Maternal Depression Screening Toolkit - Mission Health › wp-content › uploads › 2018 ›...

Maternal Depression Screening Toolkit

To download additional copies of this toolkit or documents contained within, please visit

http://tinyurl.com/maternaldepressiontoolkit

CCWNC Version 1 – 11.2016

A catalyst for patient-centered, community-oriented, provider-led quality healthcare in Western North Carolina


Table of Contents

Maternal Depression Introduction ..................................................................................... 3

What is Maternal Depression? & Referral to Treatment ................................................... 4

How to Implement a Maternal Depression Screening in Your Practice ............................. 5

Billing and Coding for Maternal Depression Screening ..................................................... 6

Edinburgh Postnatal Depression Scale (EPDS) .............................................................. 7-8

PHQ-2 Screening Tool .................................................................................................. 9-10

PHQ-9 Screening Tool ................................................................................................. 11-12

Videos: Mother’s and Provider’s Perspectives .................................................................. 13

Local Referral Resources ............................................................................................ 14-16

Closing ............................................................................................................................. 17

Visit the website below to download

individual screening tools


See page 7 for a copy of the Edinburg Postnatal Depression Scale



53 S. French Broad Ave, Suite 300 Asheville, NC 28801

Phone: 828.259.3879 Fax: 828.259.3875

www.communitycarewnc.org


This toolkit is designed to assist pediatricians and family practice providers in screening mothers of newborns for Postpartum Depression.

Toolkit Contents:

Maternal Depression Introduction

Overview of Maternal Depression Spectrum & Referral to Treatment Options

Example Workflow

Billing and Coding Guidelines for Maternal Depression Screening

Edinburgh Postnatal Depression Scale

PHQ-2 Screening Tool

PHQ-9 Screening Tool

Videos of a mother’s and providers perspectives

Local Referral Resources CCWNC’s Quality Improvement, Pediatric and Behavioral Health Departments can support your practice’s clinical and programmatic implementation of the maternal depression screening tool. Please contact us with your questions. Our team can provide individualized support and training for your practice. Contents of this toolkit are located here: http://tinyurl.com/maternaldepressiontoolkit Warm Regards, CCWNC Quality Improvement, Pediatrics and Behavioral Health Departments

https://www.filesanywhere.com/fs/v.aspx?v=8b6b6a87596775ab72a2



Maternal Depression Screening

Psycho-social screening and surveillance for risk is an integral part of routine care and the relationship with the child and

family. Medical Homes can be timely and proactive by implementing the screening, supporting the mother-child

relationship and using community resources for referral and treatment.

40% - 60% of parenting teens and mothers who have low income report depressive symptoms

Spectrum of

Maternal

Depression

Prevalence Time Frame Characteristics Recommended

Treatment

Mom

Recommended

Treatment

Dyad

Maternity

(Baby) Blues

50%-80% of

all mothers

experience

“baby blues”

after birth

Begins a few

days after

birth.

May last up to

2 weeks

Transient depressed mood,

irritability, crying, anxious,

afraid, confused

Family support Family Support

groups

Postpartum

Depression

13%-20% of

mothers

experience PD

after birth

Occurs during

postpartum or

within the 1st

year

Meets DSM V criteria as a

minor/major depressive

disorder.

depressed mood,

reduced interest in activities,

loss of energy, difficulty

concentrating

Family Support

Mental Health

provider

Psychiatry

Early

Childhood

Mental Health

provider

CC4C

CDSA

Postpartum

Psychosis (PPP)

1-3 of 1,000

mothers

experience

PPP after birth

Occurs in the

first 4 weeks

after birth

Paranoia, mood shift,

hallucinations, delusions,

suicidal/homicidal thoughts

Emergency

mental health

services

Mobile Crisis

Inpatient setting

Early

Childhood

Mental Health

provider

CC4C

CDSA

Evidence-Based Intervention:

