Columbia University Mailman School of Public Health

Massachusetts

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Massachusetts Strategies

Maternal Depression Screening and Response

Since 2014, the Massachusetts Child Psychiatry Access Project for Moms (MCPAP for Moms) program has supported health care providers, including obstetric, pediatric, adult psychiatric and primary care providers, in addressing the mental health and substance abuse concerns of their perinatal patients. The aim of the program is to build the capacity of health care providers to offer evidence-based treatment for maternal depression. MCPAP for Moms offers three core resources to health care providers: trainings and toolkits, psychiatric consultation and referral, and linkages to community resources. Providers call a hotline to speak with a resource and referral specialist who assesses their needs. These can then be addressed with a telephone psychiatric consultation, which is sometimes followed by a one-time face-to-face consultation with the patient, and with assistance connecting with community providers and resources.

The MCPAP for Moms toolkit, which is sent out to enrolled practices, includes the Edinburgh Postnatal Depression Scale and a guide to help the health care provider interpret screening results and consider treatment options. For mothers at all levels of depression – from mild to severe – the treatment options address the needs of both the parent and the infant or young children; those especially focused on the child include dyadic (mother-child) therapy and support for parenting a child with feeding, sleeping, and other self-regulation problems. MCPAP for Moms is also developing resource lists for health care providers to use with individual patients. The lists include a tailored directory of mental health providers near the patient that accept the patient’s insurance.

The obstetric practices covering approximately 85% of the 72,000 deliveries in the state are enrolled, though enrollment is not required for providers to use MCPAP for Moms services. Over 95% of pediatric practices are enrolled in the MCPAP program, which provides consultation on child mental health concerns; the MCPAP program includes information on MCPAP for Moms in the toolkits it sends to pediatric providers. Approximately five percent of calls to MCPAP for Moms are from pediatric practices. MCPAP also urges pediatricians to use the SWYC screening tool for children under one year, which has the Edinburgh Postnatal Depression Scale (EPDS) included.

Practices’ use of the services varies and has changed over time. As doctors have become more aware of the issue of maternal depression, they have become more comfortable following their patients longer through the treatment process. There has also been an increase in one-time face-to-face MCPAP for Moms psychiatric consultations with obstetricians.

Outreach to providers helps engage practices. MCPAP for Moms program staff conduct site visits with newly enrolled practices to explain the program and the importance of maternal depression screening and treatment. MCPAP for Moms also reaches out to enrolled practices that have not been calling the hotline. Quarterly webinars conducted by MCPAP for Moms are available online and generate interest in site visits among practices. When the program began, MCPAP for Moms conducted many site visits during the initial period of enrolling practices, and is now planning to increase site visits and outreach to enrolled practices.

Financing

Funding for MCPAP for Moms comes from the Massachusetts state Department of Mental Health, with approximately 50 percent of funding coming from a surcharge on commercial insurers based on the proportion of commercial clients who use MCPAP for Moms. MCPAP for Moms is free to all pregnant and postpartum women and the providers caring for them. The program’s operating costs were $8.38 per woman per year.

Monitoring and Evaluation

MCPAP for Moms tracks data on each provider encounter and provides information in annual reports to the state. On average, MCPAP for Moms receives 230 calls per quarter. Among enrolled providers there has been a 17 percent increase in reported screenings on the EPDS and a 50 percent increase on the PHQ-9.

A 2010 state law on postpartum depression requires the state department of health to produce an annual report on its activities related to screening for postpartum depression. The state also requires certain providers (OB-GYNs, family medicine practitioners, advanced practice nurses including nurse midwifes and nurse practitioners, and physician assistants) and insurers to report annually on screening for postpartum depression. Anecdotally it appears that most practices are screening, although they may not report screening to the state.

Providers can submit their screening data to the state through a data reporting form or through claims codes. The most recent state report, for calendar year 2016, presents results for both the data reporting form and claim code data. For calendar year 2016, data reporting submitted by seven providers found that 85 percent of patients were screened for postpartum depression. Of the 1,400 patients screened, 86 screened positive (6.1 percent). An analysis of claim code data for 89,289 deliveries from January 2014 through June 2015 found 5,852 mothers were screened (6.5 percent) and 297 had a positive screen.

There is currently research being conducted on how MCPAP for Moms is being used by providers. Nancy Byatt, Associate Professor of Psychiatry, Ob/Gyn, and Quantitative Health Sciences at the University of Massachusetts Medical School and Medical Director of MCPAP for Moms, is leading research efforts. An earlier journal article presented findings on the development, implementation, and utilization outcomes of the first 18 months of MCPAP for Moms.

Special thanks to Beth McGinn, Massachusetts Child Psychiatry Access Program Manager, for providing information for and reviewing this profile.