One Community’s Approach Catherine McDowell, MS Project Manager Coos Coalition for Young Children and Families Charles 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 Agenda Who 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 Background 2009 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 can Parents will be more effective when provides support Supporting the healthy development of children is everybody’s job Small changes today will produce far greater changes tomorrow We are most effective when we work together

Outcome #1 with Indicators All 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 year Percent of children referred for further assessment and treatment, if indicated

Mental Illness  Prevalence  One in four of US will experience mental illness  One in ten of US will experience severe mental illness  Onset  ½ of lifetime mental illness will start by 14 yo  ¾ 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.

Depression SYMPTOMS Depressed mood, feeling down Decreased interest / pleasure Sleep disturbance Eating / appetite disturbance Feeling bad about self Trouble concentrating Fatigue Psychomotor agitation or retardation Thoughts 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 women  20% of women will experience clinical depression in their lifetime  13-20% 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 Barriers Most people who need treatment do not access care (Up to 70%)  Awareness / Knowledge  Access to mental health professionals  Expense  Cultural  Stigma

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 services Opportunity for education, validation, empowerment Listen / assess – Especially suicide risk Provide options / choices Systemic barriers  Stigma  Adjustments to referral process  Eligibility for “State Supported” mental health services Leveraging of Infant Mental Health resources Prioritization for treatment access Funding / 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 tool Embed the PHQ-2 in their EMR Establish a clear referral relationship for maternal depression with Northern Human Services Consider 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?