You are currently browsing the monthly archive for July 2008.

I’m just going to compile a list in this post over time about the different programs that have begun around the country, maybe world wide. They may have ideas that may work here, and why not have them all in one place?

Wisconsin- Perinatal Foundation, Wisconsin Association for Perinatal Care (website)

Two team members presented “Pebbles in a Pond: The Wisconsin Experience” at the 2005 Postpartum Support International conference, in San Jose, CA. Their website link above leads to their Program Initiative Phases page. Also on that page are links to information about Postpartum Depression, Perinatal Depression Resources, PMD and the Workplace, plus Screening Tools.

Also included are stories from mothers of various backgrounds–African American, Native American, Amish, Hmong, Latina and one of unspecified cultural background. Plus there’s a quiz related to cultural competence, related to the stories. Perinatal Depression Resources

California-Santa Barbara County First 5 (website)

Postpartum Support International founder, Jane Honikman and two others presented the Postpartum Depression/Attachment Strategic Plan (2006) in a well-attended break-out session at the 2008 PSI Conference in Houston, TX. They did a very thorough plan, and the three presenters fascinated the audience. Santa Barbara and counties are far more remote than I’d ever realized, even with having driven through Santa Barbara and up the coast.

The Strategic Plan is near the bottom third of the list on the website, and linked, here.

Pennsylvania-Pennsylvania Perinatal Partnership

Postpartum Progress mentioned this here, which is what prompted me to write this whole post. She’s also on my Blog Role.

This is a Powerpoint about the process of creating a partnership between Healthy Start and the Title V programs in Pennsylvania. And a write up here by the Maternal and Child Health Branch, Using Managed Care Contracts to Promote Child Health.

That’s it for today. More will be added on this post later.

8/1/08 I’ve added a new Page up top, “Programs” and copied this post to it.  That’s where I will update with new information about programs and ideas from other places, as I find them.

Well. On Monday the Senate killed the MOTHERS Act. 52-40. 60 votes were needed. Along with the MOTHERS Act, three dozen other bills met the same fate, all as part of the “Advancing America’s Priorities Act”.

A yes vote, Republicans said, was a vote to shift from the debate in progress over ways to help relieve the burden of soaring gas prices.

Yep, Republicans apparently referred to the Act as a “trick” to take the focus away from “the number one domestic issue facing our nation.”

There you go Hawaii moms. Thank goodness providers around here aren’t waiting to be told to screen new mothers for PPD, and have taken this important task on themselves. Despite Hawaii’s high gas prices.

Read more in the Washington Post article, GOP points to cost, helps kill bill to aid victims.

UH Manoa’s Maternal & Child Health Leadership Program Director, Nancy Partika, sent a flyer recently about the program.

For those with an interest in Public Health and/or mothers and children’s health, this is a good, post-bachelors 17-credit/6 class certificate.

They recruit new students on a year-round basis, with most coursework offered in fall and spring semesters–MCH courses are now offered via distance education to improve access for rural area participants. Tuition waivers are a possibility.

Get a copy of their brochure here and an overview of the curriculum here.

It’s not happening across the board quite yet, but props to those places already screening new moms for postpartum depression here in Hawaii. The Edinburgh Postnatal Depression Scale (EPDS) is commonly used worldwide and it is a paper and pencil screening device. There is a lot of research behind it and its use, in many different populations around the world. It takes 5 minutes for the mother to fill out, < than 5 minutes to “score”. It does not diagnose a woman, but is a screening device.

First, the Waianae Coast Comprehensive Health Center‘s Perinatal Support Services screens every mom they see, says Teresa Gonsalves, LSW, director of case management and utilization. And not just once, not twice but three times in the first 6 months. Plus, they’ve been screening for a number of years now.

Second to the “list” is Tripler Army Medical Center (TAMC). According to one mom, she was given the Edinburgh, made to watch a video about postpartum depression before being allowed to leave the hospital after giving birth, and a brochure (or two) about “PPD”. Another awesome, to TAMC. Also military, Marine Corps Base Hawaii (MCBH) screens moms at baby appointments (so, the pediatrician’s office?)!

HMSA offers screening to expectant and postpartum moms if mom signs up for He Hapai Pono, The Good Pregnancy.

