Tackling Postpartum Depression and Anxiety

00;00;01;23 - 00;00;25;12

Connie Guille

Really the bottom line is that we are really failing women in this country, in the United States. Our maternal mortality rates are higher than any other developed country. And mental health conditions are a main driver of those deaths being suicide and drug overdose. And in fact, there are some states where suicide and drug overdose combined to be the leading cause of maternal mortality in the postnatal year.

00;00;26;07 - 00;00;52;13

Connie Guille

And, you know, one of the things that we've learned through kind of a retrospective analysis of these deaths by suicide and drug overdose is that 100% of those deaths were preventable and they were preventable by better screening, identification, appropriate assessments and getting women to appropriate treatment. And so that's essentially what this tool was developed to do. And so it's this tool is working in that way, and the tool works that way.

00;00;52;16 - 00;00;56;07

Connie Guille

We can have it in the hands of every pregnant and postpartum woman in this country.

00;01;01;16 - 00;01;18;05

Kevin Smith

This is the innovatively speaking podcast brought to you by the Medical University of South Carolina. You found a place where we dove into the origins of the next big things. We're talking about the who, why and how of ideas that are changing what's possible here at the Medical University of South Carolina. And in some cases, all across the world.

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Kevin Smith

I'm Kevin Smith here in the MUSC podcast studio with my co-host, Dr. Jesse Goodwin. Good morning, Doctor Jesse.

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Jesse Goodwin

Good morning, Kevin. How are you today?

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Kevin Smith

I'm doing so well. You are the chief innovation officer here at MUSC and going to be talking a lot about innovations here in this podcast. And we're super stoked to get this thing going because I think there's a lot of great content out there in the MUSC community, the stuff that people need to know about.

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Jesse Goodwin

Yeah, I agree. I think MUSC has a tremendous amount to offer and there are stories that really need to be told and the impact of that creative problem solving that's going on here.

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Kevin Smith

And that is your neighborhood.

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Jesse Goodwin

That is my neighborhood.

00;01;59;05 - 00;02;18;25

Kevin Smith

Well, today we are diving into a particular set of challenges facing women who are pregnant and then into their postpartum year. We're going to be talking with Dr. Connie Guille. She's the director of Women's Reproductive Behavioral Health. She's a professor of the Department of Psychiatry, Behavioral Sciences and OBGYN. Jesse, I know you're a big fan of Dr. Guille and her work.

00;02;19;04 - 00;02;20;29

Kevin Smith

Why did you choose her for our first guest?

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Jesse Goodwin

I chose Connie because I think that the work that she's doing is really, really important. There's such a huge unmet clinical need for the work that she's doing. And then in addition to that, I think her solution is like just beautifully simply elegant. I think sometimes when we think about innovation, we think it has to be super high tech and very complex.

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Jesse Goodwin

And quite honestly, on the sometimes the more simple the solution is, the better it is and the better engaging it is. And I think that the work that Connie is doing is just really, really illustrative of how sometimes just stepping back and taking a really sort of patient first approach in a simple fashion can have really meaningful impacts for for those that we're trying to help.

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Kevin Smith

I think it's a perfect example of innovation right down on the street level, so. Well, let's dive in.

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Connie Guille

So, Kevin, you know, in addition to these conditions being incredibly common, they carry a very significant morbidity and mortality and particularly morbidity on women's health and children's development.

00;03;22;18 - 00;03;33;02

Kevin Smith

Our conversation started with a phone call from Dr. Guille as Jesse and I were putting together this first episode. We wanted to get a clear overview of the subject matter, and Connie was glad to call in and share some insights.

00;03;33;03 - 00;04;00;22

Connie Guille

So, for example, when women are experiencing major depression or anxiety problems or substance use issues or intimate partner violence through pregnancy, they can have much more unhealthy pregnancies. They are much more likely to have pre-term births and have babies that are born as low birth weight. In the postpartum period, they're much less likely to initiate breastfeeding. And we see a much higher rate breakup with their partner or separation or divorce.

