Programmer/developer For A Mental Health Information System (Mhis) Module - Section 1

Programmer/Developer For a Mental Health Information System (MHIS) Module - Section 1   Background: Currently, the PHCCs are being trained on the integration of mental health. For that, a Mental Health Information System (MHIS) module needs to be developed and integrated in the current PHCC health information system.    Objectives The objectives of the MHIS is to: -          Provide guidance to PHCC staff on mental health protocols -          Record the mental health services provided -          Record the details of the support and supervision visit   Duties and Responsibilities: The programmer/developer is expected to conclude the following tasks: Work closely with the IT and the mental health team; Liaise with the IT and the mental health team to determine requirements and develop detailed specifications using the general Mental health information system (MHIS) specifications (see appendix 1); Ensure the Integration of the MHIS to the current health information system platform which is in Arabic, with concurrent use of English on specific interfaces; Design, test and install the different sections of the MHIS; Train end-users on using the new platform    Skills/Qualifications: Knowledgeable and competent in information systems; previous experience on health information system is an added value; Has experience in web applications development; Knowledgeable in the following technologies: C# Java script Backbone.js JQuery Html5 Reporting Excellent verbal and written communication and interpersonal skills; High attention to details; Ensure accuracy of information; Training skills and ability to communicate technical information to non-IT persons; Ensure availability of computer equipment; Use a logical approach to problem solving/analytical skills; Is Flexible and adaptive; Manage time effectively; Experience required: 3 to 5 years Education degree: Bachelor Degree (Master degree is preferable) Field of education: Computer Science, Software Engineering, Computer Engineering, Web Development, or a related field. Languages: Fluent in English and Arabic; French is a plus.    Appendix 1 - General MHIS specifications   A/ MHIS components: A1/Patient file (in Arabic and English): -          Mental health protocols (for depression, psychosis, developmental disorders, drug/alcohol use disorders, dementia and other unexplained disorders), with link to other benefit packages (see sample for depression in annex 1); to be provided by staff trained on mhGAP (nurse, social worker, doctor, case manager). The mental health protocols include guidelines for: Mental health disorder screening Mental health packages -          Mental health activity records: Mental health intake form (annex2) Care plan (annex 3) Referral form (annex 4)   A2/Support and supervision module: This module is to facilitate the support and supervision to PHCCs provided by the PHCC mhGAP supervision team. It has standard forms to be filled on each PHCC visit and summarized in a standard report (annex 5)   B/ Main requirements: B1-User management/operational access: The platform should provide different levels of access to functionality and features of the database including but not limited to the following profiles: nurse trained on mhGAP, social worker trained on mhGAP; doctor trained on mhGAP; case manager, psychologist, psychiatrist, community mental health team leader, community mental health coordinator, mhGAP PHCC supervisors, other administrative mental health team members and IT. The access to mental health sections is restricted to facility level for identified users to ensure confidentiality of sensitive information. Each profile has specific access to edit, modify, validate or read the data. B2-Maintenance access: Log files are needed. Each access is documented in log file. Reading the log files is only accessible for the IT. Management of users and profiles is ensured by the IT. Lists of values used in various variables are updated by IT. All tables should be fully audited for changes and deletions of records and/or values.   B3-Online/offline Users need to have access to a web enabled application located at central level. For the support and supervision component, they can edit data online and offline; this component need also to be responsive to tablets. B4-Specification development The design must be modular and include scalability of the platform to support the programme’s potential growth in number of beneficiaries and number of locations, as well as flexibility to support new functional requirements. Some changes may occur to the below annexes. Hence a detailed specification document will be developed by the consultant and will be cleared with the mental health team at the start of the development process.  B5-Training Central training will be provided to around 75 PHCC trained on mhGAP and the mental health team. User and technical guides will be produced.         