In July 2019, the California Medicaid (Medi-Cal) Agency, Department of Health Care Services (DHCS) announced how it would support health plan compliance with the US Preventive Services Task Force assessment of sufficient evidence and recommendation to screen and treat to prevent maternal depression. Read more here.
Other states are likely developing similar positions to provide clarity to Medicaid health plans and screening and treating providers on how services should be billed and covered.
Common and Costly Expenditures Associated with the Birth of Children in 2017 Amount to More than $14 Billion
If you ask people what they think the most common medical complication is during and after childbirth, you probably won’t hear mental health issues. Yet maternal mental health (MMH) disorders — including prenatal and postpartum depression and anxiety — top the list, affecting at least one in seven women. In addition to the substantial human toll of these conditions, they come with a hefty price tag, especially because women who have them often go untreated.
Below are the news articles that caught my eye this month. Use the comments feature below to share you thoughts with me.
AHRQ Stats: Depression Screening
Though the US Preventive Service Task Force has recommended depression screening in adults since 2009, fewer than half of all Americans ages 35 and older were screened for depression in 2015, according to the federal Agency for Health Care Research and Quality. Read it here.
Here are my favorite articles since I last shared “What I’m Reading.” Note, I’m eager to get your thoughts on any of these articles, but particularly interested in your opinions about the three articles at the bottom; are you having problems with insurers? Let us know in the comments below.
Pregnancy Specific Anxiety Impacts How Long Women Breastfeed
New research published in June links anxiety and breastfeeding, a link moms have long been sharing concerns about. Read it here.
The Federal agency, The Center for Disease Control (CDC) shared a new brief on Maternal Mortality Review (MMR) with updated 2008-2017 data on pregnancy-related deaths from 14 Maternal Mortality Review Committees (MMRCs). Arizona, Colorado, Delaware, Florida, Georgia, Hawaii, Illinois, Louisiana, Mississippi, North Carolina, Ohio, South Carolina, Tennessee and Utah voluntarily shared their data through the Maternal Mortality Review Information Application (MMRIA). MMRIA supports and standardizes record abstraction, documentation of committee decisions, and routine analyses.
The United States has the worst maternal death rates of any developed country, with Black women dying at 3-4 times the rates of white women, this rate remains unchanged when accounting for income, education and economic status. Maternal death rates for women overall in the U.S. doubled in the past 25 years, meaning that women today have a higher risk of dying at childbirth than their mothers, and the disparities that Black women face have been around for decades. For every maternal death in the country, 70 women face a life-threatening and too often, life-altering complication.
BETHLEHEM, GA – I am a maternal mental health survivor and advocate! I spent years in the darkness of MMH disorders, but I am proud to say I have made my way into the light and am committed to helping other moms join me there. I now work with moms as a childbirth educator, birth doula, and peer support group leader.
Have you ever wished that someone would monitor how often screening for maternal depression is happening and to report that rate?
It’s been a dream of mine to have such a measurement in place so we can gauge how quickly change is occurring, determine states where rates are highest/lowest, and push for more aggressive action until screening rates are in the acceptable 90% range nationally.
Now, development of such a measure, referred to as a Healthcare Effectiveness Data and Information Set (“HEDIS”) measure, is underway thanks to The California Health Care Foundation and the ZOMA Foundation.
In addition to a measure of screening, there is also a measure being developed to address whether the screening provider followed-up. Here are the proposed measures - which include assessment for screening/follow-up during both pregnancy and the postpartum period.
February is Black History Month. Now, many are calling February Black Future Month; a time to raise awareness about how to move forward as a nation and continue to heal from the past.
The month of February was officially recognized as Black History Month in 1976 by President Gerald Ford as a time to honor the rich history, culture, contributions, and importance of African Americans. It is also a time, to consider the adversity and inequities that African Americans still face in our country. We invited Kay Matthews, Executive Director of the Shades of Blue Project in Houston, Texas, to share what Black History Month means to her.