I have some reports locally from moms using other services and hospitals. Kapiolani Medical Center (KMCWC) seems to be screening moms after giving birth and there may be “PPD” brochures in the take home packets–a.k.a. “Giant Folder”. Also, possibly screenings regularly at GYN appointments for a year after birth.

I really should call each place, but these are the raw impressions moms have. A year ago, moms were reporting NOT being screened. Whether screenings were being done or not–moms were not perceiving being screened.

A couple of moms very recently have mentioned not being screened at any point in the normal course of pregnancy, birth, and early postpartum.

I hope KNOW the day IS comes COMING soon when I regularly hear about screening and information being provided. As one mom mentioned, the optimal time would be during pregnancy when one can still think, hear, learn without the haze of sleep-deprivation and needs of a new infant. Those Giant Folders are often unearthed when baby is around…. oh… 8 months already!

Still, more and more moms are reporting being screened for “PPD”.

The Star Bulletin called it down-to-the-wire in Veto overrides create 13 laws. In Hawaii governor vetoes 41 bills on final day; Legislature overrides on 13 the Honolulu Advertiser focused more on explaining the process (and some drama) to vetoes and overrides.

At any rate, one bill connected to mothers and health care was vetoed and then overridden.

» HB 2761: Allows for extension of post-partum care and care between pregnancies from eight weeks to at least six months for women in the Hawaii QUEST program.

According to data on 52,932 women in Hawaii who gave birth to children from 2004 to 2006, women enrolled in the Hawaii QUEST health insurance program were, compared with other women who have recently given birth but were covered under other health insurance:

(1) Three times less likely to access prenatal care in the first trimester of pregnancy;

(2) Just as likely to have their infants receive their first well-baby check, but twice as likely not to have received the recommended post-partum check for new mothers;

(3) One-and-a-half times more likely to have an unintended pregnancy;

(4) At three to four times and two to three times higher risk of being abused before becoming pregnant by their former and current spouses, respectively;

(5) At three to four times higher risk of experiencing intimate partner violence while pregnant;

(6) One-and-a-half times more likely to require dental services during pregnancy;

(7) Three times more likely to smoke during the last three months of pregnancy;

(8.) Three to four times more likely to use illicit drugs during pregnancy;

(9) Twice as likely to experience post-partum depression;

(10) Twice as likely not to have initiated breastfeeding; and

(11) Ten per cent more likely to have a low birthweight or premature infant.

That is a risk-factor-dense list for potential perinatal mood disorders! Is it really only 2x as likely a woman being abused will experience perinatal mood disorders, aka “post-partum depression”?

An additional reason this bill is important relates to the Compact of Free Association, a … an … agreement … between the US and the Federated States of Micronesia (FSM), which allows citizens of FSM to freely associate/move to, around within, or move from the US back to FSM. –that came about from some testing the US did does still on Kwajelein. So they are not “immigrating.” But they are arriving. And they are arriving in Hawaii. Congress looked at the impact of this migration 5 years ago and you can read more about it here http://www.bspguam.com/datacenter/compact_freeassoc.htm

Honestly, had I not spent some time working in a shelter I may have missed it all. But FSM citizens are here, and they are here because the US made arrangements that they can be here–so they have come. Some need health care, some due to that testing.

Apparently though Congress may be aware of the impact on Hawaii, as one of the first places people from FSM move, Congress has been perhaps a bit slow in $upporting Hawaii as more people do move here. Health care and social services are stretched.

It’s for these women the override was the right thing to do. For them, and for all Hawaii’s moms who also need maternal care. Eight weeks is just not long enough.

Hawaii’s Baby S.A.F.E. stands for baby in a Substance Abuse Free Environment. The State Department of Health has put out a request for information (RFI) to the community for ideas on how to improve or round out the program. Interested parties may attend meetings around the state by video conference at the video conference centers (VCCs) on each major island; Honolulu & Kapolei, Wailuku on Maui, Lihue on Kauai, and Hilo and Kona on the Big Island–July 14, between 12:30-3 pm. Public Notice link here

…to solicit information and discuss the type of substance abuse counseling practices for pregnant women that have been successfully implemented and can be replicated.

…to improve support services for substance-using pregnant women and expand the current Baby S.A.F.E. model to include a triage system that community OB/GYN providers can refer the women to.

DOH wants to improve on the current overall goal. Oahu’s Leeward coast along with Maui and Hawaii counties are the areas involved. Kauai may also be included.

