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RIVERSIDE COUNTY S.M.I.L.E SUPPORTING MOTHERS IN LIFE’S EMOTIONS PREGNANT AND POSTPARTUM SUPPORT PROGRAM FOR WOMEN WITH PERINATAL MOOD AND ANXIETY DISORDERS Amy Larsen, RN, PHN, MSN, IBCLC Certified by Postpartum Support International in Perinatal Mood and Anxiety Disorders Conflict of Interest • Nothing to disclose Perinatal Mood and Anxiety Disorders • Perinatal = pregnancy and up to 1 year postpartum • • • • • Depression Anxiety Obsessive Compulsive Disorder (OCD) Post-Traumatic Stress Disorder Postpartum Psychosis (Postpartum Support International) Perinatal Depression (PPD) is the #1 common complication of childbearing 10-20% (no history of PPD) 50-70% (with history of 1 episode of PPD) 70-90% (with history of 2 or more episodes) Gjerdingen D et al J Am Board Fam Med 22; 473-82, 2009 O Hara & Swain Int Rev Psychiatry 8; 37-54, 1996 Prevalence of Depression in Pregnancy (%) 20 18 16 14 12 10 8 6 4 2 0 13 9 Prevalence 6 3 MDD Htn DM MDD = Major Depression Disorder. Evans et al BMJ 2001;323:257-60 Centers for Disease Control Asthma Obstetric screening for depression should occur as routinely screening for diabetes Projected Birth Rates Riverside County 2013 • Projected Birth Rates Riverside County 31,378 We can expect approximately 3,137 – 6,275 women (10-20 percent) in Riverside County this year to experience perinatal depression and anxiety. (This does not take into account women experiencing symptoms up to 1 year postpartum.) •According to MIHA (Maternal and Infant Health Assessment)2011: •17.4 percent had prenatal depressive symptoms •12.0 percent had postpartum depressive symptoms Riverside County 2013 • Women who live in poverty, have multiple stressors or suffer from mental illness have a prevalence rate ranging up to 30 percent or more: Up to 9,413 women this year in Riverside County. Staggering Statistics •Over 50 percent of women who are diagnosed with perinatal depression or anxiety will not receive treatment due to multiple barriers to care. Barriers to Care • Providers perceived as uncaring and too medication focused • Cost of mental health services and/or not covered by insurance • Lack of access to mental health services • Stigma • Culturally informed beliefs about motherhood, mental illness, depression and PPD with mother and provider. • Lack of confidence and knowledge providers using screening tools and diagnosing and treatment of PPD • Provider resistance due to lack of time, fear of opening Pandora’s Box • Lack of mother’s time to participate in therapy, lack of transportation and childcare Postpartum Period • Postpartum period is a time of risk for psychiatric illness in first time mothers compared to fathers1. First time mothers have a higher rate of mental health hospitalization or out-patient treatment • One of the proposed causes of the increased risk of psychiatric illness in this period is the rapid decrease in estrogen and progesterone levels following delivery (within 24 hours) 1Munk-Olsen T et al., JAMA 2006;296:2582-9. What’s The Difference between Postpartum “Blues” and postpartum depression? • Mood swings, anxiety, irritability, tearfulness • Prevalence 15-85% • Not a psychiatric diagnosis • Onset within 72 hours, resolves within 2 weeks • Responds to support and reassurance • 20-25% will develop postpartum depression • Occurs across all cultures Henshaw C et al., J Psychosom Obstet Gynaecol 2004;25:267-72; Beck C et al., J Affect Disord 2009;113:77-87. Perinatal Mood and Anxiety Disorders are NOT related to: • • • • • education race religion sex of infant mode of delivery ..but are related to the following risk factors: • A personal or family history of • Diminished social support in depression, anxiety, caring for baby, (especially postpartum depression, bisignificant other) polar disorder , OCD, or other mental illness • Current or history of stressful life events (e.g. trauma, • Depression or anxiety during abuse, poverty, unwanted pregnancy pregnancy). • Premenstrual dysphoric disorder (PMDD or PMS) • Adolescence with increased