What is the Perinatal Mental Health Check Program?

This is Federally funded program to support the implementation of routine, universal screening using the iCOPE Digital Screening Platform. The Program was funded from July 2020 – June 2023, and likely to commence in April 2021.

 

FAQ’s – How the Platform works

How is perinatal screening undertaken using the iCOPE Platform?

There are three ways that screening can be performed:

1. On the client’s own mobile phone device – a link can be sent to the client at, or prior to, their appointment via sms, or via location-specific QR codes displayed on posters in clinical settings. This enables the client to complete their screen in the waiting room or at home prior to the consultation.
2. On an iPad – the screening can also be completed on an iPad device in the waiting room or within a consultation. All iPads are registered with the service, locked down and cannot be used for any other purpose.
3. On the clinician’s desktop – the clinician can access the screening tools on their desktop computer for completion with the woman within the consultation.

Why go digital?

The iCOPE tool has been designed to replace pen-and-paper approaches to screening. This serves to bring the following researched and documented benefits:

• Increases efficiency – average screen time 6-8 minutes (no scoring time)
• Ensures 100% accuracy – through instant, automated scoring
• Guides best practice – through the production of instant clinical reports containing clinical advice relative to screening scores and outcomes
• Encourages disclosure – by creating a private environment in which the screener can reflect upon and answer questions
• Empowers the consumer – through the provision of sensitively written individual reports which the client can nominate to receive via email or SMS
• Is inclusive of cultural populations – through the provision of screening tools and patient reports in multiple languages and/or adaptions for cultural groups
• Facilitates clinical reporting – through clinical reports which can be uploaded into health record systems.
• Facilitates data collection – Raw data can also inform screening rates and outcomes over time at a service level, Stat and Territory level or a National level.

FAQ’s – Clinical Tools and Reporting

What clinical scales will be available?

In line with the National Guideline, the recommended screening tools include a psychosocial risk assessment using the Antenatal Risk Questionnaire (ANRQ) and the Edinburgh Postnatal Depression Scale (EPDS).

Clients indicating that they are postnatal (ie they have had their baby) will also be asked the additional three postnatal items as recommended in the National Guidelines. these questions pertain to:

• birth experience – whether frightening or disappointing
• parenting experience – whether this has been a positive one
• baby wellbeing – whether unsettled or feeding poorly.

How will family violence be screened?

With the ability to now undertake screening outside of the consultation, the iCOPE Platform now allows for the family violence question(s) to be removed from the initial screen and be asked in the presence of the health professional.

Here the clinician is prompted to indicate if the client is alone, (and it is safe to be asked questions pertaining to family violence) before these appear on the clinicians desktop. As jurisdictions have varying family violence screening tools, these will be incorporated into the Platform as part of this program. Responses to individual family violence questions are detailed on the clinical report (and omitted from patent report for safety reasons).

FAQs – Accessibility

Will fathers also have access to screening under Program?

As part of this election commitment, screening will also be offered to fathers and partners. 

A review of the literature will be undertaken at the outset of the program to determine the most clinically appropriate screening and assessment tools for fathers.  To facilitate the screen outside of the hospital setting, this will involve the development of an application (App) that can be downloaded.  

Once downloaded, the application notification process will prompt and serve a digital screen.  Upon downloading the application, GP/medical provider details ensure that any screen results conducted on the smartphone platforms will allow for a copy of the screen results (event summary) to be sent to the health provider. 

This provides the appropriate sensitivity rules (screen score), as well as prompting and flagging to providers the need for follow up of fathers/partners in relation to COPE identified and administered score ratings, as needed. Established referral pathways will be integrated into the patient reports to support identification of appropriate services. 

What languages are available?

