Prenatal to Three History and Services Overview

The Prenatal to Three (PTT) initiative, established in 1996, focuses on a collaborative approach between family health and behavioral health services through a home-visiting program based on the Touchpoints philosophy. The program serves adult clients who are pregnant or within 12 months postpartum, teens who are pregnant or parenting, newborns, infants, and children up to 5 years old. Referral sources include Family Health Services, Behavioral Health & Recovery Services, and regional clinics. The program caters to children with trauma, anxiety, depression, and women facing various mental health challenges. Referral guidelines and criteria are specified for different client demographics.

• Prenatal
• Three
• Health Services
• Behavioral Health
• Home Visiting

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1. PRENATAL TO THREE HISTORY 1996 Initiative Collaboration of Family Health & Behavioral Health Services Multidisciplinary Approach Home-Visiting Program Touchpoints Philosophy

2. CRITERIA FOR PRENATAL TO THREE SERVICES Adult clients- Pregnant or 12months post partum or less Dr. Diaz/medication management criteria is pregnant & breastfeeding 12 month old baby or younger Teen Clients-pregnant and/or parenting; teen is 19 years or younger Newborns/Infants/Young Children ages 5 years & under Ages 4.5 years old-MH assessment only by PTT then referred to regional clinic for continued Mental Health treatment Ages 5 years old referral goes straight to reginal clinic

3. POPULATION Children birth to age 5 years old with trauma, anxiety, depression. Women with PTSD, substance abuse issues, depression, anxiety or other severe mental illness (SMI) Medical Insurance; indigent; undocumented

4. REFERRAL SOURCES Family Health Services-AKA Pre To Three/Nurse Family Partnership/Black Infant Health (Public Health Nurses (PHNs), Community Workers (CWs) Women, Infant, Children (WIC) Behavioral Health & Recovery Services (BHRS) Regional Clinics & Mental Health ACCESS Lucille Packard Children s Hospital (LPCH), San Mateo Medical Center (SMMC), Mills Peninsula, UCSF,Ravenswood Clinic, Fair Oaks Clinic, OB/GYN & Pediatric Clinics Psychiatric Emergency Services (PES)/ SMMC 3AB

5. HOW DO YOU REFER TO PRENATAL TO THREE? If you d like BHRS (Mental Health) services only send directly to PTT Program by : Fax: 650-341-7389 Attn: PTT Mental Health Program Specialist- Ivette Huerta/Unit Supervisor -Noelle Bruton) If interested in both Family Health (FH) and Behavioral Health services the case will be bifurcated-if sent to FH first

6. WHAT TO INCLUDE IN THE REFERRAL TO PTT BHRS? Date of Birth (DOB) of client (child or adult) If pregnant, Estimated Date of Childbirth (EDC) If not pregnant, indicate if client is breastfeeding & age of baby Symptoms and behaviors of client you are referring Any history of suicide, substance abuse, mental health Domestic Violence (DV), Trauma issues

7. THREE PHASES OF ENGAGEMENT 1) Screening/Outreach (by phone/letter/contact with referent) 2) Assessment (3 face to face sessions for adults & 4 for children) 3) Treatment (Home-visiting, clinic based, community)

8. SCREENING o Telephone Call/Outreach o Client is contacted within 5 business days of receiving the referral o 3 phone call attempts o Screening completed to determine if client meets PTT criteria & if client is interested in mental health services o If no contact after 3 calls then a letter is sent asking client to respond in one week otherwise case will be closed o Referent is contacted to provide case status

9. ASSESSMENTS If client meets criteria & medical neccesity then a Mental Health (MH) clinician is assigned to conduct MH assessment o3 Face to face sessions for adults & 4 face to face sessions for children oConducted in the home/clinic

10. MENTAL HEALTH DISORDERS OF ADULT CLIENTS Clinicians use DSM 5 to diagnose PTSD (childhood sexual/physical abuse/DV/immigration) Co-occurring (AOD issues) Major Depression Post Partum Depression/Psychosis Anxiety disorders; OCD & GAD Personality Disorders Mood disorders; Bipolar Disorders

11. MENTAL HEALTH DISORDERS OF BABIES & CHILDREN Clinicians use DC 0-5 to diagnose Post traumatic Stress Disorders Depression/Mood Disorders Regulatory Disorders Anxiety/Adjustment