psychosocial stress • A major recent life event: loss, house move, job loss ..but are related to the following risk factors: • Multiple births • Financial stress • Mothers whose infants are in Neonatal Intensive Care (NICU) • Marital and/or relationship stress • Mothers who’ve gone through infertility treatments • Complications in pregnancy, birth or breastfeeding • Women with a thyroid imbalance • Mothers of multiples • Women with any form of diabetes (type 1, type 2 or gestational) Postpartum Depression can affect anyone….. “I never thought I would have postpartum depression…..I thought I would be overjoyed….instead I felt completely overwhelmed. This baby was a stranger to me. I didn’t feel joyful. I attributed feelings of doom to simple fatigue and figured that they would eventually go away. But they didn’t; in fact, they got worse. I wanted her to disappear. I wanted to disappear. At my lowest points, I thought of swallowing a bottle of pills or jumping out the window of my apartment.” Brooke Shields, 7/2005 ….including mothers who adopt their babies • 28% of a sample of 86 women reported depressive symptoms within 4 weeks of adoption • Mothers who adopt their babies also experience: -Sleep deprivation -Significant stress -Role change -Social pressure to be “happy” - Often preceded by infertility, home study -22% were infants w/special needs Payne J et al, Arch Women’s Ment Health 13: 147-151, 2010 Adolescents with Perinatal depression and anxiety have unique characteristics • Simultaneous navigation of developmental tasks of adolescence and parenting • Feeling changed, scared • Feeling abandoned by peers and parents • Not understanding depression • Feelings of isolation and being unprepared Clemmens D Adolescence 37: 5551-65 2002 Postpartum Depression and Anxiety Risks of Not Treating • Recurrence more likely • Impaired mother-infant attachment • Increased infant anxiety • Impaired cognitive, social, and behavioral development in offspring Grace SL et al., Arch Women Mental Health 2003;6:263-74; Weissman MM et al., AmJ Psychiatry 2006;163:1001-8; Romano E et al., Pediatrics 10. Perinatal Depression Symptoms • Approximately 15 -20% of women experience significant depression following childbirth. • The percentages are even higher for women who are also dealing with poverty, and can be twice as high for teen parents. • Ten percent of women experience depression in pregnancy. Perinatal Depression Symptoms • Symptoms can start anytime during pregnancy or the first year postpartum. They differ for everyone, and might include the following: • • • • • • • • Feelings of anger or irritability Lack of interest in the baby Appetite and sleep disturbance Crying and sadness Feelings of guilt, shame or hopelessness Loss of interest, joy or pleasure in things you used to enjoy Possible thoughts of harming the baby or yourself (Postpartum Support International) Perinatal Anxiety Symptoms • Approximately 6% of pregnant women and 10% of postpartum women develop anxiety. • Sometimes they experience anxiety alone, and sometimes they experience it in addition to depression. Perinatal Anxiety Symptoms • Symptoms may include: • • • • • • Constant worry Feeling that something bad is going to happen Racing thoughts Disturbances of sleep and appetite Inability to sit still Physical symptoms like dizziness, hot flashes, and nausea (Postpartum Support International) Perinatal Obsessive Compulsive Disorder (OCD) Symptoms • Perinatal OCD is the most misunderstood and misdiagnosed of the perinatal disorders. • It is estimated that as many as 3-5% of new mothers will experience these symptoms. Perinatal Obsessive Compulsive Disorder (OCD) Symptoms • Obsessions: (intrusive thoughts) which are persistent, repetitive thoughts or mental images related to the baby. • These thoughts are very upsetting to the woman • Not something the woman has ever experienced before. Perinatal Obsessive Compulsive Disorder (OCD) Symptoms • Compulsions: where the mom may do certain things over and over again to reduce her fears and obsessions. • This may include things