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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Postpartum Mental Health Screening.

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Strategy. Self-Screening

Approach. Support providers in disseminating a self-screening tool and referral pathway pamphlet during discharge from the maternity unit after delivery.

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Overview. Self-screening interventions include the provision of self-screening tools to new mothers, prior to discharge, to identify postpartum depression and anxiety symptoms. Self-screening tools are most effective when linked to a standardized screening tool such as the Edinburgh Postnatal Depression Scale and research indicates that this intervention is most beneficial when coupled with material concerning next steps such as promotional materials around referral pathways. Evidence has found that self-screening tools can help eliminate certain socioeconomic barriers associated with access to postpartum depression and anxiety screening and could facilitate the timeliness of accessing screening.[1]

Evidence. Expert Opinion. Strategies with this rating are recommended by credible, impartial experts, guidelines, or committee statements; these strategies are consistent with accepted theoretical frameworks and have good potential to work. Often there is literature-based evidence supporting these strategies in related topic areas that indicate this approach would prove effective for this issue. Further research is needed to confirm effects in this topic area.

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source. (Read more about understanding evidence ratings).

Source. Peer-Reviewed Literature

Outcome Components. This strategy has shown to have impact on the following outcomes (Read more about these categories):

  • Mental Health. This strategy promotes emotional, psychological, and social well-being of individuals and communities.
  • Timeliness of Care. This strategy promotes delivery of healthcare services in a timely manner to optimize benefits and prevent complications.
  • Policy. This strategy helps to promote decisions, laws, and regulations that promote public health practices and interventions.

Detailed Outcomes. For specific outcomes related to each study supporting this strategy, access the peer-reviewed evidence and read the Intervention Results for each study.

Intervention Type. Screening (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).

Intervention Level. Individual/Family-Focused

Examples from the Field. There are currently no ESMs that use this strategy. As Title V agencies begin to incorporate this strategy into ESMs, examples will be available here. Until then, you can search for ESMs that have similar intervention components in the ESM database.

Sample ESMs. Here are sample ESMs to use as models for your own measures using the Results-Based Accountability framework (for suggestions on how to develop programs to support this strategy, see The Role of Title V in Adapting Strategies).

Quadrant 1:
Measuring Quantity of Effort ("What/how much did we do?")

PROCESS MEASURES:

  • Number of maternity care providers and units partnered with Title V that adopt and implement the dissemination of self-screening tools and referral pathway pamphlets for postpartum depression and anxiety during patient discharge. (Measures the uptake and spread of the strategy)
  • Number of new mothers supported by Title V who receive self-screening tools and referral pathway pamphlets for postpartum depression and anxiety prior to discharge from the maternity unit. (Measures the reach and distribution of the intervention materials)

Quadrant 2:
Measuring Quality of Effort ("How well did we do it?")

PROCESS MEASURES:

  • Percent of maternity care providers and staff who are trained in administering the self-screening tools and providing patient education on postpartum mental health and referral pathways. (Measures the workforce capacity and readiness for the strategy)
  • Percent of self-screening tools and referral pathway pamphlets that are adapted and available to meet the needs of new mothers. (Assesses the responsiveness of the intervention materials)

Quadrant 3:
Measuring Quantity of Effect ("Is anyone better off?")

PROCESS MEASURES:

  • Number of partnerships and coordination mechanisms led by Title V established between maternity care units, mental health providers, and community-based support services to ensure seamless referral and follow-up for new mothers who screen positive on the self-screening tools. (Measures the multi-sector collaboration and integration of the strategy)
  • Number of policies, protocols, and reimbursement models supported by Title V developed and adopted to support the routine implementation and sustainability of self-screening and referral process for postpartum depression and anxiety. (Measures the enabling environment and systems change approach)

OUTCOME MEASURES:

  • Number of communities and populations that achieve significant and sustained reductions in the prevalence and burden of untreated postpartum depression and anxiety through the scaled implementation of self-screening and referral interventions. (Measures the population health and well-being impact of the strategy)
  • Number of maternity care providers, mental health professionals, and patient supporters who become champions and change agents in advancing the integration of postpartum mental health screening and referral into standard care practices. (Assesses the field-building and transformation potential of the strategy)

Quadrant 4:
Measuring Quality of Effect ("How are they better off?")

PROCESS MEASURES:

  • Percent of self-screening tool development and implementation process that actively engage and incorporate the practical experiences, and preferences of new parents and families. (Measures the level of patient and community co-design in the strategy)
  • Percent of resources and funding allocated at the state level to support the dissemination, usability, and utilization of self-screening tools and referral pathways. (Measures the intentionality and investment in available resources)

OUTCOME MEASURES:

  • Percent of communities and populations that achieve significant and sustained reductions in the prevalence and burden of untreated postpartum depression and anxiety through the scaled implementation of self-screening and referral interventions. (Measures the population health and well-being impact of the strategy)
  • Percent of maternity care providers, mental health professionals, and patient supporters who become champions and change agents in advancing the integration of postpartum mental health screening and referral into standard care practices. (Assesses the field-building and transformation potential of the strategy)

Note. When looking at your ESMs, SPMs, or other strategies:

  1. Move from measuring quantity to quality.
  2. Move from measuring effort to effect.
  3. Quadrant 1 strategies should be used sparingly, when no other data exists.
  4. The most effective measurement combines strategies in all levels, with most in Quadrants 2 and 4.

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.

References

[1] Edward, K. L., Giandinoto, J. A., Stephenson, J., Mills, C., Mcfarland, J., & Castle, D. J. (2019). Self-screening using the Edinburgh post natal depression scale for mothers and fathers to initiate early help seeking behaviours. Archives of Psychiatric Nursing, 33(4), 421-427.

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.