12. Modalities Parent-Child Psychotherapy Trauma Informed Relationship Based Individual, Group, Play & Dyad Therapy Home Visiting Model NMT Interventions; Infant Massage Touchpoints Framework Multi-Disciplinary

13. NFP/Teen Program 19 years old or younger, first time mom and under 28 weeks gestation ( linked with Nurse Family Partnership (NFP) Family Health Providers) 20 years old or older, first time mom and under 28 weeks gestation (linked with NFP Family Health providers) 19 years old or younger and pregnant and/or parenting

14. Prenatal to Three Psychiatrist Medication Management (at point of referral to psychiatrist the mother is either pregnant & post partum (must be breastfeeding a baby 12 months or younger) Consultation/Collaboration with PTT Clinicians, OB/GYN, pediatricians, primary care, regional psychiatrists Telepsychiatry after initial medication evaluation

15. What type of Hand-offs or referrals are in place for patients once they or their children turn age 6? Depending if continued mental health services are recommended, a child/teen/adult can be referred to: BHRS Regional Clinics for severe symptoms and/or medication management; based on where patient lives MH ACCESS-Private Provider in the Network for low/moderate symptoms Community Agencies for low to moderate cases or parenting (i.e Star Vista)

16. Biggest Shortcoming/Hole in Coverage in the Organization? Stigma of Mental Health Gaps in the Health System/Not understanding the various health programs in San Mateo County Immigration/Political Client/Fear of Government Program Coverage? Insurance/Communication Issues among healthcare providers Time-healing takes time and readiness Fears-loss of children to the Children & Family Services (CFS) Resources-families priority is survival/housing/work/food/jobs/child care Pre To Three BHRS & PTT Family Health get confusing; different health providers & systems-can become a barrier in referring & understanding criteria

17. What type of patients is it difficult for your organization to impact? Type? All patients are treated on an individual basis with their unique story/background/history Motivation/acceptance of mental health services & commitment/time Trust can be a barrier Unresolved attachment issues-building a trusting relationship Active Substance Abuse/addiction Severe Mental Health Impairment (active hallucinations/hospitalizations) Non-compliance with medication Homeless/no phone/no home

18. Point of contact for referrals that patients/families/providers can call? (650)372-8540 & ask for Pre To Three Mental Health Program Specialist (Ivette Huerta) or Pre To Three Unit Supervisor as back-up (Noelle Bruton) See Prenatal To Three BHRS Directory How frequently can services be provided? Weekly sessions to start & then as client is meeting their treatment goals, sessions are reduced to bi-weekly PTT BHRS is not a long-term program; clients are served 6 months to one year. If long term mental health services & medication management are needed, then a transfer to our regional clinics If only medication management, then referred to Primary Care Physician

19. Are bilingual services provided & if so, what languages? Prenatal To Three has bilingual Spanish-Speaking Therapists If another language is needed, interpretation services are accessed Do you currently have a waitlist? If so, why? We do have a waitlist because we are currently in a soft-freeze & are down 3 MH clinicians Despite the waitlist, all clients are contacted within 5 days & if screening indicates crisis, then client is immediately assessed/treated All referrals are triaged by the PTT MH Program Specialist which identifies clients who are at risk of self-harm, harm to others, hospitalization or relapse PTT psychiatrists are easily accessible & accomodating

20. What barriers are prevalent for your patients in accessing mental health care? Stigma/shame/fear Time-patients are working & caring for their children & no time to engage in treatment Too many appointments-navigating the systems of care/accessing resources Fear of a government agency-myths Not being well-informed of what mental health services are and how they can be supportive, healing, & beneficial Guilt/trust issues Culture of client/culture of the field of mental health Age range-some do not believe that children ages 0-5 can have MH issues

21. What issues in do you see in the way San Mateos mental health services are offered? Providers do not understand the complexities of all the health care programs, criteria, referral process Communication-time is of essence for all providers & it can be difficult to take the time to meet, talk, set-up a provider meetings Some MH services can come across as very prescribed given all the paperwork (treatment plan goals/objectives/interventions) & less emphasis on the relationship building Duplication of questions from various health care providers & patients are tired of repeating their stories

22. Can the referring clinic get the information on the outcome of the referral to ensure families received the services they needed? Yes, the Pre To Three MH Clinician contacts the referent to inform of either: contact made & opened; no contact/letter sent; no response from patient; patient declined MH services; client did not meet PTT criteria & closed; unable to connect by phone If additional/more specific information or ongoing contact about MH services, then patient will need to sign release of information