Postnatal depression 产后抑郁症 C.C.D.S. Model of Care in Hong Kong 儿童身心全面发展服务 香港的保健模式 Dr. Bonnie Siu

C.C.D.S. Comprehensive Child Development Service (C.C.D.S.) 儿童身心全面发展服务 An innovative service model 一个创新的服务模式 Pilot launched in July 2005 in Hong Kong 于二零零五年七月在香港试行

Background背景 In the Policy Address 2005, our former Chief Executive, Mr. Tung Chee Hwa stated that: 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 “For children under five in poor families, we will launch a Head Start Programme on child development in the four local communities of Tin Shui Wai, Tuen Mun, Sham Shui Po and Tseung Kwan O on a trial and phased basis.… “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 “.…Five Maternal and Child Health Centres in the four communities will cooperate with nearby nurseries, kindergartens and other related institutions.…” “……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 “.…using additional resources allocated by the Government and through staff training, a new mode of operation will be established to provide needy parents with health and educational activities and counseling services.” “……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 Head start program was proposed by the Health, Welfare and Food Bureau for children aged 5 and below and to be implemented in phases 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 Aims to provide comprehensive and timely support to children and their families 目的是为儿童及其家庭提供全面及适切的支持

Background背景 Head start program renamed as “Comprehensive Child Development Service (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 Maternal and Child Health Centres (MCHCs) act as the platform where services can be delivered through inter-sectoral partnership among Government departments and relevant agencies 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 An integrated community-based child and family service model 是一个以社区为基础的儿童及家庭融合服务模式

Background背景 Education and Manpower Bureau 前教育统筹局 Integrated Family Service Centres of Social Welfare Department and NGOs 社会福利署及非政府机构辖下综合家庭服务中心 Department of Health (MCHCs) 卫生署 (母婴健康院) Hospital Authority (Departments of Psychiatry, Paediatrics, Obstetrics) 医院管理局 (精神科、儿科、妇产科)

Background背景 Manpower in Hospital Authority 医院管理局的人手分配 Psychiatrist精神科医生 Psychiatric nurse精神科护士 Community Paediatrician社区儿科医生 Midwife助产士

Components of CCDS组成部份 Identification and referral of children and families for social service intervention 及早识别及转介有社会服务需要的儿童及家庭 Referral and feedback system for pre-school children with physical, developmental, behavioural and family problems 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

Components of CCDS组成部份 Identification and holistic management of high risk families 及早识别和全面处理高危家庭 Identification and management of mothers with postnatal depression 及早识别和处理患有产后抑郁的母亲

Psychiatric contributions to CCDS服务范围 Identification and management of postnatal depression (PND) is the main focus for general adult psychiatric contributions to CCDS 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

Identification of PND 识别产后抑郁症 The Edinburgh Postnatal Depression Scale (EPDS) (Cox et al., 1987) 爱丁堡产后抑郁量表 10-item self-report scale 十个项目的自行填写量表 Screening questionnaire to improve the detection of PND in the community 作为一个筛查量表以改善社区产后抑郁症的侦查率

Identification of PND 识别产后抑郁症 Postnatal mothers to complete EPDS at MCHCs at about 2 months postnatally 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」 Coincide with the child immunization schedule 与儿童防疫注射安排在一起

Identification of PND 识别产后抑郁症 For mothers with scores 10 – 12 of EPDS: 在爱丁堡产后抑郁量表得十至十二分的母亲: Assess and counsel by MCHC staff 会接受母婴健康院医护人员的评估及辅导

Identification of PND 识别产后抑郁症 For mothers with scores > or = 13 / > or = 1 on Q10 (self-harm) of EPDS: 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: Refer to CCDS Psychiatric nurse for assessment and management 会被转介致精神科护士作评估及处理

Role of psychiatric nurse in CCDS 精神科护士的角色 At MCHC level在母婴健康院层面: Provide outreach clinic sessions at MCHCs 为母婴健康院提供外展诊症服务 Receive referral from nurse and doctor of MCHC and from Community Paediatrician 接受母婴健康院医护人员及社区儿科医生的转介

Role of psychiatric nurse in CCDS 精神科护士的角色 Mothers with EPDS score > or = 13 / score > or = 1 on Q10 (EPDS referral) 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 Mothers suspected to have mental health problem (Clinical referral) 怀疑患有精神健康问题的母亲

