Introduction

For Jehovany Cruz dual nationality is a core part of his identity. His right forearm displays a carefully inked Torogoz, the national bird of El Salvador, signifying family and unity. On his left, a man lifted by balloons cycles across the New York City skyline, the state where his parents settled in the 80s.

Jeho’s life today as a front-end software engineer in Los Angeles is far from the frontier of El Salvador and Honduras his parents left behind during the nation’s civil war. Their sacrifice ensured better opportunities for their unborn children, and Jeho, an accomplished React and Javascript coder, has not disappointed, recently taking his mother on a trip back to El Salvador for the first time in two decades.

“My family is from Monteca near the border. It’s all mountains, forest and dirt roads”, he says, a sharp contrast to his current home in LA’s intoxicating Koreatown. The trip to El Salvador came just before his 32nd birthday and after he relocated from New York, where he now works for Alma.

Alma is a therapy directory platform making mental healthcare in the US more accessible while providing therapists with better tools to help their patients.

“Alma’s mission resonated with me a lot”, Jeho says. “After college I wanted to find a therapist to help with anxiety and depression. I called my insurance company who sent me a huge PDF filled with information for all of the thousands of therapists in New York City. A platform like Alma would have helped me so much back then.”

Alma works across every state in the USA connecting people with one in over 9000 therapists specialising in specific areas of mental health, relevant to the patient’s needs. “It’s like Zocdoc but for therapists”, he explains, “you go to Alma and put in what type of insurance you have and your zip code and then Alma provides you with profiles of different therapists that you can reach out to alongside the issues they specialise in.

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Alma also acts as a platform for the mental health providers themselves, offering a separate login page where therapists view their patient’s profiles, assessments and overall progress.

Jeho’s role is to build up this side of the platform, working in the quality enablement team on the patient assessment pages which visualise the progress of patients.

“I was offered two jobs when I was looking for work and I chose Alma because it’s focused on mental health and that’s important to me.” Alma’s mission to improve access to mental health stretches beyond services for patients and therapists he explains, the company also provides him with a monthly stipend of $120 towards his own therapy sessions, unlimited paid time off and “great insurance”.

“ What appears simple is very complex, creating one button on a page takes several different codes ”

Technical and Ethical Considerations

Jeho’s work creating the therapists’ portals containing patient information and assessments came with several ethical and technical considerations that influenced his approach.

Technical Considerations

On the technical side of challenges was ‘how to measure mental health’. Insurance companies want information on how clients are progressing in their therapy, but mental health is hard to quantify with data, “it depends on how a patient is doing that particular day or that month.”

One route Jeho decided on was for the therapist to ascertain the patient’s overall goals for therapy early on and to chart the progress towards those goals instead, which can be assessed and quantified more accurately than the underlying mental health issue.

“So if you suffer depression or have anxiety, therapists might send you these assessments to complete before a session to gauge where you are at and how you’re progressing.” This information is then translated into data which Jeho visualises into clear charts for the provider, and insurance companies, to assess that patient’s progress. For this he uses the Javascript library Chart.js, “so that every graph doesn't need to be done from scratch.”

Chart.js was chosen because it is very compatible with React, simple in nature and highly customizable, allowing Jeho to unleash his creative side to “pad and beautify” the assessment pages.

While methods for assessing depression and anxiety - the two issues most patients currently seek therapy for - do exist, ways to quantify issues like stress are less clear. Despite this, insurance companies paying the therapists’ fees want to see clear data and rely on Alma to lead the way on what kind of data is useful to assess patients and to provide measurable results.

“That’s something I’m working on and it’s something more important than just working at a bank coding algorithms to make them more money.”

Building the tools to help the therapists with their client’s assessments and reassessments every six sessions or so “is a lot of fun” for Jeho, who prioritises accessibility and simplicity with consideration to the health providers interfacing with those pages. He predominantly works on React, the favoured framework of over 40% of developers, for its efficiency in building user interfaces.

The assessment pages use self explanatory buttons like send now, view details and every six sessions. However, what appears simple onscreen is actually complex code, he explains.

“When you click one button a modal opens up, and just to get a single modal to open takes different codes. For example, the moment a therapist clicks one of those links I want to begin a workflow for them to complete, one that updates their assessment preference for that specific patient.

“When they click the every six sessions link, a modal pops up with the option to unenroll in automatic assessments. If they click this, it starts a chain reaction in the code to send an API request to the back-end to unenroll them from the assessments and be saved in our database.

“On the front-end, the modal closes once an action is complete and we have a confirmation message that shows on the screen "unenroll successful" to let users know that the changes chosen in the modal were completed. So it’s a lot of logic and code to make that happen!”

Ethical Considerations

Given the sensitive nature of working with people’s personal medical information there were ethical considerations taken into account when working with Alma. The company provided Jeho and the other software engineers with HIPAA training (Health Insurance Portability and Accountability Act).

“They set this course up for me in my first week at Alma. The crux of the training is to make sure you never share any personal medical information about a person”, but more broadly it gave him the requisite understanding of how to work ethically with people’s private medical data.

