Core Competencies by Clinical Profession

• Understand signs and symptoms of Maternal/Paternal OCD and intrusive thoughts, including OCD subtypes
• Develop knowledge about maternal OCD and intrusive thoughts is nuanced from depression, anxiety, and psychosis
• Learn about about the valid screening tools for maternal/paternal OCD, where to locate; how to select and use;
• Recognize the recommended frequency of screening and how to screen for maternal OCD within the scope of screening for other maternal mental health disorders, during pregnancy and postpartum
• Understand how to interpret screening results
• Understand the critical differences between intrusive thoughts, which may involve a range of thoughts including suicide, pyshicatlly or sexually harming the baby and the actual risk of patients with these thoughts completing such acts
• Demonstrate ability to assess for safety including suicidality and infanticide risk vs. intrusive thoughts about suicide or harming the baby/children
• Develop knowledge of the menu of risk mitigation//treatment options (drug and non-drug treatments including non-clinical alternative practices)
• Recognize which medications are safe to start or continue in pregnancy or while breastfeeding; when multiple medications are being utilized or when multiple medications may be needed, seek a specialized reproductive mental health consultation
• Develop knowledge of how to counsel women with existing OCD who are planning pregnancies and taking medication
• Learn about and refer to the local network of MMH services where there is expertise in treating maternal/paternal OCD

• Understand signs and symptoms of Maternal/Paternal OCD and intrusive thoughts, including OCD subtypes
• Develop knowledge about maternal OCD/intrusive thoughts is nuanced from depression, anxiety, and psychosis
• Be familiar with validated screening tools and follow agency protocols in the selection and use of such tools
• Develop and implement care plans using screening results and following agency protocols on screening and interventions
• Be familiar with the menu of prevention/treatment options (drug and non-drug treatments including non-clinical alternative practices) and referral pathways
• Recognize when patient should be seen by an MD
• Recognize when to refer to the local network of MMH services with specialty services for Maternal OCD available in community
• Recognize that breastfeeding challenges can be a risk factor for anxiety and depression; be familiar with resources to support a mother’s decision to continue or discontinue breastfeeding, especially when medications are involved (i.e., psychotropics, antibiotics, and/or agents used to increase or decrease milk supply)

• Understand signs and symptoms of the range of MMH disorders and which factors place a woman at high-risk for an MMH disorder
• Develop knowledge about the valid screening tools for depression, anxiety, and bipolar disorder; where to locate; how to select and
• use; and when to screen for bipolar disorders
• Understand how to interpret screening results
• Develop knowledge of the menu of prevention/treatment options (drug and non-drug treatments including non-clinical alternative practices)
• Practice MMH evidence-based psychotherapy (cognitive behavioral therapy, exposure and response prevention/ERP  interpersonal therapy, etc.)
• Recognize when to refer to psychiatry and which psychiatrist is appropriate
• Demonstrate ability to appropriately counsel women with psychiatric illness who are planning pregnancies and taking medication
• Recognize and refer to the local network of MMH services and Maternal OCD specialists available in community
• Understand that trouble breastfeeding is a risk factor for anxiety and depression; certain medications used to treat mental health disorders are safe for use while breastfeeding; other agents used to help increase breast milk supply may trigger anxiety; and certain medications are safe to continue while breastfeeding while specialized psychiatric consultation is sought
• Identify prevalence of obsessive thoughts and compulsive behaviors in new parents
• Understand clinically significant obsessions and compulsions, and diagnostic criteria for perinatal OCD
• Differentiate between perinatal OCD and psychosis (ego syntonic vs dystonic nature of intrusive thoughts)
• Identify risk of harm to parent or infant due to presence of intrusive thoughts when contrasted with delusions present in psychosis
• Demonstrate understanding of potential for harm due to incorrect diagnosis and treatment
• Identify risk factors for perinatal OCD
• Demonstrate understanding of evidence-based treatment for perinatal OCD (CBT ERP)
• Refer to appropriate providers for evidence-based treatment
• Identify entities for obtaining additional training in evidence-based treatment of perinatal OCD
• Identify relevant screening tools for perinatal OCD, administration, scoring, and cutoffs

• Understand signs and symptoms of the range of MMH disorders, including perinatal OCD and postpartum psychosis and which factors place a woman at high-risk for an MMH disorder
• Develop knowledge about the valid screening tools for depression, anxiety, OCD, and bipolar disorder; where to locate; how to select and use; and when to screen for OCD/bipolar disorders
• Demonstrate competence in assessing for safety, particularly suicide and infanticide, and instituting appropriate acute treatment in pregnant and newly postpartum women
• Understand the critical differences between intrusive thoughts, which may involve a range of thoughts including suicide, pyshicatlly or sexually harming the baby and the actual risk of patients with these thoughts completing such acts
• Demonstrate ability to assess for safety including suicidality and infanticide risk vs. intrusive thoughts about suicide or harming the baby/children
• Understand how a differential diagnosis (distinguishing of a particular disease or condition from others that present similar symptoms) differs for pregnant and postpartum women versus the general population
• Develop knowledge of the menu of prevention/treatment options (drug and non-drug treatments including non-clinical alternative practices)
• Recognize the importance of social support and appropriate psychotherapy and how to develop a plan for assisting patients in accessing these resources
• Demonstrate understanding of evidence-based treatment for perinatal OCD and ability to provide psychoeducation about evidence-based psychotherapy to patients
• Demonstrate competency in counseling women on the risks of untreated relapse versus the risks of potential medication use in pregnancy and lactation
• Understand which medications are safe to continue in pregnancy or while breastfeeding versus which medications need to be changed immediately
• Demonstrate ability to appropriately counsel women with psychiatric illness who are planning pregnancies and will need treatment, whether pharmacological or not
• Demonstrate ability to appropriately counsel women of childbearing age on methods of birth control, their effects on psychotropic medication or symptoms, and where to go for family planning
• Develop knowledge of when to seek specialized consultation from a reproductive psychiatrist or psychiatrist with expertise in treating OCD
• Recognize and refer to the local network of MMH  and OCD services available in community
• Understand that trouble breastfeeding can be a risk factor for anxiety and depression; and some agents used to help increase breast milk supply may trigger anxiety

All competencies required of general psychiatrists plus:

• Demonstrate ability to manage complex medication regimens in pregnancy
• Provide pre-pregnancy and postpartum consultation to MDs, for women with severe mental illness and those on complex medication regimens
• Serve as a resource through expert consultation with a team of providers, including prenatal care, pediatric, social service, and other behavioral health providers

• Understand signs and symptoms of the range of MMH disorders and which factors place a woman at high-risk
• Develop knowledge about the valid screening tools for OCD, depression, and anxiety. Understand where to locate these screening tools and how to select and use them
• Understand recommended frequency of screening during pregnancy and postpartum and suggested ‘cutoff’ scores to identify who may have potential OCD, anxiety, or depression
• Be familiar with and follow agency protocols for different types healthcare workers involved in addressing MMH, which include prevention and treatment resources and referral pathways
• Understand that trouble breastfeeding can be a risk factor for anxiety and depression; and some agents used to help increase breast milk supply may trigger anxiety