Some folks in NC are working towards a coordinated system of care beginning with the youngest. In October, the NC Infant/Young Child Mental Health Association will officially form after a year of foundational work; their mission statement will include the intention to work with families from conception onward. In March, NC Institute of Medicine formed the Task Force on the Mental Health, Social, and Emotional Needs of Young Children and Their Families upon the mandate of the NC legislature. After looking at best practices beginning from pre-conception, the Task Force will conclude their work with a report and set of recommendations that will shape policy not only in NC but in other states. Former APPPAH board member Emma Miller has been working with both groups advocating for health promotion, prevention, and early identification and intervention services for families beginning with pre-conception when possible, and conception at the least.
Another recent initiative in NC is the creation of Pregnancy Medical Homes. Health care providers who agree to be in the program ensure that there are no elective deliveries (induction and cesarean section) performed before 39 weeks of gestation, offer and provide 17p (17alpha hydroxyprogesterone) for preterm labor prevention to eligible patients, maintain a primary cesarean section rate at or below 20%, screen for risks (including those related to pre- and perinatal psychology) at the first prenatal visit and integrate the plan of care with the local pregnancy care management program. Service coordination is also available for the birth to five population and their families in the Care Coordination for Children Program. One of the risk categories on the screening form is Toxic Stress (search www.developingchild.harvard.edu). This program is designed to provide community based interventions to maximize health outcomes.
Increasingly, more health and behavioral health services in NC are integrated which suggests many benefits for families. Emma Miller created a webinar for the leadership organization, The NC Center of Excellence for Integrated Care. The program, "Maternal Depression and the Psycho-Social Development of Children," noted how depression can (a) begin in pregnancy and affect the mother, significant others, siblings, and the prenate, and (b) continue to affect the infant and others in that baby’s circles with the passage of time. The same presentation was offered at the Mountain Area Health Education Center's Infant Mental Health Conference in June. Miller is presently offering infant mental health services at a pediatric practice. Clearly, NC is receptive to pre- and perinatal psychology!