May 3rd, 2023

By Kristin Aaker, Director of Postpartum Support International Colorado, and Rebecca Alderfer, MPP, CPCQC Chief Executive Officer

In May 2017, the Colorado Perinatal Care Quality Collaborative (CPCQC) and the Colorado Chapter of Postpartum Support International (CO-PSI) were represented in the legislative chamber when Colorado passed a joint resolution to acknowledge and elevate maternal mental health publicly by establishing Maternal Mental Health Week. Two of the legislators that stood to speak to the Resolution included a father who gave heartfelt testimony to why this is an important issue and was followed by a male, gay-identifying, non-parenting legislator who passionately did the same. These two, seemingly unlikely leaders, brought attention to the broadly relevant and fundamental role maternal mental health plays in the well-being of society. It was a big moment for all of us. 

Six years later, in May of 2023, we still recognize there is work to be done to improve maternal mental health. Mental health and substance use disorders are still the leading causes of maternal mortality across Colorado with alarming increases in alcohol and cannabis use in pregnancy and staggering increases in perinatal anxiety following the COVID pandemic. Left unaddressed, these behavioral health issues can affect the health and well-being of the mother and child, the economic security of the family, the partnership and well-being of the co-parent, and adversely impact child development, even while the child is in utero, potentially allowing for a lifetime of mental health and resilience risks. 

The commitment, awareness, and action to address maternal mental health have increased locally and across the country. Just last week, the Institute for Medicaid Innovation released a qualitative methods study on how women’s priorities in perinatal health rank against those that are expressed by state and federal governments. The study revealed differing priorities except that maternal mental health was ranked the #1 priority for all three groups. 

Together, CPCQC and CO-PSI are proud of the substantial efforts Colorado stakeholders, policymakers, and communities are making in addressing this shared priority of improving maternal mental health. A list of past and current efforts would prove to be lengthy. Some that we are excited about today include: 

• The upcoming implementation of paid family leave across the state: The Prenatal-3 Policy Center notes that by providing parents with the time and financial security to stay home to bond with a new child, state-paid family leave programs can improve the economic security of the family and keep parents engaged in the workforce. Paid family leave also supports child and parental health and well-being. The programs help new parents have more time to bond with their babies, develop positive caregiving skills, and build the foundation for healthy attachment. Paid family leave allows parents the time to seek timely and preventative health care for themselves and their children.

• The Colorado Behavioral Health Administration has provided additional funding to address perinatal substance misuse and the Tough as a Mother Campaign is creating a safe space for mothers to reach out and receive treatment and support for substance misuse. 

• Medicaid coverage of perinatal health now extends to 12 months postpartum. Georgetown University shares that a year of postpartum coverage, instead of the current 60-day cutoff, can also help protect new moms from medical debt and ensure that they have time to seek care for any postpartum health issues they may face, such as postpartum depression, which often does not appear until six months or more after the baby is born. 

• Increases in financial reimbursement for community-led and community-responsive support for perinatal mental health through peer support specialists and perinatal doulas (legislative approval pending for Medicaid reimbursement of doula services). 

Together, CPCQC and CO-PSI are providing leadership and support across the state on maternal mental health awareness, enhancements in care, and working on policy development and implementation. Notable highlights include:

• The Maternal Mental Health Leadership Collaborative: Colorado is fortunate to have the Colorado Maternal Mental Health Collaborative and Framework, which is a central source for Coloradans to effectively collaborate, impact action, and accelerate progress toward improved mental health and wellness of all pregnant and postpartum people in Colorado. CPCQC serves as the backbone of the Collaborative and Framework, guiding and sustaining the work, and maintaining overall strategic coherence. CPCQC coordinates and manages the day-to-day operations and implementation of work, including stakeholder engagement, communications, data collection, and analysis. Kristin, the Executive Director of CO-PSI, serves as a co-chair of the Leadership Team of the Collaborative and Framework, partnering with a group of seventeen cross-sector partners to provide oversight and strategic direction for the Collaborative & Framework. 

• Supporting Enhancements in Colorado’s Maternal Mortality Review Committee (MMRC): CPCQC staff participate in the state’s maternal mortality review committee. This work identifies whether maternal deaths were associated with or related to their pregnancy. Following legislation signed in 2019, the MMRC must submit recommendations to the legislature addressing the causes of maternal deaths. CPCQC works closely with the MMRC and CDPHE to implement state-wide clinical quality improvement based on recommendations, many of which directly address maternal mental health. 

