HAP Program PDF

CONTENT There are different ways to help people overcome Depression. The Healthy Activity Program (HAP) is based on an extremely useful type of counselling treatment for helping people overcome Depression. WHAT IS THE HEALTHY ACTIVITY PROGRAM (HAP)? As we learned in Chapter 1, there are four categor...

CONTENT There are different ways to help people overcome Depression. The Healthy Activity Program (HAP) is based on an extremely useful type of counselling treatment for helping people overcome Depression. WHAT IS THE HEALTHY ACTIVITY PROGRAM (HAP)? As we learned in Chapter 1, there are four categories of Depression symptoms. HAP focuses on changing the “action” category in order to change the other three categories (i.e., physical, feelings, and thoughts). The focus of HAP is on what patients are doing (or not doing). HAP treats Depression by helping patients do activities that are pleasurable and activities that solve problems. We may refer to this as ‘Doing Therapy’. As a HAP counsellor, you will help your patients identify the links between what they do and how they feel and use this information to identify specific at-home activities that will help your patients begin to feel better. HAP is delivered in a maximum of 8 sessions over three phases HAP focuses on patients with moderate to severe Depression as detected by the PHQ 9 (Score more than 15). This is because patients with mild Depression may not need such intensive counselling and will often improve with simple advice and support. In addition, these forms of counselling are as effective as medication in moderate to severe Depression. In fact, counselling is sometimes preferred over medication, for example, in some patients who may not tolerate medication and develop side effects more easily. HEALTHY ACTIVITY PROGRAM PHASES The Healthy Activity Program follows a general course over time – these are described as phases of counselling. Table 4 describes the phases of HAP and identifies relevant sections of this manual. Table 4: Healthy Activity Program Phases Phase Goals Description Manual Sections Early phase (Delivered in 1-2sessions) Engaging and establishing an effective counselling relationship Includes getting started, understanding the patient’s problem using the Health Activity Program model, getting commitment to thetreatment and addressing barriers to treatment engageme nt Chapter 3: Style ofa Healthy Activity Program counsellor Helping patients understand the Healthy Activity Program model Eliciting commitment for counselling CR manual – Chapter 3 13 Middle phase (Delivered in36 sessions) Assessing activation targets and encouraging activation Identifying barriers to activation and learning how to overcome these Includes assessment and activation strategiesas well as problem solving when needed. Chapter 5: Additional strategies to overcome barriers Helping patients solve (or cope with) life problems Ending phase (Delivered in 1 session) Reviewing and strengthening gains that the patient has made during treatment in order to prevent relapse. Chapter 4: Part 1: Learning together Part 2: Gettingactive and solving problems Includes summarizing key learnings from the treatment and preparing for situations in the patient’s life that may trigger Depression in the future and generating plans todeal with such situations. Chapter 4: Endingwell Moving through Healthy Activity Program Phases The three phases of HAP provide a helpful guide for the counsellor. We move from one phase to the next based on whether the goals of the previous phase have been achieved. The phases may overlap with one another, and some patients may need to remain at one phase for a longer time if the goals have not been achieved or if the patient does not show improvement (based on reduction in PHQ 9 scores). The phases of treatment are, therefore, delivered in a flexible manner across 6 to 8 sessions at weekly (preferably)/fortnightly intervals, with each session lasting 30-40 minutes. The first session is always devoted to the goals of Phase 1; although, some patients may require two (or rarely, more) sessions to achieve these goals. For most patients, we would expect to achieve the goals of all phases by session 5 or 6. However, if at the end of 4 sessions, the patient does not show improvement, this means we may have to extend the middle phase. In such situations, we need to discuss this with the medical officer in charge of the PHC and offer up to 2 more sessions to achieve the goals of the middle phase. If the patient has not recovered at the end of 8 sessions, the needs of the patient and the progress must be reviewed with the supervisor and the patient can referred to a psychiatrist appointed by the program for antidepressant medication. Ensuring Treatment Quality A rating scale, called Q-HAP, is used to assess treatment quality in the group supervisionsessions. In each session, the scale is rated by a supervisor and peers. 14 SUMMARY The Healthy Activity Program is a structured counselling treatment with focus on action The Healthy Activity Program may be referred to as ‘Doing Therapy’ The Healthy Activity Program is delivered in phases with each phase having its own goals The treatment quality is assessed using a quality assessment tool.