**2. Solutions/recommendations**

#### **2.1 iCOPE**

An initiative in Victoria, Australia is currently being used to improve psychosocial screening and assessment uptake in the public sector. iCOPE screening was initially piloted in Victoria and following its positive outcomes has been fully funded to be made available nationally to every public maternity hospital in Australia. Victoria was the first state to take up this state-wide, and in the first year of implementation screening is being digitally implemented across 90 locations and over 20,000 screens conducted across maternity (90% of public hospitals) and postnatal settings (85% MCH settings). In line with best practice [15, 37] the Antenatal Risk Questionnaire/Post Risk Questionnaire

*Perspective Chapter: Psychosocial Screening and Assessment in the Private Sector in Australia… DOI: http://dx.doi.org/10.5772/intechopen.113404*

(ANRQ/PNRQ) have been implemented. There has been development of iCOPE Digital psychosocial screening under the Commonwealth's Perinatal Mental Health Check up until July 2025. This includes administration of the Edinburgh Postnatal Depression Scale (EPDS) and the ANQR/PNQR screening tools. This has been initiated in 75% of public hospitals and child and family health services in Victoria. The digital screening tool is available in 25 different languages. As part of the development of the 2023 Guideline, recommendations were given with respect to screening for fathers and partners. Here adaptions were made to the ANRQ/PNRQ and lower cut-off scores applied to the EPDS or use of the K10. These tools and scoring algorithms have been programmed into iCOPE and also digitally available. However, since they are not deemed to be 'the patient' if screening was positive, they would need to access their General Practitioner for follow-up. iCOPE is one example of an initiative in Australia (a high-income country). The digital tool is also available, and is being used within the private sector by OBGYNS. As this is not funded under the Perinatal Mental Health Check Program, access to iCOPE at the expense of the private obstetrician or hospital, however costs can be off-set by Medicare Benefits Schedule (MBS) item number for screening antenatally (16,590/16591 and 16,522) and Postnatally (16407). More information can be found here—https://www.cope.org.au/ perinatal-mental-health-check/digital-screening-in-the-private-sector/

#### **2.2 Australian midwifery models of care**

Within Australia there are various midwifery models of care including; public hospital care, team midwifery, midwifery group practice case load care and private midwifery care [55]. Midwives may be able to address implementation gaps by providing postnatal psychosocial screening and assessment for women in the private sector, especially since there are financial initiatives via a Medicare rebate for obstetricians for screening. Collaborative obstetric care models that employ midwives with expertise and interest in psychosocial screening as key contacts for postnatal integrated care may offer a successful future solution. The difficulty for midwives working in the private sector is that they often do not have an ongoing relationship with the woman and therefore have a limited opportunity to assess/screen or identify risk factors/disorders [44]. Contributing factors that may influence the approach a midwife takes towards psychosocial screening and assessment include organisational support for continuing education, their experience as a midwife, training and exposure to the practice of others, their own personal life experience, clinical supervision opportunities, and the model of midwifery care within their setting or organisation. Midwives seem willing to have a more substantial role in recommending appropriate psychosocial treatment strategies to women with postnatal depression, however, further training is often required to ensure both confidence and competence in their psychosocial assessment and management of women [10]. Similarly, the majority of obstetricians and/or gynaecologists consider that they have a responsibility to identify depression but may not have the appropriate training and resources to screen for and treat depression. It is also evident that some maternity care providers may be reluctant to ask about depression, and women themselves may be unwilling to disclose their experiences [10, 14].
