Parental Depression Screening Implementation

1. Parental Depression Screening Implementation Bill Stratbucker, MD, MS, FAAPAmy Williams, LMSW Preventive Services Improvement Project Learning Session January 21-22, 2011

2. Objectives • Understand the expectations of primary care clinicians for parental depression screening • Discuss appropriate timing, tools, referral, referral tracking and follow-up • Develop a plan for establishing community linkages for parents with depression

3. Clinician Expectations • What do Bright Futures 3rd Edition and the AAP say? • What is the prevailing sentiment among pediatric clinicians? • Who else is worrying about parental depression?

5. Background • One of the greatest risk factors for child behavioral and mental health problems • Short and long-term effects of parental depression • Lifetime prevalence is 16.6% • Postpartum depression occurs in 10-20%

6. Risk Factors for Perinatal Depression • Personal history of depression • Family history • History of substance abuse • Teenage parent • Stressful pregnancy, delivery • Low-income • Spouse without depression is protective factor

7. Barriers to Screening • Time • Lack of reimbursement • Ownership of problem • Lack of community mental health resources • Lack of training on screening methods and implementation strategies

8. Case for Pediatric Clinician Screening • Early access to parent-infant dyad • Established continuity of care • Understand the divergent outcomes • OB colleagues not necessarily convinced • Benefits outweigh the risks • The right thing to do

9. Implementation • When? How frequent? • What tool? Back-up tool? Diagnostic tool? • Who delivers the questionnaire? • Who scores? • Who responds to the result?

10. Pre-implementation steps • Staff education • Community linkages awareness • Work flow established • Make office screen-friendly • Educate parents • Prenatal visits • Birth hospitalization • First Week Well Visit

11. Pre-implementation steps • Billing • 99420 • Set charge amount • What if insurance doesn’t cover? • Can’t selectively charge patients

13. Maternal Depression: PHQ-9

14. Maternal Depression: PHQ-2

15. Positive Screens Discussion with parent Reassurance (blues) Demystification Education *Diagnostic evaluation and treament Resource referral Mental health, OB, PCP referral Emergent disposition Follow-up

16. Spectrum Health Example • Screening at birth hospitalization • Prenatal and postnatal MOMS program • Perinatal Mood Disorders Team • Perinatal Mood Disorders Support Group • Pine Rest Mental Health day program for affected mother-infant dyads • General Pediatrics, PHQ-2 screening • Co-located LMSWs

17. Resourse Available to Anyone • Postpartum Support International • www.postpartum.net • Early Intervention • Early Head Start • Mother’s Morning Out programs • www.MedEdPPD.org

18. Establishing Community Linkages • Networking • Establish contacts • Community organizations • Hospital (nursing, social work) administration • Obstetricians • Mental health institutions, providers • Insurance companies • Support groups