A better start: Building a brighter future for perinatal mental health at the Child Study Center

May 12, 2022

Information

April 25, 2022

The second in a new series of webinars, A better start: Building a brighter future for perinatal mental health at the Child Study Center was held via zoom on Monday, April 25, 2022 with YCSC faculty members Amanda Lowell, PhD; Kieran O’Donnell, PhD; and Helena Rutherford, PhD. The session involved a conversation about a new shared vision for the future of perinatal mental health at the YCSC and beyond.

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00:00And thanks everyone for joining.
00:02We may have a couple of others hop on.
00:06This is the wonderful advantage of zoom.
00:09Umm? So just in case people
00:12are on the don't we know me?
00:14I'm Linda Mays from the Child Study
00:16Center and it's just really a great
00:19pleasure to have colleagues joining
00:21us in this virtual way for another
00:23of our fireside fireside chances.
00:26Karen points out for the White
00:27House announcement on Friday.
00:28We had no idea how historically
00:31appropriate that metaphor would be.
00:34I especially also like having it be a
00:37fireside chat in a virtual environment,
00:40but today.
00:41Now we have a real pleasure to introduce
00:44you to work in perinatal mental health.
00:46That's going on in the Child
00:48Study Center and as you'll hear,
00:50you'll hear about our commitment
00:52to not only helping children but
00:55helping families and parents
00:57and thinking across generations.
00:59So again,
01:00thank you for being here and I I want
01:02to turn it over to my colleagues.
01:03Karen,
01:04Amanda and Helena for their chat together.
01:09Good afternoon everyone.
01:10It's such a pleasure to be able
01:12to spend some time together.
01:13I'm Kieran O'Donnell and I joined the
01:16Child Study Center in September 2020,
01:19where I have a joint appointment
01:20in the Department of Obstetrics,
01:21Gynecology and Reproductive Sciences
01:23and I'm really fascinated with trying
01:26to understand how and why what happens
01:28in the womb can last a lifetime
01:31trying to unpack the biological
01:33mechanisms that allow communication
01:35between the mother and the fetus,
01:37which then can influence.
01:39Mental health trajectories across
01:41the lifespan and of course
01:43within that research program.
01:45It's critically important that we
01:47try to understand the drivers or the
01:50causes of maternal mental health and
01:52maternal mental illness really to try
01:55and realize targeted prevention efforts,
01:58and I'll pass you over onto
01:59my colleague Dr role.
02:04Hi good afternoon so my name is Amanda
02:06Lowell and I am a licensed clinical
02:09psychologist at the Child Study Center.
02:12I came in 2016 for my pre doctoral
02:15internship and have stayed for fellowship
02:18training and I'm now on the faculty where
02:22I provide clinical services and the
02:24parent and Family development program to
02:26mothers and fathers who are experiencing
02:29their own mental health challenges
02:31and are in need of parenting support.
02:33And then I try to take what I learned
02:37from my clinical work and apply it to
02:41research questions that we can better
02:43inform interventions and scale them.
02:45Make them work for the individual
02:48that really needs them,
02:49not just for large groups,
02:52but you know the person sitting
02:53in front of us and what they need.
02:56And I think that that really ties into what
02:59Helena has to say about her approach too.
03:02Hi good afternoon everybody.
03:04I'm
03:04Helena Rutherford and I'm an associate
03:06professor in the Child Study Centre
03:08and I directed before and after baby
03:10lab or the bubble as we like to call
03:12it where we're really interested in
03:14understanding how the mind and the brain
03:17changes when individuals become parents.
03:19In particular, we think about this time as
03:21being a period of development and adulthood
03:23that the brain doesn't stop developing.
03:26Once we hit adolescence and young adulthood.
03:28But really that there's times of plasticity
03:30of the brain across the adult span as well,
03:33and so we think about adult
03:35development during the perinatal
03:36period for men as well as women,
03:37and we're particularly excited to understand
03:40what that brain plasticity looks like,
03:42not only in terms of our
03:44understanding of parenting,
03:44but also where we can help identify parents
03:47who may be at risk from from challenges.
03:49In the passing period.
03:50So we use a lot of neuroimaging measures
03:52to look at how the brain works and
03:55during pregnancy in the 1st place and
03:57period to help inform us and refines,
03:59move our research questions and
04:00then hopefully feed that back
04:02then to some of the clinical work
04:04that you'll hear about as well.
04:05So I'm really excited for this conversation
04:07today I'm going to pass it back to Kieran.
04:10And you know, we really are hoping that
04:12this will be a conversation today,
04:13so please do feel free to jump in
04:15with any questions priska you really
04:17set the bar high with telling us that
04:19you're expecting your grandchild,
04:21so we will try to answer any
04:23questions that you do have for us,
04:26but we thought that we'd start
04:27as we look forward to the future,
04:30and I hope you'll agree at the
04:31end of the conversation.
04:32That is a particularly bright future
04:34for perinatal mental healthcare.
04:35Here at the Child Study Centre.
04:37But as we look forward to the
04:39future and plan for the future,
04:40we thought it's important.
04:41Think about the present and the
04:44current state of the science
04:46and the state of epidemiology.
04:48When it comes to perinatal
04:50mental illness and so why now?
04:53Why are we having this conversation today?
04:55Well, we we couldn't have timed
04:57it better with the announcement
04:58from the White House last week,
05:00but I think we were particularly
05:02interested in having this conversation
05:04just because of the compelling
05:05and overwhelming need for an
05:07increased services and investment
05:09in perinatal mental health.
05:11And you know?
05:12If we were having this
05:13conversation a couple of years ago,
05:15I would have said that
05:16approximately one in six,
05:18maybe one in five women,
05:19struggle with their mental health
05:21in and around pregnancy and using
05:23a large court in the United Kingdom
05:25of over 15,000 pregnancies where we
05:28have two generations of pregnancies,
05:30so women and then their daughters
05:32and looking at their mental health
05:34needs and their own pregnancies.
05:35We've seen a generational increase,
05:37so approximately one in four women are
05:40struggling with their mental health in.
05:42And around pregnancy,
05:44and that statistic predates
05:46the ongoing global pandemic,
05:48and so in the most recent systematic
05:50review of studies published
05:52during the pandemic,
05:54we're actually seeing that number
05:55increasing to as many as one in three.
05:57So a recent survey of over 1000
06:00women across the United States
06:02and 36% of pregnant individuals
06:04struggling with their mental health
06:06in or shortly after pregnancy.
06:09So not only have we seen
06:11this generational increase.
06:12And perinatal mood and anxiety
06:15disorders that obviously has then
06:17been exacerbated by the ongoing
06:20and COVID pandemic.
06:21So what do we think about in
06:23terms of the impact at the level
06:25of the individual will sadly,
06:26and death by suicide and overdose
06:28remains one of the leading causes
06:31of death for women in the perinatal
06:34period and in the context of the
06:37adverse effects on the next generation.
