Section 2110.10  General Applicability

This Part implements the Perinatal Mental Health Disorders Prevention and Treatment Act [405 ILCS 95] that concerns perinatal mental health disorders, commonly referred to as "post-partum depression".

Section 2110.20  Purpose

The purpose of the Perinatal Mental Health Disorders Prevention and Treatment Act and this Part is to provide information to women and their families about perinatal mental health disorders in order to lower the likelihood that new mothers will continue to suffer from this illness in silence; to develop procedures for screening for risk of perinatal mental health disorders and assessing women for perinatal mental health disorders during prenatal and postnatal visits to licensed health care professionals; to promote early detection and early treatment of perinatal mental health disorders; and, when medically appropriate, to avoid medication.

Section 2110.30  Incorporation by Reference

Clinical Report Incorporating Recognition and Management of Perinatal and Postpartum Depression into Pediatric Practice, Marian F. Earls and The Committee on Psychosocial Aspects of Child and Family Health, Pediatrics, published online October 25, 2010, available at www.pediatrics.org.

Section 2110.40  Definitions

"DHS" means the Department of Human Services.

"HFS" means the Department of Healthcare and Family Services.

"Hospital" has the meaning given to that term in the Hospital Licensing Act [210 ILCS 85/3].

"Licensed health care professional" means a physician licensed to practice medicine in all its branches, an advanced practice nurse who has a collaborative agreement with a collaborating physician that authorizes care, or a physician assistant who has been delegated authority to provide care.  A medical director within a public health setting may assign the task of screening to a subordinate, under his/her supervision, who has satisfactorily completed training on perinatal mental health disorders and use of screening tools.

"Perinatal mental health disorders", commonly referred to as "post-partum depression", means a wide range of emotional, psychological and physiological reactions to childbirth, including feelings of hopelessness, excessive guilt, sustained sadness, and thoughts of death or suicide, that challenge the stamina of a woman during pregnancy and after childbirth and impair her ability to care for her child.

"Postnatal care" means an office visit to a licensed health care professional occurring after birth, with reference to the infant or mother.

"Prenatal care" means an office visit to a licensed health care professional for pregnancy-related care occurring before birth.

"Screening" means the use of a questionnaire as a tool administered by a licensed health care professional to detect perinatal mental health disorders, such as the Edinburg Postnatal Depression Scale, the Postpartum Depression Screening Scale, the Beck Depression Inventory, the Patient Health Questionnaire, or other validated assessment methods, including any validated screening tool approved by HFS to detect perinatal mental health disorders.

Section 2110.50  Prenatal Visits

A licensed health care professional providing prenatal care to a woman at a prenatal visit shall:

a)         Once during the pregnancy, provide education regarding the signs and symptoms of perinatal mental health disorders, including but not limited to offering materials to the patient, and if possible, to fathers, partners and other family members.

b)         Once during the pregnancy, request permission from the pregnant patient to offer education regarding perinatal mental health disorders to fathers, partners and other family members.

c)         Invite the pregnant patient, at least once during the pregnancy, to complete a perinatal mental health disorders questionnaire unless the patient states that she has already completed such a questionnaire during the current pregnancy.  The questionnaire must be offered more frequently when, in the professional judgment of the licensed health care professional, a reasonable possibility exists that the woman suffers from perinatal mental health disorders.

d)         Repeat the questionnaire for perinatal mental health disorders when, in the professional judgment of the licensed health care professional, a reasonable possibility exists that the woman suffers from perinatal mental health disorders.

e)         Review the completed questionnaire in accordance with the formal opinions and recommendations of the American Congress of Obstetricians and Gynecologists. Information and materials may be found at www.acog.org., with respect to perinatal mental health disorders. The ACOG Depression Toolkit may be found at http://mail.ny.acog.org/website/DepressionToolkit.pdf.

f)         Document the offer of the questionnaire in the patient record. 

g)         Obtain the patient's consent to share the results of the questionnaire with the patient's primary licensed healthcare professional, if indicated by criteria commonly relied upon by providers in assessing a patient's mental health. If the patient is determined to present an acute danger to herself or someone else, consent is not required.

h)         Document action taken if the questionnaire indicates that the woman is experiencing symptoms of perinatal mental health disorders.

Section 2110.60  Hospital Maternity Care Services

a)         Hospitals that provide labor and delivery services shall:

1)         Provide complete information about perinatal mental health disorders, including its symptoms, methods of coping with the illness, and treatment resources to patients who have given birth, prior to discharge from the maternity unit following childbirth.  Hospitals may use written information provided by DHS to satisfy this requirement.

