CCFH adopts new home visiting strategies for addressing postpartum depression
Few occasions spark joy and celebration quite like the birth of a child. For many women, though, it marks the onset of postpartum depression. More than just “baby blues,” postpartum depression can affect a mother’s health in enduring ways, and may cause problems with her baby’s sleeping, eating, and behavior as he or she grows.
In the past, many mothers have felt they had to keep such experiences to themselves, but this is starting to change. In healthcare and in public awareness, there is increasing recognition of how common the condition is and how much suffering it can cause, even in milder forms. Still, many mothers find it difficult to disclose or to take steps to get help, and it is easy for symptoms to go unnoticed by their healthcare providers.
For CCFH home visitors, though, the signs and symptoms of postpartum depression are often readily apparent, whether or not a mother is voicing concern about what she is experiencing.
CCFH’s three prevention programs – Family Connects Durham, Healthy Families Durham, and Durham Early Head Start – send nurses and family support staff into families’ homes to help parents create safe, nurturing environments for their children. The significant time our home visitors spend with parents – especially mothers – gives them access and rapport that is rare for other healthcare providers. Also, the assessment tools used in these programs are designed to identify signs of postpartum depression and other mental health concerns.
For these reasons, postpartum depression has long been a topic of conversation in weekly case conferences. However, while CCFH home visitors felt they were more attuned to the incidence of postpartum depression, they did not feel equipped to respond adequately to what they were seeing.
In late 2017, the directors of CCFH’s prevention programs began discussing ways to better meet the needs of mothers who show signs of postpartum depression. They envisioned home visitors as effective bridges across the gap that often keeps mothers from getting treatment for their symptoms, and they embarked on a capacity-building project to give all CCFH home visitors not only a strong base of knowledge about postpartum depression but also a sophisticated set of skills for working with mothers suffering from it.
CCFH began by contracting with Chris Raines, a nurse and professor with the UNC Center for Women’s Mood Disorders, for several days of instruction in fundamentals. This included content on diagnosis, medications and standard treatment options, community supports, and substantive resources for families. She also provided ongoing consultation to ensure that the training content was translated into practice.
The next phase of the project was more ambitious: could CCFH adopt an evidence-based intervention for postpartum depression that could be provided to mothers in a home setting? Depression can rob mothers of the motivation necessary to seek out and follow up on treatment options. For some, there are also accessibility and affordability barriers to treatment. These obstacles might be overcome, if CCFH home visitors could take therapeutic care to a mother in her home alongside the services already being delivered. However, this would require a treatment model backed by strong evidence but not requiring expensive training or additional specialized staffing.
CCFH found the right solution in Mothers & Babies, an intervention developed at Northwestern University. In 15-minute sessions, the model delivers interactive lessons and activities for a mother and her baby that address underlying risk factors for postpartum depression such as limited social support, lack of pleasant activities, and harmful thought patterns. From CCFH’s perspective, the model was also attractive because it is grounded in cognitive-behavioral principles, it prioritizes attachment between mother and baby, and, most importantly, it was designed specifically to be delivered in the home.
In February of this year, all CCFH home visitors completed training in the Mothers & Babies model, and they will continue working with the developers from Northwestern on implementation over the next six months. Already, though, home visitors are putting these much-needed skills into practice with the mothers in their care.
“The day we finished training, one of our staff went straight to a home visit where she began the first session with a mom,” says Karen Carmody, director of early childhood prevention programs at CCFH. “Our staff were hungry for this, and the families we serve really need it.”
Mothers & Babies is not a substitute for appropriate clinical treatment for the symptoms of postpartum depression, and the intent is still that CCFH be an effective bridge to additional care. With this new model, though, and the broader improvements in their knowledge and skills, our home visitors are equipped to meet mothers where they are with resources that make a difference.
Postscript: We are grateful to Peter and Prue Meehan for two gifts that made possible these improvements in care for mothers experiencing postpartum depression. The public and private grants that fund CCFH’s home visiting services are limited primarily to operating expenses. By providing seed money for capacity building, the Meehans are helping improve the outcomes in our early childhood programs, which increases the efficacy of those larger grants. Just as our home visitors can now bridge the gap for mothers experiencing postpartum depression, our individual donors bridge the gap between institutional funding and the true cost of delivering excellent care to children and families.