Care Pathway

Care Pathway for the Management of Perinatal Mental Health

Home Health and WellnessHealth Care Professionals

The following pathway* provides options for mental health supports and services available to Durham Region residents experiencing Perinatal Mood Disorders (PMD).

Options are categorized in a step-care approach and based on the client’s assessed needs as determined by their care practitioner and as related to their scores:

A person can enter at any step in the pathway and move up or down based on the severity of illness and response to prior interventions. Ongoing monitoring by the care practitioner is required.

Stepped care approach

Step 1

Ask about the well-being of the pregnant or postpartum person at every visit to identify the need for mental health support and treatment.

Ask about mood and well-being of the pregnant or postpartum person at each visit and consider input from patient’s circle of care. Assessment Tools can be used, including the Edinburgh Perinatal/Postnatal Depression Scale (EPDS), Generalized Anxiety Disorder (GAD-7), and Patient Health Questionnaire (PHQ-9).

Identify factors that precipitate or exacerbate mental health symptoms (e.g., lack of support, financial difficulties, domestic violence, alcohol, or substance use disorders, etc.).

Step 2

Advise by providing education on perinatal mental health and arrange support to mitigate factors that are affecting mental health.

Provide information about mental health problems in pregnancy and postpartum, how common they are and that effective treatments are available. Discuss strategies to increase practical and emotional social support, improve night-time sleep and incorporate regular meals and physical activity. These factors may improve mental health on their own for those with mild or subclinical symptoms and in conjunction with mental health treatments for those with problems that are more severe.

Link to community supports. Across Ontario, the Healthy Babies Healthy Children (HBHC) program is a free program delivered through Ontario’s public health units in partnership with hospitals and other community partners to help families receive supports and services to enhance mental health, self-care, and parenting capacity in the community. Arrange assistance in addressing precipitating and perpetuating factors, including resources available in the community to provide support (e.g., accessing financial, legal, and domestic violence support, and accessing care for substance use disorders).

Step 3

Assess the severity of the mental health concern.

Some mental health issues can resolve on their own with time and support, or with addressing the other risk factors or concerns. However, other issues may be more persistent and develop into a clinical mental disorder requiring more than supportive interventions. For presentations that require clinical intervention, treatment planning is guided by the severity of the illness (mild, moderate, severe, and urgent), which is assessed by considering the number, nature and persistence of symptoms and the degree of impact on quality of life.

Step 4

Assist by recommending or implementing a treatment step.

A stepped-care management plan may include a range of treatment options and interventions and is adaptable to a patient’s changing needs and preferences. An individual can enter the pathway at any step and move between steps based on severity of illness and in response to interventions. Regardless of which "step" is being considered, child care support is essential in the care management plan. The HBHC program offers a home-visiting program so families can receive supports and services they need, including to enhance maternal mental health, self-care, and parenting capacity while in the community.

Step 5

Arrange follow-ups to monitor recommended treatment plan. Make modifications or changes to treatment step as required.

Address barriers to treatment uptake, review risk factors and discuss progress to determine whether new level of treatment step is required.

Frequency of initial follow-up should be at minimum every two weeks during active treatment phase (12 weeks). More frequent contact may be required if there is a higher severity of illness or medication is prescribed and may be less frequent as symptoms improve. Be clear about which health professional is providing follow-up care.

Use the assessment tools to monitor symptoms. Scores on a GAD-7 <5, PHQ-9 <5 or EPDS <10 on at least two assessments that are at least two weeks apart suggest remission.

Follow patient to remission. Follow the individual on medication treatment for at least six months or longer after remission to assess need for ongoing treatment.

Screening tools

The tools below are used internationally and have been translated into various languages and validated in diverse populations.
Tools have been formatted to be completed electronically, saved and/or printed, or shared electronically for the patient to complete.

Perinatal/Postnatal Depression Scale (EPDS)

Generalized Anxiety Disorder-7 (GAD-7)

Patient Health Questionnaire-9 (PHQ-9)

Once completed, please select the box that corresponds to your patient’s score to view supports and resources.

Patient assessment and scoring

Mild

EPDS score of 10 to 12.
PHQ-9 or GAD-7 score of 5 to 9.

Common mental health concerns such as depression or anxiety, where symptoms are mild or subclinical (may include patients for whom you are taking a watch and-wait approach).

Moderate

EPDS score of 13 to 18.
PHQ-9 or GAD-7 score of 10 to 14.

