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Maternity Mental Health Screening Update

To Our Regional Medical Staffs,

To aid our physician partners, the Providence, Southern California Women's and Children's Institute has been working in collaborat ion with our Mental Health Clinical Institute to formulate plans to meet the needs of our patient s, providers and hospital staffs to meet the clinical changes associated with universal screening and patient education as outlined by the state regulations passed in late 2018. The requirement for all providers to perform universal screening began on July 1st, 2019, and the requirement for hospitals to provide educational content to patients and families on January 1st, 2020 . We began a multidisciplinary committee in January of 2018 to carefully plan implementation of the education, tools and expanded mental health services required.

Of import, we are fortunate that colleagues at St . John's Health Center received a $709,000 grant from the Well Being Trust to achieve these goals for the region. The grant allows for getting personnel and education to achieve our lofty goals. We will be working with experts from Maternal Mental Health NOW and hope to have regional services which should be amongst the best in the region. Finally, we were fortunate to secure grant funding for the physician enterprise from Blue Shield to expand our Mental Health Counsellor program to meet the increased need for screen positive patients.

Here is some of the key aspects of the program:

In June and July 2018, education about why and how to perform screening has been offered and conducted for physicians and offices at all regional ministries. This education included a slide presentation explaining the requirements and techniques for conducting/responding to screening tools and how to utilize the Providence network resources for patients who are screen positive. In addition, all mother baby staffs have been educated on the need to educate patients and families about perinatal mood disorders. They have been trained on how to help register patients on the Circle App and find information on Perinatal Mood Disorders.

Concurrent to the above efforts, the Mental Health Clinical Institute has hired the additional counsellors and set up hotlines for physician offices and patients to get follow-up ser vices. These are operational and already seeing pati ents.

The educational material chosen for education was the pregnancy App, Circle, which was a free resource tool for patient education. The content embedded was carefully reviewed by Women's Psychiatric specialists and other mental health professionals to ensure the content was up to date and met the need for the spectrum of mental illnesses seen in pregnancy.

We elected to utilize this method based upon:

  1. Patient surveys indicating that this was preferable over additional paper handouts/brochures which are given in pregnancy
  2. The feel ing that this portable method would be available to the patient whenever they needed;
  3. Content could be expanded and updated easily
  4. Internal audits showing most of our patients had cellphones
  5. The Circle App had many benefits beyond mental health. This also is part of system efforts to modernize our care and should be augmented by other programs such as MyChart.

Despite these efforts, there may be a need to use other forms of education for: 1) Women who need content in other languages beyond English or Spanish, 2) A small number of patients who do not or refuse to use the App (initial experience in most of our ministries is this should be low single digit percentages) and 3) In patients who prefer using another pregnancy App with the same material. For these reasons we have set a goal of getting the Circle App to at least 80% of patients delivered for each ministry. Some ministries are already close to this benchmark but there are some ministries which must really increase their efforts to get to these levels. We will also be distributing to the ministry paper handouts from MMHN which cover several additional languages options for the patients who are not being covered by our electronic efforts.

Through the grant, we also are planning some important educational meetings which will be taught by Maternal Mental Health NOW including:

  1. Staff training to serve as local experts/mentors in each ministry
  2. Physician training in nuances of screening which will be open to OBGYN, Pediatrics, CNM/NP and Primary Care physicians. In addition, that training will include a primer on the treatment of mild to moderate cases by provider s.

The Steering Committee is meeting monthly to monitor our efforts and ensure these efforts continue implementation and momentum. We do have the capability of tracking compliance of our Circle App distribution. We obviously would invite your support and suggestions on how these efforts are meeting or can better meet your patient's needs.

Sincerely,

Mike Sherbun, RN, MHA, Executive Director, Executive Leader Mental Health Institute, Providence St. Joseph Health Southern California Region, 3345 Michelson Drive, Suite 100, Irvine CA 92612; (949) 381-4071; Mike.Sherbun@stjoe.org

David C. Lagrew, Jr., MD, Executive Medical Director, Executive Leader Women and Children's Services Institute, Providence St. Joseph Health Southern California Region, 3345 Michelson Drive, Suite 100, Irvine CA 92612; (949) 381-4718; David.Lagrew@stjoe.org

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