Implementation of a Resource Toolkit for Paternal Postpartum Depression: An Evidenced-Based Improvement Initiative

Paternal postpartum depression (paternal PPD) or paternal major depressive disorder with peripartum onset is an under-researched and under-identified disorder. Approximately 8-14% of fathers will present with new symptoms of depression in the peripartum period, which ranges from the first trimester to 12 months after the child's birth. An inadequate quantity of resources is available for patients and providers to help recognize and manage the disorder. Utah has a higher prevalence of both major depressive disorder and maternal postpartum depression disorder compared to the national average. The Utah Department of Health and Human Services has identified symptoms of a previous mental illness, elevated ACE scores, and co-occurring chronic illnesses as factors among those in Utah diagnosed with depression. These symptoms are associated with risk factors for the likelihood of a diagnosis of maternal postpartum depression. A quality improvement initiative was developed to improve participants' confidence and knowledge in identifying and diagnosing paternal postpartum depression. Participants included one psychiatric mental health nurse practitioner, one physician assistant, and four therapists. All six agreed to participate in the initiative. Participants completed a pre-intervention questionnaire to assess current knowledge, beliefs, screening practices, and confidence levels in recognizing, screening, and diagnosing paternal postpartum depression. Educational resources were developed and provided to participants, including an educational presentation and toolkit titled "Uplifting Fatherhood," with resources to help identify the disorder and online resources for referring and supporting patients. Post-presentation questionnaires were administered to participants to determine satisfaction with the education and willingness to use the toolkit. The participants in clinical practice implemented the toolkit for 12 weeks, and the distribution of the toolkit was monitored. Participants were provided a post-intervention questionnaire to determine changes in screening methods, number of toolkits distributed, changes in confidence, barriers and improvements to the initiative, and feasibility, usability, and satisfaction. Intervention: Participants received an evidenced-based toolkit and education on paternal postpartum depression and implemented the toolkit into practice for 12 weeks. During the intervention period, the PDSA cycles were implemented to facilitate concurrent improvement and uptake of the toolkit. The number of toolkits distributed was tallied by participants during and at the end of the intervention period. Post-intervention, all six (n= 100%) participants agreed they gained the knowledge and training to identify the disorder and can make an accurate paternal PPD diagnosis. There was a slight increase in patient screenings and the use of the Edinburgh Postnatal Depression Scale (EPDS). All six (n=100%) participants believed the toolkit was simple to integrate into their practice and agreed to continue implementing it in the future. Participants identified the need for a physical handout or a QR code to provide the toolkit to their patients. The development and implementation of the Uplifting Fatherhood toolkit and educational presentation improved participants' collective confidence in identifying, screening, and diagnosing paternal postpartum depression. Improving the data collection method for the distribution will be crucial for improving the replication of this initiative. Other disciplines, such as family medicine, pediatrics, and obstetrics, may be areas where a paternal postpartum depression toolkit may be useful to implement.

1 Implementation of a Resource Toolkit for Paternal Postpartum Depression: An Evidenced-Based Improvement Initiative Neal M Randall, Megan Hebdon College of Nursing: The University of Utah NURS 7703: DNP Scholarly Project III April 14, 2025 2 Abstract Background: Paternal postpartum depression (paternal PPD) or paternal major depressive disorder with peripartum onset is an under-researched and under-identified disorder. Approximately 8-14% of fathers will present with new symptoms of depression in the peripartum period, which ranges from the first trimester to 12 months after the child's birth. An inadequate quantity of resources is available for patients and providers to help recognize and manage the disorder. Local Problem: Utah has a higher prevalence of both major depressive disorder and maternal postpartum depression disorder compared to the national average. The Utah Department of Health and Human Services has identified symptoms of a previous mental illness, elevated ACE scores, and co-occurring chronic illnesses as factors among those in Utah diagnosed with depression. These symptoms are associated with risk factors for the likelihood of a diagnosis of paternal postpartum depression. Methods: A quality improvement initiative was developed to improve participants' confidence and knowledge in identifying and diagnosing paternal postpartum depression. Participants included one psychiatric mental health nurse practitioner, one physician assistant, and four therapists. All six agreed to participate in the initiative. Participants completed a pre-intervention questionnaire to assess current knowledge, beliefs, screening practices, and confidence levels in recognizing, screening, and diagnosing paternal postpartum depression. Educational resources were developed and provided to participants, including an educational presentation and toolkit titled "Uplifting Fatherhood," with resources to help identify the disorder and online resources for referring and supporting patients. Post-presentation questionnaires were administered to participants to determine satisfaction with the education and willingness to use the toolkit. The 3 participants in clinical practice implemented the toolkit for 12 weeks, and the distribution of the toolkit was monitored. Participants were provided a post-intervention questionnaire to determine changes in screening methods, number of toolkits distributed, changes in confidence, barriers and improvements to the initiative, and feasibility, usability, and satisfaction. Intervention: Participants received an evidenced-based toolkit and education on paternal postpartum depression and implemented the toolkit into practice for 12 weeks. During the intervention period, the PDSA cycles were implemented to facilitate concurrent improvement and uptake of the toolkit. The number of toolkits distributed was tallied by participants during and at the end of the intervention period. Results: Post-intervention, all six (n= 100%) participants agreed they gained the knowledge and training to identify the disorder and can make an accurate paternal PPD diagnosis. There was a slight increase in patient screenings and the use of the Edinburgh Postnatal Depression Scale (EPDS). All six (n=100%) participants believed the toolkit was simple to integrate into their practice and agreed to continue implementing it in the future. Participants identified the need for a physical handout or a QR code to provide the toolkit to their patients. Conclusion: The development and implementation of the Uplifting Fatherhood toolkit and educational presentation improved participants' collective confidence in identifying, screening, and diagnosing paternal postpartum depression. Improving the data collection method for the distribution will be crucial for improving the replication of this initiative. Other disciplines, such as family medicine, pediatrics, and obstetrics, may be areas where a paternal