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Lagoski M, Soghier L, Lagata J, Shivers M, Sadler E, Fischer E, Borschuk A, House M. Mental Health Support and Screening for Mood Disorders for Caregivers in the Neonatal Intensive Care Unit: Is the Call to Arms Being Answered? Am J Perinatol 2024. [PMID: 38925161 DOI: 10.1055/a-2353-0993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Abstract
OBJECTIVE Perinatal mood and anxiety disorders (PMADs) affect many neonatal intensive care unit (NICU) parents and are a significant risk factor for maternal suicide. Lack of screening and treatment interferes with infant development and bonding, compounding risks in fragile infants. We aim to describe PMAD screening in level IV NICUs across the Children's Hospitals Neonatal Consortium (CHNC) and to determine the relationship between standardized screening and mental health professionals (MHPs) presence. STUDY DESIGN We surveyed experts at 44 CHNC NICUs about PMADs screening practices and presence of NICU-specific MHPs. Kruskal-Wallis test was used to examine relationships. RESULTS Of 44 centers, 34 (77%) responded. Fourteen centers (41%) perform screening with validated tools. Thirteen (38%) centers have NICU-dedicated psychologists. Formally screening centers tend to have higher cumulative MHPs (p = 0.089) than informally screening centers. Repeat screening practices were highly variable with no difference in the number of cumulative MHPs. CONCLUSION Screening practices for PMADs vary across CHNC centers; less than half have additional MHPs beyond social workers. Creating a sustainable model to detect PMADs likely requires more MHPs in NICUs. KEY POINTS · PMADs affect many NICU parents.. · Systematic screening for PMADs is limited in level IV children's hospital NICUs.. · Additional MHPs may contribute to enhanced screening and support of parents.. · Hospitals should prioritize funds for NICU-specific MHPs to optimize outcomes..
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Affiliation(s)
- Megan Lagoski
- Division of Neonatology, Department of Pediatrics, Feinberg School of Medicine, Northwestern University and the Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Lamia Soghier
- Division of Neonatology, Department of Pediatrics, George Washington University School of Medicine, Children's National Hospital, Washington, District of Columbia
| | - Joanne Lagata
- Division of Neonatology, Department of Pediatrics, Emory University, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | - Miller Shivers
- Division of Psychiatry and Behavioral Health, Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Erin Sadler
- Division of Psychology & Behavioral Health, Department of Pediatrics, George Washington University School of Medicine, Children's National Hospital, Washington, District of Columbia
| | - Elizabeth Fischer
- Division of Pediatric Psychology and Behavioral Medicine, Department of Pediatrics, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | - Adrienne Borschuk
- Division of Psychiatry and Behavioral Sciences, Department of Pediatrics, SUNY Upstate Medical University Upstate Golisano Children's Hospital, Syracuse, New York
| | - Melissa House
- Division of Neonatology, Department of Pediatrics, Emory University of School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia
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Margolis RHF, Patel SJ, Brewer T, Lawless C, Krueger J, Fox E, Kachroo N, Stringfield S, Teach SJ. Implementation of caregiver depression screening in an urban, community-based asthma clinic: a quality improvement project. J Asthma 2023; 60:1677-1686. [PMID: 36755521 DOI: 10.1080/02770903.2023.2178935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/31/2023] [Accepted: 02/07/2023] [Indexed: 02/10/2023]
Abstract
OBJECTIVE Caregiver depressive symptoms are prevalent among children with asthma and associated with greater asthma morbidity. Identifying caregivers with depression and connecting them to appropriate treatment may reduce child asthma morbidity. The goal of this project was to implement a workflow for caregiver depression screening and treatment referral in an urban, community-based, asthma clinic serving under-resourced children. METHODS The Model for Improvement with weekly Plan-Do-Study-Act cycles was utilized. A two-item depression screening tool (Patient Health Questionnaire-2; PHQ-2) and an acceptability question using a 5-point Likert scale were added to an existing social needs screening checklist administered to all caregivers during the child's clinic visit. Caregivers with a positive PHQ-2 score (≥3) received the PHQ-9. Positive screens on the PHQ-9 (≥5) received information and referrals by level of risk. PHQ-9 positive caregivers received a follow-up phone call two weeks post-visit to assess connection to support, improvement in depressive symptoms, and satisfaction with resources provided. RESULTS The PHQ-2 was completed by 84.4% of caregivers (233/276). Caregivers had a mean age of 33.8 years (SD = 8.3; Range: 18-68) and were predominately female (86.4%), Black (80.4%), and non-Hispanic (78.4%). The majority (72.3%) found the screening acceptable (agree/strongly agree). Nearly one in six caregivers (37/233, 15.9%) reported depressive symptoms (PHQ-2 ≥ 3); 11.6% (27/233) had clinically significant symptoms (PHQ-9 score ≥ 10); and 2.1% (5/233) reported suicidal thoughts. Of those with depressive symptoms, 70.3% (26/37) participated in the follow-up phone call. While 50% (13/26) reported the resources given in clinic were "extremely helpful," no caregivers contacted or used them. CONCLUSIONS Caregiver depression screening was successfully integrated into a pediatric asthma clinic serving under-resourced children. While caregivers found screening to be acceptable, it did not facilitate short-term connection to treatment among those with depressive symptoms.
