Community Health Workers in Perinatal Mental Health: Feasibility and Challenges of Implementing a Task-Sharing Model

Despite their long history of working with infants and new birthing persons, community health workers (CHWs) could be better utilized to help address the emotional needs of individuals who recently gave birth. We adapted the Thinking Healthy Program (THP), a World Health Organization-endorsed task-sharing model, to assess the feasibility of implementing THP in six community-based organizations (CBOs) in central and western New York. We present results on the feasibility and acceptability from the CHWs, their supervisors, and chief executives of six community-based organizations. Qualitative interviews with stakeholders were carried out prior to program launch, soliciting their input on the role of CHWs and challenges related to implementing the task-sharing approach for working with persons with perinatal mood and anxiety disorders (PMADs). Feedback on knowledge, comfort, confidence and overall ability were collected from CHWs and their supervisors at baseline and post-implementation (i.e., after implementation with two clients). Qualitative interviews identified three themes: 1) the community's need for CHW engagement; 2) the current CHW roles in the management of maternal health, including PMADs; and 3) the CBO/CHWs' ongoing need for resources to continue providing task-sharing approaches. Post-implementation surveys of CHWs revealed mixed results. Although CHWs stated their knowledge, comfort, and confidence in maternal mental health declined, their supervisors noted improvements in the CHWs' skillset. Our findings highlight critical challenges associated with implementing task-sharing approaches that engage CHWs to address PMADs. Our results suggest the need for attention to organizational context; sustained supervision; and strategies to address workforce turnover, burnout, and role clarity.