Collaborative care model shows promise for perinatal mental health, but barriers remain

The Collaborative Care Model (CCM) is well suited for integration into obstetric settings to address perinatal mental health conditions, but context-specific adaptation is needed to support adoption and long-term sustainability, according to a qualitative implementation sub-study of the COMPASS+ Trial published in Pregnancy.¹

CCM is an evidence-based model to treat common mental health conditions with a focus on the primary care setting. Its workflow involves systematic communications among multidisciplinary clinicians outside of face-to-face patient meetings.²

Perinatal mood and anxiety disorders are among the leading causes of maternal mortality in the United States, affecting an estimated 600,000 to 900,000 people annually. Despite this burden, 50% to 70% of affected individuals remain undiagnosed, and less than 30% of those with a diagnosis receive treatment, even with “available, effective therapies,” according to the study authors.

“Untreated perinatal mental health conditions can lead to safety concerns including suicide and substance use, accounting for 23% of pregnancy-related deaths,” the authors noted. “Further, perinatal mental health conditions affect quality of life by increasing risk of relationship and occupational troubles. These conditions also negatively affect infant outcomes by contributing to lower breastfeeding rates and alterations in parent-child interaction.”

The CCM steps into existing medical structures. At its core, the perinatal CCM (pCCM) centers on a Care Manager responsible for treatment plan development, psychotherapy delivery, supportive check-ins, and care coordination. A patient registry supports systematic monitoring of treatment response and population-level health metrics, while weekly interdisciplinary meetings between the Care Manager and a supervising psychiatrist guide stepped care decisions. The model has demonstrated efficacy across more than 80 randomized controlled trials in primary care, with emerging evidence supporting its adaptation for obstetric settings.

What barriers did clinics identify to pCCM adoption?

Researchers conducted a qualitative implementation study guided by the Exploration, Preparation, Implementation, Sustainment (EPIS) framework, recruiting 20 clinical and administrative key informants from 5 obstetric clinics and 1 birthing hospital affiliated with the COMPASS+ Trial through purposive sampling. Semi-structured interviews were analyzed using the Rapid Qualitative Analysis process, with coding and thematic analysis organized across EPIS domains.

Several cross-cutting barriers emerged across contextual levels. At the clinic level, limited office space and workflow disruptions were commonly cited obstacles. At the population level, societal stigma surrounding the use of psychotropic medications during pregnancy posed a patient-facing barrier to engagement. Among bridging factors, participants identified a need for established mental health referral networks to support care coordination beyond the pCCM itself.

What facilitators support CCM integration into obstetric care?

Participants also identified several facilitators that position obstetric settings as well-suited for pCCM integration. The increased frequency of medical touchpoints during pregnancy offers natural opportunities for mental health screening and follow-up. Staff and leadership buy-in emerged as a key enabler, as did patients' preexisting comfort and trust with their obstetric clinicians.

“The need for site-level adaptation was an underlying theme, underscoring the opportunity to tailor implementation strategies to local contexts,” the authors wrote.

How can these findings guide future pCCM implementation?

The COMPASS+ sub-study was designed to generate practical insights applicable beyond its own trial sites, offering other perinatal programs a framework for anticipating barriers, identifying local facilitators, and structuring pre-implementation stakeholder assessments. The findings reinforced that bridging the gap between research evidence and real-world practice in perinatal mental health requires implementation strategies that address multilevel barriers while leveraging existing infrastructure and relationships within obstetric care.

References:

1. Turco, A., Chu, A., Feinberg, E., Ward, L.G., Elwy, A.R. and Miller, E.S. (2026), Scaling the collaborative care model in obstetrics: Multilevel determinants to guide implementation. Pregnancy. doi:10.1002/pmf2.70356
2. Carlo, A.D., Unützer, J., Ratzliff, A.D.H. et al. Financing for Collaborative Care—a Narrative Review. Curr Treat Options Psych. 5, 334–344 (2018). doi:10.1007/s40501-018-0150-4