Perinatal Depression Policy Roundtable Recommendations
On November 19, 2009, LA Best Babies Network and the LA County Perinatal Mental Health Task Force hosted the first Los Angeles County Perinatal Depression Policy Roundtable, convening more than 30 stakeholders in perinatal mental health to identify perinatal depression policy recommendations and solutions, and develop an action plan and policy agenda around these recommendations for L.A. County.
Focusing on four primary areas of concern:
- Access, Financing, and Standards of Care
- Education and Training of Healthcare Providers
- Public Awareness/Education and Social Support
- Mental Health Workforce
This ambitious agenda yielded the following recommendations, which guide the current maternal depression policy and advocacy efforts of the LA County Perinatal Mental Health Task force and LA Best Babies Network.
focused on access to care, including insurance coverage; reimbursement for mental health services; and standards of care for the treatment of perinatal depression; and resulted in the following policy recommendations:
- Extend and expand Medi-Cal insurance coverage for pregnant women, and implement the 1115 waiver to cover mental health treatment services for mothers during the first year after birth.
- Expand Medi-Cal fee-for-service insurance coverage for dyadic mental health screenings in order to reimburse pediatricians who screen for maternal depression during a pediatric visit.
- Implement a delivery system that includes:
- Training of Ob-Gyns, primary-care practitioners and pediatricians to carry out initial screenings and referrals for treatment.
- Treatment services that include a range of approaches, including individual psychotherapy, group therapy, social support, home visitation, and medication.
- A mental health consultation model which would make available a pool of mental health specialists to non-mental health providers, for referrals and follow-up evaluations.
- A case-management model in which a case manager within a clinic setting is responsible for coordinating the continuum of services from screening through treatment.
- Third-party reimbursement for case-management services from public and private insurance plans.
- Countywide adoption of a standardized, best-practice screening model that would include frequent, periodic screenings throughout the perinatal period, with validated, high-quality screening tools.
examined the training and education of medical providers who serve women during the perinatal period.
- Create a perinatal depression toolkit for providers, containing educational information; validated screening tools; treatment and referral algorithms; culturally competent language pertaining to maternal depression; and reimbursement strategies.
- Ensure education is provided to the entire healthcare team that serves women during the perinatal period.
- Support research into the physiological changes that take place during pregnancy, and the causes of perinatal depression, and disseminate the findings during grand rounds and via a speaker’s bureau.
Raising awareness is a vital first step in empowering women, families, and the community to confront perinatal depression. The stigma associated with perinatal mood disorders can only be addressed through education.
- Create community-based local programs where women, families and community members can learn about depression. Community members can be trained as health navigators or promoters. Their ties to the community and/or personal experiences with perinatal mental health issues can build trust and lead to acceptance of mental health services. This “women helping women” approach to community outreach has been proven effective in other arenas.
- Develop a public awareness campaign to educate women, families and communities about perinatal depression. The message should be delivered by safe and trusted organizations with established roots in the community, and by public figures with credibility. The campaign should also make use of social media and other technology to reach adolescents and young adults.
addressed the scarcity of mental health services for women in underserved communities.
- Expand linkages, raise visibility, and increase access to the existing mental health workforce with expertise in perinatal mood disorders.
- Build and expand the “informed” mental-health workforce by identifying places, services, and organizations that serve the perinatal population.
- Support specialized training for the mental health workforce; in particular those serving perinatal populations and communities in need. Resources and expertise can be increased through a "train the trainer" model, and programs that train peer group leaders and support staff.