THE NATIONAL PERINATAL DEPRESSION INITIATIVE...The National Perinatal Depression Initiative...

THE NATIONAL PERINATAL DEPRESSION INITIATIVE

A synopsis of progress to date and recommendations for beyond 2013

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Suggested citation:

Highet NJ and Purtell CA (2012) The National Perinatal Depression Initiative: A synopsis of progress to date

and recommendations for beyond 2013. Melbourne: beyondblue, the national depression and anxiety initiative.

August 2012.

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Contents

1. Executive summary 3

1.1 Key recommendations 4

2. Background and objectives 6

2.1 Rationale 6

2.2 Background 6

2.3 Objectives of the NPDI 7

2.4 Aims of this report 7

3. Progress to date and recommendations across the

six objectives of the NPDI 8

3.1 The development of perinatal Clinical Practice Guidelines 8

3.2 Workforce training and development for health professionals 10

3.3 Routine and universal screening 12

3.4. Follow-up support and care for women assessed as being at

risk for perinatal depression 14

3.5 Research and data collection 15

3.6 Community awareness 16

4. Future directions 18

5. Summary and recommendations 20

5.1 Summary 20

5.2 Recommendations 22

6. References 23

Appendix 1 26

Appendix 2 27

Appendix 3 28

Appendix 4 35

Appendix 5 36

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Australia has become a world leader in perinatal mental health with significant advances made over the past decade.

This is particularly with respect to the application of research into national mental health reform.

Identification of the high prevalence of depression in the perinatal period1 was followed by the development of a National

Action Plan2 and provided a blueprint for the translation of research into practice. This led to the development of the

National Perinatal Depression Initiative (NPDI) in 2008. The five-year Initiative (2008±13) represents a national approach to

promotion, prevention, early intervention and treatment through the implementation of routine screening and services for

those women at risk of, or experiencing perinatal mental health disorders.

As the Initiative enters the final year of initial funding, it is timely to evaluate progress undertaken to date and identify areas

for future development. This report is designed to provide a synopsis of activity under the six objectives of the NPDI,

review outcomes and provide recommendations for beyond 2013.

Figure 1 Overview of progress to date across the six objectives of the NPDI

Figure 1 highlights that significant progress has been made to date under each of the NPDI objectives. However, as

detailed in this report, there are a number of areas that require ongoing focused activity to consolidate the achievements

to date, and extend the NPDI to achieve the implementation at a national level.

1. Executive summary

1. Develop Clinical Practice

Guidelines

✓ beyondblue Guidelines developed and approved by NHMRC

✓ Dissemination of Guidelines nationally

✓ Evaluation of Guidelines' use fulness and uptake

✓ Guideline executive summary developed and disseminated

Guidelines developed

to inform and promote

best practice

2. Workforce training and

development

✓ Scoping of health professionals' t raining needs

✓ Mapping training needs ± W orkforce Training and Development Matrix

✓ Provision of free, accredited online training programs

✓ Development and dissemination of detection, management and treatment resources for health professionals

Provision and ongoing

uptake of training and

resources for health

professionals

3. Routine and universal

screening

Increasing uptake

of screening across

jurisdictions

4. Follow up support and

care for women at risk

Increasing identification

of local services for

referral

5. Research and data

collection

Variable rates of data

collection and analysis

6. Community awareness

and destigmatisation

Targeted community

awareness and

education activities

✓ Scoping health professional attitudes and barriers to screening

✓ Screening guidelines and tools for health professionals

✓ Online training programs to facilitate screening

✓ Screening is being embedded into practice

✓ Implementation of NPDI across jurisdictions

✓ Development of local pathways to care across jurisdictions

✓ Employment of clinical positions funded under the NPDI

✓ Funding a range of small research projects under the NPDI

✓ Submission ± N ational Maternity Data Development Project

✓ Increasing collection and analysis of data across jurisdictions

✓ Community knowledge/attitudes scoped

✓ Identified needs of consumers and carers

✓ Community awareness campaigns developed

✓ Millions of resources disseminated to consumers and carers

Objective Progress Outcome

NPDI synopsis and recommendations August 2012 3

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1.1 KEY RECOMMENDATIONS

The current synopsis and review highlights the need to maintain a national focus as the Initiative continues to be

implemented nationally across jurisdictions. This is paramount in order to ensure that evidence-based, best practice

continues to be applied consistently, that national momentum is maintained, duplication is avoided, and consistent

messaging is provided at a community level.

In response to this, beyondblue recommends the establishment of a National Centre of Excellence (or equivalent)

in Perinatal Mental Health. The Centre will serve to continue providing national leadership, and support a nationally-

consistent approach to implementation across Australia.

Key objectives of the Centre should include (but not be limited to):

1. Continued national leadership, support and advice for all state and territory governments and partners in the

implementation of screening and services for perinatal women. beyondblue currently provides this leadership under

the NPDI and works closely with the Federal, state and territory governments.

2. Continued advocacy to embed best practice through the consistent implementation of the perinatal

Clinical Practice Guidelines. This includes the continued promotion and provision of the Guidelines (developed by

beyondblue and approved by the National Health and Medical Research Council (NHMRC), 2011) and additional

resources for health professionals. Consideration should also be given to the centralisation of research knowledge.

The Centre would provide a central point for the maintenance of strategic partnerships with professional bodies,

training institutions and service providers.

3. The development and management of national data systems to enable screening data to be collected and

analysed in order to monitor and evaluate the impact of screening and inform service provision. This is currently a

major gap in the NPDI, and is preventing the monitoring and evaluation of screening and referral outcomes on a

national basis. beyondblue has partnered with NHMRC and is undertaking a Data Linkage Study (2012±2 014) that

will provide some insights into the items for data collection, the impact of screening and inform future directions;

however this is retrospective, and requires systems to be developed in order to provide ongoing evaluation.

4. Sustained community awareness, education, and destigmatisation activity. This includes the continued

dissemination of national campaigns and the provision of high-quality, timely, evidence-based information about

perinatal mental health disorders for consumers and carers. beyondblue currently provides this activity under the

NPDI.

5. Integration with support services. In addition to primary care services, there is a range of independent support

organisations that are well placed to provide information, education and support services to women at risk of, or

experiencing, perinatal mental health disorders. Currently, these services work largely in isolation and could be more

actively integrated into the NPDI through the support of the National Centre.

6. Research and advocacy. The Centre would continue to work with Australia' s leading perinatal clinicians and

researchers to ensure the integration and application of research outcomes into clinical practice. The Centre would

also advocate for, and potentially commission, new areas of research (for example, addressing research gaps as

identified in the Guidelines).

NPDI synopsis and recommendations August 20124

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Proposed vision for a National Centre of Excellence in Perinatal Mental Health

3. National data

analytics

and insights

(Currently not occurring

in a systematic way)

2. Support best

practice

(Currently with

beyondblue)

National

Centre of

Excellence in

Perinatal Mental

Health

4. Community

awareness

(This could continue

with beyondblue)

1. Support and

advise the NPDI

(Currently with

beyondblue)

5. Integration with

support services



6. Research and

advocacy

(Currently not

coordinated nationally)

Therefore, the aim of such a Centre is to sustain a national focus for perinatal mental health in Australia. This involves

building upon the significant progress, established partnerships, research and momentum that has been achieved to

date. The Centre would continue to work in close collaboration with beyondblue, health professional bodies, providers

of clinical and support services, and Australia' s leading researchers and clinicians from across the country.


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2.1 RATIONALE

The perinatal period, which includes pregnancy and the year following the birth of a baby, is a time of great change in a

woman' s life, placing her at significantly greater risk of developing depression3 and other mental health disorders. There

is extensive evidence to demonstrate that depression and anxiety can have a significant impact, not only on the mother4,

but also her partner5. Further, there is an ever-growing body of research which reveals the negative impact of depression

and anxiety on the developing fetus6,7,8, and the infant9 which has been associated with developmental delays in the

shorter10 and longer term11 (Refer to Appendix 1).

2.2 BACKGROUND

The beyondblue National Postnatal Depression Research Program (2001±05)

The high rate of psychiatric morbidity and corresponding impact in the immediate and longer term led to the beyondblue

National Postnatal Depression Program being undertaken in 2001± 05. This national research program identified that up

to 10 per cent (one in 10) of women experience depression during pregnancy, and this increases to almost 16 per cent

(one in seven) in the months following the birth of a baby1. This research also revealed the high levels of acceptability

surrounding screening12.

The beyondblue Perinatal Mental Health National Action Plan (2008)

This research substantiated the need for a targeted, national, early screening/detection and intervention program for

women at risk of, and experiencing perinatal depression and anxiety. As a first step toward translating this knowledge

into practice, beyondblue developed the Perinatal Mental Health National Action Plan. The National Action Plan provided

a blueprint to increase awareness, improve assessment, training and workforce development, effective support and

responses to the emotional and psychological wellbeing of women and their families2.

The National Perinatal Depression Initiative (2008±201 3)

In 2008, beyondblue attained government support for the National Action Plan, and at the Australian Health Ministers

Advisory Council (AHMAC) meeting, Federal, state and territory governments agreed to collaborate on the development

of a National Perinatal Depression Initiative (NPDI). The chief aim of the Initiative is to improve prevention and early

detection of perinatal depression and provide better support and treatment for these expectant and new mothers.

In order to achieve this aim, funding under the Initiative has been distributed by the Federal Government to:

1) State and territory government ($30M) to contribute to the roll out of routine and universal screening, support and

treatment services, and training for health professionals. State and territory governments also provided matched

funding ($30M) with the Federal Government under the NPDI.

2) Access to Allied Psychological Services (ATAPS) ($20M) component of the Better Outcomes in Mental Health

Care Program to build the capacity of Divisions of General Practice to improve support for women with perinatal

depression.

3) beyondblue ($5M) to support and advise the Initiative and its implementation. This included the implementation

of structures to facilitate and promote collaboration between the Federal, state and territory governments and

beyondblue, as well as raising community awareness about perinatal depression. beyondblue is also responsible

for developing information and training resources for health professionals who screen and treat new and expectant

mothers for perinatal depression.

2. Background and objectives


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2.3 OBJECTIVES OF THE NPDI

There are six key objectives of the NPDI13 outlined in Box 2.3.

Box 2.3 Objectives of the NPDI

1. Develop national guidelines for screening and management of perinatal depression

2. Workforce training and development of health professionals

3. Routine and universal screening

4. Follow-up support and care for perinatal women assessed as being at risk of, or experiencing perinatal depression

5. Undertake research and data collection

6. Increase community awareness

The context in which these objectives of the NPDI are being implemented is broad and complex. Screening, assessment

and treatment is required across the public and private sectors and involves a wide range of health professionals in the

antenatal period (midwives, obstetricians, general practitioners, mental health practitioners, aboriginal health workers)

and postnatal period (maternal and child family health nurses, general practitioners, mental health practitioners, aboriginal

health workers).

2.4 AIMS OF THIS REPORT

In approaching the final year of the NPDI under the initial five-year funding agreement, the need to evaluate outcomes is

paramount and becomes increasingly apparent.

Figure 2.4 beyondblue Perinatal Journey

While the initial Perinatal Framework for the NPDI indicated that an evaluation of the Initiative would be led by the Federal

Government, in association with state and territory governments, to date this has not occurred.

In response to the need to assess progress under the Initiative, beyondblue has sought to provide a synopsis and

highlight areas for future development.

The aims of this report are to:

i) provide a synopsis of progress to date under the Initiative

ii) identify gaps in the implementation of the NPDI to date

iii) make recommendations to inform future directions of the Initiative beyond 2013.

The current report provides an outline of each of these elements across the six objectives of the Initiative. Further, the key

roles of state and territory governments and beyondblue are highlighted with respect to work undertaken to date, and

recommendations are made for the future.

2001 20092005 20132003 20112007 20152002 20102006 20142004 20122008

beyondblue National Postnatal Depression Program

National Action Plan

National Perinatal Depression Initiative

Future investment recommendation


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3.1 THE DEVELOPMENT OF PERINATAL CLINICAL PRACTICE

GUIDELINES

Objective

The development of national Clinical Practice Guidelines to guide and inform best practice

among health professionals with respect to screening, treatment and management of postnatal

depression.

The development of Clinical Practice Guidelines

Under the NPDI, beyondblue was responsible for the development of Clinical Practice Guidelines14 to

guide and inform primary health care professionals in the screening and management of depression

in primary care settings. This was achieved through the formation of a Guideline Expert Advisory

Committee (GEAC) comprising of experts representing all disciplines in maternity (midwives, maternal

and child health nurses, obstetricians) and mental health (psychiatrists, psychologists) together with

consumers and carers.

While beyondblue was required only to develop guidelines with respect to depression specifically, it

was advised that it was unethical to focus solely on depression (as stipulated under the NPDI), as

the screening process would potentially identify other mental health disorders. As a result, the Guidelines were more

expansive and covered four mental health disordersÐd epression, anxiety and bipolar disorder in the antenatal and

postnatal periods, as well as puerperal psychosis.

On completion, the Guidelines were approved by the NHMRC in February 2011. Since their release, beyondblue and

state and territory partner and health professional bodies have promoted the Guidelines widely to health professionals

and service providers. This has been achieved through guideline presentations and workshops at conferences, media

interviews and editorial content, as well as articles published in scientific journals both nationally15 and internationally16.

Since their release, there has been ongoing high demand for the Guidelines from health professionals, resulting in the

dissemination of 16,853 hard copies and over 6,818 downloads of the Guidelines from the beyondblue website,

and reports that they have been among the most highly-accessed guidelines in Australia (National Institute of Clinical

Studies, NICS). This is likely to reflect the growing momentum of the NPDI as the Guidelines are embedded into practice.

Further, an independent evaluation of the Guidelines commissioned by beyondblue revealed them to be rated as highly-

relevant and applicable to the range of health professionals involved in the delivery of maternity and primary care, as well

as consumers and carers17.

The development of companion documents ± H ealth professionals

beyondblue was also required to develop resources for health professionals. In response to this, a suite of resources has

been developed in consultation with health professionals working across the range of maternity and primary care settings

in order to support Guideline implementation. These resources are outlined in Box 3.1, and a more detailed description is

provided in Appendix 2.

Since the official launch of these companion documents in April 2012, there has been significant uptake amongst health

professionals with over 3,500 Health Professional Packs ordered and disseminated in the first two months.

3. Progress to date and recommendations across the six objectives of the NPDI


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Box 3.1 Perinatal Clinical Practice Guideline resources (companion documents): Clinical documents

developed for health professionals

• Perinatal clinical practice guidelines ± E xecutive Summary: A guide for primary care health professionals

• Psychosocial assessment and management of perinatal mental health disorders: A guide for primary care health

professionals

• Edinburgh Postnatal Depression Scale (EPDS) scoring pads

• Edinburgh Postnatal Depression Scale (EPDS) scoring wheel (to assist with interpretation of EPDS scores and

follow-up action)

• Fact Sheet series to guide treatment and management of perinatal mental health disorders:

± Identifying and managing depression and anxiety in the perinatal period

± Managing bipolar disorder in the perinatal period ± A guide for primary care health professionals

± Managing puerperal (postpartum) psychosis ± A guide for primary care health professionals

± Information for health professionals regarding infant cognitive and emotional development.

