Ingram Screening: Perinatal Mental Health Screening

We’re thrilled to welcome back Lynn Ingram of Ingram Screening for a special second interview, celebrating the one-year anniversary of our podcast! Lynn dives into the importance of perinatal mental health screening, sharing insights on identifying early signs of anxiety, depression, and other challenges during pregnancy and postpartum. We discuss practical strategies for healthcare providers, the impact of early intervention on parents and babies, and why mental health screening is a vital part of prenatal and postnatal care. Whether you’re a parent, provider, or advocate, this conversation is full of valuable guidance for supporting healthy, supported families.

Transcript

Lynn Ingram McFarland: 0:00

People will come into the office and tell you that they're just overwhelmed, like I feel like a mean mom. I feel angry all the time. What they're really telling you is that they are touched out. They're overwhelmed, they are overworked, and all of these things are kind of piling on top of them, and they just don't have the bandwidth to practice patience, and it is really common, and like you said, it's getting misdiagnosed.

Unknown: 0:27

Welcome to perinatal and reproductive perspectives. This is a podcast where we empower birthing individuals, partners and health professionals with evidence based insights, holistic strategies and relatable stories hosted by a health care expert, this podcast fosters understanding equity and growth in perinatal and reproductive health. Here's your host, Becky Morrison gleed.

Rebecca Gleed: 1:00

Welcome everyone to another episode of perinatal and reproductive perspectives. We are in for a special treat today, because we are circling back after an entire year of podcast to re interview Lynn Ingram McFarlane. She is the owner of Ingram screenings. Welcome to the show.

Unknown: 1:21

Thank you. Thanks for having

Rebecca Gleed: 1:22

me back. Yeah, I was telling you, before we went live that my producer, Marisa, said she received such incredible feedback and questions about your episode. Number one, for folks, please go back and listen to Lynn's episode. She helped us launch this podcast and spoke to perinatal mood and anxiety disorder screenings. So we thought it would be incredible to invite you back to ask, what's going on in 2025 what are some of your wins? What are some of your struggles? What are the trends? What do we need to know going into 2026

Unknown: 2:02

Yeah, for sure. Thanks for having me back. So I would say the biggest wins of 2025 to date. It is not over yet, but the first one was launching the Ingram screening, perinatal mental health risk assessment screening tool. So that is called the is 20 because s 20 Questions and is for Ingram screening. Of course. How that came about is I was having providers sending me individual, siloed screening tools like the EPDs, the pH two nine for depression or anxiety, and people were not scoring positive on those. But when I looked at them together, sort of as a unit, and looked at some cross tool insights. I was realizing that we're missing a whole bunch of stuff in between with the siloed screening. So what I did with the is 20 was it kind of screens for seven different pmats, perinatal mood, anxiety disorders, and then on the back end, on the scoring sheet, is where we kind of get some cross tool insights, and looking at, you know, maybe these are compounding. Maybe this depression and this anxiety are not bad enough on their own, but compounded, they're making some issues. So that was the first one of my one of my wins this year is the is 20

Rebecca Gleed: 3:14

before we move too far past. This was a cross tool.

Unknown: 3:19

So I'm cross disorder insights, I should say actually, but cross tool insights, like I was taking the EPDs, the PHQ nine, the GAD seven, and kind of overlaying them over each other to kind of look at some compounding features. So somebody was not scoring positive for depression, but on their anxiety tool, they scored pretty high, and they may have scored almost high on the EPDs. So it's just looking at different nuances in the tools and seeing if there's any cross reference, anything, yeah.

Rebecca Gleed: 3:52

And just for anyone not knowing these acronyms, I want to invite you to go back and listen to episode one. We took a deep dive and explained more thoroughly what those meant. So if you if you're lost in the weeds, go back and listen to episode one. Yeah.

Unknown: 4:09

And real quickly, the EPDs is the standard tool for depression in the perinatal period. That's the Edinburgh postnatal depression scale. The PHQ nine is patient health questionnaire, and it has nine questions. So when you see a number, that usually means the questions, number of questions on the tool. So the is 20, was my was my big launch, working on that I'm partnering. Also, another win, partnering with two private practice physicians who are screening and sending me the screening scores, and I am sending them screening reports back for use in session. So again, I'm cross referencing these tools are sending me not the is 20, but the ones that are approved and validated already for use and sending back screening reports with narrative like this is what I'm seeing. This is what you can say to the patient. Here are my recommendations. So that's been fun, getting those two on board and getting all those contracts set up a third. Exciting. When this year was presenting at the Oregon Public Health Association, I was honored to be chosen as a presenter, and so I presented on perinatal mental health as a public health crisis here in Oregon, and I was able to pull a lot of data from from other places about Oregon, about our birth rates and the amount of people that give birth here, and and even break it down by county and how many providers we have in each county and what our gaps are. So that was, that was great to get in front of of the Oregon Public Health Association. So that was a big win. And then I think before,

Rebecca Gleed: 5:34

can you write the meat and potatoes of that presentation? I don't want to gloss over that. That sounds really impactful and meaningful?