postpartum depression toolkit may be useful to implement. Key Words: Postpartum, paternal, depression, toolkit, mental health, fathers, quality improvement 4 Implementation of a Resource Toolkit for Paternal Postpartum Depression Problem Description Paternal postpartum depression (paternal PPD) is an understudied area of depression in the mental health literature. According to research, between 8-14% of fathers will develop symptoms of depression in the first trimester of pregnancy through the first year postpartum (Nishigori et al., 2020; Rao et al., 2020). In August 2024, the U.S. Surgeon General's office released a general advisory about the growing need to address parental stress (Department of Health and Human Services, 2024). This includes an increased focus on paternal mental health during the peripartum period, which spans from the first trimester of pregnancy to twelve months after birth (Rao et al., 2020). The mental health of a partner may also act as a large risk to the father. For example, if the maternal partner is diagnosed with postpartum depression, this leads to a 50% greater risk that the paternal partner will also be diagnosed with depression (Ansari et al., 2021; Carlson et al., 2024). According to a cross-sectional study conducted by Akalin et al. (2025), paternal perinatal depression health terms appear to be poorly understood by the general public. Fathers who are unaware they may be experiencing paternal depression may present with atypical signs and symptoms of paternal PPD (Bruno et al., 2020). These signs and symptoms are known as "male presenting," which manifests as irritability or anger, impulsive decisions, social isolation, increased drug and alcohol use, and an increase in somatic complaints (Chhabra et al., 2022; Davenport et al., 2022). According to a systematic review conducted by Ansari et al. (2021), previous mental illness, a spouse with a peripartum mood or anxiety disorder, lack of social support, and financial difficulty are risk factors highly associated with fathers suffering from paternal PPD. 5 The lack of identification and awareness is the start of a difficult road for a father with unidentified depression symptoms. Paternal PPD not only takes a heavy toll on the father but can be a significant risk to their spouse/partner and child to develop their mental illness (Ashraf et al., 2023; Attia Hussein Mahmoud et al., 2024). Fathers with paternal postpartum depression tend to be more socially isolated and will invest less of their time into their family relationships (Davenport et al., 2022). This increases the spouse/partner's symptoms of distress, sense of isolation, and belief that the father is not a reliable source of assistance (Attia Hussein Mahmoud et al., 2024). Studies have shown that children are affected by their parental figures' mental health. As early as infancy, children exhibit increased behavioral and emotional lability if neglected by a father with paternal PPD, which leaves them vulnerable to developing mental illness and delays their developmental milestones (Ashraf et al., 2023; Schmitz et al., 2024). Compared to women, men have reduced help-seeking behaviors for their mental health, reduced mental health literacy, and understanding of available resources (Eddy et al., 2019). According to the Utah Health and Human Services (Utah HHS) (2024), there is a higher prevalence of depression in the state of Utah compared to the national average (26.1% in Utah compared to the national average of 21.4% in the year 2022). The Utah HHS has identified several risk factors for depression, such as increased adverse childhood events (ACEs), previous mental illness, and co-occurring chronic conditions all of which are also risk factors for fathers during the peripartum period (Ansari et al., 2021). The Utah HHS also reports that there is a higher prevalence of women with maternal postpartum depression (14.9% in Utah compared to 12.9% nationally), which is the single greatest risk factor for paternal postpartum depression. 6 Due to these circumstances, men in Utah may be at higher risk for developing paternal postpartum depression than those nationally. Available Knowledge Research has shown that early detection and improved awareness of perinatal maternal affect disorders (PMADs) are related to improved treatment prognosis (Carlson et al., 2024). Early detection before conception allows providers to educate their patients on the disorder and improves their awareness of its associated symptoms. Improved policies and support from community resources also improve the PMADs treatment prognosis (Simhi et al., 2019; Żyrek et al., 2024). Identification and treatment have shown similar benefits to fathers with paternal PPD (Bruno et al., 2020; Paulson & Bazemore, 2010), and it is recommended to screen fathers for depression in an outpatient setting to provide early interventions (Wainwright et al., 2023). Up to 70% of fathers attend pediatric appointments for their newborns, and providers theorize that an improved screening of fathers for depression will shorten the gap between recognition of symptoms and treatment interventions (Walsh et al., 2020). Many barriers influence a father's help-seeking behaviors. A qualitative study noted that over 66% of participants (men between the ages of 29 and 38) had no prior knowledge of depressive symptoms (Pedersen et al., 2021). Thirty-three percent of participants screened for paternal PPD believed there was no benefit from the screening due to the lack of follow-up support (Pedersen et al., 2021). A supportive spouse or partner helps fathers recognize their behaviors and influences their readiness to seek help. In some cases, the partner recognizes signs or a change in behavior before the father does (Pedersen et al., 2021). The lack of identification and follow-up care allows clinicians to bridge the gap in support by improving their clinical knowledge and preparing resources for their patients. In a qualitative study conducted by 7 Essadek et al. (2024), health professionals specializing in perinatal health acknowledge that they are aware of paternal depression and how it manifests but have doubts about the accuracy of the diagnosis. Despite the acknowledgments of perinatal health professionals on paternal depression, Essadek et al. elaborate that more education on how the disorder presents and to improve education that postpartum depression is not a female-only disorder is needed. Research has shown that treatment for paternal PPD uses the same methods as treating depression outside of the perinatal period. (Reay et al., 2023). Antidepressant medical treatments are available, but according to Cameron et al. (2017), fathers preferred psychological intervention over pharmacological measures. There is little research on group education or group therapy for fathers. Research following group education classes that specifically focused on the mother and the developing fetus has shown minimal impact on paternal depression and anxiety for men. The best results to improve symptoms of anxiety and depression in fathers are from studies focused on teaching coping mechanisms and psychoeducation. Unfortunately, these studies focused on group interventions for prospective parents and were not designed to study clinically diagnosed depressed or anxious men (Goldstein et al., 2020; Rodrigues et al., 2021). Rationale The design of this quality improvement (QI) initiative followed the John Hopkins Model of change. It incorporates a 3-step practice question, evidence, and translation (PET) process that allows for appraisal and synthesis of evidence and iterative testing of a quality improvement initiative (Dang et al., 2022). The process begins with identifying a practice