Enhancing Home Visiting Services through Centralized Intake and Behavioral Health Integrated Risk Screening: Lessons Learned from Four Pilot Communities

 

Background:

 

The Behavioral Health Integrated Centralized Intake project is a multi-year MIECHV funded initiative enhancing community systems of care for pregnant and postpartum women by building strategic partnerships between maternal and child health home visiting programs and community services.  Four pilot communities developed and implemented individualized community models of behavioral health integrated centralized intake. This study utilized a high risk behavioral health risk screening tool (BHRS) inclusive of a recognized substance abuse screening tool for women, along with questions regarding emotional health and intimate partner violence.  The BHRS also included an addition of the Edinburg (EPDS) 3 item screener as a brief screening for emotional health.  A CBPR approach among provider stakeholders was used to develop risk identification, service linkage, and partnership development strategies.  Using concurrent mixed methods, this poster will corroborate the qualitative and quantitative findings using the timeline of the project's implementation.

Methods:

This mixed-methods research study longitudinally examined behavioral health risk and service utilization.  Four pilot communities (N=1489) collected quantitative data inclusive of behavioral health risk identification and service utilization trends for pregnant or postpartum women.  Women were identified for referral to centralized intake in a variety of ways determined by each community including: referrals made by local hospitals, medical providers, or community service boards. 

For the qualitative component of the study, the sample (N=30) was comprised of equal representation across key stakeholder groups: coalition leaders, paraprofessionals conducting centralized intake, representatives from home visitation programs, and a community (non-home visiting) human service provider.  Individual semi-structured interviews were conducted in-person or via skype, along with thematic analysis using constant comparison to reflect stakeholders experiences.

Results:

Quantitative trends indicated that the implementation of centralized intake increased intakes conducted within the communities (90%) with an increase in women who trigger for emotional health risk, while also capturing the prevalence of women completing the EPDS at high completion rates (87%).  Ultimately, 1,345 women engaged in behavioral health risk screening with 17.8% meeting 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.

Qualitative categories represented within the data included community collaboration readiness, community partner relationships, and relationships with dominant community providers (i.e. health departments, departments of social services, etc.).  However, the most interesting category, with the least amount of concern from community partners, was the category related to acknowledgement of the needs of clients. 

Conclusions:

The findings from this study suggest that the implementation of behavioral health centralized intake increased the number of women referred to home visiting programs throughout the four pilot communities.  Also, through the centralized intake process, early detection of behavioral health risks for pregnant or postpartum women occurred, which has implications for advancing service provision by home visiting programs.   The qualitative component of this CBBR study raised awareness regarding the struggles that communities face throughout the conceptualization and implementation of centralized intake in areas ranging from community power dynamics to maintaining a client-centered focus when implementing behavioral health centralized intake within the community.