Healthy Activity Programme SOP PDF

Healthy Activity Programme Standard Operating Protocols Content: 1. What is HAP? 2. Procedure to become a HAP Counsellor 3. Responsibilities of a HAP Counsellor 4. Ethics code 5. Procedure for patient intake for an individual counsellor 6. Protocols during treatment 7. Receipt and accounting protoco...

Healthy Activity Programme Standard Operating Protocols Content: 1. What is HAP? 2. Procedure to become a HAP Counsellor 3. Responsibilities of a HAP Counsellor 4. Ethics code 5. Procedure for patient intake for an individual counsellor 6. Protocols during treatment 7. Receipt and accounting protocol 8. HAP material (+ Documentation protocol) 9. Supervision 10. Referral Pathways: self-harm and harm to others, violence, substance abuse What is HAP? The Healthy Activity Programme has been created by Sangath. The aim is to train lay-counsellors to be able to provide the created low-intensity, short-term psychological intervention to people with depression and/or depressive symptoms as found by the scores of a person’s GHQ-12 test. HAP is implemented over 6-8 weeks by a lay-counsellor under supervision. HAP focuses on the actions aspect of the thoughts-feelings-actions linkage to collaboratively, with the patient, identify the activities that are helpful, increasing them, the activities that are unhelpful, decreasing them, and learning problem solving skills to stay healthy in the future. Structure and documentation along with basic counselling skills (reflection, summarizing, normalizing, validation, etc.) are key to the programme. It is systematic, directional, patient centric. It only addresses depression and depressive symptoms. Procedure to become a HAP Counsellor: Training by Sangath Competency evaluation Practice and role plays (1 month) Completion of HAP with 2 patients Competency evaluation Responsibilities of a HAP Counsellor: 1. Self Care 2. Read registration form carefully, read up about anything mentioned in the form that you have limited knowledge about. Eg. medication and symptoms of co-morbidities and social disadvantages. 3. Mandatory weekly group supervision and monthly individual supervision 4. Staying up to date with i) training and studying ii) HAP materials iii) internal and external protocols related to HAP 5. Proper documentation of sessions and patient files 6. Proper documentation of your personal homework, feedback, supervision notes, etc. 7. Appropriate referrals 8. Appropriate boundaries with patients 9. Keep the therapy room clean, replace the water glass and bottle if needed, inform management if there are any repairs or problems. 10. Proper book-keeping of payments made to clinic Things that should be in your folder for each session and any patient, irrespective of which phase, etc.: 1. 2. 3. 4. 5. 6. Safely plan Introduction script Referral document Referral form Session notes template Mood meter Ethics code: 1. You cannot have a social relationship with your patient before or during the treatment. A social relationship post the treatment is not advised. 2. You will only communicate with your patient via your work email address. 3. You will not discriminate against your patient on the grounds of age, caste, gender, religion or anything. 4. You will always act keeping in mind what is best for your patient. 5. You will maintain confidentiality at all times except when the patient is at risk to themselves or someone else and during supervision. Even during supervision, only required information will be shared. 6. You will always behave in a professional manner. 7. You will always present your patient with all their options and give them autonomy in their treatment plan. 8. You will not go beyond the scope of HAP. For eg. prescribing medication or counselling for things beyond the scope of depression and depressive symptoms. 9. You will approach your supervisor in case of any problems. Procedure for patient intake for an individual counsellor: 1. You will receive a google calendar invite for your first session with your patient along with their patient ID. The patient ID is not to be shared with the patient. It is for internal purposes. 2. You will receive the patient’s intake/registration form with their first GHQ-12 score. 3. You will create a hard copy folder for your patient that will include: Their intake/registration form A referral form A safety plan template A HAP diagram template A HAP introduction worksheet template A HAP activity calendar and activity planner Blank paper for the patient Any notes you make Information leaflets about relevant topics as and when needed - make a record in your notes. 4. You will create a soft copy folder on the server for the patient with ALL their documents and keep updating it as the treatment progresses. 5. You will maintain an accounts sheet for all payments received by you in the format assigned by the Finance and Compliance team. Protocols for during treatment: Personal responsibility: 1. Update your hardcopy and softcopy folder for the patient within 24 hours 2. Update your softcopy folder for yourself within 24 hours 3. If the patient has consented to audio recording, you will upload the audio recording to the server (within 24 hours) and delete it from the recording device. 