Role of psychiatric nurse in CCDS 精神科护士的角色 Offer psychiatric assessment and counseling 提供精神科评估及辅导 Refer in need cases to psychiatrist 转介精神科医生 Expertise sharing/ training to MCHC staff 分享专科知识及培训母婴健康院医护人员 Deliver mental health talk to mothers and their partners 为母亲及其配偶提供精神健康讲座

Role of psychiatric nurse in CCDS 精神科护士的角色 Function as a service coordinator between MCHC, Community Paediatrician, Obstetric Unit, and Psychiatric Unit 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 Case discussion with MCHC staff and staff of Integrated Family Service Centres 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

Role of psychiatric nurse in CCDS 精神科护士的角色 At hospital level在医院层面: Assess antenatal and postnatal women at consultation liaison setting in general hospital (mainly obstetric department) 以会诊形式评估在妇产科病房生产前后的妇女 Deliver mental health talks to pregnant women/ public 为孕妇及公众提供精神健康讲座 Receive referral from midwife of obstetric unit for antenatal and postnatal women 接受助产士的转介

Role of psychiatrist in CCDS 精神科医生的角色 At hospital level在医院层面: Specialist perinatal out-patient clinic 专科门诊(围产期诊所) Receive referral from MCHCs and other sources for antenatal and postnatal women suspected to have mental health problem 接受母婴健康院及其它途径的转介 Consultation liaison service to antenatal and postnatal women in general hospital (mainly obstetric department) 提供医院内生产前后妇女的会诊服务

Role of psychiatrist in CCDS 精神科医生的角色 Psychiatric in-patient service for antenatal and postnatal women 生产前后妇女的精神科住院服务 Internal case round with psychiatric nurse and back up psychiatric nurse at any other time 统筹内部个案会议及作为精神科护士的后援 Service meeting and case discussion with midwife of obstetric department and Community Paediatrician 与助产士及社区儿科医生作个案讨论

Role of psychiatrist in CCDS 精神科医生的角色 At MCHC level在母婴健康院层面: Outreach psychiatrist clinic session 外展精神科诊症服务 Receive referral from MCHC doctor, Psychiatric nurse, Community Paediatrician 接受母婴健康院医生、精神科护士及社区儿科医生的转介

Role of psychiatrist in CCDS 精神科医生的角色 Screen and assess cases; engage/ motivate and build up rapport before referring to Specialist clinic at hospital; facilitate the referral procedure to Specialist clinic 筛查及评估个案、建立关系、协调精神科门诊的转介 On-site training to and back up of MCHC staff 实地培训及支援母婴健康院的医护人员 Case discussion with MCHC staff and staff of Integrated Family Service Centres 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

Role of psychiatrist in CCDS 精神科医生的角色 Deliver mental health talks to public 为公众提供精神健康讲座 Coordinate training programs for Hospital Authority staff and non-Hospital Authority staff (MCHC, Integrated Family Service Centres) on perinatal psychiatry 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

Hong Kong Situation概览 19 districts 十九个地区 7 clusters (in Hospital Authority) 七个医院联网 31 MCHCs 三十一所母婴健康院

CCDS in Hong Kong Piloted in Sham Shui Po district of Kowloon West Cluster (KWC) in July 2005 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 Pilot site at West Kowloon MCHC 西九龙母婴健康院为试行地点

CCDS in Hong Kong (current) 现况 Rolled out to New Territories West Cluster (NTWC) and Kowloon East Cluster (KEC) gradually since January 2006 于二零零六年一月，扩展至新界西及九龙东医院联网 Currently covers 6 districts, 3 clusters and 9 MCHCs 现共服务六个地区、三个医院联网及九所母婴健康院

CCDS in Hong Kong (current) 现况 In NTWC新界西医院联网: Tuen Mun and Yuen Long districts 屯门及元朗地区 Annual birth rate of 6000-7000 with a population of about 1 million 地区人口约一百万而年度出生率约六千至七千

CCDS in Hong Kong (current) 现况 4 MCHCs 四所母婴健康院 1 Psychiatrist, 4 Psychiatric nurses, 1 Community Paediatrician, 1 Midwife 一名精神科医生、四名精神科护士、一名社区儿科医生及一名助产士

CCDS in Hong Kong (future) 前瞻 C.C.D.S. will be rolled out in phases to cover 19 districts, 7 clusters and 31 MCHCs in Hong Kong 儿童身心全面发展服务将会分阶段逐渐扩展至全香港的社区 Depends on the funding of the Government and the readiness of the MCHCs 视乎政府的拨款及母婴健康院的筹备工作

Thank You 谢谢