Universal well-being assessment for families A path to more coordination and better health outcomes Helen Bellanca, MD, MPH Maternal Child Family Program Manager Health Share of Oregon May 6, 2014

A little background Legacy midwifery clinic approached Health Share to ask for help integrating mental health services into prenatal care We piloted a risk assessment to understand the problem and make a business case

Legacy midwifery data 2013 Medicaid (59%) Commercial (41%) Can identify a PCP29%44% Entered care in the 1 st trimester79%93% “didn’t want to be pregnant” or “bad timing” 36%24% Worried about having enough food safe housing 11% 16% 2% 5% Feel depressed Feel anxious 27% 33% 12% 14% Domestic violence8%2% Binge drinking8%12% Used illegal drugs28%14%

Meanwhile, back at the ranch Multnomah, Washington and Clackamas counties began meeting to discuss a regional maternal child health strategy and relationship with Health Share Healthy Families program was expanded legislatively to include all families (not just first-time parents), but no increase in funding Early Learning Hubs began forming I was convening a subcommittee of the Oregon Perinatal Collaborative

What is the problem we are trying to solve? The primary issues complicating maternity care are mental health issues, substance use disorders, family violence, and poverty-related social problems Public health home visiting programs have limited capacity and need to connect with health care systems Early learning hubs and CCOs must work together Everyone agrees that addressing family risks as early as possible is key

Also… Every public health program serving young families does some sort of risk assessment Health care providers do not know how to assist families needing social services We as a community do not have a good sense of exactly what the needs of our population are, and whether we are meeting them or not Maternity providers were wondering what they should take on next after success of 39 weeks initiative BabyLink in Clackamas county has shown us a model

BabyLink Resources for expecting and new parents and their families Call (971) or text "baby" to this number and we'll call you back.

BabyLink Home Visiting Programs Parent Education Classes Medical and Dental Care Information Insurance questions Linking you to resources in your community Single questionnaire to connect with any resources the families need.

What if… We had a single universal family well-being tool that was used by: every clinic offering prenatal care every public health home visiting program all early childhood providers

We could use this tool to… Coordinate care among heath care providers, public health, early learning communities Aggregate the data by county, region, CCO and state- wide to understand family needs and how they are changing Understand each other’s worlds and operate more like a team Support health and well-being and not just service provision

What would we screen for? Strengths and assets (social supports, resources, PCP, dentist) Food insecurity Housing Family violence Depression and anxiety Substance use disorders Intendedness of pregnancy Need for parenting support Oral health

Alignment CCO metrics Depression SBIRT Prenatal care Integration of public health home visiting programs into CCO global budget Early Learning Hubs’ need for coordination of services

How would it work? Prenatal or pediatric clinician Home visiting nurse or early childhood program Pregnant or child under 1 yr 211 data base 1 Check if FWBA has been done in past year, if not, complete and send 2 Refer if needed 1 Check if FWBA has been done in past year, if not, complete and send 2 Refer if needed

Oregon Perinatal Collaborative Subcommittee on Maternity Model of Care Goal: Community consensus about our next priorities regarding the quality and cost of maternity care in Oregon Participation: WHA, OHSU, Legacy, Kaiser, midwives, public health, many individual practitioners

Maternity Model of Care Prenatal care BIRTH First 30 days postpartum Healthy family Intended pregnancy Address unintended pregnancy January 17 Mental health integration with prenatal care Address substance use disorders in pregnancy Improve transition from maternity care to primary care December 20 February 21 March 21 Prioritize, determine sequential phases, build learning collaboratives

Behavioral Health Integration with Maternity Care Standardize risk assessment tool Include strengths and assets Food, housing, domestic violence, mental health and substance abuse Use to connect to services and discover unmet needs Explore collaborative partnerships versus integrated systems Psychiatric medication prescribing in maternity care