00;04;01;18 - 00;04;28;09

Connie Guille

And I think some of the most compelling data is around some of the long term outcomes around child's children's development. What we find is that if mom is suffering from moderate to severe postpartum depression or anxiety in that postpartum year, those children are three to four times more likely to have behavioral problems. They're twice as likely to have academic problems, which we see around their school, and seven times more likely to have depression during adolescence.

00;04;28;23 - 00;05;03;00

Connie Guille

So this exposure to this disease during this really critical window of time is having a huge impact on children's development and obviously women's health. So, you know, we talk about some of the racial disparities in maternal mental health. But I think it's important to have the broader picture and understand that these racial disparities permeates maternal care. So black women are two to three times more likely to die in pregnancy or the postpartum year in comparison to white women, and they're much more likely to have severe maternal morbidity.

00;05;03;11 - 00;05;24;08

Connie Guille

There 60% times more likely to give birth early pre-term delivery and twice as likely to have their infants die at the time of birth in comparison to white women. So, you know, this is this is a really it's a global huge problem in maternal health care that needs to be addressed on multiple level depression.

00;05;24;08 - 00;05;36;16

Kevin Smith

Anxiety and problems with substance abuse are the most common complications during pregnancy. That's a heavy statement. And with that, I want to welcome Dr. Connie Guille. Welcome to the MUSC Podcast Studio.

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Connie Guille

Thanks so much. It's great to be here.

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Jesse Goodwin

And second, I really want to talk about the the technology that you created, but I think it's important for us to step back and talk a little bit about the pain points that you were experiencing.

00;05;49;13 - 00;06;12;15

Connie Guille

So as Kevin stated, these problems with mood and anxiety and substance use are incredibly common. So one in five women will experience one of these over pregnancy in the postpartum year. And, you know, oftentimes when I'm seeing these women is a long time after these problems started and it becomes much more complicated and their symptoms are much more severe and their outcomes are a lot worse.

00;06;13;02 - 00;06;30;08

Connie Guille

And that's why all of our organizations say that we need to be screening for these problems early on in pregnancy and throughout the postpartum year. And that just wasn't happening. So I'm really trying to think about how do we intervene early and identify women and get them what they want before things get worse.

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Kevin Smith

You said one in five women. That is a sobering statistic. And honestly, when I read that opening statement, you know, I wouldn't have guessed that anxiety and depression and substance abuse would have been up there as far as problems. And so obviously, we want these women and their children to be healthy, but also to thrive. So what what I read on one of your papers that you had published was Systems of Care.

00;07;00;14 - 00;07;22;00

Kevin Smith

That improve mental health and Substance Use Disorder screening, brief intervention and referral to treatment for pregnant and postpartum women are needed. So that's the screening part that that we were talking about, and that needed to be in the forefront. Talk a little bit about the screening process prior to where where you have arrived now.

00;07;22;21 - 00;07;47;27

Connie Guille

Sure. So that one of the problems is that the screening process is really variable depending on where you're getting your O.B. care or your pediatric care. Despite really clear recommendations about how you screen and when you screen. So we're really fortunate at MUSC to have a pretty progressive OBGYN and pediatric department. So they were actually already screening and they were using a tool that was standardized across the state.

00;07;47;27 - 00;08;12;03

Connie Guille

So using a great tool asking the right questions. So that's we were really fortunate to be in that setting. But even in that, I hear people doing these screenings and I hear the way they ask the questions. And it's it's not always standardized. It's not always the best approach. And when you start veering away from that standardization, you start introducing a lot of biases And so that was that was my first goal.

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Connie Guille

Is that OK, let's let's figure out a way to get to a system that is hardwired where we're asking the right questions at the right time in the right way.