Annex 1: Depression protocol A/Screening for Depression Wellness package 19 years +   PHQ2 to be replaced by PHQ9 as follows: Clinical encounter Depression screening (PHQ9)   First encounter (GP or nurse)   -    Time required: 5-10 min -    Cut-off points: è If score < 4: no depression  è If 4 < score <10 à repeat PHQ9 in follow up visit  è If score ≥ 10 à refer for full assessment (as per the package below)     B/Depression package Based on PHQ9, if patient suspected to have depression, refer for full assessment for depression as per the following: Category Details / tool used Frequency Person in charge Notes Clinical encounter Depression Diagnosis mhGAP (criteria: 2-8 based on job aids)  First encounter GP or nurse   Laboratory TSH and CBC First encounter GP To rule out organic causes (if doctor suspects Hypothyroidism and/or anemia) Major loss mhGAP First encounter GP or nurse   Substance/ alcohol use mhGAP First encounter GP or nurse   Suicidal risk mhGAP Every encounter GP or nurse    Psychosocial stressors mhGAP Every encounter GP or nurse   Compliance to treatment NA Every encounter GP or nurse   Treatment Pharmacotherapy Based on essential drug list When needed GP   Referral < 18 years old Refer to mental health professional First encounter GP Psychiatrist/ psychologist, etc. Imminent risk of suicide Start suicidal risk management as per mhGAP Refer to mental health professional When needed GP Psychiatrist/ psychologist, etc. Violence or abuse Refer to a specialist or specialized NGO When needed GP or nurse   Psychotherapy If available First encounter GP or nurse CBT IPT Counseling Psychoeducation mhGAP Every encounter GP or nurse   Addressing psychosocial stressors mhGAP First  encounter Nurse   Stabilization of imminent suicidal risk mhGAP When needed GP or nurse   Problem solving   When needed Nurse   Brief intervention for substance/ alcohol use mhGAP When needed GP or nurse If patient is addicted to substance/alcohol     Number of visits needed for a person suspected with moderate to severe depression per year to the PHC centre: -          8 to 10 visits   Number of visits by GP or family doctor: -          Up to 4 visits[1]  Number of visits by nurse/social worker: -          4 to 6 visits[2]     C/Linking depression to other packages: Links to depression highlighted in yellow Package Interaction with MH Comments Wellness Benefit Package for children and adolescents (both genders) from birth till age of 18 inclusive.   1-      Up to 5 years screen for developmental disorders and maternal depression in mother of children with developmental disorders 2-      For teens check for smoking, substance use, depression 3-      For teen check for signs of psychosis if needed     Wellness Benefit Package for adult females (aged 19 years and older).   1-      Check for depression every encounter 2-      Check for alcohol substance use, every encounter 3-      After 65 check for dementia every encounter 4-      Check for depression in mother of children with mental disorders     Wellness Benefit Package for adult males (aged 19 years and older). 1-      Check for depression every encounter 2-      Check for alcohol substance use, every encounter 3-      After 65 check for dementia every encounter   Antenatal Benefit Package: Covers antenatal services as well as one postpartum visit. 1-      Maternal depression every encounter 2-      Developmental disorder 3-      Alcohol or substance use every encounter   Non Communicable Diseases Benefit Packages:  Provides disease management for Hypertension and Diabetes Mellitus   1-      Depression every encounter             Annex 2 - Mental health intake form The mental health intake form will integrate specific indicators from the mental health (MH) registry for psychiatrist with some additional indicators. It needs to be well integrated in the PHCCs HIS since some of these indicators are already well-developed. The mental health intake can be filled by the different staff working in mental health (nurse, social worker, case manager, doctor, psychiatrist, psychologist), and hence need to be easily accessible by the different profiles. The prescription of medications and medical tests is restricted to the doctor and the psychiatrist. Main indicators: Socio-Demographic Indicators: Patient code or ID; Nationality; Area of residence (place of living); Date of Birth; Gender; Marital status; Children; Living conditions; social network;  Professional situation; Educational level; Health coverage, family support (personal/relational/financial), legal status; for children: parents living in the same house and parents occupation; if patient is a woman: pregnancy status, breastfeeding Health behavior: 1-Smoking [Narguileh (specify how many per day) ___________; Cigarettes (specify how many cigarettes per day)] 2. Alcohol (specify which kind) _______ (doses per day) 3.Exercise (specify how often per week) ______ Mental health condition and co-morbidities: Patient coming for, Current complaint; Duration of symptoms before seeking medical help; current stressors; Mental disorder diagnosis (ICD-10); health co-morbidities; health co-morbidities treatment status, Suicidal attempt in the previous 12 months; Addiction with substance; Personal history of psychiatric disorder; Family history of psychiatric disorder ; Family history of medical conditions; On-going psychotropic treatment;; medications past week; history of psychotropic medications Assessment: PHQ9, GAF… Referral: Patient presenting; Main informant; Referred by Treatment plan: Patient manager, Psychotropic medication (with prescribed medications) ; Referred to psychology: Psychoeducation; medication education; Hospital admission; Prescribed tests; Medical tests to rule out medical conditions; Soclal intervention; Other referrals Follow-up: Patient still under follow up; Patient diagnosis; Change of treatment; Referral to psychotherapy; Patient status Discharge to Next appointment     Annex 