Support and Training to Enhance Primary Care for Postpartum Depression

Engagement Patient in Treatment and/or Referral

Regardless of the method for treatment, taking steps to actively engage women in the treatment or referral process will have a substantial impact on treatment outcomes. Whether you treat or refer, it is your responsibility to engage patientss with PPD and motivate them for the treatment process.

Engagement is a continual process involving communication, participation, cooperation, and a commitment to the course of action agreed upon by the patient and the provider. Key factors of engagement include:

  • A full investment by all members of the treatment team in helping the patient recover
  • A collaborative decision to follow through on the treatment option of choice, even if one or more parties prefer a different treatment option. It is imperative that all members of the treatment team feel comfortable with the decision and adhere to that treatment modality
  • A commitment by everyone involved to "stick it out" for the duration of treatment, even if a change in course is required
  • Having the best interests of the patient in mind at all times, which might be the hardest for the patient herself if engagement requires time and effort she may not feel she has

The Importance of Engagement

The use of engagement techniques can lead to more effective treatment for women with PPD. Effective engagement divides the responsibility for wellness across all members of the team (though not necessarily equally), increasing collaboration among members and increasing personal investment and accountability among staff, patients, and family members. This approach also promotes the message that everyone wants to make a difference. Studies have found the following outcomes with successful engagement: 62

  • Better adherence to the treatment plan
  • Lower dropout rates
  • Higher satisfaction with the treatment outcomes

How to Engage Women with PPD

  • Listen
    • Recognize that active listening skills and rapport with the patient are critical
    • Reflect what you are hearing back to the patient, enabling her to hear how she is wording things, to get a sense for the feelings she is expressing, and further explore these thoughts and feelings freely
    • Ask open-ended questions to facilitate dialogue
    • Be aware of your body language, and try to use nonverbal communication to convey empathy, interest, and a desire to help
  • Maintain Positive Regard for the Woman
    • Treat the patient with dignity and respect
    • Focus on the patient’s strengths
    • Facilitate a realistic goal-setting process, including self-reward
    • Acknowledge healthy changes and behaviors made by the patient
  • Take a Clear Collaborative Stance
    • View the mother as an equal partner in care
    • Reiterate to the mother that her role in the treatment process is important.
    • When possible, choose the treatment option endorsed by the mother and her family
    • Address all concerns voiced by the patient or her family about treatment
    • Reinforce the team approach to care by dividing treatment roles across staff
  • Provide Reassurance and Education
    • Help the patient identify her strengths and weaknesses as a parent, and work out plans for overcoming problems and reinforcing strengths
    • Facilitate the mother’s understanding of developmentally appropriate behavior for her child(ren) so she is less likely to interpret behavior negatively and more likely to have realistic expectations for the child(ren), and identify and foster the development of her child(ren)’s strengths