CRPN Perinatal Depression Project

Transcription

1 CRPN Perinatal Depression Project Avril S Albaugh MSSA, LISW Project Director, Cleveland Regional Perinatal Network Adjunct Assistant Professor, Psychiatry Case Western Reserve University School of Medicine Copyright 2015 Note: The slides and information in this presentation are proprietary; the written permission of the Cleveland Regional Perinatal Network is required to make any changes to material

2 CRPN Perinatal Depression Project A Model of Evidence Based Practice Developed an effective strategy to identify perinatal depression and enhance access to mental health services in Northeast Ohio. Comparing Total Referrals Created a system-wide approach to screen and refer women identified at risk by establishing universal screening and referral protocols at several health care institutions and community agencies in the Cleveland area. Accomplished through collaboration and commitment of major stakeholders within the behavioral and healthcare communities in the region. Evaluated by Case MPH candidate in % provider satisfaction rate after implementing protocols. Relevant impact on local, state-wide and national levels of public health including project duplication in other counties FY2010 Total FY2011 Total FY2012 Total FY2013 Total

3 Background and History Perinatal Depression: Defining the Problem in Cuyahoga County, Ohio in 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

4 Results : Occurrence Breakdown of Women Who Screened At Risk n= Perinatal 19% Prenatal 21% Postpartum 14% In Person 18% By Phone 23% % = subsample of women with missed appointments Cleveland Healthy Family Healthy Start Perinatal Depression Project. Feelings of African American Women: 2002

5 Results Screening and Referral Practices 29 healthcare and social service agencies surveyed: Provider screening inconsistent and only 1 using a screening tool Mental Health Services Telephone surveys of 79 mental health agencies: Half would see women experiencing perinatal depression No agency contacted had specific program for perinatal depression (2002) Survey completed by United Way First Call for Help: 2002

6 Provider 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? 2002 Findings: Provider Comments Regarding System No Continuity Fragmented Confusing Complex Impersonal What System? Cleveland Healthy Family Healthy Start Perinatal Depression Project. Feelings of African American Women: 2002

7 2002 Findings: Gaps and Barriers Provider Reluctance to screen Inconsistent screening Knowledge of resources Lack of perinatal mental health services Poor referral mechanism No follow up Lack of integration between systems Client Stigma/ Labeling Cultural Issues Mistrust of system Fear of Children & Family Services involvement Concern with taking medications while pregnant Lack of information about depressive symptoms and treatment Mental health in separate setting, issues with transportation, child care and 2-3 month wait time for intake apt Cleveland Healthy Family Healthy Start Perinatal Depression Project. Feelings of African American Women: 2002

8 Project Development How Did We Begin to Address the Issues? Reframing the concept of perinatal depression as a public health concern. Advocating that screening should be incorporated into clinical practice as a standard of care. Promoting universal screening which helps to reduce the stigma. the right questions opens doors and encourages women to disclose their feelings.

9 Identification: Screening and Referral 2005 Child and Family Health Services Block Grant to provide on site training free for all providers in Cuyahoga County and the region. Developed agency specific care paths utilizing formal depression screening tool, EPDS Created network of Perinatal Mental Health Providers (PMHP)

10 Bridge Gap Between Screening and Mental Health Providers

11 Difficulty Accessing Services What is wrong with current referral and intake and how can we make it better????

12 Improvements in Provider Linkages 2005 convened Cuyahoga Perinatal Depression Task Force consisting of multi-agency providers: Purpose: Address problems with identification, current referral and intake system and make improvements. Meets quarterly.

13 Measuring Project Outcomes Full Year 2013 PD Screenings per Agency for Cuyahoga County n= CCF CCBOH MomsFirst HMG/BB

14 2013 Referral breakdown percentages for Cuyahoga County n=773 49% 51% Intakes Withdrawn

15 Full Year 2013 Referral Sources n= UH Cleveland Clinic Self Metro MomsFirst Mental Health Newborn Home Visiting HMG-Cuyahoga CCDCFS Other HealthCare Unknown Community Social Service Managed Care Family/Friend Out of County Judge/Court NEON

16 Funding/Support Grant Funding The Ohio Department of Health, Bureau of Child and Family Health Services This work is funded either in whole or in part by a grant awarded by the Ohio Department of Health, Bureau of Child and Family Health Services, Child and Family Health Services Program as a sub-award of a grant issued by the Health Resources and Services Administration (HRSA) under the Maternal and Child Health Block Grant, grant award number B04MC26688, and CFDA number and Am. Sub. H.B. 59. ( ) MomsFirst, a City of Cleveland Department of Public Health Program This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number H49MC00082 Eliminating Disparities in Perinatal Health for $1,421,155 and 0% financed with nongovernmental sources. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements by inferred by HRSA, HHS or the U.S. Government. ( ) March Of Dimes Ohio State Chapter Community grant award 2015 Grant Fiscal Administration and in-kind Support: University Hospitals Case Medical Center