The development of companion documents ± C onsumers and carers

beyondblue has also developed resources for consumers and carers to ensure they have access to appropriately-

targeted, evidence-based information derived from the Guidelines. These resources cover the spectrum of four mental

health disorders across the perinatal period.

In particular, two new booklets have been developed specifically for consumers and carers, focusing on:

• emotional health and wellbeing

• managing mental health conditions.

The second booklet, Managing mental health conditions during pregnancy and early parenthood,

imparts information from the Guidelines. It contains detailed information about the signs of the

different perinatal mental health disorders, an overview of treatments and where and how these

treatments can be accessed. Issues surrounding the role and safety of medications are discussed,

highlighting the importance of seeking specialist advice for the more severe disorders. Developed

in consultation with consumers, carers, state and territory partners and health professionals

representing all relevant disciplines, this 47-page booklet also provides tips, strategies and useful

contacts for consumers and carers.

These new resources for consumers and carers (see also section 3.6) will be made available in the coming weeks.

FUTURE CONSIDERATIONS ± C LINICAL PRACTICE GUIDELINES

Since their release, awareness and demand for the Guidelines and companion documents continues to increase. In

order to maintain momentum around screening and Guideline implementation, promotional activity needs to continue

through collaboration with state and territory partners and health professional bodies. There is also potential to enhance

this activity through the ongoing establishment of partnerships with universities, training colleges, professional bodies and

Medicare Locals with the aim of embedding the Guideline recommendations into clinical practice.

Secondly, as this demand is likely to continue with the implementation of screening, treatment and management under

the NPDI, it is important to consider if and how these resources can continue to be made available at no cost

to health professionals, consumers, carers and their families. This is considered important in order to continue to

embed the Guideline recommendations into practice among health professionals and provide evidence-based healthcare

information to consumers and carers.

As a requirement of NHMRC, the Guidelines will need to be formally revised in 2016. Further, should there be any

significant developments in the perinatal area, this will require a review of the Guidelines to ensure they remain current

and continue to inform best practice.

Finally, there were a number of areas within the Guidelines where there was insufficient evidence to make

recommendations and hence good practice points were devised. Therefore, it is recommended that further research

is required to address these areas and inform best practice. This could be achieved by commissioning targeted

research with Australian experts across the relevant clinical areas.


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3.2 WORKFORCE TRAINING AND DEVELOPMENT FOR

HEALTH PROFESSIONALS

Objective

To equip health professionals with the knowledge and skills to increase their confidence and

competence to detect and/or manage depression in primary and maternity care settings

across Australia.

Scoping health professionals' con fidence, competence and training needs

In 2010, beyondblue conducted qualitative research with health professionals (obstetricians, general practitioners,

midwives, maternal and child health nurses) to assess their awareness and understanding of perinatal mental health

disorders and to ascertain their confidence and competence to detect, treat and manage perinatal mental health

disorders18.

This research identified the need for the Guidelines and training of maternal and child family health nurses and midwives

who are at the frontline of service delivery and ideally placed to provide screening and referral for women. The research

also revealed variable levels of knowledge and competence amongst general practitioners and highlighted the need for

women to be proactive in raising the issue within the general practice settings.

With respect to obstetricians, there was not only a lack of awareness of perinatal mental health disorders generally, but

also a perception that the incidence of mental health disorders was very low amongst their patients. Paradoxically, this

was in contrast to women who indicated that they would not disclose mental health problems to their obstetrician as

they were ashamed or felt that they were in a position where depression/anxiety was unacceptable19.

In addition to the reported lack of knowledge and skills across the range of health professionals, the research also

highlighted a number of barriers to screening and provision of care, including a lack of time and uncertainty regarding

appropriate referral and management practices. In turn, this research has informed the development of beyondblue

education and training programs and resources.

Mapping training needs ± t he development of the Workforce Training and

Development Matrix

In order to scope the education and training needs of health professionals who would be involved in the perinatal care of

women, beyondblue formed a national Workforce Training and Development Committee under the NPDI. The committee

was comprised of experts from a range of health, mental health, maternity and training/education disciplines, consumers,

carers and representatives from the Federal Government and each state and territory government involved in the

implementation of the NPDI, and beyondblue.

Under this committee, a training matrix was developed (see Appendix 3). Informed by the beyondblue perinatal Clinical

Practice Guidelines, the Matrix guides health professionals to identify training needs/objectives for those delivering

basic, intermediate and advanced levels of care, and provides those developing programs with a framework to assist

with preparation of courses and curriculum. The Matrix also identifies key objectives in increasing ` Awareness and

understanding' of perinatal mental health disorders.

Since its development, the Workforce Training and Development Matrix has been placed on the beyondblue website and

is used to inform the development of training programs and curricula across university and tertiary education settings,

both nationally and internationally. In addition, beyondblue provides and maintains a directory of training programs and

providers across the country, to assist in the alignment with the Matrix.


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The development of online training programs

Under the NPDI, beyondblue has developed a free, fully-accredited, online training program to impart knowledge around

screening, treatment and management of perinatal mental health disorders in primary and maternity care settings

(www.thinkgp.com.au/beyondblue).

The beyondblue online training program Beyond babyblues: Detecting and managing perinatal mental health disorders

in primary care is tailored to the Basic Skills section of the beyondblue Workforce Training and Development Matrix

described in the previous section. As such, the program equips health professionals with the necessary tools to identify,

screen, refer and treat perinatal depression and/or anxiety, and provide information and referral surrounding the more

severe disorders. The uptake of the various training programs continues. To date, 3,144 people are participating in,

or have completed (N=1,020) part of, or the entire entire beyondblue online training program.

More details about the development of the beyondblue online training program, objectives and accreditation are detailed

in Appendix 4.

Several online training programs have also been developed by various states including South Australia, New South Wales

and Queensland. As with the beyondblue program, each of these has been designed for health professionals, is free,

and each has a slightly different focus in terms of its learning objectives. All online training programs developed under the

NPDI continue to be accessed by a range of health professionals.

In addition to the above online training, thousands of health professionals have received face-to-face training

across various jurisdictions.

Royal Australian and New Zealand College of Obstetricians and

Gynaecologists (RANZCOG) position statement

As highlighted in beyondblue' s research, there was a significant lack of awareness of perinatal mental health disorders

particularly amongst obstetricians. Given the high proportion of women accessing private maternity care (30%), the need

to collaborate with RANZCOG was deemed essential. This led to collaboration with key leaders and has resulted in the

development of a position statement that reflects the beyondblue Clinical Practice Guidelines and plans are underway to

launch and promote the statement with the College.

FUTURE CONSIDERATIONS ± WORKFORCE TRAINING AND DEVELOPMENT

Stakeholders have highlighted the need for a national agency or centre to continue to lead and inform national training

opportunities and be identified as a repository of information about perinatal training programs nationally. In addition,

the Agency could possibly become an accreditation body and be responsible for developing standards (reflecting the

Guidelines and Matrix) and potentially endorsing perinatal training programs and resources.

Such an approach would be viable, given the ongoing need for training (both face-to-face and online) to support the

uptake of screening under the NPDI. This is particularly necessary in those areas with a high staff turnover. A national

approach would also ensure that all training programs are consistent, reflect the Clinical Practice Guidelines as

well as reflect state and territory government policies and referral pathways.

There is also the need for the provision of intermediate and advanced training programs where online training is

not suitable because face-to-face mentoring, supervision and/or peer support is required. Further, it is recommended

that current training programs are expanded to cover issues surrounding the assessment of the infant, and further

dissemination of customised programs for those working with Indigenous and culturally and linguistically diverse

(CALD) communities. While some training programs have been established for people working with Indigenous and

CALD communities specifically, the suitability of these programs for broader use needs to be scoped (for specific

community groups), and if appropriate, made available nationally.

Finally, dissemination of training needs to build on partnerships with professional bodies, service providers (e.g. Medicare

Locals) and training institutions, and to integrate core elements of established programs into curricula. There needs

to be greater uptake of training among general practitioners as well as those health professionals working within

the private sector generally. It is also important to consider ways of targeting training to those practising in rural and

remote areas.


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3.3 ROUTINE AND UNIVERSAL SCREENING

Objective

To implement routine screening across antenatal and postnatal primary care and maternity settings

to identify those women at risk of, or experiencing antenatal and/or postnatal depression.

Scoping health professionals' at titudes and identifying barriers to screening

Under the NPDI, beyondblue research with a range of health professionals (general practitioners, obstetricians, midwives,

maternal and child family health nurses) sought to explore awareness and understanding of perinatal mental health

issues and competence and confidence to identify, treat and manage perinatal mental health disorders in primary care18.

With respect to screening specifically, several barriers were identified. These included a lack of knowledge surrounding

perinatal mental health generally, the lack of skills and training resulting in low levels of confidence and competence to

undertake screening, insufficient time to implement the screening process itself and, insufficient time and skills to manage

the potential outcomes of screening.

The development of screening guidelines, and resources for healthcare

professionals

In order to increase the knowledge, skills and ability of health professionals to undertake screening, these issues were

specifically addressed in the development of the Clinical Practice Guidelines. The Guidelines provide health professionals

with specific guideline recommendations and good practice points pertaining to when and how to screen in the antenatal

and postnatal periods. In addition to screening for possible depression and/or anxiety using the Edinburgh Postnatal

Depression Scale (EPDS)20, the Guidelines also include screening for risk factors which may identify women who may

be at risk of developing a range of mental health disorders (psychosocial risk questionnaire) and prompt additional

assessments and referrals as required.

This information surrounding the screening elements of the Guidelines is being widely disseminated through several

specific companion documents developed to guide health professionals in the screening process. Information resources

pertaining specifically to screening include the Psychosocial assessment and management of perinatal mental health

disorders: A guide for primary care health professionals, the EPDS scoring wheel, and EPDS scoring pad (refer to

Appendix 2).

The development of online training programs to facilitate screening

To increase the competency of health professionals who are well-positioned to undertake screening and referral, a

number of the online training programs address screening specificallyÐin cluding the beyondblue online training program

Beyond babyblues: Detecting and managing perinatal mental health disorders in primary care, which has dedicated

accredited modules focusing specifically on screening and pathways to care. To date, around 800 health professionals

have completed, or are currently completing, the modules which specifically focus on screening.

Embedding screening into practice

In addition to providing advocacy, training and resources at a national level, several policies and initiatives have been

implemented at a state and territory level to promote screening across primary care and maternity settings. As a result

of this activity and advocacy screening is being increasingly implemented routinely across all jurisdictions, although

screening rates do vary.

One of the challenges when attempting to ascertain the level of screening currently underway under the NPDI, is the

varying methods (or absence) of data collection, both across and within states and territories21 and health professions.

As a result, it is not possible to ascertain accurate rates of screening to date under the NPDI (refer to Section 3.5 of

current report). While the nature and rates of screening vary considerably, there are however, some consistent themes

which have emerged anecdotally.


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Key observations pertaining to the implementation of routine screening

• Increasing overall rates of screening in the perinatal period: While in some areas it is unknown where, how, or

the extent to which screening is underway, there are many indicators to suggest that screening rates are increasing

over time across Australia.

• Wide variation in the implementation of screening: There is wide variability in the uptake of screening across

and within states and territories. This is particularly due to historic factors including for example, the long-time focus

on screening in metropolitan Western Australia and the introduction of state government policies such as the SAFE

START model as outlined in the New South Wales Health/Families NSW Supporting Families Early Package (2009).

• Higher rates of screening in the public sector: In line with the NPDI, screening is more prevalent in the public

sector, with screening routinely implemented across numerous health services and jurisdictions. Alternatively,

screening in the private sector is in its infancy with several pilot studies currently underway.

• Various levels of screening and screening tools are being implemented: While the Clinical Practice Guidelines

recommend that the EPDS is for the detection of depression and anxiety in the perinatal period, this scale is not

universally implemented at this time. In addition, the Guidelines identify that it is good practice to use a psychosocial

assessment tool to identify those women who are at risk of developing mental health problems in the perinatal period.

To date, however, there is no standardised toolÐh ighlighting the need for further research and development in this

area.

• Screening across Indigenous and CALD populations: Significant research and development work needs to be

undertaken in order to adapt screening tools and processes for these population groups.

• Screening is more likely in maternity care settings (excluding private) than in general practice: While screening

by midwives, and maternal and child family health nurses is increasing in a more standardised way across services,

the uptake of screening in general practice can be described as more ad hoc.

Potential barriers to screening

While there has been no formal evaluation of the current barriers to screening under the NPDI, consultations with

stakeholders who are implementing screening highlight a range of potential barriers (see Box 3.3). Many of these barriers

reflect those identified in the initial research with health professionals detailed in the previous section.

Box 3.3 Potential barriers to screening

1. Need for health professionals to have a greater awareness of the importance of screening

2. Inadequate mandatory training among health professionals

3. Lack of a consistent approach to screening across health professions

4. Time restrictions (i.e. insufficient allocation of time)

5. Limited referral pathways to support women following screening, if required

6. Lack of attendance to routine health checks to enable screening to be undertaken (particularly among Indigenous

people)

7. Need for further regulation (advocating for policy) and clinical leadership surrounding screening policy and

practice.

FUTURE CONSIDERATIONS ± R OUTINE AND UNIVERSAL SCREENING

It is recommended that there is continued leadership and advocacy to promote the uptake of universal screening

for perinatal women and promote a consistency of approach to screening (as stipulated in the Clinical Practice

Guidelines). This includes the continued promotion and provision of the perinatal Guidelines, screening tools,

information resources for health professionals and accredited training programs to embed screening into

professional practice.

Identification of the potential barriers to screening highlights a number of areas that need to be addressed, including

the need to scope and refine policies and practices to facilitate screening, and explore how provision of pathways to

care can be facilitated. This could include the development of an online directory, which could be accessed by health

professionals at the point of screening and referral (see Section 3.4).


211206_1012_BL1040.indd 13 23/10/12 11:49 AM

3.4. FOLLOW-UP SUPPORT AND CARE FOR WOMEN

ASSESSED AS BEING AT RISK FOR PERINATAL DEPRESSION

Objective

To provide timely follow-up support and care for women assessed as being at risk or experiencing

perinatal depression.

Implementation of NPDI across jurisdictions

Since the commencement of the NPDI in 2008, there has been significant recruitment and activity across the states

and territories to implement the Initiative. The number, type and nature of services vary across jurisdictions in order to

accommodate local need (details of which would be reported in the state and territory government progress reports to

the Federal government).

Pathways to care

All state and territory partners have dedicated time and resources to identify and/or establish pathways to care, to enable

women to be referred to appropriate services. While in some jurisdictions this has occurred at a localised level, for others

there appears to have been a scoping and mapping of pathways to care across the states and territories more broadly.

FUTURE CONSIDERATIONS ± F OLLOW-UP SUPPORT AND CARE

With the current commitments extending until June 2013, there is strong support for continued funding to state and

territory governments to enable these clinical services to continue to be offered under the NPDI. Further, there is

likely to be a need to expand these services to meet the local needs as the rates of screening are increased across

the country. In some areas, this needs to occur across both metropolitan and rural areas, whereas in other cases, the

focus is required across rural areas, particularly where currently, there are no dedicated services or positions.

Future funding of services across states and territories also needs to take into account the need for dedicated staff and/

or services to meet the specific needs of Indigenous and CALD consumers.

