243244 Improving Mental Health Services to Pregnant Women in an Urban Community Health Center

Monday, October 31, 2011: 4:50 PM

Chanchal Sharma, Psy D, MSEd, MA , South Bronx Health Center for Children and Families, Montefiore Medical Center, Children's Health Fund, Bronx, NY
Barbara Hackley, MS, RN, CNM , Montefiore Medical Center, Children's Health Fund, South Bronx Health Center for Children and Families, Bronx, NY
Shira Silton, LCSW, MA , South Bronx Health Center for Children and Families, Montefiore Medical Center, Children's Health Fund, Bronx
David Herszenson, MD , South Bronx Health Center for Children and Families, Montefiore Medical Center, Children's Health Fund, Bronx
Anita Hadpawat, MD, Scm , Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY
BACKGROUND: Depression is common in primary care settings. Rates of depression appear to be even higher during the perinatal period and are significantly higher than other common conditions in pregnancy. Prevalence rates for preeclampsia have been reported to be 3% and 4%- 8% for gestational diabetes compared to 15% for depression. Yet depression is overlooked in many pregnant women, often because many health care providers feel unprepared to detect or manage mental health (MH) conditions. Further compounding this problem is a paucity of available resources. Wait times for psychiatric referrals in inner city communities can be 3 months or longer. METHODS: A coordinated system of care was developed by a team of MH specialists and primary care providers at a community health center to address the unmet mental health needs of pregnant women in the South Bronx. This included implementing a standardized screening and referral process, incorporating a “meet and greet” strategy during intake, co-location of MH and primary care services, and offering on-going provider training and support. RESULTS: In the first 6 months of implementation, 89.5% of pregnant women enrolled in care were screened for depression; of these, 31.7% screened positive for depressive symptoms and needed more in-depth evaluation. Twenty-six percent were referred to a MH specialist; 100% of these women received care. CONCLUSION: Using a coordinated system of care increases screening and facilitates entry to MH care. Improving management of MH issues in pregnant mothers may also improve maternal-child bonding and future infant development.

Learning Areas:
Chronic disease management and prevention
Diversity and culture
Implementation of health education strategies, interventions and programs
Social and behavioral sciences

Learning Objectives:
1) Describe strategies to screen and refer pregnant women for mental health care 2) Demonstrate how to determine the level of care needed by women based on recommendations set by the MacArthur Initiative on Depression & Primary Care. 3) Articulate the role of primary care providers and mental health specialists in providing a coordinated system of care.

Keywords: Mental Health Care, Perinatal Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am qualified to present because I oversee the Mental Health Department Programs at the South Bronx Health Center for Children and Families, Monteifore Medical Center, A Program of the Children's Health Fund
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.