Biopsychosocial Population Health Policy Proposal

NURS FPX 6026 Assessment 2 Biopsychosocial Population Health Policy Proposal EZ

Postpartum depression (PPD) in Latina expectant mothers can lead to adverse outcomes in both mothers and babies, yet treatment remains less than optimal. PPD is common among one in eight moms, with higher prevalence rates among women of color (Ponting et al., 2020). The risk of developing PPD is higher among Latinas, affecting 37% versus 10 to 15% of women in the general population (Sampson et al., 2018).

NURS FPX 6026 Assessment 2 Biopsychosocial Population Health Policy Proposal EZ

In the United States, the Edinburgh Postnatal Depression Scale (EPDS) is the most used tool for PPD. The screening tools developed to assess for PPD were created based on symptoms that were displayed by predominantly white women in most studies. Women of color can display different signs and symptoms of PPD compared to those of white women as they have experience different challenges related to race. While EPDS is helpful in assessing Latinas for PPD, incorporating a community health worker (CHW). 

CHWs are respected and active in the community. CHWs typically share a common identity with members of their community either culture, language or socioeconomic status (Early et al., 2016). CHWs often serve as liaisons between the community and healthcare systems in the area. Adding a CHW to the interprofessional team to assist with PPD education and to partner with the clinicians to identify symptoms of PPD in Latinas is the proposed policy to increase quality of care of expectant Latina mothers.

Proposed Policy 

The goal of adding a CHW to the interprofessional team is to improve the identification and treatment of PPD in low resource Latina expectant mothers. CHWs partner with providers to fully assess Latina expectant mothers for depressive symptoms. Using a patient centered approach, CHWs will connect at risk Latinas with healthcare resources specific to their needs (Lutenbacher et al., 2018). 

CHWs should be women from the local area of the same race, culture, and language. They should have strong problem solving and communication skills.  CHWs should be familiar with resources within the area and how to access those resources. CHWs in Latino communities target a variety of health problems, provide health education, and help families navigate systems. Studies have shown rates of depressive symptoms between 20 and 38% in samples of Latino women in Florida, California, and Massachusetts (Lutenbacher et al., 2018). Left untreated, depression can have significant consequences for the woman and impact her ability to effectively bond with her newborn. 

Interprofessional Approach

The CHWs will be integrated with the obstetrics office and will be referred to Latina mothers by the obstetrician or primary nurse if the patient scores 8 or greater on the EPDS assessment. The CHWs will provide expectant mothers with needed services by collaborating with physicians, social workers, counselors, and lactation consultants. During the third trimester, the CHW will meet with the expectant mothers to complete the EPDS, discuss readiness plan and identify support for after birth. The CHW will work with clinic staff to arrange postpartum appointments six weeks later and connect with the expectant mothers either at home or telephonically to check on their wellbeing. The benefits of continued outreach by the CHWs include a connection to health care providers for maternal or neonatal clinical concerns, psychosocial support, assistance with social determinants of health, and to identify any possible symptoms of PPD (Lutenbacher et al., 2018).

NURS FPX 6026 Assessment 2 Biopsychosocial Population Health Policy Proposal EZ

Policy Recommendations

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides assistance to low income pregnant and postpartum women until the child is five years of age (Koleilat et al, 2020). WIC offers assistance through supplemental food, nutrition education, breastfeeding support, and healthcare referrals. Obstetrician practices can partner with local WIC offices to utilize one of their staff members as a CHW. WIC staff already work closely with the mothers and their newborns in nutrition and often are bilingual. Many WIC offices host peer support, nutrition, and exercise classes at no cost to the WIC participants which can be promoted in the obstetrician’s office when the patients meet with the CHWs.

Conclusion

The stressful demands of motherhood are complex and call for a careful understanding of the physical, psychological, and social changes that take place in the lives of new mothers. A mother’s postpartum care is a critical transition period for evaluating her wellbeing, preparing her for optimal long-term health, and leveraging increased access to health care into lifelong benefits for her and her child. Incorporating a Community Health Worker to aid in fully assessing Latina expectant mothers will lead to early detection and will be fundamental for a healthier mother, a healthy child, and healthy outcomes. 

References

Early, J., Burke-Winkelmann, S., & Joshi, A. (2016). On the front lines of prevention: Promotores de salud and their role in improving primary care for latina women, families, and communities. Global Journal of Health Education and Promotion, 17(2), 58. https://doi.org/10.18666/GJHEP-2016-V17-I2-7130

Koleilat, M., Kim, L. P., Cortes, B., & Kodjebacheva, G. D. (2020). Perceived motivators, barriers and intervention strategies related to weight loss after childbirth among WIC participants in southern california. American Journal of Health Promotion, 34(3), 294-302. https://doi.org/10.1177/0890117119895948

Lutenbacher, M., Elkins, T., Dietrich, M. S., & Riggs, A. (2018). The efficacy of using peer mentors to improve maternal and infant health outcomes in hispanic families: Findings from a randomized clinical trial. Maternal and Child Health Journal, 22(Suppl 1), 92-104. https://doi.org/10.1007/s10995-018-2532-z

Ponting, C., Chavira, D. A., Ramos, I., Christensen, W., Guardino, C., & Dunkel Schetter, C. (2020). Postpartum depressive symptoms in low-income latinas: Cultural and contextual contributors. Cultural Diversity & Ethnic Minority Psychology, 26(4), 544-556. https://doi.org/10.1037/cdp0000325 

Sampson, M., Torres, M. I. M., Duron, J., & Davidson, M. (2018). Latina immigrants’ cultural beliefs about postpartum depression. Affilia, 33(2), 208-220. https://doi.org/10.1177/0886109917738745