Thirty-eight percent of pregnancy-associated deaths in Colorado between 2016 and 2020 were due to suicide and unintentional overdose.
Nationwide, behavioral health challenges — including substance use — account for closer to 20% of pregnancy-associated deaths, but it is still a leading cause of maternal death.
While behavioral health has historically contributed to a greater percentage of Colorado’s maternal mortality, the state has since taken substantial steps to address the disparity, and one of its programs recently received nationwide recognition as a model for other states to follow.
According to Susann Plenus, a mother who once struggled with addiction and now counsels pregnant women struggling with substance abuse in Mesa County, the key to much of that success has been ensuring that struggling moms can access an open ear and a helping hand.
“I had my kids taken from me; I actively used in my second pregnancy,” Plenus said. “So I do understand the way these women are looked at, like, ‘Oh, why can’t you quit?’ Like we want to actually hurt our baby, and that’s not the truth. We just can’t help ourselves. When I share that with a mom, the relief on her face is like, ‘Oh, my God, somebody truly understands.’”
MAKING AN IMPACT
Colorado’s Improve Perinatal Access, Coordination and Treatment (IMPACT) program was established under the state’s Behavioral Health Administration in 2021 through a partnership with the Colorado Perinatal Care Quality Collaborative (CPCQC), a nonprofit aimed at addressing adverse outcomes among infants and mothers alike.
According to CPCQC Integrated Behavioral Health and Continuum of Care Director Kylie Hibshman, the organization previously focused on hospital-based care to improve maternal mortality outcomes, but over the years, it has expanded to include the full continuum of care, like outpatient clinics and community-based organizations.
A major area of opportunity for improvement in those settings has been the early identification and treatment of the behavioral health challenges that lead some pregnant women to die by suicide or overdose.
Hibshman added that an analysis of Colorado medical claims data found that one in three women had a diagnosable mental health condition during pregnancy or postpartum. And yet, roughly two-thirds of the women with a diagnosable condition did not receive any mental health services during pregnancy or postpartum.
Courtesy of the Colorado Behavioral Health Administration
A bar graph from the Colorado Behavioral Health Administration illustrates the leading causes of death in women who were pregnant and postpartum between 2016 and 2020 across the state.
Courtesy of the Colorado Behavioral Health Administration
“Research has shown that a lot of times that’s due to women not knowing where to access care,” Hibshman said. “Often, for providers, it can be really daunting to ask about suicidal ideation, substance use or intimate partner violence if you don’t know where to send somebody who says yes. So, oftentimes, providers don’t ask.”
Even without the mortality factor, BHA Maternal, Child and Reproductive Health Manager Kallen Thornton said that screening is important for quality of life and long-term outcomes, as roughly one in five mothers experienced a mental health complication during pregnancy or postpartum.
According to Thornton, the IMPACT program has tackled that issue with outreach to community-based and clinical providers.
The outreach primarily consists of comprehensive screening kits and stigma and bias trainings that equip the practitioner with evidence-based approaches, allowing them to confidently discuss behavioral health concerns with their patients.
With the standardized screenings and education, Thornton said Mesa County has seen a 52% increase in mental health care referrals for women who screened for depression. Referrals in Montrose County have increased by nearly 25% over that same period.
Thornton added that the IMPACT initiative also focuses on funding community-based organizations to enhance perinatal navigation services, which are essentially a maternal spin on traditional resource navigation and case management programs.
“I like to call (perinatal navigation) the connective tissue between the different spaces where a perinatal person might receive care. This short-term capacity-building funding is often used to help build up that connective tissue and infrastructure, making sure there’s dedicated staff, time, resources and infrastructure to enhance that perinatal care navigation,” Thornton said.
“We have a particular focus on rural and frontier counties because we know that … living in a rural community is one of those risks in terms of being more likely to face maternal health care shortages, behavioral health care shortages and all of those types of things.”
When IMPACT expanded into western Colorado in 2024, Thornton said they made a substantial investment in Hilltop Community Resources, which used the money to expand its B4 Babies and Beyond program into Montrose County.
