Community Needs Assessment:

Postpartum Depression (PPD)

Tiffany Isenberg & Glynn Aumiller
Pennsylvania Department of Health WIC Dietetic Internship
2021
Objectives:
➢ Understand what PPD entails and why it is crucial to address
➢ Visualize the need for support in a rural community
➢ Assess the data within the targeted population
➢ Comprehend that WIC staff often require additional:
○ PPD Resources
○ PPD Training
○ PPD Education
➢ Identify the social determinants of health relevant to our community needs
regarding PPD
➢ Recognize the one year plan and the actions intended to reach it
➢ Perceive the strategies used to achieve health equity
Purpose of Assessment:
Postpartum depression is a serious mental illness that women may experience after
birth. Many women have feelings of sadness or hopelessness within the few weeks
following delivery. In some cases, it can affect a woman’s day-to-day life for months,
or even present itself later. 1 in 9 new mothers report experiencing PPD.

It is important that community health resources, including WIC agencies, have

strategies in place to raise awareness and help those currently going through PPD.
Depressive symptoms can cause a woman to have thoughts of harming herself or
even her newborn. Due to it’s serious nature, it is crucial to implement depression
screening, proper education, and resources into the operations of WIC clinics.
Training for staff, increased participant monitoring and counseling as well as
partnering with mental health organizations are some ways our agency can fill the
gaps needed to provide adequate PPD support.
Target Population: Our South Central PA Community

We chose to complete our

Community Needs Assessment
targeting the area that our local
WIC agency (BTAMC) serves.

Our five WIC clinics serve

participants in Huntingdon,
Bedford and Fulton County.

This rural, south-central

Pennsylvania area served 1,471
participants in September
2021.
Personal Observations of Rural Community Challenges

❖ We found that there are NO local in-person support groups for postpartum
depression, located in the three counties that we serve.

❖ Working in clinics, we have also observed that many women do not initiate
postpartum depression discussion

❖ Frequently, we have observed women who are not aware the symptoms they are
experiencing can be related or attributed to postpartum depression.
Prevalence of Depression within our Local Agency

WIC PENN System Report: November 2020

Prevalence of Depression within our Local Agency vs State

WIC PENN System Report: November 2020

Local Agency Staff Data
We surveyed our entire local agency WIC CPA staff to assess how postpartum
depression is currently addressed in our clinics and concluded the following:

This data demonstrates a gap in updated support, education, and resources available to
participants in our community.
Local Agency Staff Data Continued..

We surveyed our entire local agency WIC CPA staff to assess how postpartum
depression is currently addressed in our clinics and concluded the following:

❖ Other than postpartum recertification appointments, only one of six staff

members asks about postpartum depression again at a later date.

❖ Staff agreed that they mostly only use referrals for postpartum depression
when concern is mentioned by the participant.

This data demonstrates a gap in updated support, education, and resources available to
participants in our community.
Social Determinants of Health for Our Target Population

The Centers for Disease Control and Prevention (CDC)’s Social Determinants of
Health & Healthy People 2030 outline several factors that influence health outcomes
that apply to our local rural community:

➔ Health Care & Quality: increase quality of care and provider competency
➔ Social and Community Context: reduce depression, increase support &
create support systems, bring awareness to resources
These further demonstrate the need for higher quality postpartum education,
awareness and support within our rural community.
 PPD Effects Related to Social Determinants of Health
● Mothers may interact less or be unresponsive ● Breastfeeding problems have a tendency to
to their baby’s cues, which could in turn, affect increase the prevalence of depression.
their eating and sleep patterns.
● Kimberly Langdon, M.D states that “early
● Studies have found that babies exposed to
recognition and treatment of postpartum
PPD within the first year after childbirth may
depression can lead to better symptom
be at higher risk of having long-term negative
management and faster recovery rates.”
outcomes such as behavioral issues, lower
mathematics grades and depression during
adolescence. ● It is believed that nearly 50% of women who
develop postpartum depression began
● In one study, mothers who were diagnosed experiencing depressive symptoms during
with postpartum depression at one week their pregnancy.
postpartum were more likely to experience
breastfeeding problems, be unsatisfied with
how they were feeding their infants and were ● Tragically, 10% of postpartum psychosis cases
more likely to cease breastfeeding in the first result in suicide or infanticide
couple months.
 One-Year Plan
Within the next 12 months, we aim to have our local agency’s
medical center implement at least one in-person postpartum
depression support group and to increase our WIC staff overall
confidence in postpartum depression counseling from 17% to 50%.
Current Postpartum Depression Resources Available
Currently, our clinic staff asks about depression or
depressive symptoms during discussion and while
completing the Nutrition Interview.

