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                          Screening and risk reduction are important
aspects of prenatal care however, developing a model that provides support to
every woman especially concerning mental health issues is difficult 40.

Cognitive behavior therapy (CBT) is a gold standard intervention for a variety
of mental health issues, such as depression and anxiety 40. CBT
based health promotion intervention entitled COPE (Creating Opportunities for
Personal Empowerment) is an effective program 40. COPE TEEN
program is a manualized 15-session cognitive-behavioral skills building (CBSB)
healthy lifestyle intervention program for 12 to 18-year-old adolescents, which
helps them cope with stress, depression and anxiety issues, incorporates
education and skills building on healthy lifestyle behaviors (nutrition,
physical activity, self-esteem) 41 40.  Health promotion including both physical and
mental health is a valued need of pregnant women, with special emphasis on improving
health behavior, it is important as so many women are engaging regularly with
the health care system 40.

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   Centering Pregnancy, a form of
group prenatal care works closely with health care providers from all sectors
to change health care 42. It is an evidence based model that
effectively addresses the complex social determinants of health 41.

The centering model combines health assessment and community building to help
support positive health behaviors and drive better health outcomes 42.

Centering pregnancy model has resulted in lowering rates of preterm birth when
compared with traditional individual care, even though the model does not
include any additional assessment 32. Instead this model increases
the amount of time spent in discussion and assists women in developing strong
personal connections with other participants 32. Centering
pregnancy has been successful in many health care clinics around the country.

It has increased the number of prenatal visits women obtain, decreased negative
birth outcomes and increased the amount of time a woman spends with her heath
care provider 23. Group prenatal care has improved the outcomes
when compared with individual models 32. They may be extremely
helpful with teens and emerging adults since they are peer oriented and look to
friends for support 23.  The
success of Centering Pregnancy might encourage the development of more models
of care to assist and motivate woman in obtaining and maintaining prenatal care
12.

                           To overcome financial barriers first thing
that could be done is educating women about private insurance, Medicaid and any
other type of self-pay programs. Hire more public health nurses by
collaborating with public health and community officials to obtaining funding
20. Maternal and new born charges account for 27%-29% of all Medicaid
in patient charges, and maternity procedures account for six of the top ten in
patient procedures billed under Medicaid 39. The Affordable Care
Act (ACA) has expanded services and renewed the focus on prenatal care for
Medicaid and minority population 39. In response to it, The
Centers for Medicare and Medicaid services (CMS) has launched a national set of
initiatives to improve access to prenatal care 39. Improving
prenatal care for Medicaid patients is an important opportunity to optimize
health system performance 39. Medicaid has been the primary
funding source for prenatal and maternal services for several decades 43. 

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