Standardization of Care Following a Positive Behavioral Health Screen in Pregnancy [32F]

Abstract

INTRODUCTION: Provider bias plagues behavioral health screening in pregnancy. One in three pregnant women will utilize illicit substances, experience depression/anxiety, or be a victim of violence. Following our Phase I results presented in 2019, we aimed to develop a standardized algorithm for providers to guide response to positive behavioral health screens. METHODS: Through an IRB approved protocol, we screened 260 patients at three intervals during pregnancy between January and June 2019. Patients in a Maternal Fetal Medicine clinic voluntarily completed the Integrated Screening Tool at three separate encounters. A novel, evidence-based algorithm was developed and utilized to guide provider response to a positive screen. RESULTS: During the study period, 479 eligible screening visits occurred among 260 patients. Compared to Phase I, indicated urine drug screen (UDS) completion increased from 13% to 80% (P<.001), of which 11% were positive. Across the screening intervals, 65% of patients with an initial positive screen, subsequently answered negative. Of the patients who initially screened negative, 25% had a positive screen later in pregnancy, of which 33% UDS were positive. Referral to mental health services for patients with a positive emotional health screen increased by 100% following implementation of the algorithm (P<.002). CONCLUSION: Utilizing a standardized algorithm guiding provider response to behavioral health screening in pregnancy significantly increased provider action yet did not identify a significant increase in detecting patients using illicit substances. Longitudinal screening is important as patients are likely to change their response. Additional study is indicated to further establish validity of this novel algorithm.