Unknown: 5:41

Yeah, and I posted it on LinkedIn, so anybody has access to it, because it was a PowerPoint slide, and it was basically talking about how much employers and the society loses in revenue and in income, which is what people pay attention to due to untreated pmats And so, like in Oregon, like when somebody suffering, they're not showing up for work, or they're not showing up on time, or they're there, but they're not really all there, or, you know, they call in sick a lot, or they can't get childcare. It costs close to 32,000 per Parent Infant dyad. It costs companies and society as a whole for untreated pmads, just due to that lack of workforce also included the reliance, including the reliance on social services. So going to the ER more often needing WIC WIC benefits, or, you know, needing Medicaid, or any one of those kind of things. So I kind of worked through all of that, but the fund card is running the algorithm, because I'm kind of a data nerd. And so we took, and I can't remember off top my head, but there was about, I think, almost 40,000 births in Oregon, like in 2024 and I multiplied that times 20% of sufferers, and I come up with this number, and then I take that number, and I'm like, well, 75% don't get treated. So I use that number, and then I multiply that by $32,000 and so it was something like, it's ridiculous. It's millions of dollars every year that that society and employers lose in in pmats, not not treated. So that was just kind of fun to run the numbers and show everybody in Oregon what, what it looks like.

Rebecca Gleed: 7:24

Yeah, anything that came out of that, that we can highlight, it's one thing to present. It's another thing to see some change come, or even conversations about that, and then maybe impact or trickle over to other states. Yes.

Unknown: 7:39

So the good part was that I was able to be in person with in face to face with a lot of people, some of them from the Oregon Health Authority, some of them from the Oregon perinatal collaborative, a lot of state and county health departments. So I think just bringing that subject to light, and they had no idea about it or any reference point about it, was really impactful, and I made a lot of different exchanges with people with contact information. So as far as this goes, I'm going to follow up on all those connections I made, and hopefully I've offered to to create the presentation for other states using their data. So I'm happy to do that for everybody. So like California, let's go through and and run that algorithm for California and how many births they have and what their provider care gap is. So yeah, that's my next goal. Is to create it for other states and just get it out in circulation. Congratulations.

Rebecca Gleed: 8:45

And what an impact. I heard a lot of similar feedback from your episode of I had no idea. I didn't realize even just the economic issue was like, jaw dropping.

Unknown: 8:57

Yeah, it really is. And and it was, it was great because at the Oregon Public Health Association a lot of that was physical about physical health and social services and preventing diseases and and getting flu shots and all the things. So I just brought this entirely different perspective. And people were like, Oh, wow, we never thought about that. So that was fun. But I'd like other states to also start

Rebecca Gleed: 9:20

thinking about that. So yeah, and we'll get into that after we talk about some of your other wins, but screening during pregnancy and after pregnancy. So there's this prevention, and then also tracking and following parents into

Unknown: 9:36

parenthood, right prevention and mitigation to begin with, yeah, and then, and then the follow through. So yeah, it was, it was well received, and I was happy to be able to do that. Spent two days there at that conference, doing that, and my, I think my last big win for this year was launching my sales rep program, having sales reps across the United States who sell the Ingram screening business. Model, basically, and work on commission. So that's been fun to kind of coordinate with all these people who share the same passion that I do, and kind of go to bat for Ingram screening across, you know, the country. So that was, that was good too, yeah,

Rebecca Gleed: 10:13

and a call to action that it doesn't have to be a big behemoth to utilize your services. You said you've got two just private practitioners who are using Ingram screenings to help their patients, their clients, to screen to find folks who are in need of treatment, assessment, etc.

Unknown: 10:36

Yeah, yeah. So that the and the is 20 is free on my website. It's on the front page of my website so anybody can can fill that out, and then on the back end, that's when I take it and do the cross cross assessment, cross system assessment. Yes, thank you. And then the report goes directly to the person who filled it out. It does not go to HR, it does not go to their physician. It does not go to, you know, anybody their school, or anybody that's just private for them to use. So that makes it more accessible to people.

Rebecca Gleed: 11:07

Yeah, fantastic. And is there any research? The for is the is 20 any universities or anyone who's studying this.

Unknown: 11:18

So right now, just this year too. I forgot to add that I'm working with some researchers from nested. Can be called nested, you've probably heard of them, but they're researchers out of NYU, I believe, and they are taking this on and working with me on a contract to sort of increase this value proposition by running numbers and doing research for me. So in the, you know, eight to 10 organizations that Ingram screening is already running in, that I've already trained and educated, like, what is it? What are the outcomes? So they're going to do that research for me, which is great, and then it kind of, you know, I'll end up with some sort of a, you know, one sheet that I can present to other organizations that say, Look, these are the outcomes that we're having with with Ingram screening business model. So I'm excited to work with them, and I'm actually meeting with them tomorrow morning.

Rebecca Gleed: 12:08

So congratulations. This, this crossover piece, I think, will have a meaningful impact clinically. I'm thinking, from my own perspective, it's, it's so siloed where I'm like, Okay, let's look at the PHQ nine. Let's look at the GAAD. But then had meaningful assessments of this intersection piece and how those two pieces play into functioning. And then, how in the world do you help this person? Right?