The provision of follow-up care and support for women in the private sector also remains an issue. As described in the

previous section regarding screening, due to the current lack of screening undertaken in the private sector, it is likely

that perinatal mental health disorders remain undetected and hence, follow-up care and support is not provided to

these women.

While scoping of referral pathways has occurred across jurisdictions (to varying degrees), to date this has resulted in

health workers becoming aware of pathways in their own areas, however, services outside of these areas or specific

regions are likely to remain unknown. This highlights the need for scoping and potential development of a national

online Pathways to Care service map/directory, which could be populated by local areas to provide greater awareness

of preventative, support and clinical services available across jurisdictions. If such a resource was to be developed it

would require ongoing maintenance in order to provide health professionals with appropriate referral pathways to

facilitate timely and appropriate referral. In addition providers could upload and update their details and those of

their services.

State and territory representatives also highlight the need for clear communication for both health professionals, and

consumers and carers, regarding how to access ATAPS funding or Medicare items for perinatal mental health.

The requirement for services to be equipped to address the broader spectrum of mental health needs has also been

identified. Under the NPDI, screening and psychosocial assessment is likely to reveal a range of perinatal mental health

disorders (as covered in the Guidelines) and hence, services need to be equipped with the knowledge, skills and referral

pathways to refer these women. This is particularly the case for those who may be experiencing severe mental health

problems, including the need for mother and baby units which are currently not available or easily accessible to public

patients in several states and territories.

Finally, while recognised as being out of scope of the current NPDI, many state and territory representatives highlighted

the need for existing services to expand their remit to include issues surrounding the assessment and management of

the infant, in particular, by addressing issues pertaining to mother-infant attachment.


211206_1012_BL1040.indd 14 23/10/12 11:49 AM

3.5 RESEARCH AND DATA COLLECTION

Objective

To undertake research and data collection to inform activity and progress under the NPDI.

Data collection ± cu rrent status

While a national approach to screening is currently being implemented across the country, to date, there has been

no national approach to data collection across jurisdictions. As a result, data collection across states and territories

is variable both within and across jurisdictions and in terms of the type of information that is being collected and the

way in which it is being recorded. For example, in some areas, there is no collection/recording although in other areas,

there are multiple (disconnected) databases or data systems. Further, many data collection systems are manual and/or

inadequate. Some electronic data systems are being changed or modified to include more perinatal information. Despite

these positive developments at local levels, however, there remains no national, unified approach.

As a result, the only way in which national information pertaining to screening outcomes and the impact of follow-up

care can currently be assessed is retrospectively through the analysis of perinatal Medicare/ATAPS items. However, this

presents an incomplete picture, as often, items cannot be aligned with respect to the perinatal period and information

derived will be purely retrospective.

The absence of a national approach to data collection also prevents gathering of important information (such as

screening rates, screening outcomes, service outcomes and cost effectiveness) from being captured and used to inform

service provision at a local, state and national level.

Submission to the National Maternity Data Development Project

In response to the lack of consistency of the type of information recorded, beyondblue provided a detailed submission

to the National Maternity Data Development Project being undertaken by the National Institute of Health and Welfare.

The Submission advocated for the capture of data pertaining to the psychosocial risk assessment and EPDS (as

recommended in the Clinical Practice Guidelines) to be consistently captured on a national basis (many maternity data

items are currently collected only on a state and territory basis). The outcome of this is yet to be released.

NHMRC and beyondblue Linkage Grant

External to the NPDI, beyondblue has committed financial and in-kind support as a partner organisation in an NHMRC

Linkage research grant (2012±201 4) and is represented as a Chief Investigator on the Project. This research aims to

evaluate the impact of perinatal mental health initiatives on mental health outcomes, which is critical for optimising the

quality and uptake of services. In addition, this will assist in the identification of key data items to be embedded into

the national minimum perinatal data set. This project is unique in that it will use very large population health datasets to

examine the impact of the reforms on maternal health outcomes, service utilisation and the likely cost-effectiveness of

these services. The specific aims and objectives of the Linkage Grant are detailed in Appendix 5.

FUTURE CONSIDERATIONS ± R ESEARCH AND DATA COLLECTION

With a range of research activities and evaluations being carried out under the NPDI, it is important to impart outcomes

which may have applications across jurisdictions. While this does occur currently at an informal level, this could be

enhanced through the provision of a Centre of Excellence by a national organisation.

It is recommended that consideration is given to establishing nationally-consistent items for collection and inclusion

in the national minimum data set to enable screening and treatment outcome information to be captured, analysed

and ultimately inform service provision and fiscal decision making. The potential for agreement is now increased with

the release of the Guidelines and uptake of routine psychosocial assessment.

Other issues currently pertain to data management systems, which need to be aligned with the Federal Government' s

data management strategy. Currently, there are multiple data sets that are not integrated.


211206_1012_BL1040.indd 15 23/10/12 11:49 AM

3.6 COMMUNITY AWARENESS

Objective

To raise awareness of the increased risk of depression, anxiety and other perinatal mental health

disorders during pregnancy and the year following and reduce the stigma to promote help seeking.

Assessing community knowledge and attitudes (quantitative research)

In order to determine the Australian community' s levels of awareness, knowledge, understanding

and attitudes surrounding perinatal mental health disorders, a national survey of 1,200 people

was initially conducted in 200922 and recently repeated in 2012. The results from this survey (the

beyondblue Perinatal Monitor) revealed that there are high levels of confusion between the baby

blues and postnatal depression, and the importance of family and friends as supports for those who

may be experiencing postnatal depression. Postnatal depression is regarded as serious and requiring

treatment across the community, and stigma among the broader community was not as concerning

as that observed among older people in particular. The community was also seen to hold positive

attitudes on screening for depression during pregnancy and in the postnatal period.

Identifying needs of consumers and carers (qualitative research)

Research undertaken with consumers and carers23 with a personal experience of perinatal depression and/or anxiety

revealed that, in most instances, early symptoms were missed as they were viewed as normal in the context of

pregnancy or having a baby, and hence treatment was not sought until the condition had reached the point where the

person was unable to cope from day to day24. While rates of stigma were not high across the broader community (as

indicated in the perinatal monitor), there were very high levels of self stigma, which prevented women from seeking help,

as well as disclosing their symptoms at the point of screening. This was largely because women feared this would reflect

badly on them as individuals, indicate that they were `b ad' mot hers, or in some instances, result in their infant or child/ren

being removed from their care25.

National community awareness campaign ± Ju st Speak Up!

The observed high rates of stigma, particularly self stigma, ultimately informed the development of a

national community awareness campaign `Ju st Speak Up'. Th e campaign, which featured high-

profile and everyday people talking candidly about their experience of depression and anxiety, directs

people to a dedicated website (www.justspeakup.com.au) where they are encouraged to read about

other people' s experiences and add their own story.

While the campaign has been developed for television, radio and print, limited funds have prevented

the campaign from being disseminated more broadly. Despite this, to date, there have been 43,934

visitors to the website, and over 278 stories uploaded since the launch of the campaign in

November 2010.

Education resources for consumers and carers

Developed by beyondblue, the Emotional health and wellbeing during pregnancy and early

parenthood booklet is intended for all pregnant women, mothers (and their partners), and contains

information about the importance of looking after the health and wellbeing of both parents. In a

number of studies, such a resource has been used effectively as a tool to educate and encourage

parents to employ a range of strategies that may ultimately prevent the development of mental health

problems, and/or facilitate early detection and help seeking. In addition, this booklet briefly outlines

the different types of mental health conditions that women are at greater risk of developing in the

perinatal period. These conditions are addressed in more specific detail in the second companion

booklet Managing mental health conditions during pregnancy and early parenthood (refer to section

3.1 for further information). Both booklets were developed in close consultation with consumers,

carers and health professionals, and contain consumer and carer perspectives throughout.


211206_1012_BL1040.indd 16 23/10/12 11:49 AM

In addition, beyondblue had also developed a flyer Understanding perinatal depression and anxiety, which

provides an overview of the more common mental health conditions and references more detailed resources,

information and support services available.

Information resources for Indigenous populations

Under the NPDI, several other campaigns and resources have been developed, including for

example, the Queensland Stay connected, stay strong ¼ b efore and after baby mental health

promotion DVD and a series of posters to promote awareness of health and wellbeing in Queensland.

Western Australia has also developed radio advertisements in line with the beyondblue Just Speak Up

Campaign specifically for Indigenous people, as well as resources for health professionals, consumers

and carers. South Australia has developed and distributed specific resources for Aboriginal

communities living in the EP Ylands.

Hey Dad booklet

This 16-page booklet is specifically designed for new fathers to provide some practical tips and

advice on the transition to fatherhood. Initially developed by Ngala WA, the booklet has been

expanded to incorporate information pertaining to mental health, and particularly recognising

early signs of depression and anxiety, and information about help seeking. beyondblue is able to

disseminate this booklet free of charge through funding received from the Movember Foundation.

FUTURE CONSIDERATIONS

The confusion surrounding perinatal mental health disorders in the community and high levels of self stigma

highlight the need for ongoing community awareness activity to underpin the NPDI beyond 2013. This will ultimately

encourage women (and partners) to speak up and seek help early, as well as maximise the potential for screening

(which is being implemented) to detect these conditions promptly. While there has been capacity to develop the Just

Speak Up campaign, there has been limited funding available to disseminate the campaign broadly and hence capitalise

on this investment to date.

Under the NPDI, most state and territory governments and partners rely on beyondblue to develop and provide

community awareness strategies including campaigns (e.g. Just Speak Up) and a range of resources, which are then

disseminated throughout the states and territories. In order to build upon developments to date, it is important to

continue to invest in community awareness activity to ensure the delivery of consistent messages across the country.

Several states governments have developed their own campaigns/community awareness resources (e.g. Queensland,

Western Australia and South Australia) to target Indigenous communities specifically. In turn, discussions have

commenced regarding the potential adaptation and expansion of locally-developed campaigns and resources so

that these can be tested and made available nationally.


211206_1012_BL1040.indd 17 23/10/12 11:49 AM

The current synopsis and review highlight the need to maintain a national focus as the Initiative continues to be

implemented nationally across jurisdictions. This is vital in order to ensure that evidence-based, best practice continues

to be applied consistently on a national scale, that duplication is avoided, and consistent messaging is maintained across

the community.

In order to build on the significant developments to date and address the considerations identified in the current report

under each of the NPDI objectives, it is recommended that support be given to the establishment of a national perinatal

entity, such as a National Centre of Excellence (or equivalent) in Perinatal Mental Health.

Key objectives of the Centre should include (but not be limited to):

1. Continued national leadership, support and advice for all state and territory governments in the implementation of

screening and services for perinatal women. beyondblue currently provides this leadership under the NPDI and works

closely with the Federal, state and territory governments.

2. Continued advocacy to embed best practice through the consistent implementation of the perinatal Clinical

Practice Guidelines (developed by beyondblue and approved by NHMRC in 2011). This includes the continued

promotion and provision of the Guidelines and additional resources for health professionals. Consideration should

also be given to the centralisation of research knowledge and training programs. The Centre would provide a

central point for the maintenance of strategic partnerships with professional bodies, training institutions, and service

providers.

3. The development and management of data systems to enable screening data to be collected and analysed in

order to monitor and evaluate the impact of screening and inform service provision. This is currently a major gap in

the NPDI, and is preventing the monitoring and evaluation of screening and referral outcomes on a national basis.

beyondblue has partnered with NHMRC and is undertaking a Data Linkage Study (2012±2014) that will provide some

insights into the impact of screening, however, this will not inform current service utlisation or needs.

4. Sustained community awareness, education and destigmatisation activity ± This includes the continued

provision of high-quality, timely, evidence-based information about perinatal mental health disorders for consumers

and carers. beyondblue currently provides this activity under the NPDI.

5. Integration with support services ± I n addition to primary care services, there is a range of independent support

organisations that are well placed to provide information, education and support services to women at risk of, or

experiencing perinatal mental health disorders. Potentially, these services could be more actively integrated into the

NPDI.

6. Research and advocacy ± Th e Centre would continue to work with Australia' s leading perinatal clinicians and

researchers to ensure the integration and application of research outcomes into clinical practice. The Centre would

also advocate for, and potentially commission, new areas of research (for example, addressing research gaps as

identified in the Guidelines).

The Centre would provide this leadership and integration across the components of the NPDI, by working in close

collaboration with beyondblue, health professional bodies, providers of clinical and support services, and Australia' s

expert researchers and clinicians from across the country.

4. Future directions


211206_1012_BL1040.indd 18 23/10/12 11:49 AM

Figure 4 Proposed vision for a National Centre of Excellence in Perinatal Mental Health

3. National data

analytics

and insights



2. Support best

practice

(Currently with

beyondblue)

National

Centre of

Excellence in

Perinatal Mental

Health

4. Community

awareness

(This could continue

with beyondblue)

1. Support and

advise the NPDI

(Currently with

beyondblue)

5. Integration with

support services



6. Research and

advocacy

(Currently not

coordinated nationally)

Through the adoption of such a model, a national focus on perinatal mental health would ensure that the significant

progress, partnerships, research and momentum achieved to date could be sustained and further developed and

embedded across Australia.


211206_1012_BL1040.indd 19 23/10/12 11:49 AM

5.1 SUMMARY

In response to the high prevalence and debilitating impact of perinatal mental health disorders in Australia, the NPDI was

established in an agreement between the Federal, state and territory governments and beyondblue in 2008. The aim

of the Initiative, which was initially funded for a five-year period, is to improve prevention and early detection of perinatal

depression and provide better support and treatment for expectant and new mothers.

A review of progress to date reveals that there have been significant advances in the development and implementation

of Australia' s NPDI since it' s commencement in 2008. As the Initiative approaches the final year of its original five-year

funding period, the current report sought to provide a synopsis of activity to date and recommendations for the future of

perinatal mental health in Australia.

An outline of progress and recommendations across the six objectives of the Initiative are summarised below.

1. The development of Clinical Practice Guidelines

This has been an important and significant outcome to date, as the Guidelines (approved by NHMRC) provide health

professionals with nationally-consistent, evidence-based recommendations to guide best practice. The Guidelines

are comprehensive, as they address the screening, detection and management of mental health disorders in both the

antenatal and postnatal periods. Further, the Guidelines also cover a range of mental health disorders namely depression,

anxiety, bipolar disorder and puerperal psychosis. Following the Guidelines' development, a range of resources

(companion documents) has been developed for health professionals, to embed the Guidelines into routine care across

primary and maternity settings, as well as to inform consumers and carers.

It is important that the Guidelines and resources continue to be promoted and made widely available in order to promote

and implement best practice across the diverse range of perinatal settings and professional bodies. Also, consumers and

carers need access to information pertaining to perinatal mental health disorders and treatments.

2. Workforce training and development for health professionals

Research undertaken with primary and maternity care health professionals highlighted the range of knowledge

surrounding perinatal mental health disorders generally. Further, there was a lack of confidence and competence to

identify, treat and manage perinatal mental health disorders. In response to this, beyondblue has scoped the education

and training needs of health professionals through the development of a Workforce Training and Development Matrix,

which in turn, has informed the development of various training programs and curricula. It is also vital that the Centre

continues to work closely with professional bodies and institutions.

In order to meet the high demand for training among health professionals needed to facilitate screening, referral and

provision of effective treatments, free, online training programs have been developed under the NPDI.

