Course Overview

Screening for Maternal Depression & Infant Toxic Stress

As you embark on the Maintenance of Certification Part IV (MOC IV) process, you will be happy to know that North Carolina has developed and received approval for the “Maternal Depression and Infant Toxic Stress” module that you can select for your Performance in Practice quality improvement activity. This activity, approved by both the American Board of Family Medicine (ABFM) and the American Board of Pediatrics (ABP), is intended for family physicians and pediatricians (other providers are also welcome), and is pending with the AAFP for 20 Prescribed CME credits.

This activity will be piloted with a group of 20-30 providers from around the state, and across the country, from April 2013- September 2013. Beginning April 1, 2013, interested providers may register to participate in the pilot activity. The pilot cohort will convene by webinar once monthly for the six-month period. Registration information will be sent out at the end of March.

If you wish to complete the activity on your own, beginning in October 2013, providers may register to complete this activity at their convenience, depending on when you need to complete your MOC IV requirements. An estimated timeframe for completion of this activity is 4-6 months.

Activity Goal

The aim of this project is to improve the delivery of care for the mother infant dyad in pediatric and family practices. This intervention will assess the various practices and protocols in place for working with both the mothers and the infants, including screening tools, referral and follow up patterns. This activity will be applicable to pediatricians, family physicians, ob-gyns, nurse practitioners, practice managers, and any interested primary care provider.

Suggested Resources

This activity will emphasize the importance of increasing screening rates and improving referral patterns for maternal depression. Various resources are included throughout the activity site, and under each Learning Session, in addition to the following on North Carolina support programs:, for more detailed information on resources, support, and community programs.

Also, please be sure to visit the following website for a comprehensive listing of the available clinical tools (including screening tools) for postpartum depression:

Learning Objectives

  1. Increase the use of a screening tool to 100% of time for maternal and well baby checks, such as the Edinburgh PostPartum Depression Scale, by the end of the 6 month activity period.
  2. Increase the provider's referral and follow up rate for mother and infant dyad by 25% at the end of the 6 month activity period.
  3. Enhance the provider's knowledge of infant toxic stress and its impact on early brain development, the root causes and effects within the second month of the activity period as a result of Learning Collaborative Session II.
  4. Improve the provider's routine utilization of maternal depression screening tools to 100% at the end of the activity period.
  5. Increase the provider's competence in using techniques to follow up with mothers and families on social emotional well being by the end of Learning Collaborative Session III, at the end of the third month of the activity.
  6. Increase the provider's knowledge of community resources and how to connect across various disciplines in order to most effectively make referrals for women and their children following Learning Collaborative Session V by the fifth month of the activity.

Participant Expectations

During the activity, the Physician will:

  1. Assess the policies and procedures currently in place regarding the intake and screening of infants and mothers utilizing the pre/ post assessment.
  2. Enter at least 3 separate chart extractions into activity database from 10 retrospective patient charts from infant well check visits or from check ups with the mother.
  3. Participate in the 6 learning collaboratives that convene each month by webinar. If you must miss a webinar, you can review it once it is archived on the website.
  4. Implement revised policies and procedures.
  5. Evaluate the activity model using activity evaluation at the end of activity period.

Learning Collaboratives & Key Dates for 2013 Pilot Cohort

  • Session 1: Activity Kickoff and Maternal Depression Overview | April 24, 12:30 – 2:00
  • Session 2: Infant Toxic Stress and the Impact on Brain Development | May 29, 12:30 – 1:30
  • Session 3: Referrals and Community Resources for the Mother | June 26, 12:30 – 1:30
  • Session 4: Referrals and Community Supports for Mother Infant Dyad | July 31, 12:30 - 1:30
  • Session 5: Linking Across Disciplines to Improve Referral Patterns | August 28, 12:30 – 1:30
  • Session 6: Evaluation and Wrap Up Call/ Participant Highlights | September 25, 12:30 – 1:30

