Conference Material > Slide Presentation
Bossard C, Payotte S, Scarpa G, Diallo AK, Lissouba P, et al.
MSF Paediatric Days 2024. 2024 May 3; DOI:10.57740/hbFEFb2
Conference Material > Slide Presentation
Nasser H, Jha Y, Keane G, Carreño C, Mental Health Working Group
MSF Scientific Days International 2022. 2022 May 10; DOI:10.57740/74t1-zq11
Conference Material > Video (talk)
Nasser H, Jha Y, Keane G, Carreño C, Mental Health Working Group
MSF Scientific Days International 2022. 2022 June 10; DOI:10.57740/z68q-6865
Journal Article > ResearchFull Text
Confl Health. 2022 February 14; Volume 16 (Issue 1); 6.; DOI:10.1186/s13031-022-00437-1
Ibragimov K, Palma M, Keane G, Ousley J, Carreño C, et al.
Confl Health. 2022 February 14; Volume 16 (Issue 1); 6.; DOI:10.1186/s13031-022-00437-1
BACKGROUND
'Tele-Mental Health (MH) services' are an increasingly important way to expand care to underserved groups in low-resource settings. In order to continue providing psychiatric, psychotherapeutic and counselling care during COVID-19-related movement restrictions, Médecins Sans Frontières (MSF), a humanitarian medical organization, abruptly transitioned part of its MH activities across humanitarian and resource-constrained settings to remote format.
METHODS
From June-July of 2020, investigators used a mixed method, sequential explanatory study design to assess MSF staff perceptions of tele-MH services. Preliminary quantitative results influenced qualitative question guide design. Eighty-one quantitative online questionnaires were collected and a subset of 13 qualitative follow-up in-depth interviews occurred.
RESULTS
Respondents in 44 countries (6 geographic regions), mostly from Sub-Saharan Africa (39.5%), the Middle East and North Africa (18.5%) and Asia (13.6%) participated. Most tele-MH interventions depended on audio-only platforms (80%). 30% of respondents reported that more than half of their patients were unreachable using these interventions, usually because of poor network coverage (73.8%), a lack of communication devices (72.1%), or a lack of a private space at home (67.2%). Nearly half (47.5%) of respondents felt their staff had a decreased ability to provide comprehensive MH care using telecommunication platforms. Most respondents thought MH staff had a negative (46%) or mixed (42%) impression of remote care. Nevertheless, almost all respondents (96.7%) thought tele-MH services had some degree of usefulness, notably improved access to care (37.7%) and time efficiency (32.8%). Qualitative results outlined a myriad of challenges, notably in establishing therapeutic alliance, providing care for vulnerable populations and those inherent to the communications infrastructure.
CONCLUSION
Tele-MH services were perceived to be a feasible alternative solution to in-person therapeutic interventions in humanitarian settings during the COVID-19 pandemic. However, they were not considered suitable for all patients in the contexts studied, especially survivors of sexual or interpersonal violence, pediatric and geriatric cases, and patients with severe MH conditions. Audio-only technologies that lacked non-verbal cues were particularly challenging and made risk assessment and emergency care more difficult. Prior to considering tele-MH services, communications infrastructure should be assessed, and comprehensive, context-specific protocols should be developed.
'Tele-Mental Health (MH) services' are an increasingly important way to expand care to underserved groups in low-resource settings. In order to continue providing psychiatric, psychotherapeutic and counselling care during COVID-19-related movement restrictions, Médecins Sans Frontières (MSF), a humanitarian medical organization, abruptly transitioned part of its MH activities across humanitarian and resource-constrained settings to remote format.
METHODS
From June-July of 2020, investigators used a mixed method, sequential explanatory study design to assess MSF staff perceptions of tele-MH services. Preliminary quantitative results influenced qualitative question guide design. Eighty-one quantitative online questionnaires were collected and a subset of 13 qualitative follow-up in-depth interviews occurred.
RESULTS
Respondents in 44 countries (6 geographic regions), mostly from Sub-Saharan Africa (39.5%), the Middle East and North Africa (18.5%) and Asia (13.6%) participated. Most tele-MH interventions depended on audio-only platforms (80%). 30% of respondents reported that more than half of their patients were unreachable using these interventions, usually because of poor network coverage (73.8%), a lack of communication devices (72.1%), or a lack of a private space at home (67.2%). Nearly half (47.5%) of respondents felt their staff had a decreased ability to provide comprehensive MH care using telecommunication platforms. Most respondents thought MH staff had a negative (46%) or mixed (42%) impression of remote care. Nevertheless, almost all respondents (96.7%) thought tele-MH services had some degree of usefulness, notably improved access to care (37.7%) and time efficiency (32.8%). Qualitative results outlined a myriad of challenges, notably in establishing therapeutic alliance, providing care for vulnerable populations and those inherent to the communications infrastructure.