Unknown: 12:38

Exactly? Yeah, yeah, exactly. I just think that's so critical to have that cross SIP system reference, because things aren't just you put in the algorithm. Every tool has a scoring algorithm, and you know, you people fill these out online. It pumps out a score which relates to either good or you're positive or negative, and then, and then what like? But there's no, there's no human nuance to that. That's just the AI algorithm calculating. So we have to be really careful about that, which is why the Ingram screening is done by person, the scoring is done by person,

Rebecca Gleed: 13:14

yeah, and I you, you bring up a really good point, and I wonder if we should meet again soon to talk about the AI impact. Is you integrating the usefulness of AI a quick scoring method, but then the human piece as a practitioner or a consultant piece, which is, how do we consider the human factors that can't be captured through AI, to make meaningful sense of this and then meaningful treatment or support or resources, or what

Unknown: 13:46

will you exactly so it so I was an early adopter of AI because I knew that it was here, it was coming. I was interested. I was curious. I try to remain curious. Like, how can it work for me and my business? Like, is this something that, you know, I could harness or and then I realized it's just another tool that I can use. It's like an Excel spreadsheet, and I'm pumping things into it, and it can pump things back to me. But also I'm, I'm realizing that it doesn't have a consciousness, so that the human part, the discernment part, on the back end, is where we're really going to make, make a difference, so you can fill out all the screening tools you want, get all the scores you want. But data doesn't tell the whole story, and we know this so, so cross referencing symptoms and having somebody look at this screening tool and say there's a person on the other end of this, and they're saying they agree that they have not been feeling well for over two weeks, or whatever the question is, and it can still come up as a negative screen. But if me, as a person, I'm seeing this on a screening tool, and I'm saying, well, two weeks you haven't been feeling like yourself. That's not nothing. So that's where kind of the new. Responses and come into the to the personal side of it. So I harness AI for some things and not for others.

Rebecca Gleed: 15:08

That is a beautiful example, because, let's say I have zeros in all other categories, but if I pull out, I haven't been feeling myself. That's an individual I might want to reassess in a couple weeks, or in four weeks, or to just, I'm going to pay attention to those to see if they may be developing or maybe minimizing their initial symptom set, yeah, and then a close eye on them.

Unknown: 15:33

Yes, exactly. And most of the times, I always recommend rescreening with within a couple of weeks. But, and just to be clear again, I know I said this in the first episode, but assessment versus diagnostic, this is a big deal too. So just assessment, again is kind of sits on the spectrum. It's not a diagnosis to screen. If you score positive on the APDS, it doesn't necessarily mean you have depression. I believe the chance was like between 49 and 100% or something like the the range is wide that you would actually have it. So in terms of when we're talking about assessments, the human touch is really needed. If we're talking about diagnosis, then we're getting into the numbers, which is a whole different area, but trying to harness AI as a tool for when, when I need it, and then not using it when I don't.

Rebecca Gleed: 16:27

Absolutely and I I'm appreciative of going there with AI, because I think a lot of at least the other clinicians that I'm talking to peers, folks who I've known in this space a long time, there is a lot of kind of fear and hesitation, and hopefully, by you know, folks listening to some of our conversations, it will demystify it a little bit and say, Hey, how can we use this ethically and usefully?

Unknown: 16:54

Right, right, right? And it's been so polarizing. I know people either think it's good or bad, and it doesn't have to be that way. So for me for Ingram screening now, I did my whole business model and my curriculum and everything before AI even even showed up. And it would have been helpful to have some a I was as I was working on that for sure, but also graduated college before AI hit and but now it has increased for me, is an increased efficiency in the things that I do when I want to send an email, when I need to do a LinkedIn post, when I have a new idea that pops into my head, I just go into AI or chat GPT and say, Hey, I'm thinking about, let's discuss, you know, such and such, and I'm not telling it to write for me. Sometimes I just put my content in there and say, Can you rewrite this for LinkedIn, because I don't know if it even makes sense, so I'm able to do that kind of thing. Now, sometimes it pumps back stuff, and I'm like, No, that's terrible not using that. I'll use my own. And then other times I'm like, dang, that's good. I could, I should? I wish I could like that. So I think it's yeah, in how you use it and for for your good purposes.

Rebecca Gleed: 18:00

I agree. So we'll take a deeper dive into some of these different topics. Why don't we go into what are some of the struggles that you've seen face the last year? I'd love to stay in just what are the wins, but let's, I know, let's highlight some of these struggles and how we can tend to them in 2026 Yeah.

Unknown: 18:20

So my biggest struggle is being ignored when I reach out to clinics, offices, organizations, healthcare systems. So yep, and like the health authorities, everything is very tight knit. It's very closed. They already have all of their policies and procedures they answer to the state or whomever the board. And so to get in front of these people in these organizations is so hard. And I have emailed, called, mailed, dropped by, you know, like, Hey, I'm here if you want to chat. And it's just been crickets. So and I know I'm not alone in that. It's just these, these huge healthcare systems that are just kind of their own beast, and they have their own turn on, running on their own engines, and they're looking outside and they're thinking, Oh, perinatal mental health screening, whatever, like we're already doing that. We give it. We're given the EPDs on the iPads in the waiting room. They're fine. So they don't really understand the depth and the breadth. And so the biggest challenge for me is to get through to someone, anyone, and explain to them, which is why I want to, in 2026 get more face to face meetings with people like I did at the Public Health Conference and at the Oregon perinatal collaborative and at the psi National Conference, which will be, I think, in June the 2026 just, you know, going to attending those things and getting in front of people so, but my biggest challenge is being ignored or dismissed. And I'll tell you, it really just fuels me more than more than makes me, you know, what's the word I'm looking for? It doesn't make me. Said, it just fuels my my goal. So, yeah, so the barriers to the healthcare systems, the being ignored challenge, building my social media footprint, that's taken a long time. It is slow going. It is very slow going, and that's okay. I'm I'm being patient, but you know, it's just a challenge that we all have. And you you try to use hashtags to get people's attention, and you try to produce thoughtful content. And, you know, you get three likes out of, you know, 3000 people, and you're just like so hard so and I think for me, the biggest challenge is that nobody's doing this work. Ingram screening is the only consulting business in the whole world that is dedicated just to perinatal mental health screening. So it's very special niche. It's, it's siloed, as much as I hate to use that word, but I'm the only one doing this, and so the burden is heavy, and it's, it's heavy to carry and it's hard to carry when I do have a lot of support and people behind me, but that's really a struggle, being an entrepreneur and having imposter syndrome sometimes, and just trying to, just trying to keep things going. I'm the I'm the only engine here. It's me, so I'm keeping it alive. And that's also a struggle.

