Clinical Conversations with ACCESS Mental Health
Join our ACCESS Mental Health for Moms Hub Team Psychiatrists for a free, monthly educational discussion on a variety of perinatal mental health and substance use topics. Monthly meetings will be virtual through Webex platform and will provide a short, structured didactic followed by an open discussion. Bring your questions!
Second Thursday of Every Month 12:30pm – 1:30pm
REGISTER FOR CLINICAL CONVERSATIONS 2024 SERIES
Perinatal Mental Health and Substance Use Screening Tools (expand to view trainings and tools)
AMH for Moms Clinical Conversations: “Introduction to Perinatal Mental Health Screening Tools” November 9, 2023
AMH for Moms Clinical Conversations: “5-Part Series: Screening Tools for Substance Use in Pregnancy” May 2023
Direct Access to Screening Tools
- Edinburgh Postnatal Depression Scale (EPDS) is a widely used and validated 10-item questionnaire to identify women experiencing depression during pregnancy and the postpartum period and can take less than five minutes to complete. Items of the scale correspond to various clinical depression symptoms, such as guilt feeling, sleep disturbance, low energy, anhedonia, and suicidal ideation.
- Patient Health Questionnaire (PHQ-9) is a 9-question instrument given to patients to screen for the presence and severity of depression. The PHQ-9 is widely used because it is quick, easy to administer, and does not require 2-steps to make a diagnosis. The results of the PHQ-9 may be used to make a depression diagnosis and determine severity.
- Mood Disorder Questionnaire to screen for lifetime prevalence of mania before initiating antidepressant, the MDQ is a validated, quick and easy questionnaire to screen adults for bipolar spectrum disorder. The thirteen yes or no questions take about five minutes to complete, focusing on lifetime experience of possible manic and hypomanic symptoms. The MDQ can result in positively detecting Bipolar I Disorder, and co-occurrence and severity of symptoms.
Important notes about bipolar disorder:
✓ We recommend screening all women for bipolar disorder. Minimally it needs to be done prior to initiating an antidepressant because 1 in 5 women who screen positive for depression may have bipolar disorder.
✓ Treatment of bipolar disorder with an antidepressant alone is contraindicated and is associated
with worsening of mood symptoms which can increase risk of mania, psychosis, and suicide. If a
patient has bipolar disorder, treatment with a mood stabilizer is generally indicated.
✓ In general, if bipolar disorder is suspected, consultation with or referral to psychiatry for
further assessment is indicated. Call ACCESS Mental Health for Moms: 833-978-6667
- GAD-7 Anxiety is a valid and efficient 7-item screening tool for assessing presence and severity of Generalized Anxiety Disorder. The self-report questionnaire has good reliability and may also be used to detect panic disorder, social anxiety disorder, and posttraumatic stress disorder.
- Yale-Brown Obsessive Compulsive Scale (Y-BOCS) is a rating scale designed to rate the severity and type of symptoms in patients with obsessive compulsive disorder (OCD).
- PC-PTSD-5 a screening tool designed to identify persons with probable PTSD. Those screening positive should have further assessment with a structured interview for PTSD, preferably performed by a mental health professional who has experience in diagnosing PTSD.
- PTSD Checklist – Civilian Version (PCL-C) is a standardized self-report rating scale for PTSD comprising 17 items that correspond to the key symptoms of PTSD.
- PTSD-5 (PCL-5) is a 20-iten self-report measure that assesses the presence and severity of PTSD.
- Columbia Suicide Severity Rating Scale supports suicide risk assessment through a series of simple, plain-language questions that anyone can ask. The answers help users identify whether someone is at risk for suicide, assess the severity and immediacy of that risk, and gauge the level of support that the person needs. If the answer to question number 4, 5, or 6 is YES, get immediate help by calling 988, call 911 or go to the emergency room.
- Patient Safety Screener is designed for use in acute care settings with patients who may be at risk for suicide.
- The Tobacco, Alcohol, Prescription medications, and other Substances (TAPS) Tool consists of a 4-item screening for tobacco use, alcohol use, prescription medication misuse, and illicit substance use in the past year and brief assessment. This instrument is used to assess patients for tobacco, alcohol, prescription drug, and illicit substance use and problems related to their use, and is available for self-administration and interviewer-administration to detect substance use, sub-threshold substance use disorder (i.e., at-risk, harmful, or hazardous use), and substance use disorders.
