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Maternal Depression Screening Toolkit
To download additional copies of this toolkit or documents contained within, please visit
http://tinyurl.com/maternaldepressiontoolkit
CCWNC Version 1 – 11.2016
A catalyst for patient-centered, community-oriented, provider-led quality healthcare in Western North Carolina
Maternal Depression Screening Toolkit
Table of Contents
Maternal Depression Introduction ..................................................................................... 3
What is Maternal Depression? & Referral to Treatment ................................................... 4
How to Implement a Maternal Depression Screening in Your Practice ............................. 5
Billing and Coding for Maternal Depression Screening ..................................................... 6
Edinburgh Postnatal Depression Scale (EPDS) .............................................................. 7-8
PHQ-2 Screening Tool .................................................................................................. 9-10
PHQ-9 Screening Tool ................................................................................................. 11-12
Videos: Mother’s and Provider’s Perspectives .................................................................. 13
Local Referral Resources ............................................................................................ 14-16
Closing ............................................................................................................................. 17
Visit the website below to download
individual screening tools
http://tinyurl.com/maternaldepressiontoolkit
See page 7 for a copy of the Edinburg Postnatal Depression Scale
A catalyst for patient-centered, community-oriented, provider-led quality healthcare in Western North Carolina
53 S. French Broad Ave, Suite 300 Asheville, NC 28801
Phone: 828.259.3879 Fax: 828.259.3875
www.communitycarewnc.org
Maternal Depression Screening Toolkit
This toolkit is designed to assist pediatricians and family practice providers in screening mothers of newborns for Postpartum Depression.
Toolkit Contents:
Maternal Depression Introduction
Overview of Maternal Depression Spectrum & Referral to Treatment Options
Example Workflow
Billing and Coding Guidelines for Maternal Depression Screening
Edinburgh Postnatal Depression Scale
PHQ-2 Screening Tool
PHQ-9 Screening Tool
Videos of a mother’s and providers perspectives
Local Referral Resources CCWNC’s Quality Improvement, Pediatric and Behavioral Health Departments can support your practice’s clinical and programmatic implementation of the maternal depression screening tool. Please contact us with your questions. Our team can provide individualized support and training for your practice. Contents of this toolkit are located here: http://tinyurl.com/maternaldepressiontoolkit Warm Regards, CCWNC Quality Improvement, Pediatrics and Behavioral Health Departments
A catalyst for patient-centered, community-oriented, provider-led quality healthcare in Western North Carolina
Maternal Depression Screening
Psycho-social screening and surveillance for risk is an integral part of routine care and the relationship with the child and
family. Medical Homes can be timely and proactive by implementing the screening, supporting the mother-child
relationship and using community resources for referral and treatment.
40% - 60% of parenting teens and mothers who have low income report depressive symptoms
Spectrum of
Maternal
Depression
Prevalence Time Frame Characteristics Recommended
Treatment
Mom
Recommended
Treatment
Dyad
Maternity
(Baby) Blues
50%-80% of
all mothers
experience
“baby blues”
after birth
Begins a few
days after
birth.
May last up to
2 weeks
Transient depressed mood,
irritability, crying, anxious,
afraid, confused
Family support Family Support
groups
Postpartum
Depression
13%-20% of
mothers
experience PD
after birth
Occurs during
postpartum or
within the 1st
year
Meets DSM V criteria as a
minor/major depressive
disorder.
depressed mood,
reduced interest in activities,
loss of energy, difficulty
concentrating
Family Support
Mental Health
provider
Psychiatry
Early
Childhood
Mental Health
provider
CC4C
CDSA
Postpartum
Psychosis (PPP)
1-3 of 1,000
mothers
experience
PPP after birth
Occurs in the
first 4 weeks
after birth
Paranoia, mood shift,
hallucinations, delusions,
suicidal/homicidal thoughts
Emergency
mental health
services
Mobile Crisis
Inpatient setting
Early
Childhood
Mental Health
provider
CC4C
CDSA
Evidence-Based Intervention:
Edinburgh Postpartum Depression Scale – available in English and Spanish
o Mother completes a 10 multiple choice questionnaire 4 times in infant’s first year. Note, we
recommend screening at 1, 2, 4, and 6 month visits because peak occurrence for maternal
depression is 2-3 months for minor depression; 6 weeks for major depression)
o Bill at the infant visit with CPT code 99420
o Bill at Postpartum visit with CPT Code 96127
For Positive Screens:
If the Edinburgh score is 20 or greater, or the mother answers yes on question 10, or if the
mother expresses concern about her or her baby’s safety or the PCP suspects the mother is
suicidal, homicidal, severely depressed/manic/psychotic
o Contact your Mobile Crisis provider: service available through your MCO
o Refer to emergency mental health services and be sure she leaves with a support person
Communication, Support, Demystification and focus on wellness
Referral Resources: see recommended treatment for mom and dyad above
If the mother has a positive screen, the infant should also receive a social-emotional screening. CHIPRA Quality Demonstration Grant- September 2016 (v5)
A catalyst for patient-centered, community-oriented, provider-led quality healthcare in Western North Carolina
How to Implement a Maternal Depression Screening in Your Practice
Choose Appropriate
Screening Tool & Visit Intervals
Implement screening tool
into practice workflow for infant
visits
Choose between Edinburgh or PHQ-9 (see page 7)
If Family Medicine, determine which
visits to conduct the screening: at infant visit, Postpartum or
both visits
Determine which intervals to screen
at: AAP recommends 1,2,4 and 6 months and the 2 and 6 week Postpartum visits
If yes, test changes with one MA/provider team
What is the workflow for screening tools your practice is already using?
