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March 8, 2017
Elaine Flynn-York, M.S.W., L.C.S.W.
Director of Prevention and Parenting
DMHAS Young Adult Services
Office of the Commissioner
Traci McComiskey, CLD, CCCE, RCOSPE, IMH-E(1)
Perinatal Support Director
Birth Support, Education & Beyond, LLC
Description and Outcomes of a Perinatal Support Program for Young Adults with Significant Trauma and Mental Health Issues
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Our mission is to improve the lives of young people by
providing the highest quality services possible. We do this
by forming a partnership with the individual, their family,
identified significant persons, and with other community
service providers.
By doing so we create a “community of care” that fosters
mutual respect and individualized client centered
treatment.
Who We ServeYouth ages 18 – 25 who have:
Complex psychiatric diagnoses
Complex trauma and/or significant abuse and neglect
Significant attachment disorders
Co-morbid diagnoses including substance abuse/behavioral disorders
Developmental disorders
Multiple hospitalizations
Had on average 7-10 out of home placements prior to the age of 16
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Over 50% of the young adults served transitioned from the Connecticut child welfare system.
With these conditions, the young adults face severe challenges with transitioning into adulthood.
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Service Components of YAS
Young Adult Services- Office of the Commissioner Young Adult Services/ Local Mental Health Authorities
(18 community programs, including state operated and DMHAS funded PNP (private non-profits) LMHA’s (local mental health authorities)
Specialized residential programs Inpatient units
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Clinical support services Crisis support Medication management Case management Housing support services
Educational/vocational/ employment support
Life skills development Social/recreational opportunities Perinatal support services
What DMHAS YAS Provides
Trauma sensitive, client centered treatment including:
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DMHAS Pregnant/Parenting YAS Clients
Approximately 1,400 YAS clients (10% of the YAS population) are pregnant or parenting at any given time in the CT DMHAS system.
This cohort is at risk for pregnancy and parenting adverse outcomes. These outcomes are related to exposure to childhood trauma, prior involvement in the foster care system, and the onset of mental health disorders.
(Dworski, A., & Coutney, M. E., 2010; Manlove, Welti, McCoy-Roth, Burger & Malam, (2011).
Embedded within YAS is a perinatal support program. This program provides intensive support services with trauma informed care to our vulnerable population fostering positive attachments.
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Birth Support, Education & Beyond, LLC (BSEB) DMHAS Perinatal Support Program
The home visitor model was sited to be the most effective intervention with high risk, first time parents, when services were delivered in the perinatal period. Olds, Sadler & Kitzman, 2007)
Doula services have been related to positive outcomes for young and at risk mothers in a number of areas. These areas include fewer complications with labor & delivery, increased APGAR scores, initiation of breastfeeding and enhanced maternal-child interactions. (Lee-Philips & Kelly, 2014)
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In-home prenatal support, childbirth & pregnancy education
Doula services throughout labor, birth and the immediate postpartum period
In-home postpartum supports, perinatal depression screenings & referrals
In-home parenting education services, child development screenings & referrals
Collaboration with YAS treatment teams and community providers
What BSEB Provides
Gender Race/Ethnicity Age at Admission into BSEB Services
Male 12 (13.2%) White 32(36%) Mean 21.29 or 21 years, 3 months
Female 79 (86.8%) Black 24 (27%) Standard Deviation 2.05 or 2 years, 6 months
Hispanic 29 (32.6%) Minimum 18
Mixed/Other
4 (4.5%) Maximum 26.25
The total sample is 92 clients served from January 2014 to January 2017
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Entry Point to YAS Employment atAdmission
Education at Admission
OOC 62 (68.1%) Yes 26 (28.6%) Less than HS 16 (17.8%)
Front-Door 29 (31.9%) No 65 (71.4%) HS Graduate 55 (61.1%)
Post-HS Training 3 (3.3%)
Some College 16 (17.8%)
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OOC- direct referrals from the CT Child Protection Agency to DMHAS YAS Office of the Commissioner for eligibility determination.
Front Door- referrals from families, schools, community providers, Department of Corrections or self to the state LMHA’s and PNP YAS programs for eligibility.
