What Every Provider Type Should Know and Do For Maternal Mental Health

The following provider core competencies for maternal mental health were developed and published this year by the California Task Force on Maternal Mental Health Care.  The competencies were developed to address the need for baseline knowledge and skills among various provider types treating perinatal women with the aim of improving detection and treatment.  

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Ob/Gyn, Nurse-Midwife, Primary Care Physician, and PCP Extender/Prescriber Core Competencies:

–    Understand signs and symptoms of the range of MMH disorders and which factors place a woman at high-risk for an MMH disorder

–    Develop knowledge about the valid screening tools for depression, anxiety, and bipolar disorder; where to locate; how to select and use; and when to screen for bipolar disorders

–    Recognize the recommended frequency of screening during pregnancy and postpartum

–    Understand how to interpret screening results

–    Demonstrate ability to assess for safety including suicidality and postpartum psychosis which includes an increased risk of suicide and infanticide

–    Develop knowledge of the menu of prevention/treatment options (drug and non-drug treatments including non-clinical alternative practices)

–    Recognize which medications are safe to start or continue in pregnancy or while breastfeeding; when multiple medications are being utilized or when multiple medications may be needed, seek a specialized reproductive mental health consultation

–    Develop knowledge of how to counsel women with existing psychiatric illness who are planning pregnancies and taking medication

–    Learn about and refer to the local network of MMH services

–    Understand that trouble breastfeeding can be a risk factor for anxiety and depression, and some agents used to help increase breast milk supply may trigger anxiety

 

Nursing (Registered Nurses, Public Health Nurses, and Advanced Practice Nurses) Core Competencies:

–    Understand signs and symptoms of the range of MMH disorders

–    Be able to apply the nursing process of assessment, diagnosis, planning, implementation, and evaluation for a patient population that may be experiencing a wide range of MMH disorders

–    Recognize factors that place a woman at high risk for an MMH disorder and be able to intervene within the specific nursing role

–    Be familiar with validated screening tools for depression and anxiety and follow agency protocols in the selection and use of such tools

–    Develop and implement care plans using screening results and following agency protocols on screening and interventions

–    Be familiar with the menu of prevention/treatment options (drug and non-drug treatments including non-clinical alternative practices) and referral pathways

–    Recognize when patient should be seen by an MD

–    Recognize and refer to the local network of MMH services available in community

–    Recognize that breastfeeding challenges can be a risk factor for anxiety and depression; be familiar with resources to support a mother’s decision to continue or discontinue breastfeeding, especially when medications are involved (i.e., psychotropics, antibiotics, and/or agents used to increase or decrease milk supply

 

Non-MD, Behavioral Health Providers Core Competencies:

–    Understand signs and symptoms of the range of MMH disorders and which factors place a woman at high-risk for an MMH disorder

–    Develop knowledge about the valid screening tools for depression, anxiety, and bipolar disorder; where to locate; how to select and use; and when to screen for bipolar disorders

–    Understand how to interpret screening results

–    Develop knowledge of the menu of prevention/treatment options (drug and non-drug treatments including non-clinical alternative practices)

–    Practice MMH evidence-based psychotherapy (cognitive behavioral therapy, interpersonal therapy, etc.)

–    Recognize when to refer to psychiatry and which psychiatrist is appropriate

–    Demonstrate ability to appropriately counsel women with psychiatric illness who are planning pregnancies and taking medication

–    Recognize and refer to the local network of MMH services available in community

–    Understand that trouble breastfeeding is a risk factor for anxiety and depression; certain medications used to treat mental health disorders are safe for use while breastfeeding; other agents used to help increase breast milk supply may trigger anxiety; and certain medications are safe to continue while breastfeeding while specialized psychiatric consultation is sought

 

General Psychiatrists Core Competencies:

–    Understand signs and symptoms of the range of MMH disorders, including postpartum psychosis and which factors place a woman at high-risk for an MMH disorder

–    Develop knowledge about the valid screening tools for depression, anxiety, and bipolar disorder; where to locate; how to select and use; and when to screen for bipolar disorders

–    Demonstrate competence in assessing for safety, particularly suicide and infanticide, and instituting appropriate acute treatment in pregnant and newly postpartum women

–    Understand how a differential diagnosis (distinguishing of a particular disease or condition from others that present similar symptoms) differs for pregnant and postpartum women versus the general population

–    Develop knowledge of the menu of prevention/treatment options (drug and non-drug treatments including non-clinical alternative practices)

–    Recognize the importance of social support and appropriate psychotherapy and how to develop a plan for assisting patients in accessing these resources

–    Demonstrate competency in counseling women on the risks of untreated relapse versus the risks of potential medication use in pregnancy and lactation

–    Understand which medications are safe to continue in pregnancy or while breastfeeding versus which medications need to be changed immediately

–    Demonstrate ability to appropriately counsel women with psychiatric illness who are planning pregnancies and will need treatment, whether pharmacological or not

–    Demonstrate ability to appropriately counsel women of childbearing age on methods of birth control, their effects on psychotropic medication or symptoms, and where to go for family planning

–    Develop knowledge of when to seek specialized consultation from a reproductive psychiatrist

–    Recognize and refer to the local network of MMH services available in community

–    Understand that trouble breastfeeding can be a risk factor for anxiety and depression; and some agents used to help increase breast milk supply may trigger anxiety

 

Reproductive Psychiatrists Core Competencies:

All competencies required of general psychiatrists plus:

–    Demonstrate ability to manage complex medication regimens in pregnancy

–    Provide pre-pregnancy and postpartum consultation to MDs, for women with severe mental illness and those on complex medication regimens

–    Serve as a resource through expert consultation with a team of providers, including prenatal care, pediatric, social service, and other behavioral health providers

 

Community Health Workers, Lactation Consultants, Doulas, Home Visitors, Childbirth Educators, Peer Support Leaders, etc. Core Competencies:

–    Understand signs and symptoms of the range of MMH disorders and which factors place a woman at high-risk

–    Develop knowledge about the valid screening tools for depression and anxiety. Understand where to locate these screening tools and how to select and use them

–    Understand recommended frequency of screening during pregnancy and postpartum and suggested ‘cutoff’ scores to identify who may have potential anxiety or depression

–    Be familiar with and follow agency protocols for different types healthcare workers involved in addressing MMH, which include prevention and treatment resources and referral pathways

–    Understand that trouble breastfeeding can be a risk factor for anxiety and depression; and some agents used to help increase breast milk supply may trigger anxiety