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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Postpartum Visit.

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Strategy. Motivational Interviewing and Cognitive-Behavioral Therapy

Approach. Support evidence-based behavioral/motivational therapy that encourages women to attend postpartum visits

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Overview. Hospital-based initiatives that combine brief motivational interviewing with evidence-based cognitive-behavioral therapy can increase the likelihood that postpartum women will attend postpartum visits.[1] Several studies using these interventions focused on women with a history of illicit substance use. Evidence has found that women who are motivated to stop using addictive substances during pregnancy are at heightened risk of relapsing during the postpartum period.[2] Factors such as sleep deprivation, loss of health insurance, the demands of parenting, and/or the threat of losing child custody may increase the risk of postpartum depression.[3]

Evidence. Mixed Evidence. Strategies with this rating have been tested more than once with results that sometimes trend positive and sometimes show little effect. These strategies still have potential to work; however, further research is needed to understand the components of the strategies that have the most potential in producing consistent positive results. (Clarifying Note: The WWFH database calls this "insufficient 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):

  • Access to/Receipt of Care. This strategy increases the ability for individuals to obtain healthcare services when needed, including preventive, diagnostic, and treatment services.
  • Health and Health Behaviors/Behavior Change. This strategy improves individuals' physical and mental health and their adoption of healthy behaviors (e.g., healthy eating, physical activity).

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. Counseling (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 healthcare systems, clinics, and providers partnered with Title V that offer and deliver motivational interviewing and cognitive-behavioral therapy interventions to encourage postpartum visit attendance. (Indicates the availability and usability of the strategy)
  • Number of motivational interviewing and cognitive-behavioral therapy sessions or encounters provided to postpartum individuals to support their attendance at postpartum visits. (Shows the volume and intensity of the strategy)

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

PROCESS MEASURES:

  • Percent of motivational interviewing and cognitive-behavioral therapy interventions for postpartum visit attendance that adhere to evidence-based protocols, fidelity standards, and clinical guidelines. (Indicates the quality and consistency of the strategy)
  • Percent of healthcare providers and staff who are trained and competent in delivering motivational interviewing and cognitive-behavioral therapy interventions to postpartum individuals. (Shows the workforce capacity and readiness for the strategy)

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

PROCESS MEASURES:

  • Number of partnerships and referral pathways established between healthcare providers, behavioral health specialists, substance use treatment programs, and community resources to support the delivery of motivational interviewing and cognitive-behavioral therapy interventions for postpartum individuals. (Indicates the multi-sector collaboration and care coordination in the strategy)
  • Number of postpartum individuals who report increased motivation, self-efficacy, and social support for attending postpartum visits and engaging in self-care behaviors after participating in motivational interviewing and cognitive-behavioral therapy interventions. (Shows the psychological and behavioral outcomes of the strategy)

OUTCOME MEASURES:

  • Number of communities and populations that achieve significant and sustained reductions in postpartum depression, substance use relapse, and other adverse maternal outcomes through the widespread adoption of motivational interviewing and cognitive-behavioral therapy interventions for postpartum individuals. (Indicates the population health and well-being impact of the strategy)
  • Number of postpartum individuals who become peer supporters, recovery coaches, and supporters for promoting postpartum visit attendance and maternal mental health, inspired by their positive experiences with motivational interviewing and cognitive-behavioral therapy interventions. (Shows the support and leadership development outcomes of the strategy)

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

PROCESS MEASURES:

  • Percent of partnerships and referral pathways established between healthcare providers, behavioral health specialists, substance use treatment programs, and community resources to support the delivery of motivational interviewing and cognitive-behavioral therapy interventions for postpartum individuals. (Indicates the multi-sector collaboration and care coordination in the strategy)
  • Percent of postpartum individuals who report increased motivation, self-efficacy, and social support for attending postpartum visits and engaging in self-care behaviors after participating in motivational interviewing and cognitive-behavioral therapy interventions. (Shows the psychological and behavioral outcomes of the strategy)

OUTCOME MEASURES:

  • Percent of communities and populations that achieve significant and sustained reductions in postpartum depression, substance use relapse, and other adverse maternal outcomes through the widespread adoption of motivational interviewing and cognitive-behavioral therapy interventions for postpartum individuals. (Indicates the population health and well-being impact of the strategy)
  • Percent of postpartum individuals who become peer supporters, recovery coaches, and supporters for promoting postpartum visit attendance and maternal mental health, inspired by their positive experiences with motivational interviewing and cognitive-behavioral therapy interventions. (Shows the support and leadership development outcomes 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] Stotts, A. L., Villarreal, Y. R., Green, C., Berens, P., Blackwell, S., Khan, A., Suchting, R., Velasquez, M., Markham, C., Klawans, M. R., & Northrup, T. F. (2022). Facilitating treatment initiation and reproductive care postpartum to prevent substance-exposed pregnancies: A randomized bayesian pilot trial. Drug and alcohol dependence, 239, 109602. https://doi.org/10.1016/j.drugalcdep.2022.109602.
[2] Rizk, A. H., Simonsen, S. E., Roberts, L., Taylor-Swanson, L., Lemoine, J. B., & Smid, M. (2019). Maternity Care for Pregnant Women with Opioid Use Disorder: A Review. Journal of midwifery & women's health, 64(5), 532–544. https://doi.org/10.1111/jmwh.13019

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.