- Email: [email protected]
4.4 A COMPREHENSIVE TREATMENT PROGRAM FOR PERINATAL MOOD AND ANXIETY DISORDERS: IMPLEMENTATION OF MOTHER–INFANT THERAPY GROUP
CLINICAL PERSPECTIVES 4.2 – 5.0
addresses early identification and treatment in an overlooked population— perinatal women with mental health issues. This innovation leads to more women receiving services and better outcomes for mothers, their children, and families.
PRE http://dx.doi.org/10.1016/j.jaac.2016.07.456
4.2 THE UNIVERSITY OF NEW MEXICO JOURNEYS CLINIC: AN INTEGRATED CARE APPROACH TO ADDRESSING MATERNAL MENTAL HEALTH NEEDS Anilla Del Fabbro, MD, Psychiatry, University of New Mexico, MSC 09 5030 1, University of New Mexico, Albuquerque, NM 87131 Objectives: The goal of this session is to look at how a system of care developed at a University Hospital setting through an initial collaboration between pediatrics, nursing, midwifery, and child psychiatry. Methods: An initiative to screen mothers of children 12 months, admitted to an inpatient pediatrics unit for depression with the Edinburgh Postnatal Depression Scale, resulted in a significant number of psychiatry consult requests, illustrating that there was a significant gap in services for these mothers. A perinatal psychiatric clinic was formed with one CAP in March, 2014. The clients (N ¼ 40) were assessed in the first 3 months. This has grown into a robust run by a CAP and a psychosomatic faculty attending. In addition, a half-day clinic has been embedded in the Women’s Health Clinic at the University Hospital. Results: The following actions are needed to improve the system of care for addressing depression in family units: 1) increased collaboration is needed among disciplines; and 2) improved screening is recommended for maternal depression, and timely intervention and prevention are warranted. Conclusions: Maternal depression is common. It can negatively impact children cognitively, emotionally, and behaviorally. As a result of this multidisciplinary collaboration and a concerted push by child psychiatry to adopt an integrative approach, early identification and treatment of perinatal women with mental health issues have been addressed, resulting in better outcomes for families.
INF http://dx.doi.org/10.1016/j.jaac.2016.07.457
4.3 THE HEART PROGRAM: INTEGRATED MENTAL HEALTH CARE IN AN ADOLESCENT OBSTETRIC AND TEEN-TOT MEDICAL HOME Celeste St. John-Larkin, MD, University of Colorado, and Children’s Hospital Colorado, 13123 E 16th Ave, Box B130, Aurora, CO 80045 Objectives: Pregnancy-related depression is a frequently occurring complication of pregnancy, and rates of depression and other mental health disorders occur at higher rates in adolescent mothers compared with adult mothers. This project describes screening and treatment for mental health disorders in an adolescent maternity and teen-tot medical home at a Children’s Hospital. Methods: The HEART (Healthy Expectations Adolescent Response Team) Program includes patients seen at the Colorado Adolescent Maternity Program (CAMP) and Young Mothers’ Clinic at Children’s Hospital Colorado (Aurora, CO, USA). This is a combined teen-tot clinic for adolescent mothers ages 13–22 years and their children. All patients were screened with the Edinburgh Postnatal Depression Scale and My Mood Monitor at two points during pregnancy and at postpartum and well-baby visits. Diagnosis, rates of surveillance by clinical social workers, and referrals to an integrated health psychologist and/or colocated psychiatrist were tracked. Results: From 2011 to 2014, 894 pregnant adolescents were enrolled in CAMP, and 885 patients were screened for mental health issues. Before HEART’s inception, 20 percent of patients were identified as having mood symptoms in the postpartum period. Successful referrals to community mental health facilities occurred in only 5 percent of identified patients. After the creation of HEART, 41 percent of patients were identified as needing mental health services. Nearly half of the identified patients (47 percent) engaged in mental health treatment with the psychologist. Of the patients who presented for mental health evaluation, 48.4 percent of patients were diagnosed with mood disorders, with 36.4 percent diagnosed with major depressive disorder; 27.9 percent had primary diagnoses of anxiety disorders,
J OURNAL OF THE AMERICAN ACADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 55 NUMBER 10S OCTOBER 2016
19.8 percent met criteria for an adjustment disorder, 1.6 percent had primary diagnoses of ADHD, and 0.8 percent had primary diagnoses of psychosis; 43.4 percent of patients met criteria for at least two disorders, and the most common comorbidity was PTSD and a mood disorder (21.3 percent). Conclusions: Our findings suggest that an embedded mental health program in an adolescent obstetric and pediatric medical home is successful in improving identification and engagement in mental health treatment. Access to universal screening, intensive social work and case management involvement, and ready access to onsite mental health care providers are key components.
