title: Training health visitors in cognitive behavioural and person-centred approaches for depression in postnatal women as part of a cluster randomised trial and economic evaluation in primary care: the PoNDER trial.
abstract: OBJECTIVE
  This paper aims to describe the training preparation for health visitors who took part in the intervention arm of a cluster randomised controlled trial and economic evaluation of training for health visitors - the POstNatal Depression Economic evaluation and Randomised (the PoNDER) trial. A secondary aim is to make available, by electronic links, the training manuals developed for and used for the cognitive behavioural approach (CBA) and the person-centred approach (PCA) training for the health visitors. The paper is of relevance to health visitors, general practitioners, nurse practitioners, midwives, clinical psychologists, mental health nurses, community psychiatric nurses, counsellors, and service commissioners.
  
  
  BACKGROUND
  The trial clinical outcomes have been published, indicating the pragmatic effectiveness of the package of training for health visitors to identify depressive symptoms and provide a psychologically informed intervention. The training was associated with a reduction in depressive symptoms at six months postnatally among intervention group women and some evidence of a benefit for the intervention group for some of the secondary outcomes at 18 months follow-up.
  
  
  METHODS
  The two experimental interventions examined in the PoNDER trial built upon promising work on the potential for psychological interventions to help women recover from postnatal depression as an alternative to pharmaceutical interventions and to address the limitations of previous research in the area.
  
  
  RESULTS
  The package of health visitor training comprised the development of clinical skills in assessing postnatal women and identifying depressive symptoms, and the delivery of a CBA or a PCA for eligible women. This was the largest trial a health visitor intervention and of postnatal depression ever conducted. We are aware of no other rigorously performed trial that has published details of an extensively tested training programme for the benefit of health-care professionals and clients.
authors.affiliation: School of Nursing, Midwifery and Physiotherapy, University of Nottingham, Queen's Medical Centre, Nottingham, UK. jane.morrell@nottingham.ac.uk
authors.forename: C Jane
authors.initials: CJ
authors.lastname: Morrell
authors.forename: Tom
authors.initials: T
authors.lastname: Ricketts
authors.forename: Keith
authors.initials: K
authors.lastname: Tudor
authors.forename: Chris
authors.initials: C
authors.lastname: Williams
authors.forename: Joe
authors.initials: J
authors.lastname: Curran
authors.forename: Michael
authors.initials: M
authors.lastname: Barkham
mesh_terms: D002983:Clinical Competence; D015928:Cognitive Behavioral Therapy / Q000193:education* / Q000379:methods; D019052:Depression, Postpartum / Q000175:diagnosis / Q000628:therapy*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000193:education*; D006801:Humans; D007858:Learning; D018803:Models, Economic; D018802:Patient-Centered Care / Q000379:methods*; D011247:Pregnancy; D011320:Primary Health Care / Q000191:economics / Q000379:methods*; D016730:Program Development; D015397:Program Evaluation; D013663:Teaching; D006113:United Kingdom