In order to ensure health professionals are equipped to implement the objectives of the NPDI within their clinical practice,

it is important to ensure that training continues to be made widely available and reflects the Clinical Practice Guidelines.

To achieve this, it is recommended that a national, centralised centre provides this function, to capitalise on work

developed under the Initiative and to avoid duplication. This centre should also oversee the adaptation and expansion

of existing programs to meet the needs of jurisdictions (e.g. to reflect local policies), population groups (e.g. Indigenous,

CALD) and health professionals requiring more advanced levels of training.

5. Summary and recommendations


211206_1012_BL1040.indd 20 23/10/12 11:49 AM

3. Routine and universal screening

The rollout of the NPDI has seen an increase in the uptake of screening across Australia, and this has been facilitated

through the release of the Clinical Practice Guidelines, resources for health professionals and online training programs.

While it is not possible to assess the overall rates, location or impact of screening (due to the absence of universal data

collection), current levels of screening are understood to vary considerably across states and territories, public and

private sectors, and metropolitan and rural areas.

To continue the momentum surrounding screening, national leadership and advocacy is required to promote its uptake

further. In addition, there have been a number of potential barriers to screening, which have been identified in this report,

and which need to be scoped further and addressed through the review and refinement of policy, and the development

of pathways to care.

4. Follow-up support and care for women assessed as being at risk

The process of screening aims to identify the risk of, and/or presence of perinatal mental health disorders to enable

early intervention. In response to this, there needs to be adequate resourcing to provide evidence-based treatments in

community and/or primary care settings. The level and types of services required need to take into consideration minority

groups and people in rural areas who may have limited access to services. There is also a need for clear communication

regarding how to access ATAPS funding or Medicare items for perinatal mental health for health professionals, as well as

consumers and carers.

In order to identify and promote the range of services available at a community or primary care level, it is recommended

that a National Pathways to Care Directory be scoped. This could include the identification and promotion of services at

preventative, as well as treatment level. Further, research is required to evaluate the effectiveness and feasibility of high-

and low-intensity interventions, including those that can be delivered online.

5. Research and data collection

There is no unified approach to data collection, which has resulted in disparate datasets across the countryÐa nd as a

result, it is not possible to monitor or evaluate the rates or impact of screening and follow-up care for women.

Therefore, it is recommended that nationally-consistent items for collection and inclusion in the minimum data set are

established to enable consistent information to be captured, embedded into the national minimum perinatal data set,

and analysed to ultimately inform service provision and treatment efficacy. Also, there is a need to communicate the

outcomes and learnings of local evaluations that are currently taking place in various jurisdictions to facilitate knowledge

transfer. Again, these functions could be facilitated through a National Centre of Excellence.

6. Community awareness

Through the development and dissemination of community awareness campaigns (Just Speak Up), resources, media

liaison, work with high-profile ambassadors and expert media commentary; community awareness of perinatal mental

health disorders has increased. beyondblue has played the lead role in this area, and relationships with state and territory

partners, health professionals and service providers have facilitated the dissemination of consistent messages to the

community. A smaller number of community awareness activities have also been initiated at a more local level, many of

which target specific population groups.

In order to promote, prevent and improve early detection of perinatal mental health disorders, it is important that mental

health promotion activity remains nationally consistent, is underpinned by research, is supported and sustained. This is

particularly important when considering that the effectiveness of screening hinges upon open disclosureÐwh ich can be

inhibited by the high levels of stigma that currently exist amongst women.


211206_1012_BL1040.indd 21 23/10/12 11:49 AM

5.2 RECOMMENDATIONS

A review of progress to date, under each of these six objectives of the NPDI, highlights the significant developments and

the need to maintain support to continue progress under the NPDI. As highlighted, this would be best achieved through

maintaining a national focus to ensure that evidence-based, best practice continues to be consistently applied, that

national momentum is maintained, duplication is avoided, and consistent messaging is provided at a community level.

In response to this, beyondblue recommends the establishment of a National Centre of Excellence in Perinatal Mental

Health. The Centre will continue to provide national leadership and support a nationally-consistent approach to

implementation across Australia. Initial thoughts about the role and function of such a Centre are outlined in Figure 5.2.

Figure 5.2 Proposed key objectives of a National Centre of Excellence in Perinatal Mental Health

1. Continued national leadership, support and advice for all state and territory partners in the implementation of screening and

services for perinatal women. beyondblue currently provides this leadership under the NPDI.

3. The development and management of national data systems to enable screening data to be collected and analysed in

order to monitor and evaluate the impact of screening and to inform service provision. This is currently a major gap in the

NPDI, and is preventing the monitoring and evaluation of screening and referral outcomes.

5. In addition to the primary care services, there is a range of support organisations that are well placed to provide information,

education and support services to women at risk of, or experiencing perinatal mental health disorders. Currently, these

services work largely in isolation and could be more actively scoped and integrated into the NPDI.

2. Continued advocacy to embed best practice through the consistent implementation of the perinatal Clinical Practice

Guidelines (developed by beyondblue and approved by NHMRC in 2011). This includes the continued promotion and

provision of the Guidelines and additional resources (companion documents) for health professionals. Consideration should

also be given to the centralisation of research knowledge and training programs. The Centre would provide a central point

for the maintenance of strategic partnerships with professional bodies, training institutions, and service providers.

4. Sustained community education and awareness, and destigmatisation activity: This includes the continued provision

of high-quality, timely, evidence-based information about perinatal mental health disorders for consumers and carers.

beyondblue currently provides this activity under the NPDI.

6. The Centre would continue to work with Australia' s leading perinatal clinicians and researchers to ensure the integration and

application of research outcomes into clinical practice and could oversee the ongoing evaluation of the NPDI.


211206_1012_BL1040.indd 22 23/10/12 11:49 AM

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Intervention 2001±2005, F inal Report. Vol 1: National Screening Program. Melbourne: beyondblue: the national

depression initiative.

2 beyondblue (2011) The beyondblue National Action Plan for Perinatal Mental Health (NAP). Melbourne: beyondblue:

the national depression initiative.

3 Gavin NI, Gaynes BN, Lohr KN et al (2005) Perinatal depression: a systematic review of prevalence and incidence.

Obstet & Gynecol 106 (5-1).

4 Lewis G (ed) (2007) The Confidential Enquiry into Maternal and Child Health (CEMACH). Saving Mothers' Lives:

Reviewing Maternal Deaths to make Motherhood Safer ± 2003±2005. The Seventh Report on Confidential Enquiries

into Maternal Dealths in the United Kingdom. London: CEMACH.

5 Paulson, JF and Bazemore, SD (2010) Prenatal and postpartum depression in fathers and its association with

maternal depression: a meta-analysis. Journal of the American Medical Association 303 (19) 1961±1 969.

6 Glover V and O'Con nor T (2002) Effects of antenatal stress and anxiety: implications for development and

psychiatry. Brit J Psychiatry 180: 389±91.

7 Grant K-A, McMahon C, Austin M-P et al (2009) Maternal prenatal anxiety, postnatal caregiving and infants' cortisol

responses to the still-face procedure. Dev Psychobiol 51(8): 625±3 7.

8 O'Con nor TG, Heron J, Glover V; Alspac Study Team (2002) Antenatal anxiety predicts child behavioural/emotional

problems independently of postnatal depression. J Am Acad Child Psychiatry 41(12): 1470±7 7.

9 Murray L and Cooper P (1997a) Effects of postnatal depression on infant development. Arch Disease in Childhood

77(2): 99±101.

10 Sinclair D and Murray L (1998) Effects of postnatal depression on children' s adjustment to school. Teacher' s reports.

Brit J Psychiatry 172: 58±63.

11 Verbeek T, Bockting CL, van Pampus MG, Ormel J, Meijer JL, Hartmen CA and Burger H (2012) Postpartum

depression predicts offspring mental health problems in adolescence independently of parental lifetime

psychopathology. J Affective Disord. 136 (3): 948±54.

12 Buist, A, Condon, J, Brooks, J, Speelman, C, Milgrom, J, Hayes, Bet al (2006) Acceptability of routine screening for

postnatal depression: An Australia-wide study. J Affect Disorders, 93: 233±2 37.

13 Framework for the National Depression Initiative 2008/09 ± 2012/ 13. Department of Health and Aging. March 2009,

Australia.

14 beyondblue (2011) Clinical practice guidelines for depression and related disorders ± anxiety, bipolar disorder

and puerperal psychosis ± in the perinatal period. A guideline for primary care health professionals. Melbourne:

beyondblue: the national depression initiative.

15 Austin, MP, Middleton, P, Reilly, NM, and Highet NJ (2011) Australian mental health reform for perinatal care. Med J

Aust 2011; 195 (3): 112±113

16 Austin, MP, Middleton, P, Reilly, NM, and Highet NJ (2011) Detection and management of mood disorders in the

maternity setting: the Australian Clinical Practice Guidelines. Women Birth.

17 Wallis Consulting Group (2012) The perinatal depression guideline post evaluation. Final Report. Wallis Consulting

Group.

18 Highet NJ and Stevenson A (2011) A qualitative analysis of health professionals awareness, knowledge and

perspectives of perinatal depression and anxiety. beyondblue: the national depression initiative.

19 Highet NJ and Stevenson A (2011) A qualitative analysis of consumer experiences with postnatal depression and

accessing treatments. beyondblue: the national depression initiative.

6. References


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20 Cox JL Holden JM and Sagovsky R (1987) Detection of postnatal depression: development of the 10 item

Edinburgh postnatal depression scale. Brit J Psychiatry 150: 782±8 6. EPDS

21 Hall P (2012) Current considerations of the effects of untreated maternal perinatal depression and the National

Perinatal Depression Initiative. Journal of Developmental Origins of Health and Disease (2012), 3(4): 293±295.

22 Highet, N, Gemmill, AW, Milgrom, J (2011). Depression in the Perinatal Period: Awareness, Attitudes and

Knowledge in the Australian Population. Aust NZ J Psychiatry. Vol 45, No. 3: 223±231.

23 Highet, NJ, Stevenson A L (2011) Living with perinatal depression and anxiety ± the partners experience.

Melbourne: beyondblue: the national depression initiative.

24 Highet, NJ, Stevenson A L and Purtell CA (2012) Insights into women' s personal experiences and perceptions of

postnatal depression and anxiety and implications for information and service provision. Melbourne: beyondblue:

the national depression and anxiety initiative.

25 Highet, NJ, Stevenson A L and Purtell CA (2012) Barriers to accessing support and help-seeking amongst perinatal

women ± t he power of ignorance, self stigma and feelings of failure, shame, guilt and grief. Melbourne: beyondblue:

the national depression and anxiety initiative.


211206_1012_BL1040.indd 24 23/10/12 11:49 AM

Contents

Appendix 1

The impact of mental health disorders on the fetus/infant 26

Appendix 2

Perinatal guideline companion documents for health professionals 27

Appendix 3

The beyondblue Workforce Training and Development Matrix 28

Appendix 4

The beyondblue online training program for health professionals 35

Appendix 5

The beyondblue and National Health and Medical Research Council

partnership Linkage Grant ± R esearch aims 36

Appendices

25

211206_1012_BL1040.indd 25 23/10/12 11:49 AM

THE IMPACT OF MENTAL HEALTH DISORDERS ON THE

FETUS/INFANT

Maternal distress and anxiety during pregnancy can:

• increase the risk of complications during pregnancy and birth1

• negatively affect the developing fetal brain and infant behaviour2

• be associated with difficult infant temperament3

• increase cortisol (the hormone produced when stressed) in the infant4

• increase the likelihood of behavioural difficulties in childhood5.

Postnatal mental health disorders in the first year following birth:

• negatively impacts on breastfeeding, infant nutrition and health/growth

rates delaying infant physical development

• impairs bonding and attachment with the baby and can delay the

child' s cognitive6, emotional and behavioural development7

• may lead to the development of adjustment problems in childhood8,

adolescence9 and later in life.

Appendix 1

1 Priest S and Barnett B (2008) Perinatal anxiety and depression: issues, outcomes and interventions. In: Sved-Williams A and Cowling

V (eds) Infants of Parents with Mental Illness: Developmental, Clinical, Cultural and Personal Perspectives. Bowen Hills: Australian

Academic Press.

2 Glover V and O'Con nor T (2002) Effects of antenatal stress and anxiety: implications for development and psychiatry. Brit J Psychiatry

180: 389±91.

3 Austin M-P, Hadzi-Pavlovic D, Leader L et al (2005a) Maternal trait anxiety, depression and life event stress in pregnancy: relationships

with infant temperament. Early Hum Dev 81(2): 183±90.

4 Grant K-A, McMahon C, Austin M-P et al (2009) Maternal prenatal anxiety, postnatal caregiving and infants' cor tisol responses to the

still-face procedure. Dev Psychobiol 51(8): 625±37.

5 O'Con nor TG, Heron J, Glover V; Alspac Study Team (2002) Antenatal anxiety predicts child behavioural/emotional problems

independently of postnatal depression. J Am Acad Child Psychiatry 41(12):1470±77.

6 Milgrom J, Westley D, Gemmill AW (2004) The mediating role of maternal responsiveness in some longer-term effects of postnatal

depression on infant development. Infant Behavior & Devel 27: 443±54.

7 Murray L and Cooper P (1997a) Effects of postnatal depression on infant development. Arch Disease in Childhood 77(2): 99±101.

8 Sinclair D and Murray L (1998) Effects of postnatal depression on children' s adjustment to school. Teacher' s reports. Brit J Psychiatry

172: 58±63.

9 Verbeek T, Bockting CL, van Pampus MG, Ormel J, Meijer JL, Hartmen CA and Burger H (2012) Postpartum depression predicts

offspring mental health problems in adolescence independently of parental lifetime psychopathology. J Affective Disord. 136 (3)

948±54.

26

211206_1012_BL1040.indd 26 23/10/12 11:49 AM

Appendix 2

PERINATAL GUIDELINE COMPANION DOCUMENTS FOR


1. Executive summary of the perinatal Clinical Practice Guidelines

This is a 22-page Executive Summary of the perinatal Clinical Practice Guidelines. It provides health

professionals with a synopsis of key recommendations and good practice points surrounding the detection

(screening), treatment and management of perinatal mental health disorders in primary and maternity care

settings.

2. Edinburgh Postnatal Depression Scale (EPDS) scoring pads

To promote the implementation of screening using the EPDS, scoring pads have been developed and include

instructions surrounding the administration, scoring and interpretation of the scores on the EPDS.

3. Edinburgh Postnatal Depression Scale (EPDS) scoring wheel

EPDS and Psychosocial Questionnaire scoring `wh eel' t o assist health professionals in interpreting EPDS

scores and provide recommended action.

4. Booklet on psychosocial assessment and management of perinatal mental health disorders

This 8-page `fl ip booklet' p rovides health professionals with information to guide best practice in relation to

screening and management of mental health disorders in the antenatal and postnatal periods.

One side of the booklet focuses on screening and assessment specifically, outlining how to assess a woman' s

risk of developing perinatal mental health disorders and whether a woman may be experiencing depression

and/or anxiety at the time of screening. The second side specifically focuses on the management of perinatal

mental health disorders in primary care, including the role of psychological and pharmacological treatments.

5. Information (fact) sheet on detecting and managing depression and anxiety disorders

This fact sheet provides summary information for health professionals pertaining to the most common

perinatal mental health disorders, depression and anxiety as reflected in the perinatal Clinical Practice

Guidelines.

