Hennepin County Medical Center Unveils Mother-Baby Program

The program is The first of its kind in Minnesota to offer a range of mental health services to support women and families.

The delicacy of a newborn is emotionally moving, and a medical fact. Between birth and 3 to 5 years of age, a baby’s brain is in a critical period of development shaped by genetics, environment and day-to-day experiences. One of the most important factors in brain development is the parent-child bond. Stable, nurturing relationships foster healthy development. Unstable, uncertain or neglectful relationships disrupt brain circuitry as it is being built. When a negative relationship continues over time, it can affect a child’s stress response system, immune and cardiovascular systems, socialization, mental health, and ability to regulate emotion and learning.

The importance of the mother-child relationship to early childhood development makes the incidence of maternal depression particularly concerning.

“In the general population, one out of 10 women experiences depression or anxiety symptoms during pregnancy and in the first postpartum year,” explains Helen Kim, M.D., a psychiatrist and Director of the Hennepin County Medical Center (HCMC) Women’s Mental Health Program and new Mother-Baby Program. “That number rises to one out of four women in high-risk groups, including low-income women, teenage moms and women with significant psychosocial stress.”

Group Therapy Room
Mothers with babies younger than 1 year are encouraged to bring their children with them to the Day Hospital and either keep their babies in their arms or allow them to sleep in the nursery that is connected to this group therapy room.

Dr. Kim emphasizes that depressed or anxious mothers are not abusive or “bad” mothers. Rather, they are impaired by a treatable mental health condition that, left unaddressed, can compromise their ability to parent. Depression and anxiety can have negative effects on pregnancy outcome, the health of the mother, and the quality of the mother’s interaction with her child. Research indicates child maltreatment is higher in homes where the mother is depressed. The National Survey of Child and Adolescent Well-Being named maternal depression one of the most treatable risk factors for child maltreatment. And yet, while gestational diabetes, which affects 1 in 20 pregnancies, is addressed in routine prenatal screening, screening for depression is not a routine part of prenatal or postpartum care.

The new HCMC Mother-Baby Program supports families by providing evidence-based mental health care to pregnant and postpartum women suffering with depression and anxiety. It is the first intensive mental health program of its kind in Minnesota and only the fourth in the country. HCMC’s expertise with maternal mental health developed through caring for hundreds of pregnant and postpartum women in the Hennepin Women’s Mental Health Program, founded in 1999 by Dr. Kim; Benita Dieperink, M.D.; and Monica Mandell, Ph.D., L.P.

The establishment of the HCMC Mother-Baby Program was partially supported by several grants, including funding to implement universal perinatal depression screening throughout HCMC. The hospital is one of the few in Minnesota to systematically screen for maternal depression.

“Given the high prevalence of perinatal depression, particularly in HCMC’s population, we needed a systematic approach across all HCMC clinics,” says Dr. Kim. “We did a survey of HCMC perinatal, family medicine and pediatric providers and found a high willingness to screen for perinatal depression but also a strong insistence on specific guidelines for following up with high-scoring patients and access to mental health resources. Provider feedback was loud and clear: ‘Don’t ask us to screen mothers for depression without giving us guidelines for assessment and mental health follow-up.’ This feedback led to the development of the Mother-Baby HopeLine — a phone line perinatal patients and providers can access for mental health triage and resources.”

Anxiety and depression occur during pregnancy and postpartum for many reasons. Risk factors include psychosocial stress, marital strain, lack of social support, and history of depression or struggle at earlier developmental transitions. Depression and anxiety during and after pregnancy can also occur in men. Fathers do not experience the physiological changes, but are impacted by stress related to changing family roles, societal expectations to step up as a provider, and other financial and interpersonal stressors.

“We intentionally chose to start with mothers, though we know that fathers can also suffer from depression and anxiety,” explains Dr. Kim. “Our mission is to strengthen families by supporting the mental health and parenting capacity of mothers. The Mother-Baby Program expands our focus beyond the mother to her relationship with her child. This enables us to strengthen a mother’s ability to interact with her child in a healthy and nurturing way. From research, we know this kind of positive, consistent and responsive care supports healthy brain development in babies.”

Unlike traditional mental health care models that focus on one patient, the HCMC Mother-Baby Program addresses the mother-child dyad and the family system. The Mother-Baby Program offers four distinct services designed to provide mental health support to mothers and families: the HCMC Women’s Mental Health Program, the Mother-Baby Day Hospital, the Mother-Baby HopeLine and the Parent-Child Relationship Assessment/Intervention Program.

HCMC Women’s Mental Health Program

Mother Baby Program Group
Left to right: Tasse Anderberg, mental health associate; Jessica Usem, mental health worker; Dr. Kim; and Jesse Kuendig, program coordinator, bring hope, help and support to new and pregnant moms and their families.

The long-standing Hennepin Women’s Mental Health Program is part of HCMC’s Adult Psychiatry Clinic and offers services to perinatal women who suffer from depression and anxiety and require nonintensive outpatient care. Perinatal psychiatrists, staff psychologists, and psychiatry and psychology trainees offer treatment options, including psychotherapy, psychiatry consultation, diagnostic assessment and medication treatment when appropriate.

