Healthy Mothers, Healthy Babies

Nature of the Problem

Peripartum depression is the most common complication of childbearing, affecting at least one of eight deliveries. Pregnancy exacerbates mental health issues due to financial, social and physical stresses; the mother carries these issues into delivery and beyond. Peripartum depression impacts mother-infant bonding, resulting in lasting child development and behavioral problems, in addition to mental and physical health problems for the mother. Factors such as poor support systems, poverty, drug abuse, etc. make the needs of the mother all the more urgent. In situations where the obstetrical, pediatric and mental health professionals work in silos, it is difficult to offer a comprehensive approach to meeting all the needs of the mother and baby. Peripartum depression goes both unnoticed and untreated. Additionally, 40% of women do not return for a follow up visit with their OB/GYN where problems could be identified. In 2020, screening for postpartum depression using a validated screening tool will be recommended by NCQA (National Committee for Quality Assurance). While medical practices may be able to administer the screening, they are poorly equipped to meet the second part of the requirement, the assessment. Traditional practices lack knowledge of a structure and a business model which might make this possible.

Program Description

Cherokee Health Systems provides integrated care with an OB/GYN, a Pediatrician and a Behavioral Care provider (BHC) part of the care during and following pregnancy. The integrated model includes the location of the OB/GYN Clinic and the Pediatric Clinic within close proximity and the behavioral health professionals embedded in both. Pregnant women are evaluated and treated for depression and other mental disorders throughout pregnancy. These women are subsequently seen in Pediatrics. Mothers who deliver their babies through Cherokee services customarily bring their babies back to Cherokee for pediatric care, providing the opportunity for the mother to be seen as well. All new mothers receive the Edinburgh Postpartum Depression Screening at every visit for the first six months (standard six visits) and can be seen by their OB/GYN in the pediatric office. Any Depression Screening score of 10 or higher is evaluated, treated and followed. This approach with the obstetrician and behavioral health provider evaluating and treating depression before delivery in addition to visiting the mother in the pediatric office during well child checks has resulted in a postpartum major depression rate of 4%, compared to a national rate of higher than 10% with a standard approach to prenatal care.

Disruption

The traditional model of separate Ob and pediatric postpartum visits fails to allow timely treatment of serious mental health issues discovered at the time of initial and subsequent well baby visits. The CHS integrated model is unique in providing OB visits depression screening, and early intervention at the same time and location as the well child checkup. Simultaneous access to all three providers (Ob, Peds, Mental Health) is key to changing the trajectory of postpartum mental illness.

Leadership

Healthy Mothers, Healthy Babies sets a standard of coordination for the behavioral health care and the medical community. While many referrals traditionally come from the physicians’ office, this program allows for immediate consultation between professionals. It also promotes the continuing education of these three disciplines as they consult and learn from one another.

Scalability

Healthy Mothers, Healthy Babies creates an example of how to integrate three services into a seamless delivery and will offer information of how to make it work. Cherokee Health Systems currently offers Training Academies on the Integrated Model. Such educational opportunities will be designed and offered to help other organizations learn how to integrate with their partners.

Results/Outcomes

The integrated approach at Cherokee has resulted in a postpartum major depression rate of 4%, compared to a national rate of higher than 10%. Scattergood Innovation funds may well increase the success of the program by creating a comprehensive sharing of patient records as well as by adding extended case management services.