TY - JOUR
KW - Adult
KW - Depression, Postpartum/epidemiology/therapy
KW - Female
KW - Home Care Services
KW - House Calls
KW - Humans
KW - Maternal Health Services
KW - Pregnancy
KW - Quality Improvement
KW - United States/epidemiology
AU - D. Tandon
AU - M. Mackrain
AU - L. Beeber
AU - N. Topping-Tailby
AU - M. Raska
AU - M. Arbour
A1 - 
AB - BACKGROUND: Maternal depression is common among low-income women enrolled in home visiting programs, yet there is considerable variability in the extent to which it is identified and addressed. This study examines outcomes related to postpartum depression screening, receipt of evidence-based services, and reductions in depressive symptoms among clients of home visiting programs in the Health Resources and Services Administration's Maternal, Infant, and Early Childhood Home Visiting Program Home Visiting Collaborative Improvement and Innovation Network (HV CoIIN), the first U.S. national application of the Institute for Healthcare Improvement's Breakthrough Series (BTS) Model in home visiting programs. METHODS AND FINDINGS: Fourteen home visiting programs in eight states, serving a geographically and racially diverse caseload of pregnant women and new mothers, took part in the HV CoIIN. Women in participating home visiting programs received the intervention strategies implemented by their program during participation in the collaborative. HV CoIIN strategies included specific policies and protocols for depression screening and home visitor response to screening results; home visitor training and supervision; delivery of prevention and treatment interventions; and tracking systems for screening, referral, and follow-up. HV CoIIN's proposed primary outcome was that 85% of women who accessed evidence-based services would experience a 25% reduction in depressive symptoms three months after accessing services. Secondary outcomes included an increased percentage of women who were screened for depression within three months of enrollment or birth, who verbally accepted a referral to evidence-based services, and who received one or more evidence-based service contacts. HV CoIIN resulted in improved symptoms among women who accessed services, from 51.1% to 59.9%. HV CoIIN also improved the percent of women screened for depression, from 83.6% to 96.3%, and those with positive depression screens who accessed evidence-based services, from 41.6% to 65.5%. Home visiting programs in this study were early adopters of quality improvement activities, which may limit the generalizability of these results to other home visiting programs. CONCLUSIONS: Home visiting programs can play an important role in closing gaps in maternal depression identification, referrals, service access, and symptom alleviation. Continuous quality improvement and BTS collaborative methods can be used to improve home visiting services in ways that advance national public health priorities and improve population health outcomes.
AD - Institute for Public Health and Medicine, Northwestern Feinberg School of Medicine, Chicago, IL, United States of America.; Education Development Center, Inc., Waltham, MA, United States of America.; School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America.; Education Development Center, Inc., Waltham, MA, United States of America.; Education Development Center, Inc., Waltham, MA, United States of America.; Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, United States of America.
BT - PloS one
C5 - Healthcare Disparities; Medical Home
CP - 4
DO - 10.1371/journal.pone.0230211
IS - 4
JF - PloS one
LA - eng
M1 - Journal Article
N2 - BACKGROUND: Maternal depression is common among low-income women enrolled in home visiting programs, yet there is considerable variability in the extent to which it is identified and addressed. This study examines outcomes related to postpartum depression screening, receipt of evidence-based services, and reductions in depressive symptoms among clients of home visiting programs in the Health Resources and Services Administration's Maternal, Infant, and Early Childhood Home Visiting Program Home Visiting Collaborative Improvement and Innovation Network (HV CoIIN), the first U.S. national application of the Institute for Healthcare Improvement's Breakthrough Series (BTS) Model in home visiting programs. METHODS AND FINDINGS: Fourteen home visiting programs in eight states, serving a geographically and racially diverse caseload of pregnant women and new mothers, took part in the HV CoIIN. Women in participating home visiting programs received the intervention strategies implemented by their program during participation in the collaborative. HV CoIIN strategies included specific policies and protocols for depression screening and home visitor response to screening results; home visitor training and supervision; delivery of prevention and treatment interventions; and tracking systems for screening, referral, and follow-up. HV CoIIN's proposed primary outcome was that 85% of women who accessed evidence-based services would experience a 25% reduction in depressive symptoms three months after accessing services. Secondary outcomes included an increased percentage of women who were screened for depression within three months of enrollment or birth, who verbally accepted a referral to evidence-based services, and who received one or more evidence-based service contacts. HV CoIIN resulted in improved symptoms among women who accessed services, from 51.1% to 59.9%. HV CoIIN also improved the percent of women screened for depression, from 83.6% to 96.3%, and those with positive depression screens who accessed evidence-based services, from 41.6% to 65.5%. Home visiting programs in this study were early adopters of quality improvement activities, which may limit the generalizability of these results to other home visiting programs. CONCLUSIONS: Home visiting programs can play an important role in closing gaps in maternal depression identification, referrals, service access, and symptom alleviation. Continuous quality improvement and BTS collaborative methods can be used to improve home visiting services in ways that advance national public health priorities and improve population health outcomes.
PY - 2020
SN - 1932-6203; 1932-6203
T1 - Addressing maternal depression in home visiting: Findings from the home visiting collaborative improvement and innovation network
T2 - PloS one
TI - Addressing maternal depression in home visiting: Findings from the home visiting collaborative improvement and innovation network
U1 - Healthcare Disparities; Medical Home
U2 - 32298289
U3 - 10.1371/journal.pone.0230211
VL - 15
VO - 1932-6203; 1932-6203
Y1 - 2020
Y2 - Apr 16
ER -