Incorporating Mental Health Services in a Public Health Setting Confluence 2003 Promising Practice San Antonio Metropolitan Health District - SAMHD
Background • Central mission of the San Antonio Metropolitan Health District is provision of preventative and clinical services for women and young children • SAMHD has observed that significant proportion of women seeking care in clinics display symptoms of depression
Purpose • Healthy Start requires screening for depression during perinatal period • Case review revealed 23% reported symptoms consistent with depression • To establish prevalence of depression and to lay groundwork for programming (funded by Hogg Foundation for Mental Health)
Overview Project Goals and Phases • Goals - Establish prevalence of perinatal depression - Establish triage and treatment system • Phases - Research - Implementation
Research Qualitative • Learn how women interpret and express depression • Potential barriers to seeking care • Assist in selection of screening instrument Quantitative • Probability screening to determine prevalence
Qualitative • 8 focus groups conducted among 49 women • Slightly more than 50% pregnant; less than 50% postpartum • Ages ranged from 15 to 37 years: - More than half fell between 15 and 20 years of age – youthful sample! CES-D instrument selected for use
Quantitative n n 3 interviewers hired to conduct depression screenings in SAMHD clinics To-date, over 400 interviews have been completed Demographic questions included in data collection Interviewing to continue through end of August 2003
Demographic Overview • • 93% of sample is Hispanic 66% were born in Mexico 64% of interviews conducted in Spanish language 57% are married or living with someone
Preliminary Findings - Prevalence
Implementation u No-cost services available to clients through SAMHD: Emergency consultation t Triage t Brief therapeutic intervention t Licensed Professional Counselor and 3 Licensed Master Social Workers t Graduate and Post-Graduate counseling students of Our Lady of the Lake University – San Antonio (Proposed) t
Implementation – Clinic Without Walls u Licensed professional mental health providers to provide pro-bono services to the community t Screening, intake and assessment services t Individual, group and family psychotherapy t Psychotropic medication management if indicated t Emergency referrals
Implementation – Case Management Case management services incorporated following policies: t All prenatal clients complete a CES-D interview when case is opened t Follow-up at 4 -6 weeks postpartum t Referrals to mental health triage system which includes: • • Student interns In-house counselors Clinic without Walls Community mental health providers
Discussion - Barriers Contractual/Legal t Institutional • Institutional “paradigm” – Role of mental health in public health often ignored – Clinic nurses constrained for time t Texas Policy • Mental health funding via Medicaid has been abolished for all adult clients including pregnant and postpartum mothers in the State of Texas
Discussion – Next Steps n Strategies u Create additional relationships with local Universities for practicum and internship students u Obtain external funding sources to sustain efforts u Foster development of Mental Health Division within SAMHD
n n n n n Marivel Davila Dora Baker Sara Araujo Michelle Pasos Edmund H. Baca, Jr. Monica E. Trevino Yvonne Rodriguez Melinda Navarro Linda Hook, R. N. Stephen K. Blanchard, Ph. D.
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