MATERNAL DEPRESSION
PROJECT/EAST BATON
ROUGE PARISH
Presented by Becky Decker, LCSW
Louisiana Office of Public Health
EAST BATON ROUGE PARISH
DEMOGRAPHICS:
412,852 people (2000 Census data);
472 square miles – urban;
56% Caucasian, 40% African American;
Poverty: 22.9% women of childbearing
age live below poverty level;
#2 in nation for newly-diagnosed HIV
infections in metropolitan cities (2002).
LOUISIANA DEMOGRAPHICS:
POVERTY: 4th in nation;
SYPHILIS: 1st in nation for early cases,
EBR is highest;
DV: 3rd in nation/females killed by
males 1999 data;
High single mother rate: 46.3%, 2001.
PRAMS data year 2000 study
of 7 states:
La. Had highest level of self-reported
severe Postpartum Depression of 7
states: 8.9%.
Those reporting severe depression in all
7 states: did not complete high school,
Medicaid recipients, had low birthweight babies, were physically-abused
during pregnancy, or under high stress.
LaPRAMS 2002 - Postnatal Depression
3.0%
Not Depressed
6.0%
A Little Depressed
13.5%
43.0%
Moderately
Depressed
Very Depressed
34.0%
Very Depressed &
Had to Get Help
DETERMINATION OF NEED:
30-35% new moms screened at OPH
Clinic reported depression;
Healthy Start Program also reported
30% depression rate in their clients;
OPH met with Healthy Start and Capital
Area Human Services District (CAHSD)
to discuss common findings.
WHY INTERVENE?
Maternal depression, addiction or DV
can cause: poor childhood
development, poor growth, attachment
disorders, Fetal Alcohol Spectrum
Disorder, P.T.S.D. and/or learning
disabilities in school.
Promotion of healthy behaviors is a core
function of Public Health.
DEPRESSION ADDED TO FASD
COLLABORATIVE:
CAHSD and OPH already collaborating
on FASD Prevention pilot;
The group decided to focus on maternal
depression, DV and FASD in same
project due to high depression findings;
Needs assessment was done and 8
focus groups were held.
FOCUS GROUP FINDINGS:
Factors that encouraged drinking were:
Financial problems
Family/relationship stress
Partner violence/DV
Lack of knowledge about Depression, DV,
FASD and
Lack of knowledge about resources.
COMMUNITY
COLLABORATION:
2002-2004: OPH participated in FASD
Prevention Pilot with 46 other
agencies/individuals;
Inter-agency meetings held (OPH,
CAHSD, Family Violence Center, Mental
Health, etc.);
National speakers gave technical
assistance on FASD, DV, PPD.
STEPS TAKEN:
Media publicity re: FASD;
Women/Substance Abuse Conference;
March of Dimes funded counselor at
EKL (30-40% positive sub abuse);
Healthy Start funded Perinatal
Substance Abuse visit/Dr. Ira Chasnoff;
Addictive Disorders funded 2 counselors
at 2 sites;
SURVEY OF LOCAL OB/GYNS:
62% provided NO educational nor
nutrition services to pregnant women;
56% were interested in screening and
referral for alcohol, DV and depression;
Top 5 risk factors: substance abuse,
DV, mental illness, teen pregnancy and
a history of abuse.
FINAL STEPS:
4 P’S PLUS screening tool purchased
from Dr. Chasnoff and amended to add
DV, depression questions;
Community Needs Assessment showed
service gaps:
Mental Health (severe only)
Substance Abuse (where to go?)
FUNDING SOURCES:
2 area hospitals funded 2 “Brief
Interventionist” positions to respond to
positive screens (DV, depression, S.A.);
1 “Brief Interventionist” position at EKL
hospital: March of Dimes, CAHSD and
BR Area Foundation;
OPH WIC clinics and private OB/GYNs:
existing staff will screen and refer.
SUSTAINABILITY:
Licensing fee ($5,000)/year (4P’s+);
Brief Interventionists staff/space
provided by hospitals;
Screening tool brief/easy for private
docs and OPH clinics to use;
Commitment by agencies (OPH, Mental
Health, OAD) to continue collaborating.
OUTCOMES/EVALUATION:
Track decreases in alcohol consumption
and depression in positive screens (Brief
Interventionists);
Brief Interventionists and Outreach
Worker will monitor progress via phone
calls, home visits.
CHALLENGES:
Service gaps for Mental Health care –
State OMH can only see those with
“severe, chronic” mental illness;
Only 2 psychiatrists take Medicaid;
Stigma (SA and MH);
Community education needed;
Creating services without funds.
SUCCESSES/SOLUTIONS:
Private docs agree to screen/refer!
State OMH psychiatrists will confer with
private OB/GYNs re: depression/mental
illness, advise on meds management;
Media blitz re: maternal depression, SA
and services;
Hotline #, support groups, outreach
workers.