CONCLUSION
Tele-MH services were perceived to be a feasible alternative solution to in-person therapeutic interventions in humanitarian settings during the COVID-19 pandemic. However, they were not considered suitable for all patients in the contexts studied, especially survivors of sexual or interpersonal violence, pediatric and geriatric cases, and patients with severe MH conditions. Audio-only technologies that lacked non-verbal cues were particularly challenging and made risk assessment and emergency care more difficult. Prior to considering tele-MH services, communications infrastructure should be assessed, and comprehensive, context-specific protocols should be developed.
Journal Article > ResearchFull Text
Glob Ment Health (Camb). 2022 October 21; 1-8.; DOI:10.1017/gmh.2022.53
Böhm B, Keane G, Karimet M, Palma M
Glob Ment Health (Camb). 2022 October 21; 1-8.; DOI:10.1017/gmh.2022.53
BACKGROUND
Specialised mental health (MH) care providers are often absent or scarcely available in low resource and humanitarian settings (LRHS), making MH training and supervision for general health care workers (using task-sharing approaches) essential to scaling up services and reducing the treatment gap for severe and common MH conditions. Yet, the diversity of settings, population types, and professional skills in crisis contexts complicate these efforts. A standardised, field tested instrument for clinical supervision would be a significant step towards attaining quality standards in MH care worldwide.
METHODS
A competency-based clinical supervision tool was designed by Médecins Sans Frontières (MSF) for use in LRHS. A systematic literature review informed its design and assured its focus on key clinical competencies. An initial pool of behavioural indicators was identified through a rational theoretical scale construction approach, tested through waves of simulation and reviewed by 12 MH supervisors in seven projects where MSF provides care for severe and common MH conditions.
RESULTS
Qualitative analysis yielded two sets of competency grids based on a supervisee's professional background: one for ‘psychological/counselling’ and another for ‘psychiatric/mhGAP’ practitioners. Each grid features 22–26 competencies, plus optional items for specific interventions. While the structure and content were assessed as logical by supervisors, there were concerns regarding the adequacy of the tool to field reality.
CONCLUSIONS
Humanitarian settings have specific needs that require careful consideration when developing capacity-building strategies. Clinical supervision of key competencies through a standardised instrument represents an important step towards ensuring progress of clinical skills among MH practitioners.
Specialised mental health (MH) care providers are often absent or scarcely available in low resource and humanitarian settings (LRHS), making MH training and supervision for general health care workers (using task-sharing approaches) essential to scaling up services and reducing the treatment gap for severe and common MH conditions. Yet, the diversity of settings, population types, and professional skills in crisis contexts complicate these efforts. A standardised, field tested instrument for clinical supervision would be a significant step towards attaining quality standards in MH care worldwide.
METHODS
A competency-based clinical supervision tool was designed by Médecins Sans Frontières (MSF) for use in LRHS. A systematic literature review informed its design and assured its focus on key clinical competencies. An initial pool of behavioural indicators was identified through a rational theoretical scale construction approach, tested through waves of simulation and reviewed by 12 MH supervisors in seven projects where MSF provides care for severe and common MH conditions.
RESULTS
Qualitative analysis yielded two sets of competency grids based on a supervisee's professional background: one for ‘psychological/counselling’ and another for ‘psychiatric/mhGAP’ practitioners. Each grid features 22–26 competencies, plus optional items for specific interventions. While the structure and content were assessed as logical by supervisors, there were concerns regarding the adequacy of the tool to field reality.
CONCLUSIONS
Humanitarian settings have specific needs that require careful consideration when developing capacity-building strategies. Clinical supervision of key competencies through a standardised instrument represents an important step towards ensuring progress of clinical skills among MH practitioners.
Conference Material > Abstract
Bossard C, Payotte S, Scarpa G, Diallo AK, Lissouba P, et al.
MSF Paediatric Days 2024. 2024 May 3; DOI:10.57740/K4bnf08
BACKGROUND AND OBJECTIVES
Early psychosocial stimulation for infants in precarious situations can yield both short- and long-term benefits to cognitive and social development. Comprehensive programmes, covering health, nutrition, and psychosocial stimulation prove most effective in preventing cognitive impairment and enhancing treatment for children with severe acute malnutrition (SAM). The StimNut study assesses the effects of early psychosocial stimulation on maternal mental health and mother-child relationship, as well as the acceptability of integrating such an intervention into the existing Médecins Sans Frontières (MSF) nutrition programme in Koutiala, during a 5-week period.