Common mental health concerns of mild severity that do not remit with Step 1 interventions.
Common mental health concerns of moderate severity or greater.

Severe

EPDS score greater than 19 or question 10 has a score greater than zero.
PHQ-9 or GAD-7 score greater than 15.
Active intent to harm self/others and/or suicidal ideation.

Mild or moderate mental health concerns that do not remit with Step 2 interventions.
Severe mental health concerns (severe depression or other severe mental illnesses such as bipolar disorder or schizophrenia).

Supports and resources

Mild

Treatment Step 1

Self-help

Guided self-help

BounceBack®
Free skill-building program managed by the Canadian Mental Health Association (CMHA). It is designed to help adults and youth 15+ manage low mood, mild to moderate depression and anxiety, stress or worry. Delivered over the phone with a coach and through online videos, individuals will get access to tools that will support them on their path to mental wellness.

Peer support and supportive counselling

Durham Health Connection Line 905-668-2020 or toll free: 1-800-841-2729
Public health nurses provide information and support related to health topics including mental health resources and programs. Monday to Friday, 9 a.m. to 5 p.m.

Healthy Babies Healthy Children - Durham Region
A publicly funded program delivered through Ontario’s public health units in partnership with hospitals and other community partners to help families receive supports and services to enhance mental health, self-care and parenting capacity in the community and arrange assistance in addressing precipitating and perpetuating factors, including resources available in the community to provide support (e.g., accessing financial, legal and domestic violence support, and accessing care for substance use disorders). Referral can be completed and faxed by practitioner. Public health nurse will follow-up with client to complete screen and review client needs.

Rose of Durham Young Parent Support Division
Serves young parents (females up to age 25 and males up to age 30) and their children throughout Durham Region. Holistic programs and services include attachment-based parenting programs (group and individual format), supportive strength-based counselling, high school program, life skills, social drop-in programs, and donation room services.

EarlyON Child and Family Centres
EarlyON Child and Family Centres provide opportunities for children from birth to six years of age to participate in play and inquiry-based programs, and support parents and caregivers in their roles. These centres offer safe and welcoming environments open to all families across the Durham Region, with qualified professionals and quality programs. Families and caregivers will be able to find support, make personal connections and access a network of resources.

Durham Community Health Care (f ormerly CAREA) - Wonder Woman
905-723-0036 or 1-877-227-3217 ext. 1241
Free drop-in group. All caregivers of children and youth who identify as female are welcome to participate. Each week we will focus on a topic of interest to the group. Free light snacks preschool children are welcome in program.

Community Care Durham - COPE Mental Health - Building Blocks Support Group (for mothers)
cope@communitycaredurham.on.ca
905-668-6223
Virtual support group for mothers of children (birth to six years) who are having difficulty adjusting to life with a baby, toddler or those who need support with parenting challenges.

Community Care Durham – COPE Mental Health
A unique community-based mental health service provided by Community Care Durham (CCD) that offers group support to adults aged 16 and older, with emotional and/or mental health concerns. Offering in-person, virtual, and hybrid services. Referrals accepted via self-referral.

MindShift CBT App (Anxiety Canada)
Uses scientifically proven strategies based on Cognitive Behavioural Therapy (CBT) to help individuals learn to relax and be mindful, develop more effective ways of thinking, and use active steps to take charge of their anxiety. Features a community forum, enabling clients to find and offer peer-to-peer support.

Postpartum Support International (PSI)
A call or text helpline for questions and concerns, online support groups, and a local service provider directory. Offers options for moms and dads. There is also a specialized coordinator for LGBTQIA+ parents.

Togetherall
Online peer support community provided through the Ontario Telemedicine Network where members can share experiences and express themselves in words and images, helping participants feel less socially isolated. Trained counsellors are available 24/7 to offer support and keep the community safe.

Distress Centre Durham
Specially trained responder volunteer team is made up of men and women 18 and older who are non-judgmental, empathetic, caring individuals who share the desire to make a significant and meaningful contribution to the Durham Region community. Volunteers provide support via phone or text: emotional support and encouragement, crisis management, suicide risk assessment, community resource/referral information, emergency intervention. The helpline is available 24 hours a day, seven days a week.

Telecare Distress Centre of Peterborough (serving Durham Region)
A free, anonymous, and strictly confidential 24-hour call line for people in need of a friendly person who will listen. Phones are answered by volunteers who are good listeners, enjoy talking to people and are trained to handle crisis situations. Available 24 hours a day, seven days a week.

