supporting women with symptoms of perinatal depression

1. Supporting Women with Symptoms of Perinatal Depression Pennsylvania-HRSA Grantee The Pennsylvania Perinatal Partnership August 7, 2007

2. Pennsylvania Perinatal Partnership (PPP) Is an authentic partnership between Healthy Start and Title V that emanated from member commitment and not simply in response to financial or regulatory requirements The mission of the PPP is to improve perinatal health outcomes in Pennsylvania through collaboration, intervention, joint strategies and advocacy.

3. Pennsylvania Perinatal Partnership (PPP) Participants include representatives from the six (6) PA Healthy Start projects, Medicaid (Healthy Beginnings Plus), County/Municipal Health Departments and the State Health Department, Bureau of Family and Maternal & Child Health Nurse Consultants.

4. Purpose To discuss the reasons for and the outcomes of a series three(3) trainings on Dialectical Behavior Therapy (DBT) skills that were conducted with home visiting staff.

5. Objectives To enhance Maternal and Child Health staff�s skills in addressing anxiety, stress and depression in pregnant and postpartum women To provide a condensed version of an original DBT training in order to reach larger numbers of MCH staff throughout PA, and determine if outcomes could be replicated.

6. Learning Objectives Learn about the DBT skills taught to the employees Learn the value of training workers in DBT skills Understand the connection between stress and poor birth outcomes

7. Why DBT skills? Healthy Start workers had expressed the feeling that they were not equipped with the skills they needed to help participants make the changes they thought would be beneficial. These feeling can cause stress and frustration in the workers as well as the participants.

8. Why DBT skills? Stress is a risk factor for employee burnout and also has been shown to have adverse effects on fetuses and infants.

9. Why DBT skills? DBT was developed for use with people who have been diagnosed with borderline personality disorder. Some of the same symptoms of this disorder are present in a large part of our population.

10. What is Dialectical Behavior Therapy? A modification of cognitive behavior therapy developed by Marsha Linehan in her work with people with borderline personality disorder. For those who suffer from suicidal ideation and attempts, self-cutting, depression, bipolar disorder, PTSD, anxiety, and drug and alcohol problems.

11. What is Dialectical Behavior Therapy? DBT is an empirically supported treatment; that is, it has been researched in clinical trials.

12. Basic Principle: �You have to do better before you feel better (not vice versa). Help participant get active in solving her/his day-to-day problems even though she/he may feel down or depressed.�

13. How long was the training? A two-day interactive training combined instruction, case studies , and role play. A follow-up training session was delivered 8 weeks later.

14. Who received the training? Over 100 Maternal and Child Health (MCH) staff participated. Attendees of these trainings consisted of PA Healthy Start projects, Title V MCH and Family Planning organizations PPP members and other organizations in Pennsylvania.

15. What are the skills sets taught to the employees? Behavior analysis Core mindfulness Interpersonal effectiveness Emotion modulation Distress tolerance

16. Behavior Analysis Do a careful assessment of what exactly the problem is and the steps leading up to it using the Behavioral Chain Analysis. Use solution analysis strategies-generate, evaluate and choose a solution Get a commitment to action Staff�s role is teacher and coach

17. Core Mindfulness The practice whereby a person is intentionally aware of his or her thoughts and actions in the present moment, non-judgmentally. Mindfulness is applied to both bodily actions and the mind�s own thoughts and feelings.

18. Interpersonal Effectiveness Includes effective strategies for asking for what one needs, saying no, and coping with interpersonal conflict. The skills taught are intended to maximize the chances that a person�s goals in a specific situation will be met, while at the same time not damaging either the relationship or the person�s self-respect.

19. Distress Tolerance Accepting life as it is in the moment Experiencing, tolerating, and accepting emotional pain are the ways to reduce pain Important for workers to have the ability to tolerate their own emotional distress in response to participants. Helps to reduce your own sense of emotional exhaustion and burnout of working with a group who are chronically stressed.

20. Consequences of maternal stress and depression �Depression is not a benign state,� said Katherine L. Wisner, M.D., M.S., Director Women�s Behavioral HealthCARE, Professor of Psychiatry, Obstetrics and Gynecology and Reproductive Sciences, and Epidemiology Western Psychiatric Institute and Clinic �I think of depression itself as a kind of toxic exposure.�

21. Consequences of maternal stress and depression Infant security was lower when maternal depression was higher (Coyle et al, Feb. 2002) Maternal depressive symptoms in a sample of African-American women were independently associated with spontaneous preterm birth. (Orr et al, 2002)

22. Consequences of maternal stress and depression Neonates born to mothers reporting prenatal depression spent more time fussing and crying and exhibited more stress behaviors than neonates born to non-depressed mothers or to mothers exhibiting symptoms of depression only during the postpartum Assessment (Diego et al, June 2005).

23. Our workers have skill sets just from experience Our staff has a difficult job and do not see enough progress to be encouraged

24. Outcomes: What the trainers learned Our workers deal with a very different population than the trainers do. The trainers were surprised at the myriad of issues that affect our participants. What it�s like to bring theory down from the �Ivory Tower�

25. Outcomes: What the staff learned Skills that they could not only teach to their participants but also to use themselves How to help the participants recognize and prioritize their problems Lowering their stress level would affect the participants� stress level

26. Distress Tolerance Accepting life as it is in the moment Experiencing, tolerating, and accepting emotional pain are the ways to reduce pain Important for workers to have the ability to tolerate their own emotional distress in response to participants Helps to reduce you own sense of emotional exhaustion and burnout of working with a group who are chronically stressed.

27. Dialectical Behavioral Therapy skills can be used in non-clinical settings for the benefit of participants as well as workers.

28. THANK YOU!!