Improving Mental Health Support for Neonatal Intensive Care Unit Mothers Through a Universal Screening Quality-Improvement Initiative

OBJECTIVE: To improve early perinatal mood and anxiety disorder screening for neonatal intensive care unit (NICU) mothers and facilitate timely referral to mental health services through the integration of a dedicated mental health clinician at our level 3 NICU. METHODS: A multidisciplinary team convened to address barriers to universal maternal mental health screening in our NICU. Key drivers were identified, focusing on appropriate screening tools, availability of a mental health clinician, and a robust referral process should a mother screen positive. The primary outcome measure was percentage of referrals made for mothers who screened positive for perinatal mood and anxiety disorders. The process measure was percentage of mothers screened. Clinical characteristics were compared between mothers who screened positive and those who screened negative to ensure that any disparities identified were addressed in real time. RESULTS: Since implementation of our universal screening program, 95.0% of mothers in our NICU have been screened for perinatal mood and anxiety disorders (an increase from 29.5%). Of those, 59.9% required referral for additional psychosocial support (an increase from 25.3%). Mothers who screened positive were more likely to be Black non-Hispanic ( P <.001), and mothers who screened negative were more likely to be White non-Hispanic ( P =.021). No differences were identified in delivery mode or breastfeeding at discharge. CONCLUSION: A dedicated NICU mental health clinician, with multidisciplinary buy-in, may allow the successful implementation and maintenance of a universal perinatal mood and anxiety disorder screening and referral program.