The following is a guest column from Ohio Colleges of Medicine Government Resource Center Medical Director Dr. Gil Liu.
Ask any physician. It’s no secret. Traditional approaches at improving prenatal care alone have been failing to significantly reduce low birth weight and premature births across the nation and in Ohio for quite some time.
Over the last two decades, health professionals, the US Center for Disease Control and Prevention (CDC) and health policy experts have been recommending the use of a mother’s interconception period, the time between pregnancies, to improve maternal health prior to a subsequent pregnancy.
In the face of longstanding calls to refocus efforts on the interconception period, many pediatric practices still lack systems to connect mothers to adult services, especially those related to mental health, substance use, or nutrition. Credentialing, licensing requirements, or reimbursement commonly limit the ability of pediatricians to provide direct treatment to parents. But, there’s a solution.
Recognizing that pediatric care is the most universally accessed system we have for mothers and children, Ohio’s Healthy Moms, Healthy Families Quality Improvement Program (QIP) is recruiting pediatricians to join a project leveraging this opportune interconception time to reach women who otherwise will forego needed care.
Ohio’s Healthy Moms, Healthy Families QIP, adapted from the IMPLICIT national model, targets four maternal risk factors:
- Tobacco use.
- Depression Risk.
- Lack of contraception use.
- Lack of multivitamin with folic acid intake.
I personally have experienced frustration when attempting to care for mothers of infants. Despite practicing in a well-resourced clinic—as evidenced by social workers, therapists, and care coordinators being onsite— I usually feel extremely rushed and that I’m punting complex problems. Honestly, I need stronger training and a more integrated linkage to adult health services to succeed at screening adults and addressing maternal concerns.
That is why Ohio’s Healthy Mom, Healthy Families QIP is designed specifically to be feasible to perform within the context of a well-child visit. Take Dr. Hoerr’s experience in Canton, for example.
Having two-generation conversations in the office doesn’t just make sense, it makes cents too. The US Centers for Medicaid and Medicare Services (CMS) has sought to clarify opportunities within public health insurance to cover maternal depression screening as part of a well-child visit, designating maternal depression screening as an integral part of a risk assessment for the child. Further, since the maternal depression screening is for the direct benefit of the child, the CMS allows such screenings to be claimed as a service for the child as part of the EPSDT benefit.
Throughout my 25 years of practicing general pediatrics, I’ve collected information about mother’s actions to care for their infants and counseled mothers with the intent of establishing healthy family circumstances as a primary means of promoting infant wellbeing. Since finishing medical school in 1996, I’ve had to learn new skills for supporting breastfeeding or addressing maternal postpartum depression1 as evidence-based guidelines have emerged. Such skills represent valuable opportunities for pediatricians like me to implement two-generation approaches and family-centered care.
Maybe you’re like me, and are beginning to understand that, through your professional experience and application of evidence-based care, you’ve mostly been taking a two-generation care approach already— even more of a sure sign you’ll benefit from and contribute to the statewide work of Healthy Mom, Health Families.
Maybe you’re not there yet, but know that the care you could take with a mother’s symptoms will directly benefit her child. Even better. Healthy Mom, Healthy Families has the support structure and resources to help you take the next step.
In any case, as pediatricians, most of us share the foundational view that strengthening the mother-child relationship is fundamental to ensuring that a child is on the path to a better life and brighter future.
The Ohio Chapter of the American Academy of Pediatrics (AAP) and the Ohio Colleges of Medicine Government Resource Center (GRC) are jointly recruiting pediatricians into the Healthy Mom, Healthy Families quality improvement collaborative associated with the IMPLICIT Network:
http://ohioaap.org/hmhfregistration
Dr. Gilbert Liu, MD, MS is the medical director for the Ohio Colleges of Medicine Government Resource Center and a practicing pediatrician for over 25 years.
[i] A clinical statement issued by the American Academy of Pediatrics (AAP) considers screening a mother for depression a best practice for primary care providers who care for infants and their families.