Training health visitors in cognitive behavioural and person-centred approaches for depression in postnatal women as part of a cluster randomised trial and economic evaluation in primary care: the PoNDER trial

Abstract

Aim: This paper aims to describe the training preparation for health visitors who took part in the intervention arm of a cluster randomised controlled trial and economic evaluation of training for health visitors -the POstNatal Depression Economic evaluation and Randomised (the PoNDER) trial. A secondary aim is to make available, by electronic links, the training manuals developed for and used for the cognitive behavioural approach (CBA) and the person-centred approach (PCA) training for the health visitors. The paper is of relevance to health visitors, general practitioners, nurse practitioners, midwives, clinical psychologists, mental health nurses, community psychiatric nurses, counsellors, and service commissioners. Background: The trial clinical outcomes have been published, indicating the pragmatic effectiveness of the package of training for health visitors to identify depressive symptoms and provide a psychologically informed intervention. The training was associated with a reduction in depressive symptoms at six months postnatally among intervention group women and some evidence of a benefit for the intervention group for some of the secondary outcomes at 18 months follow-up. Methods:The two experimental interventions examined in the PoNDER trial built upon promising work on the potential for psychological interventions to help women recover from postnatal depression as an alternative to pharmaceutical interventions and to address the limitations of previous research in the area. Findings: The package of health visitor training comprised the development of clinical skills in assessing postnatal women and identifying depressive symptoms, and the delivery of a CBA or a PCA for eligible women. This was the largest trial a health visitor intervention and of postnatal depression ever RESEARCH conducted. We are aware of no other rigorously performed trial that has published details of an extensively tested training programme for the benefit of health-care professionals and clients.

Postnatal women's experiences of management of depressive symptoms: a qualitative study

“…A common element of the training, preceding specific approach-based skills, involved developing empathic relationships. Two experienced psychotherapist practitioner trainers delivered the training, which was carried out according to a manual, 19 and was agreed by a training reference group, comprising experienced academically-based psychotherapy and counselling trainers. In addition, health visitors were asked to audio record their intervention sessions (with the women's consent), so that session treatment fidelity could be checked.…”

Health visitor education for today's Britain: Messages from a narrative review of the health visitor literature

“…There were improved outcomes for depressed women in the study areas, where health visitors received this additional training, over those in the control areas (Morrell et al, 2011). Further, women viewed as "low risk" were significantly less likely to develop PND in the study areas than in the control areas, where health visitors had received no extra training (Brugha et al, 2011).…”

“…In their trial of interventions to identify and treat post-natal depression (PND), Morrell et al (2009Morrell et al ( , 2011 provided health visitors with specialist knowledge on PND symptom identification and trained them to deliver cognitive behavioural (CBA) and person-centred interventions (PCA) to eligible women. There were improved outcomes for depressed women in the study areas, where health visitors received this additional training, over those in the control areas (Morrell et al, 2011).…”

“…home visiting (de la Cuesta, 1994) A C C E P T E D M A N U S C R I P T o parenting programmes (Bateson et al, 2008;Whittaker and Cowley, 2012); o sleep behaviour clinics (Merrifield, 2005); o how to identify early indicators of childhood obesity and how to act on these to childhood obesity (Barlow et al, 2010) o how to supporting families where there may be issues of substance use (Orford et al, 2007); o how to intervene to promote infant mental health and to prevent behaviour problems (Craig and Power, 2010).  Skills in assessing and identifying family strengths as well as difficulties (Barlow, 2010)  Finely tuned listening skills to 'unlock issues' (especially for women with PND) and assist the person's sense of being able to manage their own condition (Turner et al, 2010)  Skilled focusing on the psychological well-being of the mother in PND (Morrell et al, 2009;  Ability to convey respect for the individual and understanding of their unique situation (Morrell et al,2011)  Active listening, conveying acceptance of the mothers' viewpoint (Morrell et al, 2011)  Helping the mother re-formulate her interpretation of life events and motivating healthy change (Morrell et al, 2011)  Listening skills : engagement, active listening, questioning, challenging (Barlow et al, 2010)  Skills in giving sensitive messages in a way which is meaningful and not threatening for the family and which maximises their likelihood of being acted upon (Barlow et al, 2010) Universal Plus: Abilities  The ability to work with families to set small goals which reflect family relationships and family dynamics …”

Evaluation of Knowledge and Psychomotor Skills of Lady Health Visitors about Immunization

“…8 A research conducted in India showed that 23.34% of Lady Health Visitors showed "excellent knowledge", 52.32% of them had "good knowledge" and 23.34% had "average knowledge" on majority of the subjects taught to them. 9 A research paper stated that 78% had adequate knowledge to practice individually. 10 According to a study, the introduction of maternal and child health intervention progamme led to a significant improvement (p < 0.05) in the performance skills of lady health visitors related to antenatal, postnatal and newborn care.…”