The total sample is 92 clients served from January 2014 to January 2017
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BSEB Demographics
The total sample is 92 clients served from January 2014 to January 2017
Pregnant at Time of Admission
Parenting at Time of
Admission
Both Pregnant &Parenting at
Time ofAdmission
Yes 73 (81.1%) Yes 28 (33.3%) Yes 13 (15.5%)
No 17 (18.9%) No 56 (66.7%) No 71 (84.4%)
In 1st Trimester 19 (26%)
In 2nd Trimester 30 (41.1%)
In 3rd Trimester 24 (32.9%)
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40 4333
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TOTAL CHILDREN SERVED
Total Children Served
0-3 Months 3-6 Months
6-12months 12mo-3yrs
3.33% 3.58%2.75%
8.66%
QUARTERLY % OF TOTAL CHILDREN SERVED
Quarterly % of Children
Served
0-3 months 3-6 months
6-12 months 12mo-3yrs
Overall Children served from January 2014 to January 2017 220 Total Children Served
BSEB Demographics (cont.)
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CT Department of Children andFamilies (DCF) Involved Cases
% of DCF Involved Cases Quarterly 11.75%
Total # of children with DCF Involvement 141
BSEB Demographics (cont.)
Average length of Stay in BSEB Services
(In Months) 11.11
Median 8
Standard Deviation 9.43
Minimum 1
Maximum 44
Multiple admissions were averaged into length of stay therefore the single length of stay in the BSEB program is not represented in this outcome
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Number of BSEB Admissions
One 76 (83.5%)
Two 11 (12.1%)
Three 4 (4.4%)
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Edinburgh Postpartum Depression Scale (PPD) screening for mothers and involved partners: Initial Intake Prenatal 2nd trimester Prenatal 3rd trimester Postpartum 1st week at home Postpartum at 2 weeks Postpartum at 6 weeks Postpartum at 3months Postpartum at 6months Postpartum at 9 months Postpartum at 12 months Yearly there after
Parent Sense of Competency Scale (PSOC)- for mothers and involved partners: Intake At 6 months of BSEB services At 12 months of BSEB services At 18 months of BSEB services At 24 months of BSEB services And at 6 month intervals thereafter At close of services
BSEB service evaluations: After 6 months of BSEB service Yearly At close of services
PAT (Parents as Teachers) developmental milestone assessments performed at end of assessment age: Birth-1 ½ months 1 ½ months- 3 ½ months 3 ½ months- 5 ½ months 5 ½ months- 8 months 8 months- 14 months 14 months – 24 months 24 months-36 months
ASQ-3 & ASQ S/E (Ages and Stages Questionnaires) developmental, social & emotional assessments: Birth – Age 1 performed bimonthly Age 1 – Age 2 performed bimonthly Age 2 – Age 3 performed quarterly
Birth support evaluations: Within 2 weeks of birth
Domestic Violence Screenings: At intake, annually Anytime risk becomes known a referral to the clinical team is
made. DV hotline info is given to client along with encouragement to call and DV safety plan is completed with client and copies given to them and clinical team
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The (PSOC) measures parental competence on two dimensions:
Satisfaction and Efficacy – Johnston & Mash (1989)
The PSOC comprises three useful factors reflecting: Satisfaction in the Parental Role, Parenting Efficacy and Interest in Parenting. Gilmore & Cuskelly (2008)
Satisfaction section examines the parents’ anxiety, motivation and
frustration
Efficacy section looks at the parents’ competence, capability levels, and
problem-solving abilities in their parental role
Interest in parenting
Johnston, C., & Mash, E. J. (1989). A measure of parenting satisfaction and efficacy. Journal of Clinical Child Psychology, 18(2),
167-175. (who cite Gilbaud-Wallston & Wanderson, 1978).
