1. DEVELOPING A COMMUNITY PATHWAY TO IMPROVED MATERNAL MENTAL HEALTH OUTCOMES
Holly Jordt, RN
I am the nurse supervisor for Maternal Child Health Services at the Flathead City-County Health Department in Kalispell.
This is a collaboration that I am working on for my Supporting and Evaluating Community Partnerships for Health course

2. PROJECT OBJECTIVES
1) Increase awareness of Perinatal Mood and Anxiety Disorders (PMAD’s)
2) Routinize screening
3) Early ID and management of PMAD’s
4) Develop an effective and efficient system to manage PMAD’s
5) Increase referrals to community and peer supports
6) Increase provider follow up with women screening positive

3. WHAT IS THE PROBLEM?
There are significant problems associated with PMAD’s:
1) Maternal mental health is the leading complication in pregnancy
2) Impacts up to 1 in 5 women during the perinatal timeframe with many associated complications for mother and child
3) Poor health outcomes for mother/children including maternal and infant deaths related to complications of unaddressed PMAD’s

4. WHAT ARE WE DOING?
1) This project brings together partners invested in creating conditions to support improvements in maternal mental health with the formation of the Flathead Maternal Mental Health Coalition
2) We intend to develop a community pathway to better identify and treat women with PMAD’s and ensure follow up

5. VISION & MISSION OF FLATHEAD MATERNAL MENTAL HEALTH COALITION
VISION: Healthy Families
MISSION: To build a community network to support maternal mental health and to create optimal conditions to raise well-supported, healthy children

6. WHO ARE OUR PARTNERS?
Healthy Mothers, Health Babies from Helena with BCBS funding
KRMC w/ MT Healthcare Foundation funding
NVH
Local Medical Providers
Early Childhood Coalition
FCCHD
Mental Health providers
Community members who have experience PMAD’s

7. UNIVERSAL SCREENING FOR PMAD’s
Universal screening will create many benefits:
1) awareness of the prevalence of PMAD’s
2) Decrease stigma
3) Early identification of PMAD’s with fewer complications for the family unit
4) Decrease high cost of untreated PMAD’s

8. COMMUNITY-WIDE REFERRAL PROCESS
1) Creates an efficient referral system utilized in all provider offices
2) Becomes the standard of care
3) Connects families with evidence based interventions for treating PMAD’s such as medication, therapy, support groups, home visiting support services

9. SCREENING PROCESS
For the screening process to occur each providers will adopt a screening tool
The tool will be provided to each perinatal patient upon check in at prenatal, postpartum and well-child appointments on a standard timeline
Results will be evaluated by the provider

10. REFERRAL PROCESS If the score is 5 or less requires no further action
A score is 6-9 will be referred for community and peer support
A score of 10 or higher the provider will conduct further evaluation and a referral to community and peer support
If there is risk for self or infant harm, a crisis plan will be implemented

11. FOLLOW UP PROCESS
1) Within 2 weeks of the initial screening and referral the provider will follow up to assess progress with accessing the interventions referred to
2) If no interventions have been accessed, provider will assess and troubleshoot barriers to access
3) Follow up will be documented

12. CONSIDERATIONS
1) How to make process as simple as possible for patient and providers
Documentation practices in a variety of settings
Screening tool needs to be a billable tool and one that captures more than just depression
4) Sustainability of community pathway utilizing existing programs in your community

13. EVALUATION PLAN WITH QUANTITATIVE DATA
Quantitative data for this project includes:
1) # of women screening positive for PMAD’s that are referred for an intervention and have a lower follow up screening score
# of peer support groups established
Number of providers receiving education regarding the screening, referral and follow up process
Number of women participating in peer support groups

14. EVALUATION PLAN WITH QUALITATIVE DATA
PAUSE…
1) Qualitative data will be more difficult to collect and analyze for this project
2) Measure by pre and post-survey provider comfort level with screening and referral process
3) Measure by survey the ease of making a referral utilizing the community care pathway

15. WHERE DO WE GO FROM HERE? PAUSE….
As a newly formed coalition, we have a lot of work to do.
Excited that we are looking into this issue and that our community has available resources for this project
It has the potential to improve maternal, child and overall family outcomes
THANK YOU

16. References
Committee opinion: Screening for perinatal depression. (2015, May). Retrieved February 11, 2018, from Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Screening-for-Perinatal-Depression
Best, Sarah, LMSW (2015) How to help women with perinatal mood and anxiety disorders: 4 essential clinical strategies to help women recover. Psychology Today. Retrieved February 8, 2018, from
Sit, Dorothy, MD, Rothschild, Anthony J, MD, Wisner, Katherine L., MD, MS (2002): A review of postpartum psychosis, Journal of Medicine. Retrieved February 3, 2018 from
Kendig, Susan, Keats, John P., Hoffman, Camille, Kay, Lisa B., Miller, Emily S., Moore Simas, Tiffany A., Frieder, Ariela, Hackley, Barbara, Indman, Pec, Raines, Christena, Semenuk, Kisha, Wisner, Katherine L., Lemieux, Lauren A. (2017). Consensus bundle on maternal mental health: perinatal depression and anxiety. Retrieved February 3, 2018 from
Policy Brief, Spring 2018: Helping Children by Addressing Maternal Depression. Retrieved February 4, 2018 from Children's Hospital of Philadelphia.
UNC School of Medicine. Department of Psychiatry, Center for Women's Mood Disorders: Perinatal Mood and Anxiety Disorders. Periodic Title Retrieved from journal URL. Retrieved February 3, 2018 from UNC School of Medicine.
Minnesota Department of Health. Perinatal Mental Health – Information for Health Professionals. Retrieved March 18, 2018 from
Screening Recommendations. Postpartum Support International (2017). Retrieved from