INF http://dx.doi.org/10.1016/j.jaac.2016.07.458
4.4 A COMPREHENSIVE TREATMENT PROGRAM FOR PERINATAL MOOD AND ANXIETY DISORDERS: IMPLEMENTATION OF MOTHER–INFANT THERAPY GROUP Jennifer Paul, PhD, Psychiatry and Behavioral Sciences, Children’s Hospital Colorado, 13123 E 16th Ave, Box B130, Aurora, CO 80045 Objectives: Treatment programs addressing mother-infant relationship can improve outcomes for mothers, their infants, and mother-infant relationship for women experiencing perinatal mood and anxiety disorders (PMADs). In addition, medication is often a critical component of care for these women. Effectively implementing a program that targets all three points of intervention and offers medication evaluation/management in the perinatal period can be challenging in an outpatient children’s hospital. The feasibility and impact of implementing a PMADs dyadic treatment program (mother-infant therapy group, M-ITG) at this tertiary care children’s hospital were evaluated. Methods: Program feedback from 23 mothers was collected after completion of a 5-week series of individual therapeutic evaluations and an 11-week M-ITG. Mothers rated impact of program, including the extent to which treatment goals were achieved and changes experienced. Initial psychiatric evaluation, Edinburgh Postnatal Depression Scale (EPDS), and My Mood Monitor (M3) were completed on each patient. EPDS and M3 also were measured upon completion. Medications were prescribed as indicated and per mother’s preference after risks and benefits were discussed in detail. Results: Preliminary data indicate positive impact of intervention based on mother’s perceptions. Mothers (87 percent) rated all treatment goals (for self, baby, relationship with baby) as “completely achieved,” with the remainder rating these goals as “achieved to some extent.” Furthermore, mothers noted positive impact on feelings (about themselves ¼ 93 percent; about role as mother ¼ 100 percent; of competence in role as mother ¼ 100 percent); symptoms of depression (100 percent); and relationship with their child (increased enjoyment of being with child ¼ 87 percent; improved relationship ¼ 87 percent). Data also show decreases in mothers’ symptoms of depression over the course of the treatment intervention (pre-EPDS ¼ 16.7; post-EPDS ¼ 6). Data further indicate that 43 percent of patients entering the program were on medication, and 74 percent of patients were taking medications at end of program. Conclusions: M-ITG was implemented successfully in a psychiatric outpatient services setting at a tertiary care children’s hospital, with an impact on the mother, infant, and relationship between mother and infant. Medication may enhance a particular mother’s response to therapeutic interventions, especially when it is initiated before or early in the treatment.
INF http://dx.doi.org/10.1016/j.jaac.2016.07.459
CLINICAL PERSPECTIVES 5 CONCERTED CARE FOR FOSTER CHILDREN: RESULTS OF THE ANNE E. CASEY BRIDGING THE WAY HOME STUDY Glenn N. Saxe, MD, Child and Adolescent Psychiatry, NYU School of Medicine, One Park Avenue, 7th Floor, New York, NY 10016; Kimberly Hoagwood, PhD Objectives: The goal of this study is to present the results of one of the largest evaluations of an intervention model for children in foster care aimed
www.jaacap.org
S7
addresses early identification and treatment in an overlooked population— perinatal women with mental health issues. This innovation leads to more women receiving services and better outcomes for mothers, their children, and families.