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Jesse Goodwin

You know, having having had three children myself. And then, you know, in those situations where you're being asked questions, it's probably very intimidating for a lot of patients who are in either their OBS office or in their pediatrician's office to actually be forthright with those answers, because there is a part of us that worries about being judged. And so I wonder if that was another sort of pain point is that, you know, these these individuals may be experiencing symptoms and are too are are not being candid about it for a whole variety of reasons, you know, that I could only imagine, you know, it would sort of be a barrier to actually just actually reaching out for help.

00;09;00;20 - 00;09;22;19

Connie Guille

Yeah, that is a huge barrier. So stigma is one of the the probably most potent barrier for patients to acknowledge these issues. So you could ask all the right questions in the right way at the right time. And you could still miss this. So we really had to think about how how do you address stigma and really stigma is about feeling judged in a negative way.

00;09;23;03 - 00;09;39;25

Connie Guille

And that comes about when you're sitting face to face with somebody and they're asking you this question and you want to put your best self forward. That's just human nature. So we had to think about a different way to ask these questions that were felt like you weren't going to be judged. It was in a private way, in a confidential way.

00;09;40;08 - 00;10;02;00

Connie Guille

So that's kind of how we landed on the text messaging. So to to ask all these screening questions in a standardized way and also in a way that people felt an additional layer of confidentiality and privacy and not being judged. We asked these questions via text message, and it's also a super efficient way to get this done. It doesn't disrupt workflow that's happening in the clinic.

00;10;02;09 - 00;10;16;09

Connie Guille

Women can do this while they're sitting there waiting for their their doctor to come in or at any point they could do it. When they leave the office at home. So, you know, in addition to overcoming that major barrier of stigma and judgment, it was also really efficient and easy to do.

00;10;16;22 - 00;10;34;29

Jesse Goodwin

And I watched some of the material that you provided us, Connie, and I was really struck by that. The black woman who was speaking about how she didn't think that depression and anxiety was something that was allowed in the black community, that she really just thought it was something that only white women suffered, I think were her words.

00;10;35;19 - 00;10;55;04

Jesse Goodwin

And I think things like that, like really struck me about how many barriers there can be, not just about stigma, but even just allowing yourself to just say that there is a problem and feeling like you are allowed to have that. And that's a very personal thing. But obviously, there was a cultural piece for for her as well.

00;10;55;23 - 00;11;02;18

Jesse Goodwin

And I wonder if you see that sort of broadly within your office that there are these additional cultural barriers that need to be addressed as well.

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Connie Guille

Absolutely. I mean, every culture has a thought about what mental illness is and what it means. And you grew up with that. That's all around you. And so that becomes your framework for thinking about these things. And I've been told by many black women that depression is a white person disease. I don't have that. And, you know, we agree to disagree, but work through it.

00;11;25;08 - 00;11;43;01

Connie Guille

But really understanding someone's background and where they're coming from in relation to these issues is is critically important to even be able to start talking about them It doesn't really matter what we call it. You know, in the end of the day, we want women to be thriving and doing really well. So that's the goal.

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Kevin Smith

Well, as clinicians we do need to make some definitions, obviously. And I wrote down three things that I picked up from from your literature. Perinatal Mood and Anxiety Disorders as one category perinatal substance use disorders and then intimate partner violence. I think you can break those down a little bit so we can kind of get a broader scope of what the problems actually are.

00;12;04;12 - 00;12;30;28

Connie Guille

Sure. So within perinatal mood disorders, we're talking about things like depression and bipolar disorder and anxiety disorders. There's actually a whole host. So we're talking about generalized anxiety disorder, panic attacks, obsessive compulsive disorder. We also talk about some stress related disorders like post-traumatic stress disorder. In substance use, that can be anything from legal to illegal substances and intimate partner violence.

00;12;30;28 - 00;12;53;18

Connie Guille

Unfortunately, homicide is actually one of the leading causes of mortality in pregnant and postpartum women, and it's typically at the hands of an intimate partner. So, you know, while that is, you know, intimate partner violence is not a mental health condition. It's obviously very important in women's health and can frequently be co-morbid or certainly in relation to substance use.

