Perinatal and Infant Mental Health and Substance Use Provider Toolkit

Created specifically for Orange County:

The tools and resources on this page are intended to help providers advance the well-being of families by:

  • Raising awareness about perinatal-infant mental health and substance use
  • Screening and connecting clients to care as early as possible
  • Promoting parent and infant well-being.

The Perinatal and Infant Mental Health and Substance Use Provider Toolkit is divided into sections (click on link below to skip to that section, or scroll down to continue to all sections):

[The Orange County Perinatal Mental Health Toolkit was developed in 2019 by the OC Perinatal Mood and Anxiety Disorders Collaborative to build a coordinated system of support for perinatal mental health services. It was updated in 2024 by the SEEDS (Services, Education, Emotional & Developmental Support) for Thriving Families Coalition, a subcommittee of the OC Perinatal Council, and now also incorporates perinatal substance use. Questions or feedback directed to First5OC@cfcoc.ocgov.com are welcome.]

Why This Matters

Mental health conditions that occur during pregnancy or in the first 12 months postpartum are referred to as perinatal mood and anxiety disorders (PMADs), maternal or perinatal mental health conditions. Pregnancy is an opportune time to screen and connect women to resources because of an increased motivation to change habits for the future well-being of their child. Estimates of perinatal psychiatric and substance use co-morbidity range from 57 to 91%, with the most common diagnoses being depression, anxiety, and post-traumatic stress disorder. For this reason, it is crucial to screen all perinatal clients for substance use risk. Referral and follow up are warranted for any positive scores on any mental health or substance use screenings.

  • Maternal mental health (MMH) conditions are the most common complications of pregnancy and childbirth.
  • MMH conditions are also the most treatable mental health condition.
  • MMH conditions can include depression, anxiety, obsessive compulsive disorder, post-traumatic stress disorder, bipolar disorder, postpartum psychosis, alcohol and use of other substances.
    • Alcohol, tobacco, and marijuana used more frequently than other substances during pregnancy.
  • Fathers and other care givers are also affected by perinatal mental health conditions
  • Untreated maternal mental health conditions can have devastating health and long-term effects on mothers, infants, and their families.
  • Women of color experience higher rates of MMH conditions and are less likely to receive care.
  • Because children rely on positive, nurturing relationships to thrive starting in infancy, supports that foster healthy attachment during healing can be beneficial to both parents and young children.

For specific inquiries regarding mental health services and treatment programs for non-perinatal adults and children, contact 1-855-OC-LINKS (1-855-625-4657). Community members can find resources on OCNavigator.org.

Promotion and Prevention

Prioritizing Maternal Care Prenatally Through 12 Months Postpartum: 

National maternal mortality rates between 2018-2021 have increased consistently, with alarming disparities among non-Hispanic Black mothers.   Mental health conditions accounted for 1 in 9 U.S. pregnancy related deaths in 2021.  Access to care and resources are essential to combatting these rising trends.

  • Doula care has been found to shorten labor, reduce pain medication use and cesarean rates, increase satisfaction with the birth experience, and decrease the likelihood of postpartum depression.
  • The CDC Hear Her Campaign shares strategies to reduce pregnancy-related mortality.
  • Medi-Cal beneficiaries now have coverage extended through 12-months postpartum for all services to ensure adequate care and follow up for all concerns, including mental health.
  • The 4th Trimester represents a time for new parents and their infants during which to support the transition into their roles and relationships.

Protective Factors:

Based on the Strengthening Families Approach and Protective Factors Framework, services and programs that promote the Five Protective Factors (Parental Resilience, Social Connections, Knowledge of Parenting and Child Development, Social and Emotional Competence of Children, and Concrete Supports in Times of Need) help to mitigate the impacts of risks and promote family well-being.

Evidence-Based PMAD Prevention Models:

Below are two evidence-based programs proven to reduce the risk of postpartum depression by 50% among mothers at risk.

  • Mothers and Babies Program – This 6-12 week individual or group- based program provides new mothers with tools to maintain emotional well-being. The curriculum and training information are available online.
  • ROSE (Reach Out, Stay Strong, Essentials for mothers of newborns) – This preventive intervention is offered in four to eight individual or group sessions by paraprofessionals or mental health professionals in either clinic or community-based settings. ROSE provides tools stress management, role transitions, and navigating interpersonal conflict.
    • MOMS Orange County currently offers the ROSE program.  Contact (714) 352-3400 to inquire.

