltimore, Maryland. American Journal of Epidemiology, 156(9), 797–802.

    Article  PubMed  Google Scholar 

  26. Sommer, K. S., Whitman, T. L., Borkowski, J. G., Gondoli, D. M., Burke, J., et al. (2000). Prenatal maternal predictors of cognitive and emotional delays in children of adolescent mothers. Adolescence, 35(137), 87–112.

    CAS  PubMed  Google Scholar 

  27. Manlove, J. S., Terry-Humen, E., Mincielli, L. A., & Moore, K. A. (2008). Outcomes for children of teen mothers from kindergarten through adolescence, chap. 5. In R. Maynard (Ed.), Kids having kids: Economic costs and social costs of teen pregnancy (2nd ed.). Washington, DC: The Urban Institute Press.

  28. Hubbs-Tait, L., Osofsky, J. D., Hann, D. M., & Culp, A. M. (1994). Predicting behavior problems and social competence in children of adolescent mothers. Family Relations, 43, 439–446.

    Article  Google Scholar 

  29. Barnet, B., Liu, J., & Devoe, M. (2008). Double jeopardy: Depressive symptoms and rapid subsequent pregnancy in adolescent mothers. Archives of Pediatrics and Adolescent Medicine, 162(3), 246–252.

    Article  PubMed  Google Scholar 

  30. Crittenden, C. P., Boris, N. W., Rice, J. C., Taylor, C. A., & Olds, D. L. (2009). The role of mental health factors, behavioral factors, and past experiences in the prediction of rapid repeat pregnancy in adolescence. Journal of Adolescent Health, 44(1), 25–32.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Albrecht, S., & Naugle, A. E. (2002). Psychological assessment and treatment of somatization: Adolescents with medically unexplained neurologic symptoms. Adolescent Medicine: State of the Art Reviews, 13(3), 625–641.

    Google Scholar 

  32. Rushton, J., Bruckman, D., & Kelleher, K. (2002). Primary care referral of children with psychosocial problems. Archives of Pediatrics and Adolescent Medicine, 156(6), 592–598.

    Article  PubMed  Google Scholar 

  33. Kelleher, K. J., Campo, V., & Gardner, W. P. (2006). Management of pediatric mental disorders in primary care: Where are we now and where are we going? Current Opinion in Pediatrics, 18(6), 649–653.

    Article  PubMed  Google Scholar 

  34. Owens, P. L., Hoagwood, K., Horwitz, S. M., Leaf, P. J., Poduska, J. M., Kellam, S. G., et al. (2002). Barriers to children’s mental health services. Journal of the American Academy of Child and Adolescent Psychiatry, 41(6), 731–738.

    Article  PubMed  Google Scholar 

  35. Bussing, R., Zima, B. T., & Belin, T. R. (1998). Differential access to care for children with ADHD in special education programs. Psychiatric Services, 49(9), 1226–1229.

    Article  CAS  PubMed  Google Scholar 

  36. Bussing, R., Gary, F. A., Mills, T. L., & Garvan, C. W. (2007). Cultural variations in parental health beliefs, knowledge and information sources related to attention deficit hyperactivity disorder. Journal of Family Issues, 28(3), 291–318.

    Article  Google Scholar 

  37. American Academy of Pediatrics. (1992). Ad hoc task force on definition of the medical home: The medical home. Pediatrics, 90(5), 774.

    Google Scholar 

  38. American Academy of Pediatrics. (2002). The medical home: Medical home initiatives for children with special needs advisory committee. Pediatrics, 110(1 Pt 1), 450.

    Google Scholar 

  39. Klein, J. D., & American Academy of Pediatrics. (2005). Committee on, Adolescence. Adolescent pregnancy: Current trends and issues. Pediatrics, 116(1), 281–286.

    Article  PubMed  Google Scholar 

  40. Nelson, K., Key, D., Fletcher, J., Kirkpatrick, E., & Feinstein, R. (1982). The teen-tot clinic: An alternative to traditional care for infants of teenaged mothers. Journal of Adolescent Health Care, 3(1), 19–23.

    Article  CAS  PubMed  Google Scholar 

  41. O’Sullivan, A., & Jacobsen, B. (1992). A randomized trial of a health care program for first-time adolescent mothers and their infants. Nursing Research, 41(4), 210–215.

    Article  PubMed  Google Scholar 

  42. Elster, A., Lamb, M., Tevare, J., & Ralsont, C. (1987). The medical and psychosocial impact of comprehensive care on adolescent pregnancy and parenthood. JAMA, 258(9), 1187–1192.

