Supporting Mothers with Mental Illness: Postpartum Mental Health Service Linkage as a Matter of Public Health and Child Welfare Policy

Through our work in youth advocacy as, respectively, legal and public health professionals, we are all too aware of the high levels of health care fragmentation experienced during pregnancy and postpartum by poor, young mothers of color. Meredith Matone’s research highlights the heightened risk of fragmentation for girls with histories of child welfare involvement. For example, she found that 66.7% of young mothers who had resided in out-of-home placements and who had taken antipsychotic medication prior to becoming pregnant failed to fill prescriptions for antipsychotics in their first postpartum year. Put another way, two-thirds of these vulnerable young mothers—a far higher proportion than young mothers without histories of child welfare involvement—were not getting the treatment that they needed to care for themselves and their children. The very real consequences of this phenomenon can be seen in the experiences of Jesse Krohn’s clients, several of whom have their stories told here. Treatment discontinuity, particularly during the transition to parenthood, places mothers at risk for poor health outcomes and maladaptive parenting approaches; threatens the health and safety of infants; and triggers child welfare involvement. This article explores the negative consequences and root causes of treatment discontinuity, as well as particularized population vulnerabilities for treatment discontinuity including, as noted, involvement with child welfare. It will also provide public health and child welfare policy solutions for reducing treatment discontinuity and improving mental and physical health outcomes for new mothers and infants. The population of mothers at highest risk for postpartum treatment gaps is not small: more than 40% of Medicaid-financed births to young women aged 15 to 24 occurred in mothers who had a childhood relationship to the child welfare system. It is unacceptable to be aware of the pervasiveness of this problem, particularly among intersectionally vulnerable women, and not deploy a targeted and evidence-based preventative and remedial response

Describing the Health Status of Women Experiencing Violence or Abuse: An Observational Study Using Claims Data

Introduction: Violence against women (VAW) can result in long-term and varied sequela for survivors, making it difficult to evaluate healthcare intervention. This study seeks to improve understanding of the healthcare experiences of women survivors prior to a violence-related diagnosis, allowing healthcare systems to better design strategies to meet the needs of this population. Methods: Using population-based data from 2016 to 2019, this cross-sectional observational study presents healthcare spending, utilization, and diagnostic patterns of privately insured women, age 18 or older, in the 10-months prior to an episode of care for a documented experience of violence (DEV). Results: Of 12 624 764 women meeting enrollment criteria, 10 980 women had DEV. This group had higher general medical complexity, despite being 10 years younger than the comparison group (mean age 32.7 vs 43.5). These relationships held up when comparing participants in each cohort by age. Additional key findings including higher numbers of medical visits across clinical settings and higher total cost ($10 138-$4585). Conclusions: The study utilized population-based data, to describe specific areas of health and medical cost for women with DEV. Increased medical complexity and utilization patterns among survivors broaden the understanding of the health profiles and healthcare touchpoints of survivors to inform and optimize strategies for medical system engagement and resource allocation for this public health crisis.Temple University. College of Public HealthNursin

Young mothers with a history of child welfare involvement: Maternal health, pregnancy outcomes, and maltreatment perpetration

Statement of the Problem: Youth with past child welfare involvement are at risk for early entry into motherhood and increased burden of chronic health conditions. The association of these risk factors with birth outcomes and child maltreatment have been little studied. Methods: Retrospective cohort design using maternal child welfare reports, birth certificates, and linked maternal-infant Medicaid claims of mothers aged 15 to 24 delivering an infant between 2007 and 2010 in a large, Mid-Atlantic city. Descriptive and chi square statistics described the prevalence of chronic conditions and medication fills in the preconception, pregnancy and postpartum periods by maternal child welfare status. Next, multivariable logistic regression estimated the association of maternal mood disorder with birth outcomes. Finally, among a propensity score matched subsample of mothers with high likelihood of mood disorder, multivariable logistic regression estimated the association of mood disorder with child maltreatment. Results: Nearly half of all Medicaid-enrolled young women with a birth between the ages of 15 and 24 had past child welfare involvement. All mental and behavioral conditions occurred more frequently to child welfare involved mothers than non-involved mothers with the exception of anxiety and intellectual disability. Medication discontinuity for mental health conditions in the postpartum year was significantly increased among child welfare involved mothers. The positive association of mood disorder and low birth weight delivery among child welfare mothers was significant, but no association existed among mothers without child welfare. Finally, among infants born to mothers with mood disorder, the prevalence child welfare involvement, growth restriction, and emergency department reliance were significantly increased in comparison to infants born to mothers without mood disorder. Conclusions: Young mothers with a relationship to child welfare are disproportionately burdened by mental health conditions and are at high risk for postpartum treatment discontinuity. Mood disorder is highly prevalent in this population and is associated with poor birth outcomes and child maltreatment. Efforts to support primary prevention of childhood trauma as well as secondary prevention of mental health sequelae of trauma may improve maternal health and birth outcomes

