Self-Help WHOPlus (-SH+)- 培训手册：供培训主持人教授 SH+ 课程

TheSelf-HelpPlus(SH+)training

manual

FortrainingfacilitatorstodelivertheSH+course

WrldHealthorganization

TheSelf-HelpPlus(SH+)training

manual

FortrainingfacilitatorstodelivertheSH+course

worldHealthorganization

TheSelf-HelpPlus(SH+)trainingmanual:fortrainingfacilitatorstodelivertheSH+course

ISBN978-92-4-009505-2(electronicversion)ISBN978-92-4-009506-9(printversion)

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Contents

Acknowledgements viii

Glossary x

PartA.

InformationontrainingSH+facilitators 11

1.Aboutthistrainingmanual 12

2.AboutSelf-HelpPlus(SH+) 14

2.1OverviewofSH+ 14

2.2IsSH+safeandeffective? 14

3.SH+trainers 16

3.1Yourroleasatrainer 16

3.2RequirementsforSH+trainers 16

3.3TrainingtobecomeanSH+trainer 16

4.SH+facilitators 18

4.1RequirementsforSH+facilitators 18

4.2TrainingtobecomeanSH+facilitator 19

5.Languageandinterpretation 20

6.TheSH+facilitatortrainingworkshop 21

6.1Traineepreparationbeforetheworkshop(optional) 21

6.2Duringtheworkshop 21

6.3Afterthetrainingworkshop 22

6.4Adaptingthetrainingworkshop 23

7.Competency-basedtrainingandassessmentinSH+ 24

7.1WhatistheSH+facilitatorcompetencyassessmenttool? 24

7.2WhenandhowtouseSH+competencyassessments 25

7.3Providingfeedback 26

PartB.

Trainerinstructions 27

8.Howtousethetrainerinstructions 28

9.SH+trainingworkshopDay1 30

Welcomeandintroduction 30

Groundrules 33

IntroductiontoSH+ 35

ExperienceSH+ 42

DiscussSH+session 44

SH+facilitationbasics:introduction 47

SH+facilitationbasics:usingtheaudioandtheSessionInstructions 53

Day1Summary 59

10.SH+trainingworkshopDay2 60

WelcometoDay2 60

ExperienceorpractiseSession2 61

DiscussSession2 61

Basichelpingskills:introductionandethicsofbeingafacilitator 62

Basichelpingskills:communicationdemonstration 65

Basichelpingskills:overview 67

Basichelpingskills:role-play 71

Respondingtocommonchallengesduringthecourse:overview 75

Respondingtocommonchallengesduringthecourse:role-play 79

Day2Summary 82

11.SH+trainingworkshopDay3 83

WelcometoDay3 83

PractisefacilitatingSession3 84

DiscussSession3 84

Talkingwithparticipantsindividually:overview 85

Talkingwithparticipantsindividually:role-play 89

Managingimminentriskofsuicideandotherimmediatesafetyissues:overview 92

Managingimminentriskofsuicideandotherimmediatesafetyissues:role-play 98

Day3summary 101

12.SH+trainingworkshopDay4 102

WelcometoDay4 102

PractisefacilitatingSession4 103

DiscussSession4 103

Troubleshootingotherchallenges 104

Practisingself-care 108

Supervision 111

OPTIONAL:Additionaltimeforquestions,identificationofculturallyrelevantexamplesorother

adaptations 112

Day4Summary 115

13.SH+trainingworkshopDay5 117

WelcometoDay5 117

PractisefacilitatingSession5 118

DiscussSession5 118

Competencyassessments 119

SH+trainingworkshopwrap-up 122

References 124

Annexes 125

Annex1.SH+competencyassessmenttool 126

Introduction 126

Role-play1instructions 126

Role-plays2and3instructions 127

SH+competencyassessmentrecordform 129

ScoringSH+competencies 131

Annex2.Trainingworkshoptopicsandexampleschedule 138

Annex3.Trainingworkshopplanningchecklist 141

Annex4.Trainingworkshopmaterialschecklist 142

Annex5.Givinghelpfulfeedback 143

Annex6:Exampleenergizers 145

Annex7:Respondingtocommonchallenges–role-playinstructionslips 146

Annex8:Talkingwithparticipantsindividually–role-playinstructionslips 148

Annex9:Managingimminentriskofsuicideandotherimmediatesafetyissues

–role-playinstructionslips 150

viiiSelf-HelpPlus(SH+)

Acknowledgements

TheWorldHealthOrganization(WHO)wouldliketothankthemanyindividualswhocontributedtothedevelopmentofthisdocument.