00;12;53;18 - 00;13;00;27

Connie Guille

We see a lot of that happening. So. So yeah, so these are just the questions that we need to to get at and assess.

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Kevin Smith

And I can imagine intimate partner violence can... talk about a stigma. I mean, I'm sure people don't talk about that at all. So that gets us into, you know, how how important it is the system that you've built. So we've talked a little bit about racial disparity here. And one of the things that I picked up from our conversation prior to this was that black females are significantly less likely to get screened.

00;13;25;26 - 00;13;46;04

Kevin Smith

And we talked a little bit about why that is. But can you expand on that a little bit? Because what I'm hoping for is that there will be a large population of people that will hear this, hopefully women who are in this situation, but also maybe people who know someone and maybe didn't understand that there's a hesitance to get screened and to go forward.

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Kevin Smith

Can you maybe unpack that a little bit for us?

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Connie Guille

Yeah, that's a lot to unpack because it's you know, it is has to do with a lot of factors. There's patient factors, there's provider factors, and there's system level factors that are all influencing this. And result in these really significant disparities where we're not asking every single patient the right questions in the right way. And, you know, Jesse already alluded to like, you know, if you're coming from a culture that doesn't even acknowledge that depression is something or that if you acknowledge depression, that you're considered crazy or your child's going to be taken away, the fears of really actually real consequences.

00;14;27;00 - 00;14;37;19

Connie Guille

So that from a patient level is going to prevent you from from acknowledging that And we know there's structural racism within medicine in our systems. And so I'm sure that is a factor as well.

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Kevin Smith

Yeah. Lack of trust in the system.

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Connie Guille

Absolutely.

00;14;40;20 - 00;14;48;18

Kevin Smith

Well, can you maybe paint a picture? Give us a typical patient that that you feel like needs what you're offering.

00;14;49;09 - 00;15;08;13

Connie Guille

Yeah. So it's always pretty variable. But in the end of the day, what it boils down to is how are you functioning? How are things going in terms of your relationships, in your ability to take care of yourself, to take care of all of your responsibilities. Other people work, academics, whatever is important in your life. How are you doing in those domains?

00;15;08;25 - 00;15;46;12

Connie Guille

And really just understanding how the symptoms that they might be experiencing in relation to substance use or mood or anxiety, how those are impacting their ability to function. So you know, we obviously have all our criteria for what would be a diagnosis of anxiety or depression. But in the end of the day, it's about looking at the impact of those symptoms on someone's functioning So if you're not able to take care of yourself, if you're not if things are going really poorly in your relationships, if you can't function at work or academically or wherever, whenever is the most important part of your life, that suggests that there is a problem.

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Jesse Goodwin

Do you ever find that there's a tendency to diminish the symptoms as just part of being like, you know, you're supposed to be emotional while pregnant? Like, everyone cries, you know, and and sort of having a hard time distinguishing what that normal emotional variability is while you're pregnant versus what can be extreme and sort of out of the realm of normal, quote unquote.

00;16;12;22 - 00;16;38;29

Jesse Goodwin

And maybe the flip is that, you know, I think sleep deprivation has a huge impact on mental health. And at the same time, we recognize that babies don't sleep. And so you are supposed to be tired. And I feel like there's probably some level of of acceptance of of what really is sort of this normal boundary of when does it become impactful to where you're functioning and not just, quote unquote, typical, you know, pregnancy symptoms.

00;16;39;06 - 00;17;10;17

Connie Guille

Yeah, it's such a great question because I think that what happens a lot in practice is you have this you know, this symptom come up, someone's crying in your office and instead of actually taking a look at the whole entire picture, you say, oh, you're depressed, go see the psychiatrist. Right? Instead of actually recognizing that what's been happening most of day, nearly every day in this person's life and how many other things need to be also going on in order for us to say, this is this is a diagnosis of depression.