Often, staff uses www.postpartum.net as a resource to

help participants who may have discussed depression or
were assigned “Risk 361- Depression/ Clinical PP as
reported by physician/staff/self-report”

This Postpartum Support International resource is given

as a handout so that a participant has the Support Line
they may call.
New Referrals: PA Parent & Family Alliance
● Trained Family Peer Specialists
● Statewide program funded by several nonprofit
corporations and state grants such as SAMHSA
(support programs for preventing and treating
mental/substance use disorders), PA Care Partnership
and OMHSAS.
● A client either fills out an online form to be contacted
or calls the parent support line directly. From there, the
trained professionals listen to each situation, counsel,
and plan how they can help.
● Phone calls, text, online meeting platforms are available
● No time limits on any sessions, no matter the
appointment type. The length of conversation depends
on the participant’s needs.
● Webinars released twice a month on Mondays.
● These services are free to PA residents
Edinburgh Postnatal Depression
Scale (EPDS)
A 10 - question assessment tool used to screen
for perinatal depression. It is a very effective
and widely used scale. It should not replace
clinical judgement but is often used by
professionals in clinical settings.

A woman should choose the best response that

represents how she has felt over the past 7
days.

A score of at least 10 indicates possible

depression, while a score of 13 points or higher
are found in those likely experiencing a
depressive illness (of varying severity).
New Resources: Check on Mom
● Check on Mom provides inspirational content and
curates PPD information and resources for women
interested in managing maternal mental health.
● Their website offers a Maternal Mental Wellness Plan
tool that a woman can fill out and share with her “mom
team” to organize her postpartum priorities as well as
everyday to-do lists that others can help her with when
she is needing a break
● They offer virtual reminders of when it is important to
“check on mom”, signs and symptoms of PPD, and how
to have a conversation with healthcare providers about
PPD care.
 New Staff Training

●
●
Upon Hire:
○ Maternal Mental Health 101
○ FREE 90 minute complimentary
webinar
○ Presented by Postpartum Support
International and 2020 Mom
○ 5 classes spread out through the year
○ Offered through ZOOM
Continuing Education for Staff
Online trainings on PPD:
◆ WIC staff will complete at least one inservice a year on the
subject of PPD

◆ Nutrition Education Coordinator will monitor resources or

webinars available such as:
● Maternal Mental Health Now online trainings
● National Network of Depression Center educational
resources
● National Institute of Mental Health videos
● Mayo Clinic PPD webinars
Collaborative PPD Support Group
Our rural community could benefit from having a PPD Support Group in which pregnant
and postpartum women can come to meet and spread awareness of PPD and symptoms,
discuss resources and treatment conversations they can have with their health care
providers, and most importantly - connect by sharing their experiences and supporting each
other!

Planning with BTAMC Setting Schedule Spreading Awareness

1. Collaboration between our WIC 1. At least one weekday or 1 1. Establishing sign-up sheets at
Staff & BTAMC weekend a month WIC clinics

2. Planning staffing, 2. Evening hours to 2. Outreach materials

education/resources and location accommodate families work distributed in community
schedules
3. Have support group staff take
PSI’s Coaching for Support Group
Leaders training
Our Action Plan

Postpartum Support Strategy Community Components

Implement WIC clinic changes and establish

appropriate resources and referrals for a
network of postpartum care in our Mental Health Support
community.
Action Plan: continued
Annual Objectives Sector Approximate Number of
People Reached

At 12 months, all WIC clinics

in our local agency will use Healthcare 500
EPDS to screen for
postpartum depression.

At 12 months, Broad Top

Area Medical Center will
implement at least one local Healthcare 5,000
in-person support group for
postpartum women within
our community.
Action Plan: continued
Strategies Staff Overseeing Implementation Timeline

Administer new postpartum

depression training & Nutrition Education Coordinator Months 0-3
education to WIC staff

Meet with local healthcare

providers to gather updated Medical Liaison/ Outreach Months 0-3
referral data Coordinator

Requiring postpartum referral Nutrition Education Coordinator

handouts be given to & Months 3-6
participants at IC appts Outreach Coordinator

Implementing EPDS
screening during IC & at least Nutrition Education Coordinator Months 3-6
one other appointment
Action Plan: continued
Strategies Staff Overseeing Implementation Timeline

Requiring postpartum
depression follow up at 3 Nutrition Education Coordinator Months 6-9
months appointment

Initiate planning with BTAMC

to create local postpartum WIC LA Director Months 6-9
depression support group

Collaborate in implementation
of postpartum depression WIC LA Director & BTAMC Staff Months 9-12
support group

Postpartum support group will

be open to public BTAMC CEO Month 12
How our Action Plan Improves Health Equity
“Around 60 percent of rural Americans live in designated mental health provider
shortage areas.”
❖ Rural Areas
➢ Our initiation helps in creating a local resource that our community did not previously have
available.
❖ Access to Mental Health Tools and Resources
➢ By administering the EPDS screening in clinics, this adds a free service that they otherwise might
not have access to
➢ Completing and maintaining postpartum depression education for all WIC staff adds to mental
health counseling and support in our community.
➢ Partnering with local healthcare providers that offer treatment in order to distribute the appropriate
referrals to participants
❖ Work/Life Balance
➢ Offer postpartum support groups in the evenings and weekends for those who work full-time
during the week or have other obligations
Conclusion & Sharing Progress

❖ Track your progress by performing a follow up survey to those attending the

support group as well as WIC staff
❖ Will continuously analyze data to identify key successes throughout the process
❖ WIC staff will keep open communication with BTAMC to identify any obstacles
and document them as necessary

While working towards our one year goal, we intend to increase the awareness in our
rural community on postpartum depression needs and support.
 References
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