1. Bria and Angel

2. “A maternal and early childhood health program, fosters long- term success for first-time moms, their babies and society.” “Nurse-Family Partnership's maternal health program introduces vulnerable first-time parents to caring maternal and child health nurses. This program allows nurses to deliver the support first-time moms need to have a healthy pregnancy, become knowledgeable and responsible parents, and provide their babies with the best possible start in life. The relationship between mother and nurse provides the foundation for strong families, and lives are forever changed – for the better.” Retrieved from http://www.reachupincorporated.org/our-programs/nurse-family-partnership NURSE FAMILY PARTNERSHIP

3. Nurse Family Partnership (NFP) offers their services to first time mothers who are living at or below the poverty line who want to learn about their pregnancy, get guidance about health and wellness during pregnancy and delivery and how to prepare for the arrival of their new baby. To qualify: Must be the first pregnancy You can be any age Need to be under 28 weeks pregnant Qualify for Medicaid Willing to dedicate thier time to the voluntary program WHO DOES NURSE FAMILY PARTNERSHIP PROVIDE CARE TO

4. Nurse Family Partnership nurses aim to not only be a nurse and provide medical advice, but a friend to the patients. This allows the patients to feel comfortable and confide in the nurses any of their concerns, fears or….. Nurses offer a wide variety of services The beauty of the program is the needs are tailored to the patients concerns and needs. Booklet to choose the daily “menu” Conversations spark questions Videos, visual aids and handouts at 6 th grade level to help assist in learning This program is very important- sometimes these patients do not have anyone else to turn to during this confusing, exciting and changing time. The NFP nurses help these patients feel at ease during their pregnancy and after the child is born. HEALTH NEEDS OF THE POPULATION

5. Nurse Family Partnership has endless materials that cover almost all of the mothers questions, concerns and continuing education on parenting. When we asked the nurses what the most difficult conversation was to have with the patients, the topic of mental health came up. Many of the mothers to be do not have a stable home, parents, some parents are in jail, they might be young or the father of the baby might not be involved… all these factors have to potential to lead to damaging mental health WHY MENTAL HEALTH?

6. According to Healthy People 2020, the goal for mental health is…. to improve mental health through prevention and by ensuring access to appropriate, quality mental health services. Regardless of being pregnant or not, mental health effects all populations. We saw the need in our project to address mental health in pregnancy due to the correlation between mental health and overall health. Retrieved from http://www.healthypeople.gov/2020/topics-objectives/topic/mental-health-and-mental-disorders HEALTHY PEOPLE 2020

7. SERVICE LEARNING PROJECT

9. We originally had planned to give the mothers additional resources on their existing mental health issues. However, we felt that mental health is a sensitive topic to initiate a conversation, we decided that a screening tool and brochure would be a better approach to start a conversation. Finally, we formulated a brochure that utilizes a survey and a brief description of what mental health is. We felt that this would be appropriately targeted for the at risk population. PLANNING STAGE OF SERVICE LEARNING PROJECT

10. We are going to present the brochure to the entire nursing staff at NFP and explain our thoughts behind putting a screening tool rather than an overload of information on the brochure. Ideally, we would like the nurses to distribute these brochures to the patients they feel are at risk, collect the results of the survey and seek help if it is determined that the patient requires further intervention. The nurse supervisor would like to implement this into the system if it proves to be a successful screening tool. IMPLEMENTATION

11. We understand that mental health is a sensitive subject, which is why we feel the NFP is an ideal setting to present the patients with this information. The nurses have a more personal and ongoing relationship which we feel would allow the patients to answer the survey honestly. We would anticipate some misleading information given by the patients due to the nature of the questions being asked. We are hoping that the relationship between the nurse and patient is strong enough that true answers are given. PATIENT RESPONSE

12. We believe that having everyone screened for mental health issues is vital in the continued treatment of the mothers in the NFP program. Ideally, we would like to screen all mothers late in their pregnancy and early after delivery to assess their mental status. The mothers in this program often do not have the support that new mothers need. If we screen all mothers, we may catch some who may be struggling but were overlooked or disguised. CONTINUING TO ACHIEVE

13. Nurse Family Partnership has been studied for many years which includes evaluating the mother and baby’s health outcomes while receiving counseling. Due to the evidence based practice, guidelines have been established that have proven to improve the long term health outcomes of mother and baby. Attempting to implement this material, we would need to be cautious about disturbing the program’s timeline. HEALTH POLICY

14. According to WHO How big is the problem? “Mental health problems such as depression and anxiety are very common during pregnancy and after childbirth in all parts of the world. About one in ten in developed countries, have a significant mental health problem during pregnancy and after childbirth” EVIDENCE BASED RESEARCH

15. What are the consequences? “Mental health problems are often undiagnosed, because many of its core features such as fatigue and poor sleep are also commonly associated with motherhood itself and/or part of the gender stereotype of what motherhood should include. Pregnant women or mothers with mental health problems often have poor physical health and also have persistent high-risk behaviors including alcohol and substance abuse. They have increased risk of obstetric complications and preterm labor. Pregnant women or mothers with mental health problems are much more disabled and less likely to care adequately for their own needs. These women are less likely to seek and receive antenatal or postnatal care or adhere to prescribed health regimens.” EVIDENCE BASED RESEARCH

16. Impact on children “The mental health of women not only adversely affects them, but its impact on their developing infant is also severe. If the ability of women to take care of their baby is compromised, the survival and development of the infant is jeopardized. Maternal depression in resource-constrained settings is linked directly to lower infant birth weight, higher rates of malnutrition and stunting, higher rates of diarrhoeal disease, infectious illness and hospital admission and reduced completion of recommended schedules of immunization in children. It also adversely affects physical, cognitive, social, behavioral and emotional development of children.” EVIDENCE BASED RESEARCH

17. http://www.nursefamilypartnership.org/first-time-moms/pregnancy-health- services (2010). Screening for depression during and after pregnancy. American College of Obstetricians and Gynecologists. 453. doi:115:394–5 (2008). Improving maternal mental health. World Health Organization, 8(1), Retrieved from Perinatal_depression_mmh_final.pdf http://www.cdc.gov/mentalhealth/ http://www.beyondblue.org.au/docs/default-source/8.-perinatal- documents/bw0124-edinburgh-postnatal-depression-scale-(epds)-and-scoring- sheet-for-health-professionals.pdf?sfvrsn=2 REFERENCES