Rebecca Gleed: 21:19

I echo that you're not alone, Lin, that I've been in the same space for a decade. And it's not just into the last couple of years that I'm like, Oh, I'm so glad I stayed in this space, because finally, I'm more than one step forward, two steps back. Now I finally feel like it's two steps forward, one step back. But for anyone who also wants to catch Dr Sheehan fishers, he's a researcher, and he he said, I have realized I have to come on podcasts. I need to, you know, use more of the media, because otherwise it stays in the garage and no one can hear the really dire and importance of reproductive and Perinatal mental health. And so that was part of the thought process in January of 2025, is we've got to be creative, as practitioners, as assessors, as screeners, because some of these modalities, like podcasting, like media, like, yeah, you know, LinkedIn are the ways of the future of capturing and educating and advocating for this community. Yes.

Unknown: 22:32

And I got a Tiktok, which I never thought I'd do Ingram screen has a tick. Let me say I'm not there yet. It's not, it's not, you know, it's not great. I mean, like, I'm not, I think I have like, 78 followers, but like, I I'm trying new things all the time. Like, I got a Tiktok. I do have a YouTube channel, which I've never put anything on. I should put my my education on there. Tell people how to at least fill out one of the screening tools. But so there's still a lot of things that are untapped, and my brain is constantly moving with like, what's next, what's next, and, yeah, you know, how can I? But again, like you, I've been in this for eight years. I started eight years ago, and now I'm just now coming into like, oh, people know what I do, or they know of me and can refer me. So it just takes patience and a long time, yes, yes,

Rebecca Gleed: 23:19

but keep going. Yep, keep going. That's right. And something you said before that, I'll underscore, is data doesn't tell the whole story, and so we need folks who are experts and who can create meaning out of this. But what other struggles are you experiencing?

Unknown: 23:38

I mean, those were my biggest ones, that getting getting in front of healthcare professionals, getting face to face meetings with people, having people respond to me, building up my social media, being new to a system, like a new to market, like something that nobody's ever heard before. So that's a heavy lift. Like I said, those are really just some of my biggest challenges?

Rebecca Gleed: 24:02

Yeah, well, was there any themes or patterns that we can name that you did get someone to listen to, or how did you get to that conference where you were a presenter in Oregon? You know what? How do we tap into those ears and those big systems that don't always see us or hear us, yeah.

Unknown: 24:28

So all of these, all of the face to face I had, I've had this year, are through warm referrals. And so I, and especially for the Public Health Association, somebody sent that to me, somebody that had heard of me or something on LinkedIn and said, Hey, we're accepting abstracts for this Public Health Association Conference. And so it's all been warm referrals, because cold calls are not working. Obviously cold details are not working. I can't get through to HR departments. I mean anything. So it's basically just been word of mouth. Health referral, and that's, I think that's how I found you, and you found me too, just through listening or something.

Rebecca Gleed: 25:07

Yeah. So, yeah, that's the best it is. I think so too. I just remember too, the way I felt meeting you. It was we were both the poster presentation and just the energy that I think we both shared and we recognized in each other was was really special. You know it when you see it? Yes, this is someone mission oriented, passionate,

Unknown: 25:32

yeah, and it's funny that you say that, because my first experience like I didn't know that I had P mans at all until I know I had depression, but I didn't know till about 2016 actually, I walked into the My first psi conference as a board member. I was their executive treasurer on the board for psi for a few years, but it was like I walked into this room of people that I didn't have to explain anything to like i They just knew what I had been through. They were the first ones to tell me, you know, you you weren't crazy, you were sick, you know? And we can help other people. And it was like this light bulb moment. I remember my mom flew with me to Philadelphia at that conference, because I was like, I don't know how I'm gonna react to this like I'm sitting here in these, in this conferences, and I'm learning about all these things that happened to me, and am I going to, you know, have a breakdown, or am I going to be invigorated? And I was just so filled with just like gratefulness, sitting around all these people that just knew, and I was like, these are these are my people. Is my home. I don't have to, I don't have to explain anything to anybody. And it was just lovely. So getting face to face, of course, is always important,

Rebecca Gleed: 26:51

yeah, I think that's also what's so special about the Postpartum Support international conference. It it brings in a whole room of not just clinicians, but survivors. And when you're in that collective space, just the empathy, the compassion, the gratitude, is just immersive.

