Post-Partum Depression and Early Childhood Development

The bond between a mother and child is special. Because that connection is so profound, wellbeing for an infant is largely determined by the physical and mental health of their mother. According to the American College of Obstetricians and Gynecologists (ACOG), Post-Partum Depression (PPD) is one of the most common threats to maternal mental health, affecting approximately 600,000 women a year. It is estimated that 14% to 23% of mothers will experience depression at some point during pregnancy and 5%-25% experience PPD. All women who give birth are potentially at risk. Despite that fact, many mothers with PPD struggle with guilt or shame. While PPD is highly treatable, fear of being labeled a bad mother can make it hard for women to discuss the issue or reach out for the help they need.

Symptoms of PPD include feelings of anger, crying more often than usual, withdrawing from loved ones, feeling distant from the baby, worrying or feeling overtly anxious, thinking about hurting yourself or the baby, and doubting one’s ability to care for the baby. These feelings of being unable to connect to the baby can be particularly unsettling for new mothers and particularly disruptive to the attachment and responsiveness which underlies health child development. Because the first three years of life are so foundational, untreated PPD can have lifelong consequences for children.

Simple acts of care such as hugs, smiles, and lullabies create new brain pathways for infants which develop their capacity to form memories, relationships, and logic. Post-partum depression can weaken the mother-child bond, stunting cognitive and linguistic development. A number of other negative outcomes have been linked to PPD, such as higher rates of behavioral problems and lower grades. If essential neural pathways are not formed during early childhood, they may never develop. This means that treatment is especially time sensitive; early treatment allows moms to fully bond with their children as soon as possible and to optimize their child’s early developmental period. TexProtects advocates for improving post-partum mental health and other issues which impact a child’s crucial development period through our Prenatal to Three Policy Agenda.

Destigmatizing PPD and supporting mothers with mental healthcare will help ensure every child in Texas has a strong start. Last legislative session, HB 253 mandated the creation of a five-year strategic plan to raise public awareness around PPD and to improve access to mental health screening, referral, treatment, and support services. The Texas Health and Human Services Commission (HHSC) recently released their initial draft of the Post-Partum Depression Strategic Plan for public comment. TexProtects submitted comments on that draft plan that included the following key recommendations:

  1. Texas should continue strong investments in programs overseen by the Department of Family and Protective Services’ (DFPS) Prevention and Early Intervention (PEI) Division – such as Texas Home Visiting, Project HOPES, Project HIP, and Texas Nurse-Family Partnership – to reach more families. These voluntary programs are proven to improve maternal and infant health, strengthen referrals and connections, and promote positive parenting.
  2. Texas should increase investments in Texas Family Connects, a short-term evidence-based nurse home visiting program that links nurses to moms with newborns. To encourage scale-up into more Texas regions, Texas should explore additional financing strategies, including Medicaid coverage for maternal mental health screenings, case management, and nurse visits delivered through Family Connects.
  3. Texas should expand Help Me Grow, a referral line and centralized access point that helps parents with young kids to get connected to community-based resources. Department of State Health Services (DSHS) Title V has recently become a statewide hub for Help Me Grow, a national model that works to create a “Centralized Access Point” for parents with young children. Included in this work is strategic integration with statewide 2-1-1 so that families have both an effective “front door” when looking to access services and a warm handoff to regional hubs where parent navigation can ensure families get access to the right program and supports at the right time.

Increasing healthy beginnings and supporting young families are critical components of our Prenatal to Three Policy Agenda. Learn more about our work to ensure infants and toddlers (and their families) have what they need to be safe and well and maximize the potential of the early years of development.

Partnering to Bring Family Connects to North Texas

The time around birth—whether it’s your first or fifth, you’re adopting or fostering a baby, you’ve just given a baby up for adoption, or you’ve lost your baby—is an immensely vulnerable time for all families. Parenting, however it looks for you, doesn’t come with an instruction manual. But what if it came with a study buddy? Someone who could check in on you, answer your questions, point you in the right direction, and share this moment with you?

This is Family Connects, a short-term evidence-based program in which registered nurses visit families in the first few weeks after a birth, adoption or foster care placement of a newborn, or pregnancy loss, to check in and see how families are adjusting, and connect families to community resources they need. Family Connects comes at no cost to the family and is available to all —it sets the expectation for how a community cares for its families, regardless of their personal circumstances. It is also short-term—Family Connects aims to connect families to the right services for them at the right time, rather than duplicate or replace those services. Most families only need one visit, but nurses can provide up to three visits, if necessary. All families receive a follow-up call one month after their last visit to confirm that they have connected with their referrals and  had their needs met or are receiving services.