Contributors(withaffiliationattimeofcontribution)

ThisdocumentwaspreparedbyTeresaAu(WHO,DepartmentofMentalHealth,BrainHealth

&SubstanceUse)andKennethCarswell(WHO,DepartmentofMentalHealth,BrainHealth&

SubstanceUse)wholedtheconceptualizationanddevelopmentofthisSelf-HelpPlus(SH+)

trainingmanual.Thefollowingpeoplealsocontributedsubstantiallytoearlierversions:ClaudetteFoley(Melbourne,Australia),FelicityBrown(WHO,DepartmentofMentalHealth,BrainHealth&SubstanceUse),RussHarris(Melbourne,Australia)andJoAnneEpping-Jordan(Seattle,USA).

Reviewers(alphabetical,withaffiliationattimeofcontribution):

CerenAcartürk(KocUniversity,Türkiye),SarahAlHashimi(MedicalUniversityofVienna,Austria),MinnaAnttila(UniversityofTurku,FInland),CristinaCarreño(MédecinsSansFrontières,Spain),

PimCuijpers(VrijeUniversityAmsterdam,Netherlands(Kingdomofthe),BrandonGray(WHO,

DepartmentofMentalHealth,BrainHealth&SubstanceUse),JenniferHall(WHORegionalOfficefortheWesternPacific,DivisionofPacificTechnicalSupport,Suva,Fiji),PernilleHansen(Duduza,SouthAfrica),ThomasKlein(UlmUniversity,Germany),GerganaManolova(WHO,DepartmentofMentalHealth,BrainHealth&SubstanceUse),AnaMarques(MédecinsSansFrontières,Jordan),

BrianOgallo(WHO,Sudan),DuduPeace(HealthRightInternational,Uganda),AlisonSchafer(WHO),GiuliaTurrini(UniversityofVerona,Italy),JamesUnderhill(WHO),Edithvan’tHof(WHO),JohannesWancata(MedicalUniversityofVienna,Austria)andSafinaYusuf(HealthRightInternational,

Uganda).

Testing(alphabetical)

Thefollowingorganizationssupportedthedevelopmentofthistrainingmanualbyusingearlierversionsofitandprovidingfeedback:HealthRightInternational’sPeterC.AldermanProgramforGlobalMentalHealth(incollaborationwithMinistryofHealthUganda,UNHCR,WHOCountry

OfficeinUganda),JohnsHopkinsBloombergSchoolofPublicHealth,theRe-DEFINEconsortium(UniversityofVerona,IstanbulSehirUniversity,KocUniversity,UniversityofLiverpool,UniversityofYork,MedicalUniversityofVienna,UniversityofTurku,UlmUniversityandVrijeUniversity

Amsterdam)andtheWHOCountryOfficesinSouthSudan,TürkiyeandUkraine.

Funding(alphabetical)

FinancialsupportforthedevelopmentofthistrainingmanualwasreceivedfromBureaufor

HumanitarianAssistance(BHA),USAID;theEuropeanCommission(Horizon2020)researchand

innovationprogrammeSocietalChallenges,RE-DEFINEgrantagreement779255andtheResearchforHealthinHumanitarianCrises(R2HC)Programme(managedbyElrha).

Acknowledgementsix

DeclarationsofInterest

InaccordancewithWHOproceduresallexternalreviewerscompletedandsignedastandardWHODeclarationofInterest(DOI)form.Thesewerereviewedbythecoordinatingteam.Noconflictsofinterestwereidentified.

xSelf-HelpPlus(SH+)

Glossary

Audiocourse:Thefivepre-recordedSH+audiorecordingsusedtorunthefivesessionsoftheSH+course.

