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C Provider Definitions and Relationship Roles COMMUNITY/LAY WORKERS Peer/service user (PR): A peer/service user can be a family member, friend, or other patient who is either being treated for a similar condition or has a relationship with the primary patient. Patients who use health care services in the community can provide support to others, share per- sonal experiences, and participate in self-help and mutual aid activities. They can form collaborative relationships and communicate with other community members and/or health care providers to address patient needs, including prevention and treatment. Community health care worker/health extension worker (CHW): Community health workers and health extension workers provide health education, referral and follow-up, case management, and basic preven- tive health care and home visiting services to specific communities. They provide support and assistance to individuals and caregivers in navi- gating the health and social services system. They foster a foundation for sharing information, providing mutual support and a sense of belonging for patients, families, and providers. They can form collaborative rela- tionships and communicate with other community members and/or health care providers to address patient needs, including prevention and treatment. They reduce caregiver burden and can encourage the involve- ment of caregivers in treatment plans. They can both refer and receive patients. 83
84 CANDIDATE CORE COMPETENCIES FOR MNS DISORDERS IN SSA NON-SPECIALIZED, NON-PRESCRIBING PRACTITIONERS Pharmacist (PH): Pharmacists store, preserve, compound, and dispense medicines. They advise patients and family members on the proper use and adverse effects of drugs and medicines. Pharmacists dispense pre- scription medications according to the direction of medical doctors and other health professionals. They contribute to researching, testing, pre- paring, prescribing, and monitoring medicinal therapies for optimizing human health. They communicate about drug procurement or shortage issues. They may educate other providers about new drugs. They may provide assistance in accessing and coordinating with other health care providers. Social worker (SW): A social worker is a professional who plans and provides counseling, skills development, crisis intervention, and media- tion services in individual, family, or group settings to assist clientsâ function within the limitations of their environment, improve their rela- tionships, and solve personal and family problems. They may serve as counselors for a large array of issues and in a variety of settings. They may also serve as case managers. They can form collaborative relation- ships and communicate with other community members and/or health care providers to address patient needs, including prevention and treat- ment. They may consult and/or liaise with general practitioners to deliver primary interventions (e.g., drug supply, organization of community health services) and with other providers (e.g., psychiatric nurses, occu- pational therapists, psychologists). Psychosocial care provider (subcategory): Through good communi- cation and assessment skills, psychosocial care providers support pa- tients on psychological, social, and spiritual levels. They play a unique role in supporting patients through dialogue in order to un- derstand how patients view themselves as individuals, what is im- portant to them, and how their relationship with others may affect their treatment. Psychosocial care providers build a rapport with pa- tients and help other providers develop a clinical relationship with patients and their families. Occupational therapist (OT): An occupational therapist is a profes- sional who works with patients to help them achieve a fulfilled and satis-
APPENDIX C 85 fied state in life. An occupational therapist utilizes purposeful activity or interventions designed to achieve functional outcomes that promote health, prevent injury or disability, and develop, improve, sustain, or re- store the highest possible level of independence. They can form collabo- rative relationships and communicate with other community members and/or health care providers to address patient needs, including preven- tion and treatment. They may work exclusively with individuals in a par- ticular age group or with particular disabilities. Specific therapies may include facilitating the use of the hands, promoting skills for listening and following directions, fostering social skills, or teaching dressing and grooming skills. Occupational therapists may also serve as case manag- ers. They can consult and/or liaise with other providers (e.g., general practitioners, psychiatric nurses, psychologists). They may provide assis- tance in accessing and coordinating with other health care providers. NON-SPECIALIZED PRESCRIBING PRACTITIONERS Clinical officer (CO): A clinical officer is a paramedical practitioner who provides advisory, diagnostic, curative, and preventive medical ser- vices. A clinical officer performs duties that are more limited in scope and complexity than those carried out by medical doctors. They work autonomously or with limited supervision from medical doctors, and per- form clinical, therapeutic, and surgical procedures for treating and pre- venting diseases, injuries, and other physical or mental impairments common to specific communities. They can form collaborative relation- ships and communicate with other community members and/or health care providers to address patient needs, including prevention and treat- ment. Clinical officers can serve as liaisons with other providers and may provide assistance in accessing and coordinating with other health care providers. They may also work with other health care professionals to provide health education for patients, caregivers, and families. They may collaborate with health professional groups and other important partners involved in program implementation to ensure that all health workers receive appropriate education and training, including management of mental, neurological, and substance use (MNS) disorders. Nurse (RN): Nurses provide treatment, support, and care services for people experiencing the effects of illness, injury, aging, or other physical or mental impairments. They assume responsibility for the planning and
86 CANDIDATE CORE COMPETENCIES FOR MNS DISORDERS IN SSA management of the care of patients, including the supervision of other health care providers, working autonomously or in teams with medical doctors and other providers in the practical application of preventative and curative measurers in clinical and community settings. They may make referrals to other providers for patient follow-up (e.g., social work- ers, occupational therapists). They can form collaborative relationships and communicate with other community members and/or health care providers to address patient needs, including prevention and treatment. Nurses may be involved in the development and dissemination of inter- ventions to foster community mobilization and participation. They can consult and/or liaise with other providers (e.g., general practitioners, psychiatric nurses, occupational therapists, psychologists) and may pro- vide assistance in accessing and coordinating with other providers. The distinction between nursing and midwifery professionals and associate professionals should be made on the basis of the nature of the work per- formed in relation to this definition. Medical doctor/general practitioner (MD): Medical doctors/general practitioners are professionals who diagnose, treat, and prevent illness, disease, injury, and other physical and mental impairments. Their key role is to maintain the general health of patients through application of the principles and procedures of modern medicine. Medical doctors plan, supervise, and evaluate the implementation of care and treatment plans by other health care providers. They do not limit their practice to certain disease categories or methods of treatment, and may assume responsibil- ity for the provision of continuing and comprehensive medical care to individuals, families, and communities. They may lead multidisciplinary teams and supervise other providers, such as nurses and social workers. They may consult and/or liaise with other providers (e.g., psychiatric nurses, occupational therapists, psychologists) and may provide assis- tance in accessing and coordinating with other providers. They can form collaborative relationships and communicate with other community members and/or health care providers to address patient needs, including prevention and treatment. They may collaborate with health professional groups and other important partners involved in program implementation to ensure that all health workers receive appropriate education and train- ing, including management of MNS disorders.