question, which focuses on a specific clinical issue or opportunity for improvement. Stakeholders and clinicians with expertise in paternal PPD were included to improve the direction of the questions. The evidence phase involves thoroughly reviewing current research, guidelines, and expert opinions 8 to gather data that informs best practices. The translation phase transforms the evidence into specific interventions, integrating them into clinical workflows while addressing barriers to implementation through continuous improvement with academic and clinical input (Dang et al., 2022). Translation of the evidence to intervention will focus the quality improvement initiative on paternal PPD. The Plan, Do, Study, Act (PDSA) cycle is used during the project's implementation phase to seek continuous improvement through evidence-based research and stakeholder engagement (Knudsen et al., 2019). The Plan phase will utilize previously gathered data and develop a plan to test change. The Do phase will implement the change into the intervention. Observation of the changes and problems will occur. The Study phase will observe and compare the gathered data to the expected prediction. Finally, the Act Phase will refine the change based on the results and determine what modifications must be made for the next test. This model will help address the gap in clinical, provide resources for fathers from clinicians, and aid in pursuing continuous improvement. Specific Aims This Doctor of Nursing Practice evidenced-based quality improvement (QI) initiative aims to implement an evidence-based toolkit for clinician use for fathers with postpartum depression and assess feasibility, usability, and clinician satisfaction. Methods Context The QI initiative was conducted in an outpatient psychiatry clinic in urban Utah. The clinic provides in-person and telehealth psychotherapy and medication management psychiatric services and serves patients 13 years and higher. The clinic is located in an urban community in northern Utah but is open to urban and rural locations across Utah due to virtual outreach. The 9 staff comprises six clinicians: one physician assistant, one psychiatric nurse practitioner, and four therapists. Three additional administrative staff were not included in the QI initiative. The project aimed to provide equity and inclusion by advocating for comprehensive care for fathers with paternal PPD through addressing the inequity of available mental health for fathers with a new onset of depression during the postpartum period. The toolkit was created for use as a free resource to help increase clinician knowledge, practice in identifying paternal PPD, and provide support resources for fathers with paternal PPD. Intervention(s) The quality improvement initiative consisted of five phases. These phases consisted of a literature review, assessment of current practices, development of a tailored toolkit and educational presentation, implementation of the toolkit and educational presentation, and evaluation of its effectiveness. Phase 1 involved conducting a comprehensive literature review using PubMed and the National Institutes of Health (NIH) databases. Search terms included postpartum, paternal, clinician awareness, maternal, depression, peripartum, multimodal treatment, paternal support, and paternal toolkit. References from identified articles were reviewed for relevant older studies, and additional articles were located through journal databases (Ebsco host and Google Scholar) based on their relevance to the project. Findings from the literature were used to identify gaps in care and previous approaches to have been studied to improve the quality care of paternal PPD, identification of the disorder, and disorder awareness in the healthcare community. Phase 2 focused on gathering data about existing paternal PPD protocols at the clinic, including identification methods, screening, and diagnostic interventions. A pre-intervention questionnaire was developed and distributed using Research Electronic Data Capture (REDCap) 10 software (Appendix A) (Harris et al., 2019). This survey collected ordinal, nominal, and qualitative data, evaluating current beliefs and identifying barriers to treating paternal PPD (Table 1 and Table 2). Phase 3 involved the creation of the PPAD toolkit, titled Uplifting Fatherhood, which was developed using current research findings, clinical discussions, and feedback gathered during open office hours (Appendix C). The toolkit was modeled after the Kansas Department of Maternal and Child Health handout "Paternal Postpartum Depression." The toolkit consists of five sections. These sections include information on paternal postpartum depression, stigmas fathers experience, how a father’s mental health impacts their children, available treatment options, coping and self-care, and digital resources. An educational PowerPoint presentation (Appendix B) was also created to provide information about paternal PPD, screening and treatment recommendations, and the toolkit's implementation details. The educational PowerPoint presentation aimed to educate and build their awareness of its prevalence based on current research and facilitate an open discussion to implement and track the distribution of the toolkit in their practice. Phase 4 focused on conducting an educational PowerPoint presentation and implementing the toolkit into participants' clinical practice. The presentation was approximately 40 minutes long and included specific criteria for patients to whom the toolkit would be distributed. After the educational presentation, a post-education questionnaire (Appendix D) was provided to participants. Participants received the toolkit in two separate digital options: first, as a PDF, then a link to a Google document containing the toolkit. To support its implementation, open office hours and group discussions were held to clarify the toolkit's content, identify any barriers to its use, and understand participants' attitudes, feelings, and needs regarding paternal PPD care. The 11 PDSA cycle was applied during this phase: participants were asked about their experiences using the toolkit every week during their weekly meetings. The time was spent looking for solutions based on identified gaps in the toolkit application and monitoring the number of toolkits provided to patients. The PDSA cycle was used to continuously improve the toolkit's implementation and increase stakeholder investment in the quality improvement initiative. Phase 5 took place 12 weeks after the toolkit's implementation, during which a postintervention questionnaire was administered to evaluate the usability, feasibility, and clinician satisfaction with the Uplifting Fatherhood toolkit. In the post-intervention questionnaire, participants were asked to share their experiences in presenting the toolkit, their thoughts on the content and barriers to presenting the toolkit to patients, and what could have been improved in the data-collection methods. The questionnaire was developed and distributed through the Research Electronic Data Capture (REDCap) software (Harris et al., 2019). Study of the Intervention(s) The pre-intervention questionnaire was created to identify participants' baseline knowledge, confidence, and current practices regarding paternal PPD. Participants completed a post-implementation questionnaire to determine feasibility, usability, satisfaction, confidence, and change in paternal PPD management. The results from the pre-and post-implementation questionnaires were compared to identify change. A post-education questionnaire was created to identify satisfaction with the survey and to identify early barriers to implementing the Uplifting Fatherhood