Demonstration:TrainerdemonstratesanelementofSH+facilitationinfrontoftrainees.

Facilitator:Theperson(typicallyanon-specialist)whorunstheSH+groupsforparticipants.

“Facilitator”canrefertoeitheraleadfacilitatororaco-facilitator.Whenneeded,themorespecificterms“leadfacilitator”and“co-facilitator”areused(seeSection4,Part1oftheSH+coursemanual).

Participant:ApersonparticipatinginSH+groups.

Role-play:Traineespractisefacilitationbyplayingtheroleofafacilitator.

Self-HelpPlus(SH+)course:Thefive-sessiongroup-basedstressmanagementcoursefor

adults,inwhichtrainedfacilitatorsplaytheSH+audiotogroupsofparticipants,reviewtheSH+skillsintroducedbytheaudio,provideculturallyrelevantexamplesandclarificationsandreadoutdiscussionquestions.

SH+book(titledDoingWhatMattersinTimesofStress:AnIllustratedGuide):Ashort,illustratedguidetoremindparticipantsofwhatthey’velearnedinthecourse.Itisgivento

participantsaspartoftheSH+course.

SH+coursemanual:TheSH+coursemanualisthemaindocumentneededforlearningabout

andrunningtheSH+course.Part1(“EssentialInformation”)providesinformationonrunningthe

SH+course.Part2(“SessionInstructions”)givesinstructionsforfacilitatorstofollowwhileusingthepre-recordedaudioduringeachSH+session.Theappendicescontainmaterialsthatfacilitatorswillneedforeachsession(e.g.imagestoshowparticipants).

SessionInstructions:Part2oftheSH+coursemanual.FacilitatorsusethisduringeachSH+

sessiontoknowwhentopausetheaudio,readoutdiscussionquestionsandprovideinformationtoparticipants(seedescriptionaboveoftheSH+coursemanual).

Supervisor:PersonwhomeetsregularlywithSH+facilitatorstoprovidesupervision.SupervisorsareultimatelyresponsibleforensuringthatSH+groupsarefacilitatedcompetentlyandsafely.SH+supervisorsshouldbetrainedinSH+andbeabletomanagesafetyissues.

Trainee:PersonwhoisintheprocessoflearningtobeanSH+facilitator.Trainer:PersonwhoteachestraineestofacilitateSH+groups.

Trainingmanual:Thismanual,whichisfortrainerswhowillteachfacilitatorstorunSH+groups.Trainingworkshop:InteractiveworkshopfortrainingSH+facilitators.

PartA-InformationontrainingSH+facilitators11

PartA.

InformationontrainingSH+facilitators

12Self-HelpPlus(SH+)

1.Aboutthistrainingmanual

Self-HelpPlus(SH+)isafive-session,group-basedstressmanagementcourseforadultsdevelopedbytheWorldHealthOrganization(WHO).Itwasdesignedtobedeliveredtolargegroupsof

participantsbynon-specialistfacilitatorswhohavecompletedabrieftrainingworkshop.

ThistrainingmanualisforpeopleororganizationswantingtotrainSH+facilitators.Itassumesthattraineefacilitators(calledtraineesinthismanual)havenoexperienceindeliveringpsychologicalinterventionsormentalhealthandpsychosocialsupport.Forexperiencedtrainees,itdescribes

optionsforadaptingthetraining(

Section4.2.1

).

Thistrainingmanualcomprisesthreeparts:

•

PartA

InformationontrainingSH+facilitators:GeneralinformationonSH+andtrainingSH+facilitators.

•

PartB

Trainerinstructions:Detailedinstructionsforrunningatrainingworkshop.

•

Annexes:

Supplementarymaterials,includingmaterialstouseinthetrainingworkshop.

Howtousethistrainingmanual

Thistrainingmanualshouldbeusedalongsidethe

SH+coursemanual

(1)

whichprovides

essentialinformationaboutSH+(Part1)andsession-by-sessioninstructionsforfacilitatinganSH+group(Part2).

