Top

Maternal and Child Health Journal

Published in:

01-10-2019 | Affective Disorder | From the Field

Outcomes of Implementing Routine Screening and Referrals for Perinatal Mood Disorders in an Integrated Multi-site Pediatric and Obstetric Setting

Authors: Lucy J. Puryear, Yen H. Nong, Nancy P. Correa, Katherine Cox, Christopher S. Greeley

Published in: Maternal and Child Health Journal | Issue 10/2019

Abstract

Purpose

We report on a successful quality improvement project designed to increase access to perinatal mental health services through universal screening for postpartum depression (PPD) and facilitating referrals for evaluation and treatment, at a multi-site, integrated system of pediatric and obstetric practices in Houston, Texas.

Description

Obstetric practices administered screenings twice during pregnancy and at 6 weeks postpartum. Pediatric practices screened women at the 2 week and 2, 4, and 6-month well-baby visit. Women with a score of 10 or higher on the Edinburgh Postnatal Depression Scale (EPDS) or women that reported thoughts of self-harm were offered a referral to a mental health provider. Data on screening and referrals were collected from the electronic medical record.

Results

A total of 102,906 screens for PPD were completed between May 2014 and July 2018. Of those, 6487 (6.3%) screened positive. The total number of women referred to treatment were 3893 (3.8%). Of referred women 2172 (55.8%) completed an appointment with a mental health provider within 60 days of referral. Rates of completed appointments varied by the level of integration of the mental health provider and referring physician: women referred by pediatrics in a Level 1 coordinated system completed 20.0% of referrals; obstetrics Level 4 co-located system, 76.6%; and obstetrics Level 5 integrated model, 82.7%.

Conclusion

This project demonstrated that with planning, systems review and trained staff, PPD screening can be integrated into obstetric and pediatric practices and high screening and referral rates can be achieved.

Brennan, J. (2018). Postpartum depression prevention and screening: The role of OB/GYN’s and pediatricians in the diagnosis and treatment of postpartum depression. NU Writing, 9.

Bulletins—Obstetrics, ACOG Practice Bulletin: Clinical management guidelines for obstetrician–gynecologists number 92, April 2008 (replaces practice bulletin number 87, November 2007). Use of psychiatric medications during pregnancy and lactation. Obstetrics and Gynecology, 111(4), 1001–1020. https://doi.org/10.1097/aog.0b013e31816fd910.

Byatt, N., Biebel, K., Friedman, L., Debordes-Jackson, G., & Ziedonis, D. (2013). Women’s perspectives on postpartum depression screening in pediatric settings: A preliminary study. Archives of Womens Mental Health, 16(5), 429–432. https://doi.org/10.1007/s00737-013-0369-4.CrossRef

Byatt, N., Levin, L. L., Ziedonis, D., Moore Simas, T. A., & Allison, J. (2015). Enhancing participation in depression care in outpatient perinatal care settings: A systematic review. Obstetrics and Gynecology, 126(5), 1048–1058. https://doi.org/10.1097/aog.0000000000001067.CrossRefPubMedPubMedCentral

Canty, H. R., Sauter, A., Zuckerman, K., Cobian, M., & Grigsby, T. (2019). Mothers’ perspectives on follow-up for postpartum depression screening in primary care. Journal of Developmental and Behavioral Pediatrics, 40(2), 139–143. https://doi.org/10.1097/dbp.0000000000000628.CrossRefPubMed

Cox, J. L., Holden, J. M., & Sagovsky, R. (1987). Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. British Journal of Psychiatry, 150, 782–786.CrossRefPubMed

Davis, M. J., Moore, K. M., Meyers, K., Mathews, J., & Zerth, E. O. (2016). Engagement in mental health treatment following primary care mental health integration contact. Psychological Services, 13(4), 333–340. https://doi.org/10.1037/ser0000089.CrossRefPubMed

Doherty, W. J., McDaniel, S. H., & Baird, M. A. (1996). Five levels of primary care/behavioral healthcare collaboration. Behavioral Healthcare Tomorrow, 5(5), 25–27.PubMed

Dormond, M., & Afayee, S. (2016). Understanding billing restriction for behavioral health providers. Retrieved September 1, 2018 from http://www.behavioralhealthworkforce.org/wp-content/uploads/2017/01/FA3P4_Billing-Restrictions_Full-Report.pdf.

