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                          Screening and risk reduction are importantaspects of prenatal care however, developing a model that provides support toevery woman especially concerning mental health issues is difficult 40.Cognitive behavior therapy (CBT) is a gold standard intervention for a varietyof mental health issues, such as depression and anxiety 40. CBTbased health promotion intervention entitled COPE (Creating Opportunities forPersonal Empowerment) is an effective program 40.

COPE TEENprogram is a manualized 15-session cognitive-behavioral skills building (CBSB)healthy lifestyle intervention program for 12 to 18-year-old adolescents, whichhelps them cope with stress, depression and anxiety issues, incorporateseducation and skills building on healthy lifestyle behaviors (nutrition,physical activity, self-esteem) 41 40.  Health promotion including both physical andmental health is a valued need of pregnant women, with special emphasis on improvinghealth behavior, it is important as so many women are engaging regularly withthe health care system 40.                          Centering Pregnancy, a form ofgroup prenatal care works closely with health care providers from all sectorsto change health care 42. It is an evidence based model thateffectively addresses the complex social determinants of health 41.The centering model combines health assessment and community building to helpsupport positive health behaviors and drive better health outcomes 42.Centering pregnancy model has resulted in lowering rates of preterm birth whencompared with traditional individual care, even though the model does notinclude any additional assessment 32. Instead this model increasesthe amount of time spent in discussion and assists women in developing strongpersonal connections with other participants 32. Centeringpregnancy has been successful in many health care clinics around the country.

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It has increased the number of prenatal visits women obtain, decreased negativebirth outcomes and increased the amount of time a woman spends with her heathcare provider 23. Group prenatal care has improved the outcomeswhen compared with individual models 32. They may be extremelyhelpful with teens and emerging adults since they are peer oriented and look tofriends for support 23.  Thesuccess of Centering Pregnancy might encourage the development of more modelsof care to assist and motivate woman in obtaining and maintaining prenatal care12.                           To overcome financial barriers first thingthat could be done is educating women about private insurance, Medicaid and anyother type of self-pay programs. Hire more public health nurses bycollaborating with public health and community officials to obtaining funding20.

Maternal and new born charges account for 27%-29% of all Medicaidin patient charges, and maternity procedures account for six of the top ten inpatient procedures billed under Medicaid 39. The Affordable CareAct (ACA) has expanded services and renewed the focus on prenatal care forMedicaid and minority population 39. In response to it, TheCenters for Medicare and Medicaid services (CMS) has launched a national set ofinitiatives to improve access to prenatal care 39. Improvingprenatal care for Medicaid patients is an important opportunity to optimizehealth system performance 39.

Medicaid has been the primaryfunding source for prenatal and maternal services for several decades 43. 

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