During the home visit, a Family Connects nurse assesses the family to identify their needs. Overwhelmingly, families do need information and resources: Family Connects has found that 95% of families have at least one nurse-identified risk or need. Some parents may need help finding a pediatrician, managing postpartum depression or anxiety, or getting connected to housing or food resources. Others may need referrals to programs and services for family members or a link to support groups for parents in similar situations.

Nurses are not case managers and Family Connects does not duplicate existing services. Based on the individual family’s needs, the nurse uses a searchable database to identify a community resource or service provider, such as a diaper bank, home visiting program, or early childhood intervention, that addresses the family’s need, makes a warm handoff to a local service provider, and follows up with the family to close the loop and make sure the family was connected to the resource or service. In so doing, Family Connects strengthens the web of community resources and referrals. The data collected by Family Connects helps inform community leaders and stakeholders of emerging trends, gaps in resources, and successful connections, which can be used to make decisions about community priorities and resource allocation.

Much like Family Connects brings the community together around families, the program itself is strengthened by the partners who make it up. As TexProtects began looking for partners to support the program in Dallas, we learned that MHMR of Tarrant County and the Early Learning Alliance were also looking at bringing the program to Fort Worth. 

At this moment, we realized two critical things:

  1. Our programs may start and end at Highway 360, but our families don’t. North Texas is one community made up of not only Dallas and Fort Worth, but also Arlington, Plano, Cleburne, Forney, Frisco, Mansfield, and other cities and towns. We need to be forward thinking about how we can structure our programs to meet families where they are and how they live, rather than to easily fit our administrative structures.
  2. We are stronger when we work together. It didn’t make sense to have two separate Family Connects programs in North Texas when we could go through the process together, learn from one another, leverage each other’s strengths, and build one infrastructure that could support both counties and the region as a whole.

Since May of 2019, our Family Connects North Texas team has set itself up to provide one North Texas structure with two parallel branches—east (Dallas) and west (Tarrant). Based on a community needs assessment of North Texas, implementation began first in Arlington and Cleburne (west) in November 2019. During COVID-19, Family Connects has transitioned to providing virtual services. Isolated from their families, friends, and traditional support networks, parents are more eager than ever to receive these virtual connections.

As we all navigate this period of reopening our state and rebuilding our economy, we know there are so many competing needs, but our families must come first. We believe Family Connects can play an important role by helping new families get connected to the resources and services they need, so that parents and their newborns can get off to a strong start. As parents quickly find out, none of us can do it alone and we can all benefit from connections. Similarly, our organizations can’t do this alone. As we continue with our planning in the east (Dallas), we are grateful for the many partners who are working with us on funding and implementation planning to make a Dallas Family Connects pilot a reality.

Promoting Positive Family and Community Engagement For CAPM

This Child Abuse Prevention Month, TexProtects worked to increase awareness and provide families with ideas and resources.

April is National Child Abuse Prevention Month, a special observance to highlight the current initiatives improving the child welfare system. Protecting children is an everyday mission for TexProtects and our partners.

According to the Department of Family and Protective Services DataBook, in 2019:

  • There were 294,739 total reports of child abuse, 23% of which were victims of child maltreatment and 14% of which were confirmed investigations
  • Of the confirmed allegations of abuse and neglect, 55.5% of victims were ages 0-5, 27.1% were ages 6-11, and 17.3% were ages 12-17
  • 72.7% of all confirmed child maltreatment victims were due to neglectful supervision
  • 235 children died of abuse and neglect, an 11% increase from 2018
  • 18,615 children were removed from their families due to child maltreatment

The prevention of child abuse and neglect is especially important due to the challenges that COVID-19 has created. Evidence shows that numerous risk factors, including social isolation, financial instability, and other stressors have high potential to increase risk for abuse and neglect. With the impact of this pandemic, a primary concern is that although reports of abuse may decline, incidents of child maltreatment may be increasing. Educators and medical professionals make up the majority of reporters for suspected child abuse. But with stay-at-home orders leaving fewer eyes on kids, how can we, as communities, help prevent child maltreatment in the midst of this crisis?

TexProtects has proactively created a variety of tools to promote positive family and community engagement. These include:

In addition, through op-eds and statements to the press, we are working to increase awareness of child abuse and neglect prevention strategies. We are also working to provide families and communities with actionable ideas and resources to better support families and ensure children are safe, nurtured, and resilient.

Child Abuse Prevention Month carries a more meaningful purpose during this April, but the solutions remain unchanged. We must ensure that families are plugged into the network of support in their communities because no family can do it all alone. And by supporting families, we can better ensure that every child has a nurturing, responsive caregiver on which to depend. In big and small ways, each one of us has a unique opportunity to be part of this solution especially in times of social isolation. Check on a neighbor, help connect families in need to resources, offer support to the parents in your own life, and of, course, if you suspect child abuse or neglect, make a report.

To report suspected child abuse or neglect, you can call the Texas Child Abuse Hotline at 1-800-252-5400 or report online at