METHODS
Mixed-methods data were collected through standardised pre- and post- intervention questionnaires and included: a ‘Dusukasi’ screening tool for local perinatal depression-like symptoms; observations of mother-child interactions using an adapted PICCOLO (Parenting Interactions with Children: Checklist of Observations Linked to Outcomes) tool; as well as semi-structured interviews with caregivers, MSF psychosocial workers, and healthcare staff.
RESULTS
149 psychosocial stimulation sessions were conducted with 36 families by three supervised MSF psychosocial workers. Perinatal depression symptoms were found in 53% of mothers before the intervention and 28% after the intervention (p=0.001). Positive changes in the mother-child relationship were observed in 83% of families after the 5-week intervention and more frequent and appropriate responses of the caregivers to the child’s emotional state were noted. Positive changes were also perceived by the mothers as the sessions progressed: their sense of parenting skills was strengthened, their children’s health improved, and the other family members became more involved in childcare practices. The intervention also dismantled healthcare staff prejudices towards mothers of children with SAM, fostering a trusting relationship between them.
CONCLUSIONS
This study demonstrates the positive impact of the early psychosocial stimulation of children with SAM on maternal mental health and the quality of mother-child relationship. As MSF pursues further endeavours in this direction, it is important to recognise the transformative potential these interventions hold for promoting the overall wellbeing of families of children with SAM in humanitarian and low-income countries.
Early psychosocial stimulation for infants in precarious situations can yield both short- and long-term benefits to cognitive and social development. Comprehensive programmes, covering health, nutrition, and psychosocial stimulation prove most effective in preventing cognitive impairment and enhancing treatment for children with severe acute malnutrition (SAM). The StimNut study assesses the effects of early psychosocial stimulation on maternal mental health and mother-child relationship, as well as the acceptability of integrating such an intervention into the existing Médecins Sans Frontières (MSF) nutrition programme in Koutiala, during a 5-week period.
METHODS
Mixed-methods data were collected through standardised pre- and post- intervention questionnaires and included: a ‘Dusukasi’ screening tool for local perinatal depression-like symptoms; observations of mother-child interactions using an adapted PICCOLO (Parenting Interactions with Children: Checklist of Observations Linked to Outcomes) tool; as well as semi-structured interviews with caregivers, MSF psychosocial workers, and healthcare staff.
RESULTS
149 psychosocial stimulation sessions were conducted with 36 families by three supervised MSF psychosocial workers. Perinatal depression symptoms were found in 53% of mothers before the intervention and 28% after the intervention (p=0.001). Positive changes in the mother-child relationship were observed in 83% of families after the 5-week intervention and more frequent and appropriate responses of the caregivers to the child’s emotional state were noted. Positive changes were also perceived by the mothers as the sessions progressed: their sense of parenting skills was strengthened, their children’s health improved, and the other family members became more involved in childcare practices. The intervention also dismantled healthcare staff prejudices towards mothers of children with SAM, fostering a trusting relationship between them.
CONCLUSIONS
This study demonstrates the positive impact of the early psychosocial stimulation of children with SAM on maternal mental health and the quality of mother-child relationship. As MSF pursues further endeavours in this direction, it is important to recognise the transformative potential these interventions hold for promoting the overall wellbeing of families of children with SAM in humanitarian and low-income countries.
Journal Article > CommentaryFull Text
Glob Ment Health (Camb). 2021 December 31; Volume 9; 221-222.; DOI:10.1017/gmh.2022.23
Böhm B, Palma M, Ousley J, Keane G
Glob Ment Health (Camb). 2021 December 31; Volume 9; 221-222.; DOI:10.1017/gmh.2022.23
Conference Material > Abstract
Nasser H, Jha Y, Keane G, Carreño C, Mental Health Working Group
MSF Scientific Days International 2022. 2022 May 9; DOI:10.57740/n1mm-y210
INTRODUCTION
In December 2019, following a request from MSF’s intersectional working group for mental health and psychosocial services, MSF’s telemedicine (TM) services team implemented a full-time psychiatrist based in Amman, Jordan. This was in the context of a global shortage of mental health (MH) clinicians, and rapidly increasing demand for MSF to provide MH care. This specialist’s main responsibility was to deliver psychiatric training and supervision using WHO’s MH global action plan intervention guide (mhGAP-IG). Prior to implementation, psychiatric training was delivered face-to-face by national and international psychiatrists in the field, or if this was not operationally possible, patients with MH conditions went untreated or were managed with advice provided by distance. We hoped that intervention would improve MSF clinician capacity, therefore increasing access to quality care for patients with MH conditions across all projects and in particular those settings where it had not previously been feasible.