Edinburgh Postpartum Depression Scale – available in English and Spanish

o Mother completes a 10 multiple choice questionnaire 4 times in infant’s first year. Note, we

recommend screening at 1, 2, 4, and 6 month visits because peak occurrence for maternal

depression is 2-3 months for minor depression; 6 weeks for major depression)

o Bill at the infant visit with CPT code 99420

o Bill at Postpartum visit with CPT Code 96127

For Positive Screens:

If the Edinburgh score is 20 or greater, or the mother answers yes on question 10, or if the

mother expresses concern about her or her baby’s safety or the PCP suspects the mother is

suicidal, homicidal, severely depressed/manic/psychotic

o Contact your Mobile Crisis provider: service available through your MCO

o Refer to emergency mental health services and be sure she leaves with a support person

Communication, Support, Demystification and focus on wellness

Referral Resources: see recommended treatment for mom and dyad above

If the mother has a positive screen, the infant should also receive a social-emotional screening. CHIPRA Quality Demonstration Grant- September 2016 (v5)


How to Implement a Maternal Depression Screening in Your Practice

Choose Appropriate

Screening Tool & Visit Intervals

Implement screening tool

into practice workflow for infant

visits

Choose between Edinburgh or PHQ-9 (see page 7)

If Family Medicine, determine which

visits to conduct the screening: at infant visit, Postpartum or

both visits

Determine which intervals to screen

at: AAP recommends 1,2,4 and 6 months and the 2 and 6 week Postpartum visits

If yes, test changes with one MA/provider team

What is the workflow for screening tools your practice is already using?

(Ex.: ASQ, MCHAT).

Can you replicate this for Maternal Depression screening?

Are there opportunities for improvement?

Train staff and implement

Consider:

Using MAs to support provider (ie: scoring)

Inputting the screening into your EHR

o Enter in EHR (so answers can be mined for tracking) or

o Scanned into EHR (not mineable)

Billing for screening (see page 4)

Learning more about how to interpret the screen

o Seek support from CCWNC behavioral health staff if needed

When to refer/when to treat/how to treat

o Consider an in-service from CCWNC behavioral health staff

o Refer to page 2 on maternal depression screening chart


UPDATE ON BILLING AND CODING MATERNAL DEPRESSION SCREENING

As of July 1st, 2016, primary care providers will be paid for postpartum depression screening done at

infant well visits in keeping with AAP recommendations.

North Carolina Medicaid will reimburse providers for up to 4 maternal depression risk screens

administered to mothers during the infant’s first year postpartum. AAP recommends screening at the

1, 2, 4, and 6 month visits. CMS directs use of CPT code 99420 (Health Risk Screen), one (1) unit per

administration, with EP modifier when billing for this service. When conducted as part of a

comprehensive Health Check Early Periodic Screening visit, this screen may be billed to the infant’s

Medicaid coverage. Providers should carefully review the Health Check Billing Guide’s section on

“General Guidance on Use of Structured Screening Tools” and follow all documentation requirements.

Maternal Depression Screening

Description Code Payment

During an infant Well-care visit:

1 – 12 month olds (Edinburgh or PHQ-2/PHQ-9)

Use EP modifier

99420

As of January 2017

this code will change

to 96161

$7.91

During a Post-Partum Well Care Visit (Mother is the patient)

96127

$4.10


Maternal Depression Videos

A Mother’s Perspective: The Feelings are Normal and Common (8 minutes)

https://www.youtube.com/watch?v=zbUl2hZNlKY

A Provider’s Perspective: Why is it important to Screen? (7 minutes)

https://www.youtube.com/watch?v=SAkE2_YHTGQ

Visit http://tinyurl.com/maternaldepressiontoolkit to view these videos

https://www.youtube.com/watch?v=zbUl2hZNlKY

https://www.youtube.com/watch?v=SAkE2_YHTGQ



Agency Contact Telephone Number

Children’s Developmental Services Agency (CDSA)

http://www.beearly.nc.gov/index.php/contact/cdsa

828-265-5391 Blue Ridge

(Alleghany, Ashe, Avery, Mitchell,

Watauga, Wilkes & Yancey Counties)

828-433-5171 Morganton

(Alexander, Burke, Caldwell, Catawba

& McDowell Counties)

707-480-5440 Shelby

(Cleveland, Gaston, Lincoln, Polk &

Rutherford Counties)

828-251-6091 Western N.C.

