AMCHP 2005 ANNUAL CONFERENCE
DELIVERING RESULTS, IMPROVING PREGNANCY & BIRTH
February 19-23, 2005
MILO WOODWARD: Good morning, everybody. I just wanted to share with you Pennsylvania 's experience. I want to tell you we are, when you see the title Statistical Beginning, we really are at the beginning. Pennsylvania is very fortunate in that we have six Healthy Start projects, and we actually have ten local health departments where we have nine that are funded by Title V agency. And in 1998, we began Healthy Start projects in the state health department Title V agency began to meet to, you know, find areas of commonality, areas to collaborate on, I guess cognizant of the fact that we had the same populations and were trying to achieve the same goals. So we, from 1998 to 2002, we talked and talked and did some things and met and got a lot of different things accomplished within Pennsylvania, and then we decided, in June, that we needed to do something a little bit, June 2002, we needed to do something a little bit more formal. So we created an actual organization in which not only Healthy Start and Title V could participate, but our future hope was that other organizations and advocacy groups within the state would participate that had interests in perinatal populations. We named our organization the Pennsylvania Perinatal Partnership, and the goal of our partnership, or the mission statement of our partnership, was to improve maternal and child health outcomes through collaboration, joint intervention, strategies and advocacy.
Of course, we were both ‑‑ Healthy Start is federally funded. So is State Title V. And as a partnership, when we came together in 2002, we actually, as an organization, did not exist in the business world. So we had to find a way to make ourselves viable to actually create and conduct business. Our family planning counsel in Philadelphia was very helpful to us and became basically our business infrastructure and so we began our work through them. Additionally, the Healthy Start projects who got some federal encouragement to partner with Title V put forth some funding and our local health departments that were funded with Title V also contributed some funding. So that gave us some operational money to begin.
Our initial concerns when we started were that in Pennsylvania , as in other states, there's very serious issue around malpractice and access to care, because many of our obstetricians are leaving. I'm not sure where they're going. But they are leaving Pennsylvania .
We have a very diverse population. So we were concerned about cultural competency. And is everyone, perinatal depression was very much, became a part of our radar, on our radar screen.
We were very fortunate that our consultant that we hired to support the partnership went to City Match and met Jeanne. And from that Jeanne said: Why don't you, you know, figure out how you can be a partnership and create it and from this meeting ‑‑ let me just cut to the chase here, from the meeting we, the Pennsylvania Perinatal Partnership created the leadership team with the help and support of ACOG and Jeanne. And we began to talk about what should we do? What aspect of perinatal depression do we want to deal with? Do you want to talk about women who are pregnant? Do we want to talk about postpartum depression? Do we want to talk about ordeal with depression that providers told us was occurring among women postpartumly or how do we define our place to start. The leadership team decided we should hold a summit and invite the stakeholders and let the stakeholders tell us and direct us in how to define where we should go. That summit was held in October 2003, and I think everybody that we could think of in the world, we invited to this summit. We had national stakeholders, you know, including the state and national officers of ACOG. We had mental health, substance abuse staff. We had perinatal depression experts. We had child advocacy leaders. We had the executive staff from the Pennsylvania Chapter of the American Academy of Pediatrics. We had our own state public health officials there. We had family planning administrators. We had the medical directors, who were primarily obstetricians from the managed care organizations, and as well as the private insurers.
In addition to that, we invited community‑based organizations and advocacy groups from within the state. So we tried to bring everybody to the table to help us focus on what to do.
I'm going to skip who was there. It's all in the paper that you have, okay? But from the summit, four work groups were established and it was behavioral and physical health care collaborations and work group. The patient and provider education and training work group, services and screening and identification work group and the evidence‑based medicine and outcome data work group, all of these work groups are still very active and working and still very much a part of our structure for dealing with perinatal health depression.