“There are a lot of misperceptions about whether medication is safe for pregnant or nursing women,” Dr. Kim observes. “Often, medication is avoided even in cases where it could be used appropriately. Other treatments include education, psychotherapy, social support and engagement with a community.”

The HCMC Mother-Baby Day Hospital

This service is an intensive, outpatient mental health program designed for pregnant women and mothers of very young children who are struggling with their ability to take care of themselves or their children. It provides structured, supportive and more intensive care, which includes group psychotherapy, psychiatric consultation and lactation support. Pregnant patients and mothers with very young children are treated at the day hospital in group therapy sessions conducted from 10 a.m. to 3 p.m. Patients may continue treatment for as long as three weeks. Mothers are encouraged to attend with their babies if they are 12 months or younger and have access to an onsite nursery.

The Mother-Baby HopeLine

Pregnant and postpartum women with mental illness can struggle for months or even years to find appropriate help. Affected women describe feeling alone and being misdirected to providers who lack expertise in maternal depression or parenting.

The HopeLine centralizes access to mental health resources that specifically treat pregnant and postpartum women and struggling parents of young children. One of the goals of the HopeLine is to reduce the risk of child maltreatment and abuse by supporting overwhelmed parents of young children. In addition, through its Provider Education Service, the HopeLine offers support and information to health care providers who are treating perinatal women.

The HopeLine is not a crisis line with 24/7 operators. Instead, callers leave a voicemail. Within two business days, they receive a callback from mental health professionals with expertise in perinatal mental health.

Helen Kim
Helen Kim, M.D., Medical Director of Hennepin County Medical Center’s new Mother-Baby Program

“Trained staff can discern if a mother’s urgent concern is for basic needs like food, clothing or safety, or whether she is struggling with depression and in need of mental health referral,” explains Dr. Kim. “Staff can also assess whether the mother is so overwhelmed that she needs urgent intervention to protect both parent and child. The HopeLine will also partner with existing home-visiting agencies to add in-home mental health and parenting support to our services.”

As part of the HopeLine outreach efforts, the Provider Education Service provides community physicians with information about perinatal mood and anxiety conditions and evidence-based treatments.

“We want to empower providers with evidence-based information about treatment, including psychotherapy and medication, and also give them mental health resources for their pregnant and postpartum patients,” explains Dr. Kim. “Providers can post a question on our website or call with a question. The HopeLine will hopefully one day function like Minnesota’s Poison Control phone line, which is also housed at HCMC. Like the state’s Poison Control program, the HopeLine will be based here at HCMC, but over time, with adequate funding, could serve the whole state and empower perinatal women, distressed parents of young children and their providers with access to appropriate local mental health services.”

Parent-Child Relationship Assessment/Intervention Program

This emerging program serves high-risk families at the intersection of medical, legal and social service systems by providing a one-stop assessment of the mental health and parenting capacity of the caregiver and the quality of the parent-child relationship. Assessments will be integrated into a report that can be used to guide a next-step intervention that may include a mental health intervention for the parent or an in-home or in-office caregiver-child therapeutic intervention.

“We are starting this program with a pilot group of high-risk families involved with child protective services and foster care,” explains Dr. Kim. “Parents involved with foster care are often directed separately to mental health and parenting interventions, as if mental health and parenting are totally separate areas versus highly interdependent. I have often seen high-risk mothers who have six or seven social service, parenting and mental health providers, all in different agencies and all with separate agendas. This fragmented model of support adds stress to high-risk families, sets them up to fail as parents and, worst of all, sets young children up for prolonged foster care placement and disrupted care during a critical period of brain development.”

The goal of the Parent-Child Relationship Assessment/Intervention Program is to create an integrated mental health and parenting evaluation that can be a guide toward specific evidence-based interventions to support a caregiver’s ongoing ability to be a stable and nurturing presence for a child.

Dr. Kim emphasizes the Mother-Baby Program’s goal to support community physicians caring for pregnant and postpartum mothers.

“Every expectant mother, regardless of race or background, feels an innate drive to be the best parent she can be — and fears she isn’t up to the task. Depressed mothers often feel shame that can silence them. This can leave them struggling, while their children experience a mother who may be present physically but is emotionally shut down and unavailable. Physicians have a powerful opportunity to communicate that depression is common, it impacts pregnancy and parenting, and with treatment, parents and children will all be better off.”

When mothers are depressed, the mother-child relationship is being affected, and time is passing. Six months is not developmentally significant to an adult, but it is a critical window in a child’s development.

“The biggest protective factor for a child is a loving adult who sees and responds to him or her in a positive and consistent way,” says Dr. Kim. “A strong and healthy caregiver is a baby’s best hope.”

For further information, contact Hennepin Women’s Mental Health Program, (612) 373-1851; the Mother-Baby Day Hospital, (612) 873-MAMA (6262); or the Mother-Baby HopeLine, (612) 873-HOPE (4673).

Source: MD News June 2013, Twin Cities Edition