Tracey Wingold, LCSW

1. Working with Families with Perinatal Depression and Anxiety: Nurturing Families and Nurturing Yourself Tracey Wingold, LCSW Tracey Wingold, LCSW, LLC Online Mental Health Counseling (804) 316- 9694 traceywingold@itherapymail.com

2. Today’s Goal is Twofold 1) Overview of perinatal mental health • Prevalence, risk, symptoms • Role of home visitor • Screening and referral – brief overview 2) Self care for providers (YOU!) • Compassion Fatigue • Self-care checklist and discussion

3. SOME QUICK FACTS • PMADS (Perinatal Mood and Anxiety Disorders) are caused by a combination of biomedical, internal, and external factors • Moms are more at risk if they have a personal or family history, had a traumatic pregnancy or birth, or have little social support • PMADs don’t always look like depression! (Anxiety and even rage are very common.) • PMADs are COMMON and TREATABLE!

4. Disclaimers • Information from this presentation came from a variety of sources. Credit goes to Postpartum Support Virginia, for providing some of the slides, information, and handout • Additional information was obtained from The Seleni Institute, an organization that provides training for professionals around perinatal mental health. • Other sources are noted within the presentation. • The self-care checklist is being used with permission. It comes from Therapistaid.com

5. ANXIETY and DEPRESSION

6. Anxiety and/or depression affect up to 1 in 5new or expectant mothers

7. Risks of Untreated PMADs PREGNANCY Pregnant women experiencing PMADs are more likely to have poor health habits poor prenatal care substance abuse Increased risk of negative birth outcomes pre-term labor premature delivery (<37 weeks) low birth weight small head circumference low APGAR scores NICU admissions POSTPARTUM • Depressed mothers are more likely to have • fewer positive interactions with their babies • decreased response to cues • breastfeeding issues • Increased risk for children to experience • cognitive/developmental delays • emotional/behavioral problems • substance abuse • psychiatric disorders

8. Suicide • Although still very rare, suicide is a leading cause of death among women of childbearing age (CDC) • One recent study in Canada found that most suicides occurred between 9-12 months postpartum. Sources: https://www.cdc.gov/nchs/data/hestat/suicide/rates_1999_2014.htm https://www.seleni.org/advice-support/2018/3/16/what-we-can-do-to-prevent-maternal-suicide

9. PMADS and Minority Families • African American and Latina families are at higher risk of experiencing PMADs. • Factors include higher incidences of poverty, violence in relationships, single parenthood, and trauma history, which are all risk factors for PMADs. • Healthcare disparities and discrimination in healthcare can also cause PMADs to be missed due to lack of screening • One study found that AA women describe depression more through physical symptoms Source: https://www.seleni.org/advice-support/2018/3/16/pmads-such-as-ppd-and-anxiety-in-african-american-moms?rq=minorities

10. WHAT YOU MIGHT OBSERVE Overwhelmed Guilty Miserable Sad Anxious Angry Irritable Increased sensitivity Poor concentration Tired but cannot sleep Intrusive thoughts Panic attacks Physical Symptoms Lack of attachment to baby

11. WHAT IS YOUR ROLE? Home visitors have a unique opportunity to assist moms who are struggling, because of your proximity to the family. You have the opportunity to • Observe the signs • Educate (“You are not alone, you are not to blame, with help you will get well.”) • Screen (using the EPDS or other screening tool) • Refer for more help (OB, therapist, psychiatrist, support group) • Provide Support (Listen, validate)

12. WHAT A HOME VISITOR’S ROLE IS NOT Home visitors do not • Diagnose • Provide therapy • Give medical advice (some exception for nurses!)

13. What Can You Do? SUPPORT • Listen actively and without judgement • Encourage her; point out her strengths and efforts • Engage her social support system • Encourage, and help her plan for, her own self-care (eating, sleeping, exercise, time off)

14. What Should I Say and Do? ASK How are you feeling about being a new mother? How are you coping with the additional stress of a new baby? Are you able to sleep when the baby is sleeping? How is your appetite? Do you have enough energy to do the things you need to do? Do you find yourself crying a lot / all the time? Are you having any thoughts at are scaringyou? SHARE FACT SHEETS INFORMATION CARDS PATH TO WELLNESS PSVA WEBSITE SUPPORT GROUPS SAY Validate: I’m sorry you are having a tough time. Normalize: Lots of new moms have these feelings. Offer hope: You are going to get well.

15. Screening • Edinburgh Postnatal Depression Scale • Since 1987, FREE • 10 questions • Depression & anxiety • Question #10 • When • During pregnancy • At delivery • First year postpartum • Anxiety /depression are so common that we should screen all new / expectant mothers

16. Treatment Options Self-Care Social Support Talk Therapy Medication Hospitalization Easy Cheap More Involved More Expensive

17. Self Care EXERCISE Light exercise, Outdoors Vitamin D + fresh air + change of scenery + endorphins SLEEP 4-5 hours uninterrupted Women need to recover from physical & emotional effects of pregnancy & childbirth EAT Every time baby eats High protein Calories for breastfeeding TIME OFF No other job is so challenging 24/7 Keeping another person alive Mothering the mother 17

18. Resources Postpartum Support Int’l postpartum.net Postpartum Progress postpartumprogress.com MGH Center for Women’s Mental Health www.womensmentalhealth.org Postpartum Support Virginia Support for mothers and families • One-on-one support via phone / email • 20 FREE peer-led support groups • Facebook page Resources and information • Books, websites, doulas • 160+ Mental health professionals Outreach and education • Information cards, Fact Sheets, posters • Volunteer training sessions • Information and education sessions www.postpartumva.org Books by Karen Kleiman. This Isn’t What I Expected: Overcoming Postpartum Depression

19. THE POWER OF REFERRAL • Know your community providers (therapists, prescribers, support groups). • Provide a WARM HANDOFF if possible. • FOLLOW UP to be sure that care is initiated. • Be mindful of confidentiality.

20. NOW, What About YOU?

21. Compassion Fatigue and Self-Care Compassion Fatigue is a state experienced by those helping people in distress.  It is an extreme devotion to those being helped to the degree it can cause a secondary traumatic stress for the helper. Self-careis any activity that we do deliberately in order to take care of our mental, emotional, and physical health.  • Source: https://psychcentral.com/blog/what-self-care-is-and-what-it-isnt-2/?ref=sssorganicgglunkwn&prid=sbseogglunkwn

22. Managing Compassion Fatigue Develop Compassion Resilience! Rediscover that life is larger than the immediate situation, no matter how important it is.  • Restart activities that you may have stopped doing as work demands intensified. • Try something different. • Talk about your feelings and needs with a professional, or a trusted friend or family member. • Take a vacation! • Remember that compassion begins with YOURSELF! * Source – the Konterra Group Knowledge Library, http://www.konterragroup.net/compassion-fatigue-natural-happens-real/

23. Self Care Checklist Self-inventory and goals

24. Closing Thoughts • Pregnancy and postpartum is often the first time a woman deals with mental illness. • Women experiencing PMADs often feel like they are “crazy.” • Dads / partners can also experience PMADs • Mothers, babies, families can recover, and most often do, with help and support. • This work is hard for you too! It’s important to take care of yourself in order to be effective and stay healthy.

25. The Puzzle Pieces Family Lifeline Staff: • Parent Educator Ashley Davis • Program Manager Andrew Napoli • Clinical Social Worker Rebecca Lowe

26. Questions? Thank you!!