Perinatal Depression:Bridge to Community

Treatment

CityMatCHAugust 28, 2007

Marilyn Benjamin, MSN, RNProject Director,

Cleveland Regional Perinatal Network

Outline Background HFHS Project Findings Focus Group Gaps and Barriers Strategies Future Issues

Cleveland Regional Perinatal Network (CRPN) Funded by Ohio Dept of Health,

Bureau of Child and Family Health Services, Regional Perinatal Center Program

Grant to University Hospitals Case Medical Center in collaboration with MetroHealth Medical Center.

Assist coordination of regional system of perinatal resources, facilitate hospital-community agency linkages

Focus on data use to identify needs and to improve services/outcomes.

Cleveland Healthy Family/Healthy StartPerinatal Depression Project

Responded to RFP from City of Cleveland Dept of Public Health, Healthy Family/Healthy Start

Six month project 2002 “Feelings of African American Perinatal Patients”

Project Goals A. Estimate occurrence of perinatal

depression in African–American women, aged 15 to 44, residing in city of Cleveland

B. Identify screening and referral practices among health care and social service providers

C. Identify mental heath services for women with perinatal depression

D. Make recommendations

Results:Occurrence

386 participants 248 prenatal, 138 postpartum 313 in person, 73 by phone

Using EPDS* Score 13 +, 19% (72 of 386) screened at risk for

perinatal depression*Edinburgh Postnatal Depression Scale

Edinburgh

Simple to complete Acceptable to mothers and providers 10 questions In public domain

It is screening tool, not clinical diagnostic instrument

Results: Occurrence Screened at risk

Prenatal 21% Postpartum 14% Telephone respondents 23% In person 18%

As # pregnancies increased, risk increased

Results: OccurrenceReceiving services

2% said they were receiving mental health services

6% admitted to history of mental illness

Results: Agency Screening and Referral Practices

Telephone surveys of 29 healthcare and social service agencies

28 used no formal screening tool consistently

Results: PerinatalMental Health Services

Telephone surveys of 79 mental health agencies (First Call for Help)

Half would see women experiencing perinatal depression

No agency contacted had specific program for perinatal depression(2002)

Perinatal Mental Health Services

Finding the right person to speak with could be difficult.

Information provided depends on who is contacted.

Agencies sometimes made referrals to other agencies who were not able to offer services.

Risk of serious disorder prevalent in pregnancy and post partum with negative consequences for women and their infants

Gaps in identificationGaps in access to careGaps in services

Findings PresentedGet your facts first, And then you can distort them as much as you please. Mark Twain

Focus Group OB/Ped, Mental Health Care

Providers Insurance Summit

Medicaid, Managed Care Mental Health Board

Focus Group Questions What do you think of current system

of services for perinatal depression?

What do you see as gaps and barriers?

What improvements would you recommend?

Comments regarding system

No Continuity Fragmented Confusing Complex Impersonal What System?

Barriers: Provider reluctance

to screen Inconsistent

screening Knowledge of

resources Lack of specific

services

Poor referral mechanism

No follow up for referral

Lack of parity for mental health

Lack of integration between systems

Barriers: Provider

Reluctance to screen Can’t tell by looking History puts more at risk but can’t tell

just by history Didn’t think it was their business Didn’t know what to do if they did make

it their business

Barriers: Client Stigma/ Labeling Cultural Issues Mistrust of system Fear of involving children’s services Fear of

medications Depression itself

Mental health in separate setting

Transportation Wait time Lack of public

information about symptoms and treatment

Gaps

Lack of screening and referral Lack of knowledge of appropriate

services Difficulty accessing community

services Lack of follow up information after

referral Lack of public awareness

Bridge to Community Treatment

Identification: Screening and Referral Grants to provide on site training free for all

providers in Cuyahoga County and the region.

Assistance with developing agency specific care paths utilizing formal depression screening tool.

Ohio Dept of Health Help Me Grow pilot

sites utilizing training model

Overcoming resistance to screen

Group process to listen and address provider concerns

Reframe the concept of perinatal depression as a public health concern

Screening should be standard of care Asking the right questions opens

doors and encourages women to disclose their feelings

Overcoming resistance to screen

Need for Care Path How to screen When to screen What if score is elevated What if suicide item is checked How to make referral What referral is appropriate What if client refuses How to get follow up information

Knowledge of services

Resource list for providersand consumers

Original version produced in association withMomsFirst and Dr. Amy HeneghanCase Western Reserve University.Reproduced in state version byOhio Department of Mental Health.

Also in Spanish.

Mental Health Services

Educated ourselves regarding existing services for maternal depression Visited mental health providers Found out what services available Looked at intake process Told them provider issues Listened to their issues Asked what we could do to help

Access and Follow Up

Formed Perinatal Depression Referral and Intake Task Force

Perinatal HealthCare Providers Mental HealthCare Providers Mental Health Board

Currently 29 members, 16 agencies

Difficulty accessing services

What is wrong with current referral and intake and how can we make it better????

Difficulty accessing services

HC Provider issues:Voice mail/ Call backNo info backUnfamiliar with services

MHC Provider issues:Unable to reach provider or clientInsufficient informationNo shows

Fax Referral Form Sufficient client info Permission to exchange info Participating MH Providers listed

Added location, services, limitations

Part of provider training Part of care paths Pilot sites to measure effectiveness

Public EducationHandout and Poster

Future issues Screening part of routine care Central Intake No show rate for appointments Access: transportation, on site services,

alternative care delivery sites Assessments in the home Medicaid Managed Care Outcome Data

Perinatal Depression Project Funding The Ohio Department of Health,

Bureau of Child and Family Health Services Regional Perinatal Center Program and Cuyahoga County Child and Family Health

Services

City of Cleveland, Department of Public Health, MomsFirst Project, supported in part by the Healthy Start Initiative, Division of Perinatal Systems and Women’s Health, Maternal and Child Bureau, Health Resources and Services Administration, U.S.Department of Health and Human Services.

Contact Information

Marilyn.Benjamin@uhhospitals.org 11001 Cedar Ave., Suite 320 BCleveland, OH 44106216-844-3391

www.crpn.net

Discussion