Workforce Competency in the Context of Scaling-Up Mental Health and Psychosocial Support (MHPSS) in Lower-Resourced Settings

To achieve Universal Health Coverage 2030, health systems globally are demanding more educated and empowered health workers but are lacking skills-based training programs to help reach their goals. Incorporating a competency-based approach into health and social service training and supervision, including mental health and psychosocial support (MHPSS), can help organizational and governmental bodies to establish minimum competency standards and ensure achievement of the “do no harm” principle. The dissertation applies a multi-site, mixed methods, before-and-after trial design to determine if the World Health Organization’s (WHO) competency-based Foundational Helping Skills (FHS) training, guided by the WHO/UNICEF Ensuring Quality in Psychological Support (EQUIP) platform, can improve the competency of different in-service and pre-service providers from Nepal, Perú and Uganda. Additionally, to offer implementation guidance for those using EQUIP resources, this dissertation conducts an incremental cost analysis of training of trainers (ToT) and helpers (ToH) in the evidence-based, trans-diagnostic MHPSS intervention Problem Management Plus (PM+) using an EQUIP competency-based approach in Nepal. FHS trainings, on average, were 20 hours in duration, typically delivered over 4 days. Harmful behaviors decreased from pre- (M=3.27, SD=1.87) to post-training (M=.95, SD=1.47) across all sites and within each site (Nepal: MD=-3.33, 95% CI [-4.03, -2.64], Peru: MD=-2.16, 95% CI [-2.49, -1.84], Uganda: MD=-1.26 95% CI [-2.04, -.48]). Helpful behaviors increased from pre- (M=9.03, SD=4.46) to post-training (M=15.34, SD=5.68) across all sites and within each site (Nepal: MD=9.26, 95% CI [7.76, 10.77], Peru: MD=5.78, 95% CI [4.95,6.60], Uganda: MD=3.29, 95% CI [1.23,5.37]). Qualitatively, trainees and trainers strongly promoted FHS training, highlighted challenges to learning competencies and the barriers and facilitators to scaling-up FHS. For PM+ trainers, a standard PM+ ToT costs NPR 63,800.06 (US$510.40), with additional training on EQUIP competency-based approaches and digital platform costing an incremental NPR 45,111.15 (US$360.89). A standard PM+ helper training costs an average of NPR 207,906.35 (US$1,663.25) compared to an EQUIP-based PM+ ToH costing NPR 211,122.71 (US$1,688.98), for an incremental NPR 3,216 (US$25.73) per ToH. Qualitatively, trainers using EQUIP-based approaches within MHPSS training programs recognized the usefulness of using the EQUIP digital competency assessment tools to rate and provide feedback to trainees, and to iteratively tailor their training activities. Trainers highlighted learning curve with EQUIP competency-based approaches and technology, but with practice, coaching, and real-world application, trainers felt confident with the tools and see it strengthening their training approaches. An EQUIP competency-based curriculum in Foundational Helping Skills delivered through pre-service or in-service training can reduce the risk that providers display harmful behaviors when engaging with clients. Using an EQUIP competency-based approach within exiting MHPSS training programs requires initial investment through training of trainers; thenceforth, differences in time and costs are negligible when compared to standard training approaches. Given minimal cost differences and benefits for improving provider competency and client safety and outcomes, we recommend organizations and governmental bodies implement EQUIP competency-based approaches, such as the EQUIP-based FHS curriculum or an EQUIP-based approach to PM+ training, into their existing programming.

Author

• Pedersen, Gloria

Language

• en

Date created

• 2023

Type of Work

• Dissertation

License

• All rights reserved

Rights statement

• In Copyright

GW Unit

• Global Health

Degree

• Dr.P.H.

Advisor

• Kohrt, Brandon A

Committee Member(s)

• Schafer, Alison
• Long, Michael

Persistent URL

•  https://scholarspace.library.gwu.edu/etd/7w62f899g