Presenting Faculty

Marian Earls, MD
Marian F. Earls, MD, FAAP - Marian Earls is the Lead Pediatric Consultant for Community Care of North Carolina, and is the current lead on the state CHIPRA Quality Demonstration Grant for the state. From 1994 to July 2012 she was the Medical Director of Guilford Child Health., a large, non-profit, private Pediatric practice that is the pediatric division of Triad Adult and Pediatric Medicine in Greensboro, North Carolina. She is also a Developmental and Behavioral Pediatrician. Guilford Child Health is a public-private partnership between two community health systems and the department of public health, and serves families at or below 200% of the Federal Poverty Level. She is a Clinical Professor of Pediatrics for the University of North Carolina Medical School. Dr. Earls also is Medical Director of the Neonatal Follow-up Clinic (multidisciplinary) for the Level III NICU at Women’s Hospital in Greensboro. Dr. Earls is Immediate Past President of the North Carolina Pediatric Society (President 2008-2010). She is chair of the Mental Health/School Health Committee for NCPS. She has been a member of the Committee on the Psychosocial Aspects of Child and Family Health of the AAP, and was the lead author on the committees Clinical Report “Incorporating Recognition and Management of perinatal and postpartum Depression into Pediatric Practice,” (PEDIATRICS, November 2010). She is a liaison from the AAP to AACAP (American Academy of Child and Adolescent Psychiatry). She has been elected to the Executive Committee of the AAP’s Section on Early Education and Child Care. She is a member of the Mental Health Leadership Work Group of the AAP that is charged with national dissemination of mental health integration in primary care pediatrics.

Samantha Meltzer-Brody, MD
Samantha Meltzer-Brody, MD, MPH - Dr. Samantha Meltzer-Brody, MD, MPH is an Associate Professor and Director of the UNC Perinatal Psychiatry Program of the UNC Center for Women's Mood Disorders, a comprehensive clinical and research program that includes the first Perinatal Inpatient Psychiatry Unit in the U.S. Her current clinical and research efforts are focused primarily on Perinatal Depression. She is the recipient of a five-year NIH Career Development Award, K23MH085165, to investigate psychophysiological and genetic models of postpartum depression (PPD) and has recently worked to establish an international postpartum depression genetics consortium (PACT). She is a Co-I on two R01’s: The first investigating a biomarker signature of postpartum depression in African American women and the second examining the pathohysiology between lactation failure and postpartum depression and to determine the extent to which low oxytocin mediates associations between PPD and impaired development of the mother-infant dyad. Dr. Meltzer-Brody maintains an active clinical practice, has published numerous manuscripts in the field of women’s mental health, currently participates in clinical trials research in women’s mood disorders, and serves as the mental health consultant for the North Carolina Women’s Health Report Card. In 2012, the Triangle Medical Journal selected Dr. Meltzer-Brody as one of the “Top-10 Woman in Medicine” and she was also selected as an inaugural Sanders Clinician Scholar at UNC to develop an innovative program to address physician burn-out syndrome.

Andrew Garner, MDAndrew Garner, MD, PhD - Dr. Garner is a graduate of Swarthmore College, and a product of both the Medical Scientist Training (MD, PhD) Program at Case Western Reserve University and the Pediatric Residency Training Program at the Children's Hospital of Philadelphia. Dr. Garner has practiced primary care pediatrics with University Hospitals Medical Practices since 2000. He is an Associate Clinical Professor of Pediatrics at Case Western Reserve University School of Medicine and a member of the Center on Child Health and Policy at Rainbow Babies and Children's Hospital. As a member of the American Academy of Pediatrics’ (AAP) Committee on Psychosocial Aspects of Child and Family Health, Dr. Garner co-authored the Policy Statement and Technical Report on childhood toxic stress. He is currently the Chair of the AAP's Leadership Workgroup on Early Brain and Child Development and a member of the AAP's Leadership Workgroup on Epigenetics. Dr. Garner is also the Vice-President / President-Elect of the Ohio Chapter of the AAP. When not cherishing some quality time with his wife, son, daughter, and dog, Dr. Garner likes to fish, hike, canoe, and practice Tae Kwon Do.

