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Thanks for your encouragement Jessica. Currently, the program is formally targetted for mothers and their babies, however, the inclusion of fathers and other extended family members is informally encouraged - so we don't specifically exclude them, but the program is yet to identify ways to be more deliberate in their inclusion. Our brief concept study showed us, that like you say here, there appears to be a need to more deliberately include fathers and other family members in the process; and indeed, this is something we wish to examine further during design phases. In particular, we need to explore options for greater inclusion of fathers and extended family members during the design and development process when the final EttC manuals/materials are created. We would welcome any suggestions you or others might have in how we might better achieve this outcome. Alison

Hi Muideen. Thanks for your thoughts and comments. The Thinking Healthy Program is the title of the counselling and psychosocial support approach intended to be used to support mothers’ mental health. This program has effectiveness evidence from research in Pakistan, but is yet to be tested in this type of integrated program. Thinking Healthy Program uses a 5-pillars approach where CHWs are trained to use strong empathic listening skills, and support family engagement, behavioural activation and problem solving through a series of pictorial guided discovery processes. The grounding theory of the program is based on cognitive behavioural therapy approaches to maternal psychosocial wellbeing, which have a strong evidence base globally, including in low-resource settings. Should some women not improve from a purely ‘talking therapy’ and supportive approach, they will still have CHW assistance to be referred for biological interventions if deemed necessary. The advantage of these stepped approaches is that the least intensive and costly approaches can be tested with clients first. I strongly appreciate that the best treatment options for depression, including post-partum depression, can be a hotly debated topic across the professions, but low-resource settings command for us to ensure we take the most culturally relevant, least stigmatizing and more socially supportive approaches as a first line of treatment given the likely challenges for individuals to be able to sustain any medium to long term medication-based interventions. I hope this goes some way to addressing your concerns. Ali

Thanks for your encouragement Diini. Indeed, mothers the world over need support and the stress of mothers in low-resource settings is indeed just as great, if not more so, than for mothers in high-resource settings like UK. Ali