What Is Remote Mental Health and Psychosocial Support (MHPSS) Programming?
MHPSS programming encompasses all elements of an MHPSS program lifecycle, from program design to program setup and management to service delivery to capacity building (training/supervision) to monitoring and evaluation, and program closeout. MHPSS service delivery can include, but is not limited to: intake and assessments, case management, psychosocial support, counseling, psychological interventions, psychiatric care, treatment by mhGAP-trained healthcare staff, group support, awareness-raising, outreach and facilitating referrals. Remote programming entails implementation of MHPSS program elements virtually or at a distance utilizing various technology (phone, radio, Internet, etc.).
Why Create Guidelines for Remote MHPSS Programming in Humanitarian Settings?
Before the COVID-19 pandemic, few comprehensive guidelines at the global level were available to guide MHPSS programming in geographically remote or inaccessible, low-resource settings. Often, humanitarian settings present significant security risks, are difficult to travel to or from, and have limited to non-existent mobile, landline or internet connections. The COVID-19 pandemic has highlighted the additional challenge of delivering in-person MHPSS services during movement restrictions and under infection control measures and the importance of adapting services to ensure continuity of care for vulnerable populations, including children, older adults, gender-based violence (GBV) survivors, and those suffering from severe mental health disorders and other disabilities. More comprehensive guidelines, tools and training materials on how to adapt or develop remote MHPSS programming in low- and middle-income countries would contribute to improved quality and quantity of remote MHPSS capacity building and service delivery. The guidelines were developed to address this gap and to help agencies and decisionmakers understand the key recommendations for implementing effective remote MHPSS programming in humanitarian settings.
How Were These Guidelines Developed, Enhanced and Evaluated?
In April 2020, International Medical Corps developed Guidelines for MHPSS Staff Providing Tele-MHPSS to Clients during the COVID-19 Pandemic to guide program teams in ensuring continuity of MHPSS services in such challenging times. The guidelines primarily targeted MHPSS program teams and service delivery, and outlined key considerations for providing remote individual support.
In 2021, International Medical Corps undertook a multi-country case study, evaluating MHPSS programs in Central African Republic, Iraq, Libya, South Sudan and Venezuela, where MHPSS teams had transitioned to remote MHPSS programming to varying degrees. The overall objective of the case study was to synthesize International Medical Corps’ global experience and lessons learned from transitioning to remote MHPSS programming to inform revision and enhancement of the guidelines. The case study—conducted through 220 key informant interviews with International Medical Corps staff, frontline service providers (case managers/psychosocial workers, psychologists, psychiatrists and mhGAP-trained healthcare staff), external stakeholders from community leadership and the Ministry of Health (MoH), and in-depth interviews with clients and caregivers—examined the following elements of remote MHPSS programming, which have been reflected in this edition of the guidelines:
- the specific adaptations made to MHPSS programming to ensure continuity of care, as well as factors that contributed to decisions taken on service adaptations;
- factors that enabled and prevented the transition to remote programming;
- the role of outreach in continuity of care;
- the benefits and challenges of remote service delivery, as perceived by service providers
- the effectiveness of remote service delivery on client well-being and functioning;
- specific considerations made for vulnerable groups in delivery of services remotely;
- adaptations, methods and overall experience with receiving and providing remote supervision; and
- adaptations made to delivering training and supervision remotely, and perceived effectiveness of remote training and supervision.
The findings and recommendations resulting from the multi-country case study informed the revision of the existing International Medical Corps guidelines to include all aspects of MHPSS programming, such as program planning and management, supervision, training and service provision. The guidelines were further enhanced to include a compendium of resources and tools to support implementation of MHPSS programming.
The draft guidelines were reviewed by external and internal stakeholders with expertise and experience in implementing remote MHPSS programming in humanitarian settings. The external reviewers included the members of the Technical Advisory Group consisting of MHPSS experts from the IFRC Reference Centre for Psychosocial Support (Dr. Michelle Engels); International Rescue Committee (Dr. Esubalew Haile); Médecins du Monde (David Tabbara); and Médecins sans Frontières (Dr. Gregory Keane); and Partners in Health (Dr. Giuseppe Raviola). In addition, MHPSS program staff from International Medical Corps’ 10 country programs, including in Afghanistan, Central African Republic, Democratic Republic of Congo, Ethiopia, Jordan, Lebanon, Libya, South Sudan, Ukraine and Venezuela, provided technical review and feedback.
To further enhance the quality and ensure their practical application, the guidelines were field-tested by the International Medical Corps’ MHPSS program teams in Jordan and Venezuela. The feedback from the reviews and field-testing were incorporated and the guidelines were finalized for translation into Arabic, French and Spanish, and broad dissemination among humanitarian aid actors. Refer to the graphic below for the timeline of guidelines development.
Who Should Use These Guidelines?
The guidelines are primarily intended for staff and service providers at agencies implementing MHPSS programming in humanitarian settings:
- HQ technical support teams
- Organizational leadership at the country level
- MHPSS program management staff
- MHPSS service providers and other frontline workers
What Is Included in the Guidelines?
The guidelines provide a stepwise approach to remote MHPSS programming, with associated key guidance and resources that support each stage of programming. The steps are complemented by cross-cutting components, which highlight remote MHPSS programming considerations that need to be taken into account throughout the programming cycle.
What to Consider When Using the Guidelines?
While there are core steps and cross-cutting components that all agencies should consider, it is crucial to acknowledge that every context and experience is unique. For each situation, adaptations should be undertaken so that remote programming is tailored to (1) different existing capacities and human resources; (2) different systems and contexts; (3) cultural and linguistic considerations; and (4) specific needs and priorities that guide design and implementation of programming.
When and How to Use These Guidelines?
These guidelines can be used as early as the exploratory phase, when MHPSS program teams are considering the necessity and feasibility of implementing remote MHPSS programming and identifying the resources necessary for implementation. The guidelines can also be used throughout a project cycle of new MHPSS programs or to make adaptations to existing remote MHPSS programming. Each step of the guidelines corresponds to a stage in MHPSS programming and include:
- the what, why, when, who and how of implementing each step;
- sub-steps that make up each of the three steps to facilitate work planning and delegation of tasks among various team members;
- references to tools in the appendices of the guidelines to support various tasks associated with each step;
- tips and experiences from the field to support practical application of the outlined steps;
- “Key Considerations” summarized at the end of each step that can serve as a high-level checklist; and
- “Key Resources” lists at the end of each step that provide links to guidance relevant to implementing the step.
Depending on your role in the program or the stage of implementation, you may choose to reference a specific step (and accompanying appendices) or read the guidelines in their entirety.
The sections on Ethical Considerations, Capacity Building, Monitoring and Evaluation, and Staff Well-being and Self-Care cut across all steps in the guidelines and should be referenced at each stage of MHPSS programming and by all stakeholders involved in the MHPSS program implementation.