P2C024: Who Is Seen by Screens? An Equity-focused Quality Improvement Project to Implement Perinatal Depression and Anxiety Screening in a Neonatal Intensive Care Unit

Purpose/Objectives: The American Academy of Pediatrics (AAP) recommends maternal depression screening at infant well-child checks through 6 months. Neonatal Intensive Care Unit (NICU) parents are at increased risk for perinatal mental health (MH) concerns compared to parents of healthy term infants, yet some miss opportunities for outpatient screening when their infants remain hospitalized. Moreover, non-gestational NICU parents (NGP) are at similar risk compared to gestational NICU parents (GP) but are excluded from current perinatal MH screening guidelines. To address this gap, we implemented routine perinatal MH screening for NICU parents whose infants remained hospitalized at AAP-recommended intervals with a goal of achieving 70% completion by January 2023. A secondary aim was to ensure that MH screening was equitable. Here we present our first 8 weeks of data.

Design/Methods: We designed a driver diagram and screening algorithms inclusive of all parents with infants admitted to a large, academic Level IV NICU. We collected baseline data regarding referrals for MH concerns based on clinical interactions for 6 months prior to implementing screening. We developed family-facing educational resources representative of our diverse patient population, which were translated into Spanish, Somali, and Hmong. In October 2022, we began social work-led routine screening using the Edinburgh Postpartum Depression Scale (EPDS) and anxiety subscale. Outcome measure was the rate of parents undergoing MH screening. Process metric was the rate of parents above screening threshold. Balancing measures included parent, social worker, and neonatologist perceptions of screening.

Results: Baseline data showed 58 MH referrals made over a 6-month period, primarily for GP (95%) v. NGP (5%). In the first 8 weeks of screening, there were 63 parents eligible (35 GP, 28 NGP). Median screening completion rate per week was 73% (range 45-100%). Rates of screening were not different between GP and NGP. Parents with state insurance (RR=1.55, 95% CI 0.99-2.44) and previous children (RR=1.41, 95% CI 1.02-1.96) had higher risk of screening not completed. There were no differences in screening rates between White v. non-White parents nor parents with English language preference v. other language preference. 46% of screens were positive for depression and/or anxiety with no difference between groups based on gestational status, racial/ethnic group, language preference, insurance type, or previous children. Screening was identified as valuable by 92% of parents and 100% of neonatologists and social workers.

Conclusion/Discussion: Standardized perinatal MH screening in NICU parents was achievable in our large, academic Level IV NICU and was viewed positively by parents and providers. Screening rates and referrals appear equal between gestational, language, and racial/ethnic groups. However, analysis is limited by small sample size, and ongoing efforts are needed to determine whether screening is equitable. Identification of barriers to screening may improve access to perinatal MH support for NICU parents.