The DAWN intervention involves a multi-faceted approach that helps to ensure quality care. The collaborative care model designed for the Ob-Gyn population included an initial engagement session with the care manager, choice of initial treatment (psychotherapy versus medication), proactive outreach for patients who did not follow through with appointments, help for uninsured patients with charity care for medications, choice of in-person or telephone visits, and utilizing social workers as care managers to help alleviate barriers to care. The Collaborative Team component is described in the DAWN Collaborative Care Team section. Here, we’ll focus on the intervention itself.
Depression Care Manager
The Depression Care Manager is the patient’s primary contact in the DAWN intervention. The care manager meets regularly with the patient in a combination of in-person and phone visits and:
- provides evidence-based psychotherapy
- tracks each patient’s responses to treatment, medications, and adherence
- obtains feedback and suggestions from the consultant team
- coordinates closely with the patient’s Ob-Gyn provider.
In summary, the care manager has two vital roles:
- Clinician – works directly with the patient to address issues, develop behavioral plans, and provide support,
- Coordinator – manages the flow of information and treatment modifications among the patient, consultant team, Ob-Gyn, and other providers.
This pre-treatment session is included to help build rapport with, and treatment commitment from, the patient. The care manager takes time to get to know the patient, understand issues from the patient’s perspective, and identify potential barriers to care. This reinforces the collaborative nature of the intervention.
There are three components to this session:
Education: The care manager provides general information about depression and the patient’s choice in her treatment, and responds to concerns about stigma about depression. Questionnaires eliciting information about the patient (e.g., Access to Treatment Questionnaire and Engagement Session Checklist) are used by the care manager.
Evaluate Health Concerns: The care manager uses the Health Concerns Symptom Checklist to better understand the patient’s primary reason(s) for the clinic visit or specific concerns she has about her health. Once completed, the form helps the patient talk with her Ob-Gyn about those concerns.
Establish collaborative relationship: Specific training is provided to the care manager about psychological and socioeconomic issues that women often face and which negatively impact their ability to maintain care. Furthermore, care managers use a Motivational Interviewing approach, which is effective at establishing a collaborative relationship and enhancing people’s ability to make change. The care manager’s goals for this discussion are to:
- Understand the Patient’s Story – Get to know the patient from her perspectives and based on her values, using a patient-centered and collaborative style that ensures the patient feels safe.
- Emphasize the Patient’s Strengths and Coping Capacities – Underscore the patient’s resilience, creativity, knowledge, spirituality, and emotional supports.
- Provide Feedback and Psycho-education – Share information about the patient’s problems and possible treatment options.
- Address Barriers to Care – Help the patient to identify barriers to treatment that may arise and problem-solve possible solutions they can use.
- Elicit Commitment and Planning for Treatment – Emphasize that the patient has control and makes her own choices, while collaboratively creating an effective treatment plan.