Many primary care practices do not have a well-organized system for changing how clinical care and screening are delivered. In addition, practices often do not have the internal resources to follow up on positive depression screens. Thus, there is a role for either the practice's parent organization or an outside organization or agency, such as a practice network or public health department, to assist primary care practices in designing and implementing parental depression screening.
Provision of Referral and Treatment Services
In many communities, it is necessary to bring together several organizations to provide parental depression screening and treatment.
Figure 5 is a worksheet that summarizes the steps needed to prepare to implement community-wide or statewide screening. These steps are described in more detail below. A copy of the worksheet is found in the appendices.
Figure 5: Prepare Your Community (Click image to open at full size.)
Engage Your Partners
Develop a Community Approach
Explore Available Resources and Network with Collaborators
Establish Triage/Referral Mechanism
Simply identifying resources will not ensure that depressed parents identified by their child's clinician will seek and receive assessment and a diagnosis of depression. The Parent Support Line, however, is an example of a system that reaches out to depressed parents, assesses their symptoms, and refers them to appropriate care and services.
Parent Support Line The Parent Support Line (PSL) of the Parental Well-Being Project utilized the resources of a behavioral health employee assistance triage team for parents who were referred by participating practices. The triage team had licensed M.S.W. staff. Their assessments began with the chief complaint/or initial request. Within that context, triage was conducted to determine the level of functioning, particularly neuro-vegetative signs of mood disorders. Particular attention was paid to risk factors such as substance issues, violence, and suicidal/homicidal ideation. Triage explored psychosocial stressors in the work, home, and social environment, paying close attention to support systems in place or needed. Special attention was paid to how well the caller thought they were parenting while experiencing depression or stress. Triage might include one or all of the following: assessment or brief treatment by a licensed independent master's level clinician, referral to community resources, and information and resources that may be helpful in educating or informing the parent about how to cope or solve their various issues. Follow-up calls to the parent were made to ensure a satisfactory outcome.
A centralized approach—using an institutional- or community-based social worker or practice-level care manager—is another way to ensure that there is follow-up and assistance in getting treatment and support for parents who screen at risk for depression.
Organizations such as insurance companies, health agencies, hospitals, or groups of practices that want to support parental depression screening at multiple practices can do the following:
Increase awareness of clinicians about the impact of parental depression.
Provide materials to clinicians needed to implement screening in their practice.
Assist practices in changing their office system to support screening and referral.
There are several ways the external organization can support the continuation of screening programs in pediatric care practices. One is by periodically reviewing the screening and referral process and assessing the satisfaction of both the parents and the providers. Also, the external organization can educate and help to de-stigmatize depression through informational articles in local papers or local parent meetings. Information for new providers who join the mental health and primary care communities can help continuation of a broad approach. Periodic phone conferences or meetings between practice champions can offer an avenue for support and problem-solving.
Comments from Project Leader
"It was very helpful for clinicians to share their approaches to discussing maternal depression and how they addressed the issues resulting with the child. These shared discussions usually led to descriptions of instances where the parent was very appreciative of this approach to depression and reinforced their efforts."Dr. Ardis Olson
Dartmouth Medical School