HV CoIIN Measures Maternal Depression This set of measures describes a complete system of home visiting services that detect and alleviate maternal depression symptoms. They are intended to help guide quality improvement efforts and to support data-driven decision-making in practice. From 2013 to 2016, the measures underwent several iterations of testing and refinement by a group of early adopters: home visitors and supervisors in local implementing agencies, MIECHV grantees and expert faculty. Several resources have been developed to facilitate their use, including: This orientation powerpoint A Cheat Sheet that lists all of the measures with their numerators and denominators An excel data reporting template, “XX,” with data collection tools and automated run charts An instruction document with detailed instructions and operational definitions to help you complete the reporting template

Maternal Depression SMART AIM: 85% of women who screen positive for depression and access services will report a 25% reduction in symptoms in 12 weeks (from first service contact). PD 1: Standardized and reliable processes for maternal depression screening and response % of women screened, using appropriate instruments at appropriate intervals % of women with a positive screen for depression that receive a home visitor check-in within 30 days PD 2: Capacity of and support for home visitors to address maternal depression in the target population % of all enrolled women who screen positive (and are not already in evidence based services) offered referral to evidence based services % of all women offered referral who verbally accepted referral to evidence-based services % of women referred to an evidence based service with at least one evidence-based service contact. % of women referred to an evidence based service with at least one non-evidence-based service contact PD 3: Standardize processes for referral, treatment and follow-up PD 4: Family Engagement The measures include outcome and process measures. The outcome measures show progress toward the SMART AIM: % of women who screen positive for depression and access services will report a 25% reduction in symptoms in 12 weeks (from first service contact). The process measures show how well each primary driver is working. The primary drivers are essential pieces of the system that need to be in place and working well in order to reach the SMART Aim. For Primary Driver 1 (Standardized and reliable processes for maternal depression screening and response): % of women screened, using appropriate instruments at appropriate intervals % of women with a positive screen for depression that receive a home visitor check-in within 30 days For Primary Driver 3 (Standardize processes for referral, treatment and follow-up) % of all enrolled women who screen positive (and are not already in evidence based services) offered referral to evidence based services % of all women offered referral who verbally accepted referral to evidence-based services % of women referred to an evidence based service with at least one evidence-based service contact. % of women referred to an evidence based service with at least one non-evidence-based service contact For Primary Driver 5 Data system for tracking surveillance & screening periodicity, results, referral, acceptance of referral & receipt of service % of team members using CQI data in practice PD 5: Data system for tracking all clients' maternal depression screening periodicity and results, referral, acceptance of referral and receipt of service % of team members using CQI data in practice

HV CoIIN MD Report 2017 When viewed on a single page, these measures provide a visual summary of the entire system detection and alleviation of maternal depression symptoms. The white run charts show the outcome measure over time. The colored run charts who the process measures over time.

HV CoIIN Measures were selected to capture steps in the process of detection and alleviation of maternal depression symptoms My First Template Women screened appropriately Women w +screen offered referral to EB services Women w + screen accept referral to EB services Women access EB services Women who receive services experience reduction in symptoms % women screened appropriately % Women w +screen offered referral to EB svcs % women offered referral accept referral to EB svcs % women who accepted referral have 1+ EB svc contact (%) % women who receive services experience reduction in symptoms % women declining referral that receive home visitor ‘check in’ within 30 days % women who don’t receive services that experience reduction in symptoms % Women +screen that access non-EB services Another way to think about the measures is that they reflect steps in the process of detection and alleviation of maternal depression. This slide presents a simplified process map. Above the brown line, each box shows a step in the process along the way to developmental promotion, early detection of developmental risks in partnership with families, and linkage to services. The boxes below the brown line contain the measure(s) that align with each step in the process.