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MAANASI - A sustained, innovative, integrated mental healthcare model in South India

JAYARAM, Geetha
GOUD, Ramakrishna
CHANDRAN, Souhas
PRADEEP, Johnson
2019

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Studies in low and middle-income countries (LMICs) point to a significant association of common mental disorders with female gender, low education, and poverty. Depression and anxiety are frequently complicated by lack of disease awareness and non-adherence, the absence of care and provider resources, low value given to mental health by policy-makers, stigma, and discrimination towards the mentally ill. This paper aims to show that female village leaders/ community health and outreach workers (CHWs) can be used to overcome the lack of psychiatric resources for treatment of common mental disorders in rural areas.

A multidisciplinary team was set up to evaluate and treat potential clients in the villages. A program of care delivery was planned, developed and implemented by: (a) targeting indigent women in the region; (b) integrating mental health care with primary care; (c) making care affordable and accessible by training local women as CHWs with ongoing continued supervision; and (d) sustaining the program long-term.   Indigenous CHWs served as a link between the centre and the community. They received hands-on training, ongoing supervision, and an abridged but focused training module to identify common mental disorders, help treatment compliance, networking, illness literacy and community support by outreach workers. They used assessment tools translated into the local language, and conducted focus groups and client training programs. 

As a result, mental healthcare was provided to clients from as many as 150 villages in South India. Currently the services are utilized on a regular basis by about 50 villages around the central project site. The current active caseload of registered clients is 1930.  Empowerment of treated clients is the final outcome, assisting them in self-employment. 

Rural mental healthcare must be culturally congruent, and must integrate primary care and local CHWs for success. Training, supervision, ongoing teaching of CHWs, on-site resident medical officers, research and outreach are essential to continued success over two decades.

 

Disability, CBR & Inclusive Development, [S.l.], v. 30, n. 2, p. 104-113, Oct. 2019

 

 

Current access and recruitment practices in nursing education institutions in KwaZulu-Natal: A case study of student nurses with disabilities

MOODLEY, Selvarani
MCHUNU, Gugu
2019

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Background: While institutions of higher education may have increased access and accommodation for students with disabilities, institutions primarily providing nurse training in South Africa do not mirror the same practice.

 

Objectives: Notwithstanding the integration of disability policies enacted in South Africa in 2010, a majority of people with disabilities are still excluded from the activities of society equally applicable to nursing education. This article describes the current access and recruitment practices for student nurses with disabilities (SNWDs) in nursing education institutions in KwaZulu-Natal to provide baseline data, which is largely absent in nursing institutions.

 

Method: A concurrent mixed-method design using a multiple embedded case study approach was employed. This article presented phase 1 of the study, a quantitative survey of all private nursing education institutions (n = 27), complemented by individual, in-depth interviews with SNWDs (n = 10). Quantitative data were analysed using SPSS version 24, with a response rate of 78% (n = 21), whereas qualitative data were analysed using content analysis.

 

Results: The findings revealed that the majority of private NEIs lack policy guidelines for recruiting SNWDs; however, other means of guidance is sought, for example, using the technical assistance. While NEIs were willing to recruit SNWDs, access to clinical sites, lectures, support systems and reasonable accommodation was challenging.

 

Conclusion: Private NEIs are providing an inclusive education to all students including those with disabilities; however, they still have a long way to go in meeting the needs of SNWDs with regards to support and accommodation.

 

African Journal of Disability, Vol 8, 2019

Standard school eye health guidelines for low and middle-income countries

GILBERT, Clare
MINTO, Hasan
MORJARIA, Priya
KHAN, Imran
February 2018

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The purpose of these best practice guidelines is to provide direction to those planning and implementing eye health initiatives for schools, including policy makers, health care and educational authorities, health planners, eye care delivery organizations and professionals, in partnership with teachers, parents and children. In situations where resources for eye health are limited, decisions need to be made to ensure that programs not only address public health problems but are also implemented in a way that is effective, efficient and, wherever possible, sustainable. Systems for monitoring and plans for evaluation should also be developed at the outset. These practice guidelines provide an excellent learning resource for a module on school eye health that can be incorporated in optometry and ophthalmology residency curricula.  A section highlights some of the challenges in current school eye health initiatives and provides a framework in which school eye health is integrated into school health programs. Case studies are provided to emphasise the integrated approach and a 15-step approach, from situation analysis to monitoring and evaluation, is suggested. Practical recommendations for implementation are provided, including information on the equipment and technology required