PRE http://dx.doi.org/10.1016/j.jaac.2016.07.456
4.2 THE UNIVERSITY OF NEW MEXICO JOURNEYS CLINIC: AN INTEGRATED CARE APPROACH TO ADDRESSING MATERNAL MENTAL HEALTH NEEDS Anilla Del Fabbro, MD, Psychiatry, University of New Mexico, MSC 09 5030 1, University of New Mexico, Albuquerque, NM 87131 Objectives: The goal of this session is to look at how a system of care developed at a University Hospital setting through an initial collaboration between pediatrics, nursing, midwifery, and child psychiatry. Methods: An initiative to screen mothers of children 12 months, admitted to an inpatient pediatrics unit for depression with the Edinburgh Postnatal Depression Scale, resulted in a significant number of psychiatry consult requests, illustrating that there was a significant gap in services for these mothers. A perinatal psychiatric clinic was formed with one CAP in March, 2014. The clients (N ¼ 40) were assessed in the first 3 months. This has grown into a robust run by a CAP and a psychosomatic faculty attending. In addition, a half-day clinic has been embedded in the Women’s Health Clinic at the University Hospital. Results: The following actions are needed to improve the system of care for addressing depression in family units: 1) increased collaboration is needed among disciplines; and 2) improved screening is recommended for maternal depression, and timely intervention and prevention are warranted. Conclusions: Maternal depression is common. It can negatively impact children cognitively, emotionally, and behaviorally. As a result of this multidisciplinary collaboration and a concerted push by child psychiatry to adopt an integrative approach, early identification and treatment of perinatal women with mental health issues have been addressed, resulting in better outcomes for families.
INF http://dx.doi.org/10.1016/j.jaac.2016.07.457
4.3 THE HEART PROGRAM: INTEGRATED MENTAL HEALTH CARE IN AN ADOLESCENT OBSTETRIC AND TEEN-TOT MEDICAL HOME Celeste St. John-Larkin, MD, University of Colorado, and Children’s Hospital Colorado, 13123 E 16th Ave, Box B130, Aurora, CO 80045 Objectives: Pregnancy-related depression is a frequently occurring complication of pregnancy, and rates of depression and other mental health disorders occur at higher rates in adolescent mothers compared with adult mothers. This project describes screening and treatment for mental health disorders in an adolescent maternity and teen-tot medical home at a Children’s Hospital. Methods: The HEART (Healthy Expectations Adolescent Response Team) Program includes patients seen at the Colorado Adolescent Maternity Program (CAMP) and Young Mothers’ Clinic at Children’s Hospital Colorado (Aurora, CO, USA). This is a combined teen-tot clinic for adolescent mothers ages 13–22 years and their children. All patients were screened with the Edinburgh Postnatal Depression Scale and My Mood Monitor at two points during pregnancy and at postpartum and well-baby visits. Diagnosis, rates of surveillance by clinical social workers, and referrals to an integrated health psychologist and/or colocated psychiatrist were tracked. Results: From 2011 to 2014, 894 pregnant adolescents were enrolled in CAMP, and 885 patients were screened for mental health issues. Before HEART’s inception, 20 percent of patients were identified as having mood symptoms in the postpartum period. Successful referrals to community mental health facilities occurred in only 5 percent of identified patients. After the creation of HEART, 41 percent of patients were identified as needing mental health services. Nearly half of the identified patients (47 percent) engaged in mental health treatment with the psychologist. Of the patients who presented for mental health evaluation, 48.4 percent of patients were diagnosed with mood disorders, with 36.4 percent diagnosed with major depressive disorder; 27.9 percent had primary diagnoses of anxiety disorders,
J OURNAL OF THE AMERICAN ACADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 55 NUMBER 10S OCTOBER 2016
19.8 percent met criteria for an adjustment disorder, 1.6 percent had primary diagnoses of ADHD, and 0.8 percent had primary diagnoses of psychosis; 43.4 percent of patients met criteria for at least two disorders, and the most common comorbidity was PTSD and a mood disorder (21.3 percent). Conclusions: Our findings suggest that an embedded mental health program in an adolescent obstetric and pediatric medical home is successful in improving identification and engagement in mental health treatment. Access to universal screening, intensive social work and case management involvement, and ready access to onsite mental health care providers are key components.