Unknown: 27:10

It really is. And you can tell somebody there, like, I had intrusive thought I was going to throw my baby off the balcony or fall down the stairs with it, and they'd be like, Oh yeah, me too. Like, it wasn't crazy to them. It wasn't like something out of this world, like most people, like everybody there, knew about a lot of different things. And so it was just so heartwarming to see that. And actually, I will tell you, at the Public Health Conference, I mentioned about intrusive thoughts, and a woman came up to me the next day, and she said, Oh my gosh. She said, I've never heard anybody say that before, and that happened to me. And she said, I never thought I suffered with any of that stuff, but she said I really had intrusive thoughts. And she said, I was so glad to hear this, as weird as it sounds, I was so glad to hear that you also thought you would throw your baby off the balcony, you know. So it's just this, it's this sort of connection, the solar this heart connection that we have with sufferers, you know. And so it's still, I still talk about it, and I still keep saying the things out loud,

Rebecca Gleed: 28:12

yeah, I'm just thinking of how many other birthing individuals are sitting in their own, you know, sense of self or isolation, I'm not going to share that with anybody, because maybe there's something wrong with me, or somehow it's internalized. But by then, hearing, oh, this is actually a thing, they don't have to sit in the shame or the you know, self internalization of you know, and alone you're not,

Unknown: 28:41

yeah, yeah. And shame exists in the shadows and you can't. You know when you when you put light on it, it disappears. So just saying that to somebody and showing them, you know that it happens

Rebecca Gleed: 28:54

when tell us a little bit more about what we're not capturing through some of these screenings,

Unknown: 29:01

sure, there are three different areas that we aren't capturing through traditional screenings. One is anger and rage that is has been a huge issue for new parents, and it is presenting itself in both parents and it is being either ignored or misdiagnosed as something else. So rage is one. The second one is grief. Most of the standard screening tools do not really capture grief. There is a screening tool for grief. There is a screening tool for anger that should be administered, and also just a screening tool for just being scared. It's getting diagnosed as anxiety or PTSD, sometimes bipolar, but sometimes people are just literally scared. And so those are the top three, rage, grief and being scared that we're missing. Yeah.

Rebecca Gleed: 30:00

And I think we often mislabel the rage too. It's, oh, just the angry mom or, you know, she's out of control. But tell the audience a little bit more of what's involved in rage that we're just learning about, sure.

Unknown: 30:17

So people will come into the office and tell you that they're just overwhelmed. I feel like a mean mom. I feel angry all the time. What they're really telling you is that they are touched out. They are overwhelmed, they are overworked, and all of these things are kind of piling on top of them, and they just don't have the bandwidth to practice patience and have sort of that calming center focused on being a parent, and so it is really common. And like you said, it's getting misdiagnosed so and in men, it's presenting differently. They are maybe like distancing themselves or using substances. And yep, and so they so it's different in in both the moms and the dads. So it's just something that we have to be aware of and look out for if they're not screening positive on other tools that we think, you know, we might be seeing some rage or anger,

Rebecca Gleed: 31:18

yeah, when I see a parent who is exhibiting pretty high rage. I like to assess pretty quickly for anxiety, yep, and what, at least the trend that I see is severe anxiety comes across as rage. It's so misunderstood Is that what you're seeing too?

Unknown: 31:41

Yep, that's exactly what I'm seeing, yes. So it's presenting under different forms that we're screening for. So it is presenting as anxiety or PTSD, like I said, when it's really just rage and it's just anger and it's just just another component that we have to, you know, deal with and screen for. If we're getting high scores on anxiety and PTSD tests, I would always scream for anger or rage, absolutely.

Rebecca Gleed: 32:13

Yeah. And what are those screenings for the other two you

Unknown: 32:17

said, yeah, there's a there's a perinatal grief scale. It's called the PGS, and that is very good for perinatal grief, for use in the NICU. Also, there's a PPQ, I believe it's called, sorry, I can't remember off top of my head, but there's a screening for NICU parents specifically. And then for rage. There is, and I'm trying to remember the acronym for it. It's called the DAR five for anger. The DAR stands for dimensions of anger reactions. And this is a screening tool that came out of Australia. They have a lot of great screening tools, but quickly the questions center around like, I found myself getting really angry at people or situations, or when I got angry, I got really mad, or I stayed angry. So they're all of the there's like just five questions about about anger and and the last one is my anger prevented me from getting along with people as well as I would have liked to. So those are great screening tool questions. So that's the DAR five, the perineal grief scale, the PPQ two for NICU, yeah, yeah.

Rebecca Gleed: 33:33

So those are, those are separate screening tools for correct folks to use to capture other forms and presentations that are so important to hold space for right.

Unknown: 33:49

And this is where I think humanness and and the human face to face interaction will always be pertinent in this field of screening, particularly so if AI does take over, or it tries to take over this, this field, it does not have a consciousness, so it doesn't know the nuances of this. So it will screen, calculate the algorithm and spit out a score. But it's not going to take the time to stop and say, Wait, am I really assessing what I'm seeing, or are they not scoring positive on this, but they're still not feeling right, like is there another tool I can use so that sort of personal connection can't ever be taken away?

Rebecca Gleed: 34:33

I love that. It reminds me of what we talked about in our first episode, which was discernment, yes, and this human to human. It's so important to see the nuance and say, Oh, well, maybe I'm going to screen this too, in addition to fully capture this comprehensive, personalized Screening, Diagnostic assessment. And then, how do we then treat right?

Unknown: 34:58

And that's just on the physician. Patient side. So on the patient side, I think I mentioned this too, is that space between stimulus and response, and parents are making that split second decision to be like, is this a safe place for me to be honest, on the screening tool? And so that also, that also requires human interaction. So on their side and the physician side, it's, it requires human interaction. You can't just just screen and give a score and move on. That's clearly not working,

Rebecca Gleed: 35:26

and re screening too. It's because, as much as I would love that we can build rapport and 15 minutes or less, which is sometimes possible, the importance of safety and creating that space and rapport with the individuals we're working with, but maybe three sessions in you realize, oh, I think I've, I've established some trust and safety here. Why don't we screen again?

