Evaluating the Feasibility of a Stepped-Care Protocol for Postpartum Depression via Adoption and Maintenance (Cost)

• Main Authors: Morrell, Allison, Dyer, Halie, Smith, Courtney, Kuang, Kammy, Mills, Deb, Jaishankar, Gayatri, Schetzina, Karen, Polaha, Jodi
• Published: Digital Commons @ East Tennessee State University 2016
• Subjects: stepped-care protocol; postpartum depression; adoption; maintenance; Family Medicine; Pediatrics
• Online Access: https://dc.etsu.edu/etsu-works/6621

Introduction: Research has shown that Postpartum Depression (PPD) occurs in 10-20% of new mothers. Symptoms of PPD include excessive sadness, increased anxiety, guilt, and possible suicidal ideation. PPD can increase a mother’s risk for health and psychological dysfunction including future psychiatric illnesses, substance abuse, and decrease her adaptive functioning. PDD can also have negative implications on child safety practices and a child’s psychosocial and developmental wellbeing. Treatments for PPD, such as medication and psychotherapy, have been shown to be effective at reducing the number and severity of a mother’s symptoms, and generally improving their lives and the lives of their families. Unfortunately, many mothers do not receive treatment due to fears of stigma, inadequate screening practices and an inability to access care. Thus, early detection and improved access to care is critical and literature suggests formal screening practices increases the rate of detection. Pediatrician’s offices serve as ideal locations to screen mothers and connect them to appropriate services because of frequent contact with the mother. Methods: Recognizing this public health concern, the American Academy of Pediatrics developed PPD screening guidelines. ETSU Pediatrics, a local pediatric primary care clinic, adhered to these guidelines, assembled an interdisciplinary health care team, and developed a stepped care protocol to not only screen all new mothers but connect them with immediate, onsite behavioral health services. The protocol consisted of four distinct phases: 1) distribution of the Edinburgh Postnatal Depression Scale (EPDS), an evidence- based tool screening for depression in new mothers, to every mother of infants 0 to 6 months at their well- child visit; 2) appropriate documentation of the EPDS score and plan of action noted within the electronic medical record (EHR); 3) brief behavioral health intervention conducted by the on-site behavioral health consultant, and/or referral to outside provider; 4) phone call follow up with mother and referred provider. The aim of the study is to evaluate components of intervention feasibility based upon the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, and Maintenance), which stems from the Dissemination and Implementation Science field. This particular project extends past previous pilot studies to include EHR chart review from an entire year and evaluates the protocol’s feasibility by examining Adoption and Maintenance domains. Results: Results were collected from EHR and billing records of all patients, 0 to 6 months of age, seen at the clinic from February 26, 2014 to February 25, 2015 (n = 755) for their well-child visit (n = 2,459). Adoption will examine feasibility by noting the percentage of mothers who were administered the EPDS as well as the general trend in administration across the year. Maintenance will examine feasibility from a financial perspective and reveal the amount of reimbursement accrued by billing for the EPDS. Conclusions: The anticipated results will have implications on the