Stephanie Teleki, Director of Learning and Impact, California Health Care Foundation
Ian Bennett, Physician Supervisor, Family Health Services, Solano County Department of Health and Social Services
Mindy Vredevoogd, Research Scientist, University of Washington
Tess Grover, Research Coordinator, University of Washington
In California, as in the rest of the United States, the statistics regarding maternal mental health are alarming. Approximately one in five mothers suffers from mood and anxiety disorders during the perinatal period, which extends from pregnancy through one year postpartum. Yet, despite this high prevalence, the overwhelming majority of these women do not receive treatment. The barriers are systemic and multifaceted, including but not limited to behavioral health workforce shortages; a lack of integration between primary, perinatal, and behavioral health care; inadequate training for maternity care providers; and stigma.
Left untreated, these disorders can lead to adverse health outcomes for the mother, diminish the parent-child bond, and negatively impact the child’s long-term mental health and development. Death by suicide is also a leading cause of maternal mortality. To address this crisis, the California Health Care Foundation (CHCF) funded the Los Angeles County Maternal Mental Health Access (LAMMHA) project, a five-year initiative (2022-2026) to teach Los Angeles County Federally Qualified Health Centers (FQHCs) how to implement an evidence-based approach known as the Collaborative Care Model (CoCM) to better identify and treat mothers with perinatal mental health problems.
The initiative is a collaborative effort involving multiple partners, including the Community Clinic Association of Los Angeles County, Elevation Health Partners, Maternal Mental Health Now, Concert Health, and leadership from the University of Washington’s Department of Psychiatry and Behavioral Sciences.
LAMMHA shows how philanthropy can drive lasting change in health care. The program helps health centers better identify and treat maternal mental health conditions, while creating a model that can be expanded across the country.
The Solution: The Collaborative Care Model
The CoCM represents a fundamental shift from traditional, siloed medical practice. It integrates behavioral health directly into the primary care setting.
In a CoCM workflow, patients identified with mental health needs are not merely referred to a specialist—a process often fraught with months-long wait times and high drop-off rates. Instead, they are connected to an in-clinic team. This team consists of the patient’s existing primary care providers (adult and pediatric), perinatal providers (such as an OB/GYN, family physician, or midwife), a Behavioral Health Care Manager (BHCM), and a psychiatric consultant.
The BHCM, typically a licensed clinical social worker, coordinates the treatment plan, provides brief behavioral interventions, and conducts proactive follow-up. Crucially, the BHCM participates in regular, systematic case reviews with a psychiatric consultant. The sessions are guided by an advanced patient registry with features specific to perinatal collaborative care, an essential part of CoCM used to help manage caseloads, provide decision support, and track patient progress and outcomes. This consultant does not necessarily see the patient directly but supports the primary care team in medication management and treatment adjustments.
For the perinatal population, this model is transformative. It allows mothers to receive immediate mental health support in a familiar location—their obstetric or pediatric clinic, bypassing the stigma and logistical hurdles of seeking specialty psychiatric care. The model is backed by over 90 randomized controlled trials demonstrating its superiority to usual care, including specific effectiveness for perinatal populations and people of color.
The Initiative: Los Angeles Maternal Mental Health Access (LAMMHA)
While the evidence for CoCM is robust, implementation in safety-net[*] settings is complex. The LAMMHA initiative was designed to bridge the gap between theory and practice.
The initiative successfully recruited four cohorts comprising 16 individual clinics from five large FQHC systems. The program provides a comprehensive, two-year clinic-based support system that includes:
- Financial Support: Each clinic site is awarded $75,000 over two years if they meet specific milestones, to defray implementation costs.
- Intensive Training: Teams receive full-day in-person sessions and monthly virtual training covering the full care team (providers, care managers, and administrative staff). Initial training and quarterly support calls were also provided for the psychiatric consultants.
- The ECHO Model: Complementing the technical assistance is the LAMMHA Extension for Community Healthcare Outcomes (ECHO) program. This case-based virtual training approach allows providers to present anonymized cases and receive real-time feedback from specialists and peers, fostering a learning community. The LAMMHA ECHO perinatal series included ten monthly sessions held in 2023, 2024 and 2025.
Early Lessons: Implementation and Impact
As LAMMHA progresses, data from the first two cohorts (of four in total) offers vital lessons for grantmakers interested in integrated care.
