The birth of a child is often portrayed as one of the happiest moments in a family’s life. However, for some families, including those who receive care at Zuckerberg San Francisco General Hospital and Trauma Center (ZSFG), giving birth can also be a stressful experience. Many of ZSFG’s patients cope with challenges related to chronic mental illness, substance abuse, and trauma. They have few places to turn to for support and care, thereby exacerbating stress associated with pregnancy and raising a newborn child.

Bearing in mind the high-risk patient population and the specific challenges faced by this group, ZSFG offers a range of maternal mental health programs that extend beyond the traditional boundaries of medical care. These programs infuse creativity, innovation, and a broad range of services, and are built on the multidisciplinary knowledge of ZSFG’s team of caregivers.

Embedded within the Department of Psychiatry, led by James Dilley, MD, and with the support of partnerships within the hospital and throughout San Francisco, ZSFG’s maternal mental health programs offer unique services that take into consideration the mother, the child, and the entire family’s health and well-being.

According to Dr. Dilley, “The development of these programs and initiatives required a collaborative effort by a number of individuals, and a true partnership between the Chief of Pediatrics, Chief of Family & Community Medicine, Chief of Obstetrics & Gynecology (OBGYN), and the City and County of San Francisco Primary Health Program.” The maternal mental health programs were developed based on the premise that the better that parents are able to care for themselves, the better positioned they will be to care for their children.

The Infant-Parent Program (IPP), one of the programs within the Psychiatry Department’s Division of Infant, Child, and Adolescent Services, led by Marina Tolou-Shams, PhD, is an infant and early childhood mental health program focusing on the relationships between young children and their adult caregivers. A vital offering of ZSFG for nearly 35 years and one of the first programs of its kind in the country, IPP is composed of licensed clinical psychologists, social workers, marriage and family therapists, and early childhood specialists, who provide direct mental  health services to families beginning in pregnancy through childhood up to five-years-old, with the ultimate goal of enhancing the caregiver-child relationship.

Many factors can affect the patients’ mental health and well-being, as well as the parent-child relationship. Kadija Johnston, LCSW, the IPP program director, explains that “IPP’s caregivers consider who this baby might become given the parents’ history, recognizing that very often people will repeat the patterns that they’ve experienced in the past. We realize that an intervention early on can change the trajectory of the parents’ experience in relation to the baby.”

“By necessity, medical providers specialize. When a baby is born, the baby is considered the patient. There aren’t many broader interventions that also consider the mother as a patient,” continues Ms. Johnston. Continuous care is an important programmatic component at ZSFG, as is factoring in the mother’s mental health. “Every IPP family has a caretaker who follows the family and acts as a bridge to provide continuity of care, thereby increasing the likelihood that psychosocial needs will be dealt with in a consistent manner.”

In addition to IPP, there are other programs within the Department of Psychiatry that are addressing maternal mental health issues, including family and community psychiatry; infant, child, and adolescent psychiatry; high-risk obstetrics psychiatry programs; and the Kempe Behavioral Health Partnership, a program that embeds an adult psychiatrist in the high-risk pediatric clinic.

All the programs strive to improve family mental health and share an overarching goal of providing services to the target population “where they are” and linking women to available specialty and nonspecialty mental health services. These programs emerged when program managers recognized that there were support services available for children, yet nobody was treating the mothers at the hospital.

As Dr. Melissa Nau of the Department of Psychiatry explains, “We realized that although parents often neglect their own mental or physical health needs due to competing demands on time and resources, they really work hard to bring their children for pediatric care. By placing an adult psychiatrist and IPP- trained psychotherapist in the Kempe Clinic, we have been able to meet the mothers where they are and to provide care when they were able to access it, rather than asking them to come back to a different clinic on a different day.” If a mother brings her child into the Kempe Clinic, she will have an opportunity to speak to a psychiatrist or psychologist to discuss her own struggles. Clinic providers have found this specific intervention to be beneficial for some mothers, who might otherwise not seek mental health treatment.

ZSFG’s maternal mental health programs are built on the growing research and understanding of the critical nature of early childhood interventions to improve the caregiver-infant bond as a way to prevent a range  of psychosocial and even physical ailments as the child ages. The ZSFG team aspires to take into consideration all the factors that might affect both a mother’s and also a baby’s health, ultimately creating the best health outcomes for the mother, the baby, and the entire family.

In 2015, the Department of Psychiatry maternal mental health team joined the Solid Start Initiative, a new interdepartmental effort at ZSFG that aims to address the social, behavioral, and medical barriers often faced by vulnerable pregnant women and families when seeking care. Envisioned as an interdisciplinary program, Solid Start brings together multidisciplinary expertise and a robust palette of existing programs and services from the Department of Psychiatry, Pediatrics, OBGYN, and Family & Community Medicine, with the ultimate goal that every child (age 0-3) receives a “solid start” in life. Solid Start launched in 2015 through the generous support of a philanthropic gift to the San Francisco General Hospital Foundation. Private philanthropy will continue to play a significant role in the development of Solid Start. For more information on how you can support Solid Start and other maternal and child health efforts at ZSFG, please contact Sara Haynes, Vice President of Development, at shaynes@SFGHF.org.