HHS Celebrates One-Year Anniversary of the Task Force on Maternal Mental Health, Details Next Steps

The U.S. Department of Health and Human Services (HHS) is proud of the work done by the Task Force on Maternal Mental Health, building on the White House Blueprint on Maternal Mental Health and the White House Initiative on Women’s Health Research,  to develop and deliver recommendations to the Substance Abuse and Mental Health Services Administration’s Advisory Committee for Women’s Services to improve maternal mental health in the U.S.

Following the one-year anniversary of the Task Force on Maternal Mental Health launch, HHS is expanding efforts to advance maternal mental health and substance use disorder care. HHS is asking interested non-federal organizations to submit a pledge(s) highlighting new initiative(s) that address challenges and barriers to maternal mental health and substance use disorder care.

HHS will collect pledges through December 6, 2024, and announce them publicly in early 2025. Questions? Send to TFMMH@hhs.gov.

Task Force accomplishments include:

• The National Strategy to Improve Maternal Mental Health Care: The National Strategy employs a whole-of-government approach to build the necessary infrastructure to improve care for maternal mental health conditions and substance use disorders. It calls for a seamless integration of perinatal mental health and substance use care across medical, community, and social systems. The Strategy further focuses on ways to improve the prevention, identification (screening and diagnosis), timely referral and intervention (both in the community and in the clinic), and access to care and other supports for maternal mental health conditions and SUDs.
• The Maternal Mental Health Report to Congress: The report presents the Task Force findings on maternal mental health conditions and SUDs in the United States, existing federal programs and coordination, opportunities for state and local partnerships, related federal programs, and best practices. The report helps to guide efforts to implement the National Strategy.
• The HHS Secretary’s Postpartum Maternal Health Collaborative: The Collaborative is a partnership with states that builds on a wealth of efforts at both the state and federal levels and aims to change the trajectory of postpartum maternal mortality by identifying key metrics and opportunities, deploying interventions, and strengthening partnership and leadership. For example, Iowa, Minnesota, and New Mexico are working to increase perinatal screening for depression and substance use and increase referral rates and utilization of treatment services.
• HHS Office of the Assistant Secretary for Health, Office on Women’s Health (OWH) Postpartum Depression Campaign: The U.S. Department of Health and Human Services (HHS) Office on Women’s Health (OWH) launched the Talking Postpartum Depression campaign to encourage women to seek help for PPD by destigmatizing PPD through increased awareness of PPD symptoms, visibility of reliable resources, and understanding ways to access care.  OWH will launch an evaluation pilot project to assess the efficacy of the campaign resources among community members.  This pilot project will identify gaps in maternal mental health education to develop and enhance provider training opportunities.

Substance Abuse and Mental Health Services Administration (SAMHSA)

• Substance Abuse and Mental Health Services Administration Women’s Behavioral Health Technical Assistance Center: This new program enhances the capacity of women’s behavioral health providers, general healthcare providers, and others involved in the holistic care of women to address the diverse needs of women with or at risk for mental health and substance use conditions, including women with or at risk for mental and substance use conditions that were greatly impacted by COVID. With this program, SAMHSA aims to fill vital gaps in the field with regard to provider knowledge and ability to treat the mental health and substance use conditions of women across the nation.
• Substance Abuse and Mental Health Services Administration Community Based Maternal Behavioral Health Services: This new program is designed to improve access to evidence-based, timely, and culturally relevant maternal mental health and substance use (behavioral health) intervention and treatment by strengthening community referral pathways. With this program, SAMHSA aims to improve maternal behavioral health outcomes and reduce mortality in the perinatal and postpartum periods.
• SAMHSA Learning Collaboratives on Maternal Substance Use and Mental Health: SAMHSA supports states in their efforts to address maternal substance use and mental health with its Pregnant and Parenting People with Substance Use Disorders Learning Collaborative and its Maternal Mental Health Learning Collaborative. These two learning collaboratives supported Single State Agencies (SSAs) and State Mental Health Authorities (SMHAs), respectively, by offering opportunities for state officials to learn about best practices for supporting families impacted by maternal mental health and substance use conditions. Resources from both collaboratives are in development.

HHS Assistant Secretary for Planning and Evaluation (ASPE)

• In FY 2024, ASPE published a study on pregnant and postpartum women in Medicaid with opioid-exposed births. Using the 2012-2019 IBM® MarketScan® Multi-State Medicaid Database, the study found that only 45 percent of women who had an opioid-exposed birth received medications for opioid use disorder (MOUD) during pregnancy, and those who received MOUD tended to be aged 25-45 and White. Five percent of the women who had an opioid-exposed birth were in withdrawal management at some point during the pregnancy. This analysis underscores the importance of improved SUD screening during pregnancy, integration of maternity and SUD settings, and equity initiatives to reduce disparities in accessing MOUD among women in Medicaid. The ASPE brief and the results of the analysis can be accessed here.

