Meeting the Substance Use and Mental Health Needs of Maternal and Child Health (MCH) Populations during COVID-19: Local and State Health Department Solutions
Adelaide Appiah, MPH, NACCHO
Jessica Cohen AMCHP Program Analyst, Health Systems Transformation
Emily Yox, MPH, NACCHO
Stay-at-home orders, social distancing protocols, and concerns about overall well-being have increased levels of anxiety and depression for many people during the COVID-19 pandemic. Protocols such as virtual prenatal appointments, limited in-person contact with home visitors and support people during birth, and physical distancing and isolation measures have resulted in escalating concerns about mental health issues, particularly for pregnant and postpartum people. A survey that included 520 pregnant people and 380 persons who had given birth in the last year yields the following findings:
- Before the COVID-19 pandemic, 15 percent of pregnant people and 29 percent of new parents self-reported depression and anxiety.
- During the COVID-19 pandemic, 40.7 percent of pregnant people and 72 percent of new parents self-reported depression and anxiety.
High rates of depression and anxiety can trigger substance use relapse for those in recovery. Of special concern is the rising rates of overdose. Nationally, suspected drug overdoses rose by 18 percent in March; 29 percent in April; and 42 percent in May, compared to the same months in 2019. For pregnant and postpartum people with substance use disorders, COVID-19 protocols often limit access to in-person recovery support, which increases the risk of relapse and overdose.
Like their state counterparts, local health departments (LHDs) are responding to the mental health and substance use needs of their MCH populations, particularly for pregnant and postpartum people, during the COVID-19 crisis. Set out below are descriptions of three LHDs that illustrate these efforts to rise to the recent challenges and demonstrate the benefits of local-state collaboration.
Oregon Title V and the Washington County Department of Health and Human Services (WCDHHS)
Washington County is part of the Portland metropolitan area, and the WCDHHS has witnessed a significant increase in mental health concerns—specifically anxiety— among the MCH population since the beginning of the COVID-19 pandemic. The LHD has documented a considerable increase in substance use, particularly marijuana, among postpartum people and non-birthing parents, to cope with anxiety, stress, and depression attributed to the pandemic.
Before COVID-19, WCDHHS’s primary method of substance use screening among pregnant and parenting people was through home visiting and other in-person social service visits. Early in the pandemic, the state health department committed to ensuring that home visiting programs were equipped to operate virtually. The WCDHHS partnership with the state Title V program, which funds the home visiting program for infants with special health care needs, has allowed WCDHHS to continue administering critical substance use screenings to adults in these homes. Home visiting staff credit the state’s responsiveness, flexibility, and open communication as key components of the successful state-local partnership.
Sedgwick County Health Department, Kansas (SCHD)
Sedgwick County includes Wichita, the most populous city in Kansas. At the beginning of the pandemic, SCHD staff witnessed a significant increase in depression and anxiety among the MCH population. Clients also expressed a greater interest in referrals to mental health providers during routine client services and screenings. Screenings for pregnant and parenting people recently have been adjusted to include an initial postpartum visit and a virtual follow-up after two months. SCHD hopes to expand its focus on substance use screening and referral for pregnant people through its partnership with the state, as the pandemic progresses.
Columbus Public Health, Ohio (CPH)
Columbus is Ohio’s state capital. According to CPH data, the rates of drug overdose in Ohio have increased by 56 percent in Columbus since the beginning of the pandemic. Before COVID-19, CPH identified pregnant people and parents with mental health and substance use concerns through the city’s child care program and local schools, among other settings. With the COVID-19 shutdown, CPH has fewer opportunities to directly screen families and provide early intervention. The predominant concern right now is that pregnant people are less connected to the prenatal health care system than they were when they could have face-to-face interaction with health care providers. In response, the state health department is providing additional support to CPH’s efforts to provide services to this population during the pandemic. CPH held weekly clinics for nine weeks (instead of only once, annually) to do health screenings; screening and referrals for mental health and substance use disorders; as well as screening for other necessary service provisions for the pregnant population and other people. The state health department is partnering with local efforts to support CPH’s community outreach efforts.
LHDs and state health departments across the country continue to partner on addressing the needs of MCH populations during the COVID-19 pandemic. The hallmarks of local-state COVID response efforts include joint programming and communicating COVID-19 protocols. Creating sustainable funding mechanisms and prioritizing pregnant people and families who have substance use and mental health concerns are opportunities to strengthen collaboration, as the pandemic continues.
 Davenport, M. H., Meyer, S., Meah, V. L., Strynadka, M. C., & Khurana, R. (June 19, 2020). Moms are not OK: COVID-19 and maternal mental health. Frontiers in Global Women’s Health. https://doi.org/10.3389/fgwh.2020.00001
 Alter, A. A., & Yeager, C. Y. (June 2020). Overdose Detection Mapping Application Program. COVID-19 Impact on U.S. National Overdose Crisis. http://www.odmap.org/Content/docs/news/2020/ODMAP-Report-June-2020.pdf
 Ambrose, A. (September 30, 2020). Pregnancy poses challenges for people in recovery from substance use disorder. Covid-19 is taxing their support system. STAT. https://www.statnews.com/2020/09/10/pregnancy-poses-challenges-for-people-recovery-substance-use-disorder-covid-19-is-taxing-their-support-system/