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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. Collaborative Care Models

Approach. Support the coordination of care between obstetricians, primary care providers, pediatricians, and mental health providers to improve screening rates of postpartum depression and anxiety.

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Overview. Partnerships among prenatal care associations. (which include obstetricians, primary care providers, pediatricians, and mental health clinicians) that align with the American Academy of Pediatrics. (AAP) guidelines for perinatal mental health provide an opportunity for increased access and availability of postpartum depression and anxiety screening.[1] Research demonstrates that this team-based approach is effective in improving depression screening and treatment options for perinatal women.[2] Collaborative care across life course disciplines including pediatricians, primary care providers, and obstetricians also facilitates referrals and treatment options for postpartum women screening positive for postpartum depression or anxiety.[1]

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.
  • Timeliness of Care. This strategy promotes delivery of healthcare services in a timely manner to optimize benefits and prevent complications.

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 providers, including obstetricians, primary care physicians, pediatricians, and mental health specialists, partnered with Title V, who are actively engaged in postpartum collaborative care teams. (Assesses the multidisciplinary participation and buy-in for the collaborative care approach)
  • Number of collaborative care agreements led by Title V or protocols established between healthcare providers to formalize postpartum depression and anxiety screening and referral process. (Shows the structural and operational elements of the collaborative care model)

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

PROCESS MEASURES:

  • Percent of postpartum collaborative care teams that utilize evidence-based screening tools and protocols aligned with clinical guidelines. (Measures the scientific rigor and quality of the screening practices within collaborative care models)
  • Percent of providers within collaborative care teams who receive training and ongoing support to enhance their skills in postpartum mental health screening, referrals, and care coordination. (Assesses the workforce development and capacity-building efforts to support effective collaborative care)

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

PROCESS MEASURES:

  • Number of postpartum care navigation or case management services established to support women and families in accessing screening, referrals, and treatment through collaborative care models that result in improved health outcomes. (Measures efforts to address barriers and facilitate seamless care transitions)
  • Number of community-based organizations, such as social services agencies, home visiting programs, and support groups, led by Title V that are integrated into postpartum collaborative care networks that report high levels of engagement. (Assesses the breadth of cross-sector partnerships to support postpartum mental health)

OUTCOME MEASURES:

  • Number of postpartum women and families who report increased knowledge, skills, and confidence in managing their mental health as a result of education and support provided through collaborative care models. (Measures the impact of collaborative care on patient and family support)
  • Number of population-level improvements in postpartum mental health indicators, such as reduced prevalence and severity of depression and anxiety, in communities with widespread adoption of collaborative care models. (Measures the long-term, aggregate impact of the collaborative care strategy on maternal mental health outcomes)

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

PROCESS MEASURES:

  • Percent of postpartum care navigation or case management services established to support women and families in accessing screening, referrals, and treatment through collaborative care models that result in improved health outcomes. (Measures efforts to address barriers and facilitate seamless care transitions)
  • Percent of community-based organizations, such as social services agencies, home visiting programs, and support groups, led by Title V that are integrated into postpartum collaborative care networks that report high levels of engagement. (Assesses the breadth of cross-sector partnerships to support postpartum mental health)

OUTCOME MEASURES:

  • Percent of postpartum women and families who report increased knowledge, skills, and confidence in managing their mental health as a result of education and support provided through collaborative care models. (Measures the impact of collaborative care on patient and family support)
  • Percent of population-level improvements in postpartum mental health indicators, such as reduced prevalence and severity of depression and anxiety, in communities with widespread adoption of collaborative care models. (Measures the long-term, aggregate impact of the collaborative care strategy on maternal mental health outcomes)

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] Puryear, L. J., Nong, Y. H., Correa, N. P., Cox, K., & Greeley, C. S. (2019). Outcomes of implementing routine screening and referrals for perinatal mood disorders in an integrated multi-site pediatric and obstetric setting. Maternal and child health journal, 23, 1292-1298.
[2] Miller, E. S., Grobman, W. A., Ciolino, J. D., Zumpf, K., Sakowicz, A., Gollan, J., & Wisner, K. L. (2021). Increased depression screening and treatment recommendations after implementation of a perinatal collaborative care program. Psychiatric Services, 72(11), 1268-1275.

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.