Gilmore, Linda A & Cuskelly, Monica (2008) factor structure of the parenting sense of competence scale using a normative
sample. Child care, health & development 38(1). Pp. 48-55
Parenting Sense of Competence Scale (PSOC)
74.7380.03 82.18
85.25
BASELINE 1ST POST TEST 2ND POST TEST 3RD POST TEST
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PSOC – Mean Scores (n/%)
Baseline 1st
post-test2nd
post-test3rd
post-test
60/74.73% 29/80.03% 11/82.18% 4/85.25%
% Change + 5.3 + 7.45 + 10.52
Women with current depression or anxiety, a history of perinatal mood disorders, or risk factors for perinatal mood disorders warrant particularly close monitoring, evaluation, and assessment (The American College of Obstetricians and Gynecologists, (ACOG- committee opinion #453, Feb. 2010, reaffirmed, 2016)
Postpartum Support International (PSI) recommends universal screening using an evidence-based tool such as the Edinburgh Postnatal Depression Screen (EPDS) or Patient Health Questionnaire (PHQ-9) at the following frequency:
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First prenatal visit At least once in second trimester At least once in third trimester Six-week postpartum obstetrical visit (or at first postpartum visit) Repeated screening at 6 and/or 12 months in OB and primary care settings 3, 9, and 12 month pediatric visits
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Positive assessments are rescreened at sooner intervals Out of 149 EDPS Screenings, BSEB referred 47 clients for further
assessment and treatment
1st assessment within 30 days of intake into BSEB services All positive assessments are referred for further evaluation
& treatment
Prenatal
1st Trimester
2nd trimester
3rd trimester
Post-partum
1st week 2nd week
6 weeks 3 months
6 months 9 months
12 months yearly thereafter
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0
20
40
60
80
100
FEMALE MALE
Gender Distribution (%)
0
10
20
30
40
50
BLACK WHITE HISPANIC OTHER
Race/Ethnicity (%)
Total Active Clients: 23Average Length in BSEB Services = 9 months
Female 19 (82.6%)
Male 4 (17.4%)
Black 10 (43.5%)
White 8 (34.8%)
Hispanic 4 (17.4%)
Other 1 (4.3%)
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0
10
20
30
40
50
60
70
OOC LMHA
Referral Source (%)
0
10
20
30
40
50
60
70
80
YES NO
Employed (%)
Current Active BSEB Clients
Total Active Clients: 23Average Length in BSEB Services = 9 months
Referred by OOC 15 (65.2%)
Front-Door LMHA 8 (34.8%)
Working 6 (26.1%)
Not Working 17 (73.9%)
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Current Active BSEB Clients
Total Active Clients: 23Average Length in BSEB Services = 9 months
Pregnant 2 (8.7%)
Not Pregnant 21 (91.3%)
Parenting 16 (76.2%)
Not Parenting 5 (23.8%)
0
20
40
60
80
100
PREGNANT PARENTING
yes no
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Current Active BSEB Clients
0
20
40
60
80
100
YES NO
Placed Outside Home
As a Child (%)
45
46
47
48
49
50
51
52
53
URBAN NOT URBAN
Community (%)
Total Active Clients: 23Average Length in BSEB Services = 9 months
Childhood Child Welfare 20 (87%)
Childhood No DCF 3 (13%)
Urban YAS Team 12 (52.2%)
Not Urban YAS Team 11 (47.8%)
Average age of admission to YAS is 18.5 years
Average age of admission into BSEB services 21.3 years
No significant outcomes were appreciated within the
mean test scores of the PSOC and EPDS based on: race,
education level, referral base, LMHA/PNP agency or
pregnancy gestation
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Findings…
A 10.5% increase was seen in the PSOC scores within this
data collection. We can hypothesize that with the BSEB
perinatal support the clients satisfaction in their parental
role, efficacy and interest in parenting will continue to
increase over time.
Frequent perinatal mood disorder screenings with referral
for treatment allows us to lower untreated maternal
depression and avoid negative effects on maternal-infant
attachment and child development.
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Strengths…
PSOC was not consistently administered to all clients early
in the study
The data collected on the EPDS was not identified for
pregnancy vs. parenting
Overstatement of the client’s self-assessment on the PSOC
and EPDS can limit the accuracy of the outcome scores
Ability to develop a control group to compare and study
are limited due to service denial
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Limitations & Barriers…
Monthly BSEB chart reviews & audits to monitor with
assessment compliance
Revised our assessment schedule and developed an
outcome tracking tool
Administering evidence based state-wide education
curriculum for HIV & STI prevention and
contraception awareness for all DMHAS YAS clients
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Recently Implemented…
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Evaluate screening tools:
Do either of these instruments accurately capture
change over time
Are there other measurement instruments that might
better capture the two concepts of perinatal
depression and parental competency over multiple
assessments
Begin to collect data on previous foster care/out of
home placements and trauma related diagnoses upon
intake into BSEB services
Next Steps…
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“I am a single full-time dad and because of the help of this program I have accomplished so much and have become the parent I have hoped to be.”
“I love this service. It has built my confidence as a parent to know I can do this.”
… “She (BSEB provider) has been a great emotional support including the baby’s father in appointments. As a second time mom she has taught me great practical and useful skills for my 2yr old and refreshers for my newborn. She has also helped support and encourage the baby’s father with learning how to help and be supportive”
“Has helped me a great deal and taught me a lot. I’m thankful and grateful for these services because it has made me a more prepared and confident parent.”
What Clients have Said…
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Questions & Answers…
How to contact us:
Elaine Flynn-York, M.S.W., L.C.S.W.Director of Prevention and ParentingDMHAS Young Adult ServicesOffice of the [email protected]
Traci McComiskey, CLD, CCCE, RCOSPE, IMH-E(1)Perinatal Support DirectorBirth Support, Education & Beyond, [email protected]
