Overcoming Barriers to Implementing Depression Screening in the Los Angeles County (LAC) Medicaid Comprehensive Perinatal Services Program (CPSP)

Overview

 1 in 5 women are affected by depression in LAC. Depression has detrimental consequences for the mother and entire family. To improve screening and diagnosis, the LAC CPSP program, an enhanced prenatal care program, developed a perinatal depression screening and treatment training.  Over 100 medical providers and staff have been trained in the last 3 years.

Methods

CPSP providers who participated in the depression training completed a survey of 18 questions to assess attitudes, implementation, challenges, and successes. Descriptive analysis was performed. 

Results

155 providers completed the depression training. 92% (104/113) use the PHQ-9 to screen for depression. 87% screen first trimester, 58% screen during the second and third trimester and 81% screen postpartum. Reasons cited by providers for not screening for perinatal depression included ” no time”, “no depressed patients”, “patients dislike personal questions”, and “lack of resources” . Depression score (83%) and provider judgment (77%) were the primary reasons for referring a patient for depression. 69% of respondents stated they needed more training on providing treatment and 79% need more referral/resources. Providers cited less than 25% of patients screening positive for depression actually followed up with the referrals provided.

Conclusion

The CPSP depression training provides the first steps in addressing perinatal depression- increased awareness and tools for screening. Efforts need to focus on depression treatment and referrals. More importantly, strategies to ensure patient follow up when screening positive for depression need to be developed so that maternal, infant and family health improve.