Jean Ricci Goodman, M.D.
Professor and Director, Maternal-Fetal Medicine, Director, Inpatient Obstetrical Services and Director, Obstetrics Safety and Quality Co-Director, Loyola Regional Perinatal Center
Loyola University Medical Center, Maywood, Ill.
Aparna Sharma, M.D.
Associate Professor, Residency Program Director, Psychiatry and Behavioral Neurosciences,
Loyola University Medical Center, Maywood, Ill.
Background: Loyola University Medical Center, based in the west Chicago suburb of Maywood, is one of 13 Illinois hospitals and health centers recently awarded a program grant aimed at reducing disparities in health care. Through a partnership between the American Hospital Association’s Institute for Diversity and Health Equity (IFDHE) and Blue Cross Blue Shield of Illinois (BCBSIL), Loyola received funding support to implement its new perinatal mental health training program, designed to help new and expecting mothers. In this Spotlight Feature interview, Jean Ricci Goodman, M.D., and Aparna Sharma, M.D., discuss the program’s development and how it’s designed to improve maternal and child health in Loyola’s surrounding communities.
Why did your hospital decide to move forward with this new initiative?
The national maternal mortality rate is far higher than in other developed countries. Furthermore, suicide and self-harm are the largest contributors to maternal mortality from the perinatal period through the first year following delivery.
“…we felt called to do what we could in providing access and superb perinatal mental health care for our patients.”
The Illinois Maternal Morbidity and Mortality Report, published in October of 2018, reported an average of 73 Illinois women died each year within one year of pregnancy between the years 2008-2016, disturbingly higher among non-Hispanic Black women. Mental health conditions were identified as the specific underlying cause in 11% of those cases, and as a contributing factor in 19% of pregnancy-related deaths. The lack of screening for perinatal mood and anxiety disorders (PMADs) has been identified as a missed opportunity to serve vulnerable populations.
In keeping with Loyola's mission of service to our communities, and understanding the high acuity of our obstetric population with many who are non-Hispanic Black or Hispanic, we felt called to do what we could in providing access and superb perinatal mental health care for our patients. Providers and hospitals routinely miss opportunities for screening and assessment for both physical and mental health conditions.
What is the goal of your program, and how do you anticipate this program impacting your patient population?
“…educating our providers to eliminate biases as well as building respect for the cultures of patients we serve will help our program be one that achieves success and sustainability.”
We recognized gaps in our own perinatal health care system here at Loyola, missing opportunities for screening and assessment, as well as access to counseling and treatment for those with mental health conditions. We also identified that providers on all levels lacked skill and knowledge in perinatal mental health. Many also didn’t know where to refer pregnant and postpartum women with mental health and substance use disorders or about available resources for ensuring patient follow-up.
We were also concerned for our patients who didn’t know how to participate in a perinatal mental health services program or didn’t have the ability to take part due to their socioeconomic restraints.
The overarching goal of this program will be to improve maternal wellness and mental health by establishing an early recognition screening program and access to care. To do so, our multidisciplinary perinatal mental health program at Loyola University Medical Center is designed to provide prompt recognition and access to care for those at risk from onset of care through the first year postpartum.
Does a clearer understanding of socioeconomic conditions impacting patients and other barriers to health equity help you build a better program? How?
“The overarching goal of this program will be to improve maternal wellness and mental health by establishing an early recognition screening program and access to care.”
Travel for our patients to appointments is challenging logistically and financially. Understanding these barriers and providing support for transportation and childcare is critically important for our patients, so that they may benefit from a rich program of perinatal mental health services available to them as they deserve.
In addition, educating our providers to eliminate biases as well as building respect for the cultures of patients we serve will help our program be one that achieves success and sustainability.
What information would you share with other member hospitals about advancing health care equity within their organization?
A big key is to understand your patient population, and embrace a culture of service as we do here at Loyola. In our model, patients are part of the team.
Listen to your patients, and their communities. Developing a program is one thing, but it's nothing if your patients can’t benefit because they lack easy access.