The Impact of Maternal Depression During Pregnancy on Perinatal Outcomes
“ Creating a Perinatal Depression Information Network and Practice Observations from the Field”...
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Transcript of “ Creating a Perinatal Depression Information Network and Practice Observations from the Field”...
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“Creating a Perinatal Depression Information Network and
Practice Observations from the Field”Webcast
Thursday, September 17, 20093:00 – 4:30 pm (Eastern)
Sponsored by Health Resources and Services Administration Maternal and Child Health Bureau & CDC National Center on Birth Defects and Developmental Disabilities Prevention
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Disclosure Statement
CDC, our planners, and our presenters wish to disclose they have no financial interest or other relationships with the manufacturers of commercial products, suppliers of commercial services, or commercial supporters. Presentations will not include any discussion of the unlabeled use of a product or a product under investigational use.
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Learning Objectives
• Define Maternal/Perinatal Depression and its impact on the physical and mental health of women and families
• Describe the interventions used to address Maternal/Perinatal Depression• Describe the role of local health departments in addressing Maternal/Perinatal
Depression• Describe the development of a National Perinatal Depression Information Network• Identify at least two resources for local health departments to address Maternal
Depression and learn more about the National Perinatal Depression Information Network
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Continuing Medical Education (CME)This activity was planned and implemented in accordance with the Essential Areas and Policies of theAccreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the CDC,NACCHO, and CityMatCH. CDC is accredited by the ACCME to provide continuing medical education forPhysicians. The CDC designates this activity for a maximum of 1.5Category 1 credits toward the AMAPhysician's Recognition Award.Continuing Nursing Education (CNE)This activity for 1.5contact hours is provided by the CDC, which is accredited as a provider of continuingeducation in nursing by the American Nurses Credentialing Center's Commission on Accreditations.Continuing Education Contact Hours (CECH)The CDC is a designated provider of continuing education contact hours in health education by the NationalCommission for Health Education Credentialing, Inc. This program is a designated event to receive1.5Category 1 contact hours in health education. The CDC provider number is GA0082.Continuing Education Units (CEU)The CDC was reviewed and approved as an Authorized Provider by the International Association forContinuing Education and Training (IACET). The CDC will award .15CEUs to participants who successfullycomplete this program.
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If you are interested in receiving continuing education units:- Go to the CDC Training and Continuing Education Online at http://www.cdc.gov/tceonline. If you have not registered
as a participant, click on New Participant to create a user ID and password; otherwise click on Participant Login and login. You will need to enter the following verification code: NACCITYIPV1
- Once logged on to the CDC Training and Continuing Education Online website, you will be on the Participant Services page. Click on Search and Register. Use one of the 3 search options. Search for Course Number (EV1237) Click on View.
- Scroll down and click on the program title. Select the type of CE credit you would like to receive and then click on Submit. Three demographic questions will come up. Complete the questions and then Submit. A message will come up thanking you for registering for the course.
- If you have already completed the course you may choose to go right to the evaluation/posttest. Complete the evaluation/posttest and Submit. A record of your course completion and your CE certificate will be located in the Transcript and Certificate section of your record.
If you have any questions or problems please contact:CDC Training and Continuing Education Online 800-41TRAIN or 404-639-1292 or Email at [email protected]
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Franklin County Maternal Franklin County Maternal Depression InitiativeDepression Initiative
Grace Kolliesuah, MSW, LSWGrace Kolliesuah, MSW, LSWCaring For 2Caring For 2 Project Director Project Director
Columbus Public Health
CityMatCH Webinar
September 17, 2009
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Franklin County Maternal Depression Task Force Initiative
• Caring for 2 is a Federal Healthy Start Project and depression screening is one of its core service functions.
