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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. Universal Screening

Approach. Develop policy around universal screening in WIC clinics for postpartum women during the first year following a live birth.

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Overview. Developing policies that supports universal screening for postpartum women in WIC clinics can help to address socioeconomic and access barriers to postpartum depression and anxiety screening.[1] A universal screening policy that utilizes a standardized screening tool, for a specific population, such as women using WIC services, would facilitate the referral and follow-up mental health services.[1,2]

Evidence. Moderate Evidence. Strategies with this rating are likely to work. These strategies have been tested more than once and results trend positive overall; however, further research is needed to confirm effects, especially with multiple population groups. These strategies also trend positive in combination with other strategies. (Clarifying Note: The WWFH database calls this "some evidence").

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.
  • Access to/Receipt of Care. This strategy increases the ability for individuals to obtain healthcare services when needed, including preventive, diagnostic, and treatment services.
  • Social Determinants of Health. This strategy advances economic, social, and environmental factors that affect health outcomes. SDOH include the conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.

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. Community-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 policy briefs or recommendations developed to support universal screening in WIC clinics. (Assesses the production of persuasive materials to guide policy)
  • Number of WIC staff trained on the importance and implementation of universal postpartum mental health screening. (Measures workforce capacity building efforts)

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

PROCESS MEASURES:

  • Percent of WIC clinics actively participating in the development of the universal screening policy. (Measures the representativeness of the policy process)
  • Percent of policy briefs or recommendations that cite evidence-based practices and guidelines for postpartum mental health screening. (Assesses the scientific rigor of policy materials)

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

PROCESS MEASURES:

  • Number of partnerships led by Title V established between WIC clinics and community mental health providers to support universal screening and referrals who report high levels of engagement. (Measures cross-sector collaboration)
  • Number of WIC clinics partnered with Title V that integrate postpartum mental health screening results into their nutrition and health counseling services who report high levels of satisfaction with services provided. (Assesses efforts to provide holistic, coordinated care)

OUTCOME MEASURES:

  • Number of postpartum women who report increased knowledge and reduced stigma around mental health as a result of universal screening in WIC clinics. (Shows the policy's impact on psychosocial outcomes)
  • Number of WIC clinics that demonstrate sustained improvements in postpartum mental health screening rates and referral pathways. (Measures the long-term systems change achieved by the policy)

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

PROCESS MEASURES:

  • Percent of partnerships led by Title V established between WIC clinics and community mental health providers to support universal screening and referrals who report high levels of engagement. (Measures cross-sector collaboration)
  • Percent of WIC clinics partnered with Title V that integrate postpartum mental health screening results into their nutrition and health counseling services who report high levels of satisfaction with services provided. (Assesses efforts to provide holistic, coordinated care)

OUTCOME MEASURES:

  • Percent of postpartum women who report increased knowledge and reduced stigma around mental health as a result of universal screening in WIC clinics. (Shows the policy's impact on psychosocial outcomes)
  • Percent of WIC clinics that demonstrate sustained improvements in postpartum mental health screening rates and referral pathways. (Measures the long-term systems change achieved by the policy)

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] Miller, E. S., Wisner, K. L., Gollan, J., Hamade, S., Gossett, D. R., & Grobman, W. A. (2019). Screening and treatment after implementation of a universal perinatal depression screening program. Obstetrics & Gynecology, 134(2), 303-309.
[2] Zappulla, T. T., & Wechter, S. M. (2023). Seeing Through the Shadows: A Strategy to Improve Postpartum Depression Screening Practices. Journal of Doctoral Nursing Practice.

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.