Currently the Psychosocial questions (ANRQ/PNRQ) and EPDS is available in the following languages:

• English
• Arabic
• Vietnamese
• Mandarin
• Cantonese
• Punjabi
• Tamil
• Chin Hakka
• Turkish
• Dinka
• Persian
• Dari

Under this program, the iCOPE Platform will facilitate screening and patient reporting in additional languages to reflect the language needs of services.

What about Aboriginal and Torres Strait Islanders?

For those Aboriginal and Torres Strait Islander populations, specific screening tools and reporting will be incorporated into the platform and made available under this program.

Specifically COPE will work with the developers of the Kimberly Mum Mood Scale and Baby Coming – You Ready? to make these specific tools available.

How will lower cut-off scores be managed?

Currently Guidelines recommend lower cut-off scores on the EPDS for certain population groups (eg. non-english speaking clients, fathers). The algorithms for the lower EPDS cut-off scores are already in place for fathers and non-English speaking clients, and integrated into the algorithms to inform the advice on the clinical and client reports accordingly. 

The iCOPE Platform can also be adjusted to incorporate screen same-sex parents (and identify the biological versus non biological parent). The same principle can be applied for same-sex partners, with the cut-off scores similarly to be informed by research (if and as available). 

As part of this program, a systematic review of the literature to determine the most appropriate screening tools and clinical cut-off points for specific population groups.  Whilst there is growing research with respect to screening fathers, it is likely to be less substantive for same sex-couples.

What about clients who have no data on their phones?

In instances where a setting is undertaking remote screening (by sending a link to the clients phone), the service’s free wifi network can be safely and securely used. This is enabled by the fact that the iCOPE system has built-in end-to-end encryption.

What if the wifi in a setting is unreliable or difficult to access?

In the above instances it is recommended that the service has a small number of iPads available to ensure access, or use the remote screening functionality.

How will the postnatal screen be done (after discharge from hospital)?

Along the motherhood journey there are three to five touch points that allow for the downloading of the Ready to COPE application which will be used to facilitate the postnatal screen (as above). Mothers (and fathers), will receive a prompt at the six-week period following birth, to complete the screen. The Event Summary will then migrate to the provider and to the appropriate patient record. Links to referral pathways will also be incorporated into the patient report via the e-COPE Directory.

In addition, COPE has developed a regular email newsletter, Ready to COPE. The application ensures that time-appropriate handy resources and information are served to the mother’s smart phone (iOS and Android), along with the postnatal screen, in line with the Prime Minister’s Hospital to Home policy.  

FAQ’s – System integration

Can clients be sent the link to do the screen via the appointment booking system?

Yes. It is possible to automate the link to be sent to the client upon via a service’s booking reminder system. This involves sending a secure link via text message upon the client’s SMS confirmation of their upcoming appointment.

What if the client changes their phone number?

It is always possible to send the link to the client on their current number at the time of the appointment, or that can access the link via the location specific QR code at the time of the appointment.

If the client’s number is modified in their patient record, this is where the link will be sent from for future appointments.

Can the clinical reports be integrated with hospital medical record systems?

Yes. Work is currently underway to support integrating of the iCOPE event summary (clinical report) within the patient record.  

As part of this Program, COPE will work with Hospitals and IT developers to facilitate the integration of the patient report into the Hospital Health Record System.  

COPE has commenced scoping via an online survey to determine current Hospital Record Systems within and across settings, as well as scope the specific population and language needs of populations across services. 

 

FAQ’s – Referral pathways

What referral pathways exist after screening?

COPE has developed the e-COPE Directory to support referrals pathways.  As part of the implementation of the Program, COPE will work with services to identify local referral pathways for inclusion onto the e-COPE Directory to support timely and appropriate referral following screening.

As part of the Program links to the e-referral directory will be incorporated into the iCOPE clinical and patient reports. This will enable clinicians and consumers to locate services following screening in their area, online or via Telehealth. 

In addition, health professionals will be made aware of the populated e-COPE Directory as part of the training and implementation Program. 

 

FAQ’s – Data management

Where is the data stored?