00;17;10;28 - 00;17;31;17

Connie Guille

And you have to tease apart what's the normal, you know, physiological processes of pregnancy and postpartum where as you said, you know, you're not sleeping. You have all these somatic things going on. You know, there is tension in relationships. There's a whole change in the dynamic, in relationships. So it's really teasing apart for each individual. What were things like before?

00;17;31;18 - 00;18;01;19

Connie Guille

You know, what's your baseline and understanding that and then looking at things now. And it's really the whole picture. So you need to have multiple symptoms. They're occurring most of the day, nearly every day, and it's impacting your functioning. So if you're having a bad day, that should not be depression. The thing that's tricky about this sometimes is that when people do experience mood or anxiety disorders, they don't always have the insight into how they are feeling or what is going, but they don't always see it.

00;18;01;28 - 00;18;26;27

Connie Guille

And that makes sense because anxiety and depression is it's a lens. You have looked at the world differently through this lens of anxiety or depression. So you're looking at yourself differently. So a lot of times people don't pick up on it, and it's often the partners that come to us and say, hey, something is different here. And that's why I have friends and family and partners are really critical in this and helping women kind of maybe get some support that they are lacking.

00;18;27;09 - 00;18;51;18

Kevin Smith

And maybe they're bringing some depression into their pregnancy to begin with and something that is just in their mind, a part of their life anyway. And then that gets lands us exactly where we're headed, which is screening. Because if the answer to your question, Jessi, is that, you know, the the line is determined through accurate screening, and you have developed a way to do that.

00;18;51;18 - 00;19;03;14

Kevin Smith

And I want to talk about that next. I was reading your study, and there was a group before that that was just the standard in the office screening process and then your new way. Walk us through that.

00;19;03;20 - 00;19;33;02

Connie Guille

Sure. So what was happening prior to implementation of of this program was every single patient that was pregnant and coming through prenatal care was asked a specific set of eight questions and if women endorsed any of those, the provider would then do something, what we call a brief intervention. And what that should look like, it's usually a five to ten minute conversation where you are asking them all the questions about what is going on with their mental health or substance use or whatever it is that they endorsed.

00;19;33;11 - 00;19;53;17

Connie Guille

You're making kind of an assessment of what that looks like. And then your brief intervention is about helping women to find the internal motivation to change whatever behavior it is. So if it's someone who's severely depressed, and you're saying, you know, I really think you should make it to this treatment appointment, it's trying to help that woman identify herself, why she would do that?

00;19;53;17 - 00;20;12;05

Connie Guille

Not not why we would do it, but why she would do it. And so that's your brief intervention. And then you typically make that referral to where they need to go and then hopefully they attend treatment. So that was kind of the process before. So we essentially took that process. And instead of asking those questions face to face, we use text messaging.

00;20;12;05 - 00;20;30;09

Connie Guille

So it's kind of the same workflow where pregnant postpartum women's coming into prenatal care, we say to them, hey, these conditions are really common and we're going to monitor your mood and anxiety, just like we monitor your your weight and your blood pressure all through pregnancy. And instead we're going to do that via text message. And if that's OK with you.

00;20;30;17 - 00;20;53;15

Connie Guille

We'll enroll you in the system. It's going to be seen by a care coordinator and your provider. And they say, Great, well, I'll enroll. So we enrolled them in system. They have those same questions they were asked before via text message and all of that information data kind of goes through an algorithm and that provides it for a care coordinator who is notified right away as students that screening is done.

00;20;53;15 - 00;21;19;19

Connie Guille

They can look at the information and then they call that patient and they do that, that brief intervention that was happening in person. But they're doing it by phone and they're also doing it with somebody who really has the background and training to do that really well and effectively. And in addition to, you know, assessing mental health and doing that motivational interviewing, they're also looking at social determinants of health because you could give someone the best referral in the world.

00;21;19;19 - 00;21;32;20

Connie Guille

But if they can't actually make it there due to other factors, that's going to be a barrier. So that person is also assessing those things, figuring out what are going to be the barriers, as in helping that woman make it to whatever the next step is.

