By Helen Kim, MD, Director of the HCMC Mother-Baby Program, and Tessa Wetjen, Minnesota Department of Human Services
The AAP has clearly stated that pediatricians must lead efforts to reduce the impact of toxic stress on children given the lifelong impact of adverse childhood experiences on physical and mental health.
Postpartum depression occurs in 10 to 35 percent of mothers (Berkule, et al., 2014) and poses a significant risk for toxic stress in children by undermining a mother’s ability to provide the nurturing interactions children need for healthy development. Children of depressed mothers or fathers are more likely to perform lower on cognitive, emotional and behavioral assessment (Berkule, et al., 2014) and have increased risk of mental health issues later in life (Ferro & Boyle, 2015).
Screening for postpartum depression within a baby well-child check can be relatively simple and lead to improved care for the child and family. The Minnesota Department of Health (MDH) has compiled resources to make maternal depression screening meaningful for patients and families and simple and reimbursable for pediatric practices.
The MDH comprehensive guide includes background information; timeline for well-child visit screening; algorithm of interventions for high scoring mothers; guidance on documenting the score and billing for the service; and patient and provider resources. The screen can be done using a free tool (either the PHQ-9 or EPDS) and scored by rooming staff. The pediatrician can provide mom with appropriate intervention based on the score and document. The screen is billable, if the tool used is the PHQ-9, EPDS, or Beck. There are a number of ways to document the score and follow up, which should include regular social-emotional screening for the child, detailed in the clinical guidelines.
MDH has a fact sheet on perinatal mood and anxiety disorders and a “Maternal Wellbeing Plan” for mothers of infants.
For support in implementing PPD screening in pediatric practices, contact Tessa.Wetjen@state.mn.us or 651-201-3625
References available upon request. Email debilzan@mnaap.org
