Trauma-informed care in a patient-centered medical home for adolescent mothers and their children.

Abstract

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.

Trauma-Informed Organizational Dynamics and Client Outcomes in Concurrent Disorder Treatment

“…Once trust has been established, the open and genuine connection between the service user and the service provider allows the opportunity for the service user to share their experiences in a safe and nonjudgmental space (Kirst et al, 2017;Reeves, 2015). This finding has been validated in studies such as an evaluation of a Colorado maternity program conducted by Ashby et al (2019), which found that a safe and trustworthy clinic environment led to an increased number of visits by service users.…”

Depression Outcomes From a Fully Integrated Obstetric Mental Health Clinic: A 10-Year Examination

“…Hispanic adolescents are three times more likely to experience PPD compared with adult counterparts and are more likely to drink alcohol (Nunes & Phipps, 2013). Adolescent mothers have also been shown to experience higher rates of trauma and abuse (Ashby, Ehmer, & Scott, 2019). The Colorado Adolescent Maternity Program is one model that serves this vulnerable population.…”

“…The Colorado Adolescent Maternity Program is one model that serves this vulnerable population. It provides trauma-informed care, mental health, and parenting assistance girls through the age of 22 years (Ashby et al, 2019). More models that address this vulnerable population are desperately needed.…”

Improving retention in antenatal and postnatal care: a systematic review of evidence to inform strategies for adolescents and young women living with HIV

“…Two major differences between the results of the two searches are evident. In contrast to the primary search, most of the 10 studies identified in the secondary search were conducted in high-income countries, including five in the United States [70][71][72][73][74]. In addition, cluster-randomized controlled trials were the most common study design identified in the primary search, but only three of the 10 studies identified in the secondary search randomized participants [72,75,76].…”