Sunnybrook - Pregnancy and Infant Loss Network
1-888-303-PAIL (7245)
Offers a variety of peer-support services (at no cost to families) to parents and family members who have been affected by pregnancy or infant loss. Support services are offered over the phone and online and are available to residents of Ontario.

North York General Hospital – Late Loss Support Group
An open virtual support group that will gives individuals an opportunity to share experiences and connect with other parents who have experienced a recent (within the past year) late pregnancy loss or neonatal death. Late pregnancy loss is defined as 20+ weeks and includes a still birth or loss due to incompatibility with life. Eligibility criteria: individuals who have experienced a recent (within the past year) late pregnancy loss or neonatal death. You do not need to be an NYGH patient to attend the group.

Additional resources

e-Mental Health - Directory

Directory of mental health services and organizations in Ontario and throughout Canada.
Info sheets: Information about a variety of mental health conditions and topics.
Events calendar: Information about mental health events by geographical area.

211 Ontario
Highly-trained and accredited community navigators provide referrals to services to connect clients to the right supports. Services are provided by phone/voice, by text, online search, email, or chat.

Moderate

Treatment Step 2

Cognitive Behavioural Therapy (CBT) and Interpersonal Psychotherapy (IPT)

Ontario Shores - LOVE YOU by Shoppers Drug Mart Women's Clinic | Make a referral
Email: centralizedreferral@ontarioshores.ca
1-877-767-9642
Short term, focused consultation, and treatment to women with perinatal mood disorders and other reproductive issues that affect a woman's mental health. Referrals are accepted from any health care professional.

Family Services Durham
Provides individual, couple and family counselling to people who live or work in Durham Region. We provide help for a variety of problems. Service is offered in-person, by telephone or by video. Fees are based on income and family size. If fees cannot be afforded, the client can discuss this with their counsellor.

Catholic Family Services of Durham
Provides a wide variety of professional counselling services and programs for people of all ages including individuals, couples and families experiencing personal adjustment and relationship difficulties. In addition to our counselling programs, group workshops on parenting and relationships are offered. Fees are based on a sliding scale geared to income, number of dependents in the home, and ability to pay. Self-referral accepted.

Durham Counselling walk-in clinic (for youth 19 years and under and family)
The Durham Counselling walk-in clinic (DCWIC) is a free, confidential counselling "walk-in" clinic that provides services for children and youth ages three to 19 years and their families. The clinic is run by a community collaborative and is staffed by providers from: Catholic Family Services, Lakeridge Health (Pinewood Centre), Carea Community Health Centre, Frontenac Youth Services, Family Services Durham, and Lakeridge Health - Child, Youth and Family Program. Family issues, strategies for positive change, stress management, relationship challenges, parenting support, youth development, substance use concerns, etc. For more information see the welcome package or contact the clinic coordinator at 289-509-0603 ext. 3203.

North York General Hospital (NYGH) – Postpartum Support Group
An open virtual support group that gives individuals an opportunity to share experiences and connect with other parents who have experienced a recent (within the past year) late pregnancy loss or neonatal death. Late pregnancy loss is defined as 20+ weeks and includes a still birth or loss due to incompatibility with life. Eligibility criteria: individuals who have experienced a recent (within the past year) late pregnancy loss or neonatal death. Clients do not need to be an NYGH patient to attend the group. Self-referrals as well as referrals from a health care provider or clinician are accepted.

North York General Hospital (NYGH) - Late Loss Support Group
An open virtual support group that gives individuals an opportunity to share experiences and connect with other parents who have experienced a recent (within the past year) late pregnancy loss or neonatal death. Late pregnancy loss is defined as 20+ weeks and includes a still birth or loss due to incompatibility with life. Eligibility criteria: individuals who have experienced a recent (within the past year) late pregnancy loss or neonatal death. Clients do not need to be an NYGH patient to attend the group. Self-referrals as well as referrals from a health care provider or clinician are accepted.

Sunnybrook Health Sciences Centre - Women's Mood & Anxiety Clinic: Reproductive Transitions
Assessment and treatment of perinatal mood and anxiety disorders with expertise in the use of both psychotropic medication and psychotherapy during pregnancy and postpartum.

