Screening & Referral: Patients are screened by self-administration of the PHQ-9, a validated depression-screening tool to determine if depressive symptoms are present. This occurs at the beginning of a visit prior to seeing the provider and takes less than 5 minutes. In addition, Ob-Gyn providers may refer patients and, in some cases, patients may self-refer to the program.
- Eligibility & Enrollment: DAWN was designed for and was tested in women with uncomplicated unipolar depression and is not an appropriate treatment for individuals with bipolar disorder, psychosis, substance abuse, multiple prior suicide attempts, or current domestic violence. Assuming additional assessments determine that the DAWN program is appropriate for a patient, then the care manager and patient begin face-to-face meeting followed by sessions conducted in-person or by telephone.
- Engagement Interview: There are three main goals of this pre-treatment session:
- Educate about depression
- Identify other health concerns
- Engage, develop rapport, and elicit the patient’s commitment to her own treatment.
- Treatment Sessions: The patient chooses one of two options for treatment:
- The behavioral treatment (Problem Solving Treatment-Primary Care) or
- Antidepressant medications
The first phase of treatment occurs over approximately eight weeks. The care manager contacts the patient every 1-2 weeks. At each session (in-person or by phone), the care manager administers a PHQ-9 to track the patient’s depressive symptoms. After approximately four weeks, the patient’s response to treatment is assessed. If the patient has had a complete response to treatment, then she is moved into the maintenance phase. If the patient has not had a complete response to treatment, then the DAWN team suggests another course of action based on a stepped care model (e.g. switching to or adding the other treatment modality, adjusting or augmenting medications, etc.) and the patient is assessed again after a second four-week treatment period.
- Maintenance and Follow-up: Once the patient has successfully responded to treatment, the care manager contacts her monthly for another 3 to 6 months.