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SUMMER 2017
SUMMER 2017
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5
L
ast 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.
COMMUNITY PROJECTS
Hospital Collaborative Explores Maternal Depression
By Steven Clark
POPULATION HEALTH
N
ationally, 13 percent of
Americans are foreign
born and 20% speak a language
other than English at home. In
the Bronx, almost one-third of
residents are foreign born and
more than half (55.7%) speak
non-English languages at home.
Patients who come through
our hospital doors may not meet with employees who share
the same culture, communication styles and experiences with
the health care system. Questions that may seem essential to a
health professional might feel confrontational to a patient. Fear
of seeming disrespectful or calling into question a provider’s
language expertise can keep a patient or family member
from asking for an interpreter. Some patients may not feel
comfortable providing certain information about their health,
family history or housing status.
Last November, Bronx Partners for Healthy Communities
(BPHC) began offering cultural competency training to
the frontline workers of its 230-member organizations. It
has quickly become the most popular training program the
organization offers to employees.
“The word has spread and classes fill up immediately after we
announce a new training,” says Mary Morris, BPHC’s director of
Workforce Innovations.
The one-day, in-person training gives workers the skills and
insights to listen, understand and provide care and services
through the lens of a patient’s or client’s own culture, beliefs,
language and experiences with the health care system. The
training addresses issues of race, ethnicity, religion, disability
and sexual identity in the context of how people access care and
other services.
Participants learn to take the perspective of the client and see
how overwhelming it can be to try to access health care or other
community services. They can better understand the external
factors that might be guiding a patient’s decisions, the lack of
control a patient may have over their health care and how that
might make them feel.
More than 500 staff members, including nurses, community
health workers, registrars, housing specialists and SBH
leadership, have been trained. The curriculum was developed
and administered by The Jewish Board. For physicians, related
training will be offered through BPHC starting in the fall
through a program being developed and presented by the
Immigrant Health and Cancer Disparities Service at Memorial
Sloan Kettering Cancer Center.
A highlight of the training is a historical look of the Bronx
starting in the 1890s, when it was considered a “wonder
borough,” through today, including the immigration wave of
the early 20th century, the Depression and the impact of urban
renewal in the 1960s and 1970s.
“A light bulb goes off for people,” says Morris. “They see the
structural and environmental factors that contribute to the
many health disparities in the borough like high rates of
asthma, cardiovascular disease and diabetes. They understand
the framework through which many patients and clients view
their world.”
Self-awareness is another key element of the training.
Participants become more aware of their own beliefs, values,
cultural influences and the way they communicate including
their body language, tone of voice and attitude. From there,
they learn effective ways to ask open-ended questions, provide
explanations, and guide patients and clients to advocate for
themselves.
“There is value across the board [to the training],” says Arlene
Ortiz-Allende, Senior Vice President, Community and
Government Affairs/Chief Diversity Officer at SBH Health
System. “When we meet people where they are, doctors can
provide patients with the quality care they deserve and truly
engage them in their own health and wellness. That’s how we
achieve patient-centered care.”
Seeing Health Care Through Our Patients’ Eyes
By Luci de Haan