2)         If possible, provide the written information to fathers, partners and other family members.

b)         Hospitals may use resources that are provided from State or nationally recognized health, mental health or child development organizations to satisfy the requirements of this Section.

Section 2110.70  Postnatal Visits

A licensed health care professional providing primary care, obstetric or gynecological services to a woman at a postnatal visit shall:

a)         Invite a post-partum patient to complete a questionnaire to screen for risk of perinatal mental health disorders at least once post-partum.

b)         Offer the questionnaire at least once post-partum, unless the woman states that she has already completed the questionnaire during this period.  The questionnaire may be offered more frequently, based on the licensed health care professional's clinical judgment.  In deciding on the timing or frequency of any additional screenings, the licensed healthcare professional may consider the recommendations of the American Academy of Pediatrics Clinical Report Incorporating Recognition and Management of Perinatal and Postpartum Depression into Pediatric Practice (AAP in Journal of Pediatrics in 2010 126:5; pgs. 1032-1039). 

c)         Review the completed questionnaire in accordance with the formal opinions and recommendations of the American College of Obstetricians and Gynecologists, found at www.acog.org., with respect to perinatal mental health disorders. The ACOG Perinatal Depression Toolkit may be found at http://mail.ny.acog.org/website/DepressionToolkit.pdf.

d)         Document the offer of the questionnaire in the patient record. 

e)         Obtain the patient's consent to share the results of the questionnaire with the patient's primary licensed healthcare professional, if indicated.  If the patient is determined to present an acute danger to herself or someone else, consent is not required.

f)         Document actions taken if the questionnaire indicates that the woman is experiencing symptoms of perinatal mental health disorders.

Section 2110.80  Visits to Pediatric Providers

Licensed health care professionals providing pediatric care to an infant shall:

a)         Invite the infant's mother to complete a questionnaire at least once 6 weeks post-delivery to screen for risk of perinatal mental health disorder. This should occur prior to the infant's first birthday, unless the mother states that she has already completed the questionnaire during the post-partum period.  The questionnaire may be offered earlier or more frequently, based on the licensed health care professional's clinical judgment.  In deciding on the timing or frequency of any additional screenings, the licensed health care professional may consider the recommendations of the American Academy of Pediatrics Clinical Report Incorporating Recognition and Management of Perinatal and Postpartum Depression into Pediatric Practice found at http://www.pediatrics.org.

b)         Review the completed questionnaire in accordance with the formal opinions and recommendations of the American Academy of Pediatrics or the American College of Obstetricians and Gynecologists, found at www.acog.org., with respect to perinatal mental health disorders.

c)         Document the offer of the questionnaire to the mother in the infant's or the mother's record, if available.

d)         Obtain the mother's consent to share the results of the questionnaire with the mother's primary licensed healthcare professional, if indicated.  If the mother is determined to present an acute danger to herself or someone else, consent is not required.

e)         Document actions taken if the questionnaire indicates that the woman is experiencing symptoms of perinatal mental health disorders.

Section 2110.90  Questionnaire Tool

The perinatal mental health disorders questionnaire utilized must be approved by HFS.  Approved tools used for screening pregnant and post-partum women for perinatal mental health disorders can be found in the Provider Handbook at www2.illinois.gov/hfs/medicalprovider/ maternalandchildhealthpromotion.  HFS, in coordination with DHS, will notify providers of changes to the list of approved tools.

Section 2110.100  Privacy of Questionnaire Results

Documentation concerning issues of mental health are protected in accordance with the Confidentiality of Alcohol and Drug Abuse Patient Records Rules (42 CFR 2) and the Mental Health and Developmental Disabilities Confidentiality Act [740 ILCS 110] and shall be shared only with the written consent of the patient, except as provided in Section 2110.80(d).  If the licensed health care professional's patient is the infant, he/she shall request permission to share screening results with the woman's primary health care provider, except as provided in Section 2110.80(d).

Section 2110.110  Follow-Up

a)         If screening results or clinical judgment indicate a need for follow-up, pre-natal and post-natal licensed health care professionals may, in accordance with their professional judgment, offer referral to an appropriate healthcare provider for further assessment and/or treatment.

b)         If screening results or clinical judgment indicate a need for follow-up, pediatric care licensed health care professionals whose patient is the infant may, in accordance with their professional judgment, offer referral to an appropriate healthcare provider for further assessment and/or treatment.

c)         Licensed health care professionals treating patients who demonstrate risk of immediate harm to self or others shall notify emergency personnel or follow existing emergency protocols of the health care setting.