Centers for Disease Control and Prevention (CDC)

• In FY2024, CDC funded researchers at Johns Hopkins University to examine how implementation of changes to the child welfare system driven by the Family First Prevention Services Act (FFPSA) may vary across states with different prenatal drug law contexts.
  
  The proposed study is the first to use all 50 states’ Medicaid data and robust evaluation methods to examine state laws’ effects on substance use-related outcomes. It’s also the first exploration of the FFPSA with far-reaching implications for state child welfare systems’ interactions with parents with substance use. Findings will inform other researchers, health system leaders, and policymakers dedicated to improving the health and well-being of families affected by substance use.
• CDC’s Pregnancy Risk Assessment Monitoring System (PRAMS) partnered with the Association of State and Territorial Health Officials to conduct a learning community to link PRAMS data to clinical or social services data. These data, now available, can include Medicaid claims, hospital discharge records, or home visiting data. The linkages support maternal and child health research to inform clinical and programmatic improvements. CDC PRAMS data are now available through an automated research file data portal.
• The CDC’s Maternal and Child Health Epidemiology Program and PRAMS teams collaborated on developing county-level estimates of key maternal and infant indicators for 40 PRAMS sites. Sites are currently exploring the county-level data and beginning to use the data within their health departments and with external partners.

Health Resources and Services Administration (HRSA)

• HRSA announced $240 million in awards to launch and expand mental health and substance use disorder services in more than 400 HRSA-supported community health centers across the country that care for more than 10 million people. Health centers are trusted community providers and a primary source of care for individuals across the country who are uninsured, underinsured, or enrolled in Medicaid – making them well-positioned to respond to the urgent need for behavioral health services that are high- quality, stigma-free, culturally competent, and readily accessible. These grants will help expand access to needed care to help tackle the nation’s mental health and opioid crises – two pillars of the Biden-Harris Administration’s Unity Agenda for the nation. HRSA has made expanding access to mental health and substance use disorder services a top priority. In addition to this announcement, recent HRSA-supported activities include:
  • Training thousands of new mental health providers, including psychologists, psychiatric nurses, licensed clinical social workers, and counselors;
  • Securing Bipartisan Safer Communities Act funding to integrate mental health into primary care physician residency training programs;
  • Providing loan repayment for unprecedented numbers of mental health providers in return for their practice in high-need communities;
  • Training peer support specialists and other community-based providers, such as community health workers, to provide mental health services and family support to children whose parents or guardians are impacted by opioid use disorders and other substance use disorders;
  • Training community health workers, peer support specialists, and others with lived experience in supporting patients with behavioral health needs;
  • Providing tele-psychiatric consultation, care coordination support, and training to maternity care providers to screen, assess, treat, and refer pregnant and postpartum women for behavioral health conditions;
  • Expanding funding for voluntary, evidence-based maternal, infant, and early childhood home visiting services, which screen pregnant women and new moms for maternal depression and substance use, connect them to services, and support families in caring for babies exposed to substances;
  • Supporting rural communities in creating new rural access points for opioid use disorder treatment, including providing medications to treat opioid use disorder; and
  • Launching the National Maternal Mental Health Hotline at 1-833-TLC-MAMA, which provides free, confidential, 24/7 emotional support, resources, and referrals to expectant and new moms facing mental health challenges and their loved ones.

Indian Health Services (IHS)

• The IHS Maternal and Child Health (MCH) program has developed initiatives to increase access to culturally safe care in the community during pregnancy and postpartum. In May 2024, IHS funded programs to improve maternity care coordination, including screening, education, and intervention through telehealth and home visits, support obstetric emergency readiness training, and purchase of equipment and supplies. The five-year program awarded 10 federal sites across six areas with a total distribution of $11 million and the potential to reach 12,000+ pregnant and postpartum patients and their families. IHS also partnered with the Northwest Portland Area Indian Health Board to launch an Indian Country ECHO series: Care and Access for Pregnant People. The ECHO provides on-demand continuing education, clinical consultation, and resources to staff and community leaders caring for Indigenous pregnant persons. It reaches over 1000+ registrants across all 12 IHS Areas.
• In March 2023, the IHS forensic health care team funded programs to support building a community’s capacity through forensic health care program development and expansion through training opportunities for healthcare providers. The five-year program awarded six applicants, serving 15 federally-operated IHS sites, for a total distribution of $10 million. Two guidebooks have been developed to support providers caring for AI/AN patients and to focus efforts on culturally centered, trauma-informed care, program development, and prevention efforts, including medical forensic examination considerations.