Another of the ethical questions for Jeho and fellow engineers was how to anonymise patient data and profile pages on Alma, so that their sensitive information is kept secure. For this Jeho and other engineers “sanitised the code”, so that they were working within parameters defined by HIPAA, hence the unique patient ID codes used between front and back-end engineers. Jeho also uses template patient pages of people that don’t exist when showing the assessment pages he has built.

“It makes a lot of sense. If it were my information I wouldn’t want people looking at it and seeing my mental health history or what I’m currently going through. It’s also important today given how technology and databases are used to sell people’s phone numbers and email addresses for companies to profit with. If it were people’s medical information being misused it would be a lot worse.”

Coding, Language and Creativity

Growing up among the Salvadoran diaspora on Long Island, speaking Spanish at home and English at school has helped Jeho in coding, giving him the ability to “think differently.”

“Coding is like speaking to yourself in a different language. When I speak in Spanish, my head and mind pivot, activating the Spanish section. When I’m coding it’s the same concept. It helps me to be able to compartmentalise like that. There is also syntax in coding, so the same as the logic that goes into constructing sentences is that which goes into building code.”

But the concept of coding and language that resonates more with him is music. “I played viola in the select orchestra in high school and read music, which has really helped with coding.” He explains how his cohort at Codesmith was well stocked with musicians, and one in particular, a conductor, excelled remarkably quickly.

“He was just a savant at coding. I asked him if he had done it before as he took to it so naturally. But he hadn’t. The skills he’d learnt as a musician, like reading music, just translated very well to thinking in code.

The crossover of creativity and coding doesn’t stop there, with performers also joining Codesmith’s coding course to open up career options as Covid closed down so many productions.

“One friend and classmate was a Broadway actor who actually invited us to a special screening of Wicked the musical when he was performing after the pandemic eased up. He works at MongoDB now and is doing really well in the software engineering space.”

Talking again of how creativity and code come together well, Jeho emphasises how a satisfying aesthetic of his work is important to him as a front-end engineer. Similarly to when he worked in marketing and trade shows and events would visually reflect his efforts behind the scenes.

“I really connect my love of trade shows to my love for front-end coding. In front-end you see the visual representation of the code you have worked on, similarly in trade shows, I would work in the shadows on all the different elements and be proud of the output I created.”

He was a creative student in school, mastering Photoshop and creating a lot of artwork for competitions. One in particular is a piece he created at NYU while participating in the society Latinos Unidos Con Honor y Amistad (Latinos United Through Honour and Friendship). It is a striking collage of all the leaders of Latin American countries, and seeing it again after some years opens up a new conversation about identity within the coding community.

“There’s a Latino coding community that’s pretty strong. I joined a Slack channel called Techqueria”, a channel for Latinx people in the tech industry. “It’s all about the Latino community helping each other out, whether that’s through help with resume writing, posting or finding and applying for jobs, negotiating salaries, etc.”

Jeho joined Techqueria when he got out of Codesmith and was looking for a community that spoke to him as a Latino in tech and one that could potentially help him find jobs in coding. The organisation has over 12,000 Latino members and a broader network of 18,000 allies.

“It’s remote and so huge so it can be hard to know where to start off, but I joined and got involved through the introduce yourself channel and spoke to some other Latino coders there. But there’s also Pride in Tech, BlackTECH and a Latinas in Tech that serve the other communities in the coding sphere.”

Side Projects

Jeho now also works at Codesmith part time after work as a prep mentor for other students and he always tells them his story.

“If I'm able to succeed with no background in tech, you can too. Many assume other students have done professional coding before starting Codesmith. But, 80% of my cohort had no coding experience before Codesmith. Most of us were just looking for a career pivot. We were all in the same place.”

He tells a story of a terrible coding job interview he had, one he often tells Codesmith students to assure them it’s not all plain sailinzg, and even he had some awkward setbacks.

“So Codesmith taught us just to start applying for jobs all the time as you get the most experience just by doing and failing. It’s good because if you fall on your face the first few months you're getting real interview practice.

“One of the first interviews I did was a full stack job. It was back-end, which I didn’t want to do, but I wanted to get my foot in the door. In Codesmith we learned Node.js, a back-end language, still Javascript but using a different logic to front-end.

“So, in the technical assessment for this job they told me to grab some data from Notepad, bring it into the code in Node and use a particular algorithm from there. The guy running the interview assumed I knew how to extract and import the data from Notepad. But I had no idea how to do it. So I asked him if I could Google it. He said yes, but seemed unsure of me by then. I found the answer, Codesmith always taught us to be resourceful and find the answers to problems we’re facing, but by that time it was already 30 minutes into a one hour interview. The guy just said “look I know we have another 30 minutes but I’m just going to cut it short here, and made some mumbling excuse about being pulled into a meeting.”

Fortunately, Codesmith encourages students to apply, interview and even fail, while still studying, immunise them somewhat to the ruthlessness of the job industry they will face upon graduating.

“Another thing I’m working on is building a videogame with my old roommate from New York. Most games are made with languages like C Plus, C Sharp, Unreal Engine, you know, but I found this site called ReactJam, where people create games with React and Javascript and put them onto this site.

So now I’m building a game that I want to enter into the 2024 ReactJam competition. I really love React and Javascript, and honestly I’m not quite ready to learn another deeper language right now, so this is my goal at the moment.”