Los Angeles County Perinatal Mental Health Task Force

The mission of the Los Angeles County Perinatal Mental Health Task Force is to remove barriers to the prevention, screening and treatment of prenatal and postpartum depression in Los Angeles County. Common barriers include lack of screening, inaccessibility of informed treatment, stigma and lack of reimbursement from payors. In order to address these barriers and increase access to depression screening and treatment services for medically underserved pregnant and postpartum women, the Task Force has been working in partnership with USC-Eisner Family Medicine Clinic on the Maternal Mental Health Improvement project - a pilot project that embeds maternal mental health care in a primary care setting. USC-Eisner FMC is a federally qualified nonprofit community health center dedicated to improving the physical, social, and emotional well-being of people in Metro, South and South Central Los Angeles, regardless of their ability to pay. Its patient population includes high-risk, uninsured, under-insured and otherwise medically underserved women and their infants. According to the 2008 LAMB survey, 23.1% percent of new mothers in the catchment area served by USC-Eisner FMC reported depression during pregnancy and 58.2% reported some level of depression postpartum - a rate roughly twice that of pregnant women nationwide. In addition, many struggle with financial stress, poor social support and chronic illnesses such as diabetes, hypertension and thyroid disease. Additional risks include linguistic barriers, immigration status, lack of health insurance, obstacles to care such as transportation and childcare, and lack of access to mental health services. As part of the Maternal Mental Health Improvement project, which is based on the IMPACT model, all prenatal and postpartum patients are screened for perinatal mood and anxiety disorders at each visit. Patients who screen positively (10 or more on the PHQ-9 or 4 or more on the Edinburgh 3) are connected with an onsite social worker, social work intern and/or occupational therapist, who conducts a full assessment of the patient. These cases are referred to the New Family Care Team, which consists of primary care physicians, social workers, occupational therapists, psychologists and case managers at USC-Eisner FMC, as well as a consulting perinatal mental health psychiatrist, psychologist, licensed marriage family therapist and a social worker. Members of the New Family Care Team meet on a weekly basis to discuss patients who have presented as high or medium risk for perinatal depression, provide expertise from members' respective disciplines and construct an optimal treatment plan for each case. Treatment options may include individual or group therapy, psychiatric care, medication, cognitive behavioral therapy, interpersonal psychotherapy and/or psycho-dynamic psychotherapy, social support and intensive case management with warm referrals to community resources. Since January 2012, 420 pregnant and postpartum women have been screened for perinatal depression at USC-Eisner FMC. Positive screens, which account for approximately 33% of all women, are given an extensive intake assessment using a tool developed by the Task Force. The intake/assessment tool includes a comprehensive psychosocial history, including risk factors such as past trauma and loss, domestic violence, substance abuse, immigration status and social support, as well as a complete psychiatric differential diagnosis. Thus far, the intervention appears to be creating a medical home for women and their children, potentially lowering rates of fragmented medical and mental health care and addressing the physical and mental health needs of women and children. The most important observation thus far has been that time and time again, women express reluctance to being given a referral outside of the clinic, but are willing to connect with an "emotional support person" who is on the premises. In this way, women are far less likely to fall through the cracks. The Task Force is currently actively fundraising for the Maternal Mental Health Improvement project so that it can design a data dashboard that will track the project's outcomes. Data sets that will be collected through the dashboard will be used to inform conclusions about the efficiency and cost-effectiveness of the IMPACT model of collaborative mental health care as applied to maternal depression.