 

This evidence-based document is based on best practice guidelines initially developed through a joint collaboration between Sightsavers International, the London School of Hygiene and Tropical Medicine and the Brien Holden Vision Institute

The Journal of Mental Health Training, Education and Practice, vol.12, no.4 Special Issue - Mental health pathways for people with intellectual disabilities: the education, training and practice implications

CHARNOCK, David
WRIGHT, Nicola
Eds
November 2017

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"This special edition aims to address some of the complexities and challenges faced in mainstream mental health services in three ways. First, to highlight the specific needs of people with intellectual disabilities and mental health problems. Second, to promote the importance of interdisciplinary working and learning in relation to mental wellbeing and intellectual disability, showcasing innovative approaches to care and finally, to offer a voice to specialists from intellectual disability practice and research to foster practical and conceptual thinking in relation to this group of service users"

There is a freely accessible editorial and there are six papers:

  • People with intellectual disabilities accessing mainstream mental health services: some facts, features and professional considerations
  • Psychiatry and intellectual disabilities: navigating complexity and context
  • Development and dissemination of a core competency framework
  • Mental health staff views on improving burnout and mental toughness
  • Using wordless books to support clinical consultations
  • Actors with intellectual disabilities in mental health simulation training

Full articles are not free.

Healthcare provider's attitude towards disability and experience of women with disabilities in the use of maternal healthcare service in rural Nepal

DEVKOTA, Hridaya Raj
KETT, Maria
GROCE, Nora
MURRAY, Emily
June 2017

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BACKGROUND:
Women with disabilities are less likely to receive maternal healthcare services compared to women without disabilities. While few studies have reviewed healthcare experience of women with disabilities, no studies have been conducted to understand provider's attitude towards disability in Nepal, yet the attitude and behaviour of healthcare providers may have a significant influence on aspects of care and the use of service by women with disabilities. This study examines healthcare provider's attitudes towards disability and explores the experience of women with disabilities in maternal healthcare service utilization during pregnancy and childbirth.

METHOD:
The study used mixed method approach. An attitude survey was conducted among 396 healthcare providers currently working in public health facilities in Rupandehi district of Nepal. For additional insight, eighteen in-depth interviews with women with disabilities who used maternal healthcare services in a healthcare facility within the study district in their last pregnancy were undertaken. The Attitude Towards Disabled Persons (ATDP) scale score was used to measure the attitudes of healthcare providers. For quantitative data, univariate and multivariate analysis using ANOVA was used to understand the association between outcome and independent variables and qualitative analysis generated and described themes.

Reproductive Health, 2017

Problem Management Plus (PM+) Individual psychological help for adults impaired by distress in communities exposed to adversity

WORLD HEALTH ORGANIZATION
2016

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With this manual, the World Health Organization (WHO) is responding to requests from colleagues around the world who seek guidance on psychological interventions for people exposed to adversity.

The manual describes a scalable psychological intervention called Problem Management Plus (PM+) for adults impaired by distress in communities who are exposed to adversity. Aspects of Cognitive Behavioural Therapy (CBT) have been changed to make them feasible in communities that do not have many specialists. To ensure maximum use, the intervention is developed in such a way that it can help people with depression, anxiety and stress, whether or not exposure to adversity has caused these problems. It can be applied to improve aspects of mental health and psychosocial well-being no matter how severe people’s problems are.

