Colorado Maternal and Child Health State Action Plan

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1 Colorado Maternal and Child Health State Action Plan MCH Priority: Implementation Team Name: Women's Mental Health - Pregnancy Related Depression PRD State Advisory Team Lead Name: Planning Period : Lauren Bardin Team Lead 10/15-9/17 SPM: By 2020, increase the percent of mothers that report a doctor, nurse or other health care worker talked with them about what to do if they felt depressed during pregnancy or after delivery from 78.9 to (PRAMS) Overview: PRD is a MCH priority in Colorado. The MCH priority profile on PRD includes key information on the issue and priority effort. (See TBD). This action plan describes how the Maternal Wellness & Early Childhood Team will address PRD at the state level. Goal 1: By 2018, increase the number of providers and/or hospitals in Colorado (from 0 to 40 for providers and 0 to 3 for hospitals) that have a comprehensive standard of care for women with PRD, including the adoption of PRD competencies, implementation of policies and integration into standard work. Health Facility Assessments Develop competencies for providers and hospitals to more adequately address PRD. By 2017, increase the number of providers and/or hospitals in Colorado (for providers from 0 to 40 and/or for hospitals from 0 to 3) that implement key PRD competencies into standard work. tracking of implementing providers/hospitals Research existing indicators used for measuring individual-level (provider) professional competencies for addressing maternal mental health to better understand what makes a provider able to screen, refer and/or treat someone with a perinatal mood or anxiety disorders. (Existing indicators may include CoAIMH's IMH-E credentials, Washington State's credentials, & 2020 Mom's Credentialing proposal). Research existing indicators used for measuring hospital-level competencies in creating environments and conditions that are conducive to prevent perinatal mood and anxiety disorders and treat a woman with perinatal mood and anxiety disorders (e.g. including HEDIS-like measures, the Baby-Friendly Hospital Initiative and the National Network for Depression Centers).

2 Consult professionals nationally and within Colorado to learn more about barriers and successes when implementing standard practices to address maternal mental health either in individual practice settings or hospital settings. Consult pregnant and postpartum women to learn more about qualities and competencies they would want providers to exhibit during prenatal and postpartum visits. Determine whether competencies need to be at the individual or hospital level, or both. Collaborate with PRD State Advisory, local public health agencies and identified partner organizations to develop a core set of competencies. Identify incentives (monetary or non-monetary) to encourage professionals and/or hospitals to pursue and achieve competencies. Identify up to 5 individual providers and/or organizations who agree to pilot the competencies for a period of 6 months. Conduct pilot implementation of competencies with up to 5 individual providers and/or hospitals, including collection of feedback on potential incentives for achieving competency. Refine competencies and methods for implementation based upon pilot tests and establish a formalized implementation plan, including surveillance plan and materials for establishing baseline (e.g. Health Facility Assessment to determine baseline status), for scale up of competencies (e.g. "Can Do 5" model). Create a series of downloadable educational and implementation materials for ongoing maintenance of competencies. Work with partners to actively recruit providers and/or hospitals to adopt final set of competencies. Provide technical assistance through learning events (i.e. webinars, learning community calls, workshops) to facilitate adoption of competencies. Monitor and evaluate implementation on an on-going basis to identify and address barriers that prevent providers and/or hospitals from implementing or adopting the competencies. Provide technical assistance to local public health agencies. 01/16-02/16 03/16-06/16 06/16-08/16 07/16-09/16 10/16-03/17 03/17-06/17 03/17-06/17 06/17-07/17 07/17-09/17 07/17 - Ongoing / PRD State Advisory / PRD State Advisory / PRD State Advisory / PRD State Advisory / PRD State Advisory / PRD State Advisory / PRD State Advisory Explore opportunities for additional and more comprehensive population-based data metrics on PRD, for instance, inclusion of PRD data on the interagency agreement with HCPF.