• New Workforce Efforts: In addition to championing the wealth of resources provided centrally by Postpartum Support International, CO-PSI is dedicated to providing resources that meet the unique and specific needs of all Coloradans. CO-PSI’s current initiatives include the Birth Squad: Denver, a community-based support group program pilot that leverages the expertise, support, care, and navigation services of our team of mental health and peer specialists; the Virtual Resource Roundtable series, which aims to strengthen the perinatal mental health and substance use care network in regions around the state; and the provision of scholarships that Colorado-based providers and allied professionals can use to participate in specialized perinatal mental health training and certification opportunities (over 130 scholarships have already been awarded in 2023). 

• IMPACT BH, a continuum of mental health and substance disorder treatment: CPCQC’s Improve Perinatal Access, Coordination, and Treatment for Behavioral Health (IMPACT BH) program brings together hospitals, primary healthcare services, and community-based organizations as active collaborators and partners in providing wrap-around support and care navigation to pregnant and postpartum people and their families. CPCQC’s role is to facilitate the program, engage cross-sector partners, assess community needs and resources, prioritize and plan, implement strategies to enhance healthcare delivery and community-based services through existing Quality Improvement (QI) projects, evaluate outcomes, and transition to sustainability. The program expands its focus beyond the hospital by creating an integrated delivery system that brings together hospitals, community-based healthcare services, and patients as active partners in perinatal and postpartum care. CPCQC and CO-PSI recently partnered to convene a virtual perinatal mental health resource roundtable for perinatal mental health professionals and stakeholders in the counties served by the IMPACT BH program, strengthening the network of perinatal mental health care, inclusive of substance abuse, toward the collective goal of ensuring that all Colorado families have access to the resources they need to be well and thrive. 

The next big move for Colorado is accountability.  

We are still far from adequately measuring outcomes and improvement in maternal mental health in Colorado. Our efforts will continue to focus on ensuring that mental health screening is universal and utilized at regular intervals throughout pregnancy and postpartum; that access to care is realized, promoted, and tracked; and that pregnant and postpartum people are receiving appropriate care to achieve remission and sustained support for their symptoms.  In order to achieve this: 

• We need to continue to integrate behavioral health and obstetric/midwifery care and ensure that we incorporate the Health Effectiveness Data Information Set prenatal and postpartum depression measures across all insurance payors; commercial, Medicaid, and ERISA; that are active in Colorado.  

• We need to consider becoming a state that mandates screening rather than allowing it as an optional component of care like many of our peers across the county.   

• We need to ensure parity in postpartum mental health coverage, especially now that Medicaid is extended to twelve months postpartum. 

• We need to focus on equity, improve workforce education to defeat stigma, and create psychologically safe places for parents to talk and share their mental health concerns. These efforts should align with race, gender identity, and geography while protecting pregnant and postpartum people’s ability to receive life-saving care for the most common complication in pregnancy, mental health disorders without fear of legal recourse.  

Together, CPCQC and CO-PSI look forward to continuing our efforts to move the state, our healthcare systems and payers, and workforce models in this direction. 

While this work is underway, we want to ensure that all pregnant and parenting people in Colorado have access to timely, informed mental health support. To this end, one resource we would like to highlight is the HRSA National Maternal Mental Health Hotline, which is administered by Postpartum Support International. The National Maternal Mental Health Hotline provides 24/7 free, confidential support before, during, and after pregnancy. The Hotline offers callers:

• Phone or text access to professional counselors
• Real-time support and information
• Response within a few minutes, 24 hours a day, 7 days a week
• Resources
• Referrals to local and telehealth providers and support groups
• Culturally sensitive support
• Counselors who speak English and Spanish
• Interpreter services in 60 languages

Call or text 1-833-943-5746 (1-833-9-HELP4MOMS). TTY users can use a preferred relay service or dial 711 and then 1-833-943-5746.

Kristin Aaker serves as the Director of the the Colorado Chapter of Postpartum Support International. Kristin has a background in education, community development, and nonprofit leadership. She is a passionate champion of perinatal mental health and is committed to partnering with stakeholders, providers, and families throughout the state to ensure that Coloradans have access to the support and resources needed to ensure mental and emotional wellness in the perinatal period and beyond.

Rebecca Alderfer, MPP serves as the Chief Executive Officer for the Colorado Perinatal Care Quality Collaborative. She has more than 20 years of experience leading strategic efforts across complex systems, advancing impact and resources through philanthropic, private enterprise, and government partnerships, and advocating for change through policy and community leadership.