Perinatal Mood and Anxiety Learning Laboratory in a Freestanding Children's Hospital

PROJECT SUMMARY/ABSTRACT Postpartum depression (PPD) is the most common medical complication of childbirth that remains underrecognized and undertreated. Children’s Hospitals are ideal sites for postpartum mental healthcare because mothers in the Neonatal Intensive Care Unit (NICU) are at high risk and those seeking care in the Pediatric Emergency Department (PED) often miss routine office visits with a pediatrician or obstetrician. The first step to reducing the negative consequences associated with untreated PPD is timely screening and self- awareness of depressive symptoms. However, screening NICU mothers and in the PED is uncommon, expensive, personnel-heavy, and time-consuming. The second step is referral and treatment which is multifaceted and requires parents to navigate different parts of the healthcare system, a vast endeavor for a depressed individual. Redesign of healthcare systems to permit seamless screening, referral, and treatment of mothers with PPD creating an efficient “one-stop-shop solution” is urgently needed. Our long-term goal is to provide safe, comprehensive, point-of-care access to mental health services for parents of infants treated in children’s hospitals. The overall objective is to create a Perinatal Mood and Anxiety Disorder (PMAD) Learning Laboratory using a five-phase systems engineering approach that develops new solutions for clinical recognition and therapy for PPD. Our specific aims are 1. To optimize screening, referral, and treatment for postpartum depression in the NICU and PED using system dynamics group model building techniques. We will analyze the current workflow, identify barriers, elicit system requirements from stakeholders, map the system, and develop a system dynamics simulation model to test solutions in a virtual environment. 2. To design a novel software dashboard for real-time tracking of eligible mothers with its accompanying parent-facing app and develop a predictive model to identify at-risk mothers. We will then develop a measurement system to monitor key performance indicators. 3. To implement new solutions, monitor, and evaluate the system for unintended consequences before and after implementation. A difference in difference, and cost-benefit analysis will be conducted to evaluate the changes. Our PMAD Learning Lab is innovative because it is a significant departure from traditional techniques using novel approaches and new technology to assist in the recognition and treatment of PPD on a large scale in real-world settings in the NICU and PED of a free- standing children’s hospital. This is significant because if successful it will be generalizable to the treatment of other mental health disorders that affect postpartum parents and will contribute to improvement in short- and long-term health outcomes of parents and infants who are at a higher risk than the general maternal population.