Depression during pregnancy, time of delivery & postpartum have been identified with deleterious effects for mother’s, children & families. Disruption to early mother-infant relationships contributes to short- and long-term child outcomes. Depressed mood states in mothers range from brief & mild to chronic & severe. Corresponding outcomes associated with the states may also occur on a continuum from very mild to severe.

Mild depression or “Baby Blues” following the birth of a child is not uncommon & is generally no need for professional interventions. Symptoms which are more severe or persist are identified with Perinatal Depression. Statistically, this condition occurs in approximately 10-15% of women. Identification of symptoms & risks in postpartum mothers is a first step in the process of effective intervention. Facilities that can provide professional services in a variety of setting & that are uniquely tailored to address the personal issues of its community members can make a difference.

In 2007, JPS Health Network, a 450+ bed community teaching, tertiary referral, & Level II Trauma center, identified a need for postpartum depression services in conjunction with Infant Mortality initiatives in Tarrant County. The program was developed & then implemented in winter 2008 in 6 high risk targeted locations serving women & children. Currently, 70% of all deliveries are non-funded or thru emergency Medicaid services. Funding by payors (i.e. Medicaid) for individual, family, or group licensed counseling is not available.

A screening & referral algorithm was developed across departments & disciplines including providers, OB Triage, Emergency Psychiatric services, & outpatient Case Management. Educational culturally-sensitive marketing brochures were developed. A service agreement & contract was initiated with local licensed counselors. The Edinburgh Postpartum Screening Tool was added to all intake forms for women presenting at their 6-week delivery check-up. Thereafter, routine maternal health visits do not occur. Therefore, we implemented the screening to be partnered with routine newborn visits at 2, 4, 6, 9 & 12 month visits.

To date of 2,906 deliveries, there have been approximately 886 postpartum &newborn follow-up visits. This has resulted in 233 referrals for counseling services and 3 admissions for immediate hospitalization due to postpartum psychosis. This is 8% overall of our delivery services. Due to the high risk areas served, it is noted that 42% of the referrals were initiated from the targeted 6 areas. Results have shown that Hispanic patients have accepted & followed thru for counseling services, including family counseling. This is an area for further in-depth studies. This initial pilot project has shown to be effective especially when linked to a newborn follow-up program.