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Management of depression during the perinatal period: state of the evidence

Falek, Idan; Acri, Mary; Dominguez, Joanna; Havens, Jennifer; McCord, Mary; Sisco, Sarah; Wilcox, Wendy; Hoagwood, Kimberly
BACKGROUND:Perinatal depression (PND) is a prevalent ailment that affects both the woman and her family. Addressing PND in primary health care, such as pediatrics and obstetric care settings, has been proposed as an effective way to identify and treat women. OBJECTIVE:The purpose of this study is to examine best practices for management of PND in obstetric and pediatric settings, as well as investigate the evidence that supports the guidelines. METHODS:Guidelines were identified through a literature search and discussion with experts in the field of perinatal depression, while evidence was examined through a literature search of reviews and thereafter experimental studies. RESULTS:Twenty-five guidelines, across 17 organizations were retained for analysis. Findings suggest that there is little or varied guidance on the management of PND, as well as a lack of specificity. Treatment was the topic most frequently reported, followed by screening. However best practices vary greatly and often contradict one another. Across all areas, there is inadequate or contrasting evidence to support these guidelines. CONCLUSIONS:Although there was consensus on the key steps in the pathway to care, the review revealed lack of consensus across guidelines on specific issues relating to identification and management of depression during the perinatal period. Clinicians may use these recommendations to guide their practice, but they should be aware of the limitations of the evidence supporting these guidelines and remain alert to new evidence. There is a clear need for researchers and policymakers to prioritize this area in order to develop evidence-based guidelines for managing perinatal depression.
PMCID:9036756
PMID: 35468808
ISSN: 1752-4458
CID: 5217322

Beyond Screening: A Stepped Care Pathway for Managing Postpartum Depression in Pediatric Settings

Olin, Su-Chin Serene; McCord, Mary; Stein, Ruth E K; Kerker, Bonnie D; Weiss, Dara; Hoagwood, Kimberly E; Horwitz, Sarah M
The negative consequences of untreated postpartum depression (PD) for both the woman and her infant are well established. The impact of maternal depression has led to recommendations on systematic perinatal depression screening. Unfortunately, large-scale initiatives on PD screening have found no benefit unless systems are in place to facilitate appropriate interventions for women who screen positive. Pediatric primary care has been a focus of efforts to support screening and management of PD because pediatric providers, unlike adult healthcare providers, have the most frequent contact with postpartum women through well-child visits. Well-child visits thus present an unparalleled opportunity to detect and intervene with PD. Literature reviews suggest that specific strategies are feasible within pediatric settings and could benefit both the woman and her child. In this article, we present a stepped care approach for screening and managing PD, integrating common elements found in existing pediatric-based models. A stepped care approach is ideal because PD is a heterogeneous condition, with a range of presentations and hence responsiveness to various interventions. This care pathway begins with systematic screening for depression symptoms, followed by a systematic risk assessment for women who screen positive and care management based on risk profiles and responsiveness. This approach allows pediatric providers to be optimally flexible and responsive in addressing the majority of women with PD within the context of the family-centered medical home to improve child well-being. Challenges to managing PD within pediatrics are discussed, including strategies for addressing them. Implications for research, policy, and practice are discussed.
PMCID:5749581
PMID: 28409703
ISSN: 1931-843x
CID: 2528422

Engaging Caregivers in School-Based Obesity Prevention Initiatives in a Predominantly Latino Immigrant Community: A Qualitative Analysis

Berger-Jenkins, Evelyn; Jarpe-Ratner, Elizabeth; Giorgio, Margaret; Squillaro, Alexa; McCord, Mary; Meyer, Dodi
OBJECTIVES: To explore caregiver perceptions of, and barriers and facilitators to, their involvement in school-based obesity prevention programs in underserved Latino immigrant communities. METHODS: Focus groups discussions were conducted with caregivers (n = 42) at 7 elementary schools with an academic partnership-based obesity prevention program. Thematic analysis was used to identify key findings in the data. RESULTS: Caregivers described their role as (1) learners of new and often complex health information using their children as primary messengers and (2) champions within their homes in which healthier choices are assimilated. Barriers to involvement included lack of time, financial pressures, unhealthy family practices, and concern that attempts to engage peers would be perceived as intrusive. Facilitators included assurance that stigmatizing health issues would be addressed with sensitivity. CONCLUSIONS AND IMPLICATIONS: Caregiver involvement in obesity prevention may be fostered by transmitting information through children, addressing cultural barriers, and avoiding potentially stigmatizing approaches to delivering health messages.
PMID: 27692629
ISSN: 1878-2620
CID: 2273852

