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Delivery of Postnatal Depression Services by PCTs

Health Visitor
Riversdale Surgery
59 Bridge Street
DE56 1AY

Tel. 01773 822 386

A discussion/review of how we deliver services for women has come about through the transition to PCT status and fundamentally a change in our employer. Previously we were employed as a self managed, budget holding, integrated nursing team and although this has not changed with our new employer status the previous trust delivered its HV services in a different way. There were many difference across practice delivery but POND is a priority area for resolution. The trust we now work for uses the EPDS as a screening tool and we previously only used EPDS to verify our professional judgement. We worked from a point of integration, partnership working and targeting. 

To explain further:-.

In the antenatal period we worked closely with the MW.  She identified vulnerable women from the booking appt onwards and would feed in her concerns/judgements as the mum got closer to delivery.  These mum's would also be targeted to attend the parenting groups in the antenatal period ( some were reluctant but they would always be well supported by MW and HV).  During parenting group a whole session (1 out of 4 sessions) would be devoted to PND including small group work to explore expectations and challenge society's cosy view of becoming a parent, family support structure would also be discussed as would any other areas of difficulty they were experiencing.  We were lucky as many parents attended these classes (over30) and included in the main partners, so we had an opportunity for them to discuss their feelings as fathers to be and their expectations.  Following Delivery the MW would continue to monitor the emotional well being of all mum's and would again closely liase with us to ensure a seamless delivery of services and support.

During the early weeks of HV input, all mum's are closely assessed with the emotional/psychological well being a priority area. A leaflet was also distributed at the Primary visit based on the leaflet from the Royal College of Psychiatrists.  When mum's were discharged, working on partnership basis with the HIV we had the safety net of Appt clinic that was a bridge between home visiting and child health clinic.  These offered a 20 minute one to one with mum's where again they could be assessed.  We also ran a PN support group for all new mum's where we could invite mum's who were experiencing difficulties.  Also from the parenting courses new mums and dad's were encouraged to set up their own support groups in the community eg local supermarket, voluntary organisation and mum's homes.  These were supported by the HV's but ran by the mum's and dad's.

Our approach was always to strive to work in partnership with families ensuring an open and honest dialogue and any mum's who were becoming depressed/stressed/anxious (or all three!) we would provide home visiting support/EPDS and referral to GP if appropriate and in agreement with mum.  Many mums opted for anti depressant therapy and continued visits from HV's and or linking in with one of the groups on offer (it was amazing how supportive the groups run by other mum's were).  Also mum's would not always present to us first.  Sometimes they went via the GP.  All the GP's were very geared up to respond to women with PND and would make an immediate referral to us and a package of integrated care would be initiated.  Having electronic, integrated records certainly helped this process as we could immediately refer to GP's and vice versa, also the integrated records provided us both with an opportunity to see the work we had done with a family and also a better understanding of our specific roles.

A small proportion of mum's did require admission to the local Mother and Baby Unit and so had intensive amount of support both prior to admission and  on discharge.  This point could start a debate in its own right about levels of support and joint working with MH colleagues and what happens when mum's are discharged....   Currently the limitations of EPDS are being discussed (CPHVA) with debate continuing over the point of referral and the use of a tick box eroding professional judgement (Barker).  Because this vital area of practice will have to be reviewed I would appreciate other peoples' experience /views.