APPENDIX C 87 SPECIALIZED PRACTITIONERS Psychiatric nurse (PRN): A psychiatric nurse practices a specialty that cares for people of all ages with mental illness or mental distress, such as schizophrenia, bipolar disorder, psychosis, depression, or dementia. Nurses in this area receive more training in psychological therapies, building of alliances, dealing with challenging behavior, and the admin- istration of psychiatric medication. They may supervise other providers (e.g., nurses, community health workers, peer/service users) and may provide assistance in accessing and coordinating with other providers. Psychiatric nurses may be involved in training non-specialized nurses. They can form collaborative relationships and communicate with other community members and/or health care providers to address patient needs, including prevention and treatment. Psychologist (PY): Psychologists are professionals who work with pa- tients in a variety of therapeutic contexts. There are different types of psychologists, including clinical, organizational, and academic. They may serve as part of a specialist ambulatory team providing training, support, and supervision of non-specialists. They can form collaborative relationships and communicate with other community members and/or health care providers to address patient needs, including prevention and treatment. They may supervise other providers (e.g., nurses, community health workers, peer/service users) and may provide assistance in access- ing and coordinating with other providers. They will work and/or liaise with other providers (e.g., general practitioners, psychiatric nurses, occu- pational therapists). They may collaborate with health professional groups and other important partners involved in program implementation to ensure that all health workers receive appropriate education and train- ing, including management of MNS disorders. Psychologists may con- duct research or apply their knowledge as practitioners. This latter cate- gory includes clinical or counseling psychologists. Neurologist (NE): A neurologist is a physician who specializes in neu- rology and is trained to investigate, diagnose, and treat disorders of the nervous system. Neurologists diagnose and treat all categories of disease involving the central, peripheral, and autonomic nervous systems, includ- ing their coverings, blood vessels, and all effector tissue, such as muscle. They may receive referrals from psychiatrists if patients have a condition
88 CANDIDATE CORE COMPETENCIES FOR MNS DISORDERS IN SSA comorbid with a neurological condition or if a neurological condition needs to be ruled out. They may consult providers (e.g., psychiatrists, medical doctors), supervise providers (e.g., nurses, community health workers, peer/service users), and/or train providers (e.g., psychiatrists, medical doctors), and may provide assistance in accessing and coordinat- ing with other providers. They can form collaborative relationships and communicate with other community members and/or health care provid- ers to address patient needs, including prevention and treatment. The cor- responding surgical specialty is neurosurgery. Neurologists may also be involved in clinical research, and clinical trials, as well as basic research and translational research. Psychiatrist (PS): A psychiatrist is a physician who focuses on the study and treatment of mental illness and behavioral disorders. Psychiatrists are trained in diagnostic evaluation and in psychopharmacological treatment. As part of their evaluation of patients, psychiatrists can prescribe psychi- atric medications, conduct physical examinations, order and interpret laboratory tests and electroencephalograms, and may order brain imaging studies. They will receive referrals from other providers. They may lead multidisciplinary teams and supervise task shifting to medical doctors, nurses, psychologists, and social workers. They will provide ongoing assessment of treatment, education, and support services in addition to monitoring and evaluating community mental health services. They will engage in training of other providers and interact with a wide range of providers (e.g., psychiatric or general nurses, clinical psychologists, so- cial workers, occupational therapists). They can form collaborative rela- tionships and communicate with other community members and/or health care providers to address patient needs, including prevention and treatment. If resources are available, they may provide a consultancy- liaison service to outpatient and primary health center settings for com- plex cases.
