Bridget Burnett, PsyD Kathryn Jantz, MSW, MPH Sue Williamson, JD

Slides:



Advertisements
Similar presentations
Perinatal Mental Health in Colorado: What We Know and What We Can Do
Advertisements

Clinical Alliances and Partnerships Raul A. Romaguera, DMD, MPH Division of HIV/AIDS Prevention Centers for Disease Control and Prevention March 11, 2004.
National Health Information Privacy and Security Week Understanding the HIPAA Privacy and Security Rule.
The Health Insurance Portability and Accountability Act of 1996– charged the Department of Health and Human Services (DHHS) with creating health information.
Are you ready for HIPPO??? Welcome to HIPAA
CDC Recommendations for HIV Testing of Adults and Adolescents Christina Price, MPH Delta Region AIDS Education and Training Center.
NECTAC Webinar Series on Early Identification and Part C Eligibility Session 2: A Rigorous Definition of Developmental Delay March 10, 2010 Steven Rosenberg,
Minor Consent Laws Kim Belasco – (619) Rachel Miller – (619)
Informed Consent and HIPAA Tim Noe Coordinating Center.
Sharon Levy, MD, MPH Children’s Hospital Boston
Illinois Children’s Healthcare Foundation CHILDREN’S MENTAL HEALTH INITIATIVE Building Systems of Care: Community by Community Fostering Creativity Through.
Behavioral Health Coding that Works in Primary Care Mary Jean Mork, LCSW April 16 & 17, 2009.
REAL-START : Risk Evaluation of Autism in Latinos (Screening Tools and Referral Training) Assuring No Child Enters Kindergarten With an Undetected Developmental.
Nic Dibble, Consultant School Social Work (608) Department of Public Instruction
© 2007 McGraw-Hill Higher Education. All rights reserved. 1 School Health Services: Promoting and Protecting Student Health Chapter 2.
Illinois’ Initiatives in Perinatal Depression Ralph Schubert, M.Sc., M.S. Acting Associate Director for Family Health Illinois Department of Human Services.
Perinatal HIV Testing in Utah Lois Blobaum, BSN, Theresa Garrett, MSN and Nan Streeter, RN, MS Utah Department of Health.
Effective Partnerships School-Based and School Linked Health Care Michigan Perspective School Community Health Alliance of Michigan.
Minors and Mental Health Treatment: Who Gets to Decide? Center for Children’s Advocacy KidsCounsel Seminar September 29, 2009 Jay E. Sicklick, Esq. Deputy.
Comprehensive Clinical And Policy Resource Guide To Assess Children's Needs Molly A. Hicks, M.P.A. Assistant Director Department of Federal Affairs American.
HIV Testing In Vermont Update 2007 Cathleen Harris, MD Fletcher Allen Health Care.
Screening Implementation: Referral and Follow-up What Do You Do When the Screening Test Is of Concern? Paul H. Lipkin, MD D-PIP Training Workshop June.
Medical Law and Ethics Lesson 4: Medical Ethics
Enhancing Communication Among Health Care and Educational Programs How Privacy Regulations Impact Delivery of Effective Services by Karl R. White National.
MICHIGAN'S INFANT MORTALITY REDUCTION PLAN Family Impact Seminar December 10, 2013 Melanie Brim Senior Deputy Director Public Health Administration Michigan.
Medical Homes For Children in Foster Care: A Proposal for CCNC Consideration Proposal collaboratively developed by: NC Pediatric Society Foundation & Benchmarks.
We have no relevant financial relationships with the manufacturers of any commercial products and/or provider of commercial services discussed in this.