like: • Needing to clean constantly, check things many times, count or reorder things. • A sense of horror about the obsessions • Fear of being left alone with the infant • Hypervigilance in protecting the infant Perinatal Obsessive Compulsive Disorder (OCD) Symptoms •Moms with postpartum OCD know that their thoughts are bizarre and are very unlikely to ever act on them. (Postpartum Support International) Post-Traumatic Stress Disorder • Approximately 1-6% of women experience postpartum posttraumatic stress disorder (PTSD) following childbirth. • Most often, this illness is caused by a real or perceived trauma during delivery or postpartum. Post-Traumatic Stress Disorder • These traumas could include : • Prolapsed cord • Unplanned C-section • Use of vacuum extractor or forceps to deliver the baby • Baby going to NICU • Feelings of powerlessness, poor communication and/or lack of support and reassurance during the delivery • Women who have experienced a previous trauma, such as rape or sexual abuse, are also at a higher risk for experiencing postpartum PTSD. (Postpartum Support International) Post-Traumatic Stress Disorder • Symptoms of postpartum PTSD might include: • Intrusive re-experiencing of a past traumatic event (which in this case may have been the childbirth itself) • Flashbacks or nightmares • Avoidance of stimuli associated with the event, including thoughts, feelings, people, places and details of the event • Persistent increased arousal (irritability, difficulty sleeping, hypervigilance, exaggerated startle response) • Anxiety and panic attacks • Feeling a sense of unreality and detachment (Postpartum Support International) Postpartum Psychosis • Postpartum Psychosis is a rare illness, compared to the rates of postpartum depression or anxiety. • It occurs in approximately 1 to 2 out of every 1,000 deliveries, or approximately .1% of births. • The onset is usually sudden, most often within the first 4 weeks postpartum Postpartum Psychosis • Symptoms of postpartum psychosis can include: • Delusions or strange beliefs • Hallucinations (seeing or hearing things that aren’t there) • Feeling very irritated • Hyperactivity • Decreased need for or inability to sleep • Paranoia and suspiciousness • Rapid mood swings • Difficulty communicating at times (Postpartum Support International) Pilot Program – New Mothers Support Group Pilot started February 22, 2010 under the supervision of: 1. Amy Larsen, RN, Senior PHN, MSN Student CSUSB 2.Ashley Butler, MSW, Student Azusa Pacific University. • Groups were held every Monday at the Rubidoux WIC office from 12-1 p.m. with free childcare. Pilot Program – New Mothers Support Group METHODS • This was an IRB- approved phenomenological design of 11 pregnant and postpartum women recruited from WIC and the community of Riverside County. • Intake assessment - Patient Health Questionnaire (PHQ); Edinburgh Postnatal Depression Scale (EPDS); Mental Status Exam (MSE); NCAST-PCI Feeding Scale (NCAST). • Pre and Post tests: EPDS and NCAST Scale were used to monitor the progress of the women throughout the 10 week program. Pilot Program – New Mothers Support Group METHODS • All clients who scored an EPDS score of 10 or more and/ or displayed risk factors were encouraged to come to the 10 week psycho educational support group. • The support group was a weekly, one-hour session with free childcare provided. It was structured to provide an educational session for the first half and the second half allowed the participants to talk about how they were feeling and struggles that they were experiencing. • Weekly phone calls and encouragement cards were provided for additional support to the mothers. Pilot Program – New Mothers Support Group RESULTS Pilot Program – New Mothers Support Group RESULTS • This small pilot study was found to decrease depressive symptoms as displayed by EPDS scores and increase parent/infant communication, interaction and bonding as indicated by NCAST. • Common stressor themes identified were finances, caring for baby and children, father of baby or husband, unsupportive