Implementation of a Maternal Mental Health Toolkit in the Setting of Well-Child Visits

Background: Postpartum depression (PPD) can occur during pregnancy up to a year after childbirth. PPD is a serious but treatable medical illness that can include feelings of extreme sadness, anxiety, indifference, and affect sleep and the ability to care for self or infant. There are severe risks to mother and child if untreated (American Psychiatric Association, 2020). Utah's rate of PPD was 14.7% in 2020, which is above the national average of 13.2% (America's Health Rankings, n.d.). Due to a lack of screening and available resources, those suffering are not receiving the care they need, including medication, talk therapy, and social support, due to a lack of screening and available resources. Screening of women for postpartum depression ends at six weeks after the baby is born, missing the highest incidence of depression-related drug-induced death, most commonly occurring between forty-three days and one year (Smid et al., 2019). This quality improvement (QI) project aims to implement a Maternal Mental Health Toolkit in the setting of well-child checkups in the first six months of the newborn's life. Methods: An educational toolkit and training voiceover PowerPoint were created for the University of Utah Pediatric Clinic (UPC) staff. Included in the toolkit was the validated PPD screening tool; Edinburgh postpartum depression scale (EPDS), a referral process, and resources for treatment and support for mothers who screened positive. The training was disseminated by email from the clinic nurse manager to all staff. Before the training, a pre-implementation survey was conducted to evaluate the staff's knowledge, comfort, experience with, and attitude about the EPDS screening tool and referral process for positive screenings. The training was followed by a post-survey thirty days after implementation to assess any changes or improvements with these factors. Included were questions regarding the toolkit's feasibility, usability, and accessibility. A retrospective chart review compared positive EPDS screening rates two months before, during, and one month after implementation. Results: The toolkit was distributed to 27 clinic staff. Of those 4 (0.15%) completed the pre- survey, and 5 (0.19%) completed the post-survey. Additionally, only two completed pre and post-surveys were matched pairs. For the knowledge quiz portion of the survey, the pre- implementation group's mean average percentage correct was 69% (scores ranging from 62.5% to 75%), and the mean average post-implementation score was 75% (ranging from 50% to 87.5%). Analysis for statistical significance was not completed due to the small sample size. The total combined pre-and post-implementation survey responses for the most common barriers to screening for postpartum depression were time limitations (35%) and lack of a clear protocol for referral with a positive screening (28%). Conclusion: The overall statistical analysis and benefit could not be assessed due to low participation rates. However, overall, the survey data demonstrated that the toolkit increased knowledge and comfort in the referral process for PPD, a clinically important finding. The toolkit met the expectations of the hospital QI manager, who has long-term plans to disseminate it to all the pediatric clinics in the system.