Download S.M.I.L.E Supporting Mothers In Life*s Emotions Pregnant and

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
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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.
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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.
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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
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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.
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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.
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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]