06:39So research from my own group and
06:41others have shown that children.
06:43Point to women who struggle with
06:45their mental health in pregnancy
06:47have approximately doubled their
06:48risk for developing emotional
06:50and behavioral problems,
06:52and we see these effects as
06:53early as age 4 years of age,
06:56and they persist until early adulthood.
06:59So really,
07:00what we think we're seeing is
07:02the start of the trajectory that
07:04is influenced by mental health
07:07in and around pregnancy,
07:09and so if we scale up,
07:11what is the impact at the societal level?
07:14Well, the most recent cost
07:16analysis from the United States has
07:19indicated a cost of 18 billion U.S.
07:21dollars per year for the cost associated
07:25with untreated mood and anxiety disorders,
07:28and in a recent analysis,
07:30approximately 70% of those costs were due
07:33to the adverse effects of untreated mood
07:36and anxiety disorders on child outcomes.
07:38So that was a lot of numbers.
07:40I know we talked about the one in three women
07:42that struggle with their mood or anxiety.
07:44Disorders in and around pregnancy.
07:46We talked about the 18 billion U.S.
07:49dollars, the cost to the economy.
07:52We talked about the increase,
07:54the doubling of risk for
07:56emotional behavioral problems,
07:57and trillion born to women who
08:00experience mood or anxiety disorders
08:02or high levels of anxiety or
08:04depression in and around pregnancy.
08:06But you know,
08:07I I want to emphasize that, you know,
08:10there are things that can be done and
08:12we do have tools that can help us.
08:15Identify individuals that have a higher
08:17level of need in the context of their
08:20mental health in and around pregnancy.
08:22Some of those tools are somewhat
08:24dated and we can talk about some more
08:27innovative approaches and how we may be
08:30able to better identify individuals that
08:32struggle with mood or anxiety disorders.
08:36But we can ask the question
08:39about who is struggling,
08:40and in fact the American
08:42College of Obstetricians and
08:43Gynecologists recommends screening.
08:45At least once in the perinatal period and
08:48here in the Yale New Haven Hospital system,
08:50we seem to be doing that pretty well,
08:52so we screen approximately 56% of
08:56individuals in the postpartum period.
08:59But you know, being at Yale,
09:01I think we can always do better
09:03and we should do better.
09:05And in fact,
09:06in some countries there is recommendations
09:08for screening early in pregnancy,
09:10and so I think that that is one of
09:12the opportunities that we have here
09:14to exceed the American College of
09:16Obstetricians and Gynecologists.
09:17Recommendations to really realize
09:20universal screening early in pregnancy,
09:22and that's so critically important when
09:25we think about being able to provide
09:28treatment for these individuals that
09:30are struggling with their mental health,
09:32and as we'll hear from Amanda,
09:35you know we were experiencing
09:37a behavioral health surge.
09:38There is a real level of need,
09:39and even for our parent and family
09:42development program where we can
09:43target and bolster the health of
09:45pregnant individuals and their families
09:47is approximately a three month.
09:48Waiting list now if you have to
09:50wait for that three months when you
09:52have a young neonate or infant,
09:55you're just setting that individual
09:56back from being able to improve
09:59their mental health,
10:00and indeed potentially influence
10:01their at the level of care they
10:04can give to their children.
10:05And you know,
10:06as we transitioned to Doctor Lowell,
10:09just also mentioned that there
10:10are effective treatments,
10:11so an expert task force the
10:14US Preventive Services Task
10:16Force has. Provided guidance
10:19indicating that there are now
10:21multiple treatments that can actually
10:24prevent perinatal depression.
10:25So despite the increased level of need,
10:28there are things that we can do,
10:30and now I'd like to pass you over
10:32to Doctor Lowell to hear a little
10:34bit about what it is we can do.
10:38All right, thank you.
10:41I thought that it would be interesting
10:44to kind of share with folks a
10:47vignette of of a mother that I've
10:49worked with in the perinatal period
10:51just to kind of bring it to life.
10:54Think that Doctor O'Donnell shares
10:57some really staggering statistics,
10:59and they're pretty hard to
11:01wrap our minds around it.
11:03I mean, we, we recognize that.
11:07We're up against a really big problem and
11:11and we can think a lot about ways that.
11:15We can address that,
11:16but to put a face or or a
11:19person to what that looks like,
11:21I think can be really valuable.
11:23And so today I want to speak with
11:27you about a woman named Aubrey.
11:29So what we'll call her today?
11:32Actually met Aubrey in 2016 when
11:35I first came to Yale as a trainee,
11:38and at the time she was a 29 year old
11:42single mother who had a four year
11:45old son and they initially came to
11:47the youth clinic at the Yale Child
11:50Study Center because her son was
11:53experiencing some really significant
11:55emotional and behavioral problems
11:57that we're looking at bit like ADHD.
12:02A bit like oppositionality,
12:04so she came to the clinic and as
12:07I was getting to know her and her
12:10family for the sake of this child.
12:13Recognize that this is a family that's
12:16been through an incredible amount of trauma.
12:19The Speaking of treatments that work
12:22I conducted and provided an evidence
12:24based treatment for early childhood
12:27trauma called child parent psychotherapy,
12:30and so this is a dyadic treatment
12:32that I had both mother and child
12:34in the room and we really worked on
12:37processing their shared trauma and
12:40this trauma was in relation to the
12:44the families experience of the child's
12:48fathers mental illness of his own.
12:51So we completed child parent therapy.
12:53But what I really want to speak
12:55with you about is the fact that
12:57after we said goodbye for a time,
12:59she resurfaced in 2020.
13:01So right as the pandemic was hitting,
13:04I heard from Aubrey and she reached
13:07out to me and indicated that she
13:10was pregnant and that she was
13:13really struggling and she didn't
13:15know where else to go.
13:16She didn't know who else to speak to or
13:18what else to do, but remembered that.
13:20Had been helpful.
13:23It was serendipitous because I had
13:25transitioned from working in the
13:27youth side of the clinic to the
13:29parent side of the clinic or the
13:31parent and Family Development program,
13:33and my main interest has been
13:35perinatal and parental mental health,
13:37so this was a perfect opportunity for
13:40me to really support this mom and
13:42it really kind of worked out nicely,
13:44but what struck me was that she really
13:46didn't know where else to turn and
13:48this was right at the very beginnings
13:50of this mental health crisis and this.
13:53Federal health surge that we're
13:55now continuing to experience.
13:57So she had approached me.
13:59She was experiencing severe depression.
14:01She was extremely tearful.
14:03She's hopeless and she was really
14:06down most of the day,
14:08and she struggled in her daily
14:10activities and she was able to get
14:12to work and she was able to get
14:14her son to school.
