Table 3 Major themes and sub-themes with illustrative quotes
CFIR domain and sub-theme | Quotes |
|---|---|
1. Intervention | |
Appropriateness of pediatric providers screening for PPD | “In the pediatric world, you get your patient, you get their family, you get the constellation.” “The health of the mother affects the health of the child.” “For pediatrician as that piece…we have like twice the number of opportunities to screen.” |
Perception of mothers’ reactions to screening | “I think if you have a rapport with a family, it is so much better…I do think people open up more readily if I know the mom and the other children… you can even sense it more than someone you don’t know.” “Sometimes they’re a little confused because they don’t expect us to ask that, because they think that we’re here to provide care for the baby.” “I think by the sixth-month visit, sometimes they’ve gone, why are you asking me?” |
Screening tools | “… are there different questions we should be asking them based on cultural identify that might be more specific to them in how they are experiencing postpartum depression… just wondering how many we are missing based on the way we are asking the questions…” “You are asking her a whole bunch of questions. You can see that she is exhausted, you can see that she is stressed, and you do reflective questioning…You get a sense, outside of those questions, then, when you are dealing with them on a human level and you are really responding to where they are at, they are more likely to say, ‘Yes, I would talk to somebody about that. Yes, I could need some help with that’.” |
2. Inner setting | |
Practice size | “It is just hard to do in our setting. I do think people open up more readily if I know the mom and the other children.” |
Electronic medical record (EMR) | “If they’re in our system, we can easily send a letter, you know, a quick note over to the OB and say can you please get this one in, but when they’re not part of [our system] is when it becomes a nightmare.” “… if we expanded pediatrics to perinatal and OB into the baby… We[could] sign a release, the mom signs off a release, and offices talk. When they score on a peri-birth and it is positive, that goes in the baby’s chart.” |
Team responsibility | “We are still in a silo mode of ‘this is OB and this is pediatrics’. I think we are crossing into that idea that we are going to get more involved with the women’s clinic... and more involved in the prenatal care…” |
Internal linkages to behavioral health | “They [behavioral health clinicians in the system] pretty much only see private patients, so…we rarely use our own mental [health services]…” |
3. Outer setting | |
Behavioral health resources | “It’s helpful [to have co-located behavioral health care], but so I just wonder, how the other end of [the service] works, I don’t know.” “I think we would feel better if we could call [the service] ourselves…[We] get the sense that nothing’s going to really happen. You already have a therapist, but apparently…it has to be their provider who calls. They’ve made that quite clear.” “They just send us this list of some names and phone numbers, but sometimes even with that list, our patients have a lot of trouble and people don’t return their calls.” [the pediatrician] “…can’t make the referral because the mother’s not [their] patient.” |
Privacy laws | [pediatric providers ]“… have no idea at all what is going on…[with a mother’s healthcare across the health system]… [information relating to mothers is] an important piece [of caring for their children]” |
4. Processes | |
Positive screens | “I am worried if I get a positive [screen], what to do next.” “[With behavioral health services] you get advice…but you don’t always know when somebody’s going where. And you don’t get, you often – you may get that immediate [response], but after that it’s still a black hole.” |
Preventive care visit priorities | “I have to remember [to screen] and if the visit gets complicated it may not be something that crosses my mind until they have left the room and I realize we didn’t check it.” “Sometimes it [depression symptoms] comes up at the very end [of a visit] and we’re behind and it becomes challenging to address.” |