- The Parents, Partners, Past and Pregnancy Scale (4Ps) is a five-question screening tool that can detect low levels of alcohol or drug use during pregnancy. Positive screens allow practitioners to determine the severity of substance use and whether substance use treatment is recommended. The 4Ps is a reliable and effective screening measure and is recommended because it frequently captures women typically missed by other screening tools.
- 5Ps (with ‘5Ps’ being a mnemonic representing each question in this five-item measure: parents, peers, partner, pregnancy, past) is an adaptation of the 4Ps measure designed for use in pregnancy.
- SURP-P is a three-question screening tool to detect alcohol and other substance use during pregnancy. Research has shown the SURP-P to be among the most predictive of substance use screening tools during pregnancy. The SURP-P can identify use of many different substances, including alcohol, cocaine, sedatives, and opioids. Because it is brief, it can be re-administered throughout pregnancy, which is especially helpful given the risk of relapse during pregnancy for women with a history of substance abuse.
- CRAFFT is a screening tool designed to identify substance use, substance-related riding/driving risk, and substance use disorder among youth ages 12-21. It has been implemented as part of universal screening efforts in thousands of busy medical and community health settings, as it yields information that can serve as the basis for early intervention and patient-centered counseling.
Who hands out, scores, and responds to the screening tools?
Every office is different, and the workflow for addressing perinatal mood and anxiety disorders needs to be tailored to each practice environment. Clinical support staff can often provide the screening tools to patients at the time of ‘check-in’ or appointment registration, or upon rooming. Patients should be given time to complete it thoughtfully. Time in the waiting room or in the exam room while awaiting the provider can be used. Many electronic health records can be customized with templates for these screening tools.
After a patient completes the screening tools, they should be scored and reviewed by clinical staff and entered into the chart if not already done and included in an electronic medical record. Scoring is straightforward and can be done by any level of caregiver. It is imperative that they are scored before the patient leaves their appointment, so that a positive screen can be promptly addressed. The responsible licensed independent provider should be made aware of positive screening score(s), if they themselves did not administer the screening tools or did not do the scoring.
My patient’s screen is positive and I am not sure what to do next… Call ACCESS Mental Health for Moms: 833-978-6667. We will help talk you through next steps and you can request that we work with your patient directly to help them find services.
Introduction to Perinatal Mental Health (expand to view trainings and supplemental materials)
AMH for Moms Clinical Conversations: “Overview of Perinatal Mental Health” January 10, 2023
Introduction to Mood Disorders in the Perinatal Period (expand to view trainings and supplemental materials)
AMH for Moms Clinical Conversations: “Introduction to Mood Disorders in the Perinatal Period” December 14, 2023
Introduction to Anxiety Disorders in the Perinatal Period (expand to view trainings and supplemental materials)
AMH for Moms Clinical Conversations: “Introduction to Anxiety Disorders in the Perinatal Period” January 11, 2024
Introduction to Bipolar Disorders in the Perinatal Period (expand to view trainings and supplemental materials)
AMH for Moms Clinical Conversations: “Introduction to Bipolar Disorders in the Perinatal Period” February 8, 2024
If you need clinical guidance and/or resource and referral support for your patient, please contact ACCESS Mental Health for Moms at 833-978-6667, Monday-Friday 9am-5pm.
Assessment and Treatment Algorithms for Mental Health Disorders in the Perinatal Period
see our new provider toolkit for starting treatment!
A Family Care Plan is a helpful checklist for you and your patient to create together to help identify services and resources needed to support your patient’s ongoing health, development, safety and well-being. The plan should include services that will address your patient’s physical, social and emotional health. Check out SEPI CT for more information about Family Care Plans including a helpful “how to” video and Family Care Plan templates: here
PROUD educational series
Additionally, check out the Parents Recovering from Opioid Use Disorder (PROUD) educational series. Whether it’s managing the withdrawal symptoms of an infant exposed to opioids before birth, understanding how prescribing practices influence misuse and recovery, or identifying different biases providers manifest in interactions with these families, this educational series has many strategies for helping families succeed and thrive.