Comprehensive Health Insurance: Billing, Coding, and Reimbursement Deborah Vines, Elizabeth Rollins, Ann Braceland, Nancy H. Wright, and Judith S. Haynes.
Health Care Self-Management (Provider Version) Late Effects of Treatment for Childhood, Adolescent and Young Adult (AYA) Cancers Supported by a grant from.
HIPAA Training. What information is considered PHI (Protected Health Information)  Dates- Birthdays, Dates of Admission and Discharge, Date of Death.
KITS V JUNE , 2014 BREAKING DOWN AND UNDERSTANDING THE PSYCHOLOGICAL : WHAT YOU DON’T KNOW CAN HURT YOU M. Connie Almeida, PhD, LSSP, Licensed Psychologist.
Disclaimer This presentation is intended only for use by Tulane University faculty, staff, and students. No copy or use of this presentation should occur.
Juvenile Legislative Update 2013 Confidential Records and Protected Disclosures.
PRACTICE MANAGER MEETING Thursday Sept. 29th 2016 Noon – 1:15PM Instructions to join the meeting remotely: 1.Open a web browser and enter URL:
HIPAA Privacy Rule Training
Pregnancy Related Depression (PRD) Screening in the Pediatric Setting: Clinical Considerations, Complexities and Coordination Bridget Burnett, PsyD Kathryn.
Screening for Patients’ Health Insurance and Confidentiality Needs
Iowa Council for Early ACCESS: Overview
AAP Perspective on Post Partum Depression Screening
Mental Health Issues With Student-Athletes At The Collegiate Level
RCHC Developmental Screening and Referral project for Children 0-5 served by Sonoma County Community Health Centers.
Notification of Observation Status
Clinical Medical Assisting
Virginia Department of Health Staysi Blunt, Evaluator
CHAPTER 4 LEGAL AND ETHICAL PRINCIPLES
MENTAL HEALTH MEDI-CAL ADMINISTRATIVE ACTIVITIES
Changes to Medicaid Coverage of ASD
And the finer details of patient privacy
Research Questions Does integration of behavioral health and primary care services, compared to simple co-location, improve patient-centered outcomes in.
Screening and Referral
Jessica A. Lanerie, MD1 and Teresa K. Duryea, MD2
The Vision: Invent a system to increase client success…..the medical clinic model.
NEWBORN DEVELOPMENT RISK ASSESSMENT:
Introduction to Health Insurance
Refuah Community Health Collaborative (RCHC) PPS
Confidential Records and Protected Disclosures
The Emergency Medical Treatment and Active Labor Act
MDHHS Response to the Opioid Crisis
Project 3B: Reproductive, Maternal and Child Health – Logic Model 2018
Value-Based Payment Maternity, Delivery, and Infant Care
Primary Care Milestone 15
How Managed Care Can Support Family Caregivers
Pregnancy Related Depression (PRD) Screening in the Pediatric Setting: Clinical and Operational Considerations Western Slope ENSW/SIM Collaborative Learning.
Chapter 3: Basics of Health Insurance
The Basics of Play Therapy for Early Childhood Intervention
FERPA and HIPAA for School Nurses and School Based Health Center Staff
Obtaining Proof of Decision-Making Authority
SAMPLE ONLY Dominion Health Center: Your Community Partner for Excellent Care (or another defining message) Dominion Health Center is a community health.
SAMPLE ONLY Dominion Health Center: Your Community Healthcare Home (or another defining message) Dominion Health Center is a community health center.
HUMAN IMMUNODEFICIENCY VIRUS (HIV) PREVENTION & CARE
Presentation transcript:

