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University of Colorado College of Nursing

College of Nursing
 

Clinic Offers Promise for Pregnancy-Related Depression

Clinic forges relationships for continuing care


Nichole Jenkins

Nichole (Harris) Jenkins has witnessed horror the rest of us only read about.

A highly trained medic and USAF veteran of Operation Iraqi Freedom in 2007, Jenkins, 28, is a “continuity” patient at the University of Colorado Hospital’s PROMISE Clinic (Perinatal Resource Offering Mood Integrated Services and Evaluation). The clinic was established in 2009 to provide on-site screening, evaluation and treatment for perinatal women experiencing mood and anxiety disorders. Since January of this year, the clinic has seen 89 new referrals, according to certified nurse-midwife Amy Nacht, MSN, a member of the clinic’s interdisciplinary team.

Jenkins, considered a high-risk pregnancy, was referred to the PROMISE clinic during an emergency visit to University of Colorado Hospital (UCH) while she was pregnant and bleeding heavily. With the father of her first baby having distanced himself—in fact, he wanted her to terminate pregnancy—and having returned from a seven-month deployment to Iraq, where she lived in a tent and worked nearly around the clock, Jenkins suffered from depression as well as from post-traumatic stress disorder. The two conditions exacerbated each other.

The experience of taking care of insurgents as well as Americans—men, women and children with horrific injuries—was devastating, Jenkins says. “Once, a patient who was stable at the time I finished my shift later coded. After that, I was afraid to leave my shift. I felt so guilty, like it was my fault.” Jenkins, who had five years of experience working in surgical ICUs before her deployment, started being “hyper-vigilant” and would “frantically clean and stop talking to people. I was using compulsive behavior to escape.”  When she returned home, Jenkins says, “I was alone, I felt down and anxious and was crying constantly. I knew I needed help.”

At the PROMISE clinic Jenkins met with Nacht and Kristina Shillingford, RN, a patient navigator. “Changes in pregnancy can compound other feelings,” Nacht says. She and the PROMISE team work very closely with Cheryl Chessick, MD, associate professor of Psychiatry and director of the Women’s Studies and Treatment program at the University of Colorado Depression Center. Chessick helped launch the PROMISE Clinic and provides therapeutic oversight, personally helping with complicated cases.

“I’ve never been given a doctor’s cell number but Amy gave me hers. That meant a lot to me,” Jenkins recalls.  “She really cared about my well being.” In addition to her emotional condition, Jenkins injured her back while on deployment, so is in chronic pain. “Depression and chronic pain make each other worse,” Jenkins says, but Nacht put her at ease about medications.

The clinic also forges relationships with community mental health services and clinics, UCH's Outpatient Psychiatric Practice, Children's Hospital Colorado and other providers so women have continuing access to care.

“We’re very sought after,” Nacht says. “We’re the only clinic in Colorado with this interdisciplinary model.”

 “Amy and Kristina have helped a lot. I don’t know what I would’ve done without them,” says Jenkins, who will continue to go to the PROMISE Clinic until she has another therapist. Nacht has put her in touch with group resources. “I’m definitely a hard patient,” Jenkins says, “but they haven’t given up on me.”