In late 2003, probably around November of 2003, the chairman of the health and human services committee of the Pennsylvania House of Representatives, representative George Kenny, introduced legislation requiring information and referral sources be disseminated to pregnant women about postpartum depression. So the perinatal partnership saw this as an opportunity to expand our horizons and incorporate the one element that we hadn't incorporated, and that was the political element. So we contacted representative Kenny's office and to see where were our areas of commonality, where we were on the same page and what could we do to strategize to work together. From that, representative Kenny decided that he wanted to do three legislative hearings about perinatal depression to find out what was going on. We kind of, the partnership kind of encouraged him to slow down. Don't just do it right now, let's try to get a lot more of the players that we need to participate aware that these things are going to go on. So actually he wanted to hold the hearings in 2004, and we kind of slowed him down a little bit, because we wanted to make sure that all the partners that should be involved were involved. And those hearings actually at this point have not taken place, but they are still in the planning process. And we are mostly concerned that we did not exclude the mental health providers and the behavioral managed care providers, because we thought that their involvement was critical for our success.
In April of 2004, a meeting was convened with the mental health providers and the behavioral health providers in the managed care systems. And as a result of that meeting our focus was clarified. We decided that we would focus on pregnant women with symptoms or signs of perinatal depression and we would focus on training and prevention and education about postpartum depression.
So in May of 2004, A cog hosted a reception, Jeanne, hosted a reception for us in Philadelphia . And the leadership team had an opportunity to meet with the A cog depression leadership teams throughout the nation who were having their national conference in Philadelphia at the same time. So the reception provided Pennsylvania with an opportunity to exchange and share information as well as to get the experiences from the colleagues from around the nation. In addition to the reception, the partnership received an offer from the Pennsylvania Department of Health, specifically Title V, to serve as the applicant for the federal grant addressing perinatal depression. And for all of you who received that grant, we certainly congratulate you, because Pennsylvania did not.
(Chuckling).
(Inaudible) someone says we didn't either. But we were approved in the grant process but we were not funded. But the goals of that grant was to reduce the stigma associated with perinatal depression to increase the number of women and their families who would seek help and treatment and to increase the number of health and community providers who could recognize symptoms of perinatal depression and provide screening and refer for additional assessment and treatment as appropriate or necessary. And even though we didn't get the grant, Title V had the year before in its budget set aside some money to specifically address perinatal depression, because we were aware that this was an issue. And maybe it's a growing issue, but it certainly was a prominent issue that had been there for a while that we just had not been able to address. So we, you know, decided we need to do something. So when the partnership didn't get the money, Title V said: Okay, how about if we, you know, do a contract with you and take the goals of what the federal grant would address and add a few things for what we need specifically for Pennsylvania. And so at this time we are currently developing the contractual papers for that. And the goals for the contract that we're doing with the partnership, Title V is doing with the partnership, is to provide education and recognition of perinatal depression in populations that are being served for educating consumers and their families to recognize perinatal depression and to know where to get help and what is available.
We wanted to encourage the advocates to develop service systems and, services and systems that would address the needs of the population. We also wanted to include the lawyers to help assist in defining the areas of responsibility and the appropriate payers for the services and the service systems that we were asking everyone to help us develop.
We went to develop education campaigns for the general public, because we know that there's a lot of stigma around having mental health issues, and particularly having mental health issues and perinatal depression. So we wanted to develop campaigns that would break that stigma or at least help lessen the stigma. And we wanted to find strategies that would open the gates between physical health and behavioral health so that you know we could, you know, join together to address perinatal depression. Because without both of the partners we'll only be addressing a part of the issue. So that was a very important issue for us.
So also it's really important, a lot of times what Title V does is target specific populations, particularly low income populations for its services. This time we decided that we weren't going to do that. We wanted everybody to be included in the target population, because we realized that no matter what your education, no matter what your economic status, no matter where you live, whether it's rural or urban or whatever, that this is an occurrence and this is a problem that everybody is facing and everybody needs some help. So this contract will be initiating in October of this year. So just want to do this quick so we can leave some time for you all to ask questions.
But anyway, our next steps are to just assess the effectiveness and the efficacy of what we tried to do in our contractual relationship with the partnership to address specifically address perinatal depression. But another major thing that we're trying to do, and in the paper that you have, you can see the specifics that we're going to try to do as next steps but another thing that we want to do that's not in the paper is that we really need to open our partnership up so that other organizations, other providers, other people individuals who have a specific interest in perinatal health and perinatal depression can become a part and help partner with us to help address the many issues that exist within perinatal health as a broader area. And I would like to say I thank all of you for showing the interest you have in this area, and I thank AMCHP for having the foresight to address perinatal depression, because we all know it's a serious, serious problem, and we have to do something about it, like immediately. Thank you so much.