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Principal Investigator: Laura Johnson Faherty
Organization: RAND CORPORATION
Fiscal Year: 2024
Award: $677,945
Funding agency: National Institute of Mental Health
Project Abstract:
Suicide is now the leading cause of death during the perinatal period, and nearly a quarter of maternal deaths
are attributable to behavioral health (BH) conditions. As with maternal mortality and morbidity overall, poor
perinatal BH outcomes disproportionately affect historically marginalized communities of color. Despite the
prevalence and life-threatening nature of perinatal BH conditions, only 11% of individuals with these conditions
during pregnancy or postpartum receive needed care, and individuals from marginalized and under-resourced
populations are less likely to be screened or treated for BH conditions. Telehealth has enormous potential to
address the maternal morbidity and mortality crisis by improving access to perinatal BH care. It has been
shown to increase health care access and reduce missed appointments for BH care, particularly among
individuals from underserved communities. Research overwhelmingly finds comparable efficacy between in-
person and telebehavioral health (TBH) care. Finally, telehealth can help overcome particularly salient barriers
for pregnant and postpartum people. Few studies have examined TBH in the perinatal period, but evidence
suggests that TBH services for pregnant and postpartum people provide equivalent benefit to those delivered
in-person. Importantly, pregnant and postpartum individuals from historically marginalized populations, (e.g.,
Medicaid-insured; those living in rural areas; those with disabilities; and members of racial and ethnic minority
groups), face additional health care barriers, including structural racism, language barriers, and provider
shortages. The extent to which TBH diminishes or amplifies these specific barriers and reduces BH disparities
is unknown. Recently, the COVID-19 pandemic accelerated policy changes to make telehealth services more
widely available. However, state-level Medicaid policies are not uniform, and not all states retained pandemic-
era expansions in their reimbursement policy. As policies influencing availability of telehealth continue to
evolve, quantifying policy impacts on perinatal BH care access and outcomes, and better understanding the
mechanisms driving those impacts, are critical to using TBH more effectively to address maternal morbidity
and mortality from untreated perinatal BH conditions. To fill these gaps, this mixed-methods study will (1)
Develop a detailed, longitudinal dataset describing the evolution of state-level telehealth policies with relevance
to perinatal behavioral healthcare for individuals insured by Medicaid; (2) Use event-time modeling to estimate
the relationship between telehealth policies of interest and key behavioral health outcomes (e.g., emergency
department visits, overdoses, and suicide) and maternal-infant outcomes (e.g., maternal morbidity, preterm
delivery), with a focus on identifying inequities by race/ethnicity, rural residence, and disability status; and (3)
Apply the Consolidated Framework for Implementation Research in a series of in-depth interviews with patients
and providers to explain the quantitative findings through an examination of factors that influence telehealth
policy implementation and associated health outcomes.
Terms: <Acceleration><Address><Advocate><Affect><Affective Disorders><Anxiety Disorders><Appointment><Automobile Driving><COVID crisis><COVID epidemic><COVID pandemic><COVID-19 crisis><COVID-19 epidemic><COVID-19 era><COVID-19 global health crisis><COVID-19 global pandemic><COVID-19 health crisis><COVID-19 pandemic><COVID-19 period><COVID-19 public health crisis><COVID-19 years><Caring><Cause of Death><Child Care><Color><Consolidated Framework for Implementation Research><Consolidated Framework for Implementation Science><Consolidated Framework for Implementing Change><Death Rate><Disability status><ED visit><ER visit><Emergency care visit><Emergency department visit><Emergency hospital visit><Emergency room visit><Equity><Ethnic Origin><Ethnicity><Event><Evolution><Face><Gestation><Goals><Health><Health Care Providers><Health Personnel><Health Policy><Health Services><Health system><Healthcare><Healthcare Providers><Healthcare worker><Improve Access><Individual><Inequity><Interview><Investigators><Language><Lead><Leadership><Life><Maternal Health><Maternal Mortality><Maternal and Child Health><Medicaid><Mental Health Services><Mental Hygiene Services><Methods><Modality><Modeling><Mood Disorders><Morbidity><Morbidity - disease rate><NIH><NIMH><National Institute of Mental Health><National Institutes of Health><Nature><Outcome><Overdose><Patients><Pb element><Perinatal><Peripartum><Persons><Policies><Policy Maker><Population><Postpartum Period><Pregnancy><Premature Birth><Prematurely delivering><Preterm Birth><Prevalence><Prevention><Provider><Puericulture><Quasi-experiment><Quasi-experimental analysis><Quasi-experimental approach><Quasi-experimental design><Quasi-experimental methods><Quasi-experimental research><Quasi-experimental study><Quasi-experimental technique><Race><Races><Research><Research Personnel><Research Resources><Researchers><Resources><Risk><SARS-CoV-2 epidemic><SARS-CoV-2 global health crisis><SARS-CoV-2 global pandemic><SARS-CoV-2 pandemic><SARS-coronavirus-2 epidemic><SARS-coronavirus-2 pandemic><SES disparity><Series><Services><Severe Acute Respiratory Syndrome CoV 2 epidemic><Severe Acute Respiratory Syndrome CoV 2 pandemic><Severe acute respiratory syndrome coronavirus 2 epidemic><Severe acute respiratory syndrome coronavirus 2 pandemic><Structural Racism><Substance Use Disorder><Suicide><Technology><Time><Transportation><Underserved Population><United States><United States National Institutes of Health><Variant><Variation><ableism><access to health care><access to healthcare><accessibility of health care><accessibility to health care><accessibility to healthcare><attributable death><attributable mortality><behavioral health><care outcomes><class-based discrimination><classism><community marginalization><comparable efficacy><comparative efficacy><compare efficacy><coronavirus disease 2019 crisis><coronavirus disease 2019 epidemic><coronavirus disease 2019 global health crisis><coronavirus disease 2019 global pandemic><coronavirus disease 2019 health crisis><coronavirus disease 2019 pandemic><coronavirus disease 2019 public health crisis><coronavirus disease crisis><coronavirus disease epidemic><coronavirus disease pandemic><coronavirus disease-19 global pandemic><coronavirus disease-19 pandemic><disability><disparities in race><disparity due to race><disparity in health><driving><ethnic minority group><ethnic minority individual><ethnic minority people><ethnic minority population><experience><faces><facial><fatal attempt><fatal suicide><flexibility><flexible><geographic disadvantage><geographic disparity><geographic inequality><geographic inequity><geographic location disparity><health care><health care access><health care availability><health care outcomes><health care personnel><health care policy><health care service access><health care service availability><health care worker><health disparity><health equity><health provider><health workforce><healthcare access><healthcare accessibility><healthcare availability><healthcare outcomes><healthcare personnel><healthcare policy><healthcare service access><healthcare service availability><heavy metal Pb><heavy metal lead><improved><inequality due to race><inequity due to race><infant outcome><intent to die><interest><longitudinal data set><longitudinal dataset><marginalized community><marginalized group><marginalized individual><marginalized people><marginalized population><maternal death><maternal morbidity><medical personnel><member><mental health care><mental healthcare><mortality><mortality rate><mortality ratio><pandemic><pandemic disease><perinatal period><perinatal phase><post-partum><pregnant><premature childbirth><premature delivery><preterm delivery><programs><public health insurance><public insurance><race based disparity><race based inequality><race based inequity><race disparity><race related disparity><race related inequality><race related inequity><racial><racial background><racial disparity><racial inequality><racial inequity><racial minority group><racial minority individual><racial minority people><racial minority population><racial origin><racially unequal><rural area><rural dwelling><rural households><rural location><rural region><rural residence><rurality><severe acute respiratory syndrome coronavirus 2 global health crisis><severe acute respiratory syndrome coronavirus 2 global pandemic><socio-economic><socio-economic disparity><socio-economic inequality><socio-economic inequity><socio-economically><socioeconomic disparity><socioeconomic inequality><socioeconomic inequity><socioeconomically><socioeconomics><structural determinants><structural factors><substance use and disorder><suicides><telehealth><treatment provider><under served community><under served group><under served individual><under served people><under served population><underserved community><underserved group><underserved individual><underserved people><uptake>