Mental health and substance use conditions are among the most significant challenges affecting pregnant and postpartum families, and improving care for those families requires more than simply choosing the right screening tool.
That idea was at the center of WisPQC’s first topic in the Mental Health Community of Learning, where participants from clinical, hospital, public health, and community settings came together to explore practical ways to strengthen screening, referral, and follow-up across the perinatal period.
The first two sessions in the series focused on a shared question: How can we make meaningful improvements without overwhelming already-busy systems?
The answer: start small, test what works, and learn together.
Why co-screening matters
Substance use and co-occurring mental health conditions are a leading contributor to pregnancy-associated deaths. The risk extends well beyond the immediate postpartum period, with overdose deaths occurring disproportionately between six and twelve months after birth.
Participants in the Community of Learning discussed why mental health and substance use should not be treated as separate issues. These conditions frequently overlap, and screening for one without considering the other can leave important needs unidentified.
In addition, routine screening can help reduce stigma. When conversations about depression, anxiety, alcohol, tobacco, cannabis, or other substance use become a standard part of care, patients are less likely to feel singled out.
And screening does not always have to begin with a formal tool. Questions such as, “What’s feeling harder than you expected?” can open the door to honest conversations while showing genuine concern for a patient or client’s well-being.
From ideas to small tests of change
During the sessions, participants reviewed several screening tools, including the PHQ-9, GAD-7, Edinburgh Postnatal Depression Scale, and other approaches. But rather than identifying a single “perfect” combination, the group focused on using Plan-Do-Study-Act (PDSA) cycles to determine what may work best in different settings.
A PDSA test might be as small as trying two screening tools with one patient, changing how a screening link is delivered, or testing a new workflow with one provider.
During breakout discussions, one public health participant described very low response rates to mental health screeners sent by text to WIC participants. Instead of redesigning the entire process, the group identified a smaller test: have WIC staff notify a handful of participants that a screening text is coming and see whether response rates improve.
Hospital participants explored similar challenges, including inconsistent screening practices, substance use testing protocols, and how to reduce stigmatizing approaches for patients with long-term recovery histories.
Expanding the circle of care
The second session built on those conversations by exploring lived experience, patient feedback, and partner screening.
Participants were encouraged to ask patients directly how new screening processes feel. Incorporating lived experience does not require a formal advisory structure; sometimes it begins by asking, “How did that screening process work for you?”
The group explored screening partners and support people for mental health and substance use concerns. While participants saw clear value in supporting the whole family, they also surfaced real barriers: where partner information should be documented, how confidentiality is protected, what happens when a partner does not have a primary care provider, and whether referral resources are available before screening begins.
One principle emerged repeatedly during discussions: don’t screen without a plan to respond.
The discussion also acknowledged the people providing this care. Mental health and substance use conversations may intersect with providers’ own lived experiences, making attention to professional boundaries, secondary trauma, and workforce well-being an important part of improvement.
Both sessions highlighted how meaningful QI does not require solving everything at once.
Start with one patient, one workflow, and one conversation. Learn from it and build from there.
Building knowledge and confidence
Early evaluation results suggest that the shared learning and hands-on approach made a difference. Following the second session, participants reported increases in both their confidence in building and conducting a PDSA test related to perinatal mental health and substance use screening and their knowledge of this topic.
These early gains reinforce the value of a Community of Learning and creating an approachable space where participants can build skills, learn from one another, ask questions, and leave with practical ideas they can test in their own settings.
The conversations will continue this fall with two remaining sessions focused on Resource Mapping and Coalition Building, helping participants identify available supports, uncover gaps, and strengthen the partnerships needed to better support pregnant and postpartum people and their families. While registration for this Community of Learning is closed, session recordings and resources will be available to everyone through WAPC’s Learning Management System later this year.