4. Regularly attend supervision. 5. Practice self care 6. Keep the therapy room clean, replace the water glass and bottle if needed, inform management if there are any repairs or problems. 7. Take all documents and papers for that specific patient for each of their sessions. This may include a print out of notes made and taken home by them. 8. Share information leaflets about relevant topics as and when needed - make a record in your notes of which document has been shared with which patient in which session. Communication with patients: 9. If your patient is more than 15 minutes late, inform the clinic phone to follow up with them. 10. In cases of no-show (not coming without informing), the patient will be charged for 100% of the session. 11. Once a day, time and therapy room is fixed, it will remain the same for the entirety of the treatment. The patient will not be charged for cancellations however we will request them to avoid last minute cancellations so that we can help as many people as possible. If a patient needs to reschedule, the counsellor may do that depending on their own availability and the availability of the therapy room. The counsellor will schedule the re-scheduled session such that the regular day and time is reverted to within one session. 12. Refer to the roster to schedule consequent sessions - It is the counsellor responsibility to make sure the HAP roster has been updated if their patient has rescheduled a session https://docs.google.com/spreadsheets/d/121Ry_Fe4pkKzvcUhQ2FI5VylE5y1GgHE7 UjOJ_lFiLM/edit#gid=0 13. Receipt and accounting protocol: 1. Each counsellor will get a google spreadsheet from the Finance department. 2. Each therapy room will have a receipt book which is not to be removed from the room. 3. After every session, a receipt will be made and given to the patient. 4. Make sure to carry petty cash incase you need to give your patient change. You will make note of the receipt number (it is an alphanumeric code) to later add it to your google spreadsheet, along with the UPI transaction number if the payment was made via UPI (you take a picture of the receipt, fill in your details in your spreadsheet immediately and then immediately delete the image from your phone). Date - date of payment made Received with thanks from - name of person paying Sum of rupees - amount paid Towards - HAP session _1, 2, 3, etc._ by Counsellor _counsellor ID_ By Banktransfer, cheque…. - If its a UPI payment, you must note the transaction number and the description should say ‘therapy’ - the patient needs to be told this before they make the payment Signature - your sign Unusual scenarios: In case a patient is paying in advance, mention that in the “Towards” column eg. 2 HAP session/ 4 HAP sessions by Counsellor….. In case the patient is paying you for a previous session that they missed their payment for, mention that in the “Towards” column as 2 HAP sessions OR pending amount from HAP session 2 and HAP session 3 by Counsellor……., etc. Both of these will be marked in your google sheets as “balanced owed” and “balanced paid”. These columns already exist in the spreadsheet. Don’t write “advance” or anything on the receipt. But put all notes in the comment section of the google spreadsheet. HAP Material: You should be familiar with and have access to: 1. 2. 3. 4. 5. 6. 7. 8. 9. HAP diagram HAP activity planner HAP activity calendar HAP introduction worksheet Safety Plan template Session notes template Introduction script Referral pathways sheet Documental Protocols https://drive.google.com/file/d/1ifq9bKys82VA5PkcT3RDjEBE07d82k8D/view?usp=dr ive_link 10. 5 Check-lists 11. Supervision feedback - google form https://forms.gle/5Yu5yyx2VcwVQ8UV7 12. HAP quality feedback - google form https://forms.gle/9nGLB26iGDUSeqtj6 13. HAP training participant workbook 14. HAP Sangath Manual 15. Healthy Living DD Booklet 16. Supervision protocols 17. Supervision agendas for upcoming supervision sessions 18. HAP counselling roster 19. GHQ-12 https://forms.gle/HBPnQ3Qj8KmMNVE7A Supervision: Supervision will take place in groups of 4-5. The counsellors not part of the group may attend another group’s supervision but are not allowed to participate. It is voluntary. They must maintain confidentiality. Group 1: Day: Friday 2pm 1. Aishwarya 2. Jhanvi 3. Shimon 4. Sara Group 2: Day: Saturday 2pm 1. Ritika 2. Kirtana 3. Smritee Group supervision will alternate between Measurement and Non-measurement supervision, starting with measurement supervision. Measurement Supervision: The goal is to assess the quality of individual sessions and share/receive detailed feedback from one’s peers and supervisor on the quality of HAP delivered. The flow of each session will be: Taking note of each counsellors caseload The counsellor whose case is being discussed will provide a brief background on the patient and the counselling thus far. Each