There is a pain that lingers deep inside of me that sometimes surfaces to make for very dark days. Tuesday is the day of this particular week that I feel quite out of place. It’s a day I ask myself if I made the right decision to expose my feelings to the world to pick apart at their leisure.
We had the opportunity to pull leaders in the field together to review the draft USPSTF recommendation. To learn what was discussed read more here.
It has now become more well known that maternal mental health disorders are the most common complication of pregnancy and childbirth.
In 2017, after the American College of Obstetrics and Gynecology (ACOG) overturned its position to recommend screening for maternal depression, the United States Preventive Service Task Force (USPSTF) changed its position to now recommend maternal depression screening.
Now, in 2019, the USPSTF released one of the firsts of its kind, a recommendation for a clinical intervention to prevent a potential disorder, not just screen for it retrospectively. The disorder? Maternal depression. The recommendation was published in on the USPSTF website and in the Journal of American Medical Association (JAMA) Network.
SO, I just posted a “What We’re Reading” blog post a week ago, but I have more to share. Here are some of the highlights: More about the gut-biome brain connection, the latest article by our favorite journalist, April Dembosky. April calls out that America is lacking adequate inpatient treatment facilities for mothers and their babies, that reimbursement is an issue, and how lack of sleep is a public health emergency.
Kaiser Health News: Postpartum Psychosis is Rare, Real, and Dangerous
There had been no crime after all — Lisa Abramson’s destination that day wasn’t a jail cell, but rather the general psychiatric ward at Sutter Health’s California Pacific Medical Center in San Francisco. The other patients were there for drug overdoses or alcohol withdrawal. People were screaming. Read it here.
A: Ambassador, Completed the MMH Certification class
Q: 2020 Mom’s mission is to close gaps in maternal mental health care. What’s your big hope for how 2020 Mom can fulfill this bold mission?
A: The diagnosis gap seems so large, but with 2020 Mom advocating for the OBGYNs to be the primary physician in Maternal Mental Healthcare, and also asking Pediatricians to be on the lookout during a woman’s entrance into motherhood, I think they will be able to catch more people who are struggling. I remember just wanting someone to ask me or to notice that I was not operating at my full capacity. I was not finding the joy of motherhood that everyone talked about and I didn’t want to admit it. I hope that as 2020 Mom works with healthcare teams, policy makers, insurance companies, and individuals the barriers of stigma surrounding Maternal Mental Health will break down and more women will speak up and not suffer in silence.
Here are articles that caught Joy’s eye this month:
One of my favorite things to do is comb through articles that come across my desk (more like kitchen counter, where I work) from various sources. Here are the articles that I picked to share with you this month.
Diagnosing psychiatric and neurological conditions is tricky. Physicians have long reported that diagnoses are fraught with complications and subtleties. Anywhere from 35 percent to 85 percent of mental health conditions go undetected and undiagnosed, according to the World Health Organization, depending on where you live on the planet. Needless to say, to treat depression, Alzheimer's, or autism, it must first be detected. Now clinicians and researchers are trying a new tool: virtual reality. Read it here.
This week, I head to Washington DC to meet with members of Congress about maternity care.
I will be joined by several colleagues from non-profit organizations, including leaders from groups like Every Mother Counts, The Preeclampsia Foundation, Improving Birth and March for Moms. With more women ever serving in congress, it’s a particularly exciting time to address women’s health and maternity issues.
We have been asked to share what we believe should be the highest priorities in improving maternity care. This includes maternal mental health.
If I were in position to write two federal laws, this is what I’d write.
I'm pleased to share our 2018 Impact Report infographic and some of our 2018 highlights below.
If you have followed our work, you know our most celebrated accomplishment was our sponsorship and the passage of three pieces of key maternal mental health legislation. These bills made up the most comprehensive MMH legislative package ever.
GURNEE, IL – I’m that person who will be awake the earliest in the house, regardless if I had enough sleep or not, to welcome and conquer the day. I like challenges and I would travel at length to get to where I need to be, to connect with people and explore other cities. I’m a daughter, a sister, a friend, and a single mom who is currently in recovery from the aggressive downward slope of postpartum depression (PPD).
