By Stacey Porter, MSW

This year the Policy Center ran our second Government Agency Fellows program and third Nonprofit State Policy Fellows program. This May, both cohorts graduated from the 12-month programs and presented their action plans to staff, board members, and guests.

Government Agency Fellows program graduates included 14 Fellows from 8 states: California, Delaware, Florida, Indiana, North Carolina, Pennsylvania, Virginia, and Washington. We are thrilled about their action plan development and look forward to seeing it implemented over the next year using the information, tools, and resources provided during their time with us. Below are a few examples of their plans.

The California fellows from the Department of Public Health’s (CDPH) action plan includes conducting an assessment of the availability and access to programs and services related to maternal mental health in the state. They will also be leading the routine update to their Maternal Health Assessment Survey (MIHA) questions related to maternal mental health. They will be developing a plan to educate counties and Local Health Jurisdictions about maternal mental health. Their plan includes hosting technical assistance webinars on priority needs. By June 30, 2023, they will revise and update the state’s Maternal Mental Health webpage. They are adding an MMH fact sheet, a maternal suicide fact sheet, anand MIHA brief and more.

The Delaware fellows from the Health and Social Services Department will develop a Peers as Perinatal Support Pilot Program by identifying and promoting relevant perinatal training programs for certified peer specialists, developing key partnerships between Bridge Clinics - clinics which are located in every county in DE and serve as resource centers for persons with substance use disorders, Division of Vocational Rehabilitation (DVR), Healthy Women Healthy Babies (HWHB) /Division of Public Health (DPH) and providers, working with providers and peers to develop a model for Peer Support for this population, and partnering with HWHB to develop the program. Through this pilot, the fellows plan to embed peers into primary care and reproductive health provider offices and a community-based based location. The pilot aims to understand the most effective method to provide peer support services to moms. The fellows will also increase PCP and OBGYN/reproductive health provider access to training on evidence-based screening tools, peer integration, and referral to treatment workflows.

The Florida fellows from the Department of Health have developed an action plan to engage with the Severe Maternal Morbidity Task Force to promote evidence-based interventions to support maternal mental health, such as pregnancy medical homes. Pregnancy Medical Homes (PMH) are Maternal Health Nurse Specialists and Maternal Health Specialists are accessibly located at select OB/GYN offices; all of which focus on patient-centered care, health risk assessment and reduction, psychosocial screenings, and patient education. PMH also serves as a “hub” by coordinating support, resources, and referrals for additional services and is funded by the Healthy Start Coalition of Hillsborough County and Plan of Safe Care. The fellows are working with the FL Perinatal Quality Collaborative (PQC) on incorporating MMH into quality care initiatives with obstetric providers and hospitals. They have also been improving MMH awareness by creating a “Mama’s Guide Back to Self” for pregnant or postpartum individuals with information on federal and state pregnancy and postpartum resources. This was distributed to providers and community-based organizations. The fellows’ action plan includes working with the FL Maternal Mental Health Coalition to conduct a local assessment of screening efforts and create educational materials on screening and referral systems with MMH resources.

The Indiana fellows from the Department of Health are aiming to support providers in the state with screening and treatment. They have applied for the Screening and Treatment for Maternal Mental Health and Substance Use grant from HRSA. If accepted, they plan to use the funds to pilot the use of the Mammha App within sites throughout Indiana to improve surveillance of MMH and substance use through screenings, referrals, check-ins, direct clinical care, and workforce training. This app encourages continuous check-ins, reassessments, and risk assessments throughout the postpartum period. Additionally, they are working on assembling a team of care coordinators in piloted sites for patients to have access to MMH and SUD support and plan to expand this model to include bereavement and IPV in the future.

North Carolina mothers are offered care managers from the Division of Public Health. Our fellows from the Division of Public Health will release a perinatal mental health pathway for care managers who provide services to those who are pregnant and postpartum by September 1, 2023. This pathway will provide a brief overview of maternal mental health disorders and the steps a care manager should take when providing services to an individual who is experiencing or is at risk for experiencing perinatal mood disorder(s). The fellows will continue to assess the need for additional pathways pertaining to suicidality, substance use, and intimate partner violence (IPV) once the pathway is released. The NC fellows are also releasing a newsletter for mental health clinicians by August 1, 2023. This newsletter will include a clinical skills section, relevant research and/or data, and upcoming training and provider self-care. The newsletter will be sent out on a quarterly basis. Lastly, the NC fellows will complete the requirements for the Perinatal Mental Health-Certified (PMH-C) credential provided by Postpartum Support International (PSI) and the Policy Center. The 8-session webinar series on perinatal mental health was completed by May 22, 2023, and both fellows will complete the remaining requirements to fulfill the certification criteria by June 2024, so they can continue to provide leadership for these new programs developed in NC.

Fellows from the PA Department of Health are looking at maternal mental health from an equity lens. This year they created a four-hour training program for members of the Maternal Mortality Review Committee (MMRC) on implicit bias and trauma-informed care practices. The training is titled “THE EQUITY LENS: ADVOCACY FOR 21st CENTURY HUMAN NEED” and has four major components: 1) Equity, Inclusion & 21st Century Human Need, 2) Implicit Bias & Strengthening your Equity Lens, 3) Social Systems Design and Addressing Bias in Service Delivery, 4) Practical Application: Problem-Solving for Improved Outcomes. This training is scheduled for September 20, 2023. The Fellows are also looking to improve MMRC review of maternal suicide and overdose deaths by ensuring that PA MMRC members have access to complete case summaries for each maternal death, with all relevant information, so that actionable recommendations can be developed.