family and demands of school. • Most common concerns/fears about being a mom were being a good mom and being financially responsible. Pilot Program – New Mothers Support Group CONCLUSIONS • Involvement in this supportive-educative program utilizing the Orem Self-Care Framework demonstrated the following in the majority of participants: • Decreased depressive symptoms by EPDS. • Increased maternal-infant attachment by NCAST. • Orem’s Self-Care theory can be extended to both maternal and infant care, within a perinatal depression support group. • A nursing and social worker team can decrease self-care deficits. Pilot Program – New Mothers Support Group CONCLUSIONS • Limitations: Due to the study’s small sample size, inferential statistical significance for individual factors was not performed. In addition, counseling, psychiatric care and medication contributed to the results. The theme of anxiety was identified throughout the study. No pre and post tests were given to specifically measure anxiety levels. Expanded New Mothers’ Support Group (FY 2011-2012) • Expanded the program county wide in July 2011 • Funding received from Riverside County Mental Health - PEI – Preventative and Early Intervention Prop. 63 – $ 1.2 million grant • Staff Organization • • • • 2 MSW 2 PHNs 5 Health Service Assistants 1 Lead PHN • Client Benefits • • • • Free child care Free transportation Bus passes and gas vouchers Case management – provide referral and follow up to therapy and medication as needed Expanded New Mothers’ Support Group (FY 2011-2012) • Continued psycho-educational model • Intake assessment - Patient Health Questionnaire (PHQ); Edinburgh Postnatal Depression Scale (EPDS); Mills –Depression and Anxiety Feelings Checklist • Pre and Post tests: EPDS and Mills were used to monitor the progress of the women at 3 month intervals throughout the open ended program. Expanded New Mothers’ Support Group (FY 2011-2012) •Fiscal year 2011-2012 • 554 referrals received • 40% were from MD offices/hospitals • 25% from Public Health Nursing • 10% WIC • 295/554 (73%) unable to contact client • 74/554 (18%) declined services Expanded New Mothers’ Support Group (FY 2011-2012) • Average age 21-34 years • Majority Hispanic/Latino (75%) • 151/554 (27%) women received an initial mental health assessment • 73/151 (48%) never attended any sessions • 104/151 (68%) of women attended the support groups Expanded New Mothers’ Support Group (FY 2011-2012) • 31/104 (30%) of women attended 1 session • 28/104 (27%) of women attended 2-4 sessions • 45/104 (43%) of women attended 5 or more sessions Expanded New Mothers’ Support Group (FY 2011-2012) • Follow up Mills/EPDS were completed for 26/104 women who attended sessions • 77/104 (%) of women discontinued the program prior to completing follow up measures Expanded New Mothers’ Support Group (FY 2011-2012) Edinburgh- Mothers who score above 13 are likely to be suffering from a clinical depressive illness of varying severity. Mills- A score below 40 indicates mild adjustment difficulties, 40-69, moderate to severe depression and anxiety and above a 70, severe depression and anxiety. Edinburgh Average Pre-test 15.88 Mills Average Pre-test 54.08 Average Post-test 13.92 Average Post-test 45.68 Average 12% decrease Average 16% decrease Expanded New Mothers’ Support Group (FY 2011-2012) • What we learned: • Many women felt better after having a initial assessment • Need to collect more detailed information about why they feel better • More emphasis needed on compliance with follow ups and evaluations Expanded New Mothers’ Support Group (FY 2011-2012) • Initial assessment was found to be repetitive, consider revising • Change the name due to confusion with community re: “New Mothers” • Continue weekly support groups • Continue providing childcare, transportation and gas vouchers Expanded Pregnant and Postpartum Support Group Program (FY 2012-2013) • Kept program structure and changed name due to confusion with community re: “New Mothers” • Re-funded for Year 2 from Riverside County Mental Health - PEI – Preventative