• High scores are referred to the Caring for 2 Social Worker who conducts additional assessments and follow-up for service
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Caring for 2 Depression Screening Process
• Edinburgh Postnatal Depression Scale (EPDS) is administered to all CF2 participants in the 3rd trimester and postpartum
Additional assessments tools used:♦ Antepartum Questionnaire (APQ)*
♦ Modified Fatigue Symptom Checklist**Norman A. Posner, MD, Rosalind R. Unterman, M.S.W., Karen N. Williams, Ph.D, and George H. Williams, Ph.D: Journal of
Reproductive
Medicine
*Elizabeth J. Corwin, Ph.D., MSN. Ohio State University
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Caring For 2 Findings, 2007
Score < 9
Score 10 - 12
Score > 13
Edinburgh Postpartum Screening
Moms screenedto date
124 63.6%
26 13.3%
45 23.1%
195 100.0%
Low Risk
Moderate Risk -Follow-up EPDS
High Risk -Possible Referral
Total
RISKCount Column %
2007 results analysis indicated 36% of mothers were at moderate to high risk for PPD
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Caring For 2 Findings, 2008
Score < 9
Score 10 - 12
Score > 13
Edinburgh Postpartum Screening
Moms screenedto date
Screening Through 2008 results analysis indicates no significant change at 35.9% of Cf2 mothers at moderate to high risk for PPD
207 64.1%
41 12.7%
75 23.2%
323 100.0%
Low Risk
Moderate Risk -Follow-up EPDS
Higher Risk -Possible Referral
Total
EdinburghDepressionScale Risk
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Community Problem-Solving
Cf2 Change Logic Model
African/African-American women in the Columbus Community experience adverse maternal health
outcomes
Establish organized Coalition
Sub-committees review, analyze, and report information about
potential needs in the committee
Coalition identifies issues that impact adverse
maternal health outcomes
Coalition reports to the community
Coalition brings attention to the issues
Coalition facilitates community problem-
solving
Coalition facilitates access to services
Increased access to quality services
Increased positive short-term outcomes
Increased positive long- term outcomes
Conditions Activities Outcomes and Impacts
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Franklin County Maternal Depression Task Force Initiative
• Organized June, 2007 and formed into the Franklin County Maternal Depression Task Force
• Charged to explore the mental health needs of pregnant and parenting women in our community and develop services to enhance the system of care.
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Maternal Depression Task Force Members(Community-based Health and Human Services Agencies)
• Catholic Social Services• Columbus Neighborhood Health Centers• Columbus Public Health• Council on Healthy
Mothers & Babies• Dublin Counseling Center• Mount Carmel Health
System
• Nationwide Children’s Hospital
• Northwest Counseling Services
• Ohio Department of Health
• OhioHealth• Ohio State University• OSU Medical Center• POEM, Inc.
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Maternal Depression Initiative
3-Pronged Approach:• Needs assessment – identify how mental health
system works and determine how women at-risk for depression are identified
• Resource assessment – assess availability of mental health services and identify gaps in services
• Strategic action identification – identify strategies to effectively educate on the severity of maternal depression and develop mental health system improvement plan
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Mental Health System Challenges/ Barriers
• Few mental health referral sources for PPD• Long delays in getting necessary services• Lack of resource awareness• Overburdened resources and long wait times• Fear of stigma• Continuity of care; lack of compliance with
treatment plan• Lack of cultural competency and bilingual
services• Low appointment show rates• Limited screenings• Lack of transportation
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Maternal Depression Task Force Committees
Developed 3 subcommittees
► Resource List
► Outreach, Education, and Awareness
► Wait Time Assessment
Ultimate goal was increased access to mental health services for mothers.
