Molina Abigail Palmer, Palinkas Lawrence, Hernandez Yuliana, Garcia Iliana, Stuart Scott, Sosna Todd, Mennen Ferol E
Crown Family School of Social Work, Policy, and Practice, University of Chicago, 969 E. 60 Street, Chicago, IL 60637, USA.
School of Public Health & Human Longevity Science, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA.
Child Youth Serv Rev. 2024 Nov;166. doi: 10.1016/j.childyouth.2024.107938. Epub 2024 Sep 21.
Implementing maternal depression screening in child-serving programs can help ensure that more mothers receive mental health services. This study examined the implementation of universal maternal depression screening in community-based Head Start programs.
Quantitative and qualitative data were merged in a convergent mixed method design to assess four domains from the RE-AIM implementation science framework (Reach, Adoption, Implementation, and Maintenance). Qualitative data included interviews with stakeholders and meeting minutes from the implementation period. Quantitative data included intervention outcomes and administrative data.
In terms of reach, 85% of eligible Head Start mothers were screened for depression, and English-speaking mothers were more likely to refuse screening than Spanish-speaking or bilingual mothers. Barriers to screening included lack of availability, stigma, privacy concerns, lack of interest, and lack of trust. In terms of adoption, all sites and staff adopted screening due to organizational mandates. In terms of implementation, there was wide variation in rates of positive screenings across staff completing the screening (ranging from 0% to 46%), and barriers included concerns about staff role and lack of training. In terms of maintenance, screening was not sustained after the study period due to organizational priorities and lack of buy-in from staff.
Universal maternal depression screening has the potential to reach low-income Head Start mothers, but additional efforts should be made to build staff capacity to engage mothers in screening.
在儿童服务项目中实施孕产妇抑郁症筛查有助于确保更多母亲获得心理健康服务。本研究考察了在以社区为基础的“启智计划”项目中普遍开展孕产妇抑郁症筛查的实施情况。
采用融合性混合方法设计将定量和定性数据合并，以评估“RE-AIM实施科学框架”（覆盖范围、采用情况、实施过程和维持状况）的四个领域。定性数据包括对利益相关者的访谈以及实施期间的会议记录。定量数据包括干预结果和行政数据。
在覆盖范围方面，85%符合条件的“启智计划”母亲接受了抑郁症筛查，说英语的母亲比说西班牙语或双语的母亲更有可能拒绝筛查。筛查的障碍包括无法获得筛查服务、耻辱感、隐私担忧、缺乏兴趣以及缺乏信任。在采用情况方面，由于组织要求，所有站点和工作人员都采用了筛查。在实施过程方面，完成筛查的工作人员中阳性筛查率差异很大（从0%到46%），障碍包括对工作人员角色的担忧和缺乏培训。在维持状况方面，由于组织优先事项和工作人员缺乏支持，研究期结束后筛查未能持续进行。
普遍开展孕产妇抑郁症筛查有潜力覆盖低收入的“启智计划”母亲，但应做出更多努力来增强工作人员让母亲参与筛查的能力。
