Background: Postpartum-depression affects 10–20% of all and 40–60% of low-income mothers. Sixteen states have passed/pending legislation for Postpartum-depression awareness, screening and/or treatment. These policies give communities resources to address Postpartum-depression. Limited understanding exists of how community coalitions facilitate policy implementation. The Community-based Perinatal Support Model (CPSM) is a multidisciplinary coalition approach to developing organizational policies and systems for those affected by Postpartum-depression.  This study evaluated the contribution of CPSM to the efficacy of networks established to screen and treat Postpartum-depression in four Western Massachusetts communities.

Methods: A qualitative multiple embedded case-study design using 'coalitions' as the unit of analysis. Variables included coalition structure; internal/external leadership; community champions; resources; and readiness. Findings and discussion of broader systematic CPSM adoption are presented using a Multiple Streams Framework.

Results: Barriers to Community-based Perinatal Support Model implementation include competing priorities; external leadership; local contextual issues; and lack of funding/organizational support or community readiness. Facilitators to implementation include leadership development, professional training, community resources, referral/triage systems and Postpartum-depression screening protocols/tools. Strong public support was demonstrated through champion involvement; committed internal/organizational support and leadership; diverse membership; clear vision/goals; systems approach adherence; and high-quality technical assistance. Passage of mandatory Postpartum-depression screening provided the impetus for converging 'streams' to develop sustainable, comprehensive systems-based approaches. 

Implications: . Understanding streams in context of community dynamics facilitates policy implementation; improves continuity, quality and broader service dissemination; and sustains the Postpartum-depression policy agenda. Capitalizing on a policy opportunity contributes to expanded state funding allocations for CPSM statewide replication