The hospital launched its Maternal Wellness Program in August 2020 and expanded the initiative after six months.
Yale New Haven Hospital has successfully launched a clinical program to address the mental health needs of new mothers.
After childbirth, new mothers can experience a range of mental health conditions, says Maria Raffia, LCSW, a clinical social worker at Yale New Haven Hospital's Maternal Wellness program.
"There's something called the Baby Blues, which happens around two days to two weeks after a woman delivers. That impacts about 60% to 80% of women. It's due to an influx of hormones. If the mood disorder lasts longer than two weeks, that's when we see postpartum depression and postpartum anxiety, which are the main conditions we see among our moms. We also work with moms who experience postpartum obsessive-compulsive disorder," she says.
The hospital launched the Maternal Wellness Program in August 2020, with one location, but demand for services quickly led to an expansion of the initiative, says Maria Mackeil, MSN, DNP, director of women's specialties at Yale New Haven Hospital. "We originally started with just one social worker, who was trained to do therapy sessions. Within six months, we realized that we had grown beyond our capacity, so we added a second social worker and two additional sites. The social workers are at different sites on different days of the week."
Service volume is one of the key performance metrics for the Maternal Wellness Program, Mackeil says. "Volume … gives us information about whether we have capacity. When we reach capacity, we have to look at the potential for expansion of the program, which happened right after launching the program a year and half ago."
In the first six months of the program, there were 500 visits with new moms and family members, Mackeil says. From September 2020 to September 2021, the clinical social workers conducted more than 1,300 visits that affected more than 130 families, she says.
Meeting an unmet need
Yale New Haven Hospital decided to launch the Maternal Wellness Program based on feedback from obstetricians in the hospital's market, Mackeil says.
"When this program was established, it came out of a driving need that was made clear to us by our community providers. Our obstetrics providers saw a need for their patients that they were not able to meet. They saw women who had mood disorders and there was no place to refer them to. There was limited access to care, and that was our primary driver for creating this program. We listen to our community providers very closely because they clearly know what their patients need the most," she says.
A range of services are offered to new moms and their families, Mackeil says. "The Maternal Wellness Program offers services to treat our mom's mood disorders through psychotherapy, screening, psychoeducation, individual therapy, couples' therapy, and risk assessments. We also work with their obstetrics providers for coordination of care."
Screening is a key service to assess patients and gauge their progress, Raffia says. "We use the Edinburgh Postnatal Depression Scale, which is something that we do at intake and every three to four sessions. This scale looks at how moms are doing over time."
Providing access to services is a primary goal of the Maternal Wellness Program, Mackeil says. "The program is open to all women, who can self-refer, which is wonderful. One of the things that we pride ourselves on is improving access to care for our moms and families. That is why we offer the program at three locations, and we have telehealth options for moms who have trouble with access to transportation."
The coronavirus pandemic was part of the impetus to establish telehealth services at the program, Mackeil says. "We opened when COVID was hitting a peak, and that required us to be creative in establishing the telemedicine aspect of seeing patients. While we realize that telemedicine is not ideal—we want to see our patients face-to-face—it fills a need to make sure our patients have access to care."
Rising to challenges
The Maternal Wellness Program has faced several challenges since it was launched, Mackeil and Raffia say.
"There are challenges in launching in any program. For us, we had never had a program like this at Yale New Haven Hospital, so we had challenges along the way. We had to figure out the best way to build the program. We knew that we were going to have patients—planning treatment was the easy piece. The harder piece was the logistics around the program—the funding, the development of education for social workers, and the structure," Mackeil says.
The primary source of revenue for the program is service reimbursement from Medicaid and commercial insurers. "The program is financed through the hospital, and we bill for services," Mackeil says.
Stigma is a major challenge, Raffia says. "A big barrier is the stigma around postpartum depression and anxiety. Many moms feel that this should be a happy time, but they are having feelings that are not usual to them, and that is hard. We try to normalize mood disorders when our moms come in. We also have social workers in some of our community clinics, and they work with us in normalizing mood disorders and talking about it more often."
Community outreach is an ongoing challenge, Mackeil says. "We have been trying to get information out to obstetrics providers in the community to make sure that everyone is aware of the services and to see what their needs are."
It is also necessary to conduct community outreach with patients, Raffia says. "Another barrier is moms not knowing about the options for care. We are trying to address that through community outreach."
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Christopher Cheney is the senior clinical care editor at HealthLeaders.
The primary mood disorders among new mothers range from relatively mild "Baby Blues" to postpartum depression and anxiety.
The Maternal Wellness Program at Yale New Haven Hospital started with one location and one clinical social worker, then expanded to three locations staffed by two clinical social workers.
The program was launched based on feedback from local obstetricians who had patients that were experiencing mood disorders but had no place to refer them.