The Importance of Maternal Depression Screenings
When it comes to the health of women and children, Tennessee is unfortunately not doing so well. Tennessee is ranked #43 in the latest United Health Foundation’s America’s Health Rankings: 2018 Health of Women and Children Report, down one spot from 2016.
One particularly poignant statistic shows that 24.6% of children 0-17 experience 2 or more adverse childhood experiences (ACEs). The report evaluates the following ACEs: Socioeconomic hardship, parental divorce or separation, lived with someone who had an alcohol or drug problem, victim or witness of neighborhood violence, lived with someone who was mentally ill, suicidal or severely depressed, domestic violence witness, parent served time in jail, treated or judged unfairly due to race/ethnicity, and death of a parent. ACEs can have lifelong negative impacts on a child’s well-being. In addition to ACEs, maternal depression increases the risk of developmental issues like poor behavioral and cognitive outcomes.
One way to prevent and mitigate ACEs and other risks is to address maternal or caregiver depression. 15.4% of mothers are diagnosed with postpartum depression in Tennessee, but this is most likely a low estimate because maternal depression is often undiagnosed and/or untreated.
There is a solution. Starting in 2016, the Center for Medicaid and Medicare Services (CMS) authorized state agencies to allow maternal depression screenings as a service for the child as part of the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit to which Medicaid recipients are entitled.
Because depression is more prevalent among low-income women, it is vitally important for the health of women and children that Medicaid (known as TennCare in Tennessee) provides maternal depression screenings. One way to do that is at well-child visits. For babies age 0-2 years old, Tennessee is 35th in well-baby checks with 90.5% of babies receiving them. There is definitely room for improvement in the rate of babies getting well visits. Likewise, Tennessee should better promote maternal depression screenings at these visits.
How can we get more mothers screened and treated for depression?
Tennessee recommends maternal depression screening to be provided as part of a well-child visit and reimburses for the screenings, in line with CMS guidance. Fortunately, Tennessee is one of the few states that differentiates between positive and negative screenings, allowing us to have more data than states that don’t track this information. Some states don’t allow reimbursement or recommend screenings, despite CMS guidance.
However, Tennessee does not require maternal depression screening or recommend any specific tools for the screening. Some states require the screenings and even require specific tools, but Tennessee defers to the managed cared organizations (MCOs) that manage TennCare plans to decide on how to screen. Even though not required in Tennessee, consistent screening using evidence-based tools is critical for the well-being of children and new moms.
Even if TennCare does not change its policy to require screening or recommend a specific screening tool, there are other options to improve uptake. In 3 states (Arizona, Oregon, Rhode Island), 1 or more Medicaid managed care organizations (MCOs) or accountable care entities have a performance improvement project on developmental screening. Additionally, consumer outreach through print and digital materials could equip parents to ask for screenings at their child’s visits.
The argument for ongoing developmental assessments for children is well-supported and adhered to widely, through research and policy. In practice, there are ongoing efforts among all the stakeholders to make sure that kids have all the screenings, tools and services to ensure they thrive. Part C Early Intervention, Part B Special Education, Early Head Start, Maternal and Infant Early Childhood Home Visiting, child care, the medical home, and specialty medical care are all integral to evaluating and identifying children’s needs and connecting them to the resources that will help make their futures brighter.
Tennessee should evaluate its current policies and look at ways to standardize maternal depression screenings or, at the very least, increase utilization of these screenings. Supporting mothers who screen positively through existing programs and best practices will in turn help children by preventing or mitigating ACES and promote healthy child development.