产后抑郁症.ppt

Postnataldepression产后抑郁症,C.C.D.S.ModelofCareinHongKong儿童身心全面发展服务香港的保健模式Dr.BonnieSiu,C.C.D.S.,ComprehensiveChildDevelopmentService(C.C.D.S.)儿童身心全面发展服务Aninnovativeservicemodel一个创新的服务模式PilotlaunchedinJuly2005inHongKong于二零零五年七月在香港试行,Background背景,InthePolicyAddress2005,ourformerChiefExecutive,Mr.TungCheeHwastatedthat:前香港特别行政区首长董建华先生于二零零五年的施政报告中提及:,Background背景,“Forchildrenunderfiveinpoorfamilies,wewilllaunchaHeadStartProgrammeonchilddevelopmentinthefourlocalcommunitiesofTinShuiWai,TuenMun,ShamShuiPoandTseungKwanOonatrialandphasedbasis.“对于贫穷家庭的初生至五岁幼童，政府将推出儿童发展先导计划，现选定在天水围、屯门、深水埗、将军澳四个社区分阶段试行”,Background背景,“.FiveMaternalandChildHealthCentresinthefourcommunitieswillcooperatewithnearbynurseries,kindergartensandotherrelatedinstitutions.”“四区一共五间母婴健康院会与区内幼儿院及幼稚园和其它相关机构合作”,Background背景,“.usingadditionalresourcesallocatedbytheGovernmentandthroughstafftraining,anewmodeofoperationwillbeestablishedtoprovideneedyparentswithhealthandeducationalactivitiesandcounselingservices.”“利用政府增拨的资源和提供培训，建立一套新服务模式，使有需要的家长能得到全面的支持服务。”,Background背景,HeadstartprogramwasproposedbytheHealth,WelfareandFoodBureauforchildrenaged5andbelowandtobeimplementedinphases此先导计划是由前卫生福利及食物局提出，对象为五岁及以下儿童并分阶段进行Aimstoprovidecomprehensiveandtimelysupporttochildrenandtheirfamilies目的是为儿童及其家庭提供全面及适切的支持,Background背景,Headstartprogramrenamedas“ComprehensiveChildDevelopmentService(C.C.D.S.)”此先导计划亦重新命名为儿童身心全面发展服务,Background背景,MaternalandChildHealthCentres(MCHCs)actastheplatformwhereservicescanbedeliveredthroughinter-sectoralpartnershipamongGovernmentdepartmentsandrelevantagencies以母婴健康院作为服务平台，使各政府部门及有关机构作跨界别的伙伴合作Anintegratedcommunity-basedchildandfamilyservicemodel是一个以社区为基础的儿童及家庭融合服务模式,Background背景,EducationandManpowerBureau前教育统筹局IntegratedFamilyServiceCentresofSocialWelfareDepartmentandNGOs社会福利署及非政府机构辖下综合家庭服务中心DepartmentofHealth(MCHCs)卫生署(母婴健康院)HospitalAuthority(DepartmentsofPsychiatry,Paediatrics,Obstetrics)医院管理局(精神科、儿科、妇产科),Background背景,ManpowerinHospitalAuthority医院管理局的人手分配Psychiatrist精神科医生Psychiatricnurse精神科护士CommunityPaediatrician社区儿科医生Midwife助产士,ComponentsofCCDS组成部份,Identificationandreferralofchildrenandfamiliesforsocialserviceintervention及早识别及转介有社会服务需要的儿童及家庭Referralandfeedbacksystemforpre-schoolchildrenwithphysical,developmental,behaviouralandfamilyproblems为有健康、发展及行为问题的学前儿童及家庭作转介并设立反馈制度,ComponentsofCCDS组成部份,Identificationandholisticmanagementofhighriskfamilies及早识别和全面处理高危家庭Identificationandmanagementofmotherswithpostnataldepression及早识别和处理患有产后抑郁的母亲,PsychiatriccontributionstoCCDS服务范围,Identificationandmanagementofpostnataldepression(PND)isthemainfocusforgeneraladultpsychiatriccontributionstoCCDS及早识别和处理产后抑郁症是成人精神科于儿童身心全面发展服务下的重點工作,IdentificationofPND识别产后抑郁症,TheEdinburghPostnatalDepressionScale(EPDS)(Coxetal.,1987)爱丁堡产后抑郁量表10-itemself-reportscale十个项目的自行填写量表ScreeningquestionnairetoimprovethedetectionofPNDinthecommunity作为一个筛查量表以改善社区产后抑郁症的侦查率,IdentificationofPND识别产后抑郁症,PostnatalmotherstocompleteEPDSatMCHCsatabout2monthspostnatally产后母亲于生产后二个月在母婴健康院填写爱丁堡产后抑郁量表Coincidewiththechildimmunizationschedule与儿童防疫注射安排在一起,IdentificationofPND识别产后抑郁症,Formotherswithscores1012ofEPDS:在爱丁堡产后抑郁量表得十至十二分的母亲:AssessandcounselbyMCHCstaff会接受母婴健康院医护人员的评估及辅导,IdentificationofPND识别产后抑郁症,Formotherswithscoresor=13/or=1onQ10(self-harm)ofEPDS:在爱丁堡产后抑郁量表得十三分或以上或在第十项(自残)中得分的母亲:RefertoCCDSPsychiatricnurseforassessmentandmanagement会被转介致精神科护士作评估及处理,RoleofpsychiatricnurseinCCDS精神科护士的角色,AtMCHClevel在母婴健康院层面:ProvideoutreachclinicsessionsatMCHCs为母婴健康院提供外展诊症服务ReceivereferralfromnurseanddoctorofMCHCandfromCommunityPaediatrician接受母婴健康院医护人员及社区儿科医生的转介,RoleofpsychiatricnurseinCCDS精神科护士的角色,MotherswithEPDSscoreor=13/scoreor=1onQ10(EPDSreferral)在爱丁堡产后抑郁量表得十三分或以上或在第十项中得分的母亲Motherssuspectedtohavementalhealthproblem(Clinicalreferral)怀疑患有精神健康问题的母亲,RoleofpsychiatricnurseinCCDS精神科护士的角色,Offerpsychiatricassessmentandcounseling提供精神科评估及辅导Referinneedcasestopsychiatrist转介精神科医生Expertisesharing/trainingtoMCHCstaff分享专科知识及培训母婴健康院医护人员Delivermentalhealthtalktomothersandtheirpartners为母亲及其配偶提供精神健康讲座,RoleofpsychiatricnurseinCCDS精神科护士的角色,FunctionasaservicecoordinatorbetweenMCHC,CommunityPaediatrician,ObstetricUnit,andPsychiatricUnit作为母婴健康院、社区儿科医生、妇产科及精神科的服务协调人员CasediscussionwithMCHCstaffandstaffofIntegratedFamilyServiceCentres与母婴健康院医护人员及综合家庭服务中心社工作个案讨论,RoleofpsychiatricnurseinCCDS精神科护士的角色,Athospitallevel在医院层面:Assessantenatalandpostnatalwomenatconsultationliaisonsettingingeneralhospital(mainlyobstetricdepartment)以会诊形式评估在妇产科病房生产前后的妇女Delivermentalhealthtalkstopregnantwomen/public为孕妇及公众提供精神健康讲座Receivereferralfrommidwifeofobstetricunitforantenatalandpostnatalwomen接受助产士的转介,RoleofpsychiatristinCCDS精神科医生的角色,Athospitallevel在医院层面:Specialistperinatalout-patientclinic专科门诊(围产期诊所)ReceivereferralfromMCHCsandothersourcesforantenatalandpostnatalwomensuspectedtohavementalhealthproblem接受母婴健康院及其它途径的转介Consultationliaisonservicetoantenatalandpostnatalwomeningeneralhospital(mainlyobstetricdepartment)提供医院内生产前后妇女的会诊服务,RoleofpsychiatristinCCDS精神科医生的角色,Psychiatricin-patientserviceforantenatalandpostnatalwomen生产前后妇女的精神科住院服务Internalcaseroundwithpsychiatricnurseandbackuppsychiatricnurseatanyothertime统筹内部个案会议及作为精神科护士的后援ServicemeetingandcasediscussionwithmidwifeofobstetricdepartmentandCommunityPaediatrician与助产士及社区儿科医生作个案讨论,RoleofpsychiatristinCCDS精神科医生的角色,AtMCHClevel在母婴健康院层面:Outreachpsychiatristclinicsession外展精神科诊症服务ReceivereferralfromMCHCdoctor,Psychiatricnurse,CommunityPaediatrician接受母婴健康院医生、精神科护士及社区儿科医生的转介,RoleofpsychiatristinCCDS精神科医生的角色,Screenandassesscases;engage/motivateandbuilduprapportbeforereferringtoSpecialistclinicathospital;facilitatethereferralproceduretoSpecialistclinic筛查及评估个案、建立关系、协调精神科门诊的转介On-sitetrainingtoandbackupofMCHCstaff实地培训及支援母婴健康院的医护人员CasediscussionwithMCHCstaffandstaffofIntegratedFamilyServiceCentres与母婴健康院医护人员及综合家庭服务中心社工作个案讨论,RoleofpsychiatristinCCDS精神科医生的角色,Delivermentalhealthtalkstopublic为公众提供精神健康讲座CoordinatetrainingprogramsforHospitalAuthoritystaffandnon-HospitalAuthoritystaff(MCHC,IntegratedFamilyServiceCentres)onperinatalpsychiatry为医院管理局职员及非医院管理局职员统筹及提供有关的专业培训,HongKongSituation概览,19districts十九个地区7clusters(inHospitalAuthority)七个医院联网31MCHCs三十一所母婴健康院,CCDSinHongKong,PilotedinShamShuiPodistrictofKowloonWestCluster(KWC)inJuly2005于二零零五年七月在深水埗地区(九龙西医院联网)推行试行计划PilotsiteatWestKowloonMCHC西九龙母婴健康院为试行地点,CCDSinHongKong(current)现况,R