6. Information (fact) sheets on bipolar disorder in the perinatal period and puerperal (postpartum)

psychosis

These two fact sheets are designed to provide health professionals with information and guidelines

surrounding the detection and management of the more severe perinatal mental health disorders ± b ipolar

disorder and puerperal (postpartum) psychosis. The information emphasises the importance of specialist

consultation and addresses the safety issues surrounding medications.

7. Information for health professionals regarding infant cognitive and emotional development

This 4-page information resource outlines the evidence relating to the impact of perinatal mental health

disorders, namely depression and anxiety on the infant' s cognitive and emotional development. The need for

early identification, screening and support is emphasised, together with outlining how health professionals

can assess and intervene to promote the best outcomes for the mother and developing baby/infant.

27

211206_1012_BL1040.indd 27 23/10/12 11:49 AM

THE BEYONDBLUE WORKFORCE TRAINING AND

DEVELOPMENT MATRIX

The following pages contain the Training Matrix which was developed by the Workforce Training and Development

Committee under the NPDI.

Matrix Framework of PERINATAL DEPRESSION and RELATED DISORDERS

Aim of the framework:

• Provide guidelines on the core skills required by health professionals predominantly involved in screening women for

depression and related disorders in the perinatal period:

± Specifically skills in using the Edinburgh Postnatal Depression Scale (EPDS) and a psychosocial assessment, and,

as appropriate, conducting or referring on for a comprehensive assessment and diagnosis for women and their

families.

• Provide different levels of skills for the management of women and their families who are experiencing depression and

related disorders in the perinatal period:

± Including awareness, understanding management from distress through to disorders and treatment options.

• Ensure uniform standards of comprehensive clinical care informed by Clinical Practice Guidelines.

± With a focus on:

• prevention through early intervention and treatment

• optimising the infant' s environment.

• Inform organisations currently providing or developing professional development courses.

• Promote best practice across Australia for perinatal mental health training, informed by Clinical Practice Guidelines.

• The framework can be used to systemise existing training to see what is already available and where the gaps lie.

This matrix aims to define different levels of training, content areas to be covered, and which professionals could be the

target of training.

Appendix 3

28

211206_1012_BL1040.indd 28 23/10/12 11:50 AM

29

Appendix 3

SK

ILL

S T

RA

ININ

G

Aw

are

ne

ss/H

ea

lth

Pro

mo

tio

n/P

reve

nti

on

Ba

sic

Sk

ills

Ba

sic

Sk

ills

Plu

sIn

term

ed

iate

Sk

ills

Ad

va

nc

ed

Asse

ssm

en

t a

nd

Inte

rve

nti

on

Mo

du

les

Who for

•

Genera

l co

mm

unity

•

Pare

nts

•

Sig

nifi

cant

oth

ers

•

Health p

rofe

ssio

nals

•

All

perinata

l health p

rofe

ssio

nals

•

Ind

igeno

us h

ealth p

rofe

ssio

nals

•

Genera

l health w

ork

ers

•

Child

care

wo

rkers

•

NG

Os

•

Health p

rom

otio

n/

Health E

ducatio

n O

fficers

•

Mid

wiv

es

•

Mate

rnal and

Child

Health C

are

wo

rkers

(M&

CH

C)

•

Gen

era

l p

ractitio

ners

(G

Ps)

•

Alli

ed

health p

rofe

ssio

nals

•

All

perinata

l health p

rofe

ssio

nals

•

Ind

igeno

us h

ealth p

rofe

ssio

nals

•

Gen

era

l health w

ork

ers

•

Child

care

wo

rkers

•

Ob

ste

tric

ians/P

aed

iatr

icia

ns

This

mo

dule

is d

esig

ned

fo

r health

pro

fessio

nals

who

have c

om

ple

ted

the

`Ba

sic

' Skills

Onlin

e T

rain

ing

Packag

e

and

are

thus e

quip

ped

to

scre

en p

erinata

l

wo

men f

or

dep

ressio

n a

nd

anxie

ty.

It is

sp

ecifi

cally

targ

ete

d a

t health p

rofe

ssio

nals

who

want

to s

up

po

rt w

om

en w

ith m

ild

levels

of

perinata

l d

ep

ressio

n a

nd

/or

anxie

ty;

and

is a

lso

help

ful fo

r th

ose w

ho

will

have s

om

e c

ontinued

co

nta

ct

with t

he

wo

men a

cro

ss t

he p

erinata

l p

erio

d e

ven

if t

hey a

re n

ot

the p

rim

ary

pro

fessio

nal

manag

ing

the d

ep

ressiv

e e

pis

od

e.

Thus,

they w

ill n

eed

so

me b

asic

und

ers

tand

ing

of

ho

w t

o e

ffectively

wo

rk a

nd

sup

po

rt a

wo

man w

ho

is e

xp

eriencin

g m

ild d

ep

ressiv

e

and

anxie

ty s

ym

pto

ms a

t th

e p

resent

tim

e,

or

who

has b

een r

efe

rred

to

an a

pp

rop

riate

health p

rofe

ssio

nal fo

r fu

rther

assessm

en

t

and

tre

atm

ent.

This

may inclu

de:

•

Mid

wiv

es

•

Child

and

Fam

ily H

ealth N

urs

es/M

ate

rnal

and

Child

Health N

urs

es (M

&C

HN

s)

•

So

cia

l w

ork

ers

•

GP

s

•

Ob

ste

tric

ians

Ìnte

rmed

iate

' skills

are

rele

vant

to h

ealth

pro

fessio

nals

who

will

be f

acili

tating

the

treatm

ent

of

mild

to

mo

dera

te a

nxie

ty

and

dep

ressio

n s

ym

pto

ms.

Fo

r m

ore

severe

or

co

mp

lex c

ases,

sp

ecia

list

pro

vid

ers

may b

e r

efe

rred

to

and

can b

e

co

nsid

ere

d t

o h

ave à

dvanced

' skills

.

The s

kill

s b

elo

w c

an b

e d

evelo

ped

thro

ug

h d

idactic info

rmatio

n,

wo

rksho

ps

as w

ell

as c

ase p

resenta

tio

ns b

ut

imp

ort

antly n

eed

to

be c

onso

lidate

d

thro

ug

h s

up

erv

ised

pra

ctice.

Belo

w is a

n o

utlin

e o

f skill

s c

onsid

ere

d t

o

fall

in t

he ì

nte

rmed

iate

' cate

go

ry a

nd

are

desig

ned

fo

r vario

us p

rofe

ssio

nal g

roup

s

who

have s

uffi

cie

nt

backg

round

(e.g

.

co

unselli

ng

skill

s) to

manag

e m

ild a

nd

mo

dera

te m

enta

l health p

rob

lem

s.

This

may inclu

de:

•

GP

s

•

Ch

ild a

nd

Fam

ily H

ealth

Nu

rses,

M&

CH

Ns

•

Psych

olo

gis

ts

•

Men

tal h

ealth

nu

rses

•

Mid

wiv

es (w

ith

su

fficie

nt

backg

rou

nd

/

sp

ecia

list

train

ing

)

•

So

cia

l w

ork

ers

, o

ccu

patio

nal th

era

pis

ts

an

d o

ther

alli

ed

health

pro

fessio

nals

with

rele

van

t m

en

tal h

ealth

exp

ert

ise

•

Health

wo

rkers

with

men

tal h

ealth

exp

ert

ise e

.g. In

dig

en

ou

s

•

Men

tal h

ealth

clin

icia

ns

This

level o

f tr

ain

ing

is d

esig

ned

fo

r

health p

rofe

ssio

nals

who

alread

y h

ave

exte

nsiv

e m

enta

l health t

rain

ing

and

are

thus a

ssum

ed

to

alread

y h

ave t

he

kno

wle

dg

e c

overe

d in t

he B

asic

Skill

s

Onlin

e T

rain

ing

Packag

e,

as w

ell

as t

he

skill

s o

utlin

ed

in t

he B

asic

Skill

s P

lus

and

Inte

rmed

iate

Skill

s m

od

ule

s.

This

sectio

n p

rovid

es a

n o

verv

iew

of

the

essential skill

s t

hat

health p

rofe

ssio

nals

with a

menta

l health b

ackg

round

oug

ht

to h

ave,

sp

ecifi

c t

o t

he p

erinata

l field

.

It is s

pecifi

cally

targ

ete

d a

t health

pro

fessio

nals

who

will

be a

ctively

tre

ating

perinata

l d

ep

ressio

n a

nd

/or

anxie

ty,

while

als

o m

anag

ing

oth

er

co

-mo

rbid

menta

l health issues a

nd

psycho

so

cia

l

facto

rs t

hat

may b

e p

resent.

This

may inclu

de:

•

Psych

iatr

ists

•

Psych

olo

gis

ts

•

GP

s

•

Men

tal h

ealth

nu

rses

•

Men

tal h

ealth

clin

icia

ns

•

En

han

ced

MC

H w

ork

ers

•

Ap

pro

priate

pro

fessio

nal sta

ff in

pare

ntin

g c

en

tres

•

Ap

pro

priate

pro

fessio

nal sta

ff in

resid

en

tial u

nits

•

So

cia

l w

ork

ers

, o

ccu

patio

nal th

era

pis

ts

an

d o

ther

alli

ed

health

pro

fessio

nals

with

rele

van

t m

en

tal h

ealth

exp

ert

ise

211206_1012_BL1040.indd 29 23/10/12 11:50 AM

Appendix 3

30

SK

ILL

S T

RA

ININ

G

Aw

are

ne

ss/H

ea

lth

Pro

mo

tio

n/P

reve

nti

on

Ba

sic

Sk

ills

Ba

sic

Sk

ills

Plu

sIn

term

ed

iate

Sk

ills

Ad

va

nc

ed

Asse

ssm

en

t a

nd

Inte

rve

nti

on

Mo

du

les

Learning Objectives

Overa

ll O

bje

ctive:

To p

rom

ote

and

ed

ucate

wo

men in t

he p

erinata

l p

erio

d,

their

fam

ilies, o

ther

health p

rofe

ssio

nals

and

the w

ider

co

mm

unity

on p

erinata

l m

enta

l health, th

e issues a

nd

facto

rs t

hat

co

ntr

ibute

to

bo

th p

ositiv

e a

nd

neg

ative o

utc

om

es; ho

w t

o

best

sup

po

rt f

am

ilies d

uring

the p

erinata

l p

erio

d, and

the

imp

ort

ance o

f d

ecre

asin

g s

tig

ma a

sso

cia

ted

with p

erinata

l

dep

ressio

n a

nd

/or

anxie

ty.

In s

um

mary

, so

me o

f th

e k

ey o

bje

ctives inclu

de:

•

Rais

ing

co

mm

unity a

ware

ness o

f th

e h

igh p

revale

nce r

ate

s

of

ante

nata

l and

po

stn

ata

l d

ep

ressio

n a

nd

anxie

ty in t

he

perinata

l p

erio

d a

nd

the a

sso

cia

ted

co

nseq

uences.

•

Und

ers

tand

ing

:

±w

hat

perinata

l m

enta

l health is, in

clu

din

g t

he t

yp

es a

nd

pre

vale

nce o

f p

erinata

l m

enta

l health d

iso

rders

, as w

ell

as t

he m

ost

co

mm

on s

igns a

nd

sym

pto

ms

±th

e r

isk f

acto

rs t

hat

co

ntr

ibute

to

perinata

l m

enta

l health

dis

ord

ers

±th

e im

pact

of

un

treate

d P

ND

and

anxie

ty o

n w

om

en,

infa

nts

, p

art

ners

and

their f

am

ily

±p

erinata

l m

enta

l health in m

en

±th

e p

rote

ctive f

acto

rs t

hat

can f

acili

tate

po

sitiv

e

wellb

ein

g d

uring

the p

erinata

l p

erio

d a

nd

/or

imp

rove

reco

very

±th

e im

po

rtance o

f seekin

g h

elp

early.

•

Und

ers

tan

din

g t

he im

po

rtance o

f scre

enin

g a

nd

assessm

ent

of

perinata

l m

enta

l health d

iso

rders

; an

d

ap

ply

ing

co

nsis

tent

scre

enin

g a

nd

assessm

ent

pra

ctices.

•

Und

ers

tan

din

g w

here

to

access s

up

po

rt a

nd

help

fo

r

wo

men a

nd

their f

am

ilies, in

clu

din

g info

rmatio

n o

n

ap

pro

priate

:

±in

form

atio

n a

nd

sup

po

rt lin

es

±ed

ucatio

nal and

sup

po

rt m

ate

rials

, in

clu

din

g h

ow

to

pro

vid

e a

pp

rop

riate

reassura

nce a

nd

info

rmatio

n

±sup

po

rt g

roup

s

±tr

eatm

ent

op

tio

ns

±p

rovid

ers

.

•

Accessin

g a

nd

und

ers

tand

ing

the r

esults o

f p

erinata

l

menta

l health r

esearc

h (in

clu

din

g r

esults f

rom

surv

eys

and

fo

cus g

roup

s) and

usin

g t

he info

rmatio

n t

o c

reate

and

pro

mo

te c

om

munity a

ware

ness c

am

paig

ns.

•

Reco

gnis

ing

the im

po

rtance o

f re

ducin

g s

tig

ma a

sso

cia

ted

with m

enta

l health issues, b

oth

at

the ind

ivid

ual and

co

mm

unity level an

d p

rom

oting

po

sitiv

e p

ractices r

eg

ard

ing

this

issue (i.e. in

cre

asin

g c

om

munity a

ware

ness c

am

paig

ns,

ad

ap

ting

assessm

ent

pro

cesses s

o t

hat

scre

enin

g f

or

perinata

l d

ep

ressio

n a

nd

anxie

ty is s

een a

s `t

he n

orm

',

rath

er

than a

n `u

nusua

l' p

ractice).

•

To b

e a

ware

of

the k

ey f

eatu

res

and

pre

vale

nce r

ate

s o

f th

e m

ost

co

mm

on p

erinata

l m

enta

l health

dis

ord

ers

, kno

win

g h

ow

to

diffe

rentiate

betw

een t

he v

ario

us d

iso

rders

, and

und

ers

tand

ing

the im

pact

on infa

nt

health a

nd

wellb

ein

g.

•

Und

ers

tand

the b

ackg

round

, p

urp

ose

and

im

po

rtance o

f scre

enin

g,

its

ap

plic

atio

n a

nd

lim

itatio

ns.

•

Imp

lem

ent

scre

enin

g (usin

g t

he E

PD

S).

•

Und

ers

tand

the im

po

rtance o

f

co

nd

ucting

a b

road

er

psycho

so

cia

l

assessm

ent,

inclu

din

g r

isk

assessm

ent,

fo

r co

mp

rehensiv

e c

linic

al

care

.

•

Inte

rpre

t th

e E

PD

S s

co

res a

nd

inte

gra

te w

ith o

ther

assessm

ent

mate

rial as w

ell

as c

om

munic

ate

these r

esults t

o w

om

en u

sin

g b

asic

co

unselli

ng

skill

s a

nd

clie

nt

centr

ed

co

mm

unic

atio

n.

•

Have a

ware

ness o

f evid

ence-b

ased

inte

rventio

ns f

or

anxie

ty,

dep

ressio

n

and

rela

ted

dis

ord

ers

in t

he p

erinata

l

perio

d.