Fororganizationsandsupervisors

OrganizationsshouldmakeanoverallplanforimplementingSH+intheirlocalcontext,asoutlinedinWHO’spsychologicalinterventionsimplementationmanual

(2)

.SH+supervisorsandprogrammemanagersinimplementingorganizationsshouldbefamiliarwithatleast

PartA

ofthismanualandSections1–4oftheSH+coursemanual.

SupervisorsshouldunderstandhowtofacilitatetheSH+courseandhowtoensuresafetyand

competence.SupervisorscanalsobeSH+trainers,butdonotneedtobe.Formoreinformationonsupervision,seeSection3.2oftheSH+coursemanualandWHO’spsychologicalinterventionsimplementationmanual.

Approachtodevelopment

ThistrainingmanualwasdevelopedtosupportthetrainingoffacilitatorsdeliveringtheSH+

course.Aninitialdraftwasdevelopedforuseinresearchtrialsoftheinterventionandthiswasiterativelyadaptedandimprovedwitheachsuccessivetrial.Thefinalversionwasfurthereditedforclarityandbrevity.TheSH+courseofwhichthismanualispart,isconsistentwithWHO

guidelinesonstressmanagement

(3)

.

PartA-InformationontrainingSH+facilitators13

Noteontranslationandadaptationofthistrainingmanual

WHOhasavailable,onrequest,asetofmaterialsfortranslatingandadaptingthistrainingmanual(aswellastheSH+course)intodifferentlanguages.Toavoidduplicationoftranslations,please

considercontactingWHOPressthrough

/about/policies/publishing/copyright

beforebeginninganewtranslation.

14Self-HelpPlus(SH+)

2.AboutSelf-HelpPlus(SH+)

2.1OverviewofSH+

SH+isdeliveredtogroupsofparticipantsbytrainedfacilitatorsusingthreesetsofmaterials:•SH+coursemanual

(1)

:FacilitatorsfollowtheSH+SessionInstructionsintheSH+coursemanualtoplaythepre-recordedaudio,reviewSH+skillsintroducedbytheaudio,provideexamplesandclarifications,andreadoutdiscussionquestions.

•SH+audio:1Pre-recordedaudioprovidesparticipantswithinformationandinstructionontheSH+skillsformanagingstress.EachSH+sessionlastsapproximately90–100minutes,includingaround50minutesofaudioand30–40minutesofdiscussionsandotheractivities.

•SH+illustratedbook(DoingWhatMattersinTimesofStress:AnIllustratedGuide)

(4)

andaccompanyingaudiofiles:2ThebooksummarizesalltheSH+coursecontent,andcan

beusedbyparticipantsbetweensessionstoreviewandpractisetheirnewlylearnedSH+skills.TheaccompanyingaudiofilesprovidebriefSH+exercisestopractise.ItispossibletodeliverSH+withoutthebookifliteracyistooloworthecostofproducingbookstoohigh.

Mostofthecoursecontentisdeliveredthroughthepre-recordedaudio,withminimalsupportfromSH+facilitators.Facilitatorsreadoutshortscripts,encourageparticipantstousetheSH+skillsandensureparticipants’safety(i.e.respondingtosafetyissuessuchasimminentriskofsuicide).Theydonotprovidecounsellingorlengthyexplanations.

Thisapproachhelpsto:

•reducetrainingandsupervisiondemands,comparedwithmanyotherpsychologicalinterventions;

•keeptheemphasisonparticipantslearningtohelpthemselves;

•keepSH+sessionsshort;

•ensureconsistencyinhowparticipantsreceiveSH+content;and

•enabledeliverytolargegroups(e.g.30people).

Formoreinformation,seeSection2oftheSH+coursemanual.

2.2IsSH+safeandeffective?

ManyaspectsofSH+aredesignedtohelpparticipantsfeelsafe,includingthecourse-likeformatofSH+groups,noexpectationtosharepersonalinformationandremindersthatparticipantscanskipactivitiestheydonotwanttodo.

SH+hasbeenfoundtobesafeandeffectivefordiverseparticipantsexperiencingpsychological

1SH+audiofilesareavailableontheWHOSH+website:

/publications/i/item/9789240035119

2AudiofilesforDoingwhatmattersintimesofstressareavailableontheWHOwebsite:

/publications-

detail-redirect/9789240003927

.

