Coming Up...

• Attention enrolled KCC providers! Help us share our program impact with our funders by responding to an upcoming survey invitation from the team. Rumor has it, the KCC team has new swag to mail out as a thank you for your participation. Details coming to your inbox soon.
• Our final PSI-KS and KCC webinar of 2022 will focus on support for LGBQ/T families during the perinatal period. Register here and join us on Monday, November 7th from 12:00-1:00. 
• Prescribers and other providers involved in the medication management and treatment planning for perinatal mood and anxiety disorders are highly encouraged to join our upcoming Kansas Moms in Mind (KMIM): Psychiatric Case Consultation Clinic series. Our new session begins next Tuesday, October 11th from 12:00-1:00. 
• Other things on the KCC team’s mind recently:
  • For professionals working in early childhood education, Kansas Parents as Teachers has a host of professional development opportunities, including an upcoming Perinatal Mental Health Training focused on screening and what to do following a screening. 
  • The Kansas Breastfeeding Coalition's annual conference is fast approaching on October 13th. 
  • We know perinatal and child mental health are clearly linked. The 2022 Mental Health Symposium in Hays Kansas will focus on Supporting Rural Kansas Kids and cover a variety of topics aimed at improving mental health outcomes and care for children in our state. 
  • The topic of mandated reporting related to perinatal substance used continues to be a question providers and organizations navigate. This recent JAMA article expands on the conversation, reflecting on how mandated reporting policies perpetuate racial inequities in the healthcare and child welfare systems. 

Help with state-wide directory needed:

Providers often voice hesitancy in screening for or addressing perinatal behavioral health conditions because they fear having no one to refer their patients to, effectively identifying a problem to offer limited solutions. Access to quality referral options continues to be called out as a challenge for providers. The reality is, referrals to treatment can be difficult to access in many areas of the state for several reasons. One reason Kansas providers should not have to struggle with is in identifying quality referral options and resources available to them. 

Workforce education and coordinated systems of care are central to building capacity for frontline providers serving perinatal families in Kansas to improve maternal and child health outcomes. Programs and organizations like KCC, KPQC, and PSI-KS work to build the capacity of providers in our state through training, advocacy, and continuous quality improvement initiatives. And many other providers and programs in the state have been engaged in similar work. It is with this in mind that KCC and our partners at PSI Kansas are working to expand our knowledge of providers with expertise or specialized training to develop an updated and vetted state-wide directory of perinatal mental health treatment providers and resources. The directory will be utilized by PSI Kansas coordinators and the KCC Provider Consultation Line to assist help-seekers (and if you didn't already know both of these resources are available at no cost, more information here and here).  

If you are receiving this newsletter, we want to hear from you! We encourage all individuals, regardless of experience or profession, to fill out the form. We are interested in your contribution to perinatal mental health in Kansas, whether that be as a perinatal mental health champion, community organizer, or professional working with the perinatal population. Additional information on this survey and directory can be found on the PSI KS Directory and Resource List Application form. Please feel free to share this link with your networks and help us create this valuable resource for providers and the families they serve!

KCC TA Site of the Quarter

A big virtual round of applause for Geary Community Hospital (GCH) and Kayla Duncan, RN & IBCLC, for their work implementing perinatal behavioral health screening and referral best practices. Below, Kayla shares what the process at GCH has looked like, including challenges and her best advice for others working on these policies and procedures: 

Geary Community Hospital became interested in maternal mental health when we noticed a trend of increasing substance abuse in our moms. We first started with our work with KPQC and their NAS initiative. From there we built and moved on to moms for the next round of KPQC initiatives. We knew in order to help prevent or decrease babies with NAS we have to start with the moms prenatally. We were off to a great start to begin with having our OBGYN clinic and Delivering Change already doing the EPDS during prenatal and then at postpartum visits [and] added it on the inpatient side in Labor and Delivery. This was to make it a consistent screening before, during, and after child birth. The more they see it, the more normal the hard questions being asked become. Our hope is that patients will feel comfortable so we can help them feel safe and know that we are there to support them without judgment.


Geary County Process:
The EPDS was added to our daily assessment, that auto calculates a score when the nurse puts it in the computer. An additional paper copy is saved in the chart. Staff was educated on plan for EPDS and expectations prior to starting on the patient side. To educate staff an e-mail was sent out providing instructions for all staff, [and a] written copy was kept at the nurse’s station. Two primary nurses educated mini groups of nurses at shift change with what to do with a positive screen and expected referral process. Having a small unit and small number of staff this was able to be completed quickly over just a few days with full time staff.

The overarching goal for screening and referral starts with the expectation that the EPDS be done prior to the OB Provider’s discharge of the patient. EPDS scores should be reviewed with provider prior to them going in room to discharge. This process allows them to be able to talk with the patient if there are concerns or needs. At a minimum all patients are referred on to Delivering Change, which includes navigation for each patient, breastfeeding clinic, and social determinants of health screening and referrals.

Addressing staff concerns:
The biggest obstacle I encountered while initiating the EPDS was staff concern on why we needed to do yet another screening. With it being done in clinic or Delivering Change the labor and delivery staff didn’t understand the need for it to be done right after a patient delivers. The importance on consistency and frequency was conveyed- we don’t know, what we don’t asses. This was made very clear our first week doing the screening. Our first patient screened positive, had thoughts of harming herself previously but not currently, but had not told anyone in the past about these thoughts. Everyone was shocked. No one expected a positive screen to come from the patient. This one patient story helped make concrete the idea that it is important to screen all mothers postpartum. With a strong action plan and people not afraid to talk about the hard stuff we now have a solid way to help women get help and validate their feelings.

Next Goals:
Standardized substance use screening to our admission assessment. Our plan is to do a quick screen on admission to labor and delivery. Plan to implement it in the same fashion we did the EPDS. Screening will be reviewed with all nurses and what to do with positive screen.

Thank you Kayla and Geary Community Hospital for your commitment to this work!

Advice from Kayla:

“The best piece of advice I can give to a hospital would be to 'just start' even before the official policy is complete. I was waiting for policy to get approved before making screening active at the bedside. Due to some delays with policy being approved we just went for it. I later found that this has been the case of how things started for many hospitals who started with action while working and putting policy in place. 














Challenges to Process Improvement at GCCH:

• Creation of new policy to support work
• Change in hospital ownership
• Slower pace than anticipated