Improving Front-line Clinician Capacity to Address Bipolar Disorder Among Perinatal Individuals: A Longitudinal Analysis of Massachusetts Child Psychiatry Access Program (MCPAP) for Moms

Background: Perinatal mood and anxiety disorders (PMADs) are common, yet many patients do not receive mental healthcare. This can be especially true of complex illnesses like bipolar disorder (BD). The Massachusetts Child Psychiatry Access Program (MCPAP) for Moms aims to address gaps in care by increasing front-line clinician capacity to provide mental healthcare. Study objectives were to examine the extent to which MCPAP for Moms utilization increased front-line clinician ability to 1) provide treatment for PMADs, and 2) treat more complex PMADs, like BD.

Methods: MCPAP for Moms clinical encounter data were examined from first use (7/2014) through 6/2020. MCPAP for Moms aims to increase clinician capacity via education, resource and referral, and psychiatric consultation encounters (phone with clinicians or face-to-face consultations with patients). Here, we assessed the effects of the encounter types that directly assist clinicians on a one-to-one basis (resource and referral, psychiatric consultations). We examined if utilization (number of annual encounters with the program in total and by encounter type) was associated with: (1) increased frequency of front-line clinicians providing direct mental health treatment for PMADs and (2) increased frequency of encounters which resulted in the frontline clinician proving direct treatment for bipolar disorder vs. other PMADs. Effects were estimated using longitudinal negative binomial models. Exploratory group-based trajectory modeling (GBTM) was used to examine sub-groups of clinician utilization.

Results: Since July 2014, 1,006 individual clinicians have utilized MCPAP for Moms. More frequent utilization of MCPAP for Moms was associated with increased rates of front-line clinicians providing direct mental health treatment (IRR=1.07, 95% CI:1.06 to 1.07), after adjusting for elapsed time and rural community. More frequent utilization of psychiatric consultations was more predictive of increased treatment rates than resource and referral encounters. Increases in face-to-face consultation utilization were associated with the greatest increase in rates of front-line clinicians providing direct mental health treatment to patients with BD (IRR=2.12, 95%CI:1.82 to 2.41). Based on sub-groups that emerged from GBTM, clinicians with MCPAP for Moms utilization patterns that were increasing over time exhibited the strongest association with providing direct mental health treatment to patients with BD (IRR=13.5, 95%CI:4.2 to 43.2).

Conclusions: Utilization of MCPAP for Moms facilitates front-line clinicians’ ability to provide direct mental health treatment to their patients, including those with complex illnesses like BD. This study contributes to early evidence supporting the Access Program model.

References

Rusner M, Berg M, Begley C. Bipolar disorder in pregnancy and childbirth: a systematic review of outcomes. BMC Pregnancy and Childbirth. 2016;16(1):331.

Byatt N, Biebel K, Moore Simas TA, et al. Improving perinatal depression care: the Massachusetts Child Psychiatry Access Project for Moms. Gen Hosp Psychiatry. 2016;40:12-17.