Dr. Rose Molina
“We really need to expand the behavioral health workforce with particular attention to racial, ethnic, and linguistic diversity, so that people feel comfortable seeing their mental health provider. Mental health is often stigmatized in many places, cultures, and families, so it takes a lot for people to come forward with what they're struggling with, and they want to feel comfortable with the person who's sitting across from them.”
Dr. Rose Molina (she/ella) is an obstetrician-gynecologist and scholar-activist with a passion for applying language and immigration status as critical lenses for understanding and eliminating inequities in maternal health. She is an Assistant Professor of Obstetrics, Gynecology and Reproductive Biology at Harvard Medical School. She completed a Global Women’s Health Fellowship and obtained a Master of Public Health in Clinical Effectiveness from Harvard T.H. Chan School of Public Health. She works at The Dimock Center (a federally qualified community health center), where she cares for a large community of Spanish-speaking immigrants, and Beth Israel Deaconess Medical Center. She is the Lawrence Director of Professionalism, Humanism, and Health Equity in Medicine and the inaugural Director of the Medical Language Program at Harvard Medical School. Dr. Molina works at Ariadne Labs (a joint center for health system innovation between Brigham and Women’s Hospital and Harvard T.H. Chan School of Public Health) to design, test, and spread solutions to enhance the quality and equity of pregnancy care in the US and around the world. She is currently an AHRQ Learning Health Systems K12 scholar and is building a research portfolio to enhance trust when language barriers are present in pregnancy care.
This blog is made possible by a sponsorship from Sage Therapeutics. All content on this page has been curated by the Mass. PPD Fund without input from Sage Therapeutics, Inc.
October 2023 | Interviewed and edited by Jessie Colbert, Executive Director, Mass. PPD Fund
Dr. Rose Molina is an OB/GYN at The Dimock Center, a federally qualified health center in Roxbury, as well as a leading researcher, professor, and advocate on safe and respectful maternity care, with a focus on equity and social justice. The Mass. PPD Fund has been proud to partner with Dr. Molina on several projects, including advocating for the Moms Matter Act to increase and diversify the state’s perinatal behavioral health workforce, for which she is a key spokesperson.
Our interview focused on Dr. Molina’s work as a clinician, and specifically, how we can bridge gaps in care around language. She also shares a multi-pronged approach to building a more diverse perinatal mental health workforce, as well as strategies all providers can use to improve sensitive, responsive care, including across differences.
Can you share your background, and how it led to the important work you do?
I was born and raised in San Diego, 24 miles from the largest point of entry between Mexico and the United States. I grew up in an interracial family, and my father really instilled in my brothers and I a deep sensitivity to Spanish, because we lived in Southern California and especially so close to the border, recognizing that more than half of Californians speak Spanish.
I have memories of my dad taking our family on the weekends across the border to Tijuana. I remember being struck by the differences in opportunity that are afforded to people who simply happen to be born north or south of a man-made structure that divides two countries. Understanding what the border represents really informed my own passion for working in Latin America.
I decided to go into obstetrics and gynecology after I spent a summer with Partners in Health in Mexico. There were very few organizations at the time that worked specifically in Latin America. I really gravitated to midwives and their stories of strength and resilience. I felt like the social context and implications of pregnancy, not just as a condition, but as a life transition, were so constrained by different social constructs and gender norms, and by lack of access to the healthcare system. It was that constellation of issues that really drew me specifically to OB/GYN. I really wanted to be a doctor who cared for pregnant individuals and helped them through that transition.
As an OB/GYN dedicated to Maternal Mental Health (MMH), I know it’s challenging to support patients’ mental health needs when resources are limited, particularly in terms of language. How do you serve patients facing Perinatal Mood and Anxiety Disorders (PMADs) under these circumstances? And what should we be doing to increase resources?
I work at Dimock, a federally qualified community health center in Roxbury, and in some ways we have a great list of resources to offer patients. At the same time, we also are constrained with what we are able to provide.