Pregnancy Related Depression (PRD) Screening in the Pediatric Setting: Operational Considerations Bridget Burnett, PsyD Kathryn Jantz, MSW, MPH Sue Williamson, JD In collaboration with: Colorado Department of Public Health and Environment (CDPHE) Colorado SIM Office ENSW/SIM Collaborative Learning Session – Golden, CO June 2, 2017

Learning Objectives for Presentation Summarize the literature review and key informant interviews around the operational challenges of performing the PRD screening within the pediatric setting Identify findings on billing and coding for Medicaid and commercial payers for the PRD screening Describe approaches and best practices used among pediatric practices (where to document within the EMR, consent forms, policies, and procedures) Operational only-sue

Colorado Pregnancy Related Depression (PRD) Facts According to the DSM, Pregnancy Related Depression is a form of Major Depression that occurs within four weeks of delivery Prevalence: Ten percent of Colorado mothers experienced frequent PRD symptoms (2011) (1) Significant impact on children: Infants of parents with PRD often have delayed cognitive and psychological development, delayed motorized skills, lower vocalizations, and increased resource use Screening is reimbursed: Medicaid (federal and state) supports and reimburses screening by the child’s medical provider under the child’s Medicaid ID CDPHE and others don’t use DSM diagnosis Behavioral health clinicians are moving to PMADs. In setting up strong processes and procedures around PRD, practices are preparing for a more holistic, PMADs approach. (1) Colorado Department of Public Health and Environment Pregnancy Risk Assessment Monitoring System (PRAMS)

American Academy of Pediatrics (AAP) Position Includes “assessment and consideration of parental and family environmental factors that may affect children’s health”, maternal depression being one of these. Include bullets about importance- Sue

Additional Recommendations United States Preventive Services Task Force (USPSTF) – depression in general adult population including pregnant and postpartum women Centers for Medicare and Medicaid (CMS) – identifies importance of PRD screening and encourages child’s provider to refer mothers for appropriate care

Policy Perspective Encouraged to administer PRD screenings in a pediatric setting SIM initiative – PRD screening is a Clinical Quality Measurement (CQM) Medicaid and other payers reimburse PRD screening in pediatric setting

Mom is Not My Patient: Pediatric Worry List??? Do I need mom to sign consent form to administer PRD screen? Where do I record the results in my EHR? In the child’s (patient’s) records? Am I responsible for ensuring Mom has received appropriate referral to services? To what extent can I release child’s records to outside party when it includes Mom’s information? Do I have to let my risk management (malpractice) carrier know I’m doing this? Is my risk/liability greater if I do nothing? How do I know if Mom connected to the referral I made?

Findings: Notifications and Informed Consent No clear consensus what type of notification a mother or father should receive about assessments or interventions directed at them within pediatric setting Informed consent a construct for “treatment” although HIPAA defines it broadly Gray area as to whether “treatment” defined broadly enough to include administration of PRD screening to mom How to effectively and appropriately “close the loop” on referrals?

Recommendations: Notifications and Informed Consent Consider revising standard forms to notify parents that mental health screening will occur Consider notifying parents of the process for referring to other community or mental health providers Consider written policies and procedures related to the maintenance and release of mental health related data Obtain an ROI to coordinate the referral and “close the loop” with external systems Ask the group whether they have done this

Findings: Liability Treating adults not within traditional scope of pediatric practice Absence of clear standard of care for pediatrician Inference that policy recommendations serve as a proxy for standard of care Case law/risk management: insufficient evidence that addressing maternal mental health outside the scope of pediatric practice Seems reasonable that pediatricians may perform these activities Operational Only

Emergency Protocols Do you have a written protocol for when a mother indicates she may be at risk for harming herself or her child?

Recommendations: Liability Limit liability by establishing carefully defined screening, documentation of results and referral policies and procedures

Findings: Privacy and Data Management Guidelines around data management based on maintaining personal health information (PHI) for a single patient and releasing that information based on clearly defined rules No consensus about how best to document screening results and follow-up related to mental health status of the parent of the patient One legal analysis: presence of information in the child’s chart results in it becoming the child’s PHI Typically behavioral health confidentiality held to higher standard by courts

Data Management Key Decisions Where: Record information in the main EHR or in an area intended to have greater security? What: What information is retained (screening score, follow-up plan, conversations at future visits)? Release: How and when is the information released. Does it appear on your patient portal? Kathryn- Operational only Poll how many people put in their main EHR

Recommendations: Privacy and Data Management Consider establishing clear written polices about data points provided or not provided when the child’s record is solicited by another entity (including another caregiver who may have no relation to the mother)

Findings: Billing and Coding Private insurers have range of policies and coverage for PRD screening in practices Colorado Medicaid (NEW!): 3 times a year Billing and coding report

Emergency Protocols Do you have a written protocol for when a mother indicates she may be at risk for harming herself or her child?

Identified Gaps Trainings for staff on PRD Referral lists for all communities and clinics Reimbursement that supports comprehensive services and prevention associated with screening in a pediatric perspective Official guidance around policies and procedures on consent, and data management, privacy

Acknowledgements CDPHE Denver Public Health Colorado SIM HealthTeamWorks Project CLIMB Children’s Hospital Colorado