Unknown: 35:51

Yes, so screening is so important all the way through pregnancy and then up to one year postpartum, if not up to three. And so it really takes that stigma away when you see that screening tool, you know, at your first visit and your second, and it's just like part of their it's integrated into the workflow of the office. It's just part of your care. You go in and you give a urine sample, and you give your blood pressure, and you take your mental health screening tool, and so having that sort of longitudinal snapshot is so important, so that by the time somebody six weeks postpartum, you can really see a difference in their screening if they're suffering. So it's just yeah, so critical.

Rebecca Gleed: 36:33

I couldn't agree more. What? How about some contextual factors? What would be some examples of other populations, such as parents in the NICU, who we can give space to and point to of consider some different screening tools for different contextual factors and populations.

Unknown: 36:56

Sure, my top two screening tools for that are number one the aces that adverse childhood experiences. Everybody should have that taken at least once if they're 18 or older, as a snapshot. So aces. And then the second one is the social determinants of health. And so that's going to look at all the factors affecting their lives, their income and their educational background and their family support and their jobs, and so it kind of takes into this whole ecosystem of kind of what their life is like. So for especially for people in the NICU whose life has been turned upside down, like what, what kind of supports do you have? And if we can get a social determinants of health screening done, then we can start making a plan to receive help after that, so any of those, those two are good. Also, this is kind of funny. We're finding the PHQ four. It's the patient health questionnaire four. It has two questions about anxiety and two questions about depression, and that has been proven to be more accurate in populations of people of color. So in bipoc populations, the PHQ four has has been determined to be a better screening tool than like the EPDs, culturally speaking. So that's very interesting. But the PHQ four, if they score positive. If they score positive on the two anxiety questions, then you move to the GAD seven. If they score positive on the depression ones, you move to the PHQ nine, which you can bill for. You cannot bill for the PHQ four, but it it is being very it is highly validated in the bipoc population.

Rebecca Gleed: 38:41

And I will again refer folks to your initial episode, because we take a deeper dive into, you know, why the PHQ four, as opposed to the EP The Edinburgh, which was initially it's a little outdated, which is, I think, yeah, simple deduction of why we're getting better of better screening tools to generalize for other populations.

Unknown: 39:06

Yeah, and I think the PHQ four two is also great for populations that fall out of the norm, like parents, surrogacy, adoption, the LGBTQ plus community, all these sort of what we call outliers to like a normal pregnancy and birth, the PHQ four and the social determinants of health and the aces are very important to include.

Rebecca Gleed: 39:29

Yeah, I love that we're giving space to other presentations, other than just it's so quickly. Assume it's anxiety, worse depression. But there's so many more, yeah, many more diagnoses and presentations, clinically and subclinically, yeah,

Unknown: 39:48

and there, there's over, I think I've mentioned this before. There are over 27 screenings. Well, there's probably over 30 point and so what Ingram screening does is. Sort of makes sense of that for physicians, office and clinics, because you have all these screening tools out here floating around, and then you have all these people sitting in front of you showing different symptoms, and you're like, how do we piece this together? This is like a puzzle, and how do we find the right screening tool for the right person, for the right symptoms being presented, and then what does the care pathway look like? So absolutely so Ingram screening really is here to be a consultant for that. Like, what are you seeing? Pick two or your top two or three tools. But then also, offices know that if those tools are not being scored as positive and the person still suffering, that there's other options. They're not just stuck with the EPDs, which has unfortunately become the industry standard.

Rebecca Gleed: 40:47

Yeah, I'm thinking of maybe a hospital social worker or case manager in a NICU setting who might be listening to this episode and just something as simple as doing the social determinants to be able to capture, okay, what are the resources available to this family, or maybe the gaps, and how do we, if they're doing some discharge planning, how do we create a personalized plan to support them as they get ready to discharge from the NICU, Exactly?

Unknown: 41:20

And I am also a graduate of the NICU. I was a NICU mom. My first baby was in the NICU for four days, I believe, and I remember seeing him under the bilirubin lights, and he had, like they had his eyes covered, and he wasn't wearing he just had his diaper on, and he was just laying there under these lights. He looked cold, and I didn't realize he was laying on like the soft foam. I didn't. Nobody told me anything. So the first time I see him, he was eyes are covered. He's got an oxygen hood on. He's laying almost naked under this thing, and I'm bawling my eyes out, and my OB comes in and he says, oh, what's the matter? And I was like, nothing. I'm fine, the standard answer. And then finally a nurse came over and was like, you can we can touch him, Phil, he's on a soft he's on a soft pad. And this is what's happening, and all those kind of things. But had I been warned about it, or had conversations about it ahead of time? And then was sent home, was screened and then sent home with some some resources that would have gone a long way to mitigate my suffering. So I get the NICU mom thing, yeah.

Rebecca Gleed: 42:29

I mean, think that's just one component. That's just one screening tool, yeah. And you think, if we see, you know, individuals as holistically, comprehensively, you know, what do we put on their plate over here? And then what do we add over here, mental health or financial support, or there's just so much that I think we're missing, and we're so quick to just Yes,

Unknown: 42:58

and I encourage people, I just ordered my medical records from the hospital where I gave birth. So I contacted them, I got my medical records and for the three births, and it came to me on a CD, which is old school, but that's there was too big. It's 279, pages long. Wow, it is. And in 9596 when I had my first son, they weren't things were digital yet, and so it's handwriting, it's charting, and it's some of it's really hard to read, but what I'm doing is sort of piecing together how I felt versus what was actually happening so I can find that sort of sweet spot and fill the gap for people, you know, that come behind me. Because every I started reading my medical record like, oh, patient says she feels well, or, you know, patients says she's well, but her blood pressure is 160 over 100 because she has, you know. So I just encourage people to request their medical records and try to do a deep dive and just kind of piece it together for themselves. I mean, I received excellent care. I really did. It wasn't I wasn't getting this to try to prove anything. I just wanted to know what was happening to me.

