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Perinatal Depression : Bridge to Community Treatment. CityMatCH August 28, 2007 Marilyn Benjamin, MSN, RN Project Director, Cleveland Regional Perinatal Network. Outline. Background HFHS Project Findings Focus Group Gaps and Barriers Strategies Future Issues. - PowerPoint PPT Presentation
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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
[email protected] 11001 Cedar Ave., Suite 320 BCleveland, OH 44106216-844-3391
www.crpn.net
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