1. Breena Holmes, MD MCH Director

2. 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

3. CIS and Maternal Depression Awareness Support Screening Referral Vermont Department of Health

4. 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

5. 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

6. 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

7. Impact Pregnancy Inadequate prenatal care Poor nutrition Increased rate of preterm birth Vermont Department of Health

8. Impact Infants and Toddlers Cognitive development Behavior Nutrition School Aged Children Cognitive development Behavior Nutrition Vermont Department of Health

9. Definitions/Continuum Prenatal Depression/Anxiety “Baby Blues” Postpartum Depression/Anxiety Postpartum Psychosis Vermont Department of Health

10. Handout/Continuum Incidence Risk Factors Signs/Symptoms Interventions Vermont Department of Health

11. 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

12. 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

13. 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

14. 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

15. Needs Assessment Survey Scope of practice includes (%) Of those whose scope of practice includes, % who currently Talk with/educating about maternal depression 74.286.9 Screen for maternal depression 54.784.9 Diagnose maternal depression 29.189.1 Refer for maternal depression services/resources 83.891.3 Treat maternal depression 30.789.6 Vermont Department of Health

16. 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 depression76.368.0 Diagnose maternal depression78.373.9 Refer for maternal depression services/resources 70.368.5 Treat maternal depression62.056.0 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

17. Proposed Strategies Health Care Mental Health Financing Public Education Vermont Department of Health

18. Health Care Increase capacity of Vermont’s providers to educate, screen, diagnose, refer, and treat maternal depression Vermont Department of Health

19. Mental Health A robust support and treatment referral network is available to primary care providers and social service providers. Vermont Department of Health

20. Financing Understand, support, and/or enhance payment systems for maternal depression (IFS, Medicaid, private insurers). Vermont Department of Health

21. Public Education Vermonters have access to comprehensive maternal depression educational information and support and treatment options Vermont Department of Health

22. 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

23. Be in Touch! Breena.holmes@state.vt.us Vermont Department of Health