14:15But if she wasn't engaged in really
14:17either of those two activities,
14:18she was crying and she was really
14:21busy ruminating and wondering about.
14:23And questioning about whether
14:25she was a good mother or not,
14:28she was questioning her own worth,
14:30and this all seemed to be secondary
14:33to domestic violence that she was
14:35experiencing with a new partner of hers
14:38that she was expecting a child with.
14:40And she was expecting the child
14:42later that summer.
14:42And this was about March April
14:44that I was speaking with her.
14:45So there were a few months during
14:47which time she was pregnant.
14:49And I finally kind of got in there
14:51and and was able to work with her.
14:54As it turns out,
14:56she had actually sought support elsewhere
14:58in the community before she found me,
15:00and that's when she finally reached
15:02out to me and was like Amanda,
15:03I really need your help.
15:07So she had reached out also in the community,
15:09and none of that really was
15:11the right fit for her.
15:13So on top of the weight lists
15:17that were announced,
15:17seeing the treatments and the approaches
15:21themselves were not quite what she
15:23needed and what she felt like she needed,
15:27which was to be held in her role as
15:29both an individual and as a mother,
15:32and so many of the clinics that
15:35are out there in the community.
15:37Provide parenting support or skills
15:40or mental health treatment to adults
15:43and what she needed was really the
15:46intersection of the two because
15:48she was depressed as a mother and.
15:51And so I really worked hard to help
15:55her think about the intersection
15:57of those two identities.
16:00And we participated our our eye
16:03facilitated comparative behavioral
16:05therapy for depression with her
16:07entirely through telehealth.
16:10And this really worked out well,
16:12because I had a pre-existing
16:14relationship with her,
16:15but I think that the flexibility
16:17that telehealth offered was really,
16:19really vital to her continued
16:23participation during a time where we
16:25often see a lot of barriers to care
16:28when when a mother is depressed and is,
16:31I mean,
16:31depression itself makes it
16:32hard to engage in
16:33treatment. But then,
16:34being pregnant and having limited
16:36resources and having to get to lots
16:38of other doctors appointments can be
16:40really challenging. We're engaged,
16:41so telehealth was a real benefit.
16:44But we got to see throughout
16:46the COVID period.
16:48But during our treatment I
16:49worked really hard with her to
16:51challenge and or to identify first.
16:53Her really unhelpful thoughts that
16:55she was having about her own worth as
16:57a mother and her own capacities as
16:59a mother and as a partner as well.
17:02It was tough because she was
17:05experiencing a lot of emotional
17:07abuse with her partner at the time.
17:11And so we had to do a lot of
17:13thinking with her about what the
17:15reality of the situation was,
17:17and that also had to include an
17:19emphasis on thinking about her own
17:22experiences and relationships that
17:24maybe made her vulnerable to the
17:26things that that her partner was saying.
17:30That really touched on her nerves
17:31and really got her doubting herself.
17:34So to kind of harken back to
17:36what was said earlier.
17:37I mean there's this real.
17:39We're doing some real thinking about.
17:41Uhm,
17:41how her experiences in in her own
17:45childhood are now influencing how she's.
17:49Potentially about to parent a
17:51new a new child here.
17:54So in addition to really reflecting
17:56and developing some insight about her,
17:58her experiences and relationships and
18:00what was true and what wasn't maybe
18:03true about herself and those relationships,
18:05we had to focus on the emotional
18:08piece of why challenging these
18:10thoughts was really difficult for her.
18:12And then we just had to give her
18:14some concrete skills as well.
18:15For here's how to talk to someone.
18:17And here are the things to do when
18:20someone is really unkind to you.
18:22And here is. Here are the ways that you.
18:24Should or shouldn't engage with
18:26that behavior that are going to
18:28help you be healthy.
18:29So we talked a lot about it in
18:30terms of what's going to be healthy
18:32for you and what's going to be
18:34healthy for your child.
18:34And so it wasn't really until she had
18:37the opportunity to be held in her
18:39role as a as a woman and as a person.
18:41But then she could think about
18:44her child's experience.
18:46So one example that I'll share with
18:48you is is that now flash forward.
18:51She's had her baby, and they're doing well.
18:55And one of the really stark
18:57differences that I'm noticing is
19:00that she in her with her older child
19:03who remember I met many years prior.
19:07He was exposed to significant trauma
19:10because of his own father's mental illness,
19:12and that really came from Moms Aubrey's
19:14own urge and wished for her son to
19:17have a relationship with his father.
19:19Even though it wasn't the
19:20healthy thing to do.
19:21But it felt really important to
19:23mom and so now she has an infant
19:26daughter and she felt pulled and
19:29compelled to do the same thing.
19:31It was.
19:31My daughter needs to have a relationship with
19:34her father but we were able to
19:36really slow down and think about.
19:38Why that was important to her?
19:40How it turned out in her other child
19:42and his relationship with his father
19:44and what this child may need versus
19:47what it is that she wishes for
19:49and how those two things might be
19:52similar and also pretty different.
19:54So again, after having held mom in that
19:57she's much more able to hold her child,
20:00which I think really speaks
20:03to kind of almost.
20:05Where we put our our energy and our effort,
20:08if we're able to treat kind of one parent,
20:10it has a ripple effect to impact.
20:13However many children that they have,
20:15and so it's been a really beautiful
20:18experience to get to work with this mom.
20:21But I think what what's really important
20:24to be thinking about is that there's a
20:26real need to scale this type of support.
20:29We really need to be thinking
20:31about how do we help providers?
20:33Think holistically about parents,
20:34parental mental health or
20:36perinatal mental health.
20:37For you know,
20:38the intersection of an individual.
20:40Plus as as a parent or as a birthing person,
20:43or as someone who's expecting a new child.
20:47And then I think not only do we need
20:49to generally train folks on that,
20:51but then think about taking evidence
20:54based treatments and having them
20:56work for individuals and and how do
20:58we customize them and tailor them
21:00and make sure that we match them
21:02to the right folks and then get
21:04them into into the right hands.
21:07We have to do in order to do that,
21:09we need to understand the
21:10mechanisms underlying treatment.
21:111st and I think that that's
21:15where Helena comes in.
21:18Great
21:18thank you Amanda and I think it
21:20was just a beautiful segue in terms
21:22of thinking about how the research
21:24side of things we need to work and
21:26partner with clinicians who are
21:27directly working with families in
21:28order to really make sure that the
21:30research is as effective as it could
21:32be in targeting and in supporting
21:33the women who really need it more.
21:37Research lens my labs.
21:39Looking at and interested in
21:41mechanisms that may confer risk
21:43in the perinatal period and
21:45forming caring for their children.
21:47And so we really started off
21:48looking in the postpartum period and
21:50thinking about challenges to mental
21:52health and the post Natal period.