•

Und

ers

tand

the im

po

rtance o

f

kno

win

g w

here

and

ho

w t

o r

efe

r to

rele

vant

refe

rral p

ath

ways a

nd

exis

ting

treatm

ents

, in

terv

entio

ns a

nd

sup

po

rt.

•

Have a

ware

ness o

f early inte

rventio

n

and

manag

em

ent

str

ate

gie

s o

f acute

situatio

ns.

•

Ensure

kno

wle

dg

e o

f re

levant

leg

isla

tio

n.

•

Und

ers

tand

pro

fessio

nal b

ound

aries in

rela

tio

n t

o d

istr

ess a

nd

dis

ord

ers

in t

he

perinata

l p

erio

d.

•

Und

ers

tand

sco

pe o

f p

ractice.

•

Have k

no

wle

dg

e o

f C

linic

al P

ractice

Guid

elin

es f

or

menta

l health d

iso

rders

in t

he p

erinata

l p

erio

d.

Kno

wle

dg

e a

nd

skill

s c

overe

d in

th

e

Basic

Skill

s m

od

ule

are

pre

req

uis

ites.

This

mo

dule

aim

s t

o p

rovid

e:

•

kno

wle

dg

e o

n h

ow

to

man

ag

e

wo

men w

ith m

ild d

ep

ressiv

e a

nd

anxie

ty s

ym

pto

ms d

urin

g r

ou

tin

e

care

co

nsultatio

ns w

ho

eith

er

do

no

t re

quire o

nw

ard

refe

rral o

r are

waitin

g f

or

treatm

ent,

th

rou

gh

th

e

use o

f co

unselli

ng

skill

s t

hat

can

pro

mo

te a

po

sitiv

e a

nd

su

pp

ort

ive

rela

tio

nship

with t

he w

om

an

(e.g

.

active lis

tenin

g,

em

path

y, p

rob

lem

so

lvin

g), w

ith a

part

icula

r fo

cu

s

on h

ow

to

inte

gra

te t

hese s

kill

s in

dis

cussio

ns r

eg

ard

ing

th

e w

om

an

's

menta

l health a

nd

overa

ll w

ellb

ein

g.

•

kno

wle

dg

e o

f p

erinata

l m

en

tal

health d

iso

rders

and

info

rmatio

n

part

icula

rly r

ele

vant

to t

he s

ub

gro

up

of

wo

men w

ho

initia

lly p

resen

t w

ith

mild

dep

ressio

n a

nd

anxie

ty, i.e.

what

are

so

me k

ey ind

icato

rs t

hat

a

wo

man m

ay r

eq

uire s

om

e a

dd

itio

nal

sup

po

rt o

r th

at

her

sym

pto

ms a

re

escala

ting

?

•

ho

w t

o e

nco

ura

ge w

om

en

to

fo

llow

-

up

with a

ny r

efe

rrals

mad

e t

o o

ther

menta

l health p

rofe

ssio

nals

an

d

eng

ag

e o

ther

serv

ices.

•

the im

po

rtance o

f m

an

ag

ing

on

e's

ow

n e

mo

tio

ns a

nd

reactio

ns w

hen

ad

dre

ssin

g m

enta

l health

issu

es

and

psycho

so

cia

l risk f

acto

rs w

ith

wo

men.

Kn

ow

led

ge a

nd

skill

s d

escrib

ed

in

the B

asic

Skill

s m

od

ule

of

the m

atr

ix

is a

pre

req

uis

ite. T

his

mo

du

le a

ims t

o

pro

vid

e:

•

kn

ow

led

ge o

f h

ow

to

co

nd

uct

ind

ep

th a

ssessm

en

t o

f p

erin

ata

l

men

tal h

ealth

difficu

ltie

s a

nd

develo

p a

deta

iled

man

ag

em

en

t

pla

n

•

skill

s in

man

ag

em

en

t o

f m

ild-

mo

dera

te p

erin

ata

l m

en

tal h

ealth

dis

ord

ers

•

co

mp

reh

en

siv

e k

no

wle

dg

e o

f

path

ways t

o c

are

•

a b

asic

kn

ow

led

ge o

f th

era

peu

tic

inte

rven

tio

ns f

or

mo

ther, in

fan

t an

d

fath

er

an

d s

ign

ifican

t o

ther/

part

ner

•

un

ders

tan

din

g t

he im

po

rtan

ce

an

d r

ole

of

su

perv

isio

n f

or

health

pro

fessio

nals

.

Kn

ow

led

ge a

nd

co

re c

om

pete

ncie

s

co

vere

d in

th

e B

asic

an

d In

term

ed

iate

skill

s m

od

ule

s a

re a

ssu

med

kn

ow

led

ge.

Th

is m

od

ule

aim

s t

o p

rovid

e:

•

Fu

rth

er

train

ing

in

sp

ecia

list

man

ag

em

en

t o

f m

od

era

te t

o s

evere

perin

ata

l m

en

tal h

ealth

dis

ord

ers

•

Co

mp

reh

en

siv

e k

no

wle

dg

e o

f:

±evid

en

ce b

ased

tre

atm

en

t

op

tio

ns f

or

mo

dera

te/

severe

perin

ata

l m

en

tal h

ealth

dis

ord

ers

±m

an

ag

em

en

t o

f co

mp

lex c

ases

inclu

din

g in

fan

t an

d p

art

ner

issu

es.

Ad

va

nc

ed

Asse

ssm

en

t a

nd

Inte

rve

nti

on

Mo

du

les

Man

ag

ing

mo

dera

te t

o s

evere

perin

ata

l m

en

tal h

ealth

dis

ord

ers

an

d

ind

ep

th t

reatm

en

ts.

Ch

oic

e o

f M

od

ule

s (It

is lik

ely

th

at

health

pro

fessio

nals

fro

m v

ario

us

backg

rou

nd

s, w

ill b

e m

ore

fam

iliar

with

so

me o

f th

e f

ollo

win

g a

reas/

top

ics t

han

oth

ers

; th

us r

ath

er

than

a `c

om

ple

te p

ackag

e' t

he f

ollo

win

g

overv

iew

can

be u

sed

as a

gu

ide

wh

ich

clin

icia

ns c

an

use t

o s

ele

ct

the

are

as m

ost

rele

van

t to

th

eir s

pecifi

c

line o

f w

ork

an

d c

urr

en

t g

ap

s in

kn

ow

led

ge b

ase).

211206_1012_BL1040.indd 30 23/10/12 11:50 AM

Appendix 3

31

SK

ILL

S T

RA

ININ

G

Aw

are

ne

ss/H

ea

lth

Pro

mo

tio

n/

Pre

ve

nti

on

Ba

sic

Sk

ills

Ba

sic

Sk

ills

Plu

sIn

term

ed

iate

Sk

ills

Ad

va

nc

ed

Asse

ssm

en

t a

nd

Inte

rve

nti

on

Mo

du

les

Content

•

What

is p

erinata

l m

enta

l health?

•

The t

yp

es o

f p

erinata

l m

enta

l health

dis

ord

ers

•

The p

revale

nce o

f p

erinata

l m

enta

l health

dis

ord

ers

•

Sig

ns a

nd

sym

pto

ms o

f p

erinata

l m

enta

l

health d

iso

rders

•

No

rmalis

atio

n o

f neg

ative t

ho

ug

hts

•

Ris

k f

acto

rs t

hat

co

ntr

ibute

to

perinata

l

menta

l health d

iso

rders

•

Aw

are

ness a

bo

ut

scre

enin

g a

nd

assessm

ent

of

perinata

l m

enta

l health

dis

ord

ers

•

Imp

act

of

untr

eate

d p

ostn

ata

l d

ep

ressio

n

and

anxie

ty o

n w

om

en, in

fants

and

their

fam

ily

•

Ho

w t

o s

up

po

rt/h

elp

, in

clu

din

g p

rovid

ing

info

rmatio

n o

n a

pp

rop

riate

:

±in

form

atio

n lin

es

±ed

ucatio

nal and

sup

po

rt m

ate

rials

±sup

po

rt g

roup

s

•

Refe

rrals

to

prim

ary

health c

are

(e.g

. to

GP

s)

•

Usin

g r

esults o

f surv

eys t

o c

reate

co

mm

unity a

ware

ness c

am

paig

ns

•

Ap

pro

priate

reassu

rance /

info

ab

out

co

nseq

uences o

f d

isclo

sure

•

Psycho

ed

ucatio

n

1)

Ove

rvie

w o

f `p

eri

na

tal' m

en

tal h

ea

lth

•

Bab

y b

lues

•

Ante

nata

l d

ep

ressio

n (sym

pto

ms a

nd

pre

vale

nce)

•

Po

stn

ata

l d

ep

ressio

n

•

Ante

nata

l and

po

stn

ata

l anxie

ty (th

e

imp

ort

ance o

f anxie

ty a

s a

targ

et

for

sup

po

rt)

•

Rela

ted

dis

ord

ers

: P

sycho

ses,

pers

onalit

y d

iso

rders

•

Und

ers

tand

ing

ris

k f

acto

rs o

f d

ep

ressio

n

and

anxie

ty

•

Sho

rt a

nd

lo

ng

er-

term

im

pact

of

perinata

l

dis

ord

ers

on m

oth

ers

, fa

thers

and

infa

nts

(inclu

din

g a

ttachm

ent

and

eff

ects

on

bo

th s

ho

rt a

nd

lo

ng

term

develo

pm

ent

of

the c

hild

).

2)

Co

nte

xt

an

d b

ac

kg

rou

nd

to

th

e

Na

tio

na

l P

eri

na

tal D

ep

ressio

n I

nit

iati

ve

(NP

DI)

•

Pre

vale

nce o

f p

erinata

l d

iso

rders

and

its

imp

act

•

Difficultie

s in h

elp

-seekin

g b

elie

fs a

nd

behavio

urs

of

wo

men a

nd

their f

am

ilies

•

Why s

cre

en f

or

dep

ressio

n? ±

Purp

ose

of

scre

enin

g

•

Psycho

log

ical and

so

cia

l assessm

ent

for

co

mp

rehensiv

e c

linic

al care

±

und

ers

tand

ing

the w

om

an's

curr

ent

and

past

co

nte

xt

inclu

din

g r

isk f

acto

rs.

•

Brief

his

torical m

ilesto

nes (N

atio

nal

Po

stn

ata

l D

ep

ressio

n P

rog

ram

, N

HM

RC

guid

elin

es,

natio

nal im

ple

menta

tio

n).

3)

Ho

w t

o t

alk

to

wo

me

n a

bo

ut

sc

ree

nin

g

an

d f

urt

he

r a

sse

ssm

en

t

•

Basic

clie

nt

centr

ed

co

mm

unic

atio

n s

kill

s

and

mo

tivatio

nal in

terv

iew

ing

skill

s t

o

eng

ag

e w

om

en

•

Ho

w t

o r

ais

e s

cre

enin

g w

ith t

he E

PD

S

•

Fo

cusin

g o

n t

he w

ho

le w

om

an a

nd

her

life s

ituatio

n (b

road

er

psycho

so

cia

l

assessm

ent)

•

Inte

gra

ting

assessm

ent

in r

outine

co

nsultatio

ns

•

Exp

loring

wo

men's

resp

onses t

o

scre

enin

g (in

clu

de c

onsum

er

pers

pective

i.e. ªW

ha

t w

as it

like b

ein

g s

cre

ened

?º)

.

Su

pp

ort

ive

ca

re:

•

Co

nte

nt

co

vere

d u

nd

er

Basic

Skill

s

mo

dule

is a

ssum

ed

scre

enin

g,

basic

psycho

so

cia

l assessm

ent,

und

ers

tand

ing

onw

ard

refe

rral and

Path

ways t

o C

are

.

1)

Ba

sic

ma

na

ge

me

nt

sk

ills

•

Co

unselli

ng

skill

s (active lis

tenin

g,

em

path

y, r

eflecting

, p

rob

lem

so

lvin

g) to

manag

e m

ild d

ep

ressio

n a

nd

anxie

ty a

nd

sup

po

rt w

om

en w

ho

may b

e w

aitin

g f

or

treatm

ent.

2)

Co

-mo

rbid

an

d d

iffe

ren

tia

l d

iag

no

se

s

•

Kno

wle

dg

e o

f p

erinata

l m

enta

l health

dis

ord

ers

, w

ith a

part

icula

r fo

cus o

n

und

ers

tand

ing

sig

ns a

nd

sym

pto

ms

sug

gesting

incre

asin

g s

everity

of

mo

od

dis

ord

ers

, d

iffe

rential d

iag

no

ses,

and

the

co

-mo

rbid

issues t

hat

are

oft

en p

resen

t

(e.g

. o

ther

menta

l health d

iso

rders

,

sub

sta

nce a

buse,

inte

rpers

onal and

psycho

so

cia

l d

ifficultie

s).

3)

Ho

w t

o e

nc

ou

rag

e w

om

en

to

fo

llo

w-

up

wit

h a

ny r

efe

rra

ls m

ad

e t

o o

the

r

me

nta

l h

ea

lth

pro

fessio

na

ls a

nd

en

ga

ge

oth

er

se

rvic

es

•

Intr

od

uctio

n t

o M

otivatio

nal In

terv

iew

ing

Skill

s ±

ho

w c

an w

e e

nco

ura

ge

wo

men t

o e

ng

ag

e w

ith s

erv

ices/h

ealth

pro

fessio

nals

if

they a

re r

elu

cta

nt,

part

icula

rly in t

he p

resence o

f a p

ositiv

e

EP

DS

.

4)

Th

e im

po

rta

nc

e o

f m

an

ag

ing

on

e's

ow

n e

mo

tio

ns

•

Dealin

g w

ith o

ne's

ow

n r

eactio

ns w

hen

ad

dre

ssin

g m

enta

l health issues a

nd

psycho

so

cia

l risk f

acto

rs w

ith w

om

en;

seekin

g s

up

po

rt w

hen n

eed

ed

.

1)

Did

ac

tic

co

nte

nt:

[to

be s

up

po

rted

by s

up

erv

isio

n]

Man

ag

ing

mild

to

mo

dera

te p

erin

ata

l m

en

tal

health

dis

ord

ers

.

•

Co

nte

nt

co

vere

d u

nd

er

Basic

Skill

s

mo

du

le is a

ssu

med

scre

en

ing

, b

asic

psych

oso

cia

l assessm

en

t, u

nd

ers

tan

din

g

on

ward

refe

rral an

d P

ath

ways t

o C

are

2)

Asse

ssm

en

t

•

Intr

od

uctio

n t

o in

dep

th p

sych

oso

cia

l

assessm

en

t fo

r m

oth

ers

, fa

thers

,

part

ners

, in

fan

ts, co

up

les, fa

mili

es a

nd

sig

nifi

can

t o

thers

± se

e A

ttach

men

t

1 e

xam

ple

of

so

me c

om

pete

ncie

s

exp

ecte

d t

o b

e a

ch

ieved

.

3)

Dia

gn

osis

•

Ho

w t

o d

iffe

ren

tiate

betw

een

diffe

ren

t

men

tal h

ealth

pro

ble

ms s

uch

as

ad

justm

en

t d

iso

rder, d

ep

ressiv

e

ep

iso

des a

nd

rela

ted

dis

ord

ers

in

clu

din

g

co

-mo

rbid

ity.

