1. Change Package
Your Team Name: Healthy Families Rappahannock Area
Topic Area: Maternal Depression
Name of the Intervention: Tickler system for follow-up on positive depression screenings
Primary Driver: Standardized and reliable processes for maternal depression screening and response

2. Definition of the Intervention
This was a two-part intervention: a tickler/reminder system was implemented to help Family Support Workers (FSWs) remember to follow-up on positive depression screenings and referrals made to services. A tracking form was also developed to standardize documentation of follow-up and additional referrals made.

3. Description of the Intervention
Calendar reminders were created to remind staff to follow-up on positive depression screens, for the purposes of determining whether families were able to access services and to remind FSWs to rescreen families after 90 days.
A Referral Follow-Up form was developed, for FSWs to document follow-up conservations with mothers about whether they were able to access services and, if not, barriers to services and additional referrals offered.

4. Description of the Intervention
Referral Follow-Up form

5. How is the intervention carried out?
If the PHQ-9 screening is positive and a referral to services was made:
The PHQ-9 is submitted by the FSW to the Office Associate (OA)
The OA creates a calendar reminder in Microsoft Outlook for 4 weeks from the date of the screening.
At/by the 4-week mark, the Family Support Worker (FSW) has a follow-up conversation with the mom about whether she was able to access services (conversations can happen before 4 weeks, depending on the frequency with which the family is seen).
If yes, date services began is documented on the PHQ-9 Referral Follow-Up form and resubmitted to the OA
If no, FSW explores obstacles with mom and offers additional referrals or helps with problem-solving, as appropriate. Conversation is documented on the PHQ-9 Referral Follow-Up form and submitted to the OA.
If services not accessed but family still interested in services, the OA creates a second follow-up reminder and the process continues
The calendar appointment is also sent to the Program Supervisor so that the process can be discussed in supervision.
If the PHQ-9 screening is positive and the family declines a referral, an appointment is still made, with the expectation that the home visitor will touch base with the mom about her mood and offer referrals at that point.
A calendar reminder is also created for 90 days from the date of the screening to remind the home visitor to rescreen.

6. Evidence that the intervention is effective
Since beginning this intervention:
100% of moms (4 out of 4) who screened positive on the PHQ-9 had documented follow-up conversations regarding ability to access services and/or satisfaction with received services (for 1 mom already receiving EB services at the time of screening).
67% of moms who were referred to services (2 out of 3) successfully completed at least 1 EB service
1 mom was referred but moved out of the service area before accessing services
1 mom was not referred because she was already receiving EB services
Feedback from staff: they like the tickler system because it clarified expectations regarding when follow-up conversations and re-screenings should be completed and helped them be more mindful about following up and documenting conversations with families about referrals.

7. Pre-requisites for the intervention
Shared calendar system (for creating calendar reminders) (we used Outlook, but could also use Google Calendar)
Form/system for documenting follow-up with families
Office Associate time to create reminders and collect forms

8. Advice Barriers / Challenges Key advice to overcome barriers
Communication between Program Supervisor, Family Support Workers, and Office Associate
Create a system that includes notification/tracking for all partners (i.e. include the Supervisor in the calendar reminders so she knows when follow-up is expected)
FSWs feeling that they are “nagging” families about referrals/services
Adjust the timeframe to be more comfortable for FSWs while still following CoIIN faculty suggestions.
Work with staff to use strengths-based strategies for discussing with families so that it doesn’t feel “nagging”

9. Adaptations (if applicable)
Not that I know of.

10. References/ Inspiration (if applicable)
We adapted this from information shared by Lac Courte Oreilles Tribal Mino Maajisewin about their referral follow-up system.