The Parent-Infant Research Institute (PIRI) has developed a 4-step electronic clinical decision support system, PIRIMID (Perinatal Identification, Referral and Integrated Management for Improving Depression), designed to bridge the gap between perinatal depression screening and effective care. PIRIMID consists of 4 steps to assist clinicians to develop a management plan.
The following modules provide an introduction to PIRIMID and provide a look inside the Clinician Decision Support System so you can understand how to integrate perinatal depression e-Screening with pathways to care.
Module 1: Why is PIRIMID needed?
PIRIMID bridges the gap between perinatal depression screening and effective care by providing step-by-step guidance for pathways to care and a printable, one-page management plan that aligns with national perinatal mental health clinical guidelines.
Sixty percent of depressed perinatal women are not identified as depressed. Of the 40% whose depression is recognised, only 1 in 4 (10% of all depressed women) receive adequate treatment. Most women identified by screening are not connected with treatment pathways that result in recovery. Screening increases identification of perinatal depression but only reduces perinatal mental health morbidity when integrated effectively with pathways to evidence-based care.
Module 2: Accessing the admin site and screening women
In this module, you will learn how to access the administrative site, access your account and invite women to complete a screen for depression on the iCOPE tool that is linked with our PIRIMID system.
iCOPE is accessible on iPhones and is an electronic version of the Edinburgh Postnatal Depression Scale (EPDS), includes the Whooley questions and also asks about psychosocial factors. The EPDS is a short, self-administered questionnaire that helps to identify women who may be at risk for postpartum depression.
The EPDS provides important information for a clinician to follow up on but is only a screening tool. Screening results are linked with the PIRIMID tool to help professionals guide women to receive the support they need.
By inviting women to complete screening, you now have information that will be imported into the PIRIMID tool to help identify a woman at risk of depression and combine this with your knowledge of her situation. The PIRIMID system will help you then decide on management and referrals using a simple electronic decision support system.
Module 3: PIRIMID Clinical Decision Support System to identify pathways to care
In this module, you will learn how to use the 4-step electronic clinical decision support system which is accessible on your desktop.
Accessing the iCOPE results and reviewing the EPDS scores
The first screen on the clinician’s desktop shows the summary EPDS scores that have been imported from the iCOPE tool. On-screen prompts for interpretation of screening results and psychosocial information allows you to consider the need to follow up e.g., risk assessment or diagnostic assessment for depression or anxiety. Alerts appear for women scoring high on the suicidality question. As screening tools cannot provide a definitive diagnosis or risk assessment, clinicians are prompted to follow up.
Brief description of the client
PIRIMID provides a simple proforma and clinicians are prompted to enter pre-existing history and other clinical information so the information can be integrated with iCOPE screening results. On-the-spot access to gold-standard guidance for interpreting, and acting upon, screening results are provided via information bubbles, and best practice procedures.
Putting it all together
The information gathered allows the clinician to integrate the EPDS results with their own clinical information to put together a formulation of the problem. Simple prompts assist this process suggesting further assessments required and referrals needed. This will be imported to create a structured management plan tailored to each client’s needs. PIRIMID’s evidence-based decision tree ensures adherence to National Perinatal Mental Health Clinical Guidelines.
Development of a management plan
The PIRIMID management plan uses the information gathered to provide a simple one-page summary of the type of referrals and professional care is needed. PIRIMID also provides immediate links to e-mental health treatment: PIRI’s evidence based MumMoodBooster programs for pregnant and new mums available on MumSpace, funded through the Department of Health. Having selected the type of referral needed, professionals will use their own preferred networks or use the plan to inform their ongoing practice.
Module 4: Further Training, Examples and Practice Examples
To further support your understanding and use of the PIRIMID system we have created several brief practice activities. The objective of these activities is to support your familiarity and confidence in completing the PIRIMID Clinical Decision Support System (CDSS).
Please see a summary of the tasks required to complete this exercise. Please complete the tasks in the order below.
Task 1: Watch a role-play video describing the conversation a nurse might have after she has reviewed the mum’s EPDS results imported into her PIRIMID tool and is ready to talk to the mum. This mother had an EPDS score of 14 and 0 on question 10. The nurse usually begins the conversation with feedback on the scores as this is step 1 of the PIRIMID tool and usually works best that way. However, at times the steps can be modified in order based on clinical judgment. In this instance, the nurse who knows Charlotte decides to ask her a bit more about herself before discussing the scores. The main interchange occurs in the first 8 minutes of the video, and we have shown you in a more extended way the steps after clarifying the need to print out the management plan and give it to the mother or send directly to the health professional. Click here.
Task 2: Read the case study of Anna and baby Finn. Click here.
Task 3: Your turn to practice! Complete PIRIMID CDSSs 1-4 for Anna. Click here.
Task 4: Compare your entry with the sample provided in this document. Please note that your answers are not wrong and that the sample response is an example of how it can be written. Click here.