[Editor’s Note: Today we’re excited to have an amazing post by Lucy J Puryear, M.D., Associate Professor at Baylor College of Medicine. With all the talk we’ve had regarding the US Preventive Task Force’s recommendation to screen pregnant and new moms for mood disorders, we’ve seen a lot of questioning as to how to make this possible. Additionally, we recently learned that less than half of pediatricians discuss mental health with new moms. When we shared this on Twitter the other day, Lucy reached out. We’re in love with the work she’s doing in Texas. We asked her to share more about it. We hope it inspires and encourages you, too. -Jenna]
About three or four years ago my clinic, The Women’s Place in the Pavilion for Women (PFW) at Texas Children’s Hospital, received a Medicaid Waiver Grant (called 1115 waiver because our governor refused to expand Medicaid) to expand screening and treatment of women with postpartum mood and anxiety disorders (PMADs).
My goal has always been to not just screen but to provide a seamless integrated system when positive screens can easily be referred to a provider and followed on up to ensure an appointment is offered.
To date we have successfully implemented a system where every woman who delivers at the PFW (other women can come to us who don’t deliver there) is given the Edinburgh Postnatal Depression Screening Scale (EPDS) at the first prenatal visit, at 35 weeks, and 6 weeks postpartum. A best practice alert is triggered in the medical record, and the EPDS is given and entered into the chart. At any time during pregnancy or postpartum, a woman can be referred to us with a appointment request through the electronic medical record (EMR).
Our team triaged the referral, and we have a social worker who calls those women with the highest scores to make sure they are safe and to provide support and get them emergency care if needed. We try and get all women seen within seven days of the referral.
The second goal I have had for a long time is to have pediatricians screening moms at the two week newborn appointment. This has taken longer to accomplish as it requires lots of coordination with Texas Children’s Hospital (TCH) leadership and individual practice managers.
To date we have successfully rolled out to four pediatrics practices in the TCH system. Our team goes to their offices to provide education about PMADs and how to use the EPDS. The pediatricians have access to the same appointment request in the EMR that comes directly to our clinic. We have promised the pediatricians if they make the referral, we will take responsibility from there to make sure the mother is contacted and seen as necessary. We’ve been piloting two of these practices for two years and have good data and feedback from the pediatricians.
Part of this plan has been to put providers out in the community so that mothers don’t have to come into the huge medical center to be seen. Some women have been driving an hour or more to see us. Right now we have the southeast corner of Houston covered and this summer will have the northwest.
Recently TCH administration met to make rolling out this program to all 56 pediatrics practices in their system. We will be on-boarding groups using the model we’ve piloted. One thing we’ve been able to do is send someone out periodically to encourage compliance and troubleshoot problems. It makes a huge difference to keep the process going. It also makes a huge difference when you have buy in from administration mandating it be done.
This has been terribly exciting and rewarding. When finished I think we will have a national model for wrap around care for new mothers. Currently we have three psychiatrists, one social worker, and one psychologist working with us. We have a fourth psychiatrist joining us this summer. Our psychiatrists don’t always prescribe medication and but also provide supportive therapy. We have a support group we offer to all women. Any new hires from here will likely be social workers to provide evaluations out in the community.
Lucy J Puryear M.D.
Baylor College of Medicine