00;21;33;05 - 00;21;54;17

Jesse Goodwin

Yeah. So that brings us back around to to the actual, quote "innovation in your solution," Connie. And I think as I mentioned at the beginning, you know, one of the reasons that I love this is because it didn't have to be incredibly high tech to be really impactful. So can you describe a little bit about sort of the accessibility of it and why you chose the approach that you did?

00;21;54;19 - 00;21;59;26

Jesse Goodwin

Because I think that that is actually a really key factor in sort of the overall success of what you've done.

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Connie Guille

Sure. And, you know, I think part of this was looking at prior work that's been done to understand what are the interventions that actually get implemented into practice. So we know that we have really great evidence based treatments that can take up to ten years for them to be uptake in into clinical practice. So the Institute of Medicine does a great job of this and kind of defines those those variables.

00;22;22;00 - 00;22;48;25

Connie Guille

So accessibility is number one. And we know 96% of people in our country have a phone. It doesn't have to be a smartphone. It can be literally a flip phone. This is SMS text messaging. So that was the most critical piece is the accessibility. The second piece of this was really the end user input. So we talked to patients, we talked to providers, they were the ones that helped us even conceive of this idea and then gave us feedback on it.

00;22;48;25 - 00;23;05;21

Connie Guille

So, you know, if you if you have your end user in mind, it's something that's going to be be utilized And they liked that. They liked the phone, they liked the text messaging, they liked that they could just reach out so easily and have contact with somebody. So it was that like that perfect perfect technology for this.

00;23;06;09 - 00;23;24;19

Jesse Goodwin

Yeah, I think that and user feedback is really important. If you look at, you know, big corporations that we think of as you know, successful, even with their high tech products, you know, they call it voice at customer feedback and they integrate it sort of all along. And that design with the user in mind is always sort of a critical piece.

00;23;24;22 - 00;23;37;07

Jesse Goodwin

You know, you never want to presume that, you know how people want to be approached. And so I applaud you that you work that into your actual design and solicited feedback from those who you were going to be serving. Right.

00;23;37;12 - 00;23;58;03

Kevin Smith

And so the question then is, is it successful? And we have some data on that one of the things we did when we were prepping for the show was talk a little bit about that. And one of the things that stood out to me was the screening rates of of black women versus white women prior to this was what were the numbers there roughly.

00;23;58;06 - 00;24;24;07

Connie Guille

Where we really saw some significant racial disparities, whereas with in-person screening where black women were less likely to make it to treatment in comparison to white women with with the system that we use, which is called listening to pregnant and postpartum people, the there were no differences in black and white women making it to treatment. And they were significantly likely like five times more likely both black and white women to make it to treatment.

00;24;24;14 - 00;24;29;22

Kevin Smith

Wow. The disparities between black and white women just flattened out. Mm hmm. That's amazing.

00;24;30;07 - 00;24;32;20

Connie Guille

We were super, super excited. That's a big deal.

00;24;32;22 - 00;24;50;00

Kevin Smith

Everybody has a phone. And, you know, the kind of stigma I find sometimes it's easy to text something to somebody than it is to talk right to their face. And so you're giving everyone the opportunity to do exactly that and to get really honest with some struggles they're having. Think that's innovation if there ever was innovation.

00;24;50;18 - 00;24;51;25

Jesse Goodwin

I definitely agree.

00;24;53;08 - 00;24;53;13

Connie Guille

And.

00;24;53;27 - 00;25;21;21

Jesse Goodwin

So kind of like we've talked a little bit about the simplicity of the text messaging and how that made it really accessible for the patients and for the providers who were reaching out to them. But I'm sure that behind the scenes, it's much more complex than just getting a couple Yasir no's to to the text message prompts. And so how did you handle the data that you were getting in in order to appropriately determine, you know, who needed to be reached out to and who who didn't?