and Early Intervention Prop. 63 – $ 1.2 million grant Expanded Pregnant and Postpartum Support Group Program (FY 2012-2013) • Staff Organization • • • • 2 MSWs 2 PHNs 5 Health Service Assistants 1 Lead PHN • Client Benefits • Free child care • Free transportation • Case Management- provide referrals and follow up to therapy and medication as needed. Expanded Pregnant and Postpartum Support Group Program (FY 2012-2013) • Continued psycho-educational model • Streamlined Intake assessment - Edinburgh Postnatal Depression Scale (EPDS); Mills –Depression and Anxiety Feelings Checklist • Pre and Post tests: EPDS and Mills were used to monitor the progress of the women at 3 month intervals throughout the open ended program. Expanded Pregnant and Postpartum Support Group Program (FY 2012-2013) • Fiscal year 2012-2013 • 761 referrals received • 33% MD offices/hospitals • 19% WIC • 16% Self referral • 9% from Public Health Nursing • 336/761 (44%) unable to contact clients • 148/761 (19%) declined services Expanded Pregnant and Postpartum Support Group Program (FY 2012-2013) • Average age 20-29 years • Majority Hispanic/Latino (57%) followed by Caucasian (23%) • 152/761 (20%) women received an initial mental health assessment Expanded Pregnant and Postpartum Support Group Program (FY 2012-2013) • 163/152 (100%) of women attended at least one session (this includes 11 women who continued on from last FY 2011-2012) • 47/152 (31%) of women attended 2-4 sessions • 55/152 (36%) of women attended 5 or more sessions • 100/152 (66%) of women did not complete post-test measures Expanded Pregnant and Postpartum Support Group Program (FY 2012-2013) • Follow up EPDS were completed for 52/152 women who attended sessions • Edinburgh • 69% of the 52 participants were experiencing severe depression. • Average Pre-test 17 Edinburgh- Mothers who score above 13 are likely to be suffering from a clinical depressive illness of varying severity. • Average Post-test 12 • Average 29% decrease Expanded Pregnant and Postpartum Support Group Program (FY 2012-2013) EDINBURGH (EPDS) 18 Edinburgh pre-post measures were collected for 52 participants during the FY 1213. 17 16 14 12 12 10 8 6 4 2 0 Pre-Test Post-Test At intake the average participant was experiencing moderate to severe depression. Scores decreased significantly on follow up and average scores reduced to the cut-off range for minor or mild depressive symptoms. Expanded Pregnant and Postpartum Support Group Program (FY 2012-2013) • Follow up Mills were completed for 41/152 women who attended sessions • Average Pre-test 58.01 Mills- A score below 40 indicates mild adjustment difficulties, 40-69, moderate to severe depression and anxiety and above a 70, severe depression and anxiety. • Average Post-test 39.04 • Average 33% decrease Expanded Pregnant and Postpartum Support Group Program (FY 2012-2013) Mills follow-up scores were collected for 41 participants. Mills 70 60 58.1 50 39.4 40 At intake, Mills scores showed that women on average reported moderate to severe depression. By the conclusion of services, on average women were experiencing just mild adjustment difficulties. The score decreased to 39.8, just below the cutoff for this level. 30 20 10 0 Pre-Test Post-Test Expanded Pregnant and Postpartum Support Group Program (FY 2012-2013) • Evaluations of the program • What the mothers liked best: • Peer support and relating to others • Made an important difference in their lives • Felt welcome at the group meetings • Learned skills that they use each day • Feel that they are better parents • Feel safe and comfortable to talk in the group meetings • More aware of community services available Expanded Pregnant and Postpartum Support Group Program (FY 2012-2013) • Satisfaction with Support Groups • 85% of the mothers said they were very satisfied or satisfied with the support they received from the group • 80% of the mothers reported they either strongly agreed or agreed that the program has helped them cope better with their depression and anxiety. • 85% of the mothers reported they either