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Increasing Awareness and Screening in the Hospital Setting: A Comprehensive Program for Maternal Mental Health

BACKGROUND

Perinatal Mood and Anxiety Disorders (PMADs) – including postpartum depression – are the most common complications associated with pregnancy and childbirth, affecting, at minimum, one in five pregnant and postpartum women, as documented in the 2017 Report of the California Task Force on the Status of Maternal Mental Health. If left undetected and untreated, these conditions may lead to serious health risks for the mother, negatively affect the mother/child bond and the child’s long-term physical, emotional, and developmental health, and can be devastating for families. Besides human harm and suffering, a recent Mathematica Report estimated that the societal cost of untreated PMADs in California was $2.4 billion per year (2017).

This webinar illustrated how one health care system – Dignity Health – works to develop and strengthen supports for maternal mental health in its hospitals by providing staff and patient education, universal screening, resources and referrals, and by partnering with the community to enhance access to appropriate care. Click here to access the recording of the webinar.

Dignity Health is a large, not-for-profit health system that includes 29 hospitals  providing obstetric services in three states: California, Nevada, and Arizona. An average of 56,000 deliveries occur at Dignity Health hospitals annually. These hospitals employ over 1,800 perinatal nurses, and work with more than 600 OB/GYN, and 600 pediatric physician providers.

In 2016, Dignity Health leadership established maternal mental health as a priority patient care initiative. It formed a multi-disciplinary advisory committee and hired a project manager to lead the effort. The initiative was introduced to the perinatal leadership at a 2016 Dignity Health summit, and included a keynote speaker who shared her personal experience of postpartum psychosis and her advocacy for improved access to appropriate maternal mental health care. The vision of the Maternal Mental Health Project is to be a national model of excellence that actively promotes maternal and infant well-being and reduces the burden of illness associated with untreated or inappropriately treated PMADs and postpartum depression.

EDUCATION AND SCREENING, INCREASING AWARENESS

Dignity Health partnered with Maternal Mental Health NOW to offer 10 in-person provider, staff, and community PMADs educational events across California, Nevada, and Arizona. More than 1,000 individuals attended a total of 4,974 training hours. In addition to increasing the knowledge and expertise of those serving as maternal mental training champions in hospital and community settings, these events provided excellent forums for networking, sharing information about treatment resources. They also served as opportunity to catalyze local collaboration.

Another advancement was the adoption of the inpatient PMADs screening program piloted at seven hospitals using a newly created screening toolkit along with the introduction of a one-hour online PMADs educational module. Each hospital identified project leads in nursing, social services, and medical staff. Ongoing support provided through “office hours” calls to discuss barriers and best practices. The toolkit includes: patient education brochures, the Edinburgh Postnatal Depression Scale (EPDS,) a collaborative care algorithm for women who screen “at risk” or “positive,” electronic health record enhancements for EPDS documentation, assessment and summary reports, a community resource list for each hospital, and PMADs awareness posters. By July 2017, a universal education and screening program was launched across all Dignity hospitals in Arizona, California, and Nevada.  

LOCAL COMMUNITY-BASED PROJECTS  

Dignity Health’s Marian Regional Medical Center Maternal Mood Disorders project was the first local/regional pilot, receiving funding through a collaborative grant with the Dignity Health Foundation from Academy Health. A community stakeholder committee, including representatives from Santa Barbara County Maternal Child and Adolescent Health Services, Santa Barbara County Behavioral Health Services, and the Santa Barbara County Office of Education, Health Linkages Program, were held over the 18-month grant period. A web-based list of local treatment resources was created and made accessible through the Santa Barbara County 211 system; digital strategies for engaging women in their health care were explored, and a patient journey mobile phone app, called My Baby,, was selected to promote PMADs education and self-screening. Additionally, the project integrated promotores, or bilingual and bicultural community health workers. The promotores received training in maternal mental health and local resources, thereby preparing them to outreach and support Spanish-speaking and Mazateco-speaking women. 

In November 2016, the Nevada Service Area received funding from the David and Lucile Packard Foundation to support our partnership with Wildflower Health to integrate emotional wellness and mental health content and PMADs screening functionality into the My Baby app. Additionally, grant funds were utilized to engage mental health clinicians with expertise in PMADs, including a bilingual Spanish-speaking clinician, to participate in pregnancy and postpartum classes and groups, integrating mental health into those conversations, and offer in-person or telephonic support to individual women as needed. 

Dignity Health’s Woodland Hospital Family Birth Center in Yolo County was awarded a Woodland Greatest Need grant to support the Roadmap for Healthy Moms project, a collaboration between Woodland Hospital, Woodland Clinic and Yolo County Maternal, Child and Adolescent Health. This collaboration is focused on coordinating the inpatient/outpatient system of care to educate and screen women throughout their pregnancy and postpartum period, and map available resources and services to support providers in successfully referring women to appropriate care.

In 2018, The Hearst Foundations provided a grant to support the development of a regional collaborative to identify available resources and interventions for pregnant and postpartum women, and to add support groups and mental health service via telehealth to improve access to care. The North State Healthy Moms project targets the communities surrounding three Dignity Health hospitals in Siskiyou, Tehama, and Shasta Counties in California.

Another key development has been the launching of a Perinatal Psychiatry Consultation Service pilot in 2019 within the Dignity Health Medical Foundation. The provider-to-provider consultation service enables OB/GYNs, and other prescribers serving pregnant and postpartum women, an opportunity to access coaching from a psychiatric expert on diagnosis, treatment, and medication management for maternal mental health conditions.

A final key advancement has been the addition of a Perinatal Mental Health Navigator role, to be piloted to support pregnant and postpartum women in Santa Barbara and San Luis Obispo county communities. This position is designed to access needed social and behavioral health services.