Fifolt Matthew, Johnson Heather H, Preskitt Julie, Enlow Margaret, Tullier Dianna, Arbour MaryCatherine
Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham (Drs Fifolt and Preskitt and Mss Johnson and Enlow); Alabama Department of Early Childhood Education, Montgomery (Ms Tullier); and Division of Global Health Equity, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts (Dr Arbour).
Qual Manag Health Care. 2022;31(4):251-258. doi: 10.1097/QMH.0000000000000365. Epub 2022 Feb 16.
From 2013 to 2017, a national Breakthrough Series (BTS) collaborative in Maternal, Infant, and Early Childhood Home Visiting programs developed a toolkit that led to improvements in maternal depression outcomes. In 2018, Alabama's home visiting program (First Teacher) aimed to reproduce these impacts with a state-led BTS that enrolled 8 local implementing agencies (LIAs) serving more than 500 families.
LIAs tested changes in practices using Plan-Do-Study-Act cycles and tracked data regarding depression screening, referrals, service access, and symptom improvement via run charts. First Teacher administered a post-collaborative survey to assess LIA team members' satisfaction with their BTS experience.
Alabama's BTS resulted in positive shifts in maternal depression referrals, service access, and symptom improvement. Change ideas that supported these shifts included the use of a screening script, motivational interviewing, "Mothers and Babies," and a registry. LIAs noted that BTS tools and resources helped build capacity to address the difficult and frequently stigmatized topic of maternal depression.
Findings from this study indicate that evidence- and experience-based practices regarding maternal depression screening, referrals, and service access can lead to symptom improvement among mothers enrolled in a state-based home visiting program. Results of this investigation corroborate findings from previous studies while also incorporating feedback from LIAs about the BTS experience.
2013年至2017年，一项全国性的母婴及幼儿家访项目突破系列（BTS）合作开发了一套工具包，该工具包使产妇抑郁结局得到改善。2018年，阿拉巴马州的家访项目（第一教师项目）旨在通过由该州主导的BTS重现这些成效，该项目招募了8个当地实施机构（LIA），为500多个家庭提供服务。
各LIA使用计划-执行-研究-行动循环测试实践中的变化，并通过运行图跟踪有关抑郁筛查、转诊、服务获取和症状改善的数据。第一教师项目进行了一项合作后调查，以评估LIA团队成员对其BTS经历的满意度。
阿拉巴马州的BTS使产妇抑郁转诊、服务获取和症状改善方面出现了积极变化。支持这些变化的改进想法包括使用筛查脚本、动机性访谈、“母婴”项目和一个登记系统。各LIA指出，BTS工具和资源有助于增强应对产妇抑郁这一困难且常被污名化的话题的能力。
本研究结果表明，基于证据和经验的产妇抑郁筛查、转诊及服务获取实践可使参加州立家访项目的母亲的症状得到改善。本调查结果证实了先前研究的结果，同时还纳入了各LIA对BTS经历的反馈。