Lakeridge Health - Pinewood Centre - Umbrellas Program
The Early Years Program, known as "Umbrellas," offers immediate services to women who are pregnant and/or parenting children under three years of age, and who have questions/concerns regarding their use of drugs/alcohol. Community outreach, early identification, heightened case management support and fast-tracking into Pinewood Centre services are key components of this program. Financial assistance is available to reduce transportation and childcare barriers, and to access prenatal and addiction services. For more information, contact any community treatment office. No cost with valid Ontario Health Card. Referral not required. Financial assistance is available for transportation and childcare to ensure participants can attend.

Adult Integrated Mental Health Services (AIMHS) - Lakeridge Health | Make a referral
Outpatient community mental health program that is part of Lakeridge Health. Provides time-limited psychoeducation, treatment, and psychotherapy to adults over age 18. A variety of treatment options are offered, including psychoeducation groups and group programs that are more process oriented. Physician referral required.

Brock Community Health Centre
The Primary Health Care Program consists of a team of physicians, nurse practitioners, nurses, and other allied health professionals (social worker, dietitian, physiotherapist) who work in collaboration with other programs offered by Brock CHC. Services include preventative health care, treatment of chronic and episodic illnesses, mental health counselling, service navigation and referrals, access to phlebotomy, and more. All Brock CHC services are free. Office locations in Cannington and Beaverton.

Canadian Mental Health Association Durham
A Mental Health and Primary Care Hub that promotes and enhances the mental, emotional, and physical well-being of the community, through education, collaboration, advocacy, and the provision of a broad range of direct services that meet the community’s needs.

Women’s College Hospital - Mother Matters Group
Email: mothermatters@wchospital.ca
Eight-week virtual support group for mothers with mood/adjustment challenges following the birth of their baby. Mothers must have at least one infant that is younger than one year.

Metis Nation of Ontario - Mental Health and Addictions Services
1-877-767-7572
Offers a 24-hour Crisis Line and a wide range of services and supports to Metis children, youth, adults, couples, families, including parenting coaching. Services are offered in person, over the phone, or by video conference.

Perinatal Wellbeing Ontario (PWO)
Individual or group peer support options, pay what you can therapy, and other resources.

Postpartum Support International (PSI)
A call or text helpline for questions and concerns, online support groups, and a local service provider directory.

Hope for Wellness
24/7 support to all Indigenous people across Canada.

MindBeacon - Virtual mental health clinic
Private space to access a wide range of mental health supports. Access therapy wherever individual is most comfortable. Flexible pricing. Access to 24/7. Crisis text line.

Durham Community Health Clinic - Counselling Services | Make a referral
Counselling team offers brief counselling services (no cost, six to 12 sessions) to individuals, families and couples, and evidence-based psychotherapy groups. Helping clients with a range of challenges, from day-to-day problems to mild to moderate mental health concerns. Focusing on those with a low income and who do not have other means to pay for counselling, such as coverage through employee benefits plans, school/educational settings, or the ability to pay for private therapy; and those who experience barriers to care based on a range of sociocultural factors, including gender, sexual orientation, or physical ability, etc. Primary care providers may wish to complete a referral, however a referral is not required.

Additional resources

Health Connect Ontario (formerly Telehealth Ontario)
Connect with a registered nurse day or night for free, secure, and confidential health advice.

ConnexOntario
ConnexOntario provides free and confidential health services information for people experiencing problems with mental illness (and alcohol and drugs, gambling) by connecting them with services in their area. Funded by the Government of Ontario.

Community Family Services of Ontario | Make a referral
Provides counselling and therapy to individuals, couples, and their families who have diverse life issues. These problems may include self-confidence, education, marriage, career, parenting, interpersonal or intergenerational relationships, or more emotional aspects of one’s life. Parenting groups are offered. Services are available in English, Mandarin, Cantonese, and Vietnamese.

Mood Disorders Association of Ontario (online support)
The Mood Disorders Association of Ontario offers free support and recovery programs to people across Ontario living with depression, anxiety, or bipolar disorder. Provides drop-in peer support groups (Toronto), recovery programs, family and youth clinical support, early intervention for mood disorders and psychosis and online tools focused on wellness and recovery.

e-Mental Health - Directory
Directory of mental health services and organizations in Ontario and throughout Canada.

Info Sheets: Information about a variety of mental health conditions and topics.
Screening Tools: Find out if you or a loved one has a mental health concern with our free, online screening tools.
Events Calendar: Information about mental health events by geographical area.

