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: 4 th in nation; SYPHILIS: 1 st in nation for early cases, EBR is highest; DV: 3 rd 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 birth- weight babies, were physically-abused during pregnancy, or under high stress.

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: : 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.