Journal of Applied Research on Children

Informing Policy for Children at Risk

Current Issue: Social Determinants of Health

Volume 15, Issue 1 (2025)Read More

Featured Content

  • Articles
    16 March 2026

    State-level Policies Addressing Maternal Mental Health Conditions: How Texas Compares

    Nicole Cirino
    In 2019, maternal mental health conditions (MMHCs) were the most common underlying cause of pregnancy-related death in Texas, contributing to over 20% of all deaths. Furthermore, it is estimated that 13.2% of all Texas women who gave birth in 2019 had an untreated MMHC. The most common MMHCs leading to mortality were depressive disorders, substance use disorders, bipolar and psychotic disorders. In 2022, the maternal mortality rate for Black women was over twice the rate for White and Hispanic women and three times the rate for Asian women. In addition to maternal harms, untreated perinatal mental health conditions are associated with childhood harms including adverse obstetric outcomes (fetal growth restriction, preterm birth, and stillbirth); impaired neurodevelopment and behavior outcomes; and a cost burden of $14.2 billion annually. Several broad factors specific to the state of Texas pose significant challenges to mental health care access, such as widespread poverty and high levels of uninsurance exacerbated by the state’s decision not to adopt Medicaid expansion. However, over the past decade, Texas policy makers have taken several important steps to directly address maternal mental health concerns. Most notably, the Texas Health and Safety Code 32.046 of 2019 required the Texas Health and Human Services commission to develop comprehensive statewide maternal mental health policies. The result was the Maternal Depression Strategic Plan of 2021-2025, a unique-to-Texas comprehensive strategy that aimed to improve outcomes for mothers and children. The plan deploys 15 strategies in five areas: provider awareness, increasing referral networks, access to peer support services, increasing public awareness and reducing stigma, and leveraging funding to existing programs. Here, we discuss several key initiatives that emerged from the strategic plan, their relevant efficacy data, and how they compare to national benchmarks. These include 1) extension of Medicaid coverage postpartum (including telemedicine); 2) development of a statewide perinatal access program (Peripan); and 3) partnerships with community education leaders and academic centers to provide education on MMHCs and reduce stigma. We will also review national policies with demonstrated efficacy in decreasing MMHCs that Texas has not yet adopted, such as universal postpartum depression screening measures and support of inpatient maternal mental health programs. Our aim is to inform future policy development and research directions that decrease MMHCs and ultimately improve health outcomes for mothers and children.
    Read More

Current Issue: Social Determinants of Health

    • Articles11 March 2026

      Addressing Maternal Cardiovascular Mortality: The Role of Policy in Reducing Preventable Deaths and Disparities

      Matthew Mitts, Alexandra Latham, Christina Ackerman-Banks
      Maternal cardiovascular conditions now surpass hemorrhage and infection as the leading cause of pregnancy-related deaths in the United States, accounting for roughly one-third of preventable maternal fatalities. Unfortunately, stark racial and geographic inequities persist, with Black and Indigenous mothers dying at two to four times the rate of their White peers. Additionally, geography affects the risk, with rural residents facing a significantly higher risk than pregnant patients who deliver in urban centers. The physiologic changes of pregnancy function as a vascular stress test; therefore, pregnancy and postpartum offer a critical window of opportunity to identify women with a high lifetime cardiovascular risk and then to implement prevention strategies. Evidence-based interventions need to be coupled with coordinated system-wide changes in primary preventive care in order to mitigate the rising number of preventable cardiovascular deaths among women in pregnancy and beyond. Despite evidence of the efficacy of validated screening and prevention protocols, systemic gaps in maternal care persist. Maternal care deserts are expanding. In addition, those areas that offer maternal care often lack sufficient programs that incorporate validated cardiovascular risk-screening tools and do not maintain dedicated cardio-obstetric care teams. Postpartum surveillance for blood pressure and cardiac symptoms remains inconsistent, even though women with hypertensive disorders of pregnancy are nearly four times as likely to develop chronic hypertension within a year of delivery. Together, these systemic barriers, including fragmented insurance coverage and maternal care deserts with limited access even to telehealth, prevent patients from receiving life-saving essential health care, including cardiac screening and prevention programs. Here, we will highlight the differences in federal, state, and hospital-level policies that contribute to these gaps. Additionally, we will discuss evidence-based protocols, including standardized safety bundles, remote blood pressure monitoring programs, and multidisciplinary Cardio-OB clinics, that have shown promising improvements in maternal cardiovascular outcomes. Finally, we will propose policy solutions to remove barriers that limit pregnant and postpartum individuals from accessing antenatal and postpartum care in hopes of achieving meaningful, lasting reductions in maternal morbidity and mortality.
    • Articles16 March 2026

      State-level Policies Addressing Maternal Mental Health Conditions: How Texas Compares