Okay, just like PATH Clinic, what does this have to do with “All things ‘PPD’ in Hawaii”? Same thing, except I didn’t spell it out. What are the most easily accessible medications for depression? Alcohol and street drugs. And you can get them when you are YOUNG. No prescriptions, no trip to the doctor, no records of whatever brought on the need for drugs.

The important thing is that moms-to-be have access to effective treatment. So far I’ve never met a mother who didn’t want to do her best for her baby. Sometimes it’s just really hard to give baby one’s best, without some tools one may not have had before.

Some good news at PPD Support HI–referrals to their services are increasing.

When grassroots organization PPD Support HI started in fall of 2004, it took some time to actually receive a response. …That first phone call. In fact, the first call may have come in 3 months later, in January of 2005. Somewhere the records show whether it came through the Postpartum Support International (PSI) website or, the other very strong possibility, from Nancy Partika then at Healthy Mothers Healthy Babies of Hawaii.

Initially, moms called very concerned and upset and not sure what was “wrong” with them. Sometimes equally concerned fathers or the mom’s mother called to find out what was going on, where to go, or what to do to help.

In the last while though, PPD Support HI has also received more calls from providers looking to refer their clients with “PPD” for support, information and the support group.

Mothers calling are more often calling after being diagnosed these days.

Big shift! Does that mean doctors are diagnosing more often now? Or that mothers are seeking help sooner? Are they going to their doctors saying “I think I have PPD”? Or perhaps the Brown Bags Lunch from October, all about “Perinatal Mood Disorders”, coordinated by Marya Grambs at Mental Health America of Hawaii is still making ripples in the pond, increasing referrals to PPD Support HI.

Good job, Hawaii. You’re making a difference in PPD here in Hawaii.

(I write this blog, and I’m the founder of PPD Support HI, just so you know–and the above is still good news!)

A couple of local not-so-recent stories illustrate that “PPD” does indeed exist here in the paradise of Hawaii.

The first is about a family named Young; the second about a young Big Island girl. I may not get to the second one. Both are about postpartum psychosis, not the generic postpartum depression, nicknamed “PPD”.

The Young story that came out initially November 22, 1965 reappeared in 2001, six days after Andrea Yates of Houston Texas drown her five children.

Why did a 36-year-old story reappear?

Because it had happened before. Another drowning story. Five children. Right here in Hawaii. Brought up again by the Honolulu Star-Bulletin. Reporter Treena Shapiro says in Father Whose Wife Killed Their 5 Children in Aiea in 1965 Urges Compassion, that the 1965 “case remains one of the worst multiple slayings in state history”.

Unknown case, or little remembered. Even the rerun version of the Young’s story washed away again, lost to the Yates’ headlines. Is there a case recorded that is worse than these?

I’ve read the stories (there was a follow up, Bond of Sorrow connecting Russel Yates and James Young, almost a month later too) but coming back from the PSI conference in Houston I’m seeing the stories again, with new eyes. There were people there, connected with the Texas story; kind, composed, low-key, compassionate. Some perhaps still trying to understand. (And a few refusing to even try to understand.)

Maybe the obvious thing to say is that we, the country, didn’t learn the first time around, in 1965 with the Young family. The news stories reached Canada and the UK. Personally I don’t remember it, and my mother wouldn’t have mentioned it to us kids, but when I Googled it today I found the story had run in many states and countries. Did we miss the lesson?

No, I don’t think so. Unlike today (or 2001), there wasn’t 24/7 news on multiple television channels. Mental health (or illness!) “just wasn’t talked about”, except maybe in hushed tones. It was still 20 years before Oprah uncloseted our lives.

Unlike Texas, with a strong leaning towards the death penalty, Hawaii sent Mrs. Young to the State Hospital with no death penalty. In 1965. I’m not sure that would have been much different than prison, back then, no matter what state of the country.

The era of inhumane “snake-pit” institutional care “was gone, but not too far removed” said one Hawaii social worker about the early 1960’s psychiatric hospitals, in a Star-Bulletin story, Giving the lost a home.

There have been stories here in Hawaii since 1965 in which a mother with postpartum psychosis harms or kills her baby(s), herself, or both. Since 2001, there have been a couple. Fewer children involved. Prison time considered strongly. It’s difficult to make sense of what sentence a psychotic incidence will be decided for any given case.

Surely in this day and age, TREATMENT should unquestionably be a given.