Phase Two: Implement

Your obstetric care clinicians and clinical staff will need training on perinatal mood and anxiety conditions and practice workflow changes. In the first practice QI team meeting, you identified the staff responsible for organizing the trainings and decided when to complete the trainings. Your obstetric care clinicians and clinical staff may already have started training, but if not, you should finalize the plan for training to be completed during the fifth practice QI team meeting (ZIP).

Obstetric Care Clinician Training

Training and ongoing support for obstetric care clinicians includes the following …

• Education on perinatal mental health
• Training on practice level changes and the new workflow
• Dissemination of materials about the perinatal mental health care pathway

Perinatal mental health training can be provided by accessing the Lifeline for Moms Addressing Perinatal Mental Health Conditions in Obstetric Settings eModule, a four-part online asynchronous training that can be completed at a time convenient for each obstetric care clinician prior to the start of implementation. The training is comprised of the following four parts:

1. Detect, which covers screening and engagement (30 minutes)
2. Assess, which covers differential diagnosis, severity, and risk assessment (30 minutes)
3. Treat, which covers evidence-based treatments (45 minutes)
4. Follow-up, which covers follow-up, monitoring, and ongoing treatment versus treatment discontinuation (15 minutes)

Training on practice-level changes and the workflow is presented by the practice QI team when best suited to your practice (eg, all-practice meeting, obstetric care clinician rounds, individual instruction). This would ideally occur after your practice goals and workflow are finalized. If the training occurs during a meeting, be sure to introduce the champions so that your group knows who to approach with suggestions as the implementation unfolds.

Lifeline for Moms has created a practice training on mental health care workflow template (PPT). Customize the template to integrate your baseline assessment results, goals, and workflow. The PowerPoint also offers suggestions for communicating practice changes to staff about the workflow.

For ongoing reference materials about the perinatal mental health care pathway, see the Lifeline for Moms Perinatal Mental Health Tool Kit™ for actionable information, algorithms, and clinical pearls to support detection, assessment, and treatment of perinatal mood and anxiety disorders. If helpful, distribute a print copy of materials to each clinician.

Clinical Staff Training

Training for clinical staff includes education on perinatal mental health and training on practice-level changes and the new workflow. Just as when training obstetric care clinicians, you can use the Lifeline for Moms Addressing Maternal Mental Health Conditions in Obstetric Settings eModule for clinical staff training. Clinical staff will need to complete only Part 1, but of course are welcome to complete other parts of the eModule. Consider emphasizing the parts of the workflow that are most relevant to the clinical staff. Please keep in mind that it is important for everyone in the practice to know about all changes that are being made.

Administrative Staff Training

Training for administrative staff includes training on practice-level changes and the new workflow, which will be presented by the practice QI team when best suited to your practice and the group you are training (eg, all-practice meeting, routine administrative staff meeting, individual instruction). As with obstetric care clinician training, be sure to introduce the practice QI team. The same PowerPoint prepared for training obstetric care clinicians about the new workflow can be used to train the administrative staff. Emphasize parts of the workflow that are most relevant, but let administrative staff know about all changes that are being made.

It is important to determine the timing and sequence of the workflow changes you will need to make to attain your goals. You can stagger the implementation of goals based on your practice. It may make sense to implement slowly and then ramp up as appropriate based on your practice’s readiness. For example, for optimal patient care, it is best to ensure that all practice clinicians and staff are trained and that goals related to medical record documentation and identification of referrals for therapy and emergency mental health care have been implemented. You might consider stretching out your implementation over a period of months and focusing on implementing training, documentation, resources for therapy, referral to therapy, and emergency mental health goals and then follow with implementing screening.

The degree to which each of these goals are implemented can also be phased. For example, medical record documentation can start as progress note documentation, and inclusion of mental health conditions on the problem list and integration of standard language for documentation can be phased in. You can include just a few listings of mental health treatment professionals in your resource and referral directory and set a goal to include additional referral resources later to have a more comprehensive repository. You may choose to integrate transfer of care after other elements needed during pregnancy and postpartum care are integrated. Regardless of when you choose to integrate transfer of care, be sure to monitor positive screens and ensure that patients are connected to treatment.