21:54Starting to identify mechanisms then
21:55and then moving backwards and looking
21:58at seeing those mechanisms are there
21:59and present in the prenatal period too.
22:02The advantage being is if we can work
22:04with women when they're pregnant that
22:06that that the generally easier to access.
22:08That they don't necessarily have
22:10the childbearing demands that
22:11they would have postnatally,
22:13but more generally,
22:13thinking about the earlier,
22:14we can intervene the better.
22:16So why wait to baby the baby to arrive
22:18to identify risk when we could be
22:20identifying that risk much earlier?
22:21So there's a big drive in the lab now
22:23to be thinking about mechanisms across
22:25the perinatal period and as early
22:27as those mechanisms might manifest,
22:29the faster we can jump on them and always
22:31be able to start characterizing who
22:33may or may not be at risk in that way.
22:36So I wanted to give a specific example.
22:38As a way of illustrating how we've
22:41worked with clinicians to think about
22:43mechanisms and how those mechanisms
22:44can then transition back into thinking
22:47about clinical work that way,
22:49so a lot of work that we do in the lab
22:51focuses on maternal substance use disorders,
22:53and so this is a an area that Doctor
22:55Lowell has a lot of expertise in
22:57in terms of working with mothers
22:59through pregnancy and the post
23:00Natal period who have a host of
23:03different substance use disorders,
23:04but we really got interested in this.
23:06As I said in the past night
23:08period to begin with.
23:09Primarily because what we
23:10were hearing from clinicians,
23:11but also what we were seeing,
23:12being published in the literature,
23:13is that many mothers who have substance
23:15use disorders also have significant
23:17challenges in caring for their children.
23:19And it really made us think about,
23:21well,
23:21we don't want this.
23:23One size fits all approach at
23:24mothers with substance use disorders
23:25are all going to have challenges.
23:27Caregiving clearly they're going
23:28to be protective effects.
23:29It's not all mums who are
23:31having these challenges,
23:31but what is it that makes it particularly
23:33challenging for mothers of substance
23:35use disorders that we can you know,
23:37potentially work with it
23:38and try and understand.
23:39In order to help develop and
23:42refine intervention programs.
23:44So we came at this through
23:46a neurobiological lens,
23:47primarily because we wanted to get
23:48into this idea around mechanisms,
23:50and are there biological mechanisms
23:52that might under score what we're
23:54observing in mothers with substance
23:55use disorders that we can then
23:57feed back to the clinicians and
23:59to help them refine what you know
24:01the work they're doing?
24:02And then we have this iterative
24:04discussion back and forth to help them
24:06inform research wise what we're doing.
24:08And so we started off at a very basic level
24:10in terms of just looking at a
24:12whole host of research that.
24:14Listed primarily in animal studies and
24:16with far fewer studies of human mums,
24:18but you know where we've started to see
24:20you know what the neural mechanisms
24:22that might be implicated in caregiving.
24:24But also what are those neural mechanisms
24:26that are implicated in addiction and
24:28we've learned in the past ten years
24:30how much plasticity there is no in the
24:33human maternal brain that there's so
24:35much change that's happening during
24:36pregnancy and the post Natal period?
24:38This seems to be driving towards helping
24:41mom think execute maternal behaviors.
24:44Caregiving and raising her child in the
24:47post Natal period and so we wanted to
24:49think about what that plasticity is there,
24:50how my addiction be interrupting that
24:52and when we looked at the literature of
24:55the first thing that became very apparent
24:57is that in in the human studies and in
24:59the animal studies there are there are
25:01two sets of neural circuits that were
25:03really being heavily impacted by addiction.
25:06There was neurosecretory.
25:07They're implicated in
25:08stress so how individuals,
25:10irrespective of addiction,
25:11that how individuals regulate and
25:13respond to stressful situations?
25:15And the presence of addiction.
25:16And we can think about addiction as
25:19a stress dysregulation disorder.
25:20These individuals just really have a hard
25:22time in terms of regulating their stress,
25:25but we also know being a new
25:27parent is stressful.
25:28Again, in the absence of addiction.
25:30But also in the presence of addiction.
25:31Caring for a child across development
25:34is just inherently stressful too,
25:36and so we saw you know to begin with.
25:38While if there's this neurobiology
25:40of parenting that focuses on stress,
25:42but also we know those stress systems
25:44are compromised by addiction.
25:45This might give us a neurobiological pathway
25:47through which to understand where some of
25:50these challenges parents may be experiencing.
25:52If they're managing an addiction
25:53on top of caring for their child.
25:56A second, your second.
25:57We also lived here,
25:58and you're a second that are involved
26:00in reward or how we experience
26:01and understand pleasure.
26:03Again,
26:03we see that those neural circuits
26:05are compromised in addiction that
26:07individuals with addiction tend to
26:09find stimuli or information just
26:11less pleasurable and less enjoyable
26:13in comparison to the substance that
26:15they may be using and abusing.
26:17But we also know that reward is
26:19somewhat important and and pleasure
26:20so much important has so much
26:22importance of caring for the child to
26:24inherently we talk about parenting.
26:26General as being this balance of
26:27stress and reward that there's
26:29a joys of being a parent,
26:30but there's also the challenges
26:31of being a parent too,
26:33so it started to give us another
26:35neurobiological mechanism that
26:36we can think through again in
26:38the presence of addiction.
26:39Whether it's reward circuits would
26:41typically be responsive to baby,
26:43that in when addiction is present,
26:45they may be less responsive,
26:47and so we started having these
26:49these discussions around.
26:49While we've seen this,
26:51but we've not really tested that hypothesis,
26:53and so we want we wanted to look at was to
26:55see what is there any evidence in human?
26:57Those with addiction that they have
26:59this more stress reactive response
27:01and less rewarding response when
27:04engaging with their children.
27:05And so the way we went about testing
27:07that was to begin again personally.
27:09And we recruited mothers from the local
27:12community and just to view photographs
27:13of infant faces or to listen to infant
27:16cries so our infant cries being the
27:18stressful cries that we hear you kind of
27:20very early on in the first night period,
27:22but also having photographs
27:24of baby smiling, you know,
27:25especially if it's own baby smiling at them.
27:27You know, some would argue that that's the
27:29most rewarding stimulus you could show mum,
27:31and especially kind of those
27:33first few months postpartum.
27:34So we had mothers view those
27:36photographs and also listen to those
27:37infant cries and what we saw was
27:39consistent with our hypotheses.
27:40We saw that you know,
27:41particularly when mums were
27:43looking at these very positive.
27:44These very rewarding and for faces that
27:46they not only showed a decreased neural
27:49response and their reward neurosecretory,
27:51but there was also a delayed neural
27:53response in their same neuro seconds in
27:55comparison to women without substance use.
