ABSTRACT
In this final chapter, I offer some practical suggestions for synthesizing information in this book and taking the next steps. You may be setting up or adding to your program. You can decide how to and where to screen, and which interventions are feasible for your community. Telehealth has also increased access to specialized care for many smaller and rural communities. Here is one way to think through the next steps.
Select your screening tool. This is the first step. Which tool will you select? How will it be distributed? Will it go to every mother (recommended) or only ones who have symptoms? Will the screening tool be paper or electronic? If you are using the EPDS, which cutoff will you use? Will it be a wide or more narrow screen? Who will collect and score the information? How will mothers who screen positive be contacted?
Establish baseline health. I recommend checking on the physical health for all your mothers. If that is not possible for everyone, prioritize those who screened positive. I recommend checking vitamins D and B-12 to ensure that mothers are not deficient. I would also recommend that mothers be checked for hypothyroidism (T3, T4, TSH), anemia, and possible inflammation (complete blood count and C-reactive protein).
Consider anti-inflammatory supplements (EPA and curcumin). Lowering inflammation is an important part of recovering from depression. If mothers are open to it, you might suggest that they supplement with 1,000 milligrams of EPA and
milligrams of curcumin twice a day. This will be good for their physical and mental health.
Will you treat or refer? Thinking through your scope of practice, what areas can you address? Could you set up a peer or professional support network in your community (or is one already available)? Who will be in your referral network? Have you talked to them about seeing some of your clients?
Identify the treatments that mothers can access in your community. Consider exercise, bright light therapy, acupuncture, transcranial magnetic stimulation, or medications. What types of psychotherapy are available? Could mothers access these? What tel-ehealth options are available?
Evaluate your efforts. Many therapies take 4 to 6 weeks to be effective. When will you reassess mothers to see how they are doing? Many programs never check, but it is important that you do. No treatment works for everyone—even medications. The goal is for mothers’ symptoms to remit. Assessment can stop once mothers are better.
