Adolescent mothers experience higher rates of trauma and abuse, as well as increased risks for mental health disorders, compared to adolescent girls who are not mothers, making them a particularly vulnerable population and contributing to them feeling less supported by or allied with their medical provider. Women with a history of childhood abuse face increased rates of obstetric complications; their infants are at increased risk for low birthweight, developmental and intellectual delays, and behavioral problems. Trauma-informed care has become widespread in mental health settings; however, this model has not been as commonly applied to other settings, such as patient-centered medical homes (PCMHs). The Colorado Adolescent Maternity Program (CAMP) is an obstetric and pediatric medical home for pregnant and parenting adolescent girls through age 22 and their children located within Children’s Hospital Colorado. With the integration of behavioral health into CAMP, and given the prevalence of trauma histories among adolescent mothers reported in the literature, programmatic and operational changes to clinical care were made using the Substance Abuse and Mental Health Services Administration’s six key principles of a trauma-informed approach. Data showed that nearly 30% of participants reported a history of trauma. Following the inclusion of trauma-informed principles, patients had significantly higher rates of attendance at prenatal appointments (p < .001) and significantly lower rates of low birthweight babies (p = .02). Future programmatic changes and long-term assessment outcomes of this trauma-informed approach in a PCMH are also discussed.

Integrated perinatal behavioral healthcare provides opportunities to support women and their babies as part of their primary care medical home. The COVID-19 pandemic required significant changes to be made to medical practices to enhance safety and reduce risk, particularly for vulnerable populations, including pregnant women. Previously established modes of mental health service delivery in the HEART program, an integrated behavioral health program embedded in a primary care clinic for adolescent mothers and their babies, and the PROMISE Clinic, an integrated obstetric behavioral health program that serves pregnant women, quickly pivoted to telehealth services because of the pandemic. HEART serves a racially and ethnically diverse patient population, with over 85% of patients publicly insured. The PROMISE Clinic serves a socioeconomically, racially, and ethnically diverse patient population. Behavioral health clinicians implemented a variety of technology-based services including telephone interventions and support, virtual visits using iPads during medical visits, and video visits that patients accessed from their homes. In HEART, behavioral health visits continued at pre-COVID rates during telehealth adaptations.In the PROMISE clinic, the number of perinatal women seen doubled, the total number of patient contacts tripled, and the missed appointment rate significantly decreased during COVID. In the PROMISE clinic, significantly more White and Hispanic perinatal women were seen during COVID and telehealth adaptations, while significantly fewer Black perinatal women were seen during this period.Further research is indicated to examine patient attitudes towards telehealth services, barriers to treatment for Black women, and outcome data.

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