Identifying and conceptualizing what to assess: Quality of care in humanitarian contexts

• In Event: Roundtable Session (Tuesday II)
  In Refereed Round-Table Session: Inside the black box of measure development: a discussion with research-practice partnerships on the development, adaptation, and testing of holistic assessments in the Middle East

Proposal

How do we improve the quality of care with children in humanitarian and low-resource settings when working with non-specialists? For War Child Holland (WCH) one of the proposed solutions has been the development of a tool for measuring competencies of staff implementing interventions for children across a variety of sectors. It is envisioned that the tool will be used to improve recruitment, identify training needs and provide a framework for supervision and monitoring.

WCH is working towards an evidence-based system of care consisting of multiple interventions for conflict-affected children. Once an intervention has demonstrated effectiveness, quality of implementation is the next pre-requisite for scaling up that intervention. One of the quality-of-care standards is adequate competency of service providers implementing the evidence-based interventions. The We-Act is a tool designed to assess this therefore it becomes and important quality assurance tool for implementing care for children in humanitarian settings.

The development of the tool has drawn inspiration from similar work that has already been done in Nepal for service providers in the MHPSS sector working with adults (Kohrt et al., 2015a; Kohrt et al., 2015b) and is based on George Miller’s framework (1990) for (clinical) competence. This framework distinguishes between what a person knows (knowledge), knows how (application), shows how (competency), and does (core quality). For this tool WCH defines competency as the extent to which a service provider has the knowledge and skills required to deliver an intervention to the standard needed for it to achieve its expected effects (Fairburn & Cooper, 2011, p. 373).

As part of the 3EA consortium, WCH will, test the tool with facilitators of a life skills programme in Gaza. The study will have three phases
1. Feasibility and Acceptability: Research Question: Can expert raters and field staff use We-Act tool to rate common competencies?
2. Interrater reliability: Research Question: Is We-Act tool reliable, so that independent expert raters using it come to similar scores after observing service providers in situ or through standardized role-plays?
3. Sensitivity to change: Research Question: Is there a change in We-Act tool scores over time and training?

During this presentation War Child Holland will outline the various steps taken to develop this tool over the last year and a half. This has included amongst many steps a literature review, global survey and workshops with children, caregivers and service providers. We will discuss the challenges and lessons learnt on the way not only for the development of this tool but also considerations in the development of a measurement tool.

Author

• April Coetzee, War Child Holland