AMCHP 2005 ANNUAL CONFERENCE
DELIVERING RESULTS, IMPROVING PREGNANCY & BIRTH
February 19-23, 2005
JEANNE MAHONEY: Great. As I mentioned before I'm Jeanne Mahoney. I work with the Americans College of Obstetricians and Gynecologists, better known as ACOG. I want to talk to you about a couple of things today. One is to talk about what we're doing with Alison and with the Safe Motherhood Group, which is working on the National Perinatal Depression Partnership. The next is looking at particularly ACOG's Provider Partnership Project, where we have state level partnerships working on a variety of problems, including perinatal depression. And then, finally, actually, as I'm sitting here thinking, I think if Milo then speaks, and then we're going to go back and talk about really how one can begin to work on this issue at the state level, because I think that that's pretty much where many of the, what most of the people are based right now, and so maybe looking at how you get started and what you do and how you pull people together.
Okay. In September, the national group, the Safe Motherhood Group that Alison has been working with spearheaded a very large meeting involving all the federal agencies that had anything at all to do with women, particularly women of child‑bearing age, children, young children, particularly, and agencies involved with mental health and, particularly, depression. Those were pretty much all the groups; is that right?
UNKNOWN SPEAKER: Yeah.
JEANNE MAHONEY: That turned out to be 17 federal agencies and 30 plus national organizations. We came together and we looked at the evidence‑based report or the preliminary evidence‑based report that Alison has mentioned and then we looked at so now we've got this report, what do we do? And what we decided to do was to build very slowly a national partnership that was being focused on perinatal depression.
I had the opportunity to chair the steering committee for that group. There are eight federal and nonprofit representatives. We are all volunteers, so we self‑selected. We meet via conference call, and we've been doing this since November. So this is a very new process. And it's a lot of words. You can read it on your piece of paper what our purpose is, but basically what we're actually doing as a steering committee is trying to drive the initiative, not by actually doing all the work‑work, but to try doing some conceptualization, and we're looking at having eventually four subcommittees, one based on research, convention, public awareness and screening and treatment. These four subcommittees were recommended by the large summit meeting that we had.
Our role is really to facilitate the communication and coordination of efforts between organizations on a national basis. And then to come up with and develop and execute the plan that kind of helps make this all happen.
Our first job, which we're in the midst of right now, is basically developing‑although we're not using the words ‑‑ the words we're using is an activities sheet. But basically it's a major matrix that looks at what everybody is doing at least beginning with the 30 agencies that came, 30 nonprofits and the 17 governmental agencies that came, and then expanding that to agencies that we didn't initially include but that are very much a part of this. Because it's truly a word of mouth. Once we came together, even as our small steering committee and started talking, it's like: Well, didn't you know about da da da and didn't you know that this organization, the brand new organization, just up is going ahead and moving and doing this. And so what we're trying to do is to pull together just even a knowledge base to kind of figure out what's going on. Because there's a lot going on. You heard about it in the room. And that's just a small subset of what's going on in the mental health world, in the child world, at the state level, at the legislative level. A whole other level. At the payer level. So there's a lot going on. How are we going to pull this together to make a pie and to make it work?
So that's really ‑‑ I know that's a pie‑in‑the‑sky kind of thing but that's where we're trying to move. And so we're going to put this date we have on websites. And then we're looking at activities that all of our national partners can pull into. And the first thing which seems like kind of a no-brainer is to take the report that Alison was talking about and publicize it a little bit. Get some bang for our buck. They put a lot of effort into doing that. Let's get this out and let's get it publicized to the rest of the community. That's where we're at right now. Our four subcommittees have not been identified, and we have not gotten off the ground with them yet. We're beginning to work together as a steering committee. It's a lot of work. Let me tell you, to do particularly that kind of work in conference call, many of us have never met each other. And in fact when I do meet some people on the steering committee in outside meetings, it's like, oh, that's who you are. You've done it a million times because that's the way we live is on conference calls these days. But to actually see someone face to face also conference calls have to be short, you know. And we have them actually to tell you the truth, if you're doing this, and one of the partnership tools, is to have a great facilitator for conference calls and really understand and know how to do a conference call. It is not the same as doing a meeting. Not in the least bit. You know it, but there are certain tips and tools that you need to learn to do that. If you're looking at statewide level or national level, you can't bring everybody together all the time. And so being able to use, to do conference calls well takes some effort. And we're working on doing it.
Okay. ACOG and what we've been doing on providers partnership. To back up a tiny bit: In 2002, the Maternal Child Health Bureau had been funding ACOG for quite a while actually to develop interfaces between state public health and OB/GYNs and in 2002 I kind of came on board and looked at how we can do these partnerships around particular womens health issues. And the ACOG docs, the section chairs, which are basically state chairs for ACOG, we surveyed them and they said there were two issues that kind of rose to the top as far as what truly impacts their work with women, and one of them was depression, depression in general. Not just perinatal depression, but depression in general. And the other one is tobacco use. And then substance use and domestic violence. Basically tobacco use and depression were the two top ones. So just to let you know, doctors do recognize this is an issue. From that, we pulled together four teams for each of the partnerships, to kind of start out and get going. And those states looking at depression were, I don't think represented here, North Dakota , Florida , California ‑‑ I'll think of it.
I'll think of it in a second. That's okay. And these states we came together. We had meetings. It's very similar, if anyone has been working with AMCHP on their ALL process or City Match and their ALL process. It's very similar to that where we bring states together and we really do intensive work with them. These had four or five representatives from states, including physicians, Title V people. For the depression, we had people either from the mental health organizations or payers, whatever kind of work for that state. Because each state, the leadership is set up a little differently. You know, Chan was saying that Texas Department of Health used to be this and now it's that; and so not only is it set up differently, it's a changing wheel.
