Parental Depression Screening

One Community’s Approach

Catherine McDowell, MS Project Manager Coos Coalition for Young Children and FamiliesCharles Cotton, LICSW Area Director Northern Human Services

Goals for this workshop-Provide research/ background on the effects of

parental depression and the importance of creating a coordinated system for maternal depression screening that continues beyond the post partum period

Describe issues faced in creating a broader, community based maternal depression plan

Identify potential strategies and tools for a maternal depression screening at well child visits

Create an opportunity for participants to discuss plans for maternal depression screening at the local or statewide level

Workshop AgendaWho are “we” and Why are we concerned

about parental depression?

What are we trying to do in Coos?

What can you do to promote expanded/coordinated maternal depression screening at the community or state level?

Coos Coalition Background2009 Neil and Louise Tillotson Fund makes a

5 year investment in early childhood development strategies in Coos County

Mental health, family support, childcare programs, schools and health care centers identify early childhood goals and strategies for Coos

Shared focus area-optimal social and emotional development for children birth through 5 in Coos and the surrounding communities.

What do we believe?Parents want to be good parents and are

doing the best they canParents will be more effective when

provides supportSupporting the healthy development of

children is everybody’s jobSmall changes today will produce far

greater changes tomorrowWe are most effective when we work

together

Outcome #1 with IndicatorsAll children birth-5 and their families will have screening

programs in place to support healthy social and emotional development in Coos County.

Indicators for Maternal Depression:Percent of mothers who receive evidence-based screening for

maternal depression using a standardized tool Percent of mothers identified with depressive symptoms who

receive referral and treatment, if indicated Indicator for healthy social and emotional development of the

child:Percent of children 0-5 receiving ASQ and ASQ-SE screening at

least once a yearPercent of children referred for further assessment and

treatment, if indicated

Mental Illness

PrevalenceOne in four of US will experience mental

illnessOne in ten of US will experience severe mental

illness

Onset½ of lifetime mental illness will start by 14 yo¾ of lifetime mental illness will develop by 24

yo

Importance of maternal depression

Depression is the second major reason (after childbirth) for hospitalization of women in the U.S.

Infants living in neglectful environment exhibit MRI visible changes to frontal lobe as well as lasting changes in brain chemistry.

Maternal depression impacts bonding, attachment, school readiness, and complete range of development – emotional, social, intellectual / cognitive, language, physical.

DepressionSYMPTOMS

Depressed mood, feeling downDecreased interest / pleasureSleep disturbanceEating / appetite disturbanceFeeling bad about selfTrouble concentratingFatiguePsychomotor agitation or retardationThoughts of death / suicide

Incidence of depression Mood disorders vs. transient symptoms

“Baby Blues” – 50-80% of all mothers will experience

Clinical depression@ 7% of all adults will experience @ 13% of women20% of women will experience clinical depression

in their lifetime13-20% of mothers will experience post birth.

When is the risk greatest? Rates for “minor” depression peak 2-3 months

postpartum

High risk for first 6 months post partum

Major depression rates peak 6 weeks postpartum

Parental depression is not just a postpartum condition

Up to 50% of children of depressed parents will also experience depression

Who is at highest risk for depression? Women in childbearing years – At least

33% experience symptoms of depression Mothers with less income (prevalence

doubled), and / or less education 40-60% of parenting teens / low income

mothers experience depressive symptoms When mothers experience postpartum

depression, 25-50% of fathers also depressed

Treatment BarriersMost people who need treatment do not access care (Up to 70%)Awareness / KnowledgeAccess to mental health professionals

ExpenseCulturalStigma

Screening Tools Screening vs. Diagnostic Tools

PHQ-2

During past two weeks how often have you been bothered by; Little interest or pleasure in doing things Feeling down, depressed or hopeless

Not at all (0) - several days (1) - more than ½ (2) - nearly every day (3)

PHQ-9

Edinburgh

What we are trying to do In Coos Focus on well child visits-Issues and Recommendations

Joint planning with Health Care Providers and Home visiting programs

Referral Process

Maternal Depression impacts bonding, attachment, school readiness and a complete range of emotional/social, intellectual/cognitive, language and physical development

Well child visits provide an ideal opportunity for screening for maternal depression, but there are challenges as well-

What Are We Trying To Do?

Referrals for mental health servicesOpportunity for education, validation, empowermentListen / assess – Especially suicide riskProvide options / choicesSystemic barriers

StigmaAdjustments to referral process Eligibility for “State Supported” mental health services

Leveraging of Infant Mental Health resources Prioritization for treatment accessFunding / Reimbursement Questions

Goal is to have all pediatric care providers in Coos : Receive training on the prevalence of maternal

depression beyond the post partum period and the effect of maternal depression on the development of a young child

Screen for maternal depression during at least two well child visits in the child’s first year of life and then at well child visits after that

Use the PHQ-2 screening toolEmbed the PHQ-2 in their EMREstablish a clear referral relationship for maternal

depression with Northern Human ServicesConsider additional maternal depression screening

in other well child visits up to the child age of three

What can YOU do? How can we incorporate parental depression screening into the policy and practice of early childhood development

programs?What kind of training/public

awareness is needed?Who are the leaders for this effort?What are 3 things we can agree on

today to move this forward?