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 PreconceptionPregnancy Infancy / Early Childhood School age / Adolescence Adult Evidence-Based Practice for Population Health Data and Evaluation Family-Centered Care

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 2013MDWG Brainstorm Existing resources Gaps/Barriers Opportunities/Wish list January 2014Review of other State strategies February 2014Needs Assessment (n = 191 responses!) Screening, Diagnosis, Referral, and Treatment Knowledge and comfort Resources March 2014MDWG Recommended Strategies Summer 2014Action 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 Screen for maternal depression Diagnose maternal depression Refer for maternal depression services/resources Treat maternal depression Vermont Department of Health

Needs Assessment Survey Of respondents, who’s scope of practice includes: Somewhat (4) or Very (5) Knowledgeable Somewhat (4) or Very (5) Comfortable Screen for maternal depression Diagnose maternal depression Refer for maternal depression services/resources Treat maternal depression Vermont Department of Health Do you currently screen for maternal depression using a validated tool? Percent All respondents 26.2 Of those who’s scope of practice includes screening 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! Vermont Department of Health