toolkit. Participants recorded the number of the toolkits they distributed to their patients and recorded them on a Google spreadsheet. This process was followed up weekly to explore the efficacy of tracking copies of the toolkit given, and time was spent discussing any changes that 12 needed to be made based on participant feedback. The PDSA cycle was applied to introduce further change for continuous quality improvement. The expected outcome of this project includes an increase in the number of resource toolkits provided to patients and an increase in provider knowledge and confidence in paternal PPD identification, screening, diagnosis, and disorder management. Measures In Phase 2, the pre-implementation questionnaire was created to assess participants' knowledge, skills, confidence, and current paternal depression screening process. Two multiplechoice questions identified the participant's professional demographics and were organized into themes. Five multiple-choice questions were aimed at identifying a participant's current process for screening, identifying, and diagnosing patients. Four five-item Likert scale questions determined their confidence in identifying and diagnosing paternal PPD in patients. The scales were "strongly agree," "agree," "neutral," "disagree," or "strongly disagree." Finally, an openended question allowed stakeholders to voice concerns over potential barriers to screening for PPADs (Appendix A). In Phase 4, a post-education questionnaire (Appendix D) was created to identify provider satisfaction with the educational component and to address any barriers to implementing a toolkit into practice. Four Likert scale questions explored if the participants believed the material was relevant and if they were satisfied with the presentation. The answers to the Likert questions are the same as those stated in the last paragraph. Two yes/no questions explored whether they would implement the toolkit into practice, and one open-ended question asked them to identify any barriers to implementing it. 13 In Phase 5, the post-implementation questionnaire (Appendix E) evaluated changes in participants' confidence in identifying and diagnosing paternal postpartum depression, using the toolkit, and exploring the feasibility, usability, and sustainability of the quality improvement initiative. Two multiple-choice questions addressed the demographics of the stakeholders. Two multiple-choice questions focused on stakeholders' clinical practice regarding paternal PPD screening. Four Likert questions were taken from the pre-implementation questionnaire to assess for change in confidence in the participants related to paternal postpartum depression. The answers to the questions are the same as those references in the first paragraph of measures. One numeral question allowed participants to record how many toolkits they had distributed. Three Likert and one open-ended question assessed the feasibility, usability, and feasibility of the intervention, and two open-ended questions allowed participants to provide suggestions for improvement and barriers encountered. An online Google spreadsheet was provided to track the number of toolkits distributed. Participants' self-reports were recorded, and the number of copies was recorded at the end of the intervention. Analysis Pre- and post-implementation and post-education questionnaires collected quantitative and qualitative data, including yes/no questions, free-text questions, and five-point Likert scales. Qualitative data were also taken from feedback in follow-up meetings with the stakeholders. Quantitative data were analyzed using descriptive statistics and are represented using percentages and frequencies. Comparisons were made between questions regarding participants' screening methods, the number of screenings conducted in a month, and the participant's confidence levels. Content analysis was used to explore answers to free-text questions to assess for prevalent categories and subcategories. 14 Ethical Considerations The University of Utah Institutional Review Board determined the initiative to be a quality improvement. All participants attended educational presentations, answered questionnaires, and provided feedback on their own accord. Participants were all licensed and experienced professionals, and no identifiable patient or provider information was collected. Results In phase 1, all participants completed the pre-implementation questionnaire, which assessed their current screening processes, confidence, and interests in future resources. Participants, 66.6% (n=4) were licensed therapists, 16.6% (n=1) were a licensed physician assistant (PA), and 16.6% were a licensed psychiatric mental health nurse practitioner PMHNP (Table 1). Most participants (n=4, 66.6%) reported 1 to 5 years of experience in their fields of practice, with one participant (16.6%) reporting 0-1 years and the other reporting 5 to 10 years of experience. The majority (66.6%) of participants (n=4) reported working with paternal postpartum depression or major depressive disorder with peripartum onset (paternal PPD), and 33.3% (n=2) claimed to have screened for the disorder in the last 30 days (Table 2). All participants identified that psychological signs/symptoms of the disorder would prompt them to screen, and 66.6% (n=4) of the participants would screen if their family members expressed concern. Only 16.6% (n=1) made screening for paternal PPD a routine part of their practice. One participant did not screen for paternal PPD and indicated they would screen if prompted by a presentation of psychological signs/symptoms of the disorder. Frequently used screening tools used by participants included 100% (n=6) for the Patient Health Questionnaire (PHQ-9), 83.3% (n=5) for the Generalized Anxiety Disorder (GAD-7), and 66.6% (n=4) used clinical observation skills. Only one participant used the Edinburgh Postnatal Depression Scale (EDPS). When asked about 15 barriers to screening for paternal postpartum disorder, three (50%) responded that men not seeking mental health made it difficult to screen. One participant (16.67%) noted that the clinician's unawareness of the disorder was a barrier, and another participant (16.67%) stated a lack of understanding of when to initiate screenings (Table 2). Participants were asked about their confidence in knowledge and training, identifying the disorder, and determining a diagnosis (Table 2). Four participants (66.6%) felt they had the knowledge and training to recognize paternal postpartum depression, and five (83.3%) felt confident in recognizing the associated signs and symptoms. Only three participants (50%) felt confident identifying patients with paternal PPD and making an accurate diagnosis (Table 2). All six participants strongly agreed they would be willing to implement the provided resources into their practice. In Phase 3, all six (100%) participants were present for the presentation, participated in a PowerPoint presentation, and were able to complete the post-education questionnaire. Findings from the post-education questionnaire indicated that all participants felt that the presentation material provided (Appendix B) was relevant to the needs of the clinic and beneficial for the patients (Table 3). All participants agreed that the information on managing paternal PPD was valuable, and all indicated that they were satisfied with the training and planned to use the Uplifting Fatherhood toolkit (Appendix C, Table 3). Further, all participants agreed to integrate the education into their practice and use the Uplifting Fatherhood toolkit with their patients. During Phase 4, the Uplifting Fatherhood toolkit was integrated into the participant's practice. Criteria for toolkit