Untreated perinatal mental and substance use disorders are linked to high-risk pregnancy and adverse outcomes for the birthing parent and child. Often, pregnant persons often do not receive adequate mental health care (Rafferty et al., 2019), and mental health practitioners receive little training in treating this population (Osborne et al., 2015). By understanding the current gaps and needs of pregnant and breastfeeding persons, alongside mental health practitioners, the quality of care for pregnant and breastfeeding persons and their babies can be improved.

Understanding the factors associated with these gaps is critical to improving the quality of care for pregnant persons and their offspring. To address these gaps, the CDC Foundation (CDCF) awarded a cooperative agreement grant to the American Psychiatric Association (APA) to conduct a needs assessment to identify practices and barriers in treating perinatal mental and substance use disorders. The initiative was informed by a 21-member advisory panel comprised of representatives from the APA, American Psychological Association, American Association of Nurse Practitioners, American Counseling Association, and National Association of Social Workers.

APA used an integrative, multimodal approach that analyzed existing research as well as the experiences of pregnant and postpartum individuals with mental health and substance use disorders. Insights into training gaps and practice barriers were solicited from training directors as well as physician and non-physician mental health practitioners. The results of these investigations informed the development of this toolkit, which covers:

• Epidemiology and biology of perinatal mental and substance use disorders,
• Pharmacological and non-pharmacological interventions,
• Recommendations for training curricula for mental health professionals,
• Considerations for certain vulnerable populations.

• Jonathan E. Alpert, M.D., Ph.D. (Chair),
  Albert Einstein College of Medicine/Montefiore Medical Center
• Ludmila De Faria, M.D., DFAPA (Vice Chair),
  University of Florida College of Medicine
• Madeleine Becker, M.D., M.A., FACLP,
  Thomas Jefferson University Sidney Kimmel Medical College
• Felicia Boakye-Dankwah, M.D. (Fellow),
  University of Southern California
• Nancy Byatt, D.O., M.S., M.B.A.,
  UMass Chan Medical School / UMass Memorial Health
• Theadia Carey, M.D.,
  Authority Health
• Latoya Frolov, M.D.,
  UT Southwestern Medical Center
• Jacqueline Hobbs, M.D., Ph.D., DFAPA, CMQ,
  University of Washington
• Christina Khan, M.D., Ph.D., FAPA,
  Stanford University School of Medicine

• Nina Kraguljac, M.D., M.A.,
  University of Alabama at Birmingham
• Amalia Londoño Tobón, M.D.,
  Georgetown University Medical Center /MedStar Georgetown University Hospital
• Tinh Luong, M.D., Ph.D.,
  David Geffen School of Medicine/UCLA & Olive View-UCLA Medical Center
• D. Jeffrey Newport, M.D., M.S., M.Div.,
  University of Texas at Austin Dell Medical School
• Louisa Olushoga, M.D.,
  Lawndale Christian Health Center
• Gabrielle Shapiro, M.D.,
  Icahn School of Medicine at Mount Sinai
• Rubiahna Vaughn, M.D., M.P.H.,
  Albert Einstein College of Medicine/Montefiore Medical Center