The Virginia fellows from the state’s Department of Health are enhancing data and surveillance related to maternal mental health by internally reviewing all VDH data sources to identify gaps related to maternal mental health and outcomes and aligning metrics to inform maternal mental health strategies with Virginia’s Title V Maternal and Child Health State Action Plan. Additionally, they are working to increase education on protective factors that reduce the risk of maternal mental health-related adverse outcomes by advancing partnerships and exploring funding opportunities. The fellows are developing a program roadmap for MMH to identify gaps in their prevention efforts. They are also building the bidirectional linkage of care model between pediatric and obstetrics clinics to support new mothers with mental health needs. They are creating and piloting a class for prenatal and postpartum individuals on pregnancy, delivery, and the postpartum experience as a social support class that is rolled out through this network of providers. This will help to inform the public and heighten awareness of resources available on MMH. Lastly, they aim to stimulate change related to MMH through policy and education recommendations by informing policymakers, communities, and/or associations about gaps in maternal mental health-related legislation and potential injury health risks.

Washington fellows from the Washington Healthcare Authority (HCA) (the state’s Medicaid agency) have been working on updating and aligning the Maternal and Infant contract between the HCA and the Department of Health to address maternal mental health. Because this is an existing 4-year contract that is up for renewal on July 1st, 2023, this is an opportunity to increase coordination and collaboration. Both agencies will revise and finalize the contract by June 30th, 2023, and will be implementing quarterly meetings between the HCA and DOHn. The WA fellows also plan to work with the birth equity community council to expand midwifery models of care to Medicaid beneficiaries through the MCH Block Grant administered by the Dept of Health. Lastly, they will apply and implement the key recommendations from the MMRP report administered by the Department of Health by prioritizing two targeted projects for improving perinatal outcomes. These projects will be supported by the Policy Center and shared with the MMH community. Finally, the Washington HCA has created a position for a Perinatal Mental Health Program Manager to build out our capacity to support maternal mental health policy and projects.

Learn more about our Government Agency Fellows program.

Nonprofit State Policy Fellows included 9 graduates from 4 areas of the country: Massachusetts, North Carolina, Wisconsin, and Washington, D.C.

Massachusetts nonprofit fellows from Mother IS Supreme Postpartum Care and the Mass. Postpartum Depression Fund aimed to focus on inequities and birth loss in the Black community through their Maternal Mental Health Fellows action plan. Their action plan included raising awareness among legislators, including hosting an International Bereaved Mother’s Day event at the state house on May 5th, 2023. At this event, the fellows garnered legislative support for launching a Count the Kicks Campaign, an evidence-based campaign that centers around the importance of tracking fetal movements to prevent stillbirths. As a result of the fellows’ ongoing advocacy efforts and this awareness day, Representative Brandy Oakley introduced an amendment to the state’s budget to include funding for the Count the Kicks Campaign in May 2023. The fellows will continue to advocate for this budget item and raise awareness of maternal mental health and will be supported by the Policy Center in 2023-2024 to expand these efforts. Efforts could include ensuring those who have lost a baby in utero or born still, being included in MMH screening efforts in the state so these mothers are not excluded from receiving support for depression and anxiety.

North Carolina nonprofit fellows from Postpartum Support International’s (PSI) NC chapter started their action plan by passing a resolution in Elizabeth City, NC, declaring May as Maternal Mental Health Month. They are working to introduce an awareness resolution declaring May Maternal Mental Health Awareness Month in the state of NC, and a resolution to form a Maternal Mental Health Task Force, utilizing the Policy Center’s model state legislation. Their ultimate aim is to pass a law mandating obstetric provider screening, which they have already garnered interest in among NC legislators.

Wisconsin nonprofit fellows from Healing our Hearts Foundation sent thank you letters to legislators that supported the WI 2021/2022 Black Maternal Health Momnibus, scheduled in-person meetings with state legislators, and sent follow-up emails and invitations for future collaborations. In their meetings, the fellows advocated for state-level postpartum protections and grief support for pregnancy and infant loss (PAIL) parents. They have also researched past state legislation on PAIL parents and are and will continue to attend open legislation sessions to raise the importance of addressing birth inequities and stillbirth. They collaborated to host the Alana Rose Foundation Ball, an event in the rotunda with Wisconsin legislators to raise awareness and provide hope, healing, and support to families who experience pregnancy and infant loss.

In addition to advocating for postpartum protections and grief support at the state level, The fellows attended Advocacy Day at the US Capitol with Mom Congress last fall and completed storytelling and advocacy training. With the Policy Center’s support, they are now also advocating for stillbirth legislation at the federal level and urging inclusion in the Momnibus package. The fellows met with Representative Alma Adams, co-chair of the Black Maternal Health Caucus, to share the need to address stillbirth in the Momnibus. They will aim to introduce a maternal mental health and stillbirth awareness resolution in WI in 2023/2024.

The Washington, D.C. fellows from Mary’s Center were focused on researching the status of the Perinatal Mental Health Task Force, which the city passed a resolution to form several years ago. With their investigation and research, they were able to support prioritizing the formation of the task force, which is now underway. They provided feedback along with others to help shape the PMH Task Force legislation in the spring and summer of 2022. In the fall of 2022, the task force legislation was reintroduced and was funded to complete work by 8/31/2023. The DC fellow applied and was appointed to the DC PMH Task Force in December 2022, and meetings began in January 2023. In February 2023, the fellow provided oral and written testimony at DC Performance Oversight hearings for an extension of the Task Force and funds for the implementation of recommendations. The fellows are submitting testimony during the summer of 2023 related to the extension of the Task Force budget. They will continue to engage the Policy Center throughout the Task Force’s work to seize opportunities to ensure the outputs are strong.

Learn more about our Nonprofit State Policy Fellows program.