Elizabeth LaRusso, MD

1. Mother Baby Mental
Health Program: Use of
Technology & Team-Based
Care to Extend Reach in
Perinatal Psychiatry
Elizabeth M. LaRusso, MD
September 2015

2. 22
Welcome & Objectives
• Increase understanding of the mental health
landscape & what the data tell us about
women’s preferences for accessing mental
health treatment
• Increase awareness of MBMHP’s strategic
initiatives & underlying rationale
• Highlight strategic initiatives that utilize team-
based care & technology to extend reach

3. 33
A Metaphor for Mental Health

4. Everything you wanted to
know about the challenges
of perinatal mental health
program development, but
were afraid to ask.

5. 55
Perinatal Mental Illness Can (and Does)
Happen To Anyone
• Peak onset of psychiatric illness in women occurs
during childbearing years
• Postpartum depression (PPD) is one of the most
common complications of pregnancy
• Allina Health/MBCSL is the largest pregnancy
care provider in Minnesota
– >14,200 deliveries in 2014 = 2,800 patients with PPD

6. 66
No One Has This All Figured Out
• There is no clear set of best practices for the
provision of perinatal mental health care
• There is no gold-standard model for integrating
mental health care into OB/GYN
• Established national perinatal mental health
programs tend to focus on one specific element
(ex; research, specialty consultation, etc.)

7. 77
Isn’t the solution more mental health
providers?
• Yes, but no
• National shortage of mental health providers
• Most providers are uncomfortable making med recs
for pregnant & BF women
• Patient, provider, and systems-level barriers
interfere with women accessing available care
• Exceedingly high no-show rates for outpatient
mental health visits (30-50%)

8. 88
What do women want?
• Women often have exaggerated concerns &
misinformation about mental health issues during
pregnancy & the postpartum period
• Qualitative studies reveal that many women want
their OB provider to address their emotional needs
• Women note many barriers to accessing mental
health treatment & prefer to receive care from
trusted providers

9. 99
What do OB providers think?
• The majority report that they have a responsibility
to recognize maternal depression
• This does not necessarily result in delivery of care
– Lack of time
– Lack of training
– Limited knowledge of available resources
– Absence of a systematic referral process
– Perceived reluctance of patients to engage in depression
treatment

10. 1010
“I’m not depressed, I’m just poor.”
• It can be difficult to differentiate mental health
conditions from the impact of psychosocial stress
– Poverty, domestic violence, lack of adequate
supports, unplanned pregnancies, limited education,
homelessness, unemployment, etc.
• Patients with these stressors deserve care
• Often what they need exceeds what we have to
offer

11. Knowing all of this, how do
we propose to improve the
identification & treatment
of women with perinatal
psychiatric illness?

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Ideas???

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The MBMHP Mission
To improve maternal, child, and family health and
well-being by providing timely access for all
pregnant and postpartum Allina Health patients to
high quality, individualized, cost-effective mental
health care.

14. 1414
Key Strategic Priorities 2015-2017
• Increased Treatment Options
– Individual psychiatric consultations
– Individual & group psychotherapy
– Establishment of internal/external provider networks
– Web-based cognitive behavioral therapy (CBT) for postpartum depression
• Provider Education
– Invited lectures, trainings, clinical supervision
– Perinatal Psychiatry Pearls quarterly update
– MBMHP Website
• Provider Support
– Perinatal Psychiatry Provider Consult Line
– E-Consults
• Standardized Care Processes
– Perinatal Depression Care Process integrated into outpatient OB/GYN

15. MBMHP Web Site
http://akn.allina.com/csl/MotherBaby/policies/perinatalmentalhealth/index.htm

16. 1616
Who We Are: Core Team Members

17. 17
• Elizabeth M. LaRusso, MD
– Program development
– Pre-conception planning
– Consultation, short-term stabilization/treatment of
pregnant & postpartum women
– Timely access, short-term treatment, active partnering
with patient’s primary physician
• Tina Welke, LICSW
– Patient triage
– OB provider support via phone and EPIC
– Direct patient care
– Program development
17
What We Do

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What Providers Can Expect From Us
• We work as a team & triage patients
• We provide timely access
– 2-5 days for SW visits
– 5-10 days for psychiatry visits
• We help providers (OB, family practice) develop an
interim treatment plan
• We collaborate with the primary provider, Allina
mental health clinicians, & our community partners
to increase patient care options

19. 1919
What We Expect From Providers &
Patients
• An active partnership with you to implement the
treatment plan
• Patient investment in their own mental health
care
– Patients who are unable to call to schedule are likely
not ready for treatment
– Pilot study at DHMC: No-show rate decreased from
41% to 16% with implementation of triage & patients
calling to schedule

20. 2020
Key Strategic Priorities 2015-2017
• Increase Treatment Options
• Provider Education
• Provider Support
• Standardized Care Processes

21. 2121
Provider Support
• Support obstetric, family practice, & mental
health providers in the provision of care for
women with perinatal psychiatric issues
– Perinatal Psychiatry Provider Consult Line service for
non-urgent mental health questions about pregnant
and postpartum patients
– E-consult, EPIC-based provider consultation service
to address medication-specific questions

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Perinatal Psychiatry Provider Consult Line
612-863-CARE (2273)
• Telephone consultation for Allina Health & affiliated providers with
non-urgent perinatal mental health questions.
• Goal is not for MBMHP to assume care of patients, but to co-develop a
treatment plan that providers can implement with their
patients. Questions include:
– Psychiatric medications in pregnant/lactating women
– Determining if further mental health assessment is indicated
– Connection with appropriate community resources
• Providers call, leave name, contact number, patient’s name and Allina
MRN, and clinical question. Calls returned within 2 business days.
• Patients should not call directly.
• If a patient is in crisis, contact the appropriate resource/send them to
the ED for immediate assessment.

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Q1 Stats, 2015
• 56 patients & 47 providers served
• 56/56 patients = chart review & treatment
planning (100%)
• 17/56 patients = psychiatric visit (30%)
• 8/56 patients = SW visit (14%)
• 4/56 patients = psychiatry + SW (7%)
• 1/56 patients no-showed initial appt. (1.8%)
• 1/56 patients cancelled initial appt. (1.8%)

24. 2424
Perinatal Psychiatry Provider Consult
Line: What have we learned?
• OB/GYN providers are utilizing the service
• Qualitative data supports high level of patient &
provider satisfaction
• Performing triage identifies appropriate level of
care
• Very low no-show rate for outpatient psychiatric
clinic visits
• Goal is to increase provider use!

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Key Strategic Priorities 2015-2017
• Increased Treatment Options
• Provider Education
• Provider Support
• Standardized Care Processes

26. 26
• Based on cognitive behavioral therapy (CBT), an
evidence-based treatment for depression
• Developed by a multi-national team with
support from an NIMH grant
• Initial published feasibility trial reported high
level of patient engagement, acceptability, &
improvement in depressive symptoms
26
MomMoodBooster
Web-based CBT for PPD

27. 27
MomMoodBooster Web-based CBT

28. 28
Mom Mood Booster

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Take-Home Points
• The MBMHP is a work in progress!
• Our strategic initiatives are informed by the data
& adapted to the Allina Health landscape
• Team-based care & use of innovative
technologies are imperative to extend reach
• Transforming the delivery of care on the systems-
level is slow, complex, and extremely rewarding

30. 30
With your help, when we succeed…

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Thank You!
• Questions?
• Please contact us directly with questions/suggestions
• Contact information:
• Elizabeth.LaRusso@allina.com
• Tina.Welke@allina.com