Rebecca Gleed: 44:16

So, yeah, it's interesting. I had brunch with Deborah dove, who I interviewed over the weekend, and she said actually the same thing, part of her journey is to go back and request medical records and to actually go back and write a letter to her doctor. And so this would be maybe for your third episode coming back on if we take a deep dive and do some reflective work on okay, what? What comes up for you? Yeah, reading through these 200 plus pages of medical records.

Unknown: 44:49

Yeah, I was thinking about writing a book as I'm doing it, bringing everybody on that journey with me, like you're reading this at the same time I am right now, just to capture. Through my initial reactions, and, you know, see what was happening. But I need to get a little magnifying glass, because some of it's all fully but it's fascinating.

Rebecca Gleed: 45:12

Yeah, I would love to read your book. I think it's

Unknown: 45:17

I'll try to work on that in 20 in 26 but I it's just very interesting to see all of the medications that they pumped me with, the Pitocin, the epidural, the making me stay on bed rest because my blood pressure was high, you know, not letting me eat during labor for 26 hours, which they don't do anymore. So it was just so common, and so it basically starved me for her whole day. And so it's just just reading that kind of stuff. It's like, yeah, no wonder I felt horrible. But physically on my chart, it was looking fine.

Rebecca Gleed: 45:51

Let's go a step further with some of these screenings. And let's say that, you know, these organizations or hospitals are screening for an individual, and they they come out high for risk or severe clinical presentations. What advice do you have for an organization when they see Oof? This is, this is reason for concern,

Unknown: 46:17

right number one, don't panic. Do not call CPS. Do not make a huge scene in the office. Make sure the person is safe. Make sure the person is heard. Do not act surprised. Don't go running out of the office and telling every, you know, telling everybody that somebody scored positive, just because you know you're scared, so the first thing is your reaction to it. So, but not let's not panic. Let's follow the protocols that we have in the office. Most offices already have. Clinics already have a protocol for referrals. The problem is that it's so it's not a warm handoff. So it's like, the patients, like here, get a piece of paper, you schedule your own appointment with this therapist that we work with. I mean, that's that's pretty much the end of that. So I think it's important to have the internal infrastructure to be able to have conversations about this. You don't have to fix anything. You don't have to be the therapist, but you should be knowledgeable and be able to have a conversation about this, like we know what this is, and we're going to help we can help you. So I think that's the most, the most important part. And of course, with income screening, that's part of the business model, is you are, you know, creating your screening program, and then you're creating the care pathway that works for your office, and how are we going to make these warmer handoffs, yeah, and how are we going to move our patients throughout the system with integrated care? And so, yeah, right now, it's just such a cold, you know, pass through,

Rebecca Gleed: 47:57

I think too, just a tiny bit of validation can go so far of oh my gosh, you must not be feeling well. Let's get you feeling better.

Unknown: 48:05

Yeah, and it's, it's common, not normal. We don't say it's normal, but Yep, yeah. Always say this is so common. All the the moms, even my friends that I work with, are on Facebook. They'll send me a message or whatever, and they'd be like, I'm just not feeling great. And I'm like, yeah, oh my gosh, this is so normal, and I know how to help you. So that also came from a place in me where our middle son was having an autoimmune disorder a few years back, and we It took about six months to get a diagnosis, and I will always remember this day we were up at Oregon Health Sciences University, and these two physicians walked in, and they were so excited. They said, We know what you have, and we know how to fix it. And I was like, hope. I was like, You got to be kidding me. I've been trying and looking at his blood work and taking him to doctors and and and all this stuff. And so now I know that feeling as a patient, or on the other side, when somebody reaches out to me with a mental health question, or perinatal mental health in particular, and I say, I know what that is that is so common, and I know how to help it like I know how to help you, and just the relief is so amazing. So that's I. I go with that often, just to let them know I don't just throw a screening tool out and be like, sounds like you're suffering from depression. Here you go. No, I'm like, I validation like you said,

Rebecca Gleed: 49:31

yeah, yeah. Definitely. Any other like, advice that you have for organizations around that, like, even, how do they find someone for a warm handoff?

Unknown: 49:45

Sure? I think that they should start by looking at in their state with their their health authority, state health authority. They can probably provide some contact information. Information for therapists and providers. Of course, Postpartum Support International has state, state coordinators that can Find Local Help. And so I think reaching out to those two organizations before the patient comes in, and sort of setting up this like camaraderie, like I know that the psi peer coordinator here in in Oregon, knows several therapists down in the Salem Oregon area that I can meet with, or in Eastern Oregon that I can I can go to. So start creating those relationships. Make the contact log so that, depending on where your patients are, you can send them to the appropriate place. But it's really about doing work beforehand and not panicking after the fact and saying, Oh, here's a therapist over in Eastern Oregon, where I don't even live. So, right, yeah. So I think it's just a matter of creating those relationships ahead of time. So be in touch with the Oregon Health Authority. Have something printed out. A lot of clinics do of resources, but and also a follow up call in a day or two is so crucial, because if you're sending them away with a referral, a lot of them do not follow up on that, so having a follow up call by somebody in the office is super critical.