We do screen everyone with the Edinburg Postnatal Depression Scale (EPDS) at all visits, from prenatal care through postpartum. When someone screens positive for depression, either through that questionnaire or through the conversation around how they're doing, we have a model called integrated behavioral health care. Basically, that means we have behavioral health clinicians embedded within our department – actually within our clinic space. I walk down the hall, knock on the door, and ask for whichever behavioral health clinician is in that day, and they can come over and meet the patient. They’ll do a quick safety check, a very quick triage eval, and then schedule their appointment at that moment. So the patient leaves not just with making a human connection, but also with an intake appointment for a full evaluation.
One of the biggest challenges is that there’s high demand for behavioral health clinicians who speak Spanish, but we only have one, maybe two. One of the reasons I testified for the Moms Matter Act is that, because I speak Spanish, pretty much 100% of my patients are Spanish-speaking. They really value being able to speak to their clinicians directly in their language, and not having to talk about super sensitive issues with an interpreter.
In some ways we have a lot of access – there are many clinics where they don't even have a warm handoff system. But even with the intake and the follow up, the waitlist can take months. And there’s no guarantee that the warm handoff is with a clinician who speaks their language. We really need to expand the behavioral health workforce with particular attention to racial, ethnic, and linguistic diversity so that people feel comfortable seeing their mental health provider. Mental health is often stigmatized in many places, cultures, and families, so it takes a lot for people to come forward with what they're struggling with, and they want to feel comfortable with the person who's sitting across from them. That comfort comes from a lot of different things, but one of them, particularly for Spanish-speaking populations, is the ability to communicate directly in a shared language.
What do you think are the best strategies to improve care and fill in some of these gaps?
First, we need to expand and diversify the behavioral health workforce. We need to work on ways to make [the field] more accessible and attractive, and recruit people into it. We’re in this moment where many people are leaving healthcare, so we need to identify ways to retain and support folks that do choose behavioral health as a career. It’s a hard field to go into, yet can be incredibly rewarding and impactful.
I think that expanding behavioral health skills to other disciplines and other professionals is also important. There has been a lot of work around really skilling up, for example, doulas, or Community Health Workers, or peer navigators or peer support people – there’s a whole group of people who could undergo training to bridge some of the gaps. Cultural brokers [intermediaries between two cultures that help people navigate the health care system] are also people who might have those very deep, trusted relationships with particular communities, and could be important people to include in the behavioral health workforce in some way.
At the same time, given how far behind we are in the diversity of our healthcare workforce generally, I think there are things that behavioral health clinicians and others can do to be more culturally responsive and connect with people across differences. That’s really a space for growth. I know there's been a lot of efforts around cultural competency training, now cultural humility training. But I think there's even more we can do to help clinicians build the skill set to develop a meaningful relationship with a patient, even if they don't share the same language, or the same race, the same culture, the same lived experience.
I also think there's a variable desire at the individual level regarding whether a patient really wants to be paired with someone who looks exactly like them or has the exact same lived experience. For some people, that matters tremendously, because of the inherent trust in that relationship. But for other people, they just want to feel like they are seen and heard in the encounter.
I love that, absolutely. Dr. Molina, you’re a relatively new mom yourself. How has that impacted your work?
Becoming a mom has really impacted everything about my work, from how I interact with my patients, to how I do my work as a working mom. I think that I ask [my patients] different questions now and focus on different things, particularly a focus on the postpartum period. Even when I was in training, there was a subtle deprioritization of postpartum recovery compared to pregnancy and childbirth. I've really realized how important it is, and how relatively little we have in terms of support structures within the health care system in the postpartum period. Even just looking at the sheer volume of appointments, it's just completely different. Patients may have 10 or more prenatal appointments, and only one or two postpartum appointments.
Also, there are moments when I will share my experience with my patients, and I think it helps me bond with them even more. I try not to overshare, but I think in the right moments, when there is a common lived experience about something, that is an opportunity to build a deeper relationship with someone.
Join Dr. Molina, the Mass. PPD Fund, and many others pushing for the Moms Matter Act! For organizational endorsements and to join our email list for meeting announcements and action alerts, contact Jessie Colbert at jcolbert@massppdfund.org. For more info. and to join our latest action, click here.