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Maternal DepressionBreena Holmes, MD
MCH Director
ObjectivesUnderstand 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 DepressionAwareness
Support
Screening
Referral
Vermont Department of Health
DataNational 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
ImpactMaternal 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
ImpactPregnancy
Inadequate prenatal care
Poor nutrition
Increased rate of preterm birth
Vermont Department of Health
ImpactInfants and Toddlers
Cognitive developmentBehaviorNutrition
School Aged ChildrenCognitive developmentBehaviorNutrition
Vermont Department of Health
Definitions/ContinuumPrenatal Depression/Anxiety
“Baby Blues”
Postpartum Depression/Anxiety
Postpartum Psychosis
Vermont Department of Health
Handout/ContinuumIncidence
Risk Factors
Signs/Symptoms
Interventions
Vermont Department of Health
MCH Strategic Plan: A Life Course Approach
Preconception
Pregnancy
Infancy / Early Childhood
School age / Adolescence
Adult
Evidence-Based Practice for Population Health
Data and Evaluation
Family-Centered Care
MCH Strategic PlanBy 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 GroupDecember 2013 MDWG Brainstorm
Existing resourcesGaps/BarriersOpportunities/Wish list
January 2014 Review of other State strategies February 2014 Needs Assessment (n = 191 responses!)
Screening, Diagnosis, Referral, and TreatmentKnowledge and comfortResources
March 2014 MDWG Recommended Strategies Summer 2014 Action Planning
Vermont Department of Health
Maternal Depression Work GroupAHS
Integrated Family ServicesDCF (CIS)DOCDMHDVHA/High-Risk PregnancyVDH (CO, WIC, and OLH)
Blue Cross/Blue Shield Cambridge Health CenterCounseling Service Addison Co. FAHC/Maternal Fetal Medicine
Howard CenterNorthwestern Medical Center/
Ob GynNurse Family PartnershipParentUVM/Department of Psychiatry VCHIPVermont Postpartum Task Force
Vermont Department of Health
Needs Assessment Survey
Scope of practice includes (%)
Of those whose scope of practice includes, % who
currentlyTalk with/educating about maternal depression 74.2 86.9
Screen for maternal depression 54.7 84.9
Diagnose maternal depression 29.1 89.1Refer for maternal depression services/resources 83.8 91.3
Treat maternal depression 30.7 89.6
Vermont Department of Health
Needs Assessment SurveyOf respondents, who’s scope of practice includes:
Somewhat (4) or Very (5)
Knowledgeable
Somewhat (4) or Very (5)
Comfortable
Screen for maternal depression 76.3 68.0Diagnose maternal depression 78.3 73.9Refer for maternal depression services/resources 70.3 68.5
Treat maternal depression 62.0 56.0
Vermont Department of Health
Do you currently screen for maternal depression using a validated tool? Percent
All respondents 26.2Of those who’s scope of practice includes screening 46.7
Proposed StrategiesHealth CareMental Health FinancingPublic Education
Vermont Department of Health
Health CareIncrease 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
FinancingUnderstand, support, and/or enhance payment systems
for maternal depression (IFS, Medicaid, private insurers).
Vermont Department of Health
Public EducationVermonters have access to comprehensive maternal
depression educational information and support and treatment options
Vermont Department of Health
Discussion questionsHow does CIS connect to these 4 areas ?What is your experience in your communities?How do we leverage existing resources?
Vermont Department of Health
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