Background: In 2018, California becomes the 5th state in the country (following New Jersey, Illinois, Massachusetts, and West Virginia) to require screening for perinatal mood and anxiety disorders. Although screening at least once during the perinatal period is recommended by the American College of Obstetrics and Gynecology (ACOG), historically it has not been the standard of maternal care, nor has it been mandatory, in California. Maternal mental health disorders are the most common complication of pregnancy, and left untreated, can have devastating short- and long-term consequences for entire families.
What does this bill do?
- It requires OB/GYNs, nurse practitioners, physician assistants, nurse midwives, naturopathic doctors, and licensed midwives to screen for perinatal mood disorders; and
- Orders health insurers to develop maternal mental health programs that promote quality and cost-effectiveness
When does the rule become effective? July 1, 2019
What are considered best practices in screening? Maternal Mental Health NOW has implemented multiple integration projects with clinics and hospitals throughout LA County, which have enabled providers to screen their patients for perinatal mood disorders and connect them with the appropriate level of care. Based on our experience, we recommend these tools and practices:
- Use the EPDS [English Spanish] or PHQ-9 [English Spanish] instruments to screen, as they yield the most accurate results
- Screen once per trimester, once during the postpartum visit, and at well child visits through the first year
- In addition to screening, clinicians need to use their clinical judgement in their assessment for perinatal mood and anxiety disorders
- All staff implementing and/or scoring screens should receive at least basic perinatal mental health training
- Create a perinatal mental-health informed referral resource list of mental health providers in your community
- Develop protocols for referral and treatment
Here is a training video that models how to effectively screen for maternal depression and anxiety:
What do I do when a patient needs additional support?
- Record the screening data, and follow up with individuals to confirm that they received proper care and are improving
- Ensure that referrals are vetted and made through warm hand-off procedures
Where can I find referrals? Maternal Mental Health NOW’s Los Angeles County Maternal Mental Health Resource Directory is the first-of-its-kind online resource for new and expectant mothers struggling with maternal depression and anxiety. The Directory lists over X resources—Y of which offer no or low-cost services—in Los Angeles County that provide specialized treatment and support to this vulnerable population. Women and health care providers are able to search for resources based on location, services offered, ages served, languages spoken, insurances accepted, and whether no or low-cost options are available. Evidence-based services provided include support groups, individual and family therapy, specialized clinical services, and medication management for pregnant and postpartum women. The Directory is an essential tool for Los Angeles-based obstetric providers who are screening for perinatal mood and anxiety disorders, giving them referrals to informed mental health care providers who can help their patients. For resources beyond LA County, contact Postpartum Support International (PSI).