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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. Integration into Routine Care

Approach. Facilitate partnerships between mental health providers and hospital NICU staff in order to integrate postpartum depression and anxiety screening into routine care for mothers with babies in the NICU

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Overview. Research indicates that NICU hospitalization of infants has been shown to have deleterious effects on the mental health of postpartum women.[1] Interventions that include facilitating partnerships with mental health providers in the NICU have the potential to identify women displaying postpartum depression or anxiety symptoms in this group early on. Identifying postpartum women at risk of depression and anxiety in the NICU has been found to also increase screening rates overall.[2] Evidence has found that partnerships between mental health providers and NICU hospital staff have the potential to increase referral, treatment, and follow-up rates, improving overall health outcomes for women with postpartum depression and anxiety.[3]

Evidence. Emerging Evidence. Strategies with this rating typically trend positive and have good potential to work. They often have a growing body of recent, but limited research that documents effects. However, further study is needed to confirm effects, determine which types of health behaviors and conditions these interventions address, and gauge effectiveness across different population groups. (Clarifying Note: The WWFH database calls this "mixed 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.
  • Utilization. This strategy improves the extent to which individuals and communities use available healthcare services.

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. Collaboration (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 NICU nurses and staff trained on the importance and administration of postpartum depression and anxiety screening. (Assesses workforce capacity building efforts)
  • Number of NICU units partnered with Title V that establish protocols for routine postpartum mental health screening and referrals. (Shows the formalization and standardization of integrated screening practices)

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

PROCESS MEASURES:

  • Percent of NICU nurses and staff trained on the importance and administration of postpartum depression and anxiety screening. (Assesses workforce capacity building efforts)
  • Percent of NICU units partnered with Title V that establish protocols for routine postpartum mental health screening and referrals. (Shows the formalization and standardization of integrated screening practices)

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

PROCESS MEASURES:

  • Number of NICU discharge planning sessions that include discussion of postpartum mental health and linkages to community-based support services that results in an increase in knowledge and/or skill. (Assesses the integration of mental health considerations into the NICU care continuum)
  • Number of mental health providers who express satisfaction with the level of collaboration and support from NICU partners in integrating postpartum depression and anxiety screening. (Assesses the strength and reciprocity of the cross-sector partnership)

OUTCOME MEASURES:

  • Number of NICU mothers who demonstrate improved coping skills, reduced symptoms, and stronger parent-infant bonding as a result of integrated postpartum mental health support. (Shows the clinical and relational benefits of integrated screening and care)
  • Number of NICUs that sustain high rates of postpartum depression and anxiety screening and linkage to treatment over time. (Measures the long-term feasibility and impact of the integrated screening model in NICU settings)

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

PROCESS MEASURES:

  • Percent of NICU discharge planning sessions that include discussion of postpartum mental health and linkages to community-based support services that results in an increase in knowledge and/or skill. (Assesses the integration of mental health considerations into the NICU care continuum)
  • Percent of mental health providers who express satisfaction with the level of collaboration and support from NICU partners in integrating postpartum depression and anxiety screening. (Assesses the strength and reciprocity of the cross-sector partnership)

OUTCOME MEASURES:

  • Percent of NICU mothers who demonstrate improved coping skills, reduced symptoms, and stronger parent-infant bonding as a result of integrated postpartum mental health support. (Shows the clinical and relational benefits of integrated screening and care)
  • Percent of NICUs that sustain high rates of postpartum depression and anxiety screening and linkage to treatment over time. (Measures the long-term feasibility and impact of the integrated screening model in NICU settings)

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 ]Ozdil, M. (2023). Postpartum Depression Among Mothers of Infants Hospitalized in the Neonatal Intensive Care Unit During the COVID-19 Pandemic. Cureus, 15(8).
[2] Sorg, M., Coddington, J., Ahmed, A., & Richards, E. (2019). Improving postpartum depression screening in pediatric primary care: a quality improvement project. Journal of pediatric nursing, 46, 83-88.
[3] Jo James, S. (2023). Maternal Postpartum Depression Screening in a Federally Qualified Health Care Center: An Evidence-Based Pilot Project. Pediatric Nursing, 49(2).

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.