27:57Disorders and importantly,
27:58we looked at this in the context
28:01of nicotine addiction,
28:02as well as polysubstance use,
28:04and we saw very comparable findings,
28:06so we don't think this is about
28:08addiction to one specific drug,
28:09but we think it's about substance
28:11use and substance abuse.
28:12More generally,
28:13just regulating these key neural circuits
28:15that we know are important for parenting.
28:17So why is this helpful to know?
28:19Well,
28:19it gives us a chance to then feedback
28:21to clinicians like Doctor Lao to say,
28:23well,
28:23we think that there's a neurobiological
28:24basis and many of the challenges that
28:26these mothers are experiencing whilst
28:28they're caring for their children price.
28:29Lately,
28:30we think that there's this
28:31increased reactivity to stress,
28:33but also this decreased reactivity to
28:35what would be considered more rewarding,
28:38and so that allows mechanisms and money
28:40for clinicians to be thinking about.
28:42Well, how can we start targeting stress?
28:43How can we start targeting stress regulation
28:46and thinking about that as a skill?
28:47That we can work with with mums,
28:49but also how can we think about
28:51ways that mums can really take a
28:52moment really just pause and think
28:53about the enjoyment and pleasure
28:55that they're experiencing while
28:56they're engaging with children,
28:57so it allows us to very robustly
29:00think about mechanisms in terms of
29:01what we can feedback from clinicians.
29:04But also,
29:04it gives clinicians something that
29:05they can tell mothers to that this
29:07isn't something that ambiguous
29:08or cloudy that it really gives
29:10them an opportunity to say.
29:11And we think that there's a
29:13neurobiological basis to the
29:14experiences that you're you're
29:15managing managing right now,
29:16that it gives you know.
29:17Like something very concrete
29:19to be working with in that
29:21way, so that's what we really hope.
29:22This partnership between clinicians
29:24and researchers can go forwards.
29:26And I think the other piece,
29:28just to echo what Doctor Lou was
29:30saying at the end and how scalability.
29:32But it's also about important to recognize
29:34individual differences here as well.
29:36And and we really try and think
29:37about this as not as a group of
29:39mums with substance use disorders.
29:40Best is out.
29:41Or mums with depression or with anxiety.
29:43Besses starts with without but
29:44really thinking about all months
29:46and thinking about how that varies.
29:48And every mom comes to their parenting
29:50situation with a different background,
29:51a different history,
29:52their own experience of being parented,
29:54their own experience and decision
29:56making about how they want to.
29:58Present themselves,
29:58but these are all factors that we
30:00have to take into consideration too
30:02that that it's too superficial to say,
30:04OK, let's put all these mums into
30:05one camp and compare them to a
30:07group of mums in a different camp.
30:08But the individual differences approach
30:10to this idea that that we need to scale,
30:13but we need to be mindful of the nuance
30:15of the maternal experience is really
30:18important in this situation as well.
30:20So that's why I wanted to to share
30:22with you about research and trying
30:23to make that bridge then with what
30:24you're hearing from Doctor Lowell.
30:27That's wonderful, thank you so much.
30:28Doctor Rutherford. I you know,
30:30just just extending that then to thinking
30:33about the impacts on the child you
30:35touched on a topic that is very near and
30:38dear to my heart and research program.
30:40Thinking about how we can better
30:42understand individual differences
30:43and the impact of perinatal anxiety
30:46and depression on child outcomes.
30:47And that's really a public health challenge,
30:50but it's a scientifically
30:52fascinating question.
30:53You know, trying to understand the
30:55embedding of that university and.
30:57Trying to determine whether or not we can
31:00mobilize information about biological
31:01embedding to better understand and
31:03identify children at greatest risk
31:05and one of the tools that my team
31:07has been involved in developing is
31:10a measure of biological age that we
31:13can derive from simple cheek swabs.
31:15So we just collect eucalypt athelia
31:17cells or cheek swabs from neonates
31:19from infants from children.
31:21It's very well tolerated and we can
31:23estimate a child's biological age, and,
31:26in a very recent study, we examined.
31:29Biological aging in children at 6 and 10
31:33years of age and then at three months,
31:35nine months and 24 months of age
31:38and two independent cohorts,
31:39and what we found was that
31:42maternal prenatal anxiety,
31:43accelerated biological aging or epigenetic
31:46aging with marked individual differences,
31:50suggesting that not all
31:51children were affected,
31:52and indeed that's one of the outcomes
31:54that we are one of the findings
31:56that we see in multiple studies is
31:58that not all children are affected.
32:00And that's an important public
32:01health message to get across.
32:03Most children,
32:03even if they're exposed to anxiety,
32:05depression will do just fine,
32:07and that's the the the reassurance
32:09that we can provide to anyone
32:10that may be pregnant or no.
32:11People who are pregnant.
32:13But of course,
32:14the question is why is it that
32:16those children that are affected are
32:17affected in the way that they are?
32:19And that's where we're hoping that some
32:22of these biological tools might be
32:24able to help us identify individuals
32:26that are at greatest risk following
32:29exposure to perinatal anxiety.
32:31Or depression,
32:31now we've switched on a lot of
32:34topics right now,
32:35and you know doctor Little
32:36you mentioned about,
32:38you know the the the critical
32:40importance of partner support and you
32:42know they you know kind of shocking
32:44and levels of domestic violence that
32:47actually increase during pregnancy
32:49and indeed another leading cause of
32:52maternal mortalities is homicide.
32:54And you know,
32:55and doctor Ruthford you talked
32:57about really elegant neurobiological
32:58research trying to understand individual.
33:01Differences and maternal behavior.
33:03So I just wanted to to pause for
33:05a moment to see if anyone had any
33:07thoughts or questions or clarifications
33:09about anything that we've touched
33:12on and so far before we talk a
33:13little bit about some of our future
33:16plans within the center.
33:28Just looking from just looking
33:30for anyone raising their hand
33:31or putting things in the chat.
33:34Alright, well I have I'm too slow to
33:37raise my hand just a moment here and
33:39I'll there look there we go. So so.
33:44Is your substance use disorder?
33:48Work all done on an outpatient basis.
33:52And if so, how are they?
33:55How are these folks finding their
33:56with mothers finding their way to you?
34:02Yeah, that's a great question,
34:04and so yes, so we primarily been
34:06working with outpatient mothers
34:08with substance use disorders,
34:09and so there's been two real approaches that
34:12we've been able to recruit these women.
34:14One is through partnerships with clinics,
34:16and so we're at clinics who are
34:19seeing mothers for whether it's
34:21counselling or CBT based treatments,
34:24but also through medicated assistant
34:27Medicaid therapeutic approaches.
34:28For instance, methadone maintenance.
34:30So you've been working with clinics.
34:32That we found that the vast majority
34:34of our mothers have come through
34:35word of mouth and through Flyers
34:37and Community efforts that we have
34:38in the local New Haven area.