•

Ho

w t

o id

en

tify

aetio

log

ical fa

cto

rs

imp

ort

an

t fo

r m

an

ag

em

en

t fo

cu

s

(fo

rmu

latio

n s

kill

s).

4)

Tre

atm

en

t

•

Intr

od

uctio

n t

o t

reatm

en

t, in

clu

din

g:

±m

otivatio

nal in

terv

iew

ing

±co

nso

lidatin

g c

ou

nselli

ng

skill

s

±p

sych

olo

gic

al in

terv

en

tio

ns

(in

div

idu

al an

d g

rou

p s

kill

s)

±m

an

ag

ing

fam

ily v

iole

nce s

ub

sta

nce

ab

use a

nd

oth

er

psych

oso

cia

l

difficu

ltie

s

±m

ed

icatio

n.

•

Intr

od

uctio

n t

o t

reatm

en

t o

ptio

ns f

or:

±w

om

en

±p

are

nt-

infa

nt

rela

tio

nsh

ip

±co

up

les

±fa

thers

/part

ners

/sig

nifi

can

t o

thers

.

1)

Ove

rvie

w

[to

be s

up

po

rted

by s

up

erv

isio

n]

•

Co

nte

nt

co

vere

d u

nd

er

Basic

, B

asic

Plu

s

an

d In

term

ed

iate

Skill

s m

od

ule

s.

2)

Asse

ssm

en

t a

nd

Dia

gn

osis

•

Sp

ecia

lised

assessm

en

t fo

r m

oth

ers

,

fath

ers

, in

fan

ts, als

o c

overin

g:

±P

are

nt-

Infa

nt

rela

tio

nsh

ips ± A

sse

ssin

g

if t

he p

are

nt-

infa

nt

rela

tio

nsh

ip

has b

een

ad

vers

ely

aff

ecte

d b

y

perin

ata

l d

ep

ressio

n a

nd

/or

an

xie

ty.

e.g

. o

bserv

ing

an

d a

ssessin

g t

he

inte

ractio

ns b

etw

een

pare

nt

an

d

infa

nt;

ho

w d

o y

ou

kn

ow

if

inte

ractio

n

difficu

ltie

s a

re p

resen

t? H

ow

do

yo

u

assess a

mo

ther's r

esp

on

siv

en

ess t

o

her

bab

y's

cu

es a

nd

make a

clin

ical

jud

gem

en

t if a

pp

rop

riate

or

no

t? H

ow

do

yo

u a

ssess w

heth

er

issu

es s

uch

as

ab

use o

r n

eg

lect

are

pre

sen

t?

±C

o-m

orb

idity ± A

dvan

ced

kn

ow

led

ge

of

the v

ario

us c

o-m

orb

id issu

es t

hat

may b

e p

resen

t w

hen

a m

oth

er

is

severe

ly d

ep

ressed

/an

xio

us in

clu

din

g

oth

er

men

tal h

ealth

dis

ord

ers

as w

ell

as p

sych

oso

cia

l fa

cto

rs (e.g

. d

rug

an

d

alc

oh

ol is

su

es, re

latio

nsh

ip d

ifficu

ltie

s,

do

mestic v

iole

nce, fin

an

cia

l/h

ou

sin

g

issu

es, in

fan

t sle

ep

/sett

ling

/feed

ing

difficu

ltie

s, p

ers

on

alit

y d

iso

rders

,

trau

ma, re

fug

ee, m

igra

tio

n s

tress e

tc).

•

Ho

w t

o d

iag

no

se m

od

era

te t

o s

evere

perinata

l m

enta

l health d

iso

rders

±

Kno

wle

dg

e o

f w

hat

need

s t

o b

e c

overe

d

in a

dia

gno

stic inte

rvie

w, in

clu

din

g

ad

min

istr

atio

n o

f sta

nd

ard

ised

measure

s,

in o

rder

for

a fo

rmal d

iag

no

sis

to

be m

ad

e.

3)

Tre

atm

en

t/R

efe

rra

ls/M

an

ag

em

en

t

•

Sp

ecia

lised

tre

atm

en

t ele

ctives/u

nits

availa

ble

fo

r:

±M

ed

icatio

n ± K

no

wle

dg

e o

f co

mm

on

m

ed

icatio

ns p

rescrib

ed

, ty

pic

al d

oses,

sid

e-e

ffects

etc

. W

hen

is m

ed

icatio

n

warr

an

ted

an

d w

ho

is r

esp

on

sib

le

for

man

ag

ing

th

is s

ide o

f tr

eatm

en

t?

Wh

at

do

yo

u n

eed

to

kn

ow

eith

er

as

a) th

e h

ealth

pro

fessio

nal p

rescrib

ing

th

e m

ed

icatio

n o

r b

) as a

no

n-m

ed

ical

health

pro

fessio

nal th

at

is s

eein

g a

w

om

an

cu

rren

tly o

n m

ed

icatio

n?

211206_1012_BL1040.indd 31 23/10/12 11:50 AM

Appendix 3

32

SK

ILL

S T

RA

ININ

G

Aw

are

ne

ss/H

ea

lth

Pro

mo

tio

n/

Pre

ve

nti

on

Ba

sic

Sk

ills

Ba

sic

Sk

ills

Plu

sIn

term

ed

iate

Sk

ills

Ad

va

nc

ed

Asse

ssm

en

t a

nd

Inte

rve

nti

on

Mo

du

les

Content

4)

De

pre

ssio

n s

cre

en

ing

usin

g t

he

Ed

inb

urg

h P

ostn

ata

l D

ep

ressio

n S

ca

le

(EP

DS

)

•

What

is t

he E

PD

S? W

hat

do

es is

measure

? W

hat

do

esn't

it

measure

?

(inclu

de a

co

py o

f E

PD

S)

•

Lim

itatio

ns

•

Accep

tab

ility

•

EP

DS

as c

urr

ent

best

pra

ctice t

oo

l ±

(beyo

nd

blu

e/N

HM

RC

guid

elin

es a

nd

reco

mm

end

atio

ns)

•

EP

DS

in o

ther

lang

uag

es.

5)

Ho

w t

o a

dm

inis

ter

the

EP

DS

an

d h

ow

to s

co

re it

•

Recap

ho

w t

o intr

od

uce t

he E

PD

S t

o

wo

men a

nd

the im

po

rtance o

f b

asic

co

mm

unic

atio

n in r

eg

ard

s t

o intr

od

ucin

g

scre

enin

g t

oo

ls

•

Instr

uctio

ns f

or

co

mp

letio

n

•

When t

o a

dm

inis

ter

(sin

gle

tim

e v

ers

us

rep

eate

d m

easure

s)

•

What

do

sco

res m

ean?

•

Key c

ut-

off

sco

res (th

resho

ld ≥

13)

•

Tho

ug

hts

of

self h

arm

e.g

. Q

uestio

n 1

0

•

Havin

g a

co

nvers

atio

n w

ith w

om

en a

bo

ut

their r

esp

onses o

n t

he E

PD

S

•

Imp

ort

ance o

f b

asic

clie

nt

centr

ed

co

mm

unic

atio

n/c

ounselli

ng

skill

s in

reg

ard

s t

o f

eed

back a

round

scre

enin

g

and

assessm

ent

results w

ith w

om

en

•

beyo

nd

blu

e f

act

sheet

for

furt

her

info

rmatio

n.

6)

Fu

rth

er

asse

ssm

en

t (if

ne

ed

ed

)

•

Ris

k a

ssessm

ent

±S

afe

ty p

lan

±K

no

wle

dg

e o

f ap

pro

priate

refe

rral

path

way f

or

crisis

manag

em

ent

(inte

rnal/exte

rnal)

•

Psycho

so

cia

l assessm

ent

±U

nd

ers

tand

ing

the p

sycho

so

cia

l

co

nte

xt

and

to

ols

that

can b

e

ad

min

iste

red

e.g

. P

RA

M.

±S

pecia

lised

psych

olo

gic

al tr

eatm

en

ts

for

an

ten

ata

l an

d p

ostn

ata

l d

ep

ressio

n

in w

om

en

, in

clu

din

g in

patien

t care

.

±D

eta

iled

tra

inin

g in

sp

ecia

lised

psych

olo

gic

al tr

eatm

en

ts f

or

perin

ata

l

dep

ressio

n a

nd

an

xie

ty (e.g

. C

BT,

IP

T).

Un

ders

tan

din

g w

hat

the lo

cal in

patien

t

care

un

its a

re a

nd

wh

en

a r

efe

rral to

a

resid

en

tial/in

patien

t u

nit is w

arr

an

ted

;

an

d w

ho

is r

esp

on

sib

le f

or

man

ag

ing

the m

oth

er

on

ce d

isch

arg

ed

,

co

ntin

uity o

f care

an

d m

ultid

iscip

linary

care

pla

nn

ing

, w

ork

ing

with

are

a

men

tal h

ealth

serv

ices; n

on

vo

lun

tary

care

.

±F

ath

ers

± U

nd

ers

tan

din

g a

nd

reco

gn

isin

g t

he o

ccu

rren

ce o

f

dep

ressio

n in

new

fath

ers

; ap

pro

priate

treatm

en

t o

ptio

ns f

or

fath

ers

with

dep

ressio

n a

nd

/or

an

xie

ty d

urin

g t

he

perin

ata

l p

erio

d.

± P

art

ners

± U

nd

ers

tan

din

g t

he issu

es

pre

sen

t fo

r p

art

ners

of

wo

men

with

perin

ata

l d

ep

ressio

n a

nd

/or

an

xie

ty,

an

d a

vaila

ble

su

pp

ort

serv

ices.

±C

ou

ple

s ± K

no

wle

dg

e o

f an

d/o

r

train

ing

in

ap

pro

priate

tre

atm

en

t

op

tio

ns a

nd

serv

ices a

vaila

ble

fo

r

co

up

les ± i

.e. co

up

les c

ou

nselli

ng

with

a f

ocu

s o

n t

he p

erin

ata

l p

erio

d

±S

ign

ifican

t o

thers

± K

no

wle

dg

e o

f an

d/

or

train

ing

in

th

e issu

es; tr

eatm

en

t

op

tio

ns a

nd

su

pp

ort

serv

ices

rele

van

t fo

r sig

nifi

can

t o

thers

e.g

. if

a w

om

an

's m

oth

er

has a

sig

nifi

can

t

role

in

pro

vid

ing

pra

ctical/em

otio

nal

su

pp

ort

to

her

dau

gh

ter

wh

o is

exp

erien

cin

g p

ostn

ata

l d

ep

ressio

n/

an

xie

ty, it is im

po

rtan

t to

be a

ware

of

the issu

es a

nd

difficu

ltie

s s

he m

ay b

e

exp

erien

cin

g h

ers

elf a

nd

wh

at

su

pp

ort

may b

e b

en

eficia

l fo

r h

er.

± In

fan

ts ± U

nd

ers

tan

din

g w

hat

Pare

nt-

Infa

nt

Th

era

py is, w

hen

it

is

ind

icate

d a

nd

wh

o c

an

pro

vid

e t

his

treatm

en

t eff

ectively

an

d a

pp

rop

riate

ly.

Kn

ow

led

ge o

f tr

eatm

en

t o

ptio

ns

an

d s

up

po

rt s

erv

ices a

vaila

ble

fo

r

vu

lnera

ble

in

fan

ts a

nd

fam

ilies (e.g

.

Circle

of

Secu

rity

; H

UG

S).

211206_1012_BL1040.indd 32 23/10/12 11:50 AM

Appendix 3

33

SK

ILL

S T

RA

ININ

G

Aw

are

ne

ss/H

ea

lth

Pro

mo

tio

n/

Pre

ve

nti

on

Ba

sic

Sk

ills

Ba

sic

Sk

ills

Plu

sIn

term

ed

iate

Sk

ills

Ad

va

nc

ed

Asse

ssm

en

t a

nd

Inte

rve

nti

on

Mo

du

les

Content

•

Inte

gra

ting

EP

DS

sco

res a

nd

oth

er

assessm

ent

mate

rial and

fo

rmula

ting

a

manag

em

ent

pla

n

±D

ecid

ing

on t

he n

eed

fo

r d

iag

no

stic

assessm

ent

±R

ecap

: Im

po

rtance o

f b

asic

clie

nt

centr

ed

co

mm

unic

atio

n/c

ounselli

ng

.

7)

Aw

are

ne

ss o

f a

pp

rop

ria

te e

vid

en

ce

-

ba

se

d t

rea

tme

nt

op

tio

ns.

•

Tre

atm

ent

op

tio

ns f

or

wo

men,

co

up

les,

fath

ers

, p

art

ners

, sig

nifi

cant

oth

ers

•

Aw

are

ness o

f p

are

nt-

infa

nt

inte

rventio

ns

with e

vid

ence b

ase a

nd

rele

vant

theo

ries

(e.g

. att

achm

ent,

develo

pm

enta

l)

•

Med

icatio

n

•

Ind

ivid

ual and

gro

up

tre

atm

ent

mo

dels

•

Self-c

are

str

ate

gie

s.

8)

Pa

thw

ays t

o C

are

: C

olla

bo

rati

ve

pra

cti

ce

•

Imp

ort

ance o

f m

ultid

iscip

linary

care

/

co

llab

ora

tio

n b

etw

een s

erv

ice p

rovid

ers

•

Kno

wle

dg

e o

f lo

cal re

ferr

al p

ath

ways

for

mild

, m

od

era

te a

nd

severe

/co

mp

lex

men

tal health d

iso

rders

(in

clu

din

g m

enta

l

health c

are

pla

ns)

•

Kno

wle

dg

e o

f lo

cal re

ferr

al p

ath

ways f

or

wo

men a

nd

fam

ilies a

t d

iffe

rent

levels

of

risk

•

Aw

are

ness o

f lo

cal co

mm

unity s

up

po

rt

inclu

din

g c

hild

care

op

tio

ns.

9)

Cu

ltu

ral a

nd

fa

milia

l d

ive

rsit

y:

Ad

ap

tin

g s

cre

en

ing

, a

sse

ssm

en

t a

nd

refe

rra

l p

ath

wa

ys

•

Sp

ecia

l need

s g

roup

s i.e

. C

ALD

and

Ind

igeno

us c

om

munity

•

EP

DS

tra

nsla

tio

ns

•

Usin

g a

n inte

rpre

ter.

±G

rou

p t

reatm

en

ts ± K

no

wle

dg

e a

nd

/or

train

ing

in

gro

up

tre

atm

en

t p

rog

ram

s

availa

ble

an

d t

he a

sso

cia

ted

ben

efits

for

severe

ly d

ep

ressed

/an

xio

us

mo

thers

. K

no

wle

dg

e a

bo

ut

key f

acto

rs

that

may b

e c

ou

nte

r-p

rod

uctive in

gro

up

tre

atm

en

t (i.e

. if a

wo

men

has

recen

tly b

een

dis

ch

arg

ed

fro

m a

n

inp

atien

t m

oth

er-

bab

y s

erv

ice a

nd

is

still

severe

ly a

nxio

us, w

ou

ld a

refe

rral

to a

gro

up

pro

gra

m b

e a

pp

rop

riate

?

Sh

ou

ld g

rou

p t

hera

py o

ccu

r at

the

sam

e t

ime a

s o

ther

thera

pie

s?