Karn Appleyard Carmody,PhDKaren Appleyard Carmody, PhD, LCSW - Karen Appleyard Carmody, PhD, LCSW, is a licensed psychologist and clinical associate at the Center for Child and Family Health (CCFH) in the Department of Psychiatry and Behavioral Sciences at Duke University Medical Center. Dr. Carmody received her MSW from the University of Pennsylvania and her Ph.D. in clinical and developmental psychology from the University of Minnesota. Her post-doctoral training was completed at the University of North Carolina’s Center for Developmental Science. Dr. Carmody’s clinical and research expertise is in the areas of infant mental health, child-parent attachment, early childhood trauma and maltreatment, and evidence-based practices to address these issues. Dr. Carmody serves as a clinical supervisor for the Healthy Families Durham evidence-based home visiting and child maltreatment prevention program and program manager for the Durham Early Head Start Home-Based Program. Dr. Carmody also has significant experience providing trauma treatment to children and families and is the former co-director of the North Carolina Child Response Initiative, a police-mental health partnership designed to provide crisis intervention and support to children and families who have witnessed domestic and community violence. Dr. Carmody also is engaged in several program evaluation and dissemination projects for evidence-based practices for young children who have experienced trauma and early adversity. Specifically, she is leading a team at CCFH to develop the nation’s first Learning Collaborative focused on the dissemination of Attachment and Biobehavioral Catch-up (ABC) and serves as the evaluator for the PCIT of the Carolinas project, the nation’s first Learning Collaborative for Parent-Child Interaction Therapy (PCIT).

Mary S. ZaffinoMary Zaffino, MD - Mary Shell Zaffino, MD is a family medicine physician at Blue Ridge Community Health Services and soon to be faculty member for the Mountain Area Health Education Center Hendersonville Family Medicine Residency Program as the two clinics merge. She earned a Bachelor of Science at Davidson College and a Master of Education in Exercise Science at the University of Georgia before completing her Doctor of Medicine at the Medical University of South Carolina. She finished her residency at the Mountain Area Health Education Center's Asheville Program in 2011. Dr. Zaffino is a member of the Alpha Omega Alpha Honor Society and won awards for the clinical sciences and service in medical school. Her interests include prenatal and postpartum care.

Paul Trani, MDPaul Trani, MD, PhD - Dr. Trani is a full-time pediatrician at Blue Ridge Community Health Services in Hendersonville, NC. He graduated from Virginia Commonwealth University School of Medicine (MCV) and did his residency at the University of Michigan. He came directly to North Carolina from Michigan to work with the underserved migrant farm worker community at BRCHS. He also serves as the medical director for school-based health center services in Henderson County as well as on the board of the North Carolina Pediatric Society. He has been lucky enough to be surrounded by talented people, both locally and statewide, who share his fervor for providing high-quality medical homes for all children in North Carolina.

Activity Completion

Upon activity completion, the Activity Director, Marietta Ellis, will complete a Physician Attestation form on your behalf regarding your completion of the activity in order to receive full MOC IV credit. Participants will need to utilize standard self-report procedure to attain CME credits and will receive a CME certificate. Please contact her with any questions about this MOC IV Activity by email at

Activity Fee

The NC Pediatric Society and the NC Academy of Family Physicians received funding from Community Care of North Carolina’s (CCNC) federal CHIPRA grant to develop and pilot test this activity. This funding will end at the end of 2014, and a nominal registration fee for participation in this activity may be incurred at that time. North Carolina providers who register between 2013-2014 can still participate for free due to the CHIPRA funding. A nominal registration fee for out of state providers will be incurred beginning October 2013.