34:40So we have a dedicated recruitment
34:43coordinator who's a mum who lives in
34:45New Haven is a well recognized mom in
34:48the New Haven area and so she spends
34:50a lot of times in our grocery stores
34:52and our libraries and then around
34:55family areas in the New Haven area.
34:57And it's got a lot of report in
34:59the community and so we're not
35:00always specifically recruiting for
35:02mothers with substance use.
35:03So it is what we find is that when
35:05we're cutting broadly from others,
35:06a significant proportion of them
35:08have substance use disorders,
35:09and I think that that's been very
35:11striking for us when we look at
35:13our Community samples that you
35:15know their community samples with
35:16elevated levels of substance,
35:18use of a number of meeting criteria
35:20for substance use disorders.
35:21So that's kind of been our
35:23main recruitment approach.
35:27So I have a question.
35:28I have a question. This is priska,
35:30so the data is very striking that
35:33it's one in four women who are
35:35pregnant who feel depression or I.
35:38I can't remember what the terminology is,
35:40but I'm and it's possibly now one
35:42in three and I was wondering this
35:44is data hold up industrialized
35:46countries and also any speculation
35:49you know like and also within the US.
35:52Is it skew social economically?
35:54And any speculation as to why?
35:57This is going up.
35:59Yeah, that's that's a wonderful
36:00question and you know.
36:02And if I if I had been
36:03speaking to you a year ago,
36:04I would say you know in
36:06high income countries we're
36:07thinking you know one in five,
36:08perhaps one in four with
36:10this generational increase,
36:11and in some low and middle income countries
36:13the number would have been one in three.
36:15So for example,
36:17we're working with a run early
36:20intervention project in rural
36:21Vietnam and we see more than 30%
36:24of pregnant individuals struggling
36:25with their mental health.
36:27And so in in resource constrained
36:29environments or in low and
36:30middle income countries,
36:31there can be a higher level of need.
36:35But now, with the ongoing pandemic,
36:37we're seeing that the the rates
36:39the prevalence rates in the
36:40United States are even comparable
36:42to those rates observed in in
36:44resource constrained environments.
36:46Now obviously the the drivers may
36:48be slightly different across those
36:51different contexts, but you know,
36:53I think common risk factor is,
36:55you know, poverty, early stressful.
36:57Events reduced or low partner support.
37:00There's a critical role for the
37:03partner in supporting perinatal
37:05mental health and so I think that
37:08that is seen universally that partner
37:10support is one of those either
37:12protective factors or we flip it on its head.
37:15It's a risk factor,
37:16and with the absence of of partner support,
37:19and so you know the one in three is
37:21is what we would have thought of that
37:22for low and middle income countries
37:24and some low and middle income countries.
37:26But now we're seeing that
37:28in the United States.
37:29And again,
37:30that is that will depend also on
37:31the Community and Community level,
37:33risk factors and so that that number
37:35will will depend on contextual factors.
37:48Why don't you talk about your
37:49future future plans? Well,
37:52you know I think what what we hope you've
37:54seen today is that there's there's
37:56concentrated expertise in perinatal
37:58mental health here in the Child Study
38:01Center and ranging from basic research
38:03through to clinical practice and really,
38:08a placing an emphasis.
38:09Then on educating the next generation
38:12of clinicians and what we are,
38:14what are what the but the future of the CHILD
38:16Study Center in perinatal mental health?
38:17The child study?
38:18Center and we hope to capitalize on our
38:21relationships with obstetrics and gynecology
38:24and reproductive sciences and Pediatrics.
38:26To really create a coordinated approach
38:28to support mental health of pregnant
38:31individuals and their children,
38:33and so that would take three main forms.
38:38One would be realizing improved or
38:41universal screening in pregnancy
38:43or pregnant individuals.
38:45As I mentioned to you at the
38:47start of our conversation.
38:48The screening tool that's most
38:50commonly used was developed in the 80s,
38:52and it doesn't ask about substance use.
38:55It doesn't ask about partner support.
38:58There are key aspects of
39:00pregnant individuals,
39:01experience and risk factors for
39:03perinatal mood and anxiety disorders
39:05that are not captured in some of
39:08these older screening assessments,
39:09and we know that 95% of women of
39:13childbearing years and when a smartphone,
39:15for example and one of the studies that
39:17we're involved with at the moment.
39:19Is trying to determine whether we
39:21can develop digital biomarkers so
39:23biomarkers related to social support
39:25from a pregnant woman's use of
39:28her cell phone,
39:28so really trying to explore new
39:32approaches to achieve greater coverage,
39:35greater screening of pregnant
39:37individuals in pregnancy,
39:39and so approximately 7% of pregnant
39:41individuals are screened in pregnancy
39:43and in the postpartum and in in
39:45the Yale New Haven Hospital system
39:48and we really want to.
39:49Exceed those American College of
39:52Obstetricians and gynecologists
39:53recommendations and really move
39:55that number up.
39:56I think one of the biggest questions
39:58that then remains for in the field is
40:01whether or not we can improve child outcomes.
40:04If we improve maternal anxiety
40:06or depression in pregnancy.
40:09And So what we're lacking in that
40:11context is a very large scale where
40:14bus study of interventions that can to
40:17whether we can determine if we can.
40:19Move the needle on emotional behavioral
40:22problems in children and following
40:25treatment of maternal anxiety and
40:27depression and thinking about how we
40:30can develop this cross fertilization as
40:33as Doctor Rutherford and Lowell mentioned,
40:35this is already going on in the CHILD
40:37Study Center where you have research,
40:39informing practice and practice
40:41informing research and we want
40:43to bring that to scale to really
40:45develop increased access to evidence
40:48based treatments and improved.
40:50Treatments for perinatal mood and
40:52anxiety disorders and doctor Lowell
40:54touched on this a little bit.
40:56Is that you know,
40:58not all treatments will work for
41:00an individual.
41:00We need to develop a way of targeting
41:04these treatments more effectively.
41:06So in on in oncology we talk a lot about
41:08precision medicine or personalized
41:10approaches and what we want to
41:12do is really realize the full
41:15potential of personalized perinatal
41:16mental healthcare and then the
41:18final pillar of this strategy.
41:20Is really to try and ensure that
41:22there's an emphasis placed on
41:24training and education for the
41:26future generation of clinicians
41:28and scientists and so that there
41:30we can break down those silos and
41:33between disciplines to ensure that
41:36we're really trying to develop a
41:39holistic approach to improving
41:41perinatal mood and anxiety disorders.
41:46So that's the future we're working towards,
41:48and we're excited to share that vision
41:50with you and and welcome any feedback
41:52that you would have on our as we as
41:55we embark on this exciting journey.
42:07Amanda, there's a question
42:09that I think perhaps also
42:12touches on thinking about it.