CARSON, CA – I am a pediatric occupational therapist with over 15 years of experience. My passion has always been to work with children. In spring of 2016, I decided to go back to school to obtain a PhD in Infant and Early Childhood Development (with an emphasis in developmental disabilities and infant mental health) from Fielding Graduate University. Since returning to school, I have learned so much. My new passion is helping families connect by improving the parent-child relationship. If I can help families improve their bond, I think that can improve their family's legacy.
GERMANTOWN, TN – I am a mother of two and a pediatric occupational therapist. I love empowering families and focused my clinical doctorate on training occupational therapists how to screen mothers for postpartum depression. I have also experienced postpartum anxiety and witness firsthand the gaps in maternal care. This experience highlighted how much more work needs to be done to support mothers. It is why I decided to become a 2020 Mom Ambassador.
SALISBURY, MD – I am an adventure loving doula, speaker, and coach, fighting to change the way women love themselves and others. I started out as a mental health caseworker but after the premature birth of my daughter and a huge fight with postpartum depression, I decided to train as a doula and went on to open my own family wellness center that focuses on mothers and their families as they transition into their life with a new baby. I believe when women are met with love and grace they can do incredible things!
We’ve had a few surreal moments in maternal mental health this fall, this one is definitely a moment that the maternal mental health community should be jumping up and down about. In September the federal government’s Health and Human Services Agency (HRSA) announced it has awarded 4.5 million in grants to seven lucky states to address maternal mental health over five years (2018-2023).
GLOUCESTER COUNTY, NJ - I am a mom, a wife, a business-owner, an advocate. I am trained as a therapist (professional counselor) and my expertise is maternal mental health. I am driven by the desire to walk the journey with mothers as they rediscover themselves as their young families grow. Maternal mental health is directly linked to child mental health, children grow up to be adults. Start with moms seems like the best place to start if we want to make the world a better place.
LOS ANGELES, CA - I am a pediatric occupational therapist and a Robert Wood Johnson Clinical Scholar, a wife and a child and family advocate. As a pediatric occupational therapist, I am an advocate for children and families. Their vulnerability subjects them to circumstances outside of their choosing or control, and their experiences can have a lasting impact on their lives as well as on the generations after them.
I knew I wanted to work with children and families since I was 15 years old. I have fulfilled this goal in many different roles over my career as a social worker. I have been in search of a “life’s work” for many years and I have found it in maternal mental health. I have made a commitment to myself that I will do this work for the rest of my life in some capacity. There is so much needless suffering that would not occur if moms were better educated and stigma was less. My drive comes . . .
As a nurse and midwife, I have been passionate about helping moms and babies for as long as I can remember. I am currently a PhD student at Yale School of Nursing with a focus on maternal mental health and illness, and I am a Robert Wood Johnson Future of Nursing Scholar. I believe that healthy mother-child dyads are foundational to healthy communities and key to making the world a better place.
LOS ANGELES, CA - Long before working in perinatal mental health, I was a clinician working with trauma - but because therapists and clinicians aren't regularly trained in maternal mental health, I was completely unaware and unprepared for the wallop of postpartum PTSD following the emergency c-section of my first child. Unfortunately, none of my care providers had MMH training themselves, and it took a lot of tears and my own research to figure out . . .
NORTHERN CALIFORNIA - I am a first generation South Asian female clinical psychologist. I believe in providing people with effective evidence-based treatments. I also believe in suicide prevention and intervention and helping educate and connect individuals at risk for MMH problems with resources that empower them . . .
The U.S. Preventive Services Task Force (USPSTF) recently released a draft recommendation addressing screening women at risk in order to provide counseling as preventive care: Perinatal Depression: Preventive Interventions. You might recall
BAY AREA, CA - I am a mom, wife, daughter, and sister. I grew up surrounded by strong, independent women who were able to find success (broadly defined) despite adversity. Through my work as a clinical psychologist I’ve heard and experienced countless stories of sacrifice.