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Pattern of alcohol consumption
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Illegal drug usage
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Drug support needed
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Currently on drug support
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“Is there someone to talk to about your feelings or worries?”
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Yes / no / not sure / unable to ask
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“Will you be able to get practical support after the birth of your baby?”
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Yes / no / not sure / unable to ask
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“In the last 12 months have you had any major worries, stress or change?”
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no / financial difficulties / housing changes / relationship worries / significant isolation / loss or death / other / unable to ask
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“Generally do you consider yourself a confident person?”
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No / yes / sometimes / unable to ask
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“Does it worry you a lot if things get messy or out of place?”
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No / yes / sometimes / unable to ask
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“Have you ever felt anxious or depressed for more than 2 weeks?”
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No / yes / unable to ask
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If yes, “did any episode seriously interfere with your work or relationships?”
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No / yes
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And “were any of these episodes of anxiety related to pregnancy or birth?”
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No / yes PND / yes – postnatal psychosis / other / not known
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Child living away
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Department of Community Services
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Frightened by partner
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Would you like assistance with this
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Response to DV questions
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Other issues or worries
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EDS total score
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Answer to EDS question 10
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Psychosocial assessment – issues identified?
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