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Since the expansion of that program — which coordinates resources like insurance enrollment, nutrition counseling and parental education — Thornton said that more than 800 families in Mesa and Montrose counties received perinatal services.
A statement from the BHA said that success has garnered praise from the Centers for Disease Control and Prevention and earned it recognition in a Congressional briefing late last year. With that, the BHA is “building on this momentum” by expanding into Delta, Gunnison and La Plata counties.
Beyond Hilltop, Thornton said that the peer advocacy program HardBeauty has been critical to IMPACT’s recent success — especially in addressing substance abuse.
THE BEAUTY IN OVERCOMING HARD TIMES
Racquel Garcia created HardBeauty in 2019 as a “peer recovery” network, which is a growing model of addiction care that emphasizes community and connections with individuals who have experienced and overcome addiction.
“I wanted to get out of my addiction for three or four years before I finally did. But that’s because I felt like I was stuck in the situation. I had no support, no family here,” HardBeauty Perinatal Navigator and Recovery Coach Susann Plenus said.
Larry Robinson/The Daily Sentinel
Susann Plenus, perinatal navigator and addiction recovery coach with HardBeauty, poses for a photo in downtown Grand Junction on March 5.
Larry Robinson/The Daily Sentinel
“I often say that if I had someone like me back then, when I first got pregnant, none of the (issues with losing custody) would have happened.”
While the organization serves a broad population of Coloradans, it created the “Operation Care” program after Garcia encountered several women struggling with addiction while touring hospitals across Colorado.
Under Operation Care, peer recovery coaches are stationed in hospitals and prenatal care clinics as a resource for any soon-to-be-mothers who screen for substance use. When they aren’t stationed at a clinic, providers will refer clients, and a coach will contact them within one to two days.
Coaches work with each client on their most critical needs for 30 to 45 days, which typically involves connecting with a treatment center or sober living community. Coaches hold the client’s hand throughout the process, but they also bridge the gap between immediate and post-treatment care by connecting clients with less intensive services and resources.
In 2024, the program expanded onto the Western Slope, largely thanks to Plenus, who has provided the brunt of in-person services across the region.
She said it’s difficult to encapsulate the impacts of that work, having connected with nearly 50 pregnant women in active addiction over the past year. But just one example would be her time spent with Ashley, whom she connected with in December, after the soon-to-be-mother admitted herself into a local recovery facility.
“When I met her, she had nobody to be there to support her. She had no family or friends who would be able to go into the hospital,” Plenus said. “That’s one thing I always offer my clients: if you don’t have anybody to go with you in labor, I can be there for you. I spent a total of probably like 19 hours with her.
First-time mother Ashley, left, and her infant son pose for a photo alongside HardBeauty Perinatal Navigator and Recovery Coach Susann Plenus, who helped Ashley recover from substance abuse during pregnancy and accompanied her through the roughly 19-hour delivery.
Courtesy of Susann Plenus
“She asked if I would be willing to go in with her once she had the C-section, and I said, ‘Of course,’ so she opted for that, and I ended up going in. It was really touching to be there with her when they brought the baby around and put him on her chest. It was an amazing experience that I will always remember. It brought tears to my eyes, and I was just really full of gratitude that I was able to experience that.”
Plenus added that because of Ashley’s involvement with Operation Care, initial success in the recovery program and the baby’s good health, Ashley was able to complete the remainder of her time in the facility with her baby, rather than being separated.
Since then, Plenus helped Ashley connect with a sober living community in the region, where individuals can stay for up to two years. She said that they keep in touch at least once a week, as she does with many clients.
Not everyone achieves long-term recovery on their first try, Plenus said, but the vast majority of her clients have been success stories.
Courtesy of Susann Plenus
First-time mother Ashley plants a kiss on her infant son shortly after a C-section that concluded about 19 hours in the local labor and delivery ward.
Courtesy of Susann Plenus
“I’ve seen a change in her, and her belief in herself that she can, and that she’s going to be able to do this,” Plenus said. “She never had a baby. She was scared and nervous to be a parent. But I see her becoming more confident in the fact that she can recover, that she can have a good life for herself and her baby. The belief and hope in herself, that’s huge.”