00;25;21;21 - 00;25;26;23

Jesse Goodwin

Because like I said, I'm sure it's way more complex then than what it sounds on the surface.

00;25;27;12 - 00;25;56;26

Connie Guille

Well, I mean, the good thing is that we have these standardized screening tools that we can use to determine who's screening positive and who might have some at risk behaviors that they're endorsing. So it's it was really just thinking clinically and putting that into an algorithm. So one of the things that the program does that I really like, which is better than that, that in-person eight question screens, is we've got a few more questions in there.

00;25;57;18 - 00;26;17;26

Connie Guille

And if you tick those off, that's going to take you to another survey and that's going to give us a little more information. So that information kind of goes through an algorithm and puts people in clinical risk categories. And why that's helpful is because you know who to reach out to first. If someone is screening really high for depression or high risk substance use clinically, you want to talk to them, to them first.

00;26;18;24 - 00;26;40;19

Connie Guille

But it also provides a huge amount of it makes it streamlined for the care coordinator, right? So they can very easily see that. But if they want to go in and look and see what all those responses are to which are all the questions you would ask that person anyway, you have all that information and data collected. So what that then does is you call this person and you already know so much right?

00;26;40;19 - 00;26;55;03

Connie Guille

You don't have to rehash things. You're kind of like like I'm looking at this and I'm seeing where you are and kind of reflecting that back to that person, which helps engage them and streamlines the whole process. So you know, usually a brief intervention takes five to 10 minutes. We've got it down to two and a half to 3 minutes.

00;26;55;21 - 00;27;18;06

Jesse Goodwin

So I would imagine that that makes it so much more adoptable and implementable for other providers who have busy practices, who probably love the elegant ness of the solution. You know, to be able to implement something by text message and then have an algorithm, help them, you know, prioritize the patients that they need to reach out to. So it's not just adding on to to their to their workload.

00;27;18;14 - 00;27;30;03

Connie Guille

Yeah. I mean, and that's one of the other big factors is, you know, something does not get into clinical practice unless it's efficient. So you either need to be optimizing a workflow or, you know, replacing something that was not working.

00;27;30;20 - 00;27;54;15

Jesse Goodwin

So where do we go from here? Kind of so so you have a tremendous amount of data showing that it works here. I think you've done it mostly largely as sort of a research study, you know, proving a hypothesis, if you will, that you set out to to do so. How do you take it from a research study that's hypothesis driven into a tool that we can deploy more broadly?

00;27;54;19 - 00;27;56;15

Jesse Goodwin

What's your vision for that look like?

00;27;57;05 - 00;28;20;12

Connie Guille

Yeah. So you know, and I think this is the research part of my brain. I think there we can always do more research. So, you know, we've we've tested this in a certain setting and it would be really important to know how this does in different settings. So in a rural setting or with a different patient demographic. So I think that's still key information that we need to have in order to effectively implement and scale.

00;28;21;10 - 00;28;36;23

Connie Guille

The other thing that we need is that this needs to be a billable service. So in it is a clinical service and in person you can bill for this, you can bill for screening, you can bill for brief interventions, and that is enough to sustain that work. And so we need to be able to do that with text and phone.

00;28;37;12 - 00;28;45;26

Connie Guille

So if it is a billable sustainable service, then we want to be able to offer this to practices and and help them out with this process.

00;28;46;03 - 00;28;51;05

Jesse Goodwin

So does this not fit within the buckets of what is already a billable service code?

00;28;52;02 - 00;28;56;10

Connie Guille

So that's what we're working with Medicaid on right now and talking through those.

00;28;56;10 - 00;28;57;04

Jesse Goodwin

Those things and what.

00;28;57;06 - 00;29;17;07

Connie Guille

Where this does fit in because it is different in a lot of ways than some other monitoring. So we're just trying to figure out if there's something in existence that I can fit into because that's a much easier approach. And if not, then we've already talked about it. Maybe this is a different sort of carve out. So we're working through those things right now.