PartA-InformationontrainingSH+facilitators15

distressandadversityinvariouscontexts,includinghumanitariansettings.Ithasbeentranslatedintomanylanguagesandhasbeenreportedtoberelevantandusefulformanygroups.

SH+hasbeentestedinthreerandomizedcontrolledtrials(RCTs)with883adultrefugeesand

migrantsfrommorethansixcountries,livingincountriesrepresentingallincomelevels

(5,6,7)

.

Manyparticipantshadexperiencedsevereadversityandpotentiallytraumaticevents,including

physicalandsexualviolence,aswellasongoingproblemssuchasunstablelivingconditionsandfinancialinsecurity.TheindividualRCTsshowedthatSH+waseffectiveinreducingmoderate

toseverepsychologicaldistress,reducingsymptomsofcommonmentaldisorders,improving

functioningandsubjectivewell-beingand,insomestudies,preventingtheonsetofmental

disorders.Inonestudy

(4),

mostparticipants(84%)metstudycriteriaforseverepsychological

distress,butimmediatelyaftertheinterventiononly33%ofthosewhohadreceivedSH+continuedtoexperienceseverepsychologicaldistress,comparedwith58%ofparticipantswhohadnot

receivedSH+.Inanotherstudy

(6)

,participantswhoreceivedSH+were53%lesslikelytohavea

mentaldisordersixmonthsafterSH+,comparedwiththosewhodidnotreceiveSH+.NonegativeeventsrelatedtoSH+werereportedinthestudies,andtheSH+facilitationapproachwasfoundtobefeasibleandsafe.

Ameta-analysis

(8)

ofthethreeRCTsconfirmedthatSH+wasassociatedwithsignificantimprovementsindepressivesymptoms,self-identifiedproblemsandwell-beingatmid-termfollow-up(5–6monthspost-randomization).SH+wasmoreeffectiveforparticipantswithlowerbaselinewell-beingandwhowereunemployed.Theauthorsconcludedthat“SH+appearstobeanappropriateinterventionforthemanagementofdepressivesymptomsamongrefugeesandasylumseekers”.

FormoreinformationonwhoSH+isfor,seeSection2.2oftheSH+coursemanual.

16Self-HelpPlus(SH+)

3.SH+trainers

3.1Yourroleasatrainer

Asatrainer,yourmainresponsibilitiesareto:

1.Plantrainingactivities,consideringtrainees’previousexperienceandtrainingneeds(see

Section4.2.1

and

6.4

).

2.TeachtraineestofacilitatetheSH+coursesafelyandcompetently.

3.HelptraineesfeelconfidentintheirabilitytodeliverSH+,includingthroughhelpfulfeedback(see

Section7.3

and

Annex5

).

3.2RequirementsforSH+trainers

SH+trainersshouldideally:

•Haveabackgroundinmentalhealth(e.g.amentalhealthprofessional).Peoplewithouta

mentalhealthbackgroundbutwithexperienceoffacilitatingorsupervisingSH+canruntrainingsiftheyaresupportedbyamentalhealthprofessional.

•BeexperiencedandcompetentindeliveringSH+orothermentalhealthinterventions.

•BeabletodemonstratethecoreSH+facilitatorcompetencies(see

Section4.1.1

)andtrain

facilitatorsintheseduringatrainingworkshop.Trainersdonotneedanin-depthunderstandingofacceptanceandcommitmenttherapy(ACT),onwhichSH+isbased.

•Haveexperienceintrainingandbeabletotrainothers(e.g.givingeffectivepresentations,leadinggroupdiscussions,providinghelpfulfeedbackandsettinguprole-plays).

•Speakthesamelanguageastrainees,oruseaninterpreterduringthetrainingworkshop(see

Section5

).

Ideally,twotrainersrunanSH+trainingworkshoptogether,soitiseasiertododemonstrationsandmanagetrainingactivities.

TherequirementsabovearebasedonexperiencesofdeliveringSH+inresearchandreal-worldsettings.TheypointtothetypeofpersonwhomaybeabletorunanSH+trainingandmayvarybysetting.