Turn 2 Us: Outcomes of an Urban Elementary School-based Mental Health Promotion and Prevention Program Serving Ethnic Minority Youths

Montanez, Evelyn; Berger-Jenkins, Evelyn; Rodriguez, James; McCord, Mary; Meyer, Dodi
Many school-age children in the United States with social, emotional, and behavioral problems do not receive mental health services. These problems negatively affect their social and behavioral functioning and academic achievement. This is particularly a problem for Latino youths, who represent the largest ethnic minority group in the United States and the largest group with unmet need for mental health services. School-based mental health promotion and prevention programs (SBMH-PPs) can mitigate such problems. This article describes such a program, located in an underserved area of northern Manhattan, New York City. A study was conducted to examine the effects of this SBMH-PP, which served 174 predominantly Latino at-risk students from two urban elementary schools during the 2008-2009 school year. Pre and post teacher reports, attendance rates, and academic scores were used to analyze the effects of the SBMH-PP on these students. Results demonstrated increased prosocial behavior and classroom compliance, as well as improved academic achievement. Improvement was also found in attendance when compared with a control group of similar students not served by the program. The outcomes of this study provide further evidence for the effectiveness of SBMH-PPs that serve minority youths in elementary schools.
ISI:000359856800005
ISSN: 1545-682x
CID: 2344262

Primary Prevention of Early Childhood Tooth Decay through Multidisciplinary Collaborations [Meeting Abstract]

Edelstein, Burton; Chinn, Courtney; Levine, June; Williams, Sharifa Z.; McCord, Mary; Smaldone, Arlene; Matos, Sergio; Findley, Sally; Rauh, Virginia; Witte, Susan; O'Connell, Kathleen; Contento, Isobel; Wolf, Randy; Koch, Pamela; Rowe, Jessica; Yoon, Richard
ISI:000316698700307
ISSN: 1356-1820
CID: 3537852

The Healthy Schools Healthy Families Program–Physical Activity Integration into Elementary Schools in New York City

Jarpe-Ratner, Elizabeth; Zamula, Arien; Meyer, Dodi; Nieto, Andres; McCord, Mary
Increasing physical activity delivers proven results in combating childhood obesity. The high prevalence of childhood obesity and the lack of effective treatment mandate a prevention approach that targets all children. School based programming is an important tool to reach all children. Healthy Schools Healthy Families (HSHF) partnered with teachers, community groups and school leadership to increase physical activity during school hours, targeting all children in seven low resource inner city schools. The intervention targeted 5000 children in seven inner city schools in New York City. Results are reported from 2009-2010. A multi-faceted approach targeted in-class, recess and gym time with programming varying from school to school, tailored to specific school needs. Minutes of physical activity were tracked using a classroom-based logging system, with incentives provided to teachers, school-aides and schools documenting the most activity. HSHF schools averaged 110.8 minutes/week/class with significant variation between schools. HSHF successfully generated by, at all school levels, with 2010 data reaching the CDC recommendation for physical activity during school hours, despite severe resource limitations in program schools. HSHF offers a feasible model for increasing activity for all children in low-resource, inner city schools and for tracking results
ORIGINAL:0009170
ISSN: 2161-0711
CID: 1122562

Community health workers as drivers of a successful community-based disease management initiative

Peretz, Patricia J; Matiz, Luz Adriana; Findley, Sally; Lizardo, Maria; Evans, David; McCord, Mary
In 2005, local leaders in New York City developed the Washington Heights/Inwood Network for Asthma Program to address the burden of asthma in their community. Bilingual community health workers based in community organizations and the local hospital provided culturally appropriate education and support to families who needed help managing asthma. Families participating in the yearlong care coordination program received comprehensive asthma education, home environmental assessments, trigger reduction strategies, and clinical and social referrals. Since 2006, 472 families have enrolled in the yearlong program. After 12 months, hospitalizations and emergency department visits decreased by more than 50%, and caregiver confidence in controlling the child's asthma increased to nearly 100%. Key to the program's success was the commitment and involvement of community partners from program inception to date.
PMCID:3464827
PMID: 22515859
ISSN: 0090-0036
CID: 1112852

