“Creating a Perinatal Depression Information Network and

Practice Observations from the Field”Webcast

Thursday, September 17, 20093:00 – 4:30 pm (Eastern)

Sponsored by Health Resources and Services Administration Maternal and Child Health Bureau & CDC National Center on Birth Defects and Developmental Disabilities Prevention

Disclosure Statement

CDC, our planners, and our presenters wish to disclose they have no financial interest or other relationships with the manufacturers of commercial products, suppliers of commercial services, or commercial supporters. Presentations will not include any discussion of the unlabeled use of a product or a product under investigational use.

Learning Objectives

• Define Maternal/Perinatal Depression and its impact on the physical and mental health of women and families

• Describe the interventions used to address Maternal/Perinatal Depression• Describe the role of local health departments in addressing Maternal/Perinatal

Depression• Describe the development of a National Perinatal Depression Information Network• Identify at least two resources for local health departments to address Maternal

Depression and learn more about the National Perinatal Depression Information Network

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Franklin County Maternal Franklin County Maternal Depression InitiativeDepression Initiative

Grace Kolliesuah, MSW, LSWGrace Kolliesuah, MSW, LSWCaring For 2Caring For 2 Project Director Project Director

Columbus Public Health

CityMatCH Webinar

September 17, 2009

Franklin County Maternal Depression Task Force Initiative

• Caring for 2 is a Federal Healthy Start Project and depression screening is one of its core service functions.

• High scores are referred to the Caring for 2 Social Worker who conducts additional assessments and follow-up for service

Caring for 2 Depression Screening Process

• Edinburgh Postnatal Depression Scale (EPDS) is administered to all CF2 participants in the 3rd trimester and postpartum

Additional assessments tools used:♦ Antepartum Questionnaire (APQ)*

♦ Modified Fatigue Symptom Checklist**Norman A. Posner, MD, Rosalind R. Unterman, M.S.W., Karen N. Williams, Ph.D, and George H. Williams, Ph.D: Journal of

Reproductive

Medicine

*Elizabeth J. Corwin, Ph.D., MSN. Ohio State University

Caring For 2 Findings, 2007

Score < 9

Score 10 - 12

Score > 13

Edinburgh Postpartum Screening

Moms screenedto date

124 63.6%

26 13.3%

45 23.1%

195 100.0%

Low Risk

Moderate Risk -Follow-up EPDS

High Risk -Possible Referral

Total

RISKCount Column %

2007 results analysis indicated 36% of mothers were at moderate to high risk for PPD

Caring For 2 Findings, 2008

Score < 9

Score 10 - 12

Score > 13

Edinburgh Postpartum Screening

Moms screenedto date

Screening Through 2008 results analysis indicates no significant change at 35.9% of Cf2 mothers at moderate to high risk for PPD

207 64.1%

41 12.7%

75 23.2%

323 100.0%

Low Risk

Moderate Risk -Follow-up EPDS

Higher Risk -Possible Referral

Total

EdinburghDepressionScale Risk

Community Problem-Solving

Cf2 Change Logic Model

African/African-American women in the Columbus Community experience adverse maternal health

outcomes

Establish organized Coalition

Sub-committees review, analyze, and report information about

potential needs in the committee

Coalition identifies issues that impact adverse

maternal health outcomes

Coalition reports to the community

Coalition brings attention to the issues

Coalition facilitates community problem-

solving

Coalition facilitates access to services

Increased access to quality services

Increased positive short-term outcomes

Increased positive long- term outcomes

Conditions Activities Outcomes and Impacts

Franklin County Maternal Depression Task Force Initiative

• Organized June, 2007 and formed into the Franklin County Maternal Depression Task Force

• Charged to explore the mental health needs of pregnant and parenting women in our community and develop services to enhance the system of care.

Maternal Depression Task Force Members(Community-based Health and Human Services Agencies)

• Catholic Social Services• Columbus Neighborhood Health Centers• Columbus Public Health• Council on Healthy

Mothers & Babies• Dublin Counseling Center• Mount Carmel Health

System

• Nationwide Children’s Hospital

• Northwest Counseling Services

• Ohio Department of Health

• OhioHealth• Ohio State University• OSU Medical Center• POEM, Inc.

