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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. Behavioral Health Primary Care Integration

Approach. Incorporate primary care and behavioral healthcare to better screen for postpartum depression.

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Overview. Integrating behavioral health into primary care practice brings mental health and/or substance use screenings and treatments into a primary care setting. These efforts can include coordination between primary care providers, case managers or behavioral health consultants, and mental health specialists (e.g., psychiatrists), and often require training and redefinition or realignment of staff roles.[1, 2] Telehealth tools such as electronic health records. (EHRs), text messaging, mobile applications. (apps), and online therapies may be used to support integration.[3] Mental health conditions and substance use issues often occur with other chronic medical conditions; patients with severe conditions are referred to specialty care.[1]

Evidence. Scientifically Rigorous Evidence. Strategies with this rating are most likely to be effective. These strategies have been tested in multiple robust studies in a variety of populations and settings with consistently positive results, both on their own and in combination with other strategies. (Clarifying Note: The WWFH database calls this "scientifically supported evidence").

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

Source. What Works for Health (WWFH) Database (County Health Rankings and Roadmaps)

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

  • Access to/Receipt of Care. This strategy increases the ability for individuals to obtain healthcare services when needed, including preventive, diagnostic, and treatment services.
  • Mental Health. This strategy promotes emotional, psychological, and social well-being of individuals and communities.
  • 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. 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 primary care providers trained to administer postpartum depression screening tools in an integrated care setting. (Shows the capacity building efforts to support the integration strategy)
  • Number of postpartum women screened for depression in primary care practices with integrated behavioral health services with the collaboration being led by Title V. (Indicates the reach and volume of the integrated screening approach)

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

PROCESS MEASURES:

  • Percent of primary care providers who receive training on discussing postpartum depression and treatment options with patients in an integrated care context. (Shows the effectiveness of provider education and training efforts)
  • Percent of postpartum women screened for depression who receive appropriate follow-up care and support. (Indicates the responsiveness and patient-centeredness of the integrated care approach)

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

PROCESS MEASURES:

  • Number of primary care practices that implement quality improvement initiatives promoted by Title V to enhance their postpartum depression screening and treatment process. (Shows the commitment to data-driven performance improvement in integrated care delivery)
  • Number of community partnerships established to support postpartum women with depression through integrated primary care and behavioral health services (e.g., support groups, resource referrals). (Indicates the breadth of multi-sector collaboration to provide comprehensive care)

OUTCOME MEASURES:

  • Number of postpartum depression-related hospitalizations and emergency department visits prevented through early identification and intervention in integrated primary care partnerships led by Title V. (Shows the impact of the integrated approach on reducing costly and avoidable healthcare utilization)
  • Number of primary care practices that sustain and expand their integrated behavioral health services for postpartum depression beyond the initial implementation period. (Indicates the long-term viability and institutionalization of the integrated care model)

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

PROCESS MEASURES:

  • Percent of primary care practices providing integrated postpartum depression screening and treatment that regularly solicit and incorporate patient feedback garnered by Title V partners to guide quality improvement efforts. (Shows the level of patient engagement and co-design in shaping integrated care delivery)
  • Percent of primary care and behavioral health providers involved in integrated postpartum depression collaboratives led by Title V who receive ongoing training and support to maintain workforce skills. (Indicates the investment in developing a workforce equipped to serve their patient populations)

OUTCOME MEASURES:

  • Percent reduction in differences in postpartum depression screening, diagnosis, and treatment rates between different groups within the patient population served by integrated primary care practices led by Title V. (Shows the impact of the integrated approach on promoting health outcomes)
  • Percent of healthcare expenditures and resources allocated to support integrated primary care and behavioral health service collaboratives led by Title V for postpartum depression, as compared to fragmented or specialty-only care models. (Indicates the healthcare system's prioritization and investment in integrated care approaches for maternal mental health)

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] SAMHSA-HRSA Integrate - SAMHSA-HRSA Center for Integrated Health Solutions. Integrate behavioral health into primary care.

2 CG-Mental health - The Guide to Community Preventive Services (The Community Guide). Mental health.

3 Raney 2017 - Raney L, Bergman D, Torous J, Hasselberg M. Digitally driven integrated primary care and behavioral health: How technology can expand access to effective treatment. Current Psychiatry Reports. 2017;19:86.

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.