INF http://dx.doi.org/10.1016/j.jaac.2016.07.458
4.4 A COMPREHENSIVE TREATMENT PROGRAM FOR PERINATAL MOOD AND ANXIETY DISORDERS: IMPLEMENTATION OF MOTHER–INFANT THERAPY GROUP Jennifer Paul, PhD, Psychiatry and Behavioral Sciences, Children’s Hospital Colorado, 13123 E 16th Ave, Box B130, Aurora, CO 80045 Objectives: Treatment programs addressing mother-infant relationship can improve outcomes for mothers, their infants, and mother-infant relationship for women experiencing perinatal mood and anxiety disorders (PMADs). In addition, medication is often a critical component of care for these women. Effectively implementing a program that targets all three points of intervention and offers medication evaluation/management in the perinatal period can be challenging in an outpatient children’s hospital. The feasibility and impact of implementing a PMADs dyadic treatment program (mother-infant therapy group, M-ITG) at this tertiary care children’s hospital were evaluated. Methods: Program feedback from 23 mothers was collected after completion of a 5-week series of individual therapeutic evaluations and an 11-week M-ITG. Mothers rated impact of program, including the extent to which treatment goals were achieved and changes experienced. Initial psychiatric evaluation, Edinburgh Postnatal Depression Scale (EPDS), and My Mood Monitor (M3) were completed on each patient. EPDS and M3 also were measured upon completion. Medications were prescribed as indicated and per mother’s preference after risks and benefits were discussed in detail. Results: Preliminary data indicate positive impact of intervention based on mother’s perceptions. Mothers (87 percent) rated all treatment goals (for self, baby, relationship with baby) as “completely achieved,” with the remainder rating these goals as “achieved to some extent.” Furthermore, mothers noted positive impact on feelings (about themselves ¼ 93 percent; about role as mother ¼ 100 percent; of competence in role as mother ¼ 100 percent); symptoms of depression (100 percent); and relationship with their child (increased enjoyment of being with child ¼ 87 percent; improved relationship ¼ 87 percent). Data also show decreases in mothers’ symptoms of depression over the course of the treatment intervention (pre-EPDS ¼ 16.7; post-EPDS ¼ 6). Data further indicate that 43 percent of patients entering the program were on medication, and 74 percent of patients were taking medications at end of program. Conclusions: M-ITG was implemented successfully in a psychiatric outpatient services setting at a tertiary care children’s hospital, with an impact on the mother, infant, and relationship between mother and infant. Medication may enhance a particular mother’s response to therapeutic interventions, especially when it is initiated before or early in the treatment.
INF http://dx.doi.org/10.1016/j.jaac.2016.07.459
CLINICAL PERSPECTIVES 5 CONCERTED CARE FOR FOSTER CHILDREN: RESULTS OF THE ANNE E. CASEY BRIDGING THE WAY HOME STUDY Glenn N. Saxe, MD, Child and Adolescent Psychiatry, NYU School of Medicine, One Park Avenue, 7th Floor, New York, NY 10016; Kimberly Hoagwood, PhD Objectives: The goal of this study is to present the results of one of the largest evaluations of an intervention model for children in foster care aimed
www.jaacap.org
S7