Building PublicPrivate Partnerships: Women and Depression

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Building Public/Private Partnerships Women
and Depression

• MCHB Federal/State Partnership Meeting
• October 20, 2003
• Jeanne Mahoney
• American College of Obstetricians and
  Gynecologists Providers Partnership Project

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• This Activity has been supported through a
  cooperative agreement with the Maternal and Child
  Health Bureau
• Grant 6U93 MC 00161-03-03

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Overview

• Whats the big deal about depression?
• Whats a community/clinical partnership?
• Why partner?
• How do I identify and recruit partners, including
  clinicians?
• What are the basic components of these
  partnerships?
• Give me some examples

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Impact of Depression

• 20 Lifetime prevalence for women
• Somatic illnesses for women and their children
  (Grupp-Phelan 2003)
• Family distress partner and children
• Employer costs
• Estimated U.S. economic burden,
• 44 Billion (Greenberg, 1993)

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ACOGs Partnership Project

• Cooperative agreement begun in 1988
• State-level partnerships modeled after
  AMCHP/CityMatCH and focused on
• Perinatal HIV Transmission (with AMCHP) 10
  teams
• Women and Tobacco Use 5 teams
• Depression in Women 12 teams

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Definition Clinical Community Partnership

• Partnership vs.. Involvement
• Partnership vs.. Association
• Partnership vs. Collaboration
• Partnership vs. Commitment
• American Heritage dictionary
• a relationship between individuals or groups
  that is characterized by mutual cooperation and
  responsibility, as for the achievement of a
  specified goal

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Why Partner?Participant - Organizational Benefits

• Networking/information sharing
• Increase chance of positive results
• Enthusiasm and energy is infectious
• Money goes further by sharing resources
• Opportunity for leadership roles

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Why Partner?Community Benefits

• Can identify and address systemic problems not to
  be tackled alone
• Identify resources and gaps
• Able to deliver united and consistent health
  messages
• Theres power in numbers

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Goals of Most Depression Partnerships

• Universal screening by health care provider
• Providers trained in conducting assessments and
  doing brief interventions
• Womens care providers become familiar with
  medications including in pregnancy and
  lactation
• Coordination with/development of local referral
  networks and support systems
• Education of public on recognizing and getting
  help for depression

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Who Brings What?

• Commmunity programs
• Have unique community-based resources
• Able to advocate for women
• Public Health / focused organizations
• Have data on population
• Have access to resources
• Private Womens Health Providers
• Have access to patient population
• Have some flexibility in care delivery

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Why OB/GYN Providers Need to be Involved

• ¾ depressed women do not seek out mental health
  provider (Cassidy, 2003)
• OB/GYNs frequently only medical provider women
  see regularly
• Many women will not accept depression diagnosis
  especially non-White (Cooper 2003)

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Issues for depression treatment OB/GYN

• Mental health issues are not part of OB/GYN
  training
• Inadequate clinical time to assess and intervene
  for depression
• Lack of reimbursement for time spent
• Lack of knowledge of/ or unavailable referral
  resources
• Lack of diagnosis/treatment acceptance,
  particularly for African-American and Hispanic
  women (Cooper 2003)

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Getting the MD InvolvedBarriers Physician
Perceives

• Too much time out of the office
• I have nothing to offer
• Unfamiliar/uncomfortable in public health arena
• Concerns about liability issues overshadow
  interests
• Not a committee person
• Ill end up doing everything
• Independent
• Poor at delegation

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Getting the MD InvolvedFinding Physicians for
Partnerships

• Physicians to consider for teams
• State and local officers of professional
  societies
• Chairpersons of any local or state committees
• Physicians who have appeared at legislative
  hearings
• Those with an obvious interest
• Semi-retired or retired physicians

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Organizations to Consider for Partners

• Advocacy organizations- March of Dimes, Mental
  Health Association, YWCA, HMHB, Postpartum
  Support International
• Academic entities/individuals
• Local, state, federal government
• Managed care, funders of MH Services
• Mental health providers associations
• Media

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Successful Partnerships

• How did partnerships begin?
• What were the initial activities?
• What barriers were overcome?
• How can partnerships be sustained?

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Systems Service Delivery

• Partnership must involve both
• development of systems and
• the utilization of that system through service
  delivery.
• Both systems and services require evaluation.

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Systems and Services

• Systems
• Do needs assessment
• Identify gaps
• Identify partners and resources
• Choose a model of intervention
• Develop an action plan
• Develop a plan for evaluation

• Services
• Train those who are intervening
• Deliver the intervention
• Evaluate delivery and effect of intervention

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Components for strong and sustainable
partnerships

• Focus
• Stakeholders
• Plan
• Evaluable
• Funding

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Components for strong and sustainable
partnerships

• Focus
• Develop a shared vision

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Components for strong and sustainable
partnerships

• Focus
• Stakeholders
• Partner selection
• Partner maintenance

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Components for strong and sustainable
partnerships

• Focus
• Stakeholders
• Plan
• Compatible with all
• organizational cultures and values
• Realistic timeline to achieve goals

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Components for strong and sustainable
partnerships

• Focus
• Stakeholders
• Plan
• Evaluable
• Conformity of data used by all
• Cleary define outcome measures

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Components for strong and sustainable
partnerships

• Focus
• Stakeholders
• Plan Evaluable
• Funding
• Need commitment of adequate resources
• Issue of continuing concern

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Other Examples of State-Level Depression
Partnerships

• Illinois ? Florida
• North Dakota ? Indiana
• Pennsylvania
• Texas
• California
• Maryland
• Colorado
• Hawaii

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Community/Clinician Partnerships

• Joining together for healthy women
• and
• healthy
• babies

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Jeanne Mahoney Director, Providers Partnership
Project American College of Ob/Gyn 409 12th St.,
SW, Washington, DC 20024 202.314.2352
Jmahoney_at_acog.org Acknowledgements Ellen
Hutchins, ScD MCHB, HRSA Karen Hench, RN, MS
MCHB-HRSA Terrance McGaw, MD, FACOG Partnership
project leader, NV Providers Partnership meeting
notes, 1/27/03
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References

• Grupp-Phelan J, Whitaker RC, Naish AB. Depression
  in mothers of children presenting for emergency
  and primary careimpact on mothers perceptions
  of caring for their children. Ambulatory
  Pediatrics. 20033(3)142-146.
• Greenburg PE. The economic burden of depression.
  J Clin Psychiatry. 199354405-418. Abstract.
• Cassidy JM, et al. Behavioral health care
  integration in obstetrics and gynecology. General
  Medicine. 2003 5(2)
• Cooper LA, et al. The acceptability of treatment
  for depression among African-American, Hispanic,
  and white primary care patients. Medical Care.
  200341(4479-489