Home Visits Bring Perinatal Mental Health Care to Mothers Across Iowa and Indiana

Every year, home visiting programs across the American Midwest quietly reach thousands of low-income and marginalized families, offering a lifeline of support during one of the most vulnerable periods of a parent’s life. Now, a new study suggests these programs could become a powerful vehicle for delivering evidence-based mental health care to new mothers who might otherwise never receive it. The research, published in BMC Health Services Research, details a community-engaged formative evaluation designed to scale the Mothers and Babies cognitive-behavioral intervention within state home visiting programs across Iowa and Indiana. The investigation was led by Elissa Z. Faro, Ph.D., an implementation scientist and medical anthropologist at the Hackensack Meridian Center for Discovery and Innovation, alongside co-principal investigator Kelli Ryckman, Ph.D., associate dean of Research at Indiana University School of Public Health in Bloomington.

Perinatal depression and anxiety are common and potentially serious complications of pregnancy and childbirth, and their consequences extend far beyond individual suffering. These conditions directly contribute to maternal mortality and persistent health disparities, particularly among Black, Indigenous, and People of Color populations. The stakes could hardly be higher: maternal mental health problems that go untreated during the perinatal period can set families on a difficult trajectory from the very outset of parenting. Yet despite growing awareness of the problem, structured, evidence-based intervention tools remain scarce in the community settings where many at-risk mothers actually encounter the health system.

Home visiting programs represent a vital community health link that already reaches thousands of low-income and marginalized families annually. But delivering evidence-based mental health interventions through these programs poses substantial implementation challenges. The programs vary widely in operations, staffing, and funding, meaning an intervention that works smoothly in one agency may encounter entirely different obstacles in another. The researchers consequently launched a multi-faceted investigation as part of the National Institute of Mental Health-funded IMPACT trial, short for Implementing Mental Health Programs Across Communities in Iowa and Indiana. Using a modified Implementation Mapping approach, the team partnered with healthcare providers, state agency representatives, and program recipients to adapt an implementation facilitation strategy suited to the realities of home visiting.

The scale of the mapping effort was remarkable. The researchers mapped more than 500 programs across Indiana and Iowa, creating a comprehensive picture of the home visiting landscape in both states. A survey of 72 of these home visiting programs demonstrated that over 90 percent of responding programs routinely screen for perinatal depression. That finding only further emphasized the need for structured, evidence-based intervention tools during home visits: screening identifies mothers who need help, but screening alone does not deliver treatment. The gap between detection and intervention is precisely where the Mothers and Babies intervention is intended to fit.

Interviews with participants reached through the program identified key engagement barriers that could make or break the effort. Fear of judgment emerged as a central concern, alongside scheduling logistics that complicate in-home delivery. Participants also stressed the importance of involving broader social networks and family connections, reflecting a growing recognition in perinatal health research that a mother’s mental wellbeing is embedded in her relationships, not isolated within her. These insights shaped how the implementation strategy was adapted, ensuring the intervention would account for the social realities of the families it aims to serve.

In-person meetings held in Des Moines and Indianapolis brought together home visitors, supervisors, program directors, social workers, and state health department officials to understand and prioritize social determinant factors in outreach. Virtual panel meetings conducted in English and Spanish further connected the outreach to the groups, extending the community-engaged process beyond those able to attend in person. The bilingual panels reflect the demographic diversity of the families served by home visiting programs and the linguistic accessibility required for genuine engagement.

The formative evaluation revealed key differences in state priorities that underscore why a one-size-fits-all scaling strategy would fail. Indiana emphasized logistical challenges such as staff workload and integration into existing workflows, while Iowa participants homed in on the importance of communication systems, training infrastructure, and mental-health consultations. These divergent concerns illustrate a core principle of implementation science: adapting evidence-based interventions to local context is not optional refinement but essential engineering. What matters most in one state’s home visiting system may be secondary in another’s, and the adaptation process must capture those differences.

Altogether, the research group produced the IMPACT Implementation Support Package, structured around four core performance outcomes. The first is professional development and staff growth through ongoing skill development, ensuring home visitors build and maintain the competencies the intervention demands. The second is integration into systems of implementation, so the intervention becomes part of routine operations rather than an added burden. The third is better staff understanding of mental health, deepening the knowledge base of the workforce delivering care. The fourth is the ongoing building of trust and rapport among clients and client groups, the relational foundation on which in-home mental health support ultimately rests.

The findings emphasize the need to reach out to mothers who need a helping hand, and an ear, at a critical start of their parenting experience. The authors write that the findings from this study carry important implications for health service delivery and policy. For health systems grappling with maternal mortality and perinatal mental health disparities, the study offers a concrete template: leverage the existing reach of home visiting programs, adapt implementation strategies through genuine community partnership, and build support packages around workforce development, system integration, staff knowledge, and trust.

Faro’s leadership on the IMPACT study highlights the unique interdisciplinary expertise she brings to the Hackensack Meridian Center for Discovery and Innovation. An archaeologist by training with a doctorate in classical art and archaeology from the University of Michigan, her early academic work focused on understanding complex human systems and recovering the perspectives of individuals omitted from dominant historical narratives. That background in recovering overlooked voices translates directly into her current mission: by merging community engagement, implementation science, and health equity, Faro and her colleagues are working to ensure that evidence-based perinatal mental health support reaches the families who need it most. The study was published on 1 October 2026, and the authors declare no competing interests.

Subject of Research: Perinatal mental health implementation in home visiting programs

Article Title: Scaling perinatal mental-health care: CDI scientists assess home visiting programs in Midwest

Article References: Scaling perinatal mental-health care: CDI scientists assess home visiting programs in Midwest. Original publication (Bibliographic details unavailable.)

Image Credits: AI Generated

DOI: Not provided

Keywords: perinatal depression, home visiting programs, implementation science, maternal mental health, Mothers and Babies intervention, health equity, Iowa, Indiana, community engagement, BMC Health Services Research, Scaling, perinatal