Young mothers with a history of child welfare involvement: Maternal health, pregnancy outcomes, and maltreatment perpetration

Statement of the Problem: Youth with past child welfare involvement are at risk for early entry into motherhood and increased burden of chronic health conditions. The association of these risk factors with birth outcomes and child maltreatment have been little studied. Methods: Retrospective cohort design using maternal child welfare reports, birth certificates, and linked maternal-infant Medicaid claims of mothers aged 15 to 24 delivering an infant between 2007 and 2010 in a large, Mid-Atlantic city. Descriptive and chi square statistics described the prevalence of chronic conditions and medication fills in the preconception, pregnancy and postpartum periods by maternal child welfare status. Next, multivariable logistic regression estimated the association of maternal mood disorder with birth outcomes. Finally, among a propensity score matched subsample of mothers with high likelihood of mood disorder, multivariable logistic regression estimated the association of mood disorder with child maltreatment. Results: Nearly half of all Medicaid-enrolled young women with a birth between the ages of 15 and 24 had past child welfare involvement. All mental and behavioral conditions occurred more frequently to child welfare involved mothers than non-involved mothers with the exception of anxiety and intellectual disability. Medication discontinuity for mental health conditions in the postpartum year was significantly increased among child welfare involved mothers. The positive association of mood disorder and low birth weight delivery among child welfare mothers was significant, but no association existed among mothers without child welfare. Finally, among infants born to mothers with mood disorder, the prevalence child welfare involvement, growth restriction, and emergency department reliance were significantly increased in comparison to infants born to mothers without mood disorder. Conclusions: Young mothers with a relationship to child welfare are disproportionately burdened by mental health conditions and are at high risk for postpartum treatment discontinuity. Mood disorder is highly prevalent in this population and is associated with poor birth outcomes and child maltreatment. Efforts to support primary prevention of childhood trauma as well as secondary prevention of mental health sequelae of trauma may improve maternal health and birth outcomes

Supporting Mothers with Mental Illness: Postpartum Mental Health Service Linkage as a Matter of Public Health and Child Welfare Policy

Through our work in youth advocacy as, respectively, legal and public health professionals, we are all too aware of the high levels of health care fragmentation experienced during pregnancy and postpartum by poor, young mothers of color. Meredith Matone’s research highlights the heightened risk of fragmentation for girls with histories of child welfare involvement. For example, she found that 66.7% of young mothers who had resided in out-of-home placements and who had taken antipsychotic medication prior to becoming pregnant failed to fill prescriptions for antipsychotics in their first postpartum year. Put another way, two-thirds of these vulnerable young mothers—a far higher proportion than young mothers without histories of child welfare involvement—were not getting the treatment that they needed to care for themselves and their children. The very real consequences of this phenomenon can be seen in the experiences of Jesse Krohn’s clients, several of whom have their stories told here. Treatment discontinuity, particularly during the transition to parenthood, places mothers at risk for poor health outcomes and maladaptive parenting approaches; threatens the health and safety of infants; and triggers child welfare involvement. This article explores the negative consequences and root causes of treatment discontinuity, as well as particularized population vulnerabilities for treatment discontinuity including, as noted, involvement with child welfare. It will also provide public health and child welfare policy solutions for reducing treatment discontinuity and improving mental and physical health outcomes for new mothers and infants. The population of mothers at highest risk for postpartum treatment gaps is not small: more than 40% of Medicaid-financed births to young women aged 15 to 24 occurred in mothers who had a childhood relationship to the child welfare system. It is unacceptable to be aware of the pervasiveness of this problem, particularly among intersectionally vulnerable women, and not deploy a targeted and evidence-based preventative and remedial response