      Nicole Cirino
      In 2019, maternal mental health conditions (MMHCs) were the most common underlying cause of pregnancy-related death in Texas, contributing to over 20% of all deaths. Furthermore, it is estimated that 13.2% of all Texas women who gave birth in 2019 had an untreated MMHC. The most common MMHCs leading to mortality were depressive disorders, substance use disorders, bipolar and psychotic disorders. In 2022, the maternal mortality rate for Black women was over twice the rate for White and Hispanic women and three times the rate for Asian women. In addition to maternal harms, untreated perinatal mental health conditions are associated with childhood harms including adverse obstetric outcomes (fetal growth restriction, preterm birth, and stillbirth); impaired neurodevelopment and behavior outcomes; and a cost burden of $14.2 billion annually. Several broad factors specific to the state of Texas pose significant challenges to mental health care access, such as widespread poverty and high levels of uninsurance exacerbated by the state’s decision not to adopt Medicaid expansion. However, over the past decade, Texas policy makers have taken several important steps to directly address maternal mental health concerns. Most notably, the Texas Health and Safety Code 32.046 of 2019 required the Texas Health and Human Services commission to develop comprehensive statewide maternal mental health policies. The result was the Maternal Depression Strategic Plan of 2021-2025, a unique-to-Texas comprehensive strategy that aimed to improve outcomes for mothers and children. The plan deploys 15 strategies in five areas: provider awareness, increasing referral networks, access to peer support services, increasing public awareness and reducing stigma, and leveraging funding to existing programs. Here, we discuss several key initiatives that emerged from the strategic plan, their relevant efficacy data, and how they compare to national benchmarks. These include 1) extension of Medicaid coverage postpartum (including telemedicine); 2) development of a statewide perinatal access program (Peripan); and 3) partnerships with community education leaders and academic centers to provide education on MMHCs and reduce stigma. We will also review national policies with demonstrated efficacy in decreasing MMHCs that Texas has not yet adopted, such as universal postpartum depression screening measures and support of inpatient maternal mental health programs. Our aim is to inform future policy development and research directions that decrease MMHCs and ultimately improve health outcomes for mothers and children.

Most Popular Articles

  • Articles
    11 March 2026

    Addressing Maternal Cardiovascular Mortality: The Role of Policy in Reducing Preventable Deaths and Disparities

    Matthew Mitts, Alexandra Latham, Christina Ackerman-Banks
    Maternal cardiovascular conditions now surpass hemorrhage and infection as the leading cause of pregnancy-related deaths in the United States, accounting for roughly one-third of preventable maternal fatalities. Unfortunately, stark racial and geographic inequities persist, with Black and Indigenous mothers dying at two to four times the rate of their White peers. Additionally, geography affects the risk, with rural residents facing a significantly higher risk than pregnant patients who deliver in urban centers. The physiologic changes of pregnancy function as a vascular stress test; therefore, pregnancy and postpartum offer a critical window of opportunity to identify women with a high lifetime cardiovascular risk and then to implement prevention strategies. Evidence-based interventions need to be coupled with coordinated system-wide changes in primary preventive care in order to mitigate the rising number of preventable cardiovascular deaths among women in pregnancy and beyond. Despite evidence of the efficacy of validated screening and prevention protocols, systemic gaps in maternal care persist. Maternal care deserts are expanding. In addition, those areas that offer maternal care often lack sufficient programs that incorporate validated cardiovascular risk-screening tools and do not maintain dedicated cardio-obstetric care teams. Postpartum surveillance for blood pressure and cardiac symptoms remains inconsistent, even though women with hypertensive disorders of pregnancy are nearly four times as likely to develop chronic hypertension within a year of delivery. Together, these systemic barriers, including fragmented insurance coverage and maternal care deserts with limited access even to telehealth, prevent patients from receiving life-saving essential health care, including cardiac screening and prevention programs. Here, we will highlight the differences in federal, state, and hospital-level policies that contribute to these gaps. Additionally, we will discuss evidence-based protocols, including standardized safety bundles, remote blood pressure monitoring programs, and multidisciplinary Cardio-OB clinics, that have shown promising improvements in maternal cardiovascular outcomes. Finally, we will propose policy solutions to remove barriers that limit pregnant and postpartum individuals from accessing antenatal and postpartum care in hopes of achieving meaningful, lasting reductions in maternal morbidity and mortality.
    Read More
  • Articles
    16 March 2026

    State-level Policies Addressing Maternal Mental Health Conditions: How Texas Compares

    Nicole Cirino
    In 2019, maternal mental health conditions (MMHCs) were the most common underlying cause of pregnancy-related death in Texas, contributing to over 20% of all deaths. Furthermore, it is estimated that 13.2% of all Texas women who gave birth in 2019 had an untreated MMHC. The most common MMHCs leading to mortality were depressive disorders, substance use disorders, bipolar and psychotic disorders. In 2022, the maternal mortality rate for Black women was over twice the rate for White and Hispanic women and three times the rate for Asian women. In addition to maternal harms, untreated perinatal mental health conditions are associated with childhood harms including adverse obstetric outcomes (fetal growth restriction, preterm birth, and stillbirth); impaired neurodevelopment and behavior outcomes; and a cost burden of $14.2 billion annually. Several broad factors specific to the state of Texas pose significant challenges to mental health care access, such as widespread poverty and high levels of uninsurance exacerbated by the state’s decision not to adopt Medicaid expansion. However, over the past decade, Texas policy makers have taken several important steps to directly address maternal mental health concerns. Most notably, the Texas Health and Safety Code 32.046 of 2019 required the Texas Health and Human Services commission to develop comprehensive statewide maternal mental health policies. The result was the Maternal Depression Strategic Plan of 2021-2025, a unique-to-Texas comprehensive strategy that aimed to improve outcomes for mothers and children. The plan deploys 15 strategies in five areas: provider awareness, increasing referral networks, access to peer support services, increasing public awareness and reducing stigma, and leveraging funding to existing programs. Here, we discuss several key initiatives that emerged from the strategic plan, their relevant efficacy data, and how they compare to national benchmarks. These include 1) extension of Medicaid coverage postpartum (including telemedicine); 2) development of a statewide perinatal access program (Peripan); and 3) partnerships with community education leaders and academic centers to provide education on MMHCs and reduce stigma. We will also review national policies with demonstrated efficacy in decreasing MMHCs that Texas has not yet adopted, such as universal postpartum depression screening measures and support of inpatient maternal mental health programs. Our aim is to inform future policy development and research directions that decrease MMHCs and ultimately improve health outcomes for mothers and children.
    Read More

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