Tuesday, May 25, 2010

Home Visits

Alright clinicians, another question for you. What are your thoughts about home visits with PPD clients? I was thinking about Midwives and doulas often followup on the mother/father after the birth of the baby and have been thinking about the pros and cons of this. Thoughts?
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4 comments:

  1. Karen Kleiman, MSWMay 27, 2010 at 5:49 AM

    I would be interested in a discussion about this. There are definite pros and cons. My biggest con would be the boundary issue. Personally, it would be difficult for me. But I love the idea of someone following up and checking in at home (in theory). Perhaps it work best with someone other than you doing it, an associate with your practice or something like that?

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  2. Mary Joan Brinson, MSWMay 30, 2010 at 4:24 AM

    I have had one client who had PPD and agoraphobia and the only way to provide therapy for her was to attend her home, which I did. I am continuing to see her monthly at her home and it has been good. I have not felt any concerns regarding boundaries and it may be since all of our sessions have taken place in her home. Additionally, I have worked for a community agency that provided home health care where I provided medical social work services to clients in their homes, so it felt the same for me seeing my own PPD client in her home. You have to be comfortable to let go of the clinical setting. With my client, she has a very small home and young children, so she has someone look after the kids and we usually sit on her bed for our session as it is the only place we can go for privacy.

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  3. Laura Navarro Pickens, LCSWJune 3, 2010 at 7:52 PM

    In my private pratice, I have done only 1 home visit with a Mom with PPD. She was someone who originally began therapy with me for grief after a late term stillbirth. She seemed to be the perfect candidate for a home visit - she could use the extra TLC, I felt I knew her as well as you can know a client, she was super at risk for decompensating into more severe symptoms because of her loss.

    It went really well, and I decided I would offer home visits (within reason) as one of my services.

    I felt it was a great way of assessing how she was REALLY doing - seeing her in her environment and how the bonding was going.

    I haven't done another since then (9 months ago), but I do offer them to my ongoing clients. I would do them without reservation - with the idea that the client was working her way to getting out of the house with support.

    I'm looking forward to others' opinions.

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  4. KristinJune 28, 2010 at 11:06 PM

    Great discussion and opinions. I had a client who was really struggling with the thought of having PPD because she thought being a good mom and having PPD were mutually exclusive and she could only be one or the other. There was a week where she cancelled and I knew it was because it was so hard for her to continue to address and acknowledge her PPD. When I offered a home session, she gave this look of relief and said, "You would do that?" She works as a LCSW during the day and her husband works as a bar tender at night. It seemed as though she was inviting me in to more of her space, her world. I definitely think the combination of clinical gut and sound clinical judgement would need to be in play--Me personally, I don't think I would offer as a general blanket service but would offer after seeing each circumstance.

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