Effect of routine mental health screening in a low-resource pediatric primary care population

Berger-Jenkins, Evelyn; McCord, Mary; Gallagher, Trish; Olfson, Mark
OBJECTIVE: Despite evidence for its feasibility, the usage of mental health screening in primary care practices with overburdened providers and few referral options remains unclear. This study explores the effects of routine screening on mental health problem identification and management in a low-resource setting. METHODS: Medical records of 5 to 12 year-old children presenting for well visits before and after screening was implemented were reviewed. Multivariate logistic regression was used to explore associations between study period and identification/management practices. Changes in the number of visits and wait times for a co-located referral service were assessed post hoc. RESULTS: Parents disclosed more mental health problems, and providers initiated more workups but referred fewer patients after screening was implemented. The proportion of new visits and wait times for the referral service did not change. CONCLUSIONS: Even in low-resource settings, screening may facilitate parental disclosure and increase clinical attention to mental health problems without overburdening referral services.
PMID: 22157425
ISSN: 0009-9228
CID: 1112862

Characteristics of failure to thrive in a referral population: implications for treatment

Atalay, Alev; McCord, Mary
Failure to thrive (FTT) in children is an important pediatric problem. Environmental and behavioral causes predominate, and detrimental effects on neurocognitive development are well documented. Multidisciplinary clinics designed to identify and treat FTT are effective but have not been widely adopted. A retrospective chart review was conducted of all patients with FTT seen at the authors' large inner-city children's hospital over a 40-month period, including those referred to a new multidisciplinary clinic. Over 40 months, only 75 children were referred and only 20 had moderate or severe FTT (z-score <-2.0). Nutritional status improved with treatment, but the small number of referrals who were severely affected led to the closing of the clinic. Recommendations for evaluating and treating children with mild FTT in primary care settings and a standardized definition of FTT that warrants more intensive treatment would help ensure that children were referred and treated appropriately.
PMID: 21997145
ISSN: 0009-9228
CID: 1112872

Awareness of sickle cell among people of reproductive age: Dominicans and African Americans in northern Manhattan

Siddiqui, Saira; Schunk, Kelly; Batista, Milagros; Adames, Francisca; Ayala, Peggy; Stix, Benjamin; Rodriguez, Jacqueline; McCord, Mary; Green, Nancy S
Sickle cell disease is a chronic condition that is characterized by severe anemia, painful crises, and organ dysfunction. In the U.S.A., sickle cell is a health burden typically associated with African Americans. Dominicans constitute the largest Latino group in New York City (N.Y.C.) and have the second overall highest prevalence of sickle trait-one in 20 births, compared to one in 12 African American births. We aimed to document the prevalence of sickle within the largely Dominican and African American community of Northern Manhattan (Washington Heights, Inwood, Harlem), assess and compare knowledge about sickle disease and carrier status in young adults of reproductive age between African Americans and Dominicans, and elicit preferred sources of health information. N.Y. State Newborn Screening data in Northern Manhattan were analyzed by zip code. A brief oral survey was administered to 208 parents of young children-150 Dominicans and 58 African Americans. Significant differences were seen in knowledge about sickle-27% of Dominican parents surveyed correctly defined sickle cell disease as an inherited blood disorder, compared to 76% of African Americans (p < 0.001). Only 7% of African Americans did not know their own trait status, compared to 43% of Dominicans (p < 0.001). Parents were better informed if they or family members were affected by sickle conditions. Participants from both groups prefer receiving information from doctors and online. A separate group of 168 predominantly Dominican youth, ages 14-24, demonstrated knowledge levels similar to that of Dominican parents. These results suggest that many of reproductive age in a N.Y.C. community affected by sickle conditions frequently lack basic relevant information, with larger information gaps among Dominicans. Expanded efforts are warranted to inform young adults of diverse affected communities.
PMCID:3284595
PMID: 22009200
ISSN: 1099-3460
CID: 1112882