Outcomes of Implementing Routine Screening and Referrals for Perinatal Mood Disorders in an Integrated Multi-site Pediatric and Obstetric Setting
We report on a successful quality improvement project designed to increase access to perinatal mental health services through universal screening for postpartum depression (PPD) and facilitating referrals for evaluation and treatment, at a multi-site, integrated system of pediatric and obstetric practices in Houston, Texas.
Obstetric practices administered screenings twice during pregnancy and at 6 weeks postpartum. Pediatric practices screened women at the 2 week and 2, 4, and 6-month well-baby visit. Women with a score of 10 or higher on the Edinburgh Postnatal Depression Scale (EPDS) or women that reported thoughts of self-harm were offered a referral to a mental health provider. Data on screening and referrals were collected from the electronic medical record.
A total of 102,906 screens for PPD were completed between May 2014 and July 2018. Of those, 6487 (6.3%) screened positive. The total number of women referred to treatment were 3893 (3.8%). Of referred women 2172 (55.8%) completed an appointment with a mental health provider within 60 days of referral. Rates of completed appointments varied by the level of integration of the mental health provider and referring physician: women referred by pediatrics in a Level 1 coordinated system completed 20.0% of referrals; obstetrics Level 4 co-located system, 76.6%; and obstetrics Level 5 integrated model, 82.7%.
This project demonstrated that with planning, systems review and trained staff, PPD screening can be integrated into obstetric and pediatric practices and high screening and referral rates can be achieved.
KeywordsScreening Postpartum depression Edinburgh Postnatal Depression Scale Maternal and child health Pediatrics well-child visits
We would like to acknowledge Stanley Spinner and Katherine Tittle of Texas Children’s Pediatrics for their enthusiastic support and cooperation in implementing this project. Likewise, we would like to thank the Behavioral Health, Obstetric, and Pediatric Health Care Teams who were on the ground putting this plan into action. We are also greatly indebted to The Pavilion for Women Leadership Team who believe women’s mental health care is part of total health care for all women and financially support our efforts.
This project was possible by supplemental funding through the Delivery System Reform Incentive Payment Program (DSRIP) 1115 Waiver.
Compliance with Ethical Standards
Conflicts of interest
The authors declare that they have no conflict of interest.
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