distribution to specific patients were provided during the PowerPoint presentation, but participants elected to use their criteria to hand out the toolkit. Three changes, Using the PDSA method, three changes were made to the toolkit based on participants' 16 suggestions. A section was created in the toolkit to address the loss of a child. This section was suggested from the experience of a therapist who believed it would improve the inclusivity of the toolkit (Appendix C). Participants also requested a physical way to distribute the toolkit to improve distribution. A facts sheet to understand more about maternal and paternal postpartum depression, with a QR code linked to the virtual toolkit, was determined to be a beneficial option. The clinic owners requested that a rough draft of the facts sheet be sent so their graphic designer could edit and create it. The clinic owners provided no follow-up about creating the physical facts sheet after the rough draft had been sent for their approval. No follow-up was made to the clinic owners after the initial email to create a facts sheet. Finally, participants asked for a better method of reporting distributed toolkits. An Excel spreadsheet, shared with all participants, was determined to solve this problem. Participants could either add their submissions or inform the project leader of the distributed toolkit. Only three distributed toolkits were recorded on the spreadsheet. Follow-up reminders about the spreadsheet were made during their weekly clinic meeting to improve compliance. This was determined to be an underused collection method, and a self-report question was included in the post-intervention questionnaire to assess the quantity of toolkits distributed by participants. In Phase 5, all six participants completed the post-implementation questionnaire. An increase in the number of monthly screenings was reported. Participants stating they conducted 0 screenings dropped from four participants to three participants post-intervention. Two participants (33.3%) reported screening 1 to 5 patients in a month, which was similar to the preintervention findings. One participant (16.7%) reported screening 6-10 patients for paternal postpartum depression, compared to zero participants in the pre-intervention figures (Figure 1). Several changes in participants’ screening methods were reported. There was a reduction in the 17 use of the Generalized Anxiety Disorder-7 (GAD-7) to only 2 (33.3%) participants(compared to five participants pre-intervention), two (33.3%) participants reported they used the Beck Depression Inventory (BDI) (increased from only one participant), and two (33.3%) participants used the Edinburgh Postpartum Depression Scale (EPDS) (which increased from only one participant). Results from the post-intervention questionnaire revealed a change in participants’ confidence (Figure 2). All six reported they felt confident they had the knowledge and training to recognize paternal postpartum depression, which increased from four participants (66.7) preintervention (Table 2). All six reported they were confident in being able to identify a patient with paternal postpartum depression. This increased from only three participants preintervention. Five participants (83.3%) reported they were confident in recognizing the signs and symptoms of the disorder and making an accurate diagnosis; one response was missing. No change was indicated for this measure. All participants agreed they felt confident making a paternal PPD diagnosis, compared to only three (50%) pre-intervention. Four questions were focused on determining the intervention's feasibility, usability, and satisfaction. One open-ended question allowed participants to voice what barriers they saw in the toolkit and improvements they would like to see in their clinic regarding identifying, screening, and treating patients with paternal postpartum depression. For usability, all participants agreed that the toolkit was simple to integrate into their practice. In addition, all participants agreed that the project enhanced their ability to discuss paternal postpartum depression with their patients. All participants agreed that the toolkit was sustainable and planned to continue using it in their practice. Participants suggested three factors that would improve the feasibility of the toolkit: a QR code, the option of a physical copy, and a 18 "session-by-session guide for clinicians to implement." Barriers to implementing the toolkit into practice included personal disorganization and forgetting where they had saved the digital copy. The suggestion to "implement the toolkit into the EHR" (Table 2) was provided to improve this barrier. To expand screenings and treatment of paternal postpartum in the clinic, participants suggested improved advertising for men, specifically fathers, to encourage increased mental health help-seeking among men and reduce the stigma. One participant reported that they would like to find a way to identify patients with new babies to aid in the screening process. Discussion Summary Findings revealed that after implementing the toolkit into clinical practice, there was an overall increase in participant confidence in identifying, screening, and diagnosing paternal PPD. After implementation, 100% of participants agreed that this project enhanced their ability to discuss paternal peripartum affective disorders with their patients and families. All participants indicated that the toolkit was simple to integrate into their practice and would continue using it. There was a slight increase in reported screenings conducted each month. Participants were able to identify barriers to implementing the toolkit, such as a patient stigma for mental illness, personal disorganization, and patient unawareness of the disorder. A significant strength of the quality improvement initiative was the education component. Following the PowerPoint presentation, 100% of the participants agreed that the education benefited their practice and were satisfied with the material. All participants planned to integrate the training into their practice and agreed to use the proposed Uplifting Fatherhood toolkit. Interpretation The results of this quality improvement initiative support the theorized implementation of improving awareness, education on clinical practice, and resources to clinicians for paternal 19 peripartum depression. In congruence with Essadek et al. (2024) and Pedersen et al. (2021), implementing training and resources benefits the clinician through improved confidence in identifying, screening tool use, and diagnosis. Improved clinician knowledge aids in shortening the gap of care through improved identification of symptoms for paternal PPD. The improvement of disorder identification shortens the time to disorder management and benefits the mental health outcomes of both fathers and their children (Bruno et al., 2020). The limited pre- and postintervention report of the use of the Edinburgh postnatal depression scale was unexpected as this was presented as the current gold standard for screening for paternal postpartum depression. This initiative provides healthcare providers with a toolkit at no monetary cost and is easy to integrate into a user's current practice. The no-cost approach is intended to encourage providers to integrate the toolkit into their practice to reflect the full benefit of the initiative for providers and patients. Facts sheets, a modified physical copy, and QR codes are other strategies that would improve access to the toolkit and not limit access to digital options. Limitations Data collection presented as a significant limitation. Due to the request of the clinical site, chart reviews were not conducted to