Perinatal depression screening in healthy start: an evaluation of the acceptability of technical assistance consultation

A scoping review of the evaluation and effectiveness of technical assistance

Background

Although the benefits of evidence-based practices (EBPs) for advancing community outcomes are well-recognized, challenges with the uptake of EBPs are considerable. Technical assistance (TA) is a core capacity building strategy that has been widely used to support EBP implementation and other community development and improvement efforts. Yet despite growing reliance on TA, no reviews have systematically examined the evaluation of TA across varying implementation contexts and capacity building aims. This study draws on two decades of peer-reviewed publications to summarize the evidence on the evaluation and effectiveness of TA.

Methods

Guided by Arksey and O’Malley’s six-stage methodological framework, we used a scoping review methodology to map research on TA evaluation. We included peer-reviewed articles published in English between 2000 and 2020. Our search involved five databases: Business Source Complete, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Education Resources Information Center (ERIC), PsycInfo, and PubMed.

Results

A total of 125 evaluation research studies met the study criteria. Findings indicate that publications have increased over the last two decades, signaling a growth in the recognition and reporting of TA. Technical assistance is being implemented across diverse settings, often serving socially vulnerable and under-resourced populations. Most evaluation research studies involved summative evaluations, with TA outcomes mostly reported at the organizational level. Only 5% of the studies examined sustainability of TA outcomes. This review also demonstrates that there is a lack of consistent standards regarding the definition of TA and the level of reporting across relevant TA evaluation categories (e.g., cadence of contact, and directionality).

Conclusions

Advances in the science and practice of TA hinge on understanding what aspects of TA are effective and when, how, and for whom these aspects of TA are effective. Addressing these core questions requires (i) a standard definition for TA; (ii) more robust and rigorous evaluation research designs that involve comparison groups and assessment of direct, indirect, and longitudinal outcomes; (iii) increased use of reliable and objective TA measures; and (iv) development of reporting standards. We view this scoping review as a foundation for improving the state of the science and practice of evaluating TA.

Supplementary Information

The online version contains supplementary material available at 10.1186/s43058-022-00314-1.

A systematic review of screening for perinatal depression and anxiety in community-based settings

Screening for perinatal depression and anxiety in community-based maternal and child health settings may help close the detection and treatment gap among women at higher risk for these conditions. We aim to review perinatal depression and anxiety screening tools, timing, and follow-up processes for positive screens in community-based settings. We conducted a systematic review of the literature to identify papers describing screening and interventions for perinatal depression and anxiety in community-based settings. We identified 49 papers describing 47 studies of perinatal depression or anxiety screening in community-based settings. The Edinburgh Postnatal Depression Scale (EPDS) was the most frequently used screening tool. Referral and referral tracking for those who screened positive for symptoms were inadequately described. Types of training and technical assistance provided for screening varied widely. It is feasible and acceptable to screen for perinatal depression in community settings, but there is a need for systematic research examining which screening tools to use, the ideal frequency of screening, and referral completion rates. There is a lack of information regarding perinatal anxiety screening and a lack of uniformity in training regarding screening in community-based settings. Future studies should compare the efficacy of screening in community-based settings to screening in healthcare settings.

Assessing the utility of the Healthy Start Screen to predict an elevated Edinburgh Postnatal Depression Scale score

Objective To examine the utility of the Healthy Start Screen (HSS), which is an assessment of health, environment, and behavioral risk factors offered to all pregnant women in the state of Florida, in identifying women at risk for developing postpartum depression (PPD). Methods The sample for this Institutional Review Board (IRB)-approved, retrospective study consisted of patients who presented to a women's clinic for a new prenatal visit. Those patients who completed both the HSS at their prenatal visit and the Edinburgh Postnatal Depression Scale (EPDS) at their postpartum visit were included. We focused on items 1-10 of the HSS, where patients could respond with either "yes" or "no", and identified a positive EPDS as any score greater than or equal to 12. Results Women who identified as feeling down, depressed or hopeless, feeling alone when facing problems, to having ever received mental health services, or to having any trouble paying bills were more likely to have an EPDS score greater than or equal to 12. Conclusion The HSS, currently mandated by the state of Florida to be offered to all pregnant women, is a useful tool for identifying women at increased risk of developing PPD.

Depression treatment for impoverished mothers by point-of-care providers: A randomized controlled trial

OBJECTIVE

Depression in low-income, ethnic-minority women of childbearing age is prevalent and compromises infant and child development. Yet numerous barriers prevent treatment delivery. Listening Visits (LV), an empirically supported intervention developed for delivery by British home-visiting nurses, could address this unmet mental health need. This randomized controlled trial (RCT) evaluated the effectiveness of LV delivered at a woman's usual point-of-care, including home visits or an ob-gyn office.

METHOD

Listening Visits were delivered to depressed pregnant women or mothers of young children by their point-of-care provider (e.g., home visitor or physician's assistant), all of whom had low levels of prior counseling experience. Three quarters of the study's participants were low-income. Of those who reported ethnicity, all identified themselves as minorities. Participants from 4 study sites (N = 66) were randomized in a 2:1 ratio, to LV or a wait-list control group (WLC). Assessments, conducted at baseline and 8 weeks, evaluated depression, quality of life, and treatment satisfaction.

RESULTS

Depressive severity, depressive symptoms, and quality of life significantly improved among LV recipients as compared with women receiving standard social/health services. Women valued LV as evidenced by their high attendance rates and treatment satisfaction ratings.

CONCLUSIONS

In a stepped model of depression care, LV can provide an accessible, acceptable, and effective first-line treatment option for at-risk women who otherwise are unlikely to receive treatment. (PsycINFO Database Record