PU685 Unit 9 Intervention Proposal Example

Screened, Then Stalled: A Unit 9 Intervention Proposal Aimed at the Gap Between a Positive Postpartum Depression Screen and Treatment, Through a Perinatal Psychiatry Consultation Line for a Composite County's Clinicians

[Student Name]

Purdue University Global

PU685: Issues and Concepts in Maternal and Child Health

Unit 9 Intervention Proposal

[Instructor Name]

[Date]

The county, its clinics and its figures are composite; the program model, the screening tool and the research cited are real.

The Problem in Two Numbers

In the past year, the county's four obstetric practices and three pediatric practices screened 3,420 mothers in the first six months after birth with the Edinburgh Postnatal Depression Scale, a ten-item questionnaire validated for this purpose (Cox et al., 1987). Of these, 462, or 13.5 percent, screened positive. Of the 462, only 129, or 27.9 percent, had a documented start of treatment, either medication or a first therapy visit, within thirty days. The first number shows that screening works: coverage is high and the positive rate is in the expected range. The second shows where women are lost. More than 330 mothers a year are identified as likely depressed and left without treatment for at least a month. The stakes are high. When review committees in 36 states examined pregnancy-related deaths from 2017 through 2019, mental health conditions, including deaths by suicide and overdose related to substance use, were the most frequent underlying cause of pregnancy-related death (Trost et al., 2022). The county does not have a screening problem. It has a problem in the thirty days after a positive screen.

Why Positive Screens Stall

The county's needs assessment interviewed 22 obstetric and pediatric clinicians. Three reasons dominated. First, uncertainty about prescribing during pregnancy and breastfeeding: most obstetric clinicians said they would treat moderate depression if they could check a medication choice with a psychiatrist, and pediatric clinicians said they do not treat mothers at all. Second, waits: the county's two outpatient psychiatrists report a waiting time of about four months for new patients, and neither specializes in perinatal care. Third, referral loss: when clinicians refer to therapy, the mother must call herself, and the clinic rarely learns whether she did.

The Intervention

A perinatal psychiatry consultation line for clinicians, modeled on Massachusetts' MCPAP for Moms. In its first three and a half years that program enrolled 145 obstetric practices, trained 1,174 providers and served 3,699 women, and providers reported that it helped them detect and address depression and helped women begin treatment (Byatt et al., 2018). Design for the county:

1. Hours: weekdays 9 a.m. to 5 p.m., with a callback from a perinatal psychiatrist within 30 minutes.

2. Staffing: a perinatal psychiatrist at 0.2 full-time equivalent, shared through a regional academic center by telephone, and one full-time care coordinator based in the county health department.

3. Eligible callers: any obstetric, pediatric, family medicine or midwifery clinician in the county caring for a pregnant or postpartum woman up to one year after delivery.

4. Services: same-day medication advice, a one-time telehealth evaluation by the psychiatrist when needed within two weeks, and resource and referral by the care coordinator.

5. Warm handoff: the coordinator calls the mother within two business days of the clinician's call, books a therapy appointment with her on the line and confirms attendance afterward.

6. Training: a 90-minute session in each practice in the first quarter on screening follow-up, safe medication choices and using the line.

Logic Model in Brief

Inputs: psychiatrist time, coordinator, phone and telehealth system, training. Activities: consultations, evaluations, handoffs, training. Outputs: clinicians enrolled, consultations per month, handoffs completed. Short-term outcomes: share of positive screens with treatment begun within 30 days. Longer-term outcome: lower depressive symptom scores at six months postpartum.

Evaluation

Primary measure: the share of mothers with a positive screen who begin treatment within 30 days, from the same clinic records used for the baseline of 27.9 percent. Target: 50 percent by the end of year two. Secondary measures: practices enrolled, calls per month, time to callback, completed handoffs and repeat screening scores at six months. The comparison is before and after within the county, with the limits of that design stated, and clinic-level data reported so the effect of enrollment timing can be seen.

Budget, Year One

Psychiatrist, 0.2 full-time equivalent, 68,000 dollars. Care coordinator, 62,000 dollars with benefits. Telehealth platform and phone line, 9,000 dollars. Training and materials, 6,000 dollars. Evaluation, 10,000 dollars. Total 155,000 dollars.

Sustainability

The proposal requests two years of foundation funding and, in year two, pursues a state contract under the federal maternal mental health program and billing for the psychiatrist's direct evaluations. At about 330 untreated mothers a year, raising treatment starts to 50 percent would reach about 100 more mothers each year, at a cost near 1,500 dollars per additional mother treated in year one, falling as fixed costs spread.

Risks

Low clinician uptake, addressed by in-practice training and a callback promise. Psychiatrist availability, addressed by a regional backup. Therapy capacity, the hardest risk, since a faster handoff into a full therapy system only moves the wait; the coordinator will maintain a list of therapists with openings and telehealth options.

References

Byatt, N., Straus, J., Stopa, A., Biebel, K., Mittal, L., & Moore Simas, T. A. (2018). Massachusetts Child Psychiatry Access Program for Moms: Utilization and quality assessment. Obstetrics and Gynecology, 132(2), 345-353. https://doi.org/10.1097/AOG.0000000000002688

Cox, J. L., Holden, J. M., & Sagovsky, R. (1987). Detection of postnatal depression: Development of the 10-item Edinburgh Postnatal Depression Scale. British Journal of Psychiatry, 150(6), 782-786. https://doi.org/10.1192/bjp.150.6.782

Trost, S. L., Beauregard, J., Njie, F., Berry, J., Harvey, A., & Goodman, D. A. (2022). Pregnancy-related deaths: Data from maternal mortality review committees in 36 US states, 2017-2019. Centers for Disease Control and Prevention.