Integrating Behavioral Health with Centralized Intake for Maternal, Infant and Early Childhood Home Visiting (MIECHV)

Background:  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 have 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 (BH-CI) project is a four-year  effort to enhance behavioral health risk screening and service utilization among low-income and under-resourced communities in Virginia by integrating behavioral health risk screening and brief intervention into routine community practice at first point of contact for community service eligibility.

Objectives:  The overarching aim of this study is to evaluate the feasibility and effectiveness of behavioral health risk screening combined with brief intervention and referral to service (SBIRT) for women at risk for depression, substance use, interpersonal violence and/or smoking during pregnancy.  This analysis considers the initial efficacy of the BH-CI approach by 1) examining prevalence and patterns of risk for perinatal depression, substance use, interpersonal violence and smoking in community settings; 2) exploring co-occurrence among risk factors and community referral patterns for women with one or more areas of identified behavioral health risk.

Methods: Paraprofessional BH-CI coordinators in four communities were trained in a screening, brief information and referral to treatment (SBIRT) protocol. Initial identification of behavioral health risk utilized the Institute for Health and Recovery’s Behavioral Health Risks Screening Tool which includes concurrent screening for perinatal depression, substance use, interpersonal violence, and smoking.  Tiered community screening used autopopulating survey informatics via RedCap to move the interview from initial risk identification, to application of targeted standardized screening instruments and finally to psychoeducation and/or service engagement using SBIRT. This analysis examines the patterns of risk identification and referral during the implementation year across all project sites.

Results:  During the first full year of program implementation, 1,515 perinatal women participated in centralized intake and 1,409 engaged the behavioral health risk screening (93% participation).  Of these women, 22% met risk triggers for potential perinatal depression; 11.6% indicated current alcohol or substance use, 10.2% current or past intimate partner violence, and 18% current tobacco use.  Over 80% of those with identified risk were engaged in SBIRT, and of these 85% were successfully referred to home visiting, mental health/substance abuse treatment and/or community service programs.  Perinatal depression and smoking were independently and significantly related to additional risks for IPV and substance use (X² range 47.86-182.25, p<.0005). 

Conclusions: Behavioral health risk screening and service enhancement were able to be successfully implemented by paraprofessional BH-CI staff members in standard community care.  Rates of risk identification at point of first contact are similar to national prevalence estimates, and co-occurrence patterns demonstrate a great deal of psychosocial complexity in the lives of pregnant and postpartum women than can, and should, be addressed through supportive home visiting.  Embedding screening into existing community context, while partnering with multiple providers to enhance system referral, appears to be an effective way to immediately link women identified with psychosocial risk with supportive community interventions.