Rebecca Gleed: 51:14

Yeah, I've always been so grateful that I've studied some of this in advance, like you say, of well, who's a specialist in maybe some EMDR for birth trauma, or, Yes, you know, what are the Virginia laws for emergency custody orders, and knowing that in advance so I'm not sitting there with someone in my room. I can actually guide them and know confidence. I know the laws and regulations and also best practice. And how do white pepper and validation, empathy, humanness when there is an emergency, right, exactly.

Unknown: 51:50

And clinics can ask themselves, is there a pmhc in our in our vicinity, close by that we could, that we could connect with? Yeah. Is EMDR a good choice for this. Who's doing? CBT, all these therapeutic modalities that exist, patients need to know about them, so they're therefore their clinic. Their clinics need to know about them too, ahead of time, like you said, Yeah.

Rebecca Gleed: 52:14

And this speaks to informed consent. Part of the provider's responsibility, in my opinion, is that we are there to also educate and bring awareness, as you so do beautifully. Lynn is okay. Here you're screening high for trauma. Let me lay out some of the evidence based best practices, and you get to choose she. Have a right to choose your provider Exactly. And here's the list of the best

Unknown: 52:40

ones that I know and that in our community, Yep, exactly. Yep, that's exactly right.

Rebecca Gleed: 52:47

Well, it's no coincidence that I feel so grateful to have you back on the show. Can you please tell folks your your goals for 2026 help us better support you? Yeah.

Unknown: 53:00

So I'm really excited I just rebranded and have it actually have a new logo. But I decided to pick three focus areas, because what was happening was I was getting out all into the I was getting into everything, and I just kind of need to rein that in for my own mental health and to just have three focus areas. So in 2026 the first thing we're doing is our course, our consulting, training and education, which is our business model. That's very important to me. Being a speaker at symposiums and conferences. I'm holding a like a soup potluck for screening in February. We're just going to get together and talk about screening tools. Everybody's going to bring crock pot full soup. It's free, and we're just gonna be in our community talk about different screening tools. So that's coming in February.

Rebecca Gleed: 53:45

Well, do you know, have a date? I'm not yet, but

Unknown: 53:48

I'm working on February 12, which is a Thursday evening. Is this in Oregon? Yeah, in Oregon? Yeah, yes. So you know things like that that really promote the training and education piece that I'm that I'm trying to get across. So that's the first one. The second thing is, of course, the Ingram screening, perinatal mental health risk assessment screening tool, which I'm hoping gets more attention, as far as more people piloting that kind of approving and validating that, getting that ready for the Institutional Review Board. Wow. So that's my that's my goal. That's on the front page of my website. That's free as well. And then the third focus area is employee benefits. So I started this fall working on organizations that offer employee benefits, and, you know, offering them a screening, screening benefit. So I'm going to really work on that in 2026 and see where that goes. So it'd be great.

Rebecca Gleed: 54:48

Absolutely, yes, I love the idea of more accessibility and being creative, because it doesn't just have to sit on a website in the garage. It can be, yeah, really. So employers through hospital settings, through, you know, clinicians, small practices like mine,

Unknown: 55:07

yeah, yeah. Anybody that has employees and that works with pregnant, birthing people or parent, I mean, parents Zero to Three should have be able to have a screening benefit. So absolutely, yeah, those are my three focus areas for 2026 and I'm letting the rest go.

Rebecca Gleed: 55:23

Yeah, yeah. I love those goals, and in any way that we can support that, tell folks where they can find you. Ingramscreening.com.

Unknown: 55:33

Is our website. You can find me on social media at Ingram screening, pretty much everywhere. So Facebook is Instagram, tick tock. LinkedIn is just my name, though. It's, it's Lynn Ingrid McFarland. So if anybody wants to connect with me on LinkedIn, they can just search for my name. I love to connect with people in there. It's a great networking site. So that's so they can they can find me. And people can call or text me anytime. My phone number is on the website and my contact information. They can contact me through the website or through DMS on social media or email. So however they find find me is great. Yeah.

Rebecca Gleed: 56:10

And anyone in the Oregon, Pacific Northwest Area who wants to join the potluck, what Oregon Are you in? I'm in Southeast Portland. Southeast Portland. Awesome. Anyone put put it on the books for February?

Unknown: 56:24

Exactly anyone in Portland or southwest Washington, because Vancouver, Washington is right across the river. So yeah, yeah, I just, I did that because I just wanted to build community around screening and start doing that more often and getting people to a place for free that they can just offer a soup. And then let's just look at all the screening tools and just talk about them for a couple hours. So it'll be fun.

Rebecca Gleed: 56:52

I think at least that's been my experience of just getting everybody in in a room, maybe some proofs involved. But just those round tables are so powerful in those connections, and then they end up just snowballing into magic and beauty Exactly.

Unknown: 57:09

And I will have as many screening tools there as I can find, just so people know what's even available to them. So I'm excited to do that.

Rebecca Gleed: 57:19

Yes, we're excited for you. Thank you so much for coming on again and keep doing the work.

Unknown: 57:25

Yes, thank you appreciate you having me back.

Lana Manikowski: 57:31

If you would like to learn more about how we can help, visit our website at perinatal reproductive wellness.com, and while you are there, check out the latest edition of our book, employed motherhood. We also invite you to follow us on social media at employed motherhood. Finally, if you enjoyed listening to the show, please subscribe and rate it. Thank you. Foreign