And so because states are set up differently, whoever kind of works for that state works. But we tried to get payers and physicians and Title V together to develop these partnerships. And the goals of most of these partnerships included that community clinician connection, screening by healthcare providers. And these are goals actually that no matter what we never said this is the goal you have to have, but all the partnerships ended up coming up with the same thing, because you're not creating the wheel; it just happens. So screening. Training clinicians in conducting assessments and doing brief interventions, coordinating with local systems and developing more. And then increasing public awareness.
And so, truly, that's what the ACOG partnerships do. The partnerships have to include both systems and service. Now, I know that seems like kind of a broad thing. But what you're dealing with, you actually have an apples and oranges situation. You have systems people that are really looking, that are process‑oriented people. Systems people are mostly often process oriented. They're developing their matrixes. They're looking and setting up their goals and objectives. And that's a very important part of what happens. You also have to have delivery, service delivery people, people that can actually go out and test out things and work on them and also get other service delivery people involved. Systems people have a hard time getting service delivery people to sit in on things, because service delivery people are saying, okay, let's go. Okay. Got it. Let's go. Let's do it now. And to get them to sit down and actually work out the process is hard. And it's very hard to keep them going. And you're kind of all smiling because you've dealt with it. It's hard to keep service delivery people, particularly physicians, involved in this processing thing. So one of the things that we've been working on and trying to develop is how you do that and do it well. And it does work.
The roles of the partners, in order to be sustained, everybody has got to have a role, and so one of the things that we've tried to do is look at making sure that there's a leader. And it doesn't have to ‑‑ in fact some of the partnerships have physicians as leaders and some of them have Title V people as leaders. As Tan and I were just talking about that, and some of them have, oh, just different organizations as leaders. One of them the mental health association in North Dakota is the leader for the North Dakota partnership. It doesn't matter who is the leader. It matters who is willing to take the ball and consistently hold it.
Recorders, administrators, and we always need a spokesman and a politician, somebody that's out of the public health system and that can actually speak on the issue and get the politicians and the legislators to move on things.
And I've talked about the North Dakota Women With Depression Partnership. I have to tell you, North Dakota , they have awed me to no end. North Dakota has 44 obstetricians and gynecologists in the whole state, beginning to end. The good news about that is the ACOG section chair knows every one of them by names, knows their families, knows whatever. So nobody gets under the radar screen. And that's been an important part of their success. They came together with the Mental Health Association, private psychiatrists and public health, and they started out doing a demonstration project which is now spread out into four facilities. Basically what they do is they take over a town with their demonstration projects. If you can imagine, in North Dakota , because the numbers of providers are so small, if you go in and you take over a hospital, you've taken over the town. And so women in Fargo , for instance, cannot go into their obstetrician and gynecologist anywhere without being screened for depression. And they have a system set up so that the obstetrician gynecologists know the mental health providers around. And so they have direct line into them. They get their women into that mental health provider quickly, with not a lot of stigma involved. And it's a warm hand‑off rather than a cold hand‑off. So women get into treatment quickly and well.
And that's been happening across North Dakota . The Mental Health Association has taken the ball and has done a marvelous job at doing public health campaigns. And they've got a little bit of funds to do that. They also, the mental health association, who is the leader, got some extra funding from the terrible drug companies that nobody is allowed to deal with, except that you know they got money. So they've got a little money from the drug companies to be able to get this going and to be able to do the evaluation part, which, again, is very important when you're doing stuff you have to be able to evaluate it to say if it works or doesn't work. So I'm using North Dakota as an example there. I have to say our best example so far of being able to really work together and do something.
This group meets face to face. They drive to Bismark, which is a long way if you live in Fargo or live in Minette. They drive to Bismark twice a year, get together, have a face‑to‑face meeting that's sponsored by the drug companies. They do telephone calls the other bits of time, and they actually are working well together.
In Florida , Florida , as you know, is just, you know they've done wonderful MCH work for years and years, and they continue to do it. The Florida ACOG chair had this ‑‑ who is the atypical person to actually be the warm fuzzy woman's person, he's from Miami, and he's a Miami doc in every way, gold chains, the whole bit.
(Laughter)
However, he was able to help a woman with depression and that's all you need is a convert. He's been working with Annette Phelps in the Florida Department of Health and they have developed a very nice, comprehensivish system of training and support of the Mental Health Association in Florida came on in and is doing provider trainings and consistently does them. They've been doing them on their own and they've been doing them with WIC, and again it's this getting together and doing things. This team doesn't meet a whole lot, but when they get together they do great stuff.
In Texas , there you are, Jan. It was an opportunity out of tragedy is the best way to describe it. We all know the tragedy. And that caused some state legislative action, and the department of health had to come around that legislative action and figure out what are we going to do? We have this legislative action which we probably didn't want right then and right there worded exactly that way, but it happened. And so what do we do with it? We make apple sauce or lemonade out of lemons; and the department of health developed a team; they did a public campaign; worked on advocacy, pulled together resources and are continuing to meet to figure out how they're going to get these resources to women. It's a huge state. They have a big problem. But they're working on it.
And actually I'm going to turn this now over to Milo who is going to talk about the Pennsylvania partnership, which kind of developed in and of itself, other states who have partnerships, Indiana , has a provider's partnership. We've been working with the Indiana Perinatal Network, Colorado . There's 14 of them altogether, 14 states.