Field based training for mental health workers, community workers, psychosocial workers and counselors : a participant-oriented approach

VAN DER VEER, Guus
FRANCIS, Felician Thayalara
July 2011

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"This article discusses the training of mental health workers whose basic job is with clients that have been seriously affected by armed conflict and/or natural disasters by using ‘helping through talking’, and who have had little education that is relevant to this work. It sums up the characteristics required of the workers, their learning needs, the messages that the training needs to convey, and the characteristics and potential contents of a tailor made, participants-oriented programme"
Intervention, Vol 9, Issue 2

The balanced counseling strategy plus : a toolkit for family planning service providers working in high HIV/STI prevalence settings

POPULATION COUNCIL
2011

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"This "is an interactive, client-friendly approach for improving counseling on family planning and prevention, detection, and treatment of sexually transmitted infections (STIs) including HIV. The BCS+ was adapted from the Balanced Counseling Strategy, an evidence-based and well-researched tool for improving counseling on contraceptive methods. The BCS+ toolkit, developed and tested in Kenya and South Africa, provides the information and materials needed for health care facility providers to provide complete and high-quality family planning counseling to clients who live in areas with high rates of HIV and STIs.The BCS+ tools are generic and can be revised according to national and/or regional guidelines and different contexts
This second edition toolkit includes the following: * BCS+ Trainer’s Guide: Supervisors and others can use this to train health care facility directors and service providers on how to use the BCS+ for counseling family planning clients. * BCS+ User’s Guide: This guide focuses on how to implement the Balanced Counseling Strategy Plus. It can be distributed during training or used on its own with the BCS+ job aids. * BCS+ job aids comprising: - BCS+ algorithm that summarizes the 19 steps needed to implement the BCS+ during a family planning counseling session. These steps are organized into four stages: pre-choice, method choice, post-choice, and STI/HIV counseling. - BCS+ counseling cards that the provider uses during a counseling session. There are 26 counseling cards, the first of which contains six questions that the service provider asks to rule out the possibility a client is pregnant. Each of the next 16 cards contains information about a different family planning method. The next 3 cards provide advice on pregnancy and the postpartum period. The last 6 cards provide essential information for counseling on preventing, detecting, and treating STIs and HIV. - BCS+ method brochures on each of the 16 methods represented by the counseling cards. The brochures provide counseling to clients on the method they have chosen and then are given to clients for later reference. This means clients do not have to rely on their recollection of what was discussed with the provider. - WHO Medical Eligibility Criteria Wheel (offsite link) guides providers through medical conditions and medications that may be contraindications to use of particular contraceptive methods. The BCS+ tools are generic and can be revised according to national and/or regional guidelines and different contexts"
A video describing use of the BCS+ toolkit in South Africa also is available. To obtain Microsoft Word versions of BCS+ files to modify or revise according to your local setting, please contact the publisher

Building bridges: a home-based care model for supporting older carers of people living with HIV

HELPAGE INTERNATIONAL (HAI)
July 2010

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This summary guideline describes a model for supporting older home-based carers developed by HelpAge International in Tanzania, which is being implemented in several districts. The model has four elements: collecting baseline data, training older carers in home-based care and counselling, setting up support groups and linking older carers to services. This resource is useful to people interested in home-based care for supporting older carers of people living with HIV

Handbook for coordinating gender-based violence interventions in humanitarian settings

WARD, Jeanne
LAFRENIERE, Julie
July 2010

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This Handbook has been produced by the global Gender-based Violence (GBV) Area of Responsibility Working Group as a quick reference tool for all individuals and agencies involved in GBV programming and coordination in humanitarian/emergency settings. The handbook contains practical guidance on leadership roles, key responsibilities and specific actions to be taken when establishing and maintaining a GBV coordination mechanisms in a humanitarian setting. The focus is primarily on work that should be done to scale up coordination from the onset of an emergency (both conflict and natural disasters) but is also relevant to contingency planning and post-emergency stabilization phases
The goal of the handbook is to improve coordination capacity at the field level in order to facilitate accessible, prompt, confidential and appropriate services for survivors according to a basic set of principles and to put in place mechanisms to prevent GBV
The handbook can also be used as an advocacy tool to educate non-GBV programmers--including UN personnel, government officials, NGO staff and donors--about basic protection responsibilities related to GBV coordination, prevention and response

Disability and the training of health professionals

GROCE, Nora
SHAKESPEARE, Tom
LEZZONI, Lisa I
2009

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Evidence shows that people with disabilities often rate their own quality of life much higher than others rate their quality of life: subjective satisfaction of disabled people is usually comparable to that of non disabled people. [...] physicians and other healthcare professionals need to accept that many people with disabilities, particularly where their health conditions are congenital or long term, do not necessarily perceive their disability as a problem or pathology.