    Article  CAS  PubMed  Google Scholar 

  43. Cox, J., Burman, M., Woods, E., Famakinwa, O., & Harris, S. (2012). Evaluation of raising adolescent families together program: A medical home for adolescent mothers and their children. American Journal of Public Health, 102(10), 1879–1885.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Akinbami, L., Cheng, T., & Kornfield, D. (2001). A review of teen-tot programs: Comprehensive clinical care for young parents and their children. Adolescence, 36(142), 381–393.

    CAS  PubMed  Google Scholar 

  45. Jones, M., & Mondy, L. (1994). Lessons for prevention and intervention in adolescent pregnancy: A five-year comparison of outcomes for two programs for school-aged pregnant adolescents. Journal of Pediatric Health Care, 8(4), 152–159.

    Article  CAS  PubMed  Google Scholar 

  46. Radloff, L. S. (1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1(3), 385–401.

    Article  Google Scholar 

  47. Cox, J. L., Holden, J. M., & Sagovsky, R. (1987). Detection of postnatal depression: Development of the 10-item Edinburgh Postnatal Depression Scale. British Journal of Psychiatry, 150, 782–786.

    Article  CAS  PubMed  Google Scholar 

  48. Cox, J., & Holden, J. (2003). Perinatal mental health: A guide to the Edinburgh Postnatal Depression Scale (EPDS). London: Gaskell.

    Google Scholar 

  49. Hirshfield, R. M. A., et al. (2000). Development and validation of a screening instrument for bipolar spectrum disorder: The Mood Disorder Questionnaire. American Journal of Psychiatry, 157(11), 1873–1875.

    Article  Google Scholar 

  50. Gaynes, B. N., DeVeaugh-Geiss, J., Weir, S., Gu, H., MacPherson, C., Schulberg, H. C., et al. (2010). Feasibility and diagnostic validity of the M-3 checklist: A brief, self-rated screen for depressive, bipolar, anxiety, and post-traumatic stress disorders in primary care. The Annals of Family Medicine, 8(2), 160–169.

    Article  PubMed  Google Scholar 

  51. Screening for Depression in Adults, Topic Page. U.S. Preventive Services Task Force. http://www.uspreventiveservicestaskforce.org/uspstf/uspsdepr.htm

  52. Miller, L., Gur, M., Shanok, A., & Weissman, M. (2008). Interpersonal psychotherapy with pregnant adolescents: Two pilot studies. Journal of Child Psychology and Psychiatry, 49(7), 733–742.

    Article  PubMed  Google Scholar 

  53. Poleshuck, E. L., Cerrito, B., Leshoure, N., Finocan-Kaag, G., & Kearney, M. H. (2013). Underserved women in a women’s health clinic describe their experiences of depressive symptoms and why they have low uptake of psychotherapy. Community Mental Health Journal, 49, 50–60.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Reid, V., & Meadows-Oliver, M. (2007). Postpartum depression in adolescent mothers: An integrative review of the literature. Journal of Pediatric Health Care, 2(5), 289–298.

    Article  Google Scholar 

  55. Rosen, D., Tolman, R. M., & Warner, L. A. (2004). Low-income women’s use of substance abuse and mental health services. Journal of Health Care for the Poor and Underserved, 15(2), 206–219.

    Article  PubMed  Google Scholar 

  56. Mueser, K. T., Rosenberg, S. D., Goodman, L. A., & Trumbetta, S. L. (2002). Trauma, PTSD, and the course of severe mental illness: an interactive model. Schizophrenia Research, 53(1–2), 123–143.

    Article  PubMed  Google Scholar 

  57. Tandon, S. D., Leis, J. A., Mendelson, T., Perry, D. F., & Kemp, K. (2014). Six-month outcomes from a randomized controlled trial to prevent perinatal depression in low-income home visiting clients. Maternal and Child Health Journal, 18, 873–881.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Aguilera, A., & Muñoz, R. F. (2011). Text messaging as an adjunct to CBT in low-income populations: A usability and feasibility pilot study. Professional Psychology: Research and Practice, 42(6), 472–478.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Children’s Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA

    Bethany Ashby, Celeste St. John-Larkin & Stephen Scott

  2. University of Colorado School of Medicine, Aurora, CO, USA

    Nikhil Ranadive & Veronica Alaniz

Authors
  1. Bethany Ashby
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nikhil Ranadive
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Veronica Alaniz
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Celeste St. John-Larkin
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Stephen Scott
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Bethany Ashby.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ashby, B., Ranadive, N., Alaniz, V. et al. Implications of Comprehensive Mental Health Services Embedded in an Adolescent Obstetric Medical Home. Matern Child Health J 20, 1258–1265 (2016). https://doi.org/10.1007/s10995-016-1927-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10995-016-1927-y

Keywords

Search

Navigation