Telecare Distress Centre of Peterborough (serving Durham Region)
A free, anonymous, and strictly confidential 24-hour call line for people in need of a friendly person who will listen. Our phones are answered by volunteers who are good listeners, enjoy talking to people and are trained to handle crisis situations. Available 24 hours a day, seven days a week.

For fathers

Medication (within scope of primary care provider)

Canadian Network for Mood and Anxiety Treatments
Information on antidepressants in pregnancy and lactation.
MotherToBaby
LactMed

When mental health concerns do not remit with Step 2 interventions and there are severe mental health concerns (severe depression/severe mental illnesses (Bipolar Disorder or Schizophrenia) see Step 3 - Severe.

Severe

Treatment Step 2 and/or 3 AND Treatment Step 4 for urgent care

When mental health concerns do not remit with Step 2 - Moderate interventions and there are severe mental health concerns (severe depression/severe mental illnesses (Bipolar Disorder or Schizophrenia).

Refer to local acute care institution for somatic treatment (neuro-stimulation, electroconvulsive therapy) or for partial (day program) or full hospitalization.

Non-perinatal specific support

Ontario Shores - The Prompt Care Clinic | Make a referral
Provides care for individuals who require timely access to psychiatric services, but do not require an emergency department visit. A psychiatrist and/or nurse practitioner provides a clinical assessment for the purpose of providing diagnostic, and treatment recommendations that is sent back to the referral source. Referrals are accepted from, family physicians, walk-in clinic physicians, psychiatrists, and nurse practitioners. Individuals who are symptomatic to the point where a significant amount of personal distress is evident and where distress may increase if there is a delay in treatment can be referred to this clinic.

Ontario Shores - Structured Psychotherapy Program
Publicly funded, short-term, Cognitive Behavioural Therapy (CBT) to adults experiencing depression, anxiety, and anxiety-related conditions.

Ontario Shores - Assertive Community Treatment Team (ACTT)
Two Assertive Community Treatment Teams (ACTT), ACTT Durham and ACTT Haliburton, Kawartha and Peterborough Region (HKPR) provide treatment, recovery and support services to individuals with a serious mental illness and who require a high degree of support in their community.

Ontario Shores - Borderline Personality Self-Regulation Clinic for ages 18+
Provides Dialectical Behaviour Therapy (DBT) services to adults who are diagnosed with Borderline Personality Disorder (BPD) and are having difficulty managing their symptoms.

Ontario Shores - Brain Stimulation Clinic (ECT/rTMS)
This clinic offers Electroconvulsive Therapy (ECT) and repetitive Transcranial Magnetic Stimulation (rTMS) to patients affiliated with Ontario Shores.

Ontario Shores - Outpatient Complex Anxiety and Mood Disorder and Consultation Service for ages 25 to 65
For adults with a mood or anxiety disorder. The service provides assessment and medical stabilization followed by flexible and individualized ongoing support through therapy, counselling, and symptom management.

Ontario Shores - Outpatient Complex General Psychiatry and Consultation Service for ages 18 to 65
For adults who have serious or complex mental illness, where other treatments have been unsuccessful, illness has persisted, and the individual demonstrates impaired functional ability. Offered at Durham Community Clinic, Kawartha Lakes Community Clinic and York Region Community Clinic.

Ontario Shores - Outpatient Complex Psychosis and Consultation Service for ages 18 to 65
For adults who are diagnosed with a psychotic disorder and the illness persists greater than six months and the individual demonstrates impaired functional ability.

Ontario Shores - Traumatic Stress Clinic For ages 18+
Provides specialized assessment, therapy, and medication support, for individuals who have experienced or witnessed trauma and are experiencing lasting symptoms. Includes approximately 18 weekly or bi-weekly sessions.

Lakeridge Health - Early Psychosis Intervention Program | Make a referral
Contact: Whitby Mall - 1615 Dundas St. E., Lang Tower, 2nd Floor. Phone: 905-721-4747 ext. 8.