00;29;17;07 - 00;29;23;12

Connie Guille

But as soon as you could get that as a billable service, then the scalability becomes becomes great.

00;29;23;29 - 00;29;54;29

Jesse Goodwin

Yeah. I think that actually touches upon an interesting point about our ability as a health system nationally to actually roll out really good interventions and how dependent it is upon insurance companies being willing to pay for them. And I know oftentimes in my role we're looking at is there already a billing code associated with it? And sometimes that that can make or break whether or not a good technology actually makes it forward, which in a way is a shame, right?

00;29;54;29 - 00;30;16;05

Jesse Goodwin

That that sometimes good ideas don't move because there's no way to collect insurance payments for it or that path seems too long and too arduous to get to. I think it's an interesting conundrum that we have as a society, particularly in a in a, you know, wealthy first world nation like we live in, that we're still sort of hamstrung by insurance billing codes, if you will.

00;30;16;07 - 00;30;16;19

Jesse Goodwin

Right.

00;30;16;19 - 00;30;27;10

Kevin Smith

All right. Dr. Guille let's look into the future. What how do you see this being implemented? Like if you if you could have your way two years, three years out, what would it look like on a national level?

00;30;27;19 - 00;30;52;00

Connie Guille

Gosh, that's so exciting to think about. So I would love every single OB-GYN practice and pediatric practice and delivery hospital be able to offer this to their patients. And I really hope that we can be systematically collecting data to demonstrate the benefit to women's health, to children's health, and that this really is improving women's lives and families lives.

00;30;52;13 - 00;31;03;24

Kevin Smith

And some of the most vulnerable women and families as well. So. All right. Dr. Guille let's talk about some next steps then. We have kind of dreamed for the future, but what's happening right here, right now, what can we look forward to?

00;31;04;17 - 00;31;25;09

Connie Guille

Yeah, so we are really excited about this because one of the things we recognize is that we could integrate screening into routine practice, but that requires a woman to actually make it to a routine clinical care. And that's not always the case. So we really want to have a way for women to directly refer themselves if they're struggling with mental health or substance use or intimate partner violence.

00;31;25;09 - 00;31;54;15

Connie Guille

And so in May, we're going to be launching a program that is essentially a perinatal psychiatry access program. So if you're a pregnant or postpartum women struggling with any of these conditions, you literally can pick up the phone and you would be connected to a care coordinator that would do that same assessment that I talked about with the other program and what they would do if needed is get you an appointment in 30 minutes with a perinatal psychiatrist to get evaluated and treatment started and and continued if needed.

00;31;55;05 - 00;32;08;19

Connie Guille

So in that program, we will then also enroll that those women into the listening to pregnant and postpartum people so that they'll continue to be monitored over that critical window of pregnancy in the postpartum year.

00;32;08;26 - 00;32;23;07

Kevin Smith

Fantastic. Well, Dr. Guille. You have given us a lot to think about today, and you've given us a lot of hope and you have highlighted one of the things we say a lot around here, which is changing what's possible. You are certainly changing what's possible with your work. So we want to say thank you so much.

00;32;23;24 - 00;32;24;25

Connie Guille

Thanks so much for having me.

00;32;24;29 - 00;32;37;29

Jesse Goodwin

Yeah. And I would just echo that, Connie, it's great to have you on and to be able to showcase the work that you're doing and the importance of it and the impact that you're having. And I'm proud that you get to be the inaugural guest on on this podcast.

00;32;38;08 - 00;32;41;05

Connie Guille

Well, I'm honored and thrilled. Thanks so much, Jesse. Thanks, Kevin.

00;32;42;15 - 00;33;06;14

Kevin Smith

M been listening to the innovatively speaking podcast with the Medical University of South Carolina. If you enjoyed this episode and would like to support the show, leave a rating and review to hear more innovative ideas and to share your own. Subscribe to the show or visit us on our Web page. Web dot MUSC Dot edu slash innovation And remember, don't hesitate to innovate.