1. Operational Success and Readiness
The data is encouraging: Cohort 1 clinics completed nearly 90 percent of implementation tasks (e.g., completing feasibility site visits, hiring staff, and testing recording equipment) by the end of their support period. Cohort 2 is on a similar trajectory, with 80 percent of implementation tasks completed by the end of the support period. However, a key lesson has emerged regarding organizational readiness. Clinics with prior experience in quality improvement (QI) or those with dedicated QI staff were more efficient at planning and adopting CoCM than those without such infrastructure. This suggests that future philanthropic investments in integrated care may need to include capacity-building for general QI management as a prerequisite or component of the grant.
2. Clinical Outcomes
The program is delivering on its promise of improved health. Eight participating sites have already shown clinically significant changes in patient depression scores (i.e., mothers enrolled in the program get better per clinical metrics used to assess mental health).
3. The Identification Gap
A nuanced challenge has surfaced regarding screening versus identification. While clinics have successfully increased their screening rates, Cohort 1 clinics achieved total perinatal screening rates between 56 percent and 83 percent, and the rate of positive screens (those identified with risk of depression) is lower than anticipated. Research indicates that at least 15 percent of perinatal patients in low-income settings will screen positive for depression. However, LAMMHA sites are averaging a 4 percent positive screen rate.
This discrepancy highlights a critical area for further inquiry and support. Are screening workflows missing patients? Is stigma preventing honest self-reporting? Or are providers hesitant to diagnose? LAMMHA is currently deploying additional strategies to help clinics better identify patients in need, ensuring that all perinatal patients experiencing depression are identified and receive the support they need.
Sustainability and Expansion: Beyond the Grant
For philanthropy, the ultimate goal is sustainability. LAMMHA was designed not just as a pilot, but as a bridge to long-term viability. The initiative addresses sustainability through three pillars: financial viability, workforce development, and community scale.
Supporting Analysis for Financial Viability
In health care, one of the most critical components of sustainability is reimbursement. That is why, in addition to funding implementation of the CoCM, CHCF also funded an analysis of billing to help clinics identify the most appropriate billing pathways in Medi-Cal (California’s Medicaid program). This analysis found that clinics serving the Medi-Cal population can at least break even if not generate revenue when implementing CoCM. By helping clinics understand and improve billing workflows, this analysis is helping to ensure that psychiatric consultation and care management services remain reimbursable long after philanthropic funding concludes.
Building Workforce Capacity
The ECHO component does more than train current staff; it builds a pipeline of expertise. By offering continuing education credits and fostering peer-to-peer mentorship, LAMMHA is strengthening the retention and expertise of the local workforce. This creates a “train the trainer” effect that fortifies the safety net against high turnover rates common in FQHCs.
Scalability
The 16 high-volume health centers participating in LAMMHA expect to reach approximately 20,000 perinatal patients annually. These sites serve as models for broader adoption across Los Angeles County, where one quarter of all births in the state occur, as well as the nation. The program has established a learning group that allows clinics to exchange best practices and resources, creating a community of practice that can support new clinics attempting to adopt the model in the future.
Conclusion
The LAMMHA initiative illustrates the unique role philanthropy can play in transforming health care delivery. When foundations kickstart the implementation of evidence-based models on the ground and support the path to sustainability, the health care delivery system can build on that to carry the work forward. In the case of LAMMHA, CHCF played this crucial seed funder role. The next phase of the work will involve staying the course on implementation and continuing to pursue sustainability via diverse funding so existing clinics can continue the work and the model can spread in Los Angeles and beyond.
While challenges remain, particularly in optimizing identification rates, the early success of LAMMHA validates that high-quality, integrated mental health care is achievable in community settings with CoCM. For the mothers of Los Angeles, this means access to the support they need, when and where they need it, and for their infants, a healthier start.
This Views from the Field is based on a previous report by Ian Bennett, Tess Grover, and Mindy Vredevoogd of the University of Washington. You can view the report here. Any funders interested in supporting the next phase of the LAMMHA initiative can contact Stephanie Teleki at steleki@chcf.org.
References
[*] The safety-net refers to the network of clinics, hospitals, and health programs that provide care to people regardless of their ability to pay, serving as a critical resource for people with low incomes or without insurance.