Mother Baby Mental Health Program: Use of Technology & Team-Based Care to Extend Reach in Perinatal Psychiatry Elizabeth M. LaRusso, MD

September 2015

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Welcome & Objectives

• Increase understanding of the mental health landscape & what the data tell us about women’s preferences for accessing mental health treatment

• Increase awareness of MBMHP’s strategic initiatives & underlying rationale

• Highlight strategic initiatives that utilize team-based care & technology to extend reach

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A Metaphor for Mental Health

Everything you wanted to know about the

challenges of perinatal mental health program development, but were

afraid to ask.

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Perinatal Mental Illness Can (and Does) Happen To Anyone

• Peak onset of psychiatric illness in women occurs during childbearing years

• Postpartum depression (PPD) is one of the most common complications of pregnancy

• Allina Health/MBCSL is the largest pregnancy care provider in Minnesota– >14,200 deliveries in 2014 = 2,800 patients with PPD

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No One Has This All Figured Out

• There is no clear set of best practices for the provision of perinatal mental health care

• There is no gold-standard model for integrating mental health care into OB/GYN

• Established national perinatal mental health programs tend to focus on one specific element (ex; research, specialty consultation, etc.)

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Isn’t the solution more mental health providers?

• Yes, but no

• National shortage of mental health providers

• Most providers are uncomfortable making med recs for pregnant & BF women

• Patient, provider, and systems-level barriers interfere with women accessing available care

• Exceedingly high no-show rates for outpatient mental health visits (30-50%)

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What do women want?

• Women often have exaggerated concerns & misinformation about mental health issues during pregnancy & the postpartum period

• Qualitative studies reveal that many women want their OB provider to address their emotional needs

• Women note many barriers to accessing mental health treatment & prefer to receive care from trusted providers

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What do OB providers think?

• The majority report that they have a responsibility to recognize maternal depression

• This does not necessarily result in delivery of care– Lack of time– Lack of training– Limited knowledge of available resources– Absence of a systematic referral process– Perceived reluctance of patients to engage in

depression treatment

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“I’m not depressed, I’m just poor.”

• It can be difficult to differentiate mental health conditions from the impact of psychosocial stress– Poverty, domestic violence, lack of adequate

supports, unplanned pregnancies, limited education, homelessness, unemployment, etc.

• Patients with these stressors deserve care

• Often what they need exceeds what we have to offer

Knowing all of this, how do we propose to

improve the identification &

treatment of women with perinatal

psychiatric illness?

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Ideas???

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The MBMHP Mission

To improve maternal, child, and family health and well-being by providing timely access for all pregnant and postpartum Allina Health patients to high quality, individualized, cost-effective mental health care.

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Key Strategic Priorities 2015-2017

• Increased Treatment Options– Individual psychiatric consultations– Individual & group psychotherapy– Establishment of internal/external provider networks– Web-based cognitive behavioral therapy (CBT) for postpartum depression

• Provider Education– Invited lectures, trainings, clinical supervision– Perinatal Psychiatry Pearls quarterly update– MBMHP Website

• Provider Support– Perinatal Psychiatry Provider Consult Line– E-Consults

• Standardized Care Processes– Perinatal Depression Care Process integrated into outpatient OB/GYN

MBMHP Web Sitehttp://akn.allina.com/csl/MotherBaby/policies/perinatalmentalhealth/index.htm

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Who We Are: Core Team Members

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• Elizabeth M. LaRusso, MD– Program development– Pre-conception planning– Consultation, short-term stabilization/treatment of pregnant &

postpartum women– Timely access, short-term treatment, active partnering with patient’s

primary physician

• Tina Welke, LICSW– Patient triage– OB provider support via phone and EPIC– Direct patient care– Program development

What We Do

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What Providers Can Expect From Us

• We work as a team & triage patients

• We provide timely access– 2-5 days for SW visits– 5-10 days for psychiatry visits

• We help providers (OB, family practice) develop an interim treatment plan

• We collaborate with the primary provider, Allina mental health clinicians, & our community partners to increase patient care options

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What We Expect From Providers & Patients

• An active partnership with you to implement the treatment plan

• Patient investment in their own mental health care– Patients who are unable to call to schedule are likely

not ready for treatment– Pilot study at DHMC: No-show rate decreased from

41% to 16% with implementation of triage & patients calling to schedule

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Key Strategic Priorities 2015-2017

• Increase Treatment Options• Provider Education• Provider Support• Standardized Care Processes

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Provider Support

• Support obstetric, family practice, & mental health providers in the provision of care for women with perinatal psychiatric issues

– Perinatal Psychiatry Provider Consult Line service for non-urgent mental health questions about pregnant and postpartum patients

– E-consult, EPIC-based provider consultation service to address medication-specific questions

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Perinatal Psychiatry Provider Consult Line612-863-CARE (2273)

• Telephone consultation for Allina Health & affiliated providers with non-urgent perinatal mental health questions.

• Goal is not for MBMHP to assume care of patients, but to co-develop a treatment plan that providers can implement with their patients. Questions include:– Psychiatric medications in pregnant/lactating women– Determining if further mental health assessment is indicated– Connection with appropriate community resources

• Providers call, leave name, contact number, patient’s name and Allina MRN, and clinical question. Calls returned within 2 business days.

• Patients should not call directly.

• If a patient is in crisis, contact the appropriate resource/send them to the ED for immediate assessment.

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Q1 Stats, 2015

• 56 patients & 47 providers served• 56/56 patients = chart review & treatment

planning (100%)• 17/56 patients = psychiatric visit (30%)• 8/56 patients = SW visit (14%)• 4/56 patients = psychiatry + SW (7%)• 1/56 patients no-showed initial appt. (1.8%)• 1/56 patients cancelled initial appt. (1.8%)

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Perinatal Psychiatry Provider Consult Line: What have we learned?

• OB/GYN providers are utilizing the service• Qualitative data supports high level of patient &

provider satisfaction• Performing triage identifies appropriate level of

care• Very low no-show rate for outpatient psychiatric

clinic visits• Goal is to increase provider use!

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Key Strategic Priorities 2015-2017

• Increased Treatment Options• Provider Education• Provider Support• Standardized Care Processes

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• Based on cognitive behavioral therapy (CBT), an evidence-based treatment for depression

• Developed by a multi-national team with support from an NIMH grant

• Initial published feasibility trial reported high level of patient engagement, acceptability, & improvement in depressive symptoms

MomMoodBooster Web-based CBT for PPD

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MomMoodBooster Web-based CBT

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Mom Mood Booster

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Take-Home Points

• The MBMHP is a work in progress!

• Our strategic initiatives are informed by the data & adapted to the Allina Health landscape

• Team-based care & use of innovative technologies are imperative to extend reach

• Transforming the delivery of care on the systems-level is slow, complex, and extremely rewarding

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With your help, when we succeed…

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Thank You!

• Questions?• Please contact us directly with questions/suggestions

• Contact information:• Elizabeth.LaRusso@allina.com• Tina.Welke@allina.com