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Affiliation(s)
- Rachel H F Margolis
- Center for Translational Research, Children's National Research Institute, Children's National Hospital, Washington, DC, USA
| | - Shilpa J Patel
- Division of Emergency Medicine, Children's National Hospital, Washington, DC, USA
- School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA
| | - Taylor Brewer
- Center for Translational Research, Children's National Research Institute, Children's National Hospital, Washington, DC, USA
- School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA
| | - Casey Lawless
- Children's Mercy Kansas City Hospital, Kansas City, MO, USA
- UMKC School of Medicine, Kansas City, MO, USA
| | - Julie Krueger
- Division of General and Community Pediatrics, Children's National Hospital, Washington, DC, USA
| | - Eduardo Fox
- Division of General and Community Pediatrics, Children's National Hospital, Washington, DC, USA
| | - Nikita Kachroo
- Center for Translational Research, Children's National Research Institute, Children's National Hospital, Washington, DC, USA
| | - Shayla Stringfield
- Center for Translational Research, Children's National Research Institute, Children's National Hospital, Washington, DC, USA
| | - Stephen J Teach
- Center for Translational Research, Children's National Research Institute, Children's National Hospital, Washington, DC, USA
- Division of Emergency Medicine, Children's National Hospital, Washington, DC, USA
- School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA
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Sadler EM, Okito O, Soghier L. Addressing caregiver mental health in the neonatal ICU. Curr Opin Pediatr 2023; 35:390-397. [PMID: 36974450 DOI: 10.1097/mop.0000000000001242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
PURPOSE OF REVIEW The neonatal ICU (NICU) setting is a unique opportunity to not only detect major changes in caregiver mental health through universal perinatal mood and anxiety disorder (PMAD) screening but also intervene with specialized support. We review evidence for addressing caregiver mental health in the NICU, explore current guidelines and models for integrated behavioural health programmes, and describe challenges specific to NICUs, particularly in standalone paediatric hospitals. RECENT FINDINGS Parents of infants admitted to the NICU are at an increased risk for developing PMADs at rates well above the general postpartum community. Select NICUs within the United States and internationally have recognized the importance of having an embedded psychologist to address caregiver PMADs. However, organizational structures within paediatric healthcare systems are not equipped to manage the logistical, ethical, legal and practical needs of comprehensive caregiver mental health programmes. SUMMARY To properly address caregiver mental health in NICU settings, clinical and administrative teams must work together to ensure seamless service provision. Systems that facilitate the development of unique parent medical records at the onset of paediatric care are likely to significantly reduce potential liability risks and solve several challenges related to caregiver-focused mental health support in the NICU. VIDEO ABSTRACT http://links.lww.com/MOP/A70.
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Affiliation(s)
- Erin M Sadler
- Division of Psychology and Behavioral Health
- Department of Pediatrics
- Department of Psychiatry and Behavioral Sciences, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Ololade Okito
- Division of Neonatology, Children's National Hospital
- Department of Pediatrics
| | - Lamia Soghier
- Division of Neonatology, Children's National Hospital
- Department of Pediatrics
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Shah S. Going Farther by Going Together: Collaboration as a Tool in Advocacy. Pediatr Clin North Am 2023; 70:181-191. [PMID: 36402467 DOI: 10.1016/j.pcl.2022.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
With greater understanding of the impact of social determinants on child health, advocacy has become essential to promoting children's health, particularly at the population level. Successful advocacy requires coalition building. Steps on how to create a productive coalition, including the selection of partner organizations, understanding how these groups enhance your activities, and strict definition of assigned roles is reviewed. Examples of successful coalitions are reviewed. A list of potential partners, who focus on various aspects of child health, is provided.
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Affiliation(s)
- Shetal Shah
- Division of Newborn Medicine C-225A, Department of Pediatrics, Maria Fareri Children's Hospital, New York Medical College, 100 Woods Road, Valhalla, NY 10595, USA.