42:13Learning ahead. As you think about
42:16your clinical work with parents.
42:19Are there particular research
42:20questions that you would want to have?
42:23Karen Helena? Really,
42:24the three of you think about.
42:28Has that absolutely. I mean, that's.
42:35And because I think that that really
42:37closes the feedback loop as well.
42:41So my biggest wish for questions
42:46that research can answer are. How?
42:50How does treatment you know with
42:53helenas example in particular right?
42:59She speaks to the ways in which.
43:05The brain responds differently when
43:06addiction is part of the picture,
43:09and so I will come.
43:10And I'll train clinicians and I'll say
43:12that this is the case, and then the
43:15first question that gets asked is OK.
43:17So when we give them the treatment that
43:19you're training us to do, does that fix it?
43:21Does that and so that becomes.
43:23Then we know that there are these
43:26neural circuits that are disregulated.
43:30For substance use in particular,
43:32but Doctor Rutherford,
43:34you've done research on anxiety
43:36and depression as well, right?
43:39And so I think that this is kind
43:41of a broad question, but it is.
43:44When we then put the intervention into place.
43:48Then what?
43:50That's that's the $1,000,000 question.
43:54For for myself as well as,
43:55then the clinicians that
43:58I that I'm also training.
44:00And.
44:00The other layer to that is sometimes
44:03when I'm training clinicians I'm.
44:05I'm also in my in the audience and
44:08includes folks like peer recovery coaches,
44:11so these are individuals mothers with
44:14lived experience of addiction themselves,
44:17and they so they're experiencing
44:19this information on multiple levels,
44:21and that question becomes even more
44:23like the answer to that question
44:24becomes even more important to
44:26them because it matters to them
44:28professionally as well as personally.
44:30So I would love to have an answer to that.
44:33To that question.
44:36So I have so I have another question.
44:38This is priska sorry I I said I was
44:41going to ask a lot of questions.
44:43I'm not clear as to how you define addiction.
44:47So is it like?
44:48People who can't get through
44:51the day or is it?
44:53So I just I don't know anything about
44:56addiction and I do know that marijuana
44:59use is now being legalized across
45:01many States and I was wondering,
45:04does that count?
45:05Is that considered an addictive?
45:08Is that something that will fall
45:09or do people do fine with that?
45:11And so I just like to be clear
45:13to what makes how do you classify
45:16someone as as as being an addict?
45:21I'm going to actually. Yeah,
45:24I'm going to. I'm going to let either.
45:27I see Doctor Rutherford nothing. Yeah,
45:29I didn't know if you wanted to
45:31start the flow and then I can.
45:32I can tell you how we do
45:34it through research lens,
45:34but I don't know if you wanted to
45:36speak to you. Sure, sure,
45:37because I I I have a feeling that I know
45:40what you might say from the research
45:41lens and I think that you're taking
45:43it in a really exciting direction
45:45because to to spoil that actually,
45:49you know it becomes less of
45:51a categorization I think,
45:52and more of a of a question
45:55about degree of substance use and
45:57severity of of substance use and.
46:00Anyway, so I'll I'll let Doctor
46:02Rutherford explain a little bit
46:04about that but addiction, you know,
46:07I think clinically we're thinking
46:08about it in terms of physical
46:10dependence on the substance,
46:12and so the need to use the substance
46:15in order to remain at homeostasis.
46:19And then when you have not used
46:21that substance in some time,
46:22your body begins to go into
46:24withdrawal symptoms.
46:24And that's a pretty clear cut
46:28definition of what addiction?
46:30Might be,
46:30but I think it's much more complex than that,
46:33and that's where I'll let Doctor
46:35Weatherford speak about it.
46:39Q So the only piece I would add then is that
46:41we're trying to move away from this
46:43categorical present or absent distinction.
46:45That's usually the case in research
46:47studies and that you have your criteria,
46:50whether it's an interview that
46:51the individuals complete,
46:52or whether it's a checklist of symptoms,
46:55and so we're trying to move it into
46:57more of what we call continue as
46:58approach to thinking about the frequency
47:00or the severity of the substance.
47:02Use has two advantages.
47:04One is that we move away from this time.
47:09And then you know it's just
47:11one category of individuals,
47:12whether their mums or otherwise
47:13going into that group.
47:14But it also gives us as a second piece
47:17an opportunity to look more broadly,
47:19so to look across mothers everywhere
47:22in the context of our research,
47:23that we don't necessarily think about,
47:24then only mothers who meet
47:26these particular criteria.
47:27But we can include mothers who may
47:29be smoking cannabis regularly but
47:31aren't dependent upon it in the way
47:33that Amanda was describing in terms of
47:35needing to maintain that homeostatic,
47:37or that that.
47:38Physiological balance in their body,
47:40and so it really allows us to think more
47:42about what the substance use represents,
47:44how it's being used,
47:45rather than the physical dependency.
47:47And that's going to that,
47:48you know,
47:49we think that that's going to vary a lot.
47:50Kind of parent by parent in terms of why
47:52that substance is being used to begin with.
47:54So we we've just have a paper under
47:56review where we've replicated all
47:57the categorical findings with
47:59this new continuous approach.
48:00So we're really excited that
48:02that's going to be coming out soon.
48:03And now we're trying to push that
48:05a bit further to say, OK,
48:06how does this then these brain substance use?
48:09Associations now then linked to
48:11behavior and behavior that we
48:13can observe in parents too.
48:15So thank you for setting that up, Doctor.
48:19Risk of the set help.
48:26Yes, yes it does. Yes it does.
48:28I knew it's kind of a broad question.
48:30A little off topic, but as you were talking
48:33I realized I didn't have a great appreciation
48:35of how addiction is defined. So thank you.
48:39And I would just add I don't
48:41know that it's so much.
48:42It's actually not all topic and I
48:43don't know if Doctor Rutherford
48:45wants to speak more to this,
48:46but we because you did touch on it.
48:48Helena that we think about how
48:50addiction and reward systems come
48:52together and how parenting and
48:54reward systems come together.
48:56Do you want to?
48:58It's not saying that parents
48:59are addicted, but
49:01yeah, although early on in the kind
49:03of the literature that that language
49:04is being used to describe how
49:06parents respond to their children,
49:07they do become addicted that it is
49:09this your complete preoccupation
49:10with a child and that very much
49:12you're if you look at just the
49:15behavioral description of how mothers
49:16were talking about their children
49:17and thinking about their children,
49:19that it paralleled and addictive state too.
49:21So there's some history there in terms of
49:24thinking and that about it in that way.
49:26So I think that that's where.
49:28That there's a lot of overlap here in
49:30terms of these neural circuits and
49:31neural circuits are implicated in
49:33attachment behaviour and parenting behaviour,
49:35but also an addiction to the other piece.
