Transcript Document 7424293

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.
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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
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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
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“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
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“.…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
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“.…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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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