The Durham Amaze Early Psychosis Intervention (EPI) Program is a specialized outpatient, early intervention service for youth and adults, aged 14 to 34, who have experienced their first episode of psychosis during the past year.
Psychosis is a disorder that affects the brain, causing a distortion of reality or some loss of contact with reality. Symptoms of psychosis may include delusions, hallucinations, changes in thinking and behaviour, and social and emotional withdrawal.
The program provides early detection, assessment, education, intensive intervention and support to clients and families with the goal of reducing the duration of untreated psychosis, which can also reduce the severity of the illness and enhance quality of life.
The EPI team consists of social workers, registered nurses, addiction counsellors, recreation therapists and psychiatrists who work collaboratively with the family, school, and community to optimize recovery. Referrals are accepted from a range of sources including physicians in the hospital and community, other community agencies, self, family, and school personnel.

Centre for Addiction and Mental Health (CAMH) - Telemental Health | Make a referral
Telemental Health offers real-time client care for those in northern communities and community partners that serve First Nations, Inuit and/or Métis patients specifically via secure videoconferencing.

Centre for Addiction and Mental Health (CAMH) – Services & Clinics – Anxiety/Depression
From assessment to brief interventions, inpatient programs, day hospital services, continuing care, outpatient services and family support, CAMH provides a wide range of clinical care services.

9-8-8 Suicide Crisis Helpline (call or text)
For clients dealing with thoughts of suicide, or for those who are worried about them. A trained responder will listen without judgement, provide support and understanding, and review available resources. Helpline follows a network model where clients will reach a responder at one of nearly 40 local, provincial and territorial, and national crisis lines, who co-deliver the service. Clients are connected to a responder within their local community. Service partners include Hope for Wellness who offer specialized support for First Nations, Inuit and Métis.

Primary care practitioner consultation services

Ontario Shores - Psychiatry Telephone Consultation - A Primary Care Collaboration
For family doctors or nurse practitioners seeking telephone consultation with a psychiatrist can request a scheduled appointment.

Ontario Telemedicine Network - Provider to psychiatrist e-consultation
To sign up for eConsult, or for any questions, please contact the eConsult Centre of Excellence at eConsultCOE@TOH.ca.

Lakeridge Health - Crisis Intervention Team
Individual checks in with the emergency department triage nurse to access a member of the Crisis Intervention Team. Team members meet with individuals and individual's family or support team to discuss immediate concerns and review options. A person may be discharged with a follow-up plan, while others may be admitted to the inpatient mental health program. Follow-up and referral options, either within Lakeridge Health or in the community are provided.

Contact: Ajax Pickering - 905-683-2320 or Oshawa - 905-576-8711 ext. 34384
Directions: Ajax Pickering Emergency Department - 24-hours a day or Oshawa Emergency Department - 24-hours a day.

Urgent care

Immediate action: Urgent risk assessment. Safety first.
Call emergency services as needed to ensure safe transport for patient to the closest emergency department.

A person with possible mania, psychosis and/or thoughts of harming self or baby should NOT be left alone or with baby until an appropriate assessment is complete. Many pregnant and postpartum individuals do have "intrusive" thoughts of harm coming to their baby with no "active" intent. Each provider will have a different level of comfort with this assessment.
Provider is concerned about mania, psychosis or harm to self or others: Initiate plan to transfer patient for emergency psychiatric assessment. MDs can complete an Ontario application for extended assessment (Form 1 Mental Health Act). Call emergency services as needed to ensure safe transport for patient to the closest emergency department. Call local Children’s Aid Society/Family and Children’s Services if concerned about harm to child.
Provider assesses that there is no active intent or plan for harm to self or others, and that patient has appropriate support, as well as capacity to access crisis services if symptoms worsen acutely: Mobilize patient’s support system; Ensure the individual has contact information for crisis services.
Maintain close follow-up, follow treatment Steps 2 and 3 as appropriate.
Maintain and update plan of action with patient and patient’s support system, including providers in patient’s circle of care.

The scope of this work does not include guidance on specific mental disorder(s) and/or substance use. In addition, specific details about recommended pharmacological (drug) treatments or their potential benefits and harms when used in pregnancy and/or lactation are not included in this resource. Links to evidence-based information are provided in the PCMCH Perinatal Mental Health Guidance document. Health care providers must perform an individualized assessment and apply clinical judgment to ensure a safe and effective plan of care. This resource does not take the place of national or provincial medical guidelines. The resources and services hyperlinked in the care pathway and guidance document are current and consistent with the intended purpose of this work, as of the date of publication.

*Tool and step-care approach outlined here is based on, and has been adapted from the pathway developed by the Provincial Council for Maternal and Child Health (PCMCH).

To learn more about the PCMCH care pathway visit:

Updated: November 2023