Introducing and Integrating Perinatal Mental Health Screening: Development of an Equity-informed Evidence-based Approach

Abstract

Background: Pregnancy is a time of increased risk for developing or re-experiencing mental illness. Perinatal mental health screening for all women is recommended in many national guidelines but a number of systems-level and individual barriers often hinder policy implementation. These barriers result in missed opportunities for detection and early intervention, and are likely to be experienced disproportionately by women from culturally and linguistically diverse backgrounds, including women of refugee backgrounds. The objectives of this study were to develop a theory-informed, evidence-based guide for introducing and integrating perinatal mental health screening across health settings; and to synthesise the learnings from an implementation initiative and multi-sectoral partnership between the Centre of Perinatal Excellence (COPE), and a university-based research centre. COPE is a peak body in perinatal mental health and Non-Governmental Organization commissioned to update the Australian national perinatal mental health guidelines, train health professionals and rollout innovative digital screening across healthcare settings. Methods: In this case study, barriers to implementation were prospectively identified and strategies to overcome them were developed. A pilot perinatal screening program with a strong health equity focus was implemented and evaluated at a large public maternity service delivering care to a culturally diverse population of women in metropolitan Melbourne, Australia, including women of refugee background. Strategies identified pre-implementation and post-evaluation were mapped to theoretical frameworks. An implementation guide was developed to support future policy, planning and decision-making by healthcare organisations. Results: Using a behavioural change framework (COM-B), the key barriers, processes, and outcomes are described for a real-world example designed to maximise accessibility, feasibility, and acceptability. A program logic model was developed to demonstrate the relationships of the inputs, which included stakeholder consultation, resource development, and a digital screening platform, with the outcomes of the program. A seven-stage implementation guide is presented for use in a range of healthcare settings. Conclusions: These findings describe an equity-informed, evidence-based approach that can be used by healthcare organisations to address common systems and individual level barriers to implement perinatal mental health screening guidelines.

Disrupting patterns of exclusion in participatory spaces: Involving people from vulnerable populations

“…Second, what kind of methods are used in projects based on these partnerships? The papers report systematic reviews, 23–25 original research using qualitative, quantitative and mixed‐methods studies 26,29–31,34–37,39–42 and reflective practice 22 . This resonates with a key finding in the wider literature about meaningful partnerships 3,4 : collaborative research orientation is the core issue rather than the nature of the methods being used.…”

“…First, we consider who is in spaces for sharing decisions about research, services and policy in this special issue. There are papers with lead authors from seven countries: the United Kingdom, 22–28 Australia, 29–33 Canada, 34–38 the United States, 39,40 the Netherlands, 41,42 France 43 and Ecuador 44 . There are important examples involving people who experience homelessness, 22,23,34 people who have disabilities, 26,41,42 people who live in socioeconomically disadvantaged circumstances 35,37 and people who are migrants and/or from ethnic minority groups 25,31,36 .…”

“…There are papers with lead authors from seven countries: the United Kingdom, 22–28 Australia, 29–33 Canada, 34–38 the United States, 39,40 the Netherlands, 41,42 France 43 and Ecuador 44 . There are important examples involving people who experience homelessness, 22,23,34 people who have disabilities, 26,41,42 people who live in socioeconomically disadvantaged circumstances 35,37 and people who are migrants and/or from ethnic minority groups 25,31,36 . There are also papers involving people with diabetes who experience stigma because of their condition 30 and COVID vulnerable populations, such as those with genetic, undiagnosed and rare disorders 39 .…”

Measuring the Optimal Time Interval Between Arrival and First Mental Health Evaluation’s for Refugees in Québec: A Scoping Review

“…To propose a framework for good practice to promote improved access, equity, and quality of care in service delivery for newly arrived refugee children X X need or lack of training for practitioners on refugee health, refugee mental health assessment, and how to address traumatic experiences with refugees (Anude, 2008;Blackmore, 2021;Fängström, Dahlberg, Ådahl, Rask, et al, 2019;Kaltenbach, Härdtner, Hermenau, Schauer, & Elbert, 2017;Shannon, 2014;Woodland et al, 2010).…”

A Theoretical FRAMEWORK for the Development of Perinatal Period Mental Health Guidelines in Zimbabwe

“…The guidelines were developed on the realization that an increased incidence of 1 in 5 women would succumb to a noteworthy mental health challenge in the perinatal period, with only an unimportant number of them looking for assistance, unfortunately. Without treatment, mental illness may result in augmented obstetric complications, and compromised mother-child relationship [4,7,8].…”