3- Care plan The care plan of the patient is family-centered, goal and strength focused and recovery-oriented. It can involve one of more staff trained in mental health Main indicators: List patient needs/ main issues, and for each of these include: Crisis/ relapse - if required, note the arrangements for crisis intervention and/or relapse prevention Appropriate psycho-education provided (yes/no) Copy (or parts) of the plan shared with other providers (yes/no/not required) Completing the plan - on completion of the plan, the staff is to record that s/he has discussed with the patient: the assessment all aspects of the plan and the agreed date for review, and offered a copy of the plan to the patient and/or their carer (if agreed by patient) Date plan completed Review date (initial review 4 weeks to 6 months after completion of plan) Review comments (progress on actions and tasks). Note: If required, a separate form may be used for the review. Outcome tool and results on review Goals - record the mental health goals agreed to by the patient and staff and any actions the patient will need to take Treatments - treatments, actions and support services to achieve patient goals Referrals           Annex 4: Referral form This referral form is to be used inside the health center and between health centers. Most of the info is directly taken from the already filled health information system (HIS). Referral form: The patient came on” (first MH consultation date from HIS) “to the” (health center name, phone number and address) If referred by nurse or social worker or case manager: “for” (MH diagnosis from HIS) “and was seen seen by” (name and function of nurse or social worker or social manager)“. His initial PHQ9 score was” (from HIS) “He received” (in case of any MH management activity recorded by HIS such as psychoeducation with number of sessions…; if no MH management activity, remove this sentence) “His PHQ9 on” (last date from HIS – if different from initial PHQ9 date; else remove this sentence) “was” (score from HIS) “He is referred for further diagnosis and management” If referred by a doctor or a psychologist “He was diagnosed by“ (name of doctor or psychologist) “as having” (MH diagnosis from HIS) “He received a psychological assessment on” (date from HIS) “He was treated with” (number of psychotherapy sessions from HIS if applicable) (name and duration of medications from HIS if applicable); “his last blood test results were” (if lab tests are mandatory, name and results from HIS or manually) “Last GAF was” (score from HIS) “His status is currently  Unchanged                Partial remission            Complete remission He was assessed as having a risk for (Sentence showed if any of the following options is selected)  self  other He is referred for:  Dispensing of prescription (name, dose, daily dosage and treatment duration of psychotropic medications from the HIS)  for further diagnosis and management  for follow-up   for admission”   Annex 5 – Support and Supervision forms The support and supervision is provided by mental health technical staff to PHCC staff trained on mhGAP. Main indicators: Information about PHCC staff trained on mhGAP: Name, position, facility, date trained, date of supervision, next date of supervision, comments/progress Facility mhGAP Report form: facility name, date of visit, availability of psychotropic medications, mechanism for patient consultation ot referral in place/functioning, mhGAP Master Chart displayed in the examination room,  mhGAP IG kept in an easily accessible place in the examination room(s), mhGAP IG used to manage and treat MH disorders, Examination room allows confidentiality, Clinical notes gathered in a relevant and appropriate manner, Number of days per week mhGAP health care providers are available for treatment of MNS disorders, Percentage of working time dedicated to MNS disorders (mhGAP) daily, any administrative/clinical problems related to the implementation of mhGAP Clinical Support and Supervision Form: Part A: Information collected during monitoring a clinical interview of trained health care provider -          Health care provider correctly assessed the MNS patient -          Health care provider correctly classified the patient using mhGAP-IG -          Health care provider correctly treated the patient or advised on a management plan -          Proper education and treatment are advised along with appropriate referral -          Health care provider adequately kept the record of the patient -          What were the strengths and weakness of the clinical interview conducted by the trainee? (Address gaps in communication skills, assessment, psychosocial or pharmacological management, and referral/follow-up advice) PART B: Ask the mhGAP trainee if they have any problems related to mhGAP implementation (e.g. referral process, availability of drugs, examination room, clinical notes, working hour, etc.).         [1] Initial visit to diagnose and prescribe if need be. If prescription is made the second visit should be at 6 weeks to assess improvement. If improvement, see at 9 months to consider stopping then at 12 months to stop. If not, continue to see once every 6 months. If no need for medication, refer to nurse or social worker and assess after 6-8 weeks and accordingly refer back or prescribe. [2] These visits are for Psychoeducation, problem solving, addressing psychosocial stressors, activating social network, and following up on medication.