The innovation: New protocol integrates perinatal mental health screening for all seeking fetal cardiac care at Children’s Health
The prevalence of perinatal mental health conditions is striking. It is estimated that 1 in 5 birthing people in the general population experience perinatal mood and anxiety disorders (PMADs). That rises to 2 in 5 among people who are of color or who are economically disadvantaged, and 3 in 5 among those whose children face complex medical issues like congenital heart defects.
Yet efforts to identify those experiencing PMADs and connect them to care remain inconsistent – even among the most vulnerable populations.
In October 2023, the Fetal Heart Program at Children’s Medical Center Dallas, part of Children’s Health℠, became one of the few places in the country to routinely screen everyone seeking care in their clinic for perinatal mental health conditions. In addition to screening for depression, anxiety and stress, the new protocol includes pathways to appropriate levels of care into the program’s clinical workflow.
“Maternal mental health profoundly affects fetal and infant health, so addressing challenges early is imperative – especially for a patient population with such a high prevalence," says Randi Cheatham-Johnson, Ph.D, Pediatric Psychologist at Children’s Health and Assistant Professor of Psychiatry at UT Southwestern. "Our new protocol allows us the opportunity to intervene before a mental health concern becomes a crisis. And that can improve the well-being and medical outcomes of the whole family.”
The big picture: untreated PMADs can have dire consequences
Perinatal mental health difficulties do not discriminate – affecting both women and men. These conditions are treatable and even preventable. Yet in the U.S., less than 50% of those who need care ever receive it. The consequences of untreated PMADs can be severe:
- PMADs are the leading underlying cause of pregnancy-related deaths, including those from overdose or suicide.
- They raise the risk of preterm birth, low birth weight, socioemotional issues and cognitive development delays.
- They cost the U.S. economy an estimated $14.2 billion a year.
“Screening can help us identify caregivers who are at-risk for perinatal mental health conditions, but the key to improving parental and neonatal outcomes is in connecting the dots to care” says Maria Ossa Galvis, M.D., Pediatric Cardiologist at Children’s Health and Assistant Professor of Pediatrics at UT Southwestern.
As the mother of a child with a congenital heart defect, Dr. Ossa Galvis knows firsthand the emotional impact such a diagnosis can have. Her personal experience inspired her work with Dr. Catherine Ikemba, the Fetal Heart Center Medical Director, Dr. Cheatham-Johnson, and Marissa Helm, L.C.S.W., to develop the Fetal Heart Program’s new protocol.
Key Details: Integrated into clinical workflow
Every birthing person referred to the Fetal Heart Program with a suspected or confirmed prenatal diagnosis of congenital heart disease can take a screening survey at their first appointment and at regular intervals throughout their medical journey. Since the protocol was launched, 94% of patients have completed the initial screening.
The standardized screening takes about five minutes to complete on a tablet. Patients who screen high on any of the three measurements (depression, anxiety or stress) have an in-person assessment with a member of the social work team or Dr. Cheatham-Johnson. The pathways to additional care and support depend on a patient’s needs and the treatment journey related to their fetal diagnosis. These can include:
- Psychoeducation
- Introduction to Postpartum Support International (PSI) resources and free virtual support groups
- Referral to resources within their home communities
- Follow-up phone calls and regular check-ins during appointments in the Fetal Heart Program
- Care of a psychologist at the bedside (for those whose children are hospitalized)
Initial response to the protocol is enthusiastic: 97% of patients said the screening was helpful or very helpful.
“Our protocol only adds a few minutes to our clinical workflow, but the benefit is big. Every pregnant person who walks through our door gets the chance to talk openly about their mental health and ask for help,” says Helm. “It’s gratifying to see how this support directly impacts their emotional well-being and medical outcomes.”
Key details: A little support goes a long way
“Perhaps the most important thing we’ve learned since launching the protocol is that most parents want to talk about the emotional challenges associated with a fetal diagnosis of heart disease. Incorporating a mental health assessment into routine care helps us overcome the stigma that comes from the lack of understanding,” says Dr. Ossa Galvis.
She and Dr. Cheatham-Johnson encourage all clinicians who care for patients during the perinatal period to integrate mental health screening into their practices. Vetted screening tools and other perinatal mental health resources are available from:
- PeriPAN: The Perinatal Psychiatry Access Network. This free, evidence-based clinician-to-clinician program is offered through the University of Texas and provides access to resources and a multidisciplinary network of mental health experts.
- PSI: Postpartum Support International is a global organization offering patient education, provider training, support groups and access to multilingual helplines.
Why Children’s Health: Caring for the whole patient and their family
Children’s Health offers the only cardiac neurodevelopmental program in North Texas and specializes in diagnosing and treating congenital heart conditions.
In addition, they are committed to caring for all aspects of this vulnerable population's health. The fact that nearly 100% of patients found the new protocol useful validates the approach and leaves Dr. Cheatham-Johnson hopeful that similar protocols in other clinics could help more caregivers at a critical time.
“At the end of the day, it’s about doing the right thing for our patients,” she says. “We look at it from a preventive framework. Connecting caregivers to mental health care when they need it has an outsized impact on the physical, mental and social well-being of children.”