Evaluating the Perinatal Depression Screening and Referral Process at the Nash County Health Department Using the CIPP Model

Perinatal depression is a significant public health issue with important consequences for maternal and infant health. Untreated symptoms may impair maternal functioning, contribute to adverse birth outcomes, disrupt mother-infant bonding, and negatively affect child development. Although perinatal depression can affect women across populations, the burden is often greater among low-income women and among Black and Hispanic women, who may also face barriers to screening, treatment, and follow-up. In rural public health settings, these risks may be amplified by transportation barriers, stigma, limited mental health resources, staffing constraints, and fragmented systems of care. The purpose of this Doctor of Nursing Practice project was to evaluate the current perinatal depression screening and referral process at the Nash County Health Department (NCHD) using the Context, Input, Process, and Product (CIPP) evaluation model. Specifically, the project examined screening consistency across recommended time points, assessed use of the validated screening tool used in practice, evaluated provider response and referral patterns for positive screens, and identified system-level gaps to inform future practice improvement. This project used a program evaluation design with retrospective chart review and stakeholder interviews. Quantitative data were collected from 174 perinatal patient charts at the Rocky Mount and Nashville clinic sites and analyzed using descriptive statistics, including frequencies and percentages. PHQ-9 scores were further categorized by severity to better describe symptom distribution. Qualitative data obtained through staff interviews were analyzed thematically to identify recurring workflow barriers, documentation concerns, and implementation challenges. Findings demonstrated that depression screening was highly consistent at the initial prenatal visit, with 173 of 174 charts showing a documented intake PHQ-9, representing a screening rate of 99.4%. However, repeat screening was substantially less consistent, with only 8 charts (4.6%) containing a PHQ-9 at 24 to 28 weeks and 21 charts (12.1%) showing a documented postpartum PHQ-9. A total of 35 patients (20.1%) had positive screens using the clinic’s operational threshold of PHQ-9 greater than or equal to 5. Of these, 23 patients (65.7%) had mild symptoms and 12 patients (34.3%) had moderate-to-severe symptoms. Documented provider response was limited. Seven positive screens (20.0%) had documentation of passive education through pamphlet-based response, and only 2 patients (5.7%) had a documented active referral. In both referral cases, the chart indicated that the patient requested the referral. No consistent documentation of referral follow-up completion was present in the health department record. Overall, the evaluation showed that NCHD had effectively incorporated depression screening into the initial prenatal workflow, but important gaps remained in longitudinal screening, structured provider response, referral tracking, and continuity across maternity and family planning services. These findings support the need for standardized screening across time points, stronger EHR prompts and documentation systems, clearer response protocols, more active referral practices, and culturally sensitive patient education to improve equitable perinatal mental health care in a rural public health setting.