(Buncombe, Cherokee, Clay, Graham,

Haywood, Henderson, Jackson,

Macon, Madison, Swain, &

Transylvania counties)

Care Coordination for Children (CC4C) http://www.buncombecounty.org/governing/Depts/Health/CareCoordination.aspx Services are contracted and arranged through Community Care of Western North Carolina

Program Information: Sherry Noto

Care Management Referrals: Amy Ray

Sherry Noto: Pediatric Care

Management Program Coordinator:

828-348-2829

Amy Ray: Care Management Referral

Coordinator: 828-348-2823

VAYA Health (formerly Smoky Mountain Managed Care Organization)

www.vayahealth.com

(i.e. Early Childhood Mental Health Providers for children ages 3+, Family Support Groups, Psychiatry)

24-hour Access to Services Line

1-800-849-6127

LOCAL REFERRAL RESOURCES

http://www.beearly.nc.gov/index.php/contact/cdsa

http://www.buncombecounty.org/governing/Depts/Health/CareCoordination.aspx

http://www.buncombecounty.org/governing/Depts/Health/CareCoordination.aspx

http://www.vayahealth.com/


Mobile Crisis Number by County including Walk-in Centers

http://vayahealth.com/community/comprehensive-care-centers/walk-crisis-centers/

Buncombe

Walk-In Centers:

Family Preservation Services: 828-

225-3100

RHA Health Services: 828-254-2700

Mobile Crisis: 888-573-1006

Cherokee

Walk-In Centers:

Appalachian Community Services:

828-837-0071

Mobile Crisis: 1-888-315-2880

Clay

Walk-In Centers:


828-389-1494


Graham

Walk-In Centers:


828-479-6466


Haywood

Walk-In Centers:


828-452-1395

Mobile Crisis – Call 1-888-315-2880

Henderson

Walk-In Centers:

Family Preservation Services:

828-697-4187


Jackson

Walk-In Centers:

Meridian Health Services:

828-631-3973


Madison

Walk-In Centers:



Macon

Walk-In Centers:


828-524-9385


828-524-6342





Continued:

Mobile Crisis Number by County including Walk-in Centers


McDowell

Walk-In Centers:



Mitchell

Walk-In Centers:

RHA Health Services; 828-765-0894


Polk

Walk-In Centers:

Family Preservation Services:

828-894-2290


Swain

Walk-In Centers:


828-488-3294


Transylvania

Walk-In Centers:

Blue Ridge Community Health:

828-883-5550


828-883-2708


Yancey

Walk-In Centers:






53 S. French Broad Ave, Suite 300

Asheville, NC, 28801 Phone: 828.259.3879

Fax: 828.259.3875 www.communitycarewnc.org

Maternal Depression Screening Toolkit Please feel free to contact the CCWNC team below regarding use and programmatic implementation of this toolkit. If you are viewing a printed version of this toolkit and would like an electronic version, as well as access to the screening tool, please go to this link: http://tinyurl.com/maternaldepressiontoolkit We look forward to working with you and your practice to benefit children, mothers and families. Warm Regards, CCWNC Quality Improvement, Pediatric and Behavioral Health Departments

Contacts

Eric Christian, MAEd, LPC, NCC, Director of Integrated Care [email protected] | Office: 828.348.2833 |Fax: 828.348.2744

Adrienne Gilbert, MPH, QI Specialist, Practice Support [email protected] | Office: 828.348.2822 |Fax: 828.348.2777 Sherry Noto, RN, Pediatric Program Coordinator [email protected] | Office: 828.348.2829

Carrie Pettler, MPH, CPHQ, QI Specialist, Team Lead [email protected] | Office: 828.348.2810 |Fax: 828.348.2756


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