Problem: Texas enacted House Bill 2466, effective September 1, 2017, to provide Medicaid and child health plan coverage for maternal depression screening during an office visit for the child.  The purpose of this brief report is to inform clinicians of this coverage and urge Pediatricians to standardize the practice of perinatal screening during well child checks in the first year. 

Background: One out of every seven women experience depression during pregnancy or within one year of delivery, defined as “perinatal depression”.  This staggering statistic makes perinatal depression the most underdiagnosed obstetric complication in the United States.  If untreated, perinatal depression can have devastating consequences for the mother, their child, and their families.  Research has shown a higher incidence and risk for preterm birth, low birth weight, intrauterine growth restriction, pre-eclampsia, substance use during pregnancy, suicidality and infanticide.

• Prevalence of perinatal depression is 2x greater in low-income women
• Perinatal depression can threaten the initial mother-child relationship – i.e. attachment, bonding, breastfeeding
• Perinatal depression can negatively affect all aspects of a child’s development – lower level of engagement, lower activity level, poor regulation, withdrawal

Last year the U.S. Congress enacted the “21^st Century Cures Act”, which included the “Bringing Postpartum Depression Out of the Shadows Act of 2015”.  This law established and expanded pre-existing state funding for maternal depression screening and treatment in primary care settings. The goal was to provide doctors with the training and resources to complete screening, as well provide the follow up support and treatment therapies necessary.

In response to the new federal law, Texas passed the House Bill 2466.  Texas’ new law directs the state agency to develop rules for implementing the maternal depression screening and provide Medicaid coverage for it, regardless of whether the mother is also a recipient of Medicaid.

For guidance, clinicians can review the work done by leaders in Massachusetts to identify women facing perinatal depression and engaging them in appropriate therapies.  The Massachusetts Child Psychiatry Access Project (MCPAP) for Moms developed as a spinoff program of the successful MCPAP launched in 2005.  The original MCPAP was designed to help pediatricians manage pediatric psychiatric needs.  MCPAP for Moms provides three main services: https://www.mcpapformoms.org/

1. Trainings and toolkits to assist Pediatricians in depressing screening, referral, medication discussions, and other treatment options
2. Real-time psychiatric telephone consultation for providers caring for pregnant and post-partum women
3. Networking opportunities with community-based resources to support pregnant and post-partum women

Recommendations/Takehome points: As Pediatricians, we are often the first to see a mother after she leaves the hospital.  We have a unique and important opportunity to identify those struggling with perinatal depression, and get them the help they need and deserve quickly.

• Perinatal depression screening can be appropriately integrated at the 1, 2, 4, and 6 month visits for the child.
• It can be as simple as two questions:

Over the past 2 weeks:

(1) Have you ever felt down, depressed, or hopeless?

(2) Have you felt little interest or pleasure in doing things?

• Screening does not require the Pediatrician to treat the mother. It gives an opportunity to refer her to the appropriate resources.

Alison Kimura, MD, MPH

 

Resources:

1. http://www.legis.state.tx.us/billlookup/text.aspx?LegSess=85R&Bill=HB2466
2. https://www.congress.gov/bill/114th-congress/senate-bill/2311?q=%7B%22search%22%3A%5B%22bringing+postpartum+depression%22%5D%7D&r=1
3. https://www.congress.gov/bill/114th-congress/house-bill/34/actions
4. https://www.mcpapformoms.org/
5. http://escholarship.umassmed.edu/cgi/viewcontent.cgi?article=1003&context=parentandfamily
6. Byatt, Nancy, et al. “Improving perinatal depression care: the Massachusetts Child Psychiatry Access Project for Moms.” General hospital psychiatry40 (2016): 12-17.
7. Earls, Marian F., and Committee on Psychosocial Aspects of Child and Family Health. “Incorporating recognition and management of perinatal and postpartum depression into pediatric practice.” Pediatrics5 (2010): 1032-1039.