Home Visitation Programs As a Point of Entry for Maternal and Infant Mental Health: Lessons from a Multi-Community System Enhancement Pilot

Background and Purpose:  Enhancing women’s mental health during and around the time of pregnancy is a public health concern.  However, statewide approaches to universal depression screening for new mothers has been criticized for identification without service engagement, particularly for low income women receiving public assistance (Kozhimannil et al, 2011).  The Behavioral Health Integrated Centralized Intake project is a four-year  effort to enhance behavioral health risk screening and service utilization among low-income and under-resourced communities in Virginia.  During the past two years, four communities engaged in co-creating centralized intake programs that included behavioral health risk screening at first point of contact.  This presentation examines behavioral health risk patterns and service utilization among pregnant and postpartum women participating in this first round pilot (N=1,489)

Methods: Four communities in geographically distinct areas of Virginia were identified to partner with the research team and develop Centralized Intake for home visiting services.  The research team augmented typical centralized intake through the addition of behavioral health risk screening using the Institute for Health and Recovery (IHR) Behavioral Health Risks Screening Tool which includes concurrent screening for perinatal depression, substance abuse, interpersonal violence, and smoking.  This tiered screening moves from initial risk identification, to application of standardized screening from “risk triggers” and finally to service engagement using an SBIRT protocol to educate and link participants to home visitation and/or community services.

Results:  The four pilot communities engaged in an average of six months of collaborative planning to build a screening, brief intervention and referral network among their home visitation, mental health, and community service agencies.  During 18 months, 1,489 pregnant or postpartum women participated in centralized intake and 1,345 engaged the behavioral health risk screening (90% participation).  Of these women, 17.8% met risk triggers for perinatal depression, 7.9% for current alcohol or substance use, 16.5% for current or past intimate partner violence, and 20% for smoking.  Collectively, over 80% were engaged in SBIRT.  For women with a positive risk screen, over 70% were successfully referred to home visitation and one or more additional mental health or community service programs.  Clusters of identified risk were associated with higher rates of referral.

Conclusions and Implications: In our engagement with four pilot communities, behavioral health risk screening and service enhancement was able to be successfully implemented by centralized intake staff members.  Training in behavior health risk screening, Motivational Interviewing, and SBIRT was consistently provided to all project staff, none of whom had prior experience in mental health assessment or intervention.  Rates of risk identification at point of first contact are similar to national prevalence estimates, which suggests that early screening has strong potential to identify risks early in pregnancy or postpartum.  Embedding screening within a delivery system context with multiple providers engaged in creating a “safety net” of services appears to be an effective way to immediately link women with identified risks with varying levels of supportive interventions in community settings.  Further research and usual care comparisons will be undertaken to assess the benefit of this system enhancement.