strongly agreed or agreed that they would return to the program if needed. Expanded Pregnant and Postpartum Support Group Program (FY 2012-2013) •Common Improved Behaviors as a result of the Program 1. Increased coping abilities during a crisis 2. Having an optimistic outlook on one’s situation Expanded Pregnant and Postpartum Support Group Program (FY 2012-2013) • Overall, the majority of the mothers were satisfied with the program. • Of the 71 evaluation forms completed 87% of the mothers reported feeling happy and satisfied. Expanded Pregnant and Postpartum Support Group Program (FY 2012-2013) •What we learned: • Some women don’t feel comfortable coming to a support group and would prefer listening visits • Women asked for support for men • Continue to collect detailed information about why they feel better Expanded Pregnant and Postpartum Support Group Program (FY 2012-2013) • Look at trends of women with PMAD symptoms • Continued improvement needed on compliance with follow ups and evaluations • Look at changing name Expanded S.M.I.L.E – Supporting Mothers in Life’s Emotions (FY 2013-2014) • Changed name to S.M.I.L.E program • Funding reauthorized for Year 3 from Riverside County Mental Health - PEI – Preventative and Early Intervention Prop. 63 – $ 1.2 million grant Expanded S.M.I.L.E – Supporting Mothers in Life’s Emotions (FY 2013-2014) • Staff Organization • • • • 2 MSW 2 PHNs 5 Health Service Assistants 1 Lead PHN • Client Benefits • • • • Free child care Free transportation Bus passes and gas vouchers Case management – provide referral and follow up to therapy and medication as needed. Expanded S.M.I.L.E – Supporting Mothers in Life’s Emotions (FY 2013-2014) • Changed program components to offer more services 1. Support groups twice a month in English and Spanish 2. Offer home listening visits twice a month in English and Spanish 3. Offer 4 family evening meetings per year to involve fathers, family members and friends to learn about PMADs. Expanded S.M.I.L.E – Supporting Mothers in Life’s Emotions (FY 2013-2014) • In addition to the 71 clients from last fiscal year, we enrolled 263 new women to the program who received a mental health intake assessment. • Total 334 clients served. • We received 804 referrals. 58 % MD offices/hospitals 27 % WIC 15% Community Programs (ie: PHN, MH etc.) • 263/804 (34%) referrals were enrolled into the program. • 154/263 (59%) new clients enrolled attended support groups or home visits • 109/263 (41%) of new clients enrolled never attended any sessions Expanded S.M.I.L.E – Supporting Mothers in Life’s Emotions (FY 2013-2014) • Average age 22-37 years • 225/334 (67%) women attended support groups or home visits (New enrolled clients & old clients) • 109/334 (33%) women did not attend support groups or home visits Expanded S.M.I.L.E – Supporting Mothers in Life’s Emotions (FY 2013-2014) • 62/225 (27%) attended 1 support group or home visit • 49/225 (22%) attended 2 support groups or home visits • 113/225 (50%) attended 3 or more support groups or home visits • 97/225 (43%) of women who attended support groups or home visits completed 135 post-test measures. Expanded S.M.I.L.E – Supporting Mothers in Life’s Emotions (FY 2013-2014) 90 79 80 70 60 50 40 30 Support Groups (SG) 35 27 34 30 19 20 10 0 1 SG or 1 HV 2 SG or 2 HV 3 or more SG or HV Home Visits (HV) Expanded S.M.I.L.E – Supporting Mothers in Life’s Emotions (FY 2013-2014) • Follow up Edinburgh (EPDS) • Average Pre-test – 15.2 • Average Post-test -11.1 • Average 27% decrease Expanded S.M.I.L.E – Supporting Mothers in Life’s Emotions (FY 2013-2014) Edinburgh (EPDS) 16 15.2 14 12 11.1 10 8 Edinburgh pre-post test measures were collected on 119 participants FY 13-14. At intake the average participant was experiencing moderate – severe depression. Mothers who score above 13 are likely suffering from a clinically depressive illness of varying severity. 