Maternal Depression Initiative

3-Pronged Approach:• Needs assessment – identify how mental health

system works and determine how women at-risk for depression are identified

• Resource assessment – assess availability of mental health services and identify gaps in services

• Strategic action identification – identify strategies to effectively educate on the severity of maternal depression and develop mental health system improvement plan

Mental Health System Challenges/ Barriers

• Few mental health referral sources for PPD• Long delays in getting necessary services• Lack of resource awareness• Overburdened resources and long wait times• Fear of stigma• Continuity of care; lack of compliance with

treatment plan• Lack of cultural competency and bilingual

services• Low appointment show rates• Limited screenings• Lack of transportation

Maternal Depression Task Force Committees

Developed 3 subcommittees

► Resource List

► Outreach, Education, and Awareness

► Wait Time Assessment

Ultimate goal was increased access to mental health services for mothers.

Resource List Subcommittee

● Conducted survey of mental health providers - to assess specific PPD trainings, waiting list, access to service, payment method, interpreter services, etc

• Developed 2 service directories♦ Consumer version♦ Healthcare provider version

• Directories were distributed to healthcare providers- i.e. nurses, social workers, community health workers

Front Page

Directory outline

Provider directory

Provider directory

Consumer directory

Consumer directory

Outreach, Education & Awareness

• Developed a PowerPoint education tool for healthcare professionals

• Organized 2 trainings in April and June, 2009

• Objectives:◊ discuss symptoms and occurrence of Perinatal Mood Disorders

(PMD)

◊ identify screening tools used to identify Maternal Depression

◊ list treatment options for PMD

◊ identify resources for PMD

• Approximately 124 people attended

Wait Time Evaluation

• Baseline wait time assessment conducted by Social Work students in 2008

• Follow-up assessment conducted in Spring, 2009

• Additional assessments planned for 2010 after the distribution of the resource directories

• PPD rates for program moms are not out of line with other estimates – in fact, they might be a bit higher

• Many moms have combinations of risk factors that cause or exacerbate depression◊ stress, lack of support, limited economic resources,

strained relationships, etc.

• Untreated depression complicates our efforts to help moms achieve good birth outcomes

Conclusion

Conclusion

• Our local data were compelling that underscored the need for available community resources for screening and treating depression for high risk mothers

• Data highlight a critical community need for a mental/behavioral health partnership that responded quickly and effectively to maternal depression

• The Columbus Public Health provided crucial leadership role in group facilitation, coordination of intervention, and outcome evaluation

• Strategic community partnership can be effective to produce results

Next Steps

• Establish/maintain contracted community partnership

• Upkeep and expansion of directory• Expand training with on site workshops-Grand

Rounds to service providers• Increase number of providers performing screening • Monitor wait times on an ongoing basis• Healthy Start Interconception Care Learning

collaborative is focused on maternal mental health

Contact Information

Grace Kolliesuah, Caring For 2 Project DirectorColumbus Public Health

614-645-1697gmkolliesuah@columbus.gov

Karen Gray, Co-Chairperson-FCMDTFColumbus Public Health

614-645-2134kareng@columbus.gov

Supported by Columbus Public Health’s Caring For 2 Healthy Start project H49MC00028 from the US department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau (Title V, Social Security Act)

Developing a National Perinatal Depression Information Network

Sarah Gibbons

Public Affairs Manager

Family Planning Council, Philadelphia, PA

On behalf of:

Pennsylvania Perinatal Partnership (PPP)

SarahL@familyplanning.org

PPP

The Pennsylvania Perinatal Partnership represents the collaborative efforts of Pennsylvania’s Healthy Start Projects and Title V Maternal and Child Health (MCH) Programs.

PPP Mission

To improve women’s and children’s health outcomes in Pennsylvania through:

–Education

–Advocacy

–Collaboration

Issue

• Perinatal depression is the #1 complication of childbirth

• Affects as many as 1 in 7 pregnant women and new mothers

• If left untreated, this will affect both the woman and her baby’s health and cause disruption in the family

Background

Since 2006, PPP has undertaken a multifaceted project on perinatal depression inPennsylvania to:• Increase screening• Improve access to care & care

coordination• Raise public awareness & consumer

knowledge• Advocate for systems changes

Background

• Researched public awareness campaigns in other states and regions of the United States to examine and replicate model projects