collect data on the toolkit distribution. The proposed Excel spreadsheet rendered only a few submissions, which limited data collection related to toolkit distribution. A question was added to the post-intervention questionnaire to track the toolkits distributed at the end of the 12-week intervention period. This limited the accuracy of the number of toolkits distributed due to recall bias. Conclusions This quality improvement initiative improved confidence, knowledge, and resources for clinicians in a mental health setting by implementing a paternal PPD-specific toolkit and 20 educational presentation. Participants found this initiative to be valuable to their practice. They determined that the initiative was easy to integrate and a usable resource for future clinical practice. Participants voiced that barriers such as the unavailability of a physical copy limited distribution, and integrating the toolkit into their EHR would help improve distribution. Barriers such as mental health stigma among men remained before and after the intervention period, limiting the clinician's access to providing resources and services to the desired population. Implementing the quality improvement initiative among different medical disciplines will improve representation among healthcare professionals. Disciplines such as family medicine, obstetrics, and pediatrics all play a role in the health of the family dynamic, which presents the opportunity to interact with fathers or members of the family who are in direct contact with them. Future projects could focus on providing resources for fathers in clinical locations that do not specialize in mental health, potentially in specialties such as obstetrics, pediatrics, and family practice. Other areas of focus include strategies to decrease mental health stigmatization and increase help-seeking behaviors among fathers. Acknowledgments I want to thank Dr. Megan Hebdon, Project Chair; Dr. Colin Riley, Content Expert; Dr. Julie Gee, Assistant Dean of Academic Affairs; Dr. Sheila Deyette, Program Director; and the participants who participated in the quality improvement initiative. 21 References Akalin, A., D’haenens, F., Tricas-Sauras, S., Vermeulen, J., Demedts, D., Buyl, R., & Fobelets, M. (2025). Awareness, knowledge, and attitudes of the Belgian general population towards paternal perinatal depression: A descriptive cross-sectional study. Frontiers in Psychiatry, 15. https://doi.org/10.3389/fpsyt.2024.1455629 Ansari, N. S., Shah, J., Dennis, C.-L., & Shah, P. S. (2021). Risk factors for postpartum depressive symptoms among fathers: A systematic review and meta-analysis. Acta Obstetricia et Gynecologica Scandinavica, 100(7), 1186–1199. https://doi.org/10.1111/aogs.14109 Ashraf, S., Shah, K., Vadukapuram, R., Shah, B., Jaiswal, S., Mansuri, Z., & Jain, S. (2023). Impact of paternal depression on child neurodevelopmental outcomes and disorders. The Primary Care Companion for CNS Disorders, 25(1). https://doi.org/10.4088/PCC.22r03303 Attia Hussein Mahmoud, H., Lakkimsetti, M., Barroso Alverde, M. J., Shukla, P. S., Nazeer, A. T., Shah, S., Chougule, Y., Nimawat, A., & Pradhan, S. (2024). Impact of paternal postpartum depression on maternal and infant health: A narrative review of the literature. Cureus, 16(8), e66478. https://doi.org/10.7759/cureus.66478 Bruno, A., Celebre, L., Mento, C., Rizzo, A., Silvestri, M. C., De Stefano, R., Zoccali, R. A., & Muscatello, M. R. A. (2020). When fathers begin to falter: A comprehensive review on paternal perinatal depression. International Journal of Environmental Research and Public Health, 17(4). https://doi.org/10.3390/ijerph17041139 Cameron, E. E., Hunter, D., Sedov, I. D., & Tomfohr-Madsen, L. M. (2017). What do dads want? Treatment preferences for paternal postpartum depression. Journal of Affective Disorders, 215, 62–70. https://doi.org/10.1016/j.jad.2017.03.031 22 Carlson, K., Mughal, S., Azhar, Y., & Siddiqui, W. (2024). Postpartum depression. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK519070/ Chhabra, J., Li, W., & McDermott, B. (2022). Predictive Factors for Depression and Anxiety in Men During the Perinatal Period: A Mixed Methods Study. American Journal of Men's Health, 16(1). https://doi.org/10.1177/15579883221079489 Dang, D., Dearholt, S., Bissett, K., Ascenzi, J., & Whalen, M. (2022). Johns Hopkins evidencebased practice for nurses and healthcare professionals: Model and guidelines. 4th ed. Sigma Theta Tau International https://ebookcentral.proquest.com/lib/utah/detail.action?docID=6677828. Davenport, C., Lambie, J., Owen, C., & Swami, V. (2022). Fathers' experiences of depression during the perinatal period: A qualitative systematic review. JBI Evidence Synthesis, 20(9). https://doi.org/10.11124/JBIES-21-00365 Department of Health and Human Services. (2024, August 28). U.S. Surgeon General issues advisory on the mental health and well-being of parents. https://www.hhs.gov/about/news/2024/08/28/us-surgeon-general-issues-advisory-mentalhealth-well-being-parents.html Eddy, B., Poll, V., Whiting, J., & Clevesy, M. (2019). Forgotten fathers: Postpartum depression in men. Journal of Family Issues, 40(8), 1001–1017. https://doi.org/10.1177/0192513X19833111 Essadek, A., Marie, A., Rioux, M.-A., Corruble, E., & Gressier, F. (2024). Perception of paternal postpartum depression among healthcare professionals: A qualitative study. Healthcare, 12(1), Article 1. https://doi.org/10.3390/healthcare12010068 23 Goldstein, Z., Rosen, B., Howlett, A., Anderson, M., & Herman, D. (2020). Interventions for paternal perinatal depression: A systematic review. Journal of Affective Disorders, 265, 505–510. https://doi.org/10.1016/j.jad.2019.12.029 Harris, P. A., Taylor, R., Minor, B. L., Elliott, V., Fernandez, M., O'Neal, L., McLeod, L., Delacqua, G., Delacqua, F., Kirby, J., & Duda, S. N. (2019). The REDCap consortium: Building an international community of software platform partners. Journal of Biomedical Informatics, 95, 103208. https://doi.org/10.1016/j.jbi.2019.103208 Knudsen, S. V., Laursen, H. V. B., Johnsen, S. P., Bartels, P., Ehlers, L. H., & Mainz, J. (2019). Can quality improvement improve the quality of care? A systematic review of reported effects and methodological rigor in plan-do-study-act projects. BMC Health Services Research, 19(1). https://doi.org/10.1186/s12913-019-4482-6 Nishigori, H., Obara, T., Nishigori, T., Metoki, H., Mizuno, S., Ishikuro, M., Sakurai, K., Hamada, H., Watanabe, Z., Hoshiai, T., Arima, T., Nakai, K., Kuriyama, S., & Yaegashi, N. (2020). The prevalence and risk factors for postpartum depression symptoms of fathers at one and 6 months postpartum: An adjunct study of the Japan environment & children's study. The Journal of Maternal-Fetal & Neonatal Medicine, 33(16), 2797– 2804. https://doi.org/10.1080/14767058.2018.1560415 Paulson, J. F., & Bazemore, S. D. (2010). Prenatal and postpartum depression in fathers and its association with maternal depression: A meta-analysis. JAMA, 303(19), 1961–1969. https://doi.org/10.1001/jama.2010.605 Pedersen, S. C., Maindal, H. T., & Ryom, K. (2021). "I wanted to be there as a father, but I could not": A qualitative study of fathers' experiences of postpartum depression and their help- 24 seeking behavior. American Journal of Men's Health, 15(3). https://doi.org/10.1177/15579883211024375 Rao, W.-W., Zhu, X.-M., Zong, Q.-Q., Zhang, Q., Hall, B. J., Ungvari, G. S., & Xiang, Y.