Earls, M. F., & Committee on Psychosocial Aspects of Child and Family Health, American Academy of Pediatrics. (2010). Incorporating recognition and management of perinatal and postpartum depression into pediatric practice. Pediatrics, 126(5), 1032–1039. https://doi.org/10.1542/peds.2010-2348.CrossRefPubMed

Emerson, M. R., Mathews, T. L., & Struwe, L. (2018). Postpartum depression screening for new mothers at well child visits. MCN: The American Journal of Maternal/Child Nursing, 43(3), 139–145. https://doi.org/10.1097/nmc.0000000000000426.CrossRef

Gjerdingen, D. K., & Yawn, B. P. (2007). Postpartum depression screening: Importance, methods, barriers, and recommendations for practice. Journal of American Board of Family Medicine, 20(3), 280–288. https://doi.org/10.3122/jabfm.2007.03.060171.CrossRef

Heneghan, A. M., Morton, S., & DeLeone, N. L. (2007). Paediatricians’ attitudes about discussing maternal depression during a paediatric primary care visit. Child: Care, Health and Development, 33(3), 333–339. https://doi.org/10.1111/j.1365-2214.2006.00648.x.CrossRef

Kurtz, S., Levine, J., & Safyer, M. (2017). Ask the question: Screening for postpartum mood and anxiety disorders in pediatric primary care. Current Problems in Pediatric and Adolescent Health Care, 47(10), 241–253. https://doi.org/10.1016/j.cppeds.2017.08.002.CrossRefPubMed

O’Connor, E., Rossom, R. C., Henninger, M., Groom, H. C., & Burda, B. U. (2016). Primary care screening for and treatment of depression in pregnant and postpartum women: Evidence report and systematic review for the US Preventive Services Task Force. JAMA, 315(4), 388–406. https://doi.org/10.1001/jama.2015.18948.CrossRefPubMed

Shemesh, E., Lewis, B. J., Rubes, M., Ambrose, M. A., Cahill, M. K., Knight, C., et al. (2016). Mental health screening outcomes in a pediatric specialty care setting. Journal of Pediatrics, 168(193–197), e193. https://doi.org/10.1016/j.jpeds.2015.09.046.CrossRef

Smith, S., Granja, M., Ekono, M., Robbins, T., & Nagarur, M. (2017). Using Medicaid to help young children and parents access mental health services: Results of a 50-state survey. Updated. Retrieved September 1, 2018 from http://www.nccp.org.

Title: Outcomes of Implementing Routine Screening and Referrals for Perinatal Mood Disorders in an Integrated Multi-site Pediatric and Obstetric Setting
Authors: Lucy J. Puryear
Yen H. Nong
Nancy P. Correa
Katherine Cox
Christopher S. Greeley
Publication date: 01-10-2019
Publisher: Springer US
Keywords: Affective Disorder
Postpartum Depression
Postpartum Depression
Affective Disorder
Pediatrics
Published in: Maternal and Child Health Journal / Issue 10/2019
Print ISSN: 1092-7875
Electronic ISSN: 1573-6628
DOI: https://doi.org/10.1007/s10995-019-02780-x

ACC 2024 Congress

Springer Medicine

Outcomes of Implementing Routine Screening and Referrals for Perinatal Mood Disorders in an Integrated Multi-site Pediatric and Obstetric Setting

Abstract

Purpose

Description

Results

Conclusion

ACC 2024 Congress

Springer Medicine

Abstract

Purpose

Description

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 10/2019

Family Socioeconomic Status and Early Life Mortality Risk in the United States

Google AdWords and Facebook Ads for Recruitment of Pregnant Women into a Prospective Cohort Study With Long-Term Follow-Up

Early Term Delivery and Breastfeeding Outcomes

Effects of a Multi-site Expansion of Group Prenatal Care on Birth Outcomes

Integrating Community Health Worker Roles to Improve Facility Delivery Utilization in Tanzania: Evidence from an Interrupted Time Series Analysis

Exploring Human Resource Managers’ Decision-Making Process for Workplace Breastfeeding-Support Benefits Following the Passage of the Affordable Care Act