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Perinatal Depression Screening and Intervention A Protocol for the Prenatal Plus Program

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Title: Perinatal Depression Screening and Intervention A Protocol for the Prenatal Plus Program


1
Perinatal Depression Screening and InterventionA
Protocol for the Prenatal Plus Program
  • Healthy Women Healthy Babies Roundtable
  • Tuesday, September 29th, 2009

2
Postpartum Depression
  • Baby Blues
  • up to 2 weeks after birth
  • clears up without treatment
  • prevalence could be as high as 80
  • Postpartum Depression (PPD)
  • clinical depression, requires treatment
  • occurs within the first year after birth
  • prevalence estimated at 10-20
  • Postpartum Psychosis
  • dangerous to mother and child
  • Exceedingly rare .01 or 1 in 1000 women

3
Why Should We Care?
  • PPD is one of the most common complications of
    childbirth, but it can be treated successfully
  • Impact on the mother
  • depressed mood, guilt, anxiety, irritability,
    insomnia, loss of interest and pleasure,
    tearfulness, sadness, anger, thoughts of harming
    oneself or infant
  • Impact on the child and family
  • Decreases mothers caregiver capacity
  • Studies show increase in childs risk for
  • Social/emotional problems
  • Cognitive and linguistic delays
  • Poor self-control, aggression, relationship
    problems
  • Difficulty in school as older children

4
Purpose of Intervention
  • To begin addressing the issue by identifying,
    educating and facilitating treatment for women at
    highest risk for perinatal depression
  • Ultimate goal is to reduce the prevalence and
    duration of this serious mental health issue

5
Prenatal Plus Overview
  • Since 1996 the Prenatal Plus Program has provided
    case management services to Medicaid-eligible
    pregnant women in Colorado at high risk of
    delivering a low birthweight infant
  • Services are provided throughout pregnancy and up
    to 2 months postpartum by a care coordinator,
    mental health professional and dietitian
  • In July 2008, program added depression screening
    protocol requirement

6
2008 Prenatal Plus Demographics
  • 86 are single
  • 41 have less than 12 years of education
  • 33 are teenagers (age lt 18)
  • 23 have a history of child abuse
  • 22 have a history of, or are currently
    experiencing, domestic violence
  • 25 have 4 or more High Life Stress indicators
  • 42 have a history of, or a current, psychiatric
    diagnosis (including depression)

Source Prenatal Plus Program Data, 2008
7
Intervention Background
  • Protocol developed in collaboration with state
    and local health department staff, including
    mental health professionals
  • 6-month pilot at Tri-County Health Department
  • Protocol, materials and data collection were
    revised
  • Implemented in July 2008 in all 21 Prenatal Plus
    agencies across Colorado

8
Intervention Preparation
  • Increase skill in staff to provide perinatal
    depression education to clients and to identify,
    screen, refer and provide brief counseling to
    women
  • Increase community awareness of Prenatal Plus and
    client mental health needs
  • Improve capacity of community resources to treat
    perinatal depression effectively

9
PDSI Resource Manual
10
Short Term Intervention Outcomes
  • Increase womans knowledge of Perinatal
    Depression
  • Increase her awareness of resources
  • Increase her motivation and self-efficacy to seek
    help
  • Decrease sense of helplessness and despair

11
Intervention Protocol
12
The Pathway
  • Three screening periods
  • Initial Assessment (within 4 weeks)
  • Third Trimester (28-32 weeks)
  • Postpartum (2-6 weeks after delivery)

13
Initial Screen at Intake
  • Clients asked at initial encounter Over the
    past month, how often have you been bothered by
    any of the following problems?
  • Little interest in doing things
  • Feeling down, depressed or hopeless

14
Scoring Initial Screen
  • Positive Some of the time, Most of the time
    or All of the time for either question ?
    complete an Edinburgh Screen
  • Negative Not at all for both ? wait until
    28-32 weeks to screen again

15
Third Trimester and Postpartum Screen
  • Third Trimester 28-32 weeks
  • Postpartum 2-6 weeks
  • The Edinburgh Postnatal Depression Scale (EPDS)
    is administered to all women in the program,
    regardless of previous responses at intake

16
The Edinburgh Postnatal Depression Scale
  • Simple 10 item scale
  • Designed to screen for depression in women during
    childbearing years
  • Does not evaluate physical signs of depression
    such as sleep difficulties since these symptoms
    can also be associated with pregnancy and newborn
    care
  • Does not replace clinical judgment the scale
    does not detect moms with anxiety neuroses,
    phobias or personality disorders.

17
Using the EPDS
  • Answers based on previous 7 days
  • All ten items must be completed
  • Avoid discussion of answers with others
  • The woman completes the scale herself, unless she
    has limited English or difficulty reading
  • Each question is scored on a scale of 0, 1, 2 or
    3 for each response

18
Interpreting the Scores
  • A score of 10 or greater is positive and
    indicates a likelihood of depression. If under
    12, provider follows protocol for a Medium
    Score (10-12).
  • A score of 13 or greater is positive and
    indicates a very high likelihood of depression.
    Provider follows protocol for High Score (13).

19
Question 10
The thought of harming myself has occurred to
me Yes, quite often Hardly Sometimes Never
  • If the woman answers anything other than Never
    on question 10, the provider must clarify any
    suicidal or homicidal thought or intent and refer
    appropriately

20
Evaluation Tools
  • Data Collection
  • women educated
  • women screened/ screened
  • referred to treatment
  • entering treatment (if known)
  • Type of additional support provided
  • Client Exit Survey

21
Conclusion
  • To increase identification and treatment of
    perinatal depression
  • Conduct regular and universal screening
  • Provide appropriate education, resources and
    referrals
  • Facilitate treatment and offer follow-up
  • For ALL women throughout pregnancy and
    postpartum.

22
Resources for Perinatal Depression
  • Womens Health Perinatal Depression Website
  • http//www.cdphe.state.co.us/pp/womens/ppd/index.
    html

23
Thank You!
  • Mandy McCulloch
  • Prenatal Program Director
  • mandy.mcculloch_at_state.co.us
  • 303-692-2495
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