National Institutes of Health (NIH)

• IMPROVE Initiative: NIH has advanced community-driven, evidence-based solutions aimed at reducing preventable causes of maternal deaths and improving health for women before, during, and after delivery. For example, its IMPROVE Initiative has established 12 Maternal Health Research Centers of Excellence across the United States to design and implement culturally appropriate research projects to address the biological, environmental, and structural factors that affect pregnancy-related complications and deaths. The scientific breadth of the Centers is impressive and includes the following:
  • Evaluating approaches such as integrating community health workers (including doulas) and applying artificial intelligence and machine learning to electronic medical records.
  • Developing strategies to address implicit biases among health care providers.
  • Assessing the effects of social determinants of health, including housing instability, interpersonal violence, access to care, nutrition disparities, and food insecurity.
  • Addressing a range of conditions, ranging from anemia and preeclampsia to substance use disorder and mood and anxiety disorders.
• Understanding the Impact of the Health Care System and Clinician Factors on Disparities in Maternal Morbidity and Mortality: NIH released a Notice of Funding Opportunity with the aim to support multidisciplinary and innovative intervention research to understand and address maternal morbidity and mortality in the U.S., particularly but not exclusively among racial and ethnic minority, socioeconomically disadvantaged, and underserved rural populations, with a focus on understudied healthcare factors.
• NIMH High-Priority Areas for Research on Women's Mental Health during the Perinatal Period: The purpose of this Notice of Information is to outline high-priority areas of research related to women's mental health during the perinatal period. NIH’s National Institute of Mental Health is interested in receiving applications that will provide new knowledge in perinatal mental disorders and that will test strategies for translating this knowledge into improved diagnostics, therapies, and services to improve women’s mental health during the perinatal period.
• NIH Women's Health Roundtable: Maternal Mental Health Research: On September 16, 2024, NIH hosted a roundtable as part of its Elevating Women’s Voices to Improve Maternal Mental Health event series. This series is responsive to a Presidential Memorandum that launched the White House Initiative on Women’s Health Research and encourages NIH and other federal government entities to galvanize women’s health research, develop innovative and cutting-edge interventions that promote women’s health, and ensure that women across the United States have access to high-quality health care. During the roundtable, speakers highlighted high-priority research related to women's mental health during pregnancy and the postpartum period, described research gaps, and explored how research advances can reduce the burden of mental illnesses that contribute to maternal morbidity and mortality.

Veterans Health Administration (VHA)

VHA Office of Women’s Health

• Veterans Health Administration (VHA) provides maternity care coordination to all interested pregnant Veterans through a structured program of contacts throughout pregnancy and, as of October 2023, through the full year postpartum. In these contacts, Maternity Care Coordinators screen Veterans for depression, PTSD, relationship health and safety, and social determinants of health needs; ensure appropriate referral and care coordination between outpatient maternity providers and VHA services and providers, including primary care, mental health, and specialty care; distribute needed supplies including breast pumps; as well as provide socioemotional support to Veterans throughout pregnancy and postpartum. The VHA Maternity Care Coordinator program is a national model that has been shared with the Indian Health Service as well as the Department of Defense (DoD), which are both exploring their own tailored version as a pilot for their systems.

VHA Office of Mental Health

• To enhance access to high-quality perinatal mental health care, VHA has a national Reproductive Mental Health Consultation Program. A multidisciplinary team of subject matter experts provides evidence-based responses to questions about reproductive mental health. In the past year, over 200 consultations have been completed. In partnership with the Defense Health Agency, an initial pilot of this program is underway at select DoD sites of care. This pilot will help determine the feasibility, impact, and resources needed for the implementation of an enterprise-level DoD consultation service.
• VHA also offers a 12-session, foundational knowledge course in reproductive mental health, completed by more than 400 VHA clinicians.
• VA and DoD collaborated to produce the 2023 evidence-based clinical practice guideline (CPG) on the Management of Pregnancy. The update included a thorough review of the evidence for the efficacy of nonpharmacologic interventions for preventing and treating perinatal depression. The most robust evidence supported a strong recommendation for interpersonal psychotherapy (IPT). VHA provides in-depth, competency-based training in IPT for Reproductive Mental Health to enhance access to this highly effective intervention. The CPG also found evidence for the efficacy of peer support to alleviate symptoms of postpartum depression. VHA strategically expands peer support services for women Veterans by implementing national training initiatives. These efforts include training peer specialists of all genders to provide effective peer support for perinatal mental health conditions.