3 Goal 2: By 2018, increase the number of pregnant and postpartum women with PRD symptoms referred for treatment from XX to XX. Unknown, see comment Strengthen referral networks for providers to address PRD. By 2017, increase the number of Medicaid providers who screen pregnant or postpartum women for PRD from XX to XX as measured by Medicaid claims data. (We need to request baseline data from HCPF to get this number and then be able to set a target). And increase the % of providers who talk to a woman about what to do if they experience signs and symptoms of depression from 78.9 percent to 82 percent as measured by PRAMS. HCPF Claims data & PRAMS Continue to roll-out and disseminate the PRD Guidance document and supporting referral resources to providers through various external stakeholder events (webinars, annual conferences, newsletters, etc.) This includes promotion of the PSI Coordinators statewide. Collaborate with state and national experts to develop and/or implement training modules for providers that align with the PRD Guidance document and standard competencies identified in Goal 1 to screen, identify, assess, address, and/or make referrals for women experiencing PRD (one-on-one, online, statewide conferences, in-clinic staff meetings, etc.) Develop appropriate evaluation metrics to monitor knowledge, understanding and appropriate use of PRD Guidance tool and corresponding resources Identify opportunities for integration of maternal mental health efforts with other CDPHE initiatives focused on pregnant and postpartum women (ex: marijuana, prescription drug, tobacco cessation, etc.) Identify opportunities for integration of maternal mental health efforts with external stakeholders (ex: substance use, tobacco cessation, domestic violence, etc.) 12/15-01/16 / PRD State Advisory / Other MIT Teams / VIP - MHP Branch / PRD State Advisory Leverage Colorado Opportunity Project and corresponding staff hired in RCCOs to strengthen referral networks for postpartum women experiencing perinatal mood and anxiety disorders. / HCPF/ RCCOs Review membership of PRD Advisory on an annual basis to ensure representation from women who have experienced PRD to inform challenges with the system of screening --> referral --> evaluation / PRD State Advisory

4 Establish consensus on a screening schedule within the pediatrics setting with Colorado Children's Health Care Access Program (CCHAP) and PRD State Advisory. 10/15-11/15 / PRD State Advisory / CCHAP Explore development of a provider QI activity with support from Assuring Better Child Health & Development (ABCD) to increase implementation of PRD screening and referral practices in pediatric and family practice settings. 01/16-03/16 / ABCD If feasible, develop a provider QI activity with support from Assuring Better Child Health & Development (ABCD) to increase implementation of PRD screening and referral practices in pediatric and family practice settings. 04/16-06/16 / ABCD Administer a mid-point survey to providers across the state to update the "map" and gauge progress of existing state level referral systems for treatment of PRD. Rate existing linkages on a scale of 1-3 stars, identify progress and gaps. 05/16-06/16 Disseminate findings of survey to inform any revisions needed to our strategies to strengthen referral networks. Develop train-the-trainer sessions for partners interested in conducting in-person trainings with local-level programs and community leaders. Provide technical assistance to local public health agencies. 06/16-07/16 06/16-09/16 Explore opportunities for additional and more comprehensive population-based data metrics on PRD, for instance, inclusion of PRD data on the interagency agreement with HCPF. Goal 3: By 2020, increase the % of pregnant and postpartum women who understand that PRD is common and that it is okay to ask for help. CHAS & BRFSS Develop and implement a public awareness initiative to address stigma. By September 2017, increase public acceptance of PRD through roll-out of messaging campaign. TBD Review results of market research completed in Sept 2015 to better understand current knowledge, attitudes, and helpseeking behaviors held by women and their support systems in Colorado to inform public awareness efforts. Identify areas for additional market research for populations under represented or not included in Phase I findings. Use findings, including vetted messages and phrases, from the market research project to refine scope and approach for a public awareness campaign. 10/15-11/15 11/15-12/15 / PRD State Advisory / PRD State Advisory

5 As funding allows, conduct additional market research with other identified populations to enhance understanding of what marketing approaches should be taken. Research and identify additional funding sources and partners to assist with and/or own development of a public awareness campaign (Phase II) to ensure sustainability and its existence long-term. Develop public awareness campaign materials and final messaging. Identify traditional sources (LPHAs, advisory committee network, Bright ByThree) and non-traditional sources (maternity stores, prenatal yoga classes, food banks) as avenues to disseminate messaging. Disseminate campaign messages broadly through identified avenues. Identify opportunities to improve surveillance for this strategy including use of CHAS and BRFSS data and additional mechanisms to track public acceptance (e.g. use of PSI call line, PRD calls to 211, or web analytics). TBD 10/15-02/16 02/16-09/16 06/16-09/16 09/16-09/17 10/15-12/17 / BRFSS staff / CHAS staff # of changes/decisions to program planning, implementation and evaluation influenced by community members. Target:

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