METHODS
Intervention impact was assessed by analysing the total number of countries and projects where support was provided, the number of clinicians trained, and the number of supervision sessions provided. Analysis was supplemented through analysis of 15 structured interviews with stakeholders, including clinicians (8), activity managers (4), section mental health advisors (4) and the TM psychiatrist.
ETHICS
This work met the requirements for exemption from MSF Ethics Review Board review, and was conducted with permission from Clair Mills, former Medical Director, Operational Centre Paris, MSF, and Sebastien Spenser, former Medical Director, Operational Centre Brussels, MSF.
RESULTS
A total of 13 MSF projects across eight countries received TM support in 2020. mhGAP-IG training was provided online to 39 clinicians, followed by 123 supervision sessions. Structured interviews demonstrated delivery of mhGAP-IG training online in MSF projects, with adherence to MSF guidelines. Improved capacity building was reported, with clinicians observed to have greater clinical confidence and being considered more likely to provide MH assessment and care. Impact in terms of increased volume of patient care was difficult to analyse, partly related to restrictions and activity alterations occurring during the COVID-19 pandemic.
CONCLUSION
Ongoing challenges requiring future consideration include ensuring adequate information technology infrastructure (internet connection, access to adequate communication equipment, broader use of secure platforms such as Siilo) and standardised approaches to supervision. Future analyses could consider impact on quality of care, for example by measuring secondary outcomes such as MH activity and default rates. This project continues; we propose it comprises an innovative way to improve access to patient care and to provide clinician learning and development.
CONFLICTS OF INTEREST
None declared.
In December 2019, following a request from MSF’s intersectional working group for mental health and psychosocial services, MSF’s telemedicine (TM) services team implemented a full-time psychiatrist based in Amman, Jordan. This was in the context of a global shortage of mental health (MH) clinicians, and rapidly increasing demand for MSF to provide MH care. This specialist’s main responsibility was to deliver psychiatric training and supervision using WHO’s MH global action plan intervention guide (mhGAP-IG). Prior to implementation, psychiatric training was delivered face-to-face by national and international psychiatrists in the field, or if this was not operationally possible, patients with MH conditions went untreated or were managed with advice provided by distance. We hoped that intervention would improve MSF clinician capacity, therefore increasing access to quality care for patients with MH conditions across all projects and in particular those settings where it had not previously been feasible.
METHODS
Intervention impact was assessed by analysing the total number of countries and projects where support was provided, the number of clinicians trained, and the number of supervision sessions provided. Analysis was supplemented through analysis of 15 structured interviews with stakeholders, including clinicians (8), activity managers (4), section mental health advisors (4) and the TM psychiatrist.
ETHICS
This work met the requirements for exemption from MSF Ethics Review Board review, and was conducted with permission from Clair Mills, former Medical Director, Operational Centre Paris, MSF, and Sebastien Spenser, former Medical Director, Operational Centre Brussels, MSF.
RESULTS
A total of 13 MSF projects across eight countries received TM support in 2020. mhGAP-IG training was provided online to 39 clinicians, followed by 123 supervision sessions. Structured interviews demonstrated delivery of mhGAP-IG training online in MSF projects, with adherence to MSF guidelines. Improved capacity building was reported, with clinicians observed to have greater clinical confidence and being considered more likely to provide MH assessment and care. Impact in terms of increased volume of patient care was difficult to analyse, partly related to restrictions and activity alterations occurring during the COVID-19 pandemic.
CONCLUSION
Ongoing challenges requiring future consideration include ensuring adequate information technology infrastructure (internet connection, access to adequate communication equipment, broader use of secure platforms such as Siilo) and standardised approaches to supervision. Future analyses could consider impact on quality of care, for example by measuring secondary outcomes such as MH activity and default rates. This project continues; we propose it comprises an innovative way to improve access to patient care and to provide clinician learning and development.
CONFLICTS OF INTEREST
None declared.
Conference Material > Poster
Bossard C, Lissouba P, Payotte S, Diallo AK, Keane G, et al.
MSF Paediatric Days 2022. 2022 November 30; DOI:10.57740/05ty-ra38