1. Addressing Maternal Depression Healthy Start Interconception Care Learning Collaborative Kimberly Deavers, MPH U.S. Department of Health & Human Services Maternal & Child Health Bureau Division of Healthy Start & Perinatal Services

2. Presentation Overview  What is the Healthy Start ICC-LC?  How does it work?  Healthy Start ICC-LC & Maternal Depression  Results, Challenges, & Lessons Learned

3. What is the Healthy Start ICC-LC?  The Healthy Start ICC-LC was developed by MCHB to engage all HS Grantees in quality improvement of Interconception care services.  ICC-LC Project Goals include:  Advancing the quality and efficacy of HS ICC services.  Address identified gaps in ICC service provision.  Develop a toolkit to assist other MCH programs in the quality improvement process.

4. Why Focus on Interconception Care?  For HS grantees, the Interconception Period is the 24 months after the pregnancy of a high risk woman.  ICC services are a required component for all HS grants.  Evidence- based practices can be implemented or promoted by HS Grantees.  Content of ICC services had not been operationalized, and this project provided an opportunity for HS Grantees to apply new evidence.

5. ICC-LC Change Process  Each Healthy Start grantee chooses an ICC Core Content Area & Change Concept.  Teams with similar change projects are then grouped together to create a Learning Collaborative.  Web-based tools And collaborative conference calls facilitate the exchange of information.

6. Characteristics of the ICC-LC  Bring Together Teams with Similar Project Aims  Short-Term Initiative  Scheduled Learning Sessions  Organized Action Periods

7. The Model for Improvement What are we trying to accomplish? How will we know that a change is Improvement? What changes can we make that will result in Improvement? Plan Do Study Act The Improvement Guide, 1996 Jossey-Bass

8. ICC-LC Framework for Change Change Concepts  Strengthening Linkages & Partnerships  Advancing the Use of Evidence-Based Tools & Data Collection  Improving Healthy Start Staff Skills & Protocols Core Content Areas  Case Management  Primary Care  Maternal Depression  Family Planning  Healthy Weight  Screening Assessment

9. Healthy Start ICC & Maternal Depression  Strengthening Linkages & Partnerships  Using Evidence-Based Tools  Improving Staff Skills & Protocols

10. Strengthening Linkages & Partnerships to Address Maternal Depression Aim To assure that HS consumers in need of mental health services are referred to mental health providers that are responsive to their needs. Change Develop strong working relationships one or two mental health providers within the community that will accept HS referrals, and appropriately serve HS consumers.

11. Change Projects on Improving Linkages & Partnerships  Increase the number of mental health providers available for the referral and treatment of HS consumers.  Decrease wait time from referral to appointments for HS consumers.  Develop support groups for consumers suffering from post- partum depression.

12. Change Project Highlights: Prevention Partnerships for Children Change Project  To ensure that HS participants that score positive (12 or above) on the Edinburgh Depression Screening Tool will be referred to a mental health provider for additional assessment and services. Aim  To meet with staff at mental health agencies to inform them of HS participant needs.  To develop an established staffing structure to discuss shared clients between nurses and mental health providers.  To identify and address any barriers to mental health services for HS participants.

13. Using Evidence-Based Tools to Address Maternal Depression Aim To provide depression screening to all consumers using an evidence-based approach. Change To adopt and/or implement consistent use of a validated, objective depression screening tool, as secondary screening to ICC screening.

14. Change Projects on Using Evidence-Based Tools  Develop a standardized protocol for maternal depression screening.  Select an evidence-based tool to be used for maternal depression screening.

15. Change Project Highlights Health Coalition of Southern Oregon Aim  To initiate screening for maternal depression, and that 75% of consumers who are enrolled in the program will be screened for maternal depression. Change  Three counties will use a standardized tool for screening during the prenatal and post-partum period. Participants will be screened at a minimum of one time during the prenatal period, and one time during the post-partum period.

16. Improving Staff Skills to Address Maternal Depression Aim To assure that Healthy Start participants receive effective treatment for depression in a timely fashion. Change To develop and implement protocols to assist participants that screen positive for depression gain access to appropriate diagnosis, treatment, and medication within 60 days postpartum.

17. Change Projects on Improving Staff Skills & Protocols  To provide staff training to enhance staff skills in addressing potentially sensitive consumer issues in order to better coordinate care.  To train staff to deliver brief interventions during home visits for participants screening positive for depression.

18. Change Project Highlights State of Virginia Aim  That at least 80% of Healthy Start staff members will have increased their skills in providing interventions for participants who experience depression. Change  Staff will be able to provide a brief intervention during home visits to participants that screen positive for depression.

19. Results  Each HS grantees working to improve maternal depression identified a change project, and made progress using the PDSA quality improvement process.  On the topic of Maternal Depression in Cycle II:  Peer-to-peer learning increased over the 9 month learning cycle.  With minor adaptations, the quality improvement model utilized can be implemented on a large scale in other case management-oriented public health organizations.

20. Challenges Encountered  Staff Turnover  Limited Resources  Increasing Staff Buy-In  Transportation  Learning Curve and New Technologies Used  Data System Limitations  Competing Demands between Change Project & other Grant Responsibilities

21. Lessons Learned  Quality Improvement Process & the PDSA Cycle can help improve Healthy Start ICC services.  Focusing intently on making one change at a time has allowed projects to accomplish more.  The ICC-LC assisted HS staff with addressing unmet needs, by identifying gaps, and implementing processes and protocols to meet consumer and staff needs.  Evidence-based and strengths-based tools exist for use within a variety of areas related to interconception care services.  Quality Improvement and PDSA is different than evaluation and performance based monitoring.  Projects have shared protocols, tools, data, and methods with each other. This has allowed them to improve efficiency and effectiveness in service provision.

22. Thank you! For more information, please contact: Kimberly Deavers 5600 Fishers Lane, Room 18-12 Rockville, MD 20851 Kdeavers@hrsa.gov