Improving Partnerships to Address Maternal Depression

1. Improving Partnerships to Address Maternal Depression Kenya McDuffy, BSW, MSM Case Management Coordinator Indianapolis Healthy Start

2. Indianapolis Healthy Start Stress Reduction TeamAKA“No More Drama Club”

3. Background • In October 2008 a contractual agreement was established between Indianapolis Healthy Start (IHS) and Family Enrichment Center, a local mental health provider, to help increase the number of IHS program participants receiving and completing referrals for mental health care. • IHS uses the Edinburgh Postnatal Depression Scale (EPDS) to screen for depression. IHS protocol for depression screening requires that every Indianapolis Healthy Start program participant receive a minimum of two (2) depression screenings: one baseline screening while pregnant and one postpartum. • IHS program participants are referred for assessment and treatment of depression when scoring positive (12+) for depression on the EPDS tool.

4. Maternal Depression/Mental Illness • “Maternal depression, alone, or in combination with other risks, can pose serious but typically unrecognized barriers to healthy early development and school readiness, particularly for low-income young children (1).” • “Physiology aside, studies have found that mental illness can affect a mother’s functional status, her ability to obtain prenatal care, and her ability to avoid unhealthy behavior. Women suffering from depression are more likely to smoke or use alcohol or other substances, which may confound pregnancy outcome(3).”

5. Maternal Depression & Fetal/Obstetrical Outcomes • Untreated depression/anxiety can have negative fetal/obstetrical and neonatal outcomes. The impact of the symptoms of depression and anxiety can cause risk to the mother and also have a negative effect on child development(4).” • Spontaneous early labor/preterm delivery • Lower birth weight; fetal distress • Decreased fetal growth • Increased risk for spontaneous abortion

6. Objectives • Increase the number of clients completing a referral to mental health services. • Thorough assessment and treatment of psychiatric diagnosis in individual sessions. • Expose clients to a positive experience with mental health care services. • Assist clients in the development of coping skills. • Build a sense of community with peers in a group setting.

7. Method and Design: • A contract was established between IHS and Family Enrichment Center for the provision of group and individual mental health services. A Stress Reduction support group was implemented. • The group was intentionally held in a non-traditional group care setting and participants were given personal invitations by their case manager to attend. • The Family Enrichment Center therapist facilitated the groups and Case Managers followed up with clients to assure that services were received.

8. Method and Designcont… • The therapist was able to build rapport with participants and later convince those in need of further assessments to begin individual counseling sessions.

9. Results: • Between 2007 and 2009 an average 25% of IHS clients annually were given a referral for further assessment or treatment for depression. • Initial referral completion rates in 2007 lingered at 66%. • During the 3rd quarter in 2008, IHS began offering the stress reduction group as an alternative to traditional treatment for depression. • By December 2009, IHS saw a 26% increase in the number of clients completing a referral for further evaluation of and treatment of depression.

10. Improved Referral completion rates

11. Successes • Clients who suffered from clinical depression or other DSM-IV psychiatric diagnosis were referred for services. • Majority of clients completed self-sufficiency related goals. • Some family sessions were provided.

12. Challenges • Transportation • Indianapolis Healthy Start provided door-to-door transportation by way of taxi. • Medicaid cabs were used to off set some the cost. • Insurance • Medicaid was billed if client had active insurance. • Childcare not available on-site.

13. References: 1. Reducing Maternal Depression and Its Impact on Young Children Toward a Responsive Early Childhood Policy Framework Authors: Jane Knitzer, Suzanne Theberge, and Kay Johnson Publication Date: January 2008 2. Bonari, Lori; Pinto, Natasha; Ahn, Eric; Einarson, Adrienne; Steiner, Meir; Koren, Gideon. 2004. Perinatal Risks of Untreated Depression During Pregnancy. Canadian Journal of Psychiatry 49 (11):726-735. 3. Zuckerman B, Amaro H, Bauchner H, Cabral H. Depressive symptoms during pregnancy: relationship to poor health behaviors. Am J ObstetGynecol1989;160:1107–11. 4. ACOG Committee on Practice Bulletins--Obstetrics. ACOG Practice Bulletin No. 92: Use of psychiatric medications during pregnancy and lactation. ObstetGynecol 2008;111(4):1001-20.

14. Questions? Contact Information: Kenya McDuffy Email: dmcduffy@hhcorp.org (317) 221-3336