All data collected is securely stored within Australia.

How is the data stored?

Currently all data is collected and stored in the purpose-built, secure Virtual Private Network (VPN).  The Virtual Private Network (VPN) has been built with Australian medical digital data encrypted data storage facilities and secure enterprise data access protocols.

The iCOPE Platform collects data in real time and this is encrypted and stored on the secure health server.  This provides the capacity to immediately identify and respond to any technical issues experienced across locations nationally, through the de-identified screening number generated by the system.

Who owns the data?

As with paper records, all reports and data is owned by the service.

All data generated by the iCOPE system will be be securely transferred to the Australian Institute of Health and Welfare who will be the data custodians for the Commonwealth Government.

 

How is data accessed by the Services?

As well as accessing data via the automatically generated patient reports, individual services will also have the capability to download their identified screening data at any point in time to inform screening rates and outcomes across sites and the service as a whole. 

This is facilitated by the service being able to register all users with different levels of permissions within the system. Those deemed by the service to have Managerial or Administrator permission levels, will be able to have access and download service and location data. Two-factor authentication protocols are in place to secure this access to patient data from the secure server.

FAQ’s – Hardware

If tablets are used, does the system require iPads specifically?

Screening and creating medical event summaries require mobile device security.  The most secure mobile device platform for protection of patient data is the Apple Mobile Device Business Manager platform.  This has the ability to customise the operational and security features of the device at an enterprise level. 

Apple mobile devices are used by Police jurisdictions, including Victoria, Queensland, Western Australia and New Zealand, and offer the following benefits:

Security System:  All iOS devices have a “secure boot chain”, negating the ability for the device to be tampered with, even during start up.  Apple also releases software updates regularly to provide fixes to any new security threats. 

Apple’s Secure Enclave provides and maintains integrity of data protection.  The enclave is fused to the device’s Unique ID (UID) and Group IDs (GID) at the time of manufacturing. 

Encryption and Data Protection: Cryptographic operations are implemented, as each device has an AES-256 crypto engine built in for efficient encryption, while maintaining battery life and performance.  Each device’s UID and GID cannot be read by any firmware or software directly—they can only access the results of encryption and decryption operations by dedicated AES engines. 

App security: iOS provides various layers of protection to protect user’s data.  All apps must be signed, verified and sandboxed.  This creates a stable and secure platform for apps without impacting the security of the system preventing malicious apps and attacks.

Network Security: iOS devices support “Always-on VPN” which is configured through the Apple Business Manager.  This ensures the device only communicates patient data through the VPN while allowing iCOPE to secure and encrypt the IP traffic transmission.

Device Controls: Mobile Device Management (MDM) provides iCOPE with the ability to securely configure and manage iPads.  Through the Apple Business Manager, the managed device can be enrolled to the iCOPE program, configured and updated by iCOPE wirelessly and remotely locked (Lost Mode) or wiped (Remote Wipe) the device if needed.

For further information regarding Apple’s iOS Security, please see:  https://www.apple.com/business/docs/site/iOS_Security_Guide.pdf

For further information regarding Apple’s current Security Certifications and programs, please go to https://support.apple.com/HT202739

What if a device is lost or stolen?

All devices have GPS tracking enabled and are setup to a specific location.  Should the device be removed from the location, the iPad can be remotely disabled and tracked.  Due to the iPad management, the GPS, tracking and remote disable ability cannot be turned off or tampered with.  No patient data whatsoever is stored on any Apple tablet device.

What if a device is faulty or does not work?

If a tablet fails to work, the device will be replaced within a 48-hour period within metro areas, and 72 hours nationally under our Provisioning Provider Agreement.

What technical support will be available?

The iCOPE Platform is support by a national triage support line operating between the hours of 8.00am to 8.00pm on weekdays.  A-level disruption events are supported 24 hours a day, seven days a week for hospitals.  Back up hardware is available for specific events.