-T. (2020). Prevalence of prenatal and postpartum depression in fathers: A comprehensive meta-analysis of observational surveys. Journal of Affective Disorders, 263, 491–499. https://doi.org/10.1016/j.jad.2019.10.030 Reay, M., Mayers, A., Knowles-Bevis, R., & Knight, M. T. D. (2023). Understanding the barriers fathers face to seeking help for paternal perinatal depression: Comparing fathers to men outside the perinatal period. International Journal of Environmental Research and Public Health, 21(1). https://doi.org/10.3390/ijerph21010016 Rodrigues, A. L., Ericksen, J., Watson, B., Gemmill, A. W., & Milgrom, J. (2021). Interventions for perinatal depression and anxiety in fathers: A mini-review. Frontiers in Psychology, 12. https://doi.org/10.3389/fpsyg.2021.744921 Simhi, M., Sarid, O., & Cwikel, J. (2019). Preferences for mental health treatment for postpartum depression among new mothers. Israel Journal of Health Policy Research, 8(1), 84. https://doi.org/10.1186/s13584-019-0354-0 Schmitz, K., Jimenez, M. E., Corman, H., Noonan, K., & Reichman, N. E. (2024). Paternal depression in the postpartum year and children's behaviors at age 5 in an urban U.S. birth cohort. PloS One, 19(4). https://doi.org/10.1371/journal.pone.0300018 Utah Department of Health and Human Services. (2024, February 29). Complete health indicator report depression: Adult prevalence. https://ibis.utah.gov/ibisphview/indicator/complete_profile/Dep.html 25 Utah Department of Health and Human Services. (2024, August 1). Complete health indicator report: Postpartum depression. https://ibis.utah.gov/ibisphview/indicator/complete_profile/PPD.html Wainwright, S., Caskey, R., Rodriguez, A., Holicky, A., Wagner-Schuman, M., & Glassgow, A. E. (2023). Screening fathers for postpartum depression in a maternal-child health clinic: A program evaluation in a midwest urban academic medical center. BMC Pregnancy and Childbirth, 23(1). https://doi.org/10.1186/s12884-023-05966-y Walsh, T. B., Davis, R. N., & Garfield, C. (2020). A Call to Action: Screening Fathers for Perinatal Depression. Pediatrics, 145(1). https://doi.org/10.1542/peds.2019-1193 Żyrek, J., Klimek, M., Apanasewicz, A., Ciochoń, A., Danel, D. P., Marcinkowska, U. M., Mijas, M., Ziomkiewicz, A., & Galbarczyk, A. (2024). Social support during pregnancy and the risk of postpartum depression in Polish women: A prospective study. Scientific Reports, 14(1). https://doi.org/10.1038/s41598-024-57477-1 26 Tables and Figures Table 1 Participant Demographics (N=6) Professional role Nurse Practitioner Physician Assistant Therapist Other Experience in role Less than 1 year 1 to 5 years 5 to 10 years Greater than 10 years Pre-Intervention n= 6 (%) Post-Intervention n= 6 (%) 1 (16.7) 1 (16.7) 4 (66.7) 0 (0) 1 (16.7) 1 (16.7) 4 (66.7) 0 (0) 1 (16.7) 4 (66.7) 1 (16.7) 0 (0) 1 (16.7) 3 (50) 2 (16.7) 0 (0) 27 Table 2 PPADs Experience and Confidence in Providers at an Outpatient Psychiatry Clinic (N = 6) Pre-Intervention n=6 (%) Post-Intervention n=6 (%) Yes, once Yes, more than once No Unsure Do you believe that paternal postpartum depression is a problem among patients in your practice? 1 (16.7) 3 (50.0) 1 (16.7) 1 (16.7) N/A N/A N/A N/A Yes No Somewhat Unsure What prompts you to screen for paternal postpartum depression? Psychological signs/symptoms Patient expresses concern Family member expresses concern Routine screening Other I don't screen Around how many patients have you screened for paternal postpartum depression in the last month? 0 1-5 6-10 11-15 16-20 21-30 More than 30 If you do screen for paternal postpartum depression, what screener(s) do you use? Edinburgh Postnatal Depression Scale Patient Health Questionnaire Generalized Anxiety Disorder-7 Beck Depression Inventory Clinical Interview & Observation 6 (100) 0 (0) 0 (0) 0 (0) N/A N/A N/A N/A 6 (100) 3 (50.0) 4 (66.7) 1 (16.7) 0 (0) 1 (16.7) N/A N/A N/A N/A N/A N/A 4 (66.7) 2 (33.3) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 3 (50) 2 (33.3) 1 (16.7) 0 (0) 0 (0) 0 (0) 0 (0) 1 (16.7) 2 (33.3) 6 (100) 5 (83.3) 1 (16.7) 4 (66.7) 4 (66.7) 2 (33.3) 2 (33.3) 4 (66.7) While working in my profession, I have directly or indirectly interacted with a patient with paternal postpartum depression or major depression with peripartum onset. 28 What do you feel are the greatest barriers to screening for paternal postpartum depression? Men seeking help/stigma Clinicians who are unaware When to initiate screenings I have the knowledge and training needed to recognize when a patient may have paternal postpartum depression Strongly agree Agree Neutral Disagree Strongly Disagree I feel confident that I am adequately identifying patients with paternal postpartum depression in my clinic Strongly agree Agree Neutral Disagree Strongly Disagree I feel confident in my ability to identify signs and symptoms of paternal postpartum depression Strongly agree Agree Neutral Disagree Strongly Disagree Missing I feel confident making a diagnosis of paternal postpartum depression Strongly agree Agree Neutral Disagree Strongly Disagree Please provide any suggestions you have to improve the toolkit and access to the toolkit Include QR Code Physical Handout None Pre-Intervention n=6 (%) Post-Intervention n=6 (%) 3 (50) 1 (16.7) 1 (16.7) N/A N/A N/A 2 (33.3) 2 (33.3) 1 (16.7) 1 (16.7) 0 (0) 2 (33.3) 4 (66.7) 0 (0) 0 (0) 0 (0) 2 (33.3) 1 (16.7) 3 (50) 0 (0) 0 (0) 2 (33.3) 4 (66.7) 0 (0) 0 (0) 0 (0) 2 (33.3) 3 (50) 1 (16.7) 0 (0) 0 (0) N/A 3 (50) 2 (33.3) 0 (0) 0 (0) 0 (0) 1 (16.7) 2 (33.3) 1 (16.7) 3 (50) 0 (0) 0 (0) 3 (50) 3 (50) 0 (0) 0 (0) 0 (0) N/A N/A N/A 1 (16.7) 1 (16.7) 2 (33.3) 29 If given the resources to improve the diagnosis and treatment of paternal postpartum depression, I would be willing to implement them into my practice Strongly agree Agree Neutral Disagree Strongly Disagree How often have you shared the Uplifting Fatherhood Toolkit with a patient in the last 90 days? Nurse Practitioner Physician Assistant Therapists The Uplifting Fatherhood toolkit was simple to integrate into my practice Strongly agree Agree Neutral Disagree Strongly Disagree I plan to continue using the Uplifting Fatherhood toolkit in my practice Strongly agree Agree Neutral Disagree Strongly Disagree This project enhanced my ability to discuss peripartum paternal mood disorder treatment options with patients and families. Strongly agree Agree Neutral Disagree Strongly Disagree What barriers did you encounter with providing the Uplifting Fatherhood toolkit to patients? Personal Disorganization Getting men who need toolkit into therapy Patient Unawareness to disorder Pre-Intervention n=6 (%) Post-Intervention n=6 (%) 6 (100.0) 0 (0) 0 (0) 0 (0) 0 (0) N/A N/A N/A N/A N/A N/A N/A N/A 8 2 6 N/A N/A N/A N/A N/A 2 (33.33) 4 (66.67) 0 0 0 N/A N/A N/A N/A N/A 5 (83.33) 1 (16.67) 0 0 0 N/A N/A N/A N/A N/A 5 (83.33) 1 (16.67) 0 0 0 N/A N/A 1 (16.7) 1 (16.7) N/A 1 (16.7) 30 Please provide any suggestions you have to improve the toolkit and access to the toolkit. A QR code Physical copy Session by session guide for clinicians None What would you like to see improve in identifying, screening, and treating peripartum paternal affect disorders in your clinic? Identify patients with new babies Group support therapy for men Increased Advertisement to men Normalizing men's mental health None Pre-Intervention n=6 (%) Post-Intervention n=6 (%) N/A N/A N/A 1 (16.7) 1 (16.7) 1 (16.7) N/A 2 (33.3) N/A N/A N/A N/A N/A 1 (16.7) 1 (16.7) 1 (16.7) 1 (16.7) 1 (16.7) 31 Table 3 Post Education Questionnaire (N=6) Post Education n=6 (%) Do you feel the material provided today is relevant to the needs of the clinic? Strongly agree Agree Neutral Disagree Strongly Disagree Was the educational training on paternal postpartum depression beneficial for your work with patients? Strongly agree Agree Neutral Disagree Strongly Disagree Were you satisfied with today's training on paternal postpartum depression? Strongly agree Agree Neutral Disagree Strongly Disagree Was the information on the importance of managing paternal postpartum depression valuable Strongly agree Agree