Addressing Maternal Depression Through Home Visiting: One State's Experience With a Breakthrough Series Collaborative.

BACKGROUND AND OBJECTIVES: From 2013 to 2017, a national Breakthrough Series (BTS) collaborative in Maternal, Infant, and Early Childhood Home Visiting programs developed a toolkit that led to improvements in maternal depression outcomes. In 2018, Alabama's home visiting program (First Teacher) aimed to reproduce these impacts with a state-led BTS that enrolled 8 local implementing agencies (LIAs) serving more than 500 families. METHODS: LIAs tested changes in practices using Plan-Do-Study-Act cycles and tracked data regarding depression screening, referrals, service access, and symptom improvement via run charts. First Teacher administered a post-collaborative survey to assess LIA team members' satisfaction with their BTS experience. RESULTS: Alabama's BTS resulted in positive shifts in maternal depression referrals, service access, and symptom improvement. Change ideas that supported these shifts included the use of a screening script, motivational interviewing, "Mothers and Babies," and a registry. LIAs noted that BTS tools and resources helped build capacity to address the difficult and frequently stigmatized topic of maternal depression. CONCLUSION: Findings from this study indicate that evidence- and experience-based practices regarding maternal depression screening, referrals, and service access can lead to symptom improvement among mothers enrolled in a state-based home visiting program. Results of this investigation corroborate findings from previous studies while also incorporating feedback from LIAs about the BTS experience.

Advancing Quality Improvement in Public Health by Exploring CQI in Alabama's Home Visiting Program.

Continuous Quality Improvement (CQI) is the use of a deliberate and defined improvement process to advance organizational systems. Quality improvement in public health is increasingly widespread, but there are still limited examples of success or descriptions of developmental trajectories for building CQI capacity. The goal of this article is to add to the extant knowledge on the topic by describing one state's implementation of evidence-based CQI in the Maternal, Infant, and Early Childhood Home Visiting program between 2014 and 2019. On the basis of a systematic review of Annual Yearly Progress reports and semistructured key informant interviews, analysis yielded 3 themes that facilitated successful implementation of CQI in Alabama: starting small and building capacity; engaging in continuous and supported learning; and establishing and maintaining a culture of quality. This project demonstrates that CQI can help public health practitioners refine processes and grow capacity to best serve clients' diverse needs.

Improving Asthma Conditions for Children and Adolescents by Expanding the Statewide Learning Collaborative Model Through Health Homes.

BACKGROUND AND OBJECTIVES: Asthma is one of the most common diseases among children in the United States. Increasing provider adherence to national asthma guidelines and connecting patients to Health Homes can increase optimal asthma care. The objectives of this article are to report the results of an asthma learning collaborative and explore the role of Health Homes in contributing to its success. METHODS: Quantitative and qualitative data were collected regarding the experiences of 14 pediatric primary care practices and 6 Health Homes participating in a 9-month learning collaborative. RESULTS: Practices exceeded process aims of 80% compliance with optimal asthma care and the use of an Asthma Action Plan among patients aged 2 to 21 years. Health Home care coordinators also reported improvements in self-management strategies for asthma conditions, including the presence of an Asthma Action Plan, medications, spacers, and proper spacing techniques. Providers and Health Home care coordinators identified role clarity, mitigation of environmental triggers, and management of asthma conditions as benefits of the experience. CONCLUSIONS: The results of this asthma learning collaborative increased provider adherence to national guidelines and significantly improved optimal asthma care for patients. This multipronged, holistic approach to asthma care proved successful for controlling and maintaining asthma conditions among patients.

Using Continuous Quality Improvement Tools to Promote Tobacco Cessation Among Primary Caregivers in a Home Visiting Program in Alabama.

Alabama's Maternal, Infant, and Early Childhood Home Visiting-funded program was one of 10 state teams accepted to participate in the first wave of the Federal Home Visiting Program State and Territory Continuous Quality Improvement Practicum. This article reports methods and results of Alabama's continuous quality improvement (CQI) project and lessons learned in developing CQI capabilities among state and local public health practitioners. The Alabama team tracked CQI data weekly for the duration of the practicum using an annotated run chart. Participants included 20 identified tobacco users in 2 participating LIAs. This article highlights specific CQI tools to achieve the project aim. On the basis of CQI interventions, Alabama reached its goal; 12 of 20 primary caregivers in 2 home visiting programs made quit attempts. Alabama utilized multiple CQI tools to reach an ambitious, behavior-based aim; these same concepts could be broadly applied to quality improvement initiatives in any federal or state public health program to guide process- and outcomes-based improvement efforts.