6 4 2 0 Pre test Post test Expanded S.M.I.L.E – Supporting Mothers in Life’s Emotions (FY 2013-2014) • 118/225 (52%) of women who attended support groups or home visits completed post-test measures. • Follow up Mills Depression and Anxiety Feeling Checklist (Mills) • Average Pre-test – 50.5 • Average Post-test -31.9 • Average 36% decrease Expanded S.M.I.L.E – Supporting Mothers in Life’s Emotions (FY 2013-2014) Mills 60 50 50.5 40 31.9 30 Mills follow up scores were collected for 118 participants. At intake Mills scores showed that women on average reported moderate to severe depression and anxiety symptoms . 20 By the conclusion of services, on average women were experiencing mild adjustment difficulties. 10 0 Pre-Test Post-Test Expanded S.M.I.L.E – Supporting Mothers in Life’s Emotions (FY 2013-2014) 18 16 Support Groups 16.3 15.3 Home Visits 14 12 10.6 11.1 10 8 Average % change for EPDS support group participants was 30%. Average %change for EPDS home visit participants was 31% Even though on average women enrolled in the home visit program had more severe symptoms, percentage change was similar in both programs. 6 4 2 0 Pre-Test EDPS Post-Test EDPS Expanded S.M.I.L.E – Supporting Mothers in Life’s Emotions (FY 2013-2014) 60 50 Support Groups 55.8 Home Visits 49.8 Average % change for Mills support group participants was 39%. 40 30.3 30 32 Average % change for Mills home visit participants was 42% Again, even though on average, women enrolled in the home visit program had more severe symptoms, percentage change was similar in both programs. 20 10 0 Pre-Test Mills Post-Test Mills Expanded S.M.I.L.E – Supporting Mothers in Life’s Emotions (FY 2013-2014) Characteristics of women enrolled: • Approximately 65% of women enrolled in the program stated they had a history of abuse: physical, emotional, and/or sexual. • Approximately 61% of women enrolled have a family history of mental illness and/or substance use Expanded S.M.I.L.E – Supporting Mothers in Life’s Emotions (FY 2013-2014) Characteristics of Women Enrolled: • Approximately 43% of women have seen or are currently seeing a therapist at the time of intake • Approximately 42% of women have taken or are currently taking psychiatric medication • Approximately 23% of women have been hospitalized before due to mental illness Expanded S.M.I.L.E – Supporting Mothers in Life’s Emotions (FY 2013-2014) • We have received 139/225 (62%) program evaluations: • 97 % strongly agreed or agreed that if they were going to seek help for postpartum depression again they would return to this program. • 94 % satisfied with support they received in the program. Expanded S.M.I.L.E – Supporting Mothers in Life’s Emotions (FY 2013-2014) • 93% strongly agreed or agreed that the program has made an important difference in their lives. • 89% strongly agreed or agreed that they learned skills that I have used everyday. • 88% agreed that the program has helped me to better cope with my depression and anxiety Expanded S.M.I.L.E – Supporting Mothers in Life’s Emotions (FY 2013-2014) • Additional comments • This program made me confident to be a better mother. • Very informative, caring, compassionate and non-judgmental. • It helped me to feel better about myself and to know that I can help others. They listened and showed real interest in helping us. • When I started going to the groups, I started to feel better and I didn’t want to miss any group meeting. Expanded S.M.I.L.E – Supporting Mothers in Life’s Emotions (FY 2013-2014) Additional comments • I was just amazed by how many women have the same problems and anxiety as I did. I should of came here long time ago. • I want to thank you for the support group which gives us hope and courage to deal with our depression. • Thank you for spending your time and paying attention to us. • They helped me to see another point of view and what I can do. I have depression but with the help of the program I can manage it better. The therapy groups I attended were very helpful for me. The staff were very good and helpful. Expanded S.M.I.L.E – Supporting Mothers in Life’s Emotions (FY 2013-2014) • Family Evening Meetings • Were held every 3 months from 6:30 -8:30 pm. • Invites family members, friends and significant others to come and