Neutral Disagree Strongly Disagree Do you see yourself using the Uplifting Fatherhood toolkit with your patients? Yes No Maybe Do you see yourself integrating the information provided in this training into your practice? Yes No Maybe Please describe any perceived barriers to implementing the Uplifting Fatherhood Toolkit into your practice. Men seeking mental healthcare Mental health stigma 5 (83.33) 1 (16.67) 0 (0) 0 (0) 0 (0) 6 (100) 0 (0) 0 (0) 0 (0) 0 (0) 6 (100) 0 (0) 0 (0) 0 (0) 0 (0) 5 (83.33) 1 (16.67) 0 (0) 0 (0) 0 (0) 6 (100) 0 (0) 0 (0) 6 (100) 0 (0) 0 (0) 2 (33.3) 1 (16.7) 32 Figure 1 Change in Screenings Completed for Paternal Postpartum Depression NUMBER OF SCREENINGS COMPLETED Post-Intervention 0 SCREENINGS 1-5 SCREENINGS 6-10 SCREENINGS 0 0 0 1 2 2 3 4 Pre-Intervention GREATER THAN 10 SCREENINGS 33 Figure 2 Change in Confidence from Pre- and Post-Intervention Questionnaires Change in Confidence Pre- and Post-Intervention (N=6) 7 6 5 4 3 2 1 0 Knowledge and Training Adequately Identifying Pre-intervention Confidence (Stongly Agreed/Agreed) Identify Sigs/Symptoms Making Diagnosis Post-intervention Confidence (Stongly Agreed/Agreed) 34 Appendix A Pre-Intervention Questionnaire 1. What is your Professional Role? a. Therapist b. Nurse Practitioner c. Physician's Assistant d. Other 2. How many years of experience do you have in your role? a. Less than 1 year b. 1-5 years c. 6-10 years d. More than 10 years 3. While working in my profession, I have directly or indirectly interacted with a patient with paternal postpartum depression or major depression with peripartum onset. a. Yes, it has happened once b. Yes, it has happened more than once c. No d. Unsure 4. Do you believe that paternal postpartum depression is a problem among patients in your practice? a. Yes b. No c. Somewhat d. Unsure 5. What prompts you to screen for paternal postpartum depression? (Select all that apply) a. Patient shows psychological signs/symptoms b. Patient expresses concern for paternal postpartum depression c. Partner or family member expresses concern d. Routine screening in postnatal visits e. Other f. I don't screen for paternal postpartum depression 6. Around how many patients have you screened for paternal postpartum depression in the last month? a. 0 b. 1-5 c. 6-10 d. 11-15 e. 16-20 f. 21-30 g. More than 30 35 7. If you do screen for paternal postpartum depression, what screener(s) do you use? (Select all that apply) a. Edinburgh Postnatal Depression Scale (EPDS) b. Patient Health Questionnaire (PHQ-9) c. Generalized Anxiety Disorder 7 (GAD-7) d. Beck Depression Inventory (BDI) e. Clinical interviews and observational methods f. Other (please specify): 8. What do you feel are the greatest barriers to screening for paternal postpartum depression? 9. I have the knowledge and training needed to recognize when a patient may have paternal postpartum depression. a. Strongly agree b. Agree c. Neutral d. Disagree e. Strongly disagree 10. I feel confident that I am adequately identifying patients with paternal postpartum depression in my clinic. a. Strongly agree b. Agree c. Neutral d. Disagree e. Strongly disagree 11. I feel confident in my ability to identify signs and symptoms of paternal postpartum depression. a. Strongly agree b. Agree c. Neutral d. Disagree e. Strongly disagree 12. I feel confident making a diagnosis of paternal postpartum depression. a. Strongly agree b. Agree c. Neutral d. Disagree e. Strongly disagree 13. If given the resources to improve the diagnosis and treatment of paternal postpartum depression, I would be willing to implement them into my practice a. Strongly agree b. Agree c. Neutral d. Disagree e. Strongly disagree 36 Appendix B Educational PowerPoint 37 38 39 Appendix C Uplifting Fatherhood Toolkit 40 41 42 43 44 Appendix D Post Education Questionnaire 1. Do you feel the material provided today is relevant to the needs of the clinic? 2. 3. 4. 5. 6. 7. a. Strongly agree b. Agree c. Neutral d. Disagree e. Strongly disagree Was the educational training on paternal postpartum depression beneficial for your work with patients? a. Strongly agree b. Agree c. Neutral d. Disagree e. Strongly disagree Were you satisfied with today's training on paternal postpartum depression? a. Strongly agree b. Agree c. Neutral d. Disagree e. Strongly disagree Was the information on the importance of managing paternal postpartum depression valuable? a. Strongly agree b. Agree c. Neutral d. Disagree e. Strongly disagree Do you see yourself using the Uplifting Fatherhood toolkit with your patients? a. Yes b. No Do you see yourself integrating the information provided in this training into your practice? a. Yes b. No Please describe any perceived barriers to implementing the Uplifting Fatherhood Toolkit into your practice. 45 Appendix E Post Implementation Questionnaire 1. What is your Professional Role? a. Therapist b. Nurse Practitioner c. Physician's Assistant d. Other 2. How many years of experience do you have in your role? a. Less than 1 year b. 1-5 years c. 6-10 years d. More than 10 years 3. Around how many patients have you screened for paternal postpartum depression in the last month? a. 0 b. 1-5 c. 6-10 d. 11-15 e. 16-20 f. 21-30 g. More than 30 4. If you do screen for paternal postpartum depression, what screener(s) do you use? (Select all that apply) a. Edinburgh Postnatal Depression Scale (EPDS) b. Patient Health Questionnaire (PHQ-9) c. Generalized Anxiety Disorder 7 (GAD-7) d. Beck Depression Inventory (BDI) e. Clinical interviews and observational methods f. Other (please specify): 5. I have the knowledge and training needed to recognize when a patient may have paternal postpartum depression. a. Strongly agree b. Agree c. Neutral d. Disagree e. Strongly disagree 6. I feel confident that I am adequately identifying patients with paternal postpartum depression in my clinic. a. Strongly agree b. Agree c. Neutral d. Disagree e. Strongly disagree 46 7. I feel confident in my ability to identify signs and symptoms of paternal postpartum depression. a. Strongly agree b. Agree c. Neutral d. Disagree e. Strongly disagree 8. I feel confident making a diagnosis of paternal postpartum depression. a. Strongly agree b. Agree c. Neutral d. Disagree e. Strongly disagree 9. How often have you shared the Uplifting Fatherhood Toolkit with a patient in the last 90 days? (Enter a number): 10. The Uplifting Fatherhood toolkit was simple to integrate into my practice a. Strongly agree b. Agree c. Neutral d. Disagree e. Strongly disagree 11. I plan to continue using the Uplifting Fatherhood toolkit in my practice a. Strongly agree b. Agree c. Neutral d. Disagree e. Strongly disagree 12. This project enhanced my ability to discuss peripartum paternal mood disorder treatment options with patients and families. a. Strongly agree b. Agree c. Neutral d. Disagree e. Strongly disagree 13. Please provide any suggestions you have to improve the toolkit and access to the toolkit. 14. What barriers did you encounter with providing the Uplifiting Fatherhood toolkit to patients? 15. What would you like to see improve in identifying, screening, and treating peripartum paternal affect disorders in your clinic? 47 Appendix F !"#$B&'E#)*B++I-.)) *B++I-.!! "#A%CD#E!F*HAF#CAI-!.%FC%HH/*DM!*C!-#N*C!.%FC%HH/*D!O/AP!F%C/F#CAI-!*DH%AM!/H!#D!ID.%CHAI./%.!#D.!ID.%CH%CQ%.!-%DA#E! P%#EAP!./H*C.%CR!SFFC*T/-#A%EU!9W;<=!*>!>#AP%CH!O/EE!FC%H%DA!O/AP!D%O!HU-FA*-H!*>!.%FC%HH/*D!/D!AP%!F%C/D#A#E!F%C/*.M! HF%?/>/?#EEU!/D!AP%!F*HAF#CAI-!F%C/*.R!@P%!AI#E/AU!/-FC*Q%-%DA!/D/A/#A/Q%!#..C%HH%.!AP%!D%%.!>*C!-*C%!C%H*IC?%H!#D.!A*! /-FC*Q%!?E/D/?/#DHB!#C/E/AU!A*!/.%DA/>UM!H?C%%D!>*CM!#D.!./#aD*H%!F#A%CD#E!F*HAF#CAI-!.%FC%HH/*DR!b-FE%-%DA/Da!#! 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