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Resource List Subcommittee
● Conducted survey of mental health providers - to assess specific PPD trainings, waiting list, access to service, payment method, interpreter services, etc
• Developed 2 service directories♦ Consumer version♦ Healthcare provider version
• Directories were distributed to healthcare providers- i.e. nurses, social workers, community health workers
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Front Page
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Directory outline
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Provider directory
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Provider directory
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Consumer directory
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Consumer directory
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Outreach, Education & Awareness
• Developed a PowerPoint education tool for healthcare professionals
• Organized 2 trainings in April and June, 2009
• Objectives:◊ discuss symptoms and occurrence of Perinatal Mood Disorders
(PMD)
◊ identify screening tools used to identify Maternal Depression
◊ list treatment options for PMD
◊ identify resources for PMD
• Approximately 124 people attended
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Wait Time Evaluation
• Baseline wait time assessment conducted by Social Work students in 2008
• Follow-up assessment conducted in Spring, 2009
• Additional assessments planned for 2010 after the distribution of the resource directories
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• PPD rates for program moms are not out of line with other estimates – in fact, they might be a bit higher
• Many moms have combinations of risk factors that cause or exacerbate depression◊ stress, lack of support, limited economic resources,
strained relationships, etc.
• Untreated depression complicates our efforts to help moms achieve good birth outcomes
Conclusion
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Conclusion
• Our local data were compelling that underscored the need for available community resources for screening and treating depression for high risk mothers
• Data highlight a critical community need for a mental/behavioral health partnership that responded quickly and effectively to maternal depression
• The Columbus Public Health provided crucial leadership role in group facilitation, coordination of intervention, and outcome evaluation
• Strategic community partnership can be effective to produce results
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Next Steps
• Establish/maintain contracted community partnership
• Upkeep and expansion of directory• Expand training with on site workshops-Grand
Rounds to service providers• Increase number of providers performing screening • Monitor wait times on an ongoing basis• Healthy Start Interconception Care Learning
collaborative is focused on maternal mental health
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Contact Information
Grace Kolliesuah, Caring For 2 Project DirectorColumbus Public Health
Karen Gray, Co-Chairperson-FCMDTFColumbus Public Health
Supported by Columbus Public Health’s Caring For 2 Healthy Start project H49MC00028 from the US department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau (Title V, Social Security Act)
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Developing a National Perinatal Depression Information Network
Sarah Gibbons
Public Affairs Manager
Family Planning Council, Philadelphia, PA
On behalf of:
Pennsylvania Perinatal Partnership (PPP)
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PPP
The Pennsylvania Perinatal Partnership represents the collaborative efforts of Pennsylvania’s Healthy Start Projects and Title V Maternal and Child Health (MCH) Programs.
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PPP Mission
To improve women’s and children’s health outcomes in Pennsylvania through:
–Education
–Advocacy
–Collaboration
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Issue
• Perinatal depression is the #1 complication of childbirth
• Affects as many as 1 in 7 pregnant women and new mothers
• If left untreated, this will affect both the woman and her baby’s health and cause disruption in the family
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Background
Since 2006, PPP has undertaken a multifaceted project on perinatal depression inPennsylvania to:• Increase screening• Improve access to care & care
coordination• Raise public awareness & consumer
knowledge• Advocate for systems changes
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Background
• Researched public awareness campaigns in other states and regions of the United States to examine and replicate model projects
• Goal was to develop recommendations for an effective campaign in Pennsylvania
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Background
• PPP held a statewide Perinatal Depression Summit in 2007
• Asked for recommendations to improve outcomes in Pennsylvania
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Discovery
No national perinatal depression information
network exists to provide a platform for
networking and information sharing among
states or to promote the adoption of best
practices and stimulate cross-state
collaborations
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Problem
• With limited funding, programs across the
country are looking for innovative
ways to tackle perinatal depression
• PPP’s project is one example
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Solution
Created a Perinatal Depression Information Network (PDIN):
• National initiative
• Web-based
• 15 month project
• July 2008-September 2009
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Funding
PDIN is a public-private undertaking supported with grants from:
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Spotlight on Local Resources
• Numerous perinatal depression web-based resources exist at the national level for consumers and professionals
• Few focus on local resources that can be easily replicated by others at a community level
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Purpose
To link professionals involved in model
perinatal depression projects with those
searching for cost effective and innovative
program ideas, including:
–Provider Resources–Materials for Women & Families–Medical Reimbursement–Legislation
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Audience
Web based platform for networking and
information sharing about perinatal
depression at the state or local level
among:
– Medical professionals– Program administrators– Advocates– Public policy makers– Funders
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Focus
All aspects of perinatal depression including:
• Public financing• Systems change• Policy information• Public awareness• Provider training• Research• Promotion of best practice models
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Activities
• Conducted in-depth interviews with state level Departments of Health, universities, doctors, and program administrators from all 50 states and Washington D.C.