learn about perinatal mood and anxiety disorders. • Provide transportation • Provide childcare • Provide a light dinner Expanded S.M.I.L.E – Supporting Mothers in Life’s Emotions (FY 2013-2014) • 114 Family Evening Meeting evaluations were received • 89% strongly agreed or agreed that they could recognize the signs and symptoms of perinatal mood and anxiety disorders. • 89% strongly agreed or agreed that they learned who to call for additional support. • 80% strongly agreed or agreed that they felt they could support their significant other/family member better after the meeting. Expanded S.M.I.L.E – Supporting Mothers in Life’s Emotions (FY 2013-2014) • Additional Comments: • Excellent resource for couples/women/men dealing with PPD in their life. • I believe that this is a very educational event that should be more frequent. • I loved the meeting, it was very informational for me and my family. This is exactly what I needed. • Thanks very much, so helpful equally for us men. Expanded S.M.I.L.E – Supporting Mothers in Life’s Emotions (FY 2013-2014) • Additional Comments : • Thank you so much for all that you do without you guys I wouldn’t be the way I am now, a strong woman who is still dealing and noticing the signs of depression. • I hope to see and help more with fathers having mental disorders and family counseling. • I’m happy that there are theses types of groups because they really help us deal with our feelings. Thank you for helping us. • Great thing that you guys are doing for our wives. Thank you so much. We need a male support group. Expanded S.M.I.L.E – Supporting Mothers in Life’s Emotions (FY 2013-2014) • Additional Comments: • Love the support group and these type of couple meetings. It really helps my husband understand me more. • Thank you we males need more of these meetings. Expanded S.M.I.L.E – Supporting Mothers in Life’s Emotions (FY 2013-2014) • What we learned: • Pre and post scores for EPDS and Mills in support group and home visitation programs were similar – 34 % decrease EPDS in both programs and 51% decrease in Mills for support group and 48% decrease for home visits. • Decreasing the support regimen from weekly to bi-monthly did not negatively effect EPDS and Mills post test scores. EPDS post test percentage change increased by 12% and Mills post test percentage change increased by 37% compared to FY 2012-2013. Expanded S.M.I.L.E – Supporting Mothers in Life’s Emotions (FY 2013-2014) • What we learned: • Continue QA/QI on compliance with post-test evaluations. Increased 42% this year, improvement is still needed. • Develop QA/QI measures to improve follow up on mothers who never attend a support program after intake assessment. • Develop men’s support group. • Continue family evening meetings. In Summary • Pilot Study showed 36% decrease of depressive symptoms as measured by Edinburgh and 11 % increase in bonding behaviors as measured by NCAST Feeding Scale • FY 2011 – 2012 showed 12% decrease of depressive symptoms as measured by EPDS and 16% decrease of depressive/anxiety symptoms as measured by Mills. In Summary • FY 2012-13 showed 29% decrease of depressive symptoms as measured by EPDS and 33% decrease of depressive/anxiety symptoms as measured by Mills. • FY 2013-February 2014 showed 33% decrease of depressive symptoms as measured by EPDS and 53% decrease of depressive/anxiety symptoms as measured by Mills. In Summary • Overall mothers feel that this program has made an important difference in their lives and they learned skills that they use each day. • Overall the components of the support groups, listening visits and family evening meeting provide great support for families suffering from PMADs • Overall fathers feel that the family evening meetings provide support but more work is needed. In Summary • S.M.I.L.E is an innovative program that has decreased depression and anxiety symptoms and is a promising development of evidence based PMADs support programs. •Questions • Contact Information: • Amy Larsen, RN, PHN, MSN, IBCLC Work - 951-210-1344 Cell – 951-318-2821 [email protected]