(Ex.: ASQ, MCHAT).
Can you replicate this for Maternal Depression screening?
Are there opportunities for improvement?
Train staff and implement
Consider:
Using MAs to support provider (ie: scoring)
Inputting the screening into your EHR
o Enter in EHR (so answers can be mined for tracking) or
o Scanned into EHR (not mineable)
Billing for screening (see page 4)
Learning more about how to interpret the screen
o Seek support from CCWNC behavioral health staff if needed
When to refer/when to treat/how to treat
o Consider an in-service from CCWNC behavioral health staff
o Refer to page 2 on maternal depression screening chart
A catalyst for patient-centered, community-oriented, provider-led quality healthcare in Western North Carolina
UPDATE ON BILLING AND CODING MATERNAL DEPRESSION SCREENING
As of July 1st, 2016, primary care providers will be paid for postpartum depression screening done at
infant well visits in keeping with AAP recommendations.
North Carolina Medicaid will reimburse providers for up to 4 maternal depression risk screens
administered to mothers during the infant’s first year postpartum. AAP recommends screening at the
1, 2, 4, and 6 month visits. CMS directs use of CPT code 99420 (Health Risk Screen), one (1) unit per
administration, with EP modifier when billing for this service. When conducted as part of a
comprehensive Health Check Early Periodic Screening visit, this screen may be billed to the infant’s
Medicaid coverage. Providers should carefully review the Health Check Billing Guide’s section on
“General Guidance on Use of Structured Screening Tools” and follow all documentation requirements.
Maternal Depression Screening
Description Code Payment
During an infant Well-care visit:
1 – 12 month olds (Edinburgh or PHQ-2/PHQ-9)
Use EP modifier
99420
As of January 2017
this code will change
to 96161
$7.91
During a Post-Partum Well Care Visit (Mother is the patient)
96127
$4.10
A catalyst for patient-centered, community-oriented, provider-led quality healthcare in Western North Carolina
A catalyst for patient-centered, community-oriented, provider-led quality healthcare in Western North Carolina
A catalyst for patient-centered, community-oriented, provider-led quality healthcare in Western North Carolina
A catalyst for patient-centered, community-oriented, provider-led quality healthcare in Western North Carolina
A catalyst for patient-centered, community-oriented, provider-led quality healthcare in Western North Carolina
A catalyst for patient-centered, community-oriented, provider-led quality healthcare in Western North Carolina
A catalyst for patient-centered, community-oriented, provider-led quality healthcare in Western North Carolina
Maternal Depression Videos
A Mother’s Perspective: The Feelings are Normal and Common (8 minutes)
https://www.youtube.com/watch?v=zbUl2hZNlKY
A Provider’s Perspective: Why is it important to Screen? (7 minutes)
https://www.youtube.com/watch?v=SAkE2_YHTGQ
Visit http://tinyurl.com/maternaldepressiontoolkit to view these videos
A catalyst for patient-centered, community-oriented, provider-led quality healthcare in Western North Carolina
Agency Contact Telephone Number
Children’s Developmental Services Agency (CDSA)
http://www.beearly.nc.gov/index.php/contact/cdsa
828-265-5391 Blue Ridge
(Alleghany, Ashe, Avery, Mitchell,
Watauga, Wilkes & Yancey Counties)
828-433-5171 Morganton
(Alexander, Burke, Caldwell, Catawba
& McDowell Counties)
707-480-5440 Shelby
(Cleveland, Gaston, Lincoln, Polk &
Rutherford Counties)
828-251-6091 Western N.C.