±M

otivatio

nal in

terv

iew

ing

± K

no

wle

dg

e

ab

ou

t skill

s a

nd

str

ate

gie

s t

hat

can

be u

sefu

l in

en

co

ura

gin

g w

om

en

to e

ng

ag

e in

tre

atm

en

t an

d a

ccess

su

pp

ort

serv

ices, esp

ecia

lly w

hen

severe

ly d

ep

ressed

.

± C

o-m

orb

idity ± M

an

ag

ing

co

-mo

rbid

issu

es t

hat

may b

e p

resen

t w

hen

a w

om

an

pre

sen

ts a

s s

evere

ly

dep

ressed

/an

xio

us (e.g

. d

rug

an

d

alc

oh

ol is

su

es, d

om

estic v

iole

nce,

fin

an

cia

l/h

ou

sin

g issu

es, in

fan

t sle

ep

/

sett

ling

/feed

ing

difficu

ltie

s, re

fug

ee

sta

tus e

tc). P

rovid

ing

lo

w a

nd

hig

h

inte

nsity c

are

. W

ork

ing

with

oth

er

ag

en

cie

s t

o p

rovid

e a

co

mp

reh

en

siv

e

man

ag

em

en

t p

lan

. C

ase m

an

ag

em

en

t.

211206_1012_BL1040.indd 33 23/10/12 11:50 AM

Appendix 3

34

SK

ILL

S T

RA

ININ

G

Aw

are

ne

ss/H

ea

lth

Pro

mo

tio

n/P

reve

nti

on

Ba

sic

Sk

ills

Ba

sic

Sk

ills

Plu

sIn

term

ed

iate

Sk

ills

Ad

va

nc

ed

Asse

ssm

en

t a

nd

Inte

rve

nti

on

Mo

du

les

Ethics, Duty of Care and Supervised Practice

No

t ap

plic

ab

le.

Eth

ics,

Du

ty o

f C

are

an

d S

up

erv

ise

d P

rac

tic

e

•

It is e

xp

ecte

d t

hat

all

health p

rofe

ssio

nals

will

co

nd

uct

them

selv

es in a

manner

that

pro

mo

tes a

nd

ad

here

s t

o t

he

pro

fessio

nal co

de o

f eth

ics w

hic

h is r

ele

vant

to o

ne's

ow

n s

erv

ice p

rovid

er

gro

up

, and

will

be a

cco

un

tab

le f

or

decis

ion

s m

ad

e.

•

It is a

lso

exp

ecte

d t

hat

issues r

eg

ard

ing

ap

pro

priate

sup

erv

ised

pra

ctice,

inclu

din

g a

ccess t

o o

ng

oin

g s

up

po

rt a

nd

su

perv

isio

n

for

health p

rofe

ssio

nals

acro

ss a

ll skill

levels

will

be a

n inte

gra

l p

art

of

each h

ealth p

rofe

ssio

nals

' clin

ical p

ractice.

Du

ty o

f C

are

an

d S

up

erv

isio

n:

•

Pro

fessio

nal re

sp

onsib

ilities a

nd

duty

of

care

princip

les r

ela

ted

to

the s

cre

enin

g

and

assessm

ent

pro

cess ±

e.g

. ensuring

that

there

is a

deq

uate

tim

e t

o c

om

ple

te

the s

cre

enin

g a

nd

assessm

ent

pro

cess

with w

om

en,

reco

gnis

ing

the im

po

rtance

of

havin

g a

nd

build

ing

up

on r

ele

vant

skill

s,

kno

wle

dg

e o

f re

ferr

al p

ath

ways

bo

th w

ithin

the o

rganis

atio

n [d

ep

end

ing

on c

onte

xt]

as w

ell

as e

xte

rnally

within

the c

om

munity).

•

Fro

nt

line h

ealth p

rofe

ssio

nals

will

need

to

have t

he o

pp

ort

unity t

o

access p

rofe

ssio

nal sup

po

rt f

or

issues

asso

cia

ted

with t

he s

cre

enin

g p

rocess,

inclu

din

g t

ime t

o d

iscuss c

halle

ng

ing

clie

nts

and

ad

ditio

nal sup

po

rts t

hat

may

be r

eq

uired

.

Du

ty o

f C

are

an

d S

up

erv

isio

n:

•

Kno

win

g h

ow

, w

here

and

when t

o r

efe

r

els

ew

here

(i.e.

kno

win

g w

hat

to d

o w

hen

a w

om

an w

ho

initia

lly p

resente

d w

ith o

nly

mild

dep

ressiv

e a

nd

anxie

ty s

ym

pto

ms

no

w a

pp

ears

to

be e

xp

eriencin

g

mo

dera

te/s

evere

sym

pto

ms a

nd

/or

oth

er

difficultie

s).

•

Kno

win

g h

ow

, w

here

and

where

to

access s

up

po

rt f

or

one's

self (i.e.

reco

gnis

ing

the im

po

rtance a

nd

kno

win

g

ho

w t

o m

anag

e y

our

ow

n e

mo

tio

ns a

nd

`se

para

te' y

ours

elf f

rom

yo

ur

clie

nt

and

their p

resenting

pro

ble

ms.

Bein

g a

ware

of

the issues y

ou n

eed

to

be m

ind

ful o

f

and

what

to d

o if

yo

u n

otice y

ours

elf

beco

min

g a

ffecte

d b

y t

he w

om

an's

pre

senta

tio

n a

nd

/or

circum

sta

nces e

.g.

yo

u t

oo

have p

revio

usly

exp

erienced

do

mestic v

iole

nce,

num

ero

us

mis

carr

iag

es e

tc.

•

As h

ealth p

rofe

ssio

nals

will

be e

ng

ag

ing

in s

om

e m

anag

em

ent

or

`ho

ldin

g' t

here

is

likely

to

be a

need

fo

r in

cre

ased

access

to p

rofe

ssio

nal sup

po

rt.

Du

ty o

f C

are

an

d S

up

erv

isio

n:

•

Kn

ow

ing

ho

w a

nd

wh

ere

to

refe

r

els

ew

here

wh

en

th

e s

co

pe o

f th

e c

lien

ts'

issu

es a

re o

uts

ide o

f o

ne's

skill

ran

ge

(th

is w

ill v

ary

dep

en

din

g o

n s

kill

set

of

each

health

pro

fessio

nal an

d t

he n

atu

re

an

d s

everity

of

the d

iag

no

sed

dis

ord

er

an

d a

sso

cia

ted

issu

es) e.g

. kn

ow

ing

wh

at

to d

o if

a w

om

an

's m

en

tal h

ealth

has d

ete

rio

rate

d e

ven

if

sh

e is a

lread

y

en

gag

ed

in

tre

atm

en

t w

ith

yo

u ± kn

ow

ing

wh

at

oth

er

refe

rral p

ath

ways m

ay b

e

ap

pro

priate

an

d n

ecessary

to

refe

r to

.

•

Health

pro

fessio

nals

wh

o a

re a

ctively

invo

lved

in

th

e m

an

ag

em

en

t an

d

treatm

en

t p

rocess, w

ill o

nce a

gain

req

uire in

cre

ased

su

pp

ort

fo

r is

su

es

pert

ain

ing

to

th

e m

an

ag

em

en

t o

f m

en

tal

health

issu

es, an

d o

ug

ht

to h

ave a

ccess

to a

pp

rop

riate

su

perv

isio

n ± e

.g. access

to in

div

idu

al o

r p

eer

su

perv

isio

n t

hat

allo

ws t

he h

ealth

pro

fessio

nals

to

dis

cu

ss

treatm

en

t an

d m

an

ag

em

en

t is

su

es o

f

mild

or

mo

dera

te d

ep

ressio

n a

nd

an

xie

ty

an

d a

sso

cia

ted

ch

alle

ng

es.

Du

ty o

f C

are

an

d S

up

erv

isio

n:

•

Kn

ow

ing

ho

w, w

here

an

d w

hen

to

refe

r els

ew

here

wh

en

th

e s

co

pe o

f

the c

lien

ts' i

ssu

es a

re o

uts

ide o

f o

ne's

skill

ran

ge ± t

his

will

on

ce a

gain

vary

dep

en

din

g o

n t

he s

kill

set

of

each

health

pro

fessio

nal an

d t

he n

atu

re a

nd

severity

of

the d

iso

rder

bein

g t

reate

d

an

d o

ther

co

mp

licatin

g f

acto

rs t

hat

may

be p

resen

t, e

.g. w

hat

do

yo

u d

o w

hen

a w

om

an

wh

o in

itia

lly p

resen

ted

with

severe

dep

ressio

n a

nd

an

xie

ty b

ut

low

risk o

f h

arm

ing

hers

elf o

r o

thers

is n

ow

rep

ort

ing

in

cre

ased

su

icid

al id

eatio

n a

nd

/

or

has a

ttem

pte

d t

o h

arm

hers

elf a

nd

/or

her

bab

y?

•

Health

pro

fessio

nals

tre

atin

g s

evere

an

d c

om

ple

x m

en

tal h

ealth

issu

es w

ill

req

uire in

cre

ased

access t

o o

ng

oin

g a

nd

sp

ecia

lised

su

perv

isio

n. It

is c

ritical th

at

so

me f

orm

of

ap

pro

priate

su

perv

isio

n

is a

lways a

ccessib

le, is

th

ere

is a

n

incre

ased

ris

k o

f w

ork

ing

with

escala

tin

g

circu

msta

nces a

nd

issu

es r

ela

tin

g t

o

safe

ty.

•

It is a

lso

essen

tial th

at

wh

en

learn

ing

sp

ecia

lised

tre

atm

en

ts, e.g

. p

are

nt-

infa

nt

sp

ecia

list

thera

pie

s, in

form

atio

n a

nd

skill

s

rela

ted

to

th

ese a

re in

itia

lly c

on

so

lidate

d

thro

ug

h r

eg

ula

r su

perv

isio

n. C

on

tin

ued

peer

su

perv

isio

n is e

nco

ura

ged

wh

en

ever

sp

ecia

list

treatm

en

ts a

re b

ein

g

imp

lem

en

ted

, re

gard

less o

f exp

erien

ce.

How to deliver*

•

Bro

ad

/sp

ecifi

c c

am

paig

ns (b

eyo

nd

blu

e)

•

Am

bassad

ors

•

blu

eVo

ices

•

Web

site

•

Med

ia

•

beyo

nd

blu

e R

eso

urc

es/f

act

sheets

•

Co

nfe

rences/s

em

inars

•

DV

Ds

•

Web

sites

•

Sp

ecia

lised

tra

inin

g p

ackag

es

•

Onlin

e

•

Face t

o f

ace

•

Accre

ditatio

n

•

Curr

iculu

m (und

er

develo

pm

ent)

•

DV

Ds

•

Case p

resenta

tio

ns

•

Cro

ss a

gency d

eliv

ery

/lo

cal netw

ork

wo

rksho

ps

•

Man

ualis

ed

tre

atm

en

ts f

or

face-t

o-f

ace

wo

rk

•

On

line t

reatm

en

ts

•

Self-h

elp

bo

oks

•

Wo

rksh

op

s/m

ulti-

dis

cip

linary

gro

up

*Als

o ± O

ther

meth

od

s a

s r

eq

uired

211206_1012_BL1040.indd 34 23/10/12 11:50 AM

Appendix 4

THE BEYONDBLUE ONLINE TRAINING PROGRAM FOR


Objectives of the beyondblue online training program

The beyondblue online training program Beyond babyblues: Detecting and managing perinatal mental health disorders in

primary care, was developed with the Parent-Infant Research Institute (PIRI) in consultation with the beyondblue National

Perinatal Depression Initiative (NPDI) Workforce Training and Development Committee, together with consumer and carer

representatives, and other health professional experts.

All materials were produced by GenesisEd, an accredited provider with the Royal Australian College of General

Practice (RACGP) and Royal College of Nursing Australia (RCNA), the Australian College of Rural and Remote Medicine

(ACRRM) and the Australian College of Midwives (ACM). The program has been tailored to the Basic Skills section of the

beyondblue Perinatal Workforce Training and Development Matrix (see Appendix 2).

Aims of the beyondblue online training program

1. Differentiate between and understand the range of perinatal mental health disorders.

2. Understand the background, purpose and importance of screening, its application and limitations, and how to

implement screening using the Edinburgh Postnatal Depression Scale (EPDS).

3. Understand the importance of conducting a broader psychosocial assessment, including risk assessment, for

comprehensive clinical care.

4. Interpret and integrate the EPDS scores and other assessment material, and communicate these results to

women using basic counselling skills and client-centred communication.

5. Be aware of evidence-based interventions for anxiety, depression and related disorders in the perinatal period and

integrating these in the development of care plans for patients.

6. Understand the importance of knowing where and how to refer to relevant pathways and existing treatments,

interventions and support.

This program consists of six different learning activities, which can be completed as one Active Learning Module (ALM)

or as six separate educational activities. Activities 5 and 6 of this program are aimed specifically at general practitioners;

however all primary health professionals are encouraged to complete these activities also.

The ALM has successfully been accredited for RACGP (40 pt), ACRRM (6 pt) and endorsed by the RCNA (6 pt), ACM

(6 pt) and each of the six individual educational activities has been fully accredited for RACGP (2 pt), ACRRM (2 pt) and

endorsed by the RCNA (1 pt) and ACM (1 pt). This program has also been accredited by the General Practice Mental

Health Standards Collaboration (GPMHSC) as a Mental Health Skills Training (MHST) activity.

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Appendix 5

THE BEYONDBLUE AND NATIONAL HEALTH AND MEDICAL

RESEARCH COUNCIL PARTNERSHIP LINKAGE GRANT ±

RESEARCH AIMS

External to the NPDI, beyondblue has committed financial and in-kind support as a partner organisation in a National

Health and Medical Research Council (NHMRC) Linkage Research Grant (commenced in 2012). This research aims to

evaluate the impact of perinatal mental health initiatives on mental health outcomes, which is critical for optimising the

quality and uptake of services. This project is unique in that it will use very large population health datasets to examine

the impact of the reforms on maternal health outcomes, service utilisation and the likely cost-effectiveness of these

services (see below).

Research aims of the beyondblue/NHMRC Linkage Grant Research

Aim 1

To examine mental health service utilisation and cost associated with introduction of key perinatal mental health

initiatives, and likely cost-effectiveness of these reforms.

Objectives

1a. To measure i) hospital-related and ii) Medicare mental health service utilisation in women presenting with mental

health morbidity in the perinatal period.

1b. To measure i) hospital-related service and ii) Medicare mental health item costs in women presenting with mental

health morbidity in the perinatal period.

2. To assess the range of factors (e.g. socio-demographic, geographical, clinical) associated with mental health

service utilisation by perinatal women.

3. To assess the impact of perinatal mental health initiatives on mental health service utilisation across time.

4. To determine the likely cost-effectiveness of key reforms in perinatal mental health.

Aim 2

To use the outcomes of Aim 1 to engage key stakeholders in a consideration of:

5. The further implementation and evaluation of the NPDI, with a particular focus on universal depression screening

and psychosocial assessment (henceforth referred to as `s creening' )

6. The development of data elements (for inclusion in the Perinatal National Minimum Dataset), which can be used to

evaluate the implementation of universal `s creening'.

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THE NATIONAL PERINATAL DEPRESSION INITIATIVE...The National Perinatal Depression Initiative...

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