Last year, Dr. David Perlstein, then working as a pediatric attending, was concerned about the health of an infant who was being seen repeatedly in the hospital’s clinic and emergency department.
Dr. Perlstein, now SBH’s president and chief executive officer, and his team surmised that the condition of the mother’s mental health was behind the infant’s failure to thrive.
This led in spring 2016 to the hospital’s formation of a Maternal Depression Collaborative to study and find answers to this issue. The collaborative brought together clinicians from different hospital departments that had previously worked, for the most part, in siloes when it came to maternal depression – OB, pediatrics, behavioral health and nursing – to explore the problem and create a standardized maternal depression screening and referral process. Coincidentally, at the same time, the Greater New York Hospital Association (GNYHA) started a similar collaborative. By becoming one of GNYHA’s participating hospitals in the project, the hospital assured itself of additional resources and support from the citywide effort.
“It started a conversation [within the hospital] of ‘what can we do better?’” says Dr. Kathleen Asas, a pediatrician who serves as the project leader. “Before this, while some of our doctors were screening for maternal depression in their clinics, we had no standardized screening process in place and there were challenges with consistent communication between departments regarding patients referred. We wanted to document the data and, when necessary, connect patients to behavioral health as part of the referral process. We still have a long way to go, but we’re moving in the right direction.”
While celebrities like Chrissy Teigen, Hayden Panettiere, Drew Barrymore and Gwyneth Paltrow have candidly discussed their own bouts with maternal depression, the problem is particularly pervasive in areas like the south Bronx, where socioeconomic, health and educational factors compound the severity of the problem and its occurrence (with as many as 1 in 5 patients reportedly affected here). New York, like most states, does not require maternal depression screening.
Pilot sites at SBH outpatient clinics have since been introduced, with a self-screening tool, the Edinburgh Postnatal Depression Scale, used to monitor mothers during their initial prenatal visit and later during their child’s 1-week, 2-month and either 4-month or 6-month pediatric visits. Results of the 10-question test are evaluated at each stage and patients referred to behavioral health when necessary.
The use of technology and EMR has enabled doctors to more effectively gather and track data between departments, says Dr. Asas. This allows for more timely handoffs between OBs, nurses and pediatricians, and referrals to behavioral health specialists.
The challenges, however, remain significant. Due to myriad factors – language, education, fear of losing their children, fear of being deported – many mothers at SBH are still either hesitant to complete the surveys or answer the questions candidly. Others refuse a referral to behavioral health should they score over a certain point total on the screening. Still, the percentage of patients in compliance with the program has increased in recent months.
And, patients have benefitted. The mother who appeared in Dr. Perlstein’s clinic a year ago, for example, was found during the screening to have depression. The team connected her with behavioral health services and the city’s Administration for Children’s Services (ACS). She received treatment and resources that provided her with additional care. In recent checkups, her pediatrician reported being pleased that the child had gained weight and is now meeting his developmental marks. Both mother and child are now connected to additional support services to assist with their health and well-being as a family.