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The application of best treatment practices is essentially the staple of the social service profession and it is through evidence-based research that social scientists continue to improve the quality of treatment for underserved populations. As individuals and societies present with new and worsening problems, the study of cause-effect and possible solutions becomes an even more interdisciplinary study, involving not only the involvement of research in a theoretical framework, but also dependent largely on the data collected by social work professionals who utilize these theories in application on a daily basis. Because psychology and sociology are dynamic and interdisciplinary fields of study, successful treatment of individuals often requires the implementation of a multitude of treatment options, and often a process of trial and error until the desired result is achieved. In recent years, the focus has shifted from absolute treatment to relative treatment, and has taken the focus from treating the problem or symptom to treating the individual as a whole. This person first, client-centered treatment model has vastly expanded the role of the case manager in the community and within the social service profession. It has also added enormously to the responsibility of the case manager to recognize and utilize effective case management practices while working with the specific population of people that they serve. This research paper will focus on the effective understanding and implementation of best treatment practices by case management professionals working with women suffering from post-partum depression.
Post-partum depression is largely misunderstood, therefore mothers often face harsh criticism and ridicule for the rejection of their own child. Post-partum depression is a recognized mental health diagnosis that can have serious negative consequences for the entire family unit. It can manifest itself as severe depression or anxiety that cripples the mother and can leave her unable to care for her own child. Although the symptoms of post-partum depression may range from mild to severe, they can sometimes lead to state of psychosis or behavior that is harmful to the mother and child. Because this condition has been stigmatized by the general public, research into post-partum depression, as both a psychological and social problem, has explored many angles, and it is due to this research that social scientists have found that women with previous mental health problems are more likely to experience post-partum depression.
However, rejection does not necessarily mean that the mother does not care for her child, rather she is experiencing an onset of unrecognized emotions for which she was not prepared. The implementation of proper coping skills and other prenatal adjustment techniques can significantly influence the possibility of a positive parturient and post birth transition for both the mother and her child. It has been over a half of century since social scientists have made the link between underlying mental health issues and the subsequent attitudes and symptoms of rejection, thereby opening the door for the research into effective treatment options for this particular population group. It is through this research that social service professionals have begun to place an emphasis on intervention, rather than correction.
Just as any effective case management model, the best method of intervention seems to be a comprehensive approach that encompasses a multitude of services, and one that provides services relative to the needs of each individual or family. A successful treatment model should include a psychosocial program, case management, child therapeutic services, family services, substance abuse treatment, mental health treatment, and outreach services. One such program, known as the The Mother’s Project, took up this model in the early nineties, even including a therapeutic nursery for children. The focus of the program was intervention for the purpose of decreasing the number of young children placed in foster homes, and ultimately the program was seen as an economic success for the state of Illinois. However, the results pertaining to long term social and economic impact were not collected, therefore the most effective approach is still relatively unknown. Even so, the focus of all-encompassing treatment and intervention are still utilized as the most effective means of treatment throughout the social work profession, and it is the responsibility of the case manager to ensure that relevant data is collected during treatment to further the effectiveness of future services.
Devising a treatment plan and working toward achieving goals is much more than the meeting the desires of the client. The treatment plan is put into place in order to meet the essential needs of the client that would otherwise cause adverse mental health or substance abuse behavior. They may be put into place to ensure the safety of the client or the client’s family, devise a plan to escape domestic violence, or prevent other abusive and neglectful behavior. Most of the time, the focus is on reaching a point of self-sufficiency and sound mind, allowing the client to be an independently functioning and productive member of society for the good of everyone involved. So, often the key objectives are securing employment, applying for state benefits and entitlements, securing safe housing, or getting transportation to important medical appointments, but they can also include things like educational goals, and relationship goals, that are not traditionally addressed in the rest of the social service setting.
As long and short term goals are developed, the idea is that the client will start taking the initiative to achieve these goals on their own and eventually reach a point where they no longer need the services of a case manager, because they are essentially able to manage their own life. This is not always the case, and it depends strongly on the severity of mental illness, the level of functioning of each individual client, and the steps they have taken to reach their intended goal. For example, one client may have a long term goal to secure Social Security Disability and find appropriate housing for her and her child, while another client may have a long term goal to seek employment, but intends to remain living at home with her extended family.
In a study of post-partum women, Douglas Symons, of Acadia University, found that mothers who returned to work after giving birth had a smoother recovery from post-partum depression. This suggests that, not only is employment a source of security for women suffering from post-partum depression, but the mere concentration on a long term goal can have positive effects on secure-behavior in mothers who experienced symptoms of post-partum depression. In other words, it is speculated that employment or any other form of higher achievement in mother with post-partum depression can have a positive influence on alleviating mental health symptoms.
Since the most effective approach to case management with post-partum women tends to be intervention, the case management professional has a responsibility to identify signs and symptoms of susceptible mothers who are pregnant or plan to be pregnant, and identify the best approach to implementing a successful plan before childbirth. Because the research suggests that women with prior mental health problems are at a higher risk for post-partum depression, a majority of the population group will already be available without the need for outreach.
However, there is a segment of the general population comprised of people with untreated mental health problems, and it will ultimate be necessary for a collaboration to be formed between case management professionals and obstetricians in order to implement effective intervention methods. The obstetrician has an advantage in which they can identify signs that the patient may have a negative reaction to childbirth, and after a referral to a case management professional, the case manager and the client can work together to formulate an actionable plan to prevent the manifestation of post-partum depression in the form of severe psychotic reactions or other negative mental health symptoms. The treatment options for this population group are not limited to direct support services, and should encompass any non-traditional services that will promote the healthy mental capacity and functioning of a new mother. Successful treatment goals that aim to eliminate stress, anxiety, depression, and security issues are all beneficial in promoting the treatment of mental health diagnoses, including post-partum depression.
References
Highet, N., & Drummond, P. (2004, April). A comparative evaluation of community treatments for post-partum depression: implications for treatment and management practices. Australian & New Zealand Journal of Psychiatry, 38(4), 212-218.
Markham, S. (1961). A comparative evaluation of psychotic and nonpsychotic reactions to childbirth. American Journal of Orthopsychiatry, 31(3), 565-578.
Symons, D. K. (1998). Post-partum employment patterns, family-based care arrangements, and the mother–infant relationship at age two. Canadian Journal of Behavioural Science, 30(2), 121-131.
Zeitz, M. A. (1995, Summer). The mothers' project: A clinical case management system. Psychiatric Rehabilitation Journal, 19(1), 56-62.
Zemlick, M. J., & Watson, R. I. (1953, June). Maternal attitudes of acceptance and rejection during and after pregnancy. American Journal of Orthopsychiatry, 23(3), 570-584.
