Maternal Depression and Social Emotional Resources

The Illinois Chapter, American Academy of Pediatrics (ICAAP) is excited to offer tainings on mental health of children and families, including screening children for social/emotional delays and mothers for perinatal depression. For more information on these topics, as well as other child development presentations, please visit www.edopc.org.

The Perinatal Mental Health Disorders Prevention and Treatment Act was enacted in January 1, 2008 to increase awareness and to promote early detection and treatment of perinatal depression. For more information on this act, including a letter from Governor Blagojevich and a list of perinatal depression resources, click here or visit the Illinois Department of Human Services Web site.

As of December 1, 2004, the Illinois Department of Healthcare and Family Services (IDHFS, formerly the Illinois Department of Public Aid) began reimbursing providers for screening mothers for perinatal depression when the child is on KidCare, the state’s Medicaid program. You can view IDHFS' provider notice regarding this new policy by going to www.hfs.illinois.gov/assets/112904pd.pdf.

Here are some useful tips and resources to get health professionals started in these exciting new initiatives:

Screening Tools
Maternal/Postpartum Depression Resources
Social/Emotional and Developmental Issues Resources
Billing Procedures
Record Keeping Procedures

For more information on any of the ICAAP developmental projects, or if would like to schedule a presentation for your office, clinic, or hospital, please e-mail ttoppe@illinoisaap.com or call 312/733-1026, ext 201.

Screening Tools

For more information about developmental screening tools, including links to comparisons of commonly used tools and ordering information, please visit
www.edopc.org/links.aspx

IDHFS will reimburse providers for the use of the following screening tools:

Maternal/Postpartum Depression Resources

University of Illinois at Chicago’s Health Resources and Services Administration’s (HSRA) Perinatal Depression Project (www.psych.uic.edu/clinical/HRSA/index.htm)
Designed to increase awareness and understanding about maternal depression.
The Web site offers information about the project and the staff involved in this initiative. It also offers links to other perinatal depression resources. In addition, you can find out how to take part in a free workshop that is offered to service providers on the recognition and treatment of perinatal depression. In addition, the project is sponsoring a toll free number (800/573-6121) as a resource for providers with questions about perinatal depression screening, referral, and treatment.

University of Wisconsin at Madison's Perinatal Foundation (www.perinatalweb.org/foundation/index.htm)
The University of Wisconsin at Madison’s Perinatal Foundation conducts research on child and maternal health. Its mission is to secure and provide resources to improve the health of babies, mothers, and families from preconception to early childhood. You can obtain free copies of the Edinburgh Postnatal Depression Scale, in both English and Spanish, by visiting www.perinatalweb.org/foundation/pmdresources.htm, and then scrolling down to the “Screening Tools” section of the page.

Postpartum Support International (www.postpartum.net)
Offers support and resources for mothers suffering from depression, as well as for their partners.

Postpartum Depression Alliance of Illinois (www.ppdil.org)
Includes information about local resources, individual treatment options, and support groups.
The mission of the Postpartum Depression Illinois Alliance (PPD IL) is to promote awareness, prevention and treatment of maternal mental health issues throughout the state of Illinois.

The Center for Postpartum Health (www.postpartumhealth.com)
The Center for Postpartum Health addresses the physical, mental, and emotional needs of pregnant and postpartum women and their families, facilitating the transition from pregnancy to parenthood.

Social/Emotional and Developmental Issues Resources

Zero to Three (www.zerotothree.org)
includes free reproducible materials for parents
ZERO TO THREE is a national non-profit organization that is devoted to the promotion of the healthy development of infants and toddlers.

Society for Developmental and Behavioral Pediatrics (www.dbpeds.org)
Independent web site created to promote better care and outcomes for children and families affected by developmental, learning, and behavioral problems. Provides links to several other organizations, materials and information for physicians, fellows, resident physicians and students.

Dr. Spock (www.drspock.com)
Created by doctors and other experts to offer a complete, personalized resource for parenting information, including behavior concerns, covering every stage of pregnancy and childhood, from newborns to teens.

KidsGrowth (www.kidsgrowth.com)
Has a great deal of information and articles regarding developmental, physical and behavioral health of child.

The Whole Child (www.pbs.org/wholechild)
Sponsored by PBS, the website has information for providers and parents on a wide range of developmental and behavioral concerns. Site is written in both English and Spanish.

Healthy Steps for Young Children (www.healthysteps.org)
Healthy Steps for Young Children is national initiative aimed at enhancing the quality of preventive health care for young children. Healthy Steps emphasizes a close relationship between health care professionals and parents in addressing the physical, emotional, and intellectual growth and development of children from birth to age 3. Free handouts are available for downloading through the Commonwealth Fund's Web site.

Billing Procedures

IDHFS has announced that it will reimburse providers for screening mothers for perinatal depression. Please note that providers may bill for maternal depression screenings until the child is one year old. While there is no limit to the number of screenings conducted during the child’s first year, experts affiliated with ICAAP recommend screening at well-child visits, and at least twice during the first year. In order to bill for these maternal depression screenings, either the mother or the child must receive KidCare (Medicaid) benefits. If the mother receives the benefits, providers should use her ID number when billing. If the child receives the benefits, use his member ID number.

Please remember that IDHFS will only reimburse for the use of an approved screening tool. At this time, the approved tools are: the Edinburgh Postnatal Depression Scale (EPDS); the Beck Depression Inventory (BDI); and the Primary Care Evaluation of Mental Disorders Patient Health Questionnaire (PRIME-MD/PHQ). Please keep in mind that IDHFS and ICAAP recommend developing a practice-wide policy and screening all mothers for depression consistently. However, insurance companies are not yet reimbursing separately for the screening, as they assume that the assessment of family status and risk is incorporated into the well child visit.

Visit www.hfs.illinois.gov/assets/112904pd.pdf for the IDHFS provider notice that explains the new billing procedure. For more information about billing Medicaid, please call IDHFS at 877/782-5565, or visit www.hfs.illinois.gov/.

The code for postpartum depression screening is 99420 and providers are reimbursed $14.60 for each developmental or social/emotional screen.  For more information, if you have any questions about billing procedures, or would like to request training on developmental or social/emotional screening for your office, please e-mail ttoppe@illinoisaap.com or call or 312/733-1026, ext 201.

Record Keeping Procedures

Providers and their office staff may have questions regarding how to maintain appropriate records when screening mothers for depression. In family practices, both the new baby and the mother are likely to be patients, which eliminates the need for unique record keeping procedures. But in pediatric offices and some family practice situations, the mother is not a patient, and questions will arise as to whether the maternal depression screen can or should be kept in the child’s record.

While the Health Insurance Portability and Accountability Act (HIPAA) does not prevent including the maternal depression screen in the child’s record as part of the child’s risk assessment, many individual institutions and practices may have more strict policies. In addition, there may be some concerns involving confidentiality, what might happen during divorce proceedings, and other issues. So we are recommending that the hard copy of the screening tool is shredded (or given to the mother directly, if she desires). Be sure to document in the child’s chart that you completed the screening tool, what the score was, the result of question #10 (if there was a concern), and if a referral for additional assessment was made (and to whom). The AAP also recommends that you speak with your practice’s attorney if you have any questions, to be on the safe side.

Please note: the Web sites referenced above are for informational use only. The material may reflect views or recommendations which do not necessarily reflect the views of ICAAP. The listing of a person or company in any part of the above Web sites in no way implies any form of endorsement by ICAAP of the products or services provided by that person or company.