20.4 EVALUATING COMPETENCIES OF NONSPECIALIST PROVIDERS IN CHILD AND ADOLESCENT MENTAL HEALTH: THE UNICEF-WHO EQUIP INITIATIVE

Abstract

As delivery of psychological interventions by nonspecialists becomes more commonplace, assurance that training and supervision methods achieve minimum competency standards is needed. The United Nations Children’s Fund and World Health Organization (UNICEF-WHO) Ensuring Quality in Psychological Support (EQUIP) platform is a digital tool to provide guidance on conducting competency-based trainings of nonspecialists. The platform includes competency assessment tools for adults (the ENhancing Assessment of Common Therapeutic Factors [ENACT] tool) and for children (Working with children—Assessment of Competencies Tool [WeACT]), as well as a suite of treatment-specific competency tools for adult- and child-focused psychological interventions. Role-play based (RPB) competency assessment tools were evaluated in a range of global settings for feasibility and acceptability. Study sites included Ethiopia, Kenya, Lebanon, Nepal, the occupied Palestinian territory, Peru, Uganda, and Zambia. In addition, a US pilot of the tool was conducted in New York City (NYC). Acceptability and feasibility were evaluated through both qualitative assessments and evaluation of interrater reliability (IRR) and responsivity to change. IRR ranged from 0.54 to 0.80 across sites and tools. The use of microcompetency video demonstrations of helpful vs potential harmful/unhelpful techniques helped increase IRR. Most individual competencies showed responsivity to change when evaluated pre- vs posttraining. For child competencies, youth drama clubs were feasibly trained to be actors in the standardized role-plays. Competencies were also modified for remote delivery of psychological interventions, which is of particular importance to deliver services during the COVID-19 pandemic. RPB assessments of competencies can be implemented in diverse settings ranging from refugee camps in low-income countries to urban centers of high-income countries (HICs). Rater training and standardized actors require a significant time investment, which can then yield high rates of IRR for observational assessments. With the transition to more remote care, RPB structured competency assessments are increasingly feasible even in low-resource settings. Reciprocal learning with the NYC site demonstrated that the tool can also be beneficial in an HIC.