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Bloyd C, Murthy S, Song C, Franck LS, Mangurian C. National Cross-Sectional Study of Mental Health Screening Practices for Primary Caregivers of NICU Infants. CHILDREN 2022; 9:children9060793. [PMID: 35740730 PMCID: PMC9221644 DOI: 10.3390/children9060793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 05/16/2022] [Accepted: 05/27/2022] [Indexed: 12/02/2022]
Abstract
Universal screening for postpartum mood and anxiety disorders (PMADs) has been recommended for all new parents at outpatient postpartum and well-child visits. However, parents of newborns admitted to the NICU are rarely able to access these services during their infant’s prolonged hospitalization. The objective of this study was to determine the prevalence of mental health screening and treatment programs for parents or other primary caregivers in NICUs across the country. In this cross-sectional study, US NICU medical directors were invited to complete an online survey about current practices in mental health education, screening, and treatment for primary caregivers of preterm and ill infants in the NICU. Comparative analyses using Fisher’s exact test were performed to evaluate differences in practices among various NICU practice settings. Survey responses were obtained from 75 out of 700 potential sites (10.7%). Of participating NICUs, less than half routinely provided caregivers with psychoeducation about mental health self-care (n = 35, 47%) or routinely screened caregivers for PPD or other mental health disorders (n = 33, 44%). Nearly one-quarter of the NICUs did not provide any PMAD screening (n = 17, 23%). Despite consensus that postpartum psychosocial care is essential, routine mental health care of primary caregivers in the NICU remains inadequate.
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Affiliation(s)
- Cooper Bloyd
- School of Medicine, University of California, San Francisco, CA 94143, USA; (C.B.); (S.M.)
- Department of Pediatrics, University of California, San Francisco, CA 94143, USA
| | - Snehal Murthy
- School of Medicine, University of California, San Francisco, CA 94143, USA; (C.B.); (S.M.)
| | - Clara Song
- Southern California Permanente Medical Group, Pasadena, CA 91188, USA;
| | - Linda S. Franck
- School of Nursing, University of California, San Francisco, CA 94143, USA;
| | - Christina Mangurian
- School of Medicine, University of California, San Francisco, CA 94143, USA; (C.B.); (S.M.)
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA 94143, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA 94143, USA
- Correspondence: ; Tel.: +1-415-206-5925; Fax: +1-415-206-8942
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Hicks LM, Ou C, Charlebois J, Tarasoff L, Pawluski J, Roos LE, Hooykaas A, Fairbrother N, Carter M, Tomfohr-Madsen L. Assessment of Canadian perinatal mental health services from the provider perspective: Where can we improve? Front Psychiatry 2022; 13:929496. [PMID: 36213903 PMCID: PMC9537741 DOI: 10.3389/fpsyt.2022.929496] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 09/05/2022] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Perinatal mental health disorders are common, and rates have increased during the COVID-19 pandemic. It is unclear where providers may improve perinatal mental health care, particularly in countries lacking national guidelines, such as Canada. METHODS A cross-sectional survey of perinatal health providers was conducted to describe the landscape of perinatal mental health knowledge, screening, and treatment practices across Canada. Providers were recruited through listservs, social media, and snowball sampling. Participants completed an online survey that assessed their perinatal mental health training, service provision types, their patient wait times, and treatment barriers, and COVID-19 pandemic-related impacts. RESULTS A total of 435 providers completed the survey, including physicians, midwives, psychologists, social workers, nurses, and allied non-mental health professionals. Most (87.0%) did not have workplace mandated screening for perinatal mental illness but a third (66%) use a validated screening tool. Many (42%) providers stated their patients needed to wait more than 2 months for services. More than half (57.3%) reported they did not receive or were unsure if they received specialized training in perinatal mental health. Most (87.0%) indicated there were cultural, linguistic, and financial barriers to accessing services. Over two-thirds (69.0%) reported the COVID-19 pandemic reduced access to services. CONCLUSION Survey findings reveal significant gaps in training, screening tool use, and timely and culturally safe treatment of perinatal mental health concerns. There is critical need for coordinated and nationally mandated perinatal mental health services in Canada to improve care for pregnant and postpartum people.
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Affiliation(s)
- Laurel M Hicks
- Renée Crown Wellness Institute, University of Colorado Boulder, Boulder, CO, United States
| | - Christine Ou
- School of Nursing, University of Victoria, Victoria, BC, Canada
| | | | - Lesley Tarasoff
- Department of Health and Society, University of Toronto Scarborough, Toronto, ON, Canada
| | - Jodi Pawluski
- IRSET - Institut de Recherche en Santé, Environnement et Travail, University of Rennes 1, Rennes, France
| | - Leslie E Roos
- Department of Psychology, University of Manitoba, Winnipeg, MB, Canada
| | - Amanda Hooykaas
- College of Social and Applied Social Sciences, University of Guelph, Guelph, ON, Canada
| | | | - Michelle Carter
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
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