El Camino Health Maternal Mood Services Program Generating Positive Results

The Mountain View, California-based health system's initiative features a partial hospitalization program and an intensive outpatient program.

The Maternal Outreach Mood Services (MOMS) program at El Camino Health has a significantly positive impact on new mothers experiencing psychiatric conditions, according to data presented last weekend at the American Psychiatric Association Annual Meeting.

The perinatal period is associated with the risk of psychiatric disorders, including depression, anxiety, and post-traumatic stress disorder (PTSD). During the perinatal period, the prevalence of depression is 19%, the prevalence of anxiety is 13%, and the prevalence of PTSD is 8%, the research presented at the American Psychiatric Association Annual Meeting says.

The MOMS program features a partial hospitalization program and an intensive outpatient program, says Nicole Tarui, MD, an El Camino Health psychiatrist and medical director of the MOMS program.

"At the partial hospitalization level of care, it is generally five days a week and six hours per day. Folks are usually in that level of care for two to three weeks, depending on how they are doing and how they are progressing through treatment. Once a patient is doing better and symptoms are reducing, they step down to the intensive outpatient program. That program is similar to the partial hospitalization program, but it is fewer hours. It starts at five days per week for three hours per day, then gradually goes down to four days per week and three days per week as folks get close to graduation," she says.

The MOMS program features a multidisciplinary team, with social workers, psychologists, perinatal psychiatrists, and nurses who deliver the care. The program offers group and individual therapy as well as medication management. New mothers are treated with their babies present. The types of therapy provided include cognitive behavioral therapy, dialectical behavioral therapy, and infant-parent psychotherapy.

The main sources of referrals into the MOMS program are other mental health providers, obstetricians/gynecologists, pediatricians, and the inpatient women's specialty unit at El Camino Hospital.

The research presented at the American Psychiatric Association Annual Meeting focuses on Edinburgh Postnatal Depression Scale (EPDS) scores for 88 mothers who participated in the MOMS program from July 2020 to June 2022. The patients ranged from 22 weeks of gestation to two years postpartum. The EPDS is a screening tool with 10 questions generating a score from 0 to 30. A score of 10 or higher indicates possible depression, according to the University of California-San Francisco.

The study includes two key findings:

• For all diagnoses among the 88 patients, the mean EPDS score was 15 at admission to the MOMS program and 6 at discharge
   
• For the 57 patients who were diagnosed with major depressive disorder, the mean EPDS score was 17 at admission to the MOMS program and 7 at discharge

Unique aspect of care

One of the unique aspects of the MOMS program is that mother and baby are together while the mother is in treatment, Tarui says. "On a daily basis, we are getting to see them interact in a group setting as well as in individual sessions. This is where I help parents understand that there may be some challenges that they are facing and how to overcome those challenges to develop a secure attachment with the baby."

Infant-parent psychotherapy is one of Tarui's areas of expertise.

"I work individually with the parent and their baby to be able to talk about their history, relationship dynamics, and the impacts on bonding with baby. … We use the information about someone's history to be able to understand whether there are challenges in the bonding. We also get a lot of information in real time—being able to see the interaction between mom and baby. We can see whether the mom is responding to the baby's cues and how the baby is responding to mom," she says.

In infant-parent psychotherapy sessions, the goal is not to be directive, Tarui says. "It is more about encouraging the parent to be able to understand how their past or their symptoms might be impacting the bonding. I just gently point out interactions that I am seeing. For example, if the baby is crying and mom is feeling particularly distressed at that moment, I am curious about what is happening for her and how she can tolerate that level of distress. I want to help her become attuned to the baby and his or her cues. That is what helps build reflective capacity in mom and develop a secure attachment to the baby."

Advice for health systems and hospitals

Tarui offered three pieces of advice for other health systems and hospitals interested in launching initiatives similar to the MOMS program.

First, collaboration is essential the MOMS program, she says. "There are many different aspects to the care and treatment, on the group level, the individual level, and in medication management. Being able to talk with colleagues who have done this work and have this expertise is crucial to understanding the barriers to treatment and other challenges."

Second, ongoing education is important, Tarui says. "Even for myself and the staff that we have in the MOMS program, the field of perinatal psychiatry is vast and there is so much to learn on an ongoing basis. I educate myself on developing treatments and new therapeutic modalities. That is key to delivering the highest quality of care."

Third, seek out education on infant-parent psychotherapy, she says. "Recently, we have been doing a lot of work with infant-parent psychotherapy, and we had an expert in the field from University of California-San Francisco come to train us. We have been able to integrate that education into the care that we are providing both on the group and individual level."

Related: Yale New Haven Hospital Helping New Moms to Address Mood Disorders