By October 30th, please work with your team to complete this birth site-level survey for the period of July through September 2021. The person completing this survey should gather and verify the information from a multi-disciplinary team. Please use the same process each time when completing the survey (e.g., if the person who typically completes the survey is out of the office when the survey is due, it is okay to complete the survey when that person returns unless there is a reliable contingency process in place where the back-up person is trained in the same protocol for completing the surveys.) For examples of best practice survey competition processes, please see the July 29, 2020 presentation and recording available at https://www.whamglobal.org/member-content/materials-from-sessions#Past-Key-Intervention-Webinars.)

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* 1. Please enter the name and title/role of the person completing this survey.

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* 2. Your PA PQC Hospital or Affiliation

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* 3. Which settings are you completing this survey on behalf of?

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* 4. Do you screen people with a validated mental health screening tool during the prenatal period? (see Q7 for a list of validated screening tools)

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* 5. Do you screen people with a validated mental health screening tool during the postpartum period?  (see Q7 for a list of validated screening tools)

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* 6. If you answered "yes" to Q4 and/or Q5,
What depression screening approach do you use?

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* 7. If you answered "yes" to Q4 and/or Q5,
What depression screening tool do you use? (Please check all that apply.)

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* 8. If you answered "yes" to Q4 and/or Q5, 
Where does the depression screening process occur?

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* 9. Do you have a standardized protocol to follow-up on positive depression screens?

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* 10. If you answered "yes" to Q9, 
What follow-up actions occur in your hospital or outpatient offices in response to a positive depression screen? (check all that apply)

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* 11. Which quality metrics do you use to inform continuous improvements to your depression screening and follow-up processes?

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* 12. If you selected a quality metric in Q11: 
Do you stratify the maternal depression and follow-up measures by race?

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* 13. Have you conducted a quality improvement project to reduce racial disparities for maternal mental health quality measures?

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* 14. Does your organization analyze how institutional policies are facilitating or alleviating racial disparities in a standardized way?

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* 15. Does your organization provide staff-wide education on perinatal racial and ethnic disparities and root causes?

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* 16. Do you work with patient/family advocates or community resources to inform your maternal mental health screening and follow-up processes?

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* 17. Do you work with patient/family advocates or community resources to inform your work to reduce racial disparities?

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