• Goal was to develop recommendations for an effective campaign in Pennsylvania

Background

• PPP held a statewide Perinatal Depression Summit in 2007

• Asked for recommendations to improve outcomes in Pennsylvania

Discovery

No national perinatal depression information

network exists to provide a platform for

networking and information sharing among

states or to promote the adoption of best

practices and stimulate cross-state

collaborations

Problem

• With limited funding, programs across the

country are looking for innovative

ways to tackle perinatal depression

• PPP’s project is one example

Solution

Created a Perinatal Depression Information Network (PDIN):

• National initiative

• Web-based

• 15 month project

• July 2008-September 2009

Funding

PDIN is a public-private undertaking supported with grants from:

Spotlight on Local Resources

• Numerous perinatal depression web-based resources exist at the national level for consumers and professionals

• Few focus on local resources that can be easily replicated by others at a community level

Purpose

To link professionals involved in model

perinatal depression projects with those

searching for cost effective and innovative

program ideas, including:

–Provider Resources–Materials for Women & Families–Medical Reimbursement–Legislation

Audience

Web based platform for networking and

information sharing about perinatal

depression at the state or local level

among:

– Medical professionals– Program administrators– Advocates– Public policy makers– Funders

Focus

All aspects of perinatal depression including:

• Public financing• Systems change• Policy information• Public awareness• Provider training• Research• Promotion of best practice models

Activities

• Conducted in-depth interviews with state level Departments of Health, universities, doctors, and program administrators from all 50 states and Washington D.C.

• Formed a national advisory committee with members representing a broad range of professional expertise

• Designed a multi-tiered, interactive website

Interviews

• Hour long phone interviews • Used an interview guide to collect data• Collected information on the following:

– Reason the state began its perinatal depression initiatives

– Detailed description of projects– Barriers and obstacles– Funding and reimbursement– Legislation– Focus areas to address in the future

PDIN Expert Advisory Committee

1. Diana Cheng, MD, Baltimore, Maryland2. Ann Conway, MS, MPA, RN, Madison, Wisconsin3. Nurit Fishler, Salem, Oregon4. Lisa Kirshenbaum, Providence, Rhode Island5. Birdie Gunyon Meyer, RN, MA, CLC, Indianapolis, Indiana6. Laura Miller, MD, Chicago, Illinois7. Brian Shanahan, New York, New York8. Brian Stafford, MD, MPH, Denver, Colorado9. Katherine Stone, Atlanta, Georgia10. Rita Suri, MD, Los Angeles, California11. Gayle Whatley, Birmingham, Alabama12. Katherine Wisner, MD, MA, Pittsburgh, Pennsylvania13. Linda Worley, MD, Little Rock, Arkansas

Coming soon to a computer near you…

www.PDInfoNetwork.org

PDIN Website Features

1. Project promotion

2. Engaging in dialogue with others across the country

PDIN Website Features

Project Promotion

PDIN Website

Main Features:1. State by State Information2. Spotlight3. Research & Funding Opportunities4. Events5. About Us6. Contact Us7. Find Services8. Forum9. Search

Search Capabilities

Users will be able to search for

information by:

1. State

2. Program

3. Keyword

State Specific Pages

Project listings include:– Focus– Lead organization– Collaborators– Funding sources– Timeframe– Contact– Website – Hotline– Provider Resources– Materials for Women & Families– Medical Reimbursement– Legislation

PDIN Project Listings

• Search process was in-depth, but not exhaustive

• Constantly adding & updating the website

• Interested in any state or local perinatal depression project to add as a resource on the PDIN website

• Submit your project to: SarahL@familyplanning.org

PDIN Website Features

Engaging in dialogue with others across the

country

What About Consumers?

• Recognize that consumers will visit the PDIN website

• “Find Services” section will feature state specific websites and hotlines

• National websites will also be listed

Barriers

• Collecting data from across the country has proved to be very challenging

• Ensuring that the information is accurate and up-to-date is a constant demand

• Must guarantee its future and find a permanent home at a well-known organization committed to perinatal depression issues

Implications

• PDIN fills a major gap in sharing information and knowledge about this often neglected type of depression through cross state collaborations

• States will have the tools to more effectively and efficiently help women and their families get support, help, and treatment for perinatal depression

Until then…

E-mail Sarah Gibbons at SarahL@familyplanning.org

to:

• Join the Listserv

• Submit an event

• Submit a project

• For more information

Questions?

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Please join us for the next EMCH Webcast, October 15, 2009, which will address healthy weight and the impact of the built environment.

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