The Lancet
Volume 374, Issue 9704, 28 November–4 December 2009, Pages 1815-1816

Quest for quality : interventions to improve human resources for health among faith-based organisations

ADJEI, George A
et al
February 2009

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"Traditionally, faith-based health organisations have been important health care providers in many remote and other under-serviced areas. Currently, these facilities bear the brunt of the competition for scarce human resources. It is important for faith-based organisations to learn from recent experiences and from the creative ways in which colleagues seek to retain their health workers and improve quality of human resource management. [As part of a]"...linking and learning programme, some faith-based umbrella organisations in Tanzania, Ghana, Uganda, and Malawi have joined forces to share their experiences in confronting the human resources crisis: by developing retention schemes, offering in-service training, task shifting, developing the planning and management skills of their staff, better coordination of salary and incentive structures with the public systems, and the development of lobbying instruments for national and international use"

Task shifting : rational redistribution of tasks among health workforce teams : global recommendations and guidelines

WORLD HEALTH ORGANIZATION (WHO)
2008

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These guidelines and 22 recommendations are designed to support for countries that face a high HIV burden and acute shortages within the health workforce. Task shifting involves the rational redistribution of tasks among health workforce teams. Specific tasks are moved, where appropriate, from highly qualified health workers to health workers with shorter training and fewer qualifications in order to make more efficient use of the available human resources for health. The key elements that must be in place if the approach is to prove safe, efficient, effective, equitable and sustainable, cover the need for consultation, situation analysis and national endorsement, and for an enabling regulatory framework. They specify the quality assurance mechanisms, including standardised training, supportive supervision, and certification and assessment, that will be important to ensure quality of care

Integrating mental health into primary care : a global perspective

WORLD HEALTH ORGANIZATION (WHO)
WORLD ORGANIZATION OF FAMILY DOCTORS (WONCA)
2008

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This report provides the rationale and know-how on integrating mental health into primary health care. It outlines primary care for mental health in context and then presents primary care for mental health in practice, highlighting 12 case studies and key lessons learnt from specific countries. A detailed annex on the core functions of primary care workers is provided, as well as 10 core principles of mental health integration. This resource is useful to anyone interested in integrating mental health into primary care

Does shortening the training on integrated management of childhood illness guidelines reduce effectiveness? results of a systematic review|Final report

ROWE, Alexander K
et al
2008

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This comprehensive report presents the findings of a systematic review of the effectiveness of shortening Integrated Management of Childhood Illness (IMCI) strategy training. The results are useful for NGOs and other national and international bodies working in the field of childhood illness
Health Policy and Planning (in press)

Positive prevention : HIV prevention with people living with HIV. A guide for NGOs and service providers

INTERNATIONAL HIV/AIDS ALLIANCE
September 2007

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This guide is intended as a resource to help nongovernmental organisation (NGO) staff and HIV service providers working across the spectrum of HIV prevention, treatment, care and support services to take steps towards integrating HIV prevention for, by and with people living with HIV. It is hoped it will also be of use both to individual people living with HIV and to their partners. The guide does not intend to discuss or review all HIV prevention strategies. Rather, it is a starting point from which to consider different strategies to assist NGO staff and HIV service provider organisations to support HIV positive people to live well with HIV and have safer sexual relationships within a full and healthy life. This guide focuses largely on the sexual transmission of HIV

Let's talk about HIV counselling and testing : facilitators' guide

International HIV/AIDS Alliance
December 2006

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This is a toolkit to help NGOs and community-based organisations working to mobilise communities to improve their awareness of HIV counselling and testing and to improve the up-take of HIV counselling and testing; advocating for increased access to quality HIV counselling, testing, care, treatment and prevention; or interested in providing HIV counselling and testing services. It is divided into eight sections: What is HIV and what is AIDS?; what is involved in HIV counselling and testing; who is providing these services in the community and who they are for; the advantages and barriers of counselling and testing; stigma, discrimination and confidentiality; the needs of people after being tested and ideas for community activities. Each section has an accompanying information sheet

Working together for health : the world health report 2006

WORLD HEALTH ORGANIZATION
2006

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"The 'World Health Report 2006 - Working together for health' contains both an expert assessment of the current crisis in the global health workforce and an ambitious set of proposals to tackle it over the next ten years, starting immediately"

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