Screening and Identification

Below are some commonly used, evidence-based tools to screen for depression, anxiety, or both, some of which may already be included in your practice’s electronic medical record (EMR). Otherwise, patients may be able to complete surveys on a printed form or tablet, after which the score can be entered into the chart. Some practices may choose to screen all patients with an initial Patient Health Questionnaire (PHQ)-2 or PHQ-4 as part of routine intake and follow up a positive score with the PHQ-9 or Edinburgh. California data shows that women of color experience proportionately higher rates of perinatal mood and anxiety disorders than White women. Research studies also found Black and Hispanic women had a longer timespan between the start of experiencing symptoms and when they sought care, compared to White women. Further, although they expressed less feelings of depression and anxiety, Black women had much higher rates of PMADs than their White counterparts. For these reasons, the National Perinatal Association recommends lowering the threshold for referral by 2-3 points on the screening tool to ensure earlier identification and support. A bi-directional relationship exists between mental health and substance use. While clients with increasing severity of perinatal depression and anxiety have increased risk of perinatal substance use, polysubstance use is associated with a high risk of perinatal depression and anxiety.  This co-occurrence underscores the importance of screening for both mental health and substance use during the perinatal period. (Pentecost R, 2021)

Anxiety and Depression Screening Tools

Suicide Screening Tool

OC Perinatal Mental Health Screening and Care Pathway

Normalizing Conversations about Substance Use:

It is important to encourage a woman who may be reluctant to admit to substance use or to accept help. Reassure her that by enrolling in supportive services earlier, she increases the likelihood of delivering a healthy baby that can remain safely in the home. For pregnant clients with a history of past or current alcohol or substance use, a Family Wellness Plan/Plan of Self-Care utilizes a cross-sector collaborative approach to addressing the needs of caregivers and infants to prevent risks to the infant and other crises related to perinatal substance use.

Perinatal Substance Use Screening

  • 4P’s Plus (Parents, Partner, Past, Present Pregnancy; licensing fee required; designed specifically for pregnant persons)
  • 5 Ps (Parents, Peers, Partner, Past, Present; designed specifically for pregnant persons)
  • CRAFFT (Car, Relax, Alone, Forget, Friends, Trouble; for adolescents)
  • TAPS (Tobacco, Alcohol, Prescription medications and other Substances; replaced NIDA)
  • DAST-10 (Drug Abuse Screening Test; use requires permission)
  • SURP-P (Substance Use Risk Profile-Pregnancy; specifically for pregnant persons)

Treatment and Referrals

Parent-Child Relationship Support

24/7 Call or Text Lines

Perinatal Mental Health Programs

Perinatal Substance Use

  • California Substance Use Line: (844) 326-2626.  This is a free 24/7 confidential consultation line for clinicians which is staffed by physicians and pharmacists available to answer questions about substance use evaluation, managements, medication to develop patient-tailored guidance and resources to prevent and treat substance use disorder.
  • Perinatal Residential
    • Vera’s Sanctuary (20301 Flanagan, Trabuco Canyon 92679, 800-685-7460)- Serves pregnant/parenting clients ages 18+, including victims of human trafficking. Able to accommodate mothers with infant and another child up to age 5. Provide substance use disorder treatment, mental health, family relationships support, on-site child care, and address other basic needs, as needed.
  • Perinatal Outpatient Clinics
    • Free County Outpatient Programs: Provide substance use disorder (SUD) treatment, mental health, parenting support on-site childcare, and basic needs, as needed.
      • Aliso Viejo Outpatient Substance Use Disorder and Perinatal Services: 5 Mareblue Suite 100, 200, & 250 Aliso Viejo, CA 92656, (949)-643-6930
      • Anaheim Outpatient Substance Use Disorder and Perinatal Services: 2035 E. Ball Road Anaheim, CA 92806, (714) 517-6140
      • Santa Ana Outpatient Substance Use Disorder and Perinatal Services: 401 W. Civic Center Drive Santa Ana, CA 92701, (714) 480-6660
    • Community clinics: Provide Medication Assisted Treatment (MAT), substance use disorder treatment, and primary medical and behavioral treatment.
  • Creating a Plan of Safe Care (called Family Wellness Plan in Orange County: A Plan of Safe Care (POSC) or Family Wellness Plan (FWP) is a plan required by federal law for families with infants who are or were exposed to substances during pregnancy.  The FWP is personalized guide to support the family by communicating strengths, needs, and accomplishments, coordinating care, and making sure resources and support systems are in place in order to strengthen the family unit, help mothers have a healthy pregnancy, and keep child(ren) safely at home. Ideally, a FWP should be developed during pregnancy but can also be completed after birth.

 

 

 

Client and Provider Education

Client Educational Materials

 

 

 

Provider Education/Trainings

Perinatal Mental Health:  Below are several online resources where providers and staff working with new and expecting parents can become more aware of the impact of mental health, substance use, and implicit bias on parental and infant well-being, and what they can do to help.

Perinatal Substance Use / Infant Substance Exposure: These resources demonstrate recommended screening and intervention strategies for perinatal substance use and substance-exposed infants.

Perinatal Health Equity:

  • Dignity in Pregnancy and Childbirth is a free implicit bias and reproductive justice course for perinatal providers developed in accordance with the training requirements outlined in the California Dignity in Pregnancy and Childbirth Act (Senate Bill 464).  More information about this California Health Care Foundation funded project is available at diversityscience.org.