James Meloche, Executive Director Healthy Human Development Table Meeting January 14, 2015 2
1. Introduction to PCMCH 2. Overview of Perinatal Mental Health 3. Perinatal Mental Health Initiatives at PCMCH 4. Next Steps 3
4 INTRODUCTION TO PCMCH
5 Be the provincial forum in which clinical and administrative leaders in maternal and child health can identify patterns and issues of importance in health and health care delivery for system support and advice Improve the delivery of maternal child health care services by building provincial consensus regarding standards of care, leading practices and priorities for system improvement Provide leadership and support to Ontario s maternal and child health care providers, planners and stewards in order to maximize the efficiency and effectiveness of health system performance Mobilize information and expertise to optimize care and contribute to a high-performing system therefore improving the lives of individual mothers and children, providers and stewards of the system
Target Population: Focused on the maternal-child population and successful transition to adulthood Clinical Engagement: Work is supported by standing committees and focused, time-limited expert panels Comprehensive Perspective: Council and advisory committees reflect all levels of care, and the full geographic diversity of the province Service Continuum: Scope includes maternal, newborn, child and youth health care services across both community and hospital settings 6
Low Risk Maternal Newborn Strategy Low Risk Birth QBP Prenatal Screening Strategy Standards of Post- Discharge Care VBAC Pathways Neonatal Followup Clinics Mat & Newborn Levels of Care Evaluation Neonatal Transport Antenatal Records Baby Friendly Initiative 7
OVERVIEW OF PERINATAL MENTAL HEALTH 8
9 Ontario lacks a provincial policy for identifying and treating maternal depression and other mental health disorders Regional variation in practice Poor access to care in rural and remote areas
10 Creating a strategy for perinatal mental health that focuses on three levels of prevention: - Primary - education and increased public awareness - Secondary - screening - Tertiary - treatment, early intervention, support, and recovery
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PERINATAL MENTAL HEALTH INITIATIVES AT PCMCH 12
13 1. Ontario Perinatal Record - Update of the Ontario Antenatal Record - A new page has been added to the updated guide to screen for mental health issues (anxiety and depression) as well as alcohol use during the antenatal and postnatal periods - The validated screening tools aim to help identify women who need assistance or referral
14 2. Low Risk Maternal Newborn Strategy - Objective is to design a framework that: Promotes access to safe, woman- and family-centred care that is equitable, regardless of race, ethnicity, gender, sexual orientation, class, (dis)ability, language, age, religion, or region/location Support a system of care that provides women and their families with equitable choice in birth environment and provider Optimize system/provider frameworks to promote normal birth
15 2. Low Risk Maternal Newborn Strategy
16 Framework identifies counselling and referral for mental health from pre-pregnancy and through the postpartum period as essential components of maternal and newborn care
17 3. Standards of Post Natal Care - The aim is to develop and disseminate standards for post-natal care by hospitals and community care providers - This work will include an accountability and evaluation framework to assign responsibility to different care providers and ensure that standards are followed - There is an opportunity to include standards of care for perinatal mood disorders in this work
18 3. Neonatal Follow up Clinics - Developed a report that details the current state of Neonatal Follow- Up Clinics (NNFU Clinics) in Ontario and includes a series of clinic and broader system recommendations - Aim is to leverage existing resources within the healthcare system and to address the needs of the NNFU population - The six clinic recommendations aim to standardize practice across Ontario s clinics to equally serve new moms, babies and their families - The three broader system recommendations aim to work with relevant government Ministries to ensure continued support for children, and their families, as they transition to school
1. Neonatal Abstinence Syndrome - Developed recommendations regarding both harm reduction and the optimal management of Neonatal Abstinence Syndrome 2. Mother-Baby Dyad - Developed recommendations regarding mother-baby dyad care, including skin-to-skin contact of healthy infants and mothers - Continuous, uninterrupted skin-to-skin contact immediately after birth is important not only for the infant s development but for maternal mental health and wellbeing 19
20 4. Late-Preterm Birth - Developed recommendations for risk reduction for late pre-term births - Developed clinical guidelines for late pre-term birth, including clinical assessments and interventions required for pre-term birth
21 NEXT STEPS
22 Collect more data related to perinatal mental health Better support and education for parents Earlier identification and intervention through pre-screening Create linkages within our work - Work with partners and stakeholders to integrate perinatal mental health in current and future initiatives
23 From the PCMCH Team