• Formed a national advisory committee with members representing a broad range of professional expertise
• Designed a multi-tiered, interactive website
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Interviews
• Hour long phone interviews • Used an interview guide to collect data• Collected information on the following:
– Reason the state began its perinatal depression initiatives
– Detailed description of projects– Barriers and obstacles– Funding and reimbursement– Legislation– Focus areas to address in the future
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PDIN Expert Advisory Committee
1. Diana Cheng, MD, Baltimore, Maryland2. Ann Conway, MS, MPA, RN, Madison, Wisconsin3. Nurit Fishler, Salem, Oregon4. Lisa Kirshenbaum, Providence, Rhode Island5. Birdie Gunyon Meyer, RN, MA, CLC, Indianapolis, Indiana6. Laura Miller, MD, Chicago, Illinois7. Brian Shanahan, New York, New York8. Brian Stafford, MD, MPH, Denver, Colorado9. Katherine Stone, Atlanta, Georgia10. Rita Suri, MD, Los Angeles, California11. Gayle Whatley, Birmingham, Alabama12. Katherine Wisner, MD, MA, Pittsburgh, Pennsylvania13. Linda Worley, MD, Little Rock, Arkansas
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Coming soon to a computer near you…
www.PDInfoNetwork.org
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PDIN Website Features
1. Project promotion
2. Engaging in dialogue with others across the country
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PDIN Website Features
Project Promotion
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PDIN Website
Main Features:1. State by State Information2. Spotlight3. Research & Funding Opportunities4. Events5. About Us6. Contact Us7. Find Services8. Forum9. Search
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Search Capabilities
Users will be able to search for
information by:
1. State
2. Program
3. Keyword
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State Specific Pages
Project listings include:– Focus– Lead organization– Collaborators– Funding sources– Timeframe– Contact– Website – Hotline– Provider Resources– Materials for Women & Families– Medical Reimbursement– Legislation
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PDIN Project Listings
• Search process was in-depth, but not exhaustive
• Constantly adding & updating the website
• Interested in any state or local perinatal depression project to add as a resource on the PDIN website
• Submit your project to: [email protected]
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PDIN Website Features
Engaging in dialogue with others across the
country
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What About Consumers?
• Recognize that consumers will visit the PDIN website
• “Find Services” section will feature state specific websites and hotlines
• National websites will also be listed
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Barriers
• Collecting data from across the country has proved to be very challenging
• Ensuring that the information is accurate and up-to-date is a constant demand
• Must guarantee its future and find a permanent home at a well-known organization committed to perinatal depression issues
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Implications
• PDIN fills a major gap in sharing information and knowledge about this often neglected type of depression through cross state collaborations
• States will have the tools to more effectively and efficiently help women and their families get support, help, and treatment for perinatal depression
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Until then…
E-mail Sarah Gibbons at [email protected]
to:
• Join the Listserv
• Submit an event
• Submit a project
• For more information
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Questions?
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Thank you for your participation!
Please take a moment to submit the online evaluation form for this webcast using the link below:
http://www.zoomerang.com/Survey/?p=WEB229MCCBAWJN
To obtain continuing education credits, visit http://www.cdc.gov/tceonline
Please join us for the next EMCH Webcast, October 15, 2009, which will address healthy weight and the impact of the built environment.
Thank you. You may now disconnect.