peer will give feedback on what was done well as well as what needs to be improved based on the criteria of the HAP quality feedback form. Discussing feedback for the pre-decided session Any other business You will receive a report of the supervision session by the supervisor on the same day. You will fill in a feedback form about the supervision session within two days of the supervision session. Prep: ➔ You will be sent an agenda 3 days prior ➔ You will be sent a pre-decided recording of a session along with the agenda ➔ You must listen to the recording and fill in the HAP quality feedback form 1 day before the supervision session. ➔ You will bring your notes and comments to the supervision session. Non-Measurement Supervision: The goal is to discuss and practice particular skills or techniques in which the group requires additional training and share/receive feedback from peers and supervisors. The flow of each session will be: Taking note of each counsellors caseload Discussing challenges and issues that the counsellors have: related to patient, study or personal - the group will choose which areas will be looked at in that particular session based on a priority order suggested by the supervisor One challenge or situation will be picked for a role-play by the group: Role play: There are two possible formats. See one- Do one: Two 10-minute role plays, in the first (See one phase), the patient role is played by the counsellor who has faced a challenge and the counsellor role is played by the supervisor and in the second (Do one phase), the counsellor's role is played by the counsellor who has faced a challenge. Round robin: One continuous role play, the counsellor role is played by the supervisor throughout and the HAP counsellors take turns playing the role of the patient. Role play feedback Any other business You will receive a report of the supervision session by the supervisor on the same day. You will fill in a feedback form about the supervision session within two days of the supervision session. Prep: ➔ You will be sent an agenda 3 days prior ➔ You will make a list of concerns, challenges and questions and submit it 1 day prior. ➔ You will bring your notes and comments to the supervision session. Individual supervision: The goal is to check on the counsellor’s caseload, documentation and other issues at the patient, study and personal level. Flow: The counsellor informs the HAP Supervisor about the list of patients that need to be discussed and provides updates about each patient. The supervisor will address the counsellor’s listed issues and provide guidance on the next steps. Necessarily study plan will be created Schedule next individual supervision Prep: ➔ The counsellor prepares a list of all patients whose follow-up has been inadequate and those not showing adequate improvement despite follow-up since the previous supervision. ➔ The counsellor makes a list of issues to discuss with the HAP Supervisor. These can be divided into patient, study and personal issues. Referral Pathways: 1. ➔ ➔ ➔ (i) Harm to self: Assess Risk. Basic Mental Health Support Involve appropriate health care professional (Psychiatrists, psychologist, general practitioner - check referral pathway sheet for contact details: ➔ ➔ ➔ ➔ ➔ https://docs.google.com/document/d/1azU3bi7Fe01_2S2oZ2V73wOkdNMolMD1wI_ 6LPdI-Cw/edit ) Create safety plan: https://drive.google.com/file/d/19G3ChdwU8fh4-N8D17ahTtdZQqc2MqYc/view?usp= drive_link Create support circle: - Identify at least 3 people who the patient can reach out to and can be a regular support during times of distress, especially imminent distress. At least 1 person needs to be in the same city. - Have a meeting to explain them their responsibilities and go over patients safety plan - Involve patient in this meeting - Share reading material and resources to members of the support circle - Give them your email address for questions Have POC with support circle Follow up at appropriate intervals with the POC as per recommendations in mhGAP Inform supervisor immediately: collaboratively decide to continue or not continue HAP (ii) Harm to others: ➔ Explicit imminent intent to harming others needs to flagged to the supervisor immediately and law-inforcement must be alerted. ➔ If the counsellor thinks the patient is likely to harm others because of lack of control, the patient needs to be referred to a psychiatrist. Immediately alert your supervisor. Together you can get in touch with their emergency contact. This will be case by case. 2. ➔ ➔ ➔ Violence: Assess Risk Basic Mental Health Support Referral using referral pathway sheet https://docs.google.com/document/d/1azU3bi7Fe01_2S2oZ2V73wOkdNMolMD1wI_ 6LPdI-Cw/edit ) ➔ Inform supervisor immediately: collaboratively decide to continue or not continue HAP 3. ➔ ➔ ➔ Substance Abuse: Assess Risk Basic Mental Health Support Referral using referral pathway sheet https://docs.google.com/document/d/1azU3bi7Fe01_2S2oZ2V73wOkdNMolMD1wI_ 6LPdI-Cw/edit ) ➔ Inform supervisor immediately: collaboratively decide to continue or not continue HAP