49:37If it's just a right to add on quickly
49:39to what Doctor Laura was saying too,
49:41was that you know she and I had
49:43shared a bit about addiction and and
49:45Doctor O'Donnell had talked about
49:46depression anxiety,
49:47and I think one of the areas that
49:49we all want to see grow is the ideas
49:51of biomarkers not being specific
49:53to 1 clinical disorder,
49:54but how they may be transdiagnostic too,
49:56and I think it's really important
49:58to recognize.
49:58At the fundamental level of
50:00Eminem is caring for a child.
50:02That child stimulus is exactly the
50:04same across all these parents.
50:05In terms of there's a dependent there,
50:07there's a child there that's pulling
50:08for mum's attention and mum is trying
50:10to put off for their attention and
50:12what we're interesting is trying to
50:14to understand the Intersect in biology
50:16and psychology here to to figure out
50:18is this all going to be specific to
50:201 clinical disorder or are we going
50:23to see commonalities across depression,
50:24anxiety and substance use?
50:26Especially so many of these that
50:27comorbid of each other too.
50:30Lynn, you had a question.
50:33Yeah. Kind of a comment and a question,
50:37so I'm in Minneapolis, also
50:39known as the treatment capital of the country
50:43and. I recently learned that we
50:47have two programs here that take.
50:51For inpatient substance abuse treatment.
50:54That allow mothers to bring children.
50:58Is that common? Do you?
51:00Do you have that and and?
51:02And why don't?
51:02Why don't we see more of that
51:04for inpatient mental health?
51:09Because I would, I would imagine that
51:11it would overcome some resistance
51:14towards attending treatment.
51:16If you could bring your.
51:18Your kid. Absolutely.
51:21Amanda, you were nodding.
51:23Do you want to start that?
51:25I would say that it's not uncommon for
51:30this to be the case for residential
51:34substance use treatment. Umm?
51:37At least in the communities that I've served,
51:41and that I've worked in.
51:44And it's not an uncommon model
51:48and and I think that.
51:52The neurobiology research becomes
51:54so important when we're thinking
51:57about if we're trying to kind of.
51:59Reverse. The circuitry and
52:03make parenting more rewarding,
52:06like at the child's presence
52:09becomes very important.
52:10I'm not sure the answer as to why
52:13that's not extremely common for mental
52:15health treatment I I actually am
52:17racking my brain and can't think of.
52:20Personally, any settings where that occurs.
52:24I don't know if others are familiar
52:26with that kind of model, yeah?
52:31In the UK, actually it's a very common
52:33model for mother and baby units,
52:35and so we're pregnant individuals
52:37or individuals with neonates and
52:40can be admitted on to award,
52:42and actually a large systematic
52:44review hasn't found clearly convincing
52:47evidence for clinical benefits,
52:50but certainly benefits in the context of
52:53patient reported and kind of perception
52:56of the care that they've experienced.
52:58I do know, anecdotally.
53:00That a mother and baby that was
53:02set up one of the first to be set
53:05up here in the United States and
53:07that was found it challenging to
53:10actually have insurers and reimburse
53:13for the stay of healthy neonates.
53:16So there was no justification for
53:19the hospitalization of the neonate,
53:21and so the neonate could stay with
53:23the mother during visiting hours.
53:25And during the day,
53:26but then couldn't stay overnight in
53:28that particular mother and baby unit.
53:31So it is a it is a model of care.
53:33And but it's there.
53:34May be contextual factors here that
53:36that limit its widespread availability.
53:44I wonder too. Also, if there are factors
53:47around how often times child and adult
53:50services go by different tracks and.
53:55Right, right? I mean that's a really big
53:58implementation question that we have at
54:01this moment when it comes to delivering
54:03evidence based parenting support to mothers
54:05with the with addictions in particular.
54:08So those in treatment for for opioid use
54:12disorder who need parenting to support,
54:14where do they get that?
54:15Is that meant to be delivered at
54:17in the substance?
54:17Use treatment setting?
54:19Or is it meant to be delivered by
54:22in the child development setting?
54:25And it it's it's a question around insurance,
54:28but it's also around a question
54:30around expertise because there's not
54:33much cross pollination among these
54:35two worlds or expertise of folks who
54:38know about addiction and parenting.
54:41And oftentimes, which I just
54:42underscores what the three of you are
54:45highlighting around the perinatal.
54:47That type program in perinatal
54:50behavioral health would be in a child
54:53study center as we're really trying
54:56to blend expertise across disciplines.
54:58Obstetrics Pediatrics,
55:00adult psychiatry, child psychiatry.
55:05I think we have time for one more question.
55:09Turning to the turning to the group.
55:15And Krista has put a A in the chat.
55:18Has put about the feedback.
55:26So let me just say to the three
55:28of you I know we've spoken about
55:31the the great opportunities.
55:33Are there any challenges that we might
55:36still also frame as opportunities
55:38that you'd want to to highlight?
55:41Or any concluding remarks that
55:43you'd want to have for us.
55:48I think that we've made progress on stigma,
55:51but I think stigma surrounding
55:53perinatal mental health still remains.
55:56I think that is a challenge both
55:58when thinking about screening,
56:00you know whether or not people are likely
56:02to disclose and their their their struggles,
56:04particularly if we think about
56:07minoritized populations,
56:08and I think they're you know has been,
56:11you know, kind of challenges in the
56:13past with with those families getting
56:15victimized by Child Protective Services.
56:17And so I think that we need to be aware.
56:19Of issues and barriers to people being
56:21able to disclose how they're feeling,
56:23perhaps you know,
56:24the generational increase that
56:26we're seeing in rates of mood and
56:29anxiety disorders actually reflects
56:31maybe a greater openness to discuss
56:34and individuals mental health,
56:36but I think that stigma does
56:37remain a challenge, and, you know,
56:39I'm aware that this is a heavy topic.
56:40We're aware that this is a heavy topic,
56:42and it's heavy because it's it's important,
56:44but what we've really tried to
56:46emphasize today is that there
56:47are there is hope there is.
56:49There are.
56:49You know,
56:50kind of research breakthroughs that
56:51Doctor Ruth but has been talking about.
56:53You know Doctor Lowell has talked about
56:55really advances in our ability to
56:57treat and move the needle on improving
56:59and mood and anxiety disorders,
57:01so we don't.
57:02We do want you to leave you on
57:04a hopeful note that,
57:05and really,
57:05the future is bright in the
57:07context of perinatal mental health
57:09care at the Child Study Center,
57:11and that we really are standing on
57:12the on the shoulders of giants here
57:14in the CHILD Study Center as we try
57:17in advance and perinatal mental health.
57:20Thanks so much to everyone for joining
57:23and thank you for the three of you for.
57:25Bringing us all into this this area,
57:29so thanks again and please stay tuned for
57:34another fireside chat. Thanks everyone.