(Buncombe, Cherokee, Clay, Graham,
Haywood, Henderson, Jackson,
Macon, Madison, Swain, &
Transylvania counties)
Care Coordination for Children (CC4C) http://www.buncombecounty.org/governing/Depts/Health/CareCoordination.aspx Services are contracted and arranged through Community Care of Western North Carolina
Program Information: Sherry Noto
Care Management Referrals: Amy Ray
Sherry Noto: Pediatric Care
Management Program Coordinator:
828-348-2829
Amy Ray: Care Management Referral
Coordinator: 828-348-2823
VAYA Health (formerly Smoky Mountain Managed Care Organization)
www.vayahealth.com
(i.e. Early Childhood Mental Health Providers for children ages 3+, Family Support Groups, Psychiatry)
24-hour Access to Services Line
1-800-849-6127
LOCAL REFERRAL RESOURCES
A catalyst for patient-centered, community-oriented, provider-led quality healthcare in Western North Carolina
Mobile Crisis Number by County including Walk-in Centers
http://vayahealth.com/community/comprehensive-care-centers/walk-crisis-centers/
Buncombe
Walk-In Centers:
Family Preservation Services: 828-
225-3100
RHA Health Services: 828-254-2700
Mobile Crisis: 888-573-1006
Cherokee
Walk-In Centers:
Appalachian Community Services:
828-837-0071
Mobile Crisis: 1-888-315-2880
Clay
Walk-In Centers:
Appalachian Community Services:
828-389-1494
Mobile Crisis: 888-315-2880
Graham
Walk-In Centers:
Appalachian Community Services:
828-479-6466
Mobile Crisis: 888-315-2880
Haywood
Walk-In Centers:
Appalachian Community Services:
828-452-1395
Mobile Crisis – Call 1-888-315-2880
Henderson
Walk-In Centers:
Family Preservation Services:
828-697-4187
Mobile Crisis: 888-573-1006
Jackson
Walk-In Centers:
Meridian Health Services:
828-631-3973
Mobile Crisis: 888-315-2880
Madison
Walk-In Centers:
RHA Health Services: 828-649-9174
Mobile Crisis: 888-573-1006
Macon
Walk-In Centers:
Appalachian Community Services:
828-524-9385
Meridian Health Services:
828-524-6342
Mobile Crisis: 888-315-2880
A catalyst for patient-centered, community-oriented, provider-led quality healthcare in Western North Carolina
Continued:
Mobile Crisis Number by County including Walk-in Centers
http://vayahealth.com/community/comprehensive-care-centers/walk-crisis-centers/
McDowell
Walk-In Centers:
RHA Health Services: 828-652-2919
Mobile Crisis: 888-573-1006
Mitchell
Walk-In Centers:
RHA Health Services; 828-765-0894
Mobile Crisis: 888-573-1006
Polk
Walk-In Centers:
Family Preservation Services:
828-894-2290
Mobile Crisis: 888-573-1006
Swain
Walk-In Centers:
Appalachian Community Services:
828-488-3294
Mobile Crisis: 888-315-2880
Transylvania
Walk-In Centers:
Blue Ridge Community Health:
828-883-5550
Meridian Health Services:
828-883-2708
Mobile Crisis: 888-573-1006
Yancey
Walk-In Centers:
RHA Health Services: 828-682-2111
Mobile Crisis: 888-573-1006
A catalyst for patient-centered, community-oriented, provider-led quality healthcare in Western North Carolina
53 S. French Broad Ave, Suite 300
Asheville, NC, 28801 Phone: 828.259.3879
Fax: 828.259.3875 www.communitycarewnc.org
Maternal Depression Screening Toolkit Please feel free to contact the CCWNC team below regarding use and programmatic implementation of this toolkit. If you are viewing a printed version of this toolkit and would like an electronic version, as well as access to the screening tool, please go to this link: http://tinyurl.com/maternaldepressiontoolkit We look forward to working with you and your practice to benefit children, mothers and families. Warm Regards, CCWNC Quality Improvement, Pediatric and Behavioral Health Departments
Contacts
Eric Christian, MAEd, LPC, NCC, Director of Integrated Care [email protected] | Office: 828.348.2833 |Fax: 828.348.2744
Adrienne Gilbert, MPH, QI Specialist, Practice Support [email protected] | Office: 828.348.2822 |Fax: 828.348.2777 Sherry Noto, RN, Pediatric Program Coordinator [email protected] | Office: 828.348.2829
Carrie Pettler, MPH, CPHQ, QI Specialist, Team Lead [email protected] | Office: 828.348.2810 |Fax: 828.348.2756