Insights Statewide Equity in Action: KMMS Coverage for First Nations Mothers

The importance of mental health screening in perinatal care is widely acknowledged. It is understood that structured and validated tools are regarded as a reliable mechanism for recognising risk early enough to intervene. Left to opportunistic or unprompted disclosure, conditions such as perinatal mood disorders are frequently missed. This is why national guidelines in Australia recommend routine screening using validated tools rather than clinical judgement alone (Australian Institute of Health and Welfare, 2024).

However, it is also important that the tools that are administered reflect the population that is being screened, as a tool validated on one population cannot be assumed to perform equivalently, or to be trusted equivalently, on another.

The Edinburgh Postnatal Depression Scale (EPDS) is the default instrument used for screening across most Australian services. Although the EPDS can be effective in identifying present risk, the tool was neither developed nor validated on all population groups.

Health professionals in the Kimberley region identified that the EPDS was not culturally appropriate for the Aboriginal women it was being used to screen (WA Health, n.d.). In response, researchers ran a participatory action research process, working with over 100 Kimberley Aboriginal women and 72 health professionals to co-design a different approach. The result was the Kimberley Mums Mood Scale: a two-part tool combining a modified set of screening questions with a yarning template for exploring the psychosocial areas of stress and resilience in a woman's life, built on the understanding that risk factors alone don't capture the full picture, and that protective factors, particularly family relationships, matter just as much.

KMMS was then independently validated in remote Aboriginal health care settings in the Kimberley, showing strong internal consistency (Cronbach's α = 0.89) and good diagnostic accuracy against clinical assessment (83% sensitivity, 87% specificity) (Marley et al., 2017).

The validation study also looked at acceptability alongside its psychometric results. Health providers reported that the EPDS could create distrust before a conversation even started, while Aboriginal women found KMMS's language more straightforward and relevant to their own experience. This suggests KMMS's value lies not only in its validity, but also in how it was received compared with the mainstream alternative, which can matter for whether a tool is used, alongside its ability to detect risk.

In practice, the two parts play out differently. The screening questions can be completed on a tablet in clinic or on a woman's own phone, at a time that suits her. The yarn, though, always happens face-to-face with her clinician during the appointment.

Screening in Australia has shifted decisively towards digital delivery, with the EPDS, psychosocial screening and family violence screening now commonly administered on a platform rather than on paper. Diginostic’s screening platform reflects this scale, supporting thousands of health professionals and hundreds of thousands of completed screens across public and private maternity services nationally. Queensland’s rollout of the KMMS sits within this broader shift, built into the same digital platform that delivers the state’s wider perinatal mental health screening program rather than being added separately.

Diginostic has worked with Queensland Health to build the KMMS into electronic medical record systems and the clinical workflows of public maternity and child health services across metropolitan, regional, rural and remote Hospital and Health Services statewide.

The KMMS is built into the Diginostic platform, and its use follows directly from how a client identifies. As part of the screening process, a question records whether the client and/or her baby identifies as Aboriginal and/or Torres Strait Islander. When this is answered affirmatively, the platform triggers the KMMS pathway as part of the standard workflow. The rollout was supported by dedicated workshops and staff training. The KMMS is now active in more than 90% of services using the platform, and the screening process continues to be refined in consultation with the Queensland Perinatal Mental Health Screening Advisory Committee, alongside the platform’s work on family violence screening and risk flagging.

A dedicated KMMS report focuses on the protective and risk factors identified through the process and provides families with information and support pathways built around them. Thousands of women go on to access this support information following screening, whether prompted by their own request or provided as part of routine follow-up.

What happens around a screening tool matters as much as the tool itself. How it is delivered, how it is followed up and whether people feel it was made for them all shape whether an identified risk turns into support that is taken up. This is what sits behind Diginostic’s approach to screening: not just delivering a validated tool but building a responsive process around it that can be shaped to fit the community using it. The work done in Queensland reflects this in practice and has supported the platform’s rollout into other jurisdictions, including the Northern Territory, where every service using the platform now has the KMMS active. More broadly, this suggests that a tool’s reach depends as much on the process built around it as on the tool itself. A well-designed process can become the foundation for broader reach.