Maternal Depression Breena Holmes MD MCH Director Objectives
Maternal Depression Breena Holmes, MD MCH Director
Objectives �Understand the context of maternal depression, nationally and locally and become familiar with Vermont improvement strategies. �Comprehend the biological and socio-emotional impact of maternal depression on attachment and child development. �Describe the progress of VDH Maternal Depression Work group and identify areas for CIS input and integration Vermont Department of Health
CIS and Maternal Depression �Awareness �Support �Screening �Referral Vermont Department of Health
Data �National data show 10 -20% of women experience depression either during pregnancy or in the years following the birth of a child �Depression screening by our Nurse Family Partnership home visitors has placed the rate closer to 50% (with select population of first time pregnant women who are Medicaid eligible) Vermont Department of Health
Awareness �Reproductive-age women are anxious and depressed in higher numbers than previously described �Unidentified anxious and depressed mothers struggle with attachment, talk less to their babies, are isolated Vermont Department of Health
Impact �Maternal depression can lead to serious health risks for both the mother and the child, increasing the risk of complications during birth and causing long lasting effects on child development and well-being Vermont Department of Health
Impact �Pregnancy �Inadequate prenatal care �Poor nutrition �Increased rate of preterm birth Vermont Department of Health
Impact �Infants and Toddlers �Cognitive development �Behavior �Nutrition �School Aged Children �Cognitive development �Behavior �Nutrition Vermont Department of Health
Definitions/Continuum �Prenatal Depression/Anxiety �“Baby Blues” �Postpartum Depression/Anxiety �Postpartum Psychosis Vermont Department of Health
Handout/Continuum �Incidence �Risk Factors �Signs/Symptoms �Interventions Vermont Department of Health
MCH Strategic Plan: A Life Course Approach Preconception Adult Pregnancy School age / Adolescence Infancy / Early Childhood Family-Centered Care Evidence-Based Practice for Population Health Data and Evaluation
MCH Strategic Plan By September 2015, conduct an assessment to determine existing maternal depression resources and gaps, and develop a plan to increase capacity of treatment providers and educate primary care Vermont Department of Health
Maternal Depression Work Group December 2013 MDWG Brainstorm Existing resources Gaps/Barriers Opportunities/Wish list January 2014 Review of other State strategies February 2014 Needs Assessment (n = 191 responses!) Screening, Diagnosis, Referral, and Treatment Knowledge and comfort Resources March 2014 Summer 2014 MDWG Recommended Strategies Action Planning Vermont Department of Health
Maternal Depression Work Group �AHS �Integrated Family Services �DCF (CIS) �DOC �DMH �DVHA/High-Risk Pregnancy �VDH (CO, WIC, and OLH) �Blue Cross/Blue Shield �Cambridge Health Center �Counseling Service Addison Co. �FAHC/Maternal Fetal Medicine �Howard Center �Northwestern Medical Center/ Ob Gyn �Nurse Family Partnership �Parent �UVM/Department of Psychiatry �VCHIP �Vermont Postpartum Task Force Vermont Department of Health
Needs Assessment Survey Scope of practice includes (%) Of those whose scope of practice includes, % who currently Talk with/educating about maternal depression 74. 2 86. 9 Screen for maternal depression 54. 7 84. 9 Diagnose maternal depression 29. 1 89. 1 Refer for maternal depression services/resources 83. 8 91. 3 Treat maternal depression 30. 7 89. 6 Vermont Department of Health
Needs Assessment Survey Of respondents, who’s scope of practice includes: Somewhat (4) or Very (5) Knowledgeable Screen for maternal depression 76. 3 Diagnose maternal depression 78. 3 Refer for maternal depression 70. 3 services/resources Treat maternal depression 62. 0 Do you currently screen for maternal depression using a validated tool? All respondents Of those who’s scope of practice includes screening Vermont Department of Health Somewhat (4) or Very (5) Comfortable 68. 0 73. 9 68. 5 56. 0 Percent 26. 2 46. 7
Proposed Strategies �Health Care �Mental Health �Financing �Public Education Vermont Department of Health
Health Care �Increase capacity of Vermont’s providers to educate, screen, diagnose, refer, and treat maternal depression Vermont Department of Health
Mental Health �A robust support and treatment referral network is available to primary care providers and social service providers. Vermont Department of Health
Financing �Understand, support, and/or enhance payment systems for maternal depression (IFS, Medicaid, private insurers). Vermont Department of Health
Public Education �Vermonters have access to comprehensive maternal depression educational information and support and treatment options Vermont Department of Health
Discussion questions �How does CIS connect to these 4 areas ? �What is your experience in your communities? �How do we leverage existing resources? Vermont Department of Health
Be in Touch! �Breena. holmes@state. vt. us Vermont Department of Health
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