The WHO EQUIP Foundational Helping Skills Trainer's Curriculum
Authors: Sarah Watts, Jen Hall, Gloria A. Pedersen, Katherine Ottman, Kenneth Carswell, Edith van‘t Hof, Brandon A. Kohrt, Alison Schafer
Journal: World Psychiatry (2021)

Foundational helping skills are the provider's competencies needed to build a warm and trustworthy relationship with a client. Examples include effective verbal and non-verbal communication, demonstrating empathy, rapport building, and promoting hope and expectancy of change1. These skills have been widely established as an essential and universal prerequisite for the delivery of any effective psychosocial or psychological care1, and identified as core competencies required for all health workers in the forthcoming World Health Organization (WHO)'s Global Competency Framework for Universal Health Coverage2. Competent use of these skills by providers improves treatment outcomes for people accessing the whole range of health services, from surgery to mental health services1, 3, and use of these skills has been shown to support greater treatment compliance also outside the mental health field – for example, HIV treatment adherence4. The recent global experience of the COVID-19 pandemic has demonstrated that mental health and psychosocial support skills cannot be limited to mental health specialists only. Health systems will be able to better respond to public health emergencies as well as provide superior routine care if all health care providers are competent in foundational helping skills. Yet, in many health training programs, the attention to these skills and their evaluation is limited5. The WHO developed the Ensuring Quality in Psychological Support (EQUIP) project, which aims to strengthen quality in the delivery of psychosocial support and psychological training within the Universal Health Coverage agenda. The EQUIP platform will offer materials for trainers, supervisors, and program managers on competency-based training and assessment6. One such resource for trainers is the competency-based Foundational Helping Skills Trainer's Curriculum. The formative process to develop this training package included a narrative review, identification of empirically supported common factors used across effective interventions7, human centered design inputs, and extensive expert consultation, including experts from field sites, programme managers, and academics. Based on these contributions, a range of skills were identified. Examples include verbal and non-verbal communication skills, using culturally and age-appropriate terminology and concepts for distress, confidentiality, normalization of feelings, expression of empathy, promoting hope, and suicide risk assessment. In addition, based on the importance of attitudes in motivating caring behaviours8, a module on attitudes toward helping others was included. The training curriculum is in a modular format, to allow trainers to fit it to the trainees' needs based on brief competency assessments conducted throughout the training programme. The curriculum includes didactics, participatory group activities, and skill remediation techniques, which can be delivered online, face-to-face, or in a combined approach. Role-play based competency assessments9 are conducted throughout the training to monitor progress, to determine minimum competency, and to ensure that the trainee does not engage in harmful behaviours (e.g., being dismissive or judgmental, ignoring or minimizing suicide warning signs)9. The EQUIP Foundational Helping Skills Trainer's Curriculum is intended to be a brief course: approximately 20 content hours, with flexibility based on the prior skill level of trainees. It is designed for implementation across a wide variety of government and non-government organization sectors, such as public health, family and community services, education, and law enforcement, with trainees such as professionals and para-professionals without prior training in mental health and psychosocial support skills. Pilot testing of the training package is currently underway in Uganda, Nepal and Peru, assessing its feasibility, acceptability, and perceived benefit for remote and in-person delivery. The EQUIP Foundational Helping Skills Trainer's Curriculum aims to meet an indispensable need by ensuring that the growing workforce of health care professionals and non-specialist providers are competent in foundational helping skills. This, alongside other activities, will hopefully lead to improved quality of care and will be one step closer to achieving the goal of a competent health workforce for Universal Health Coverage.