ABSTRACT
Background: We pilot-tested the feasibility and short-term impacts of "Healthier Wealthier Families" (HWF), which seeks to reduce financial hardship by developing a referral pathway between universal child and family health (CFH) services and financial counselling. Method(s): Setting: CFH services in five sites (Victoria, New South Wales), coinciding with the COVID-19 pandemic. Participant(s): Caregivers of children aged 0-5 years. Eligible clients disclosed financial hardship using a study-designed screening tool. Design(s): Pilot randomised controlled trial (RCT). With mixed progress in Sites 1-3, we conducted an implementation evaluation and adapted the protocol to a simplified RCT (Site 4) and direct referral with pre-post evaluation (Site 5). Intervention(s): Financial counselling. The comparator was usual care. Measures: Feasibility was assessed via proportions of clients screened, enrolled, followed-up, and who accessed financial counselling. Impacts (quantitative surveys, qualitative interviews) included finances to 6 months post-enrolment. Result(s): 72%-100% of clients across sites answered the financial screen. In RCT sites (1-4), less than one-quarter enrolled. In Site 5, n = 44/64 (64%) clients were eligible and engaged with financial counselling. Common challenges facing these clients were utility debts (73%), obtaining government entitlements (43%) and material aid/emergency relief (27%). On average, their household income increased $250 per fortnight ($6504 annually), and families received average single payments of $784. Caregivers identified benefits including reduced stress, practical help, increased knowledge and empowerment. Conclusion(s): Financial hardship screening via CFH, and direct referral, were acceptable to caregivers. Individual randomisation was infeasible. Matching between populations and CFH practice is necessary to incorporate a HWF model of care.
ABSTRACT
Purpose/Objectives: Recognizing the impact of Perinatal Mood and Anxiety Disorders (PMAD) on childrens and their caregivers, providers from the Pediatric Emergency Department (PED) and the Neonatal Intensive Care Unit (NICU) at Children's National (CN) Hospital sought to institute universal screening of parents for PMADs. Early identification of those with depressive symptoms would allow for the provision of resources that promote caregiver mental health. Our goal is to improve the mental health post-partum caregivers through early detection. Design/Methods: In August 2018, the Edinburgh Postpartum Depression Screen (EPDS) was selected as a screening tool, and an electronic form was developed and housed in REDCap. Using the IHI model for improvement, several interventions were performed. A part-time family services staff member was hired to screen during normal business hours all caregivers who fit the eligibility criteria. Real-time social work interventions and linkage to resources were provided to all screened caregivers. Those who screened positive received further care and referral. Screening was changed from an opt-in to an opt-out process as staff became comfortable with approaching parents. When the pandemic hit, screening was halted for 1 month. In July 2020, new funding was obtained which allowed an increase in the workforce, extending the coverage to evenings and weekends. A part-time psychologist was then hired to provide telemedicine therapy for parents requiring further treatment. Results: In the NICU, 1105 parents were approached from August 2018 to June 2021. Of those approached 982 (88%) completed screening, 245 (24%) were positive, 38 indicated having suicidal thoughts (3%), and 112 were fathers (11%). In the PED, 1586 parents were approached in the same time period. Of those approached 1338 (89%) completed the screen, 220 (16%) of parents screened positive, 39 indicated having suicidal thoughts (3%), and 118 were fathers (9%). Major challenges were lack of caregiver time or bedside availability (NICU), no translator availability for languages other than English and Spanish, caregiver refusal, no night coverage, COVID concerns, and inadequate staff buy-in at the beginning of the project. Screening in the PED was hampered by rapid patient turnover. Conclusion/Discussion: Our data shows that PMAD rates at CNH are higher than the published literature. A universal postpartum depression and anxiety screening program is a critical first step for hospitals caring for postpartum parents both in the inpatient and outpatient setting. Electronic tools such as electronic screens and telemedicine can aid significantly in expanding screening and follow up. Human resources are key to success. Remote screening, overnight access, care coordination, and translation of screens into other languages will be key next steps.