3.3TrainingtobecomeanSH+trainer

ThereisnoformalWHOprocessorcertificationtobecomeanSH+trainer.Ultimately,thetrainerandtheorganizationimplementingSH+mustdecidewhethertheyarepreparedfortheirrole.

Mentalhealthprofessionalswhomeettherequirementsin

Section3.2

maybeabletotrain

themselvesasSH+facilitators(see

Section4.2.1

),usingthecoursemanualandforthcomingSH+orientationcourse,andthenastrainers,usingthismanual.

PartA-InformationontrainingSH+facilitators17

Alternatively,prospectivetrainerscouldattendatrainingoftrainers(TOT)workshopifavailableintheirsetting.Thisisnotessentialbutofferssomeadvantagesoverself-training,including:

•increasedconfidenceandmotivationtotrainothersinSH+;

•hands-onpracticeofrunningatrainingworkshop;

•networkingwithothertrainers;and

•opportunitiesforimplementingorganizationstoobservefuturetrainers.

AnSH+TOTworkshopcouldbeledbyanSH+trainerwhohasthenecessaryexpertiseandexperiencefordeliveringTOTs.

AnSH+TOTcanincludethreemainactivities:

1.LearnandpractisehowtobeanSH+facilitator.

2.Improvegeneraltrainingability(e.g.givingeffectivepresentations,leadinggroupdiscussions,etc.).

3.Practisedeliveringpartsofthetrainingworkshopasatrainer,using

PartB

ofthistrainingmanual.ThecontentanddurationofaTOTshouldbebasedontheexistingexperienceandcapabilities

ofprospectivetrainers.WHOhasnotpublishedamanualonhowtorunaTOTforSH+orother

psychologicalinterventions.AfteraTOT,traineesmaystillneedadditionalpracticewithfacilitating

SH+andleadinganSH+trainingworkshop,beforetheyarefullyabletodeliveratraining.

18Self-HelpPlus(SH+)

4.SH+facilitators

4.1RequirementsforSH+facilitators

SH+wasdesignedtobedeliveredbybrieflytrained,non-specialistfacilitatorswithoutprevious

experienceofdeliveringpsychologicalinterventions(e.g.volunteers,communityworkers,universitygraduatesinpsychologywithoutclinicaltraining).

SH+facilitatorsshould:

•Speakthesamelanguageandideallyhaveasimilarculturalbackgroundtothatofparticipants.RunninganSH+groupwithinterpretationispossible(see

Section5

).

•Beabletoreadandwrite(preferablyhavingcompletedhighschooleducation).

•Haveagenuineinterestinhelpingothers.

•BewillingtolearnandpractisetheSH+skillsintheirownlives.

4.1.1SH+facilitatorcompetencies

Competenciesarethingsapersondemonstrateswhentheyintegrateknowledge,skillsand

attitudesintohowtheyperformatask

(9)

.Inotherwords,competenciescanbeseenandobserved.Theyaretrainable,durable,andmeasurable.Facilitatorsneedtodemonstratethefollowing:

•SH+-specificfacilitationcompetencies.Theseinclude:

。Followingthestep-by-stepSessionInstructions(Part2oftheSH+coursemanual).。Usingaminimalsupportapproach(e.g.notprovidingcounsellingorlongin-depthresponses)whenspeakingwithparticipantsindividuallyorrespondingtoquestionsordisruptions.

•Foundationalhelpingcompetencies.Theseapplytoallpsychologicalinterventionsandinclude:。Basichelpingskills,suchasmaintainingconfidentiality,validatingandacknowledging

emotions,usingappropriatenon-verbalcommunicationandavoidinggivingadvice(Section5oftheSH+coursemanual).

。Knowinghowtoaddressimmediatesafetyissues,includingimminentriskofsuicide(Section7oftheSH+coursemanual).

FacilitatorsalsoneedtobefamiliarwithSH+coursecontent.WhilemostSH+contentisdeliveredbythepre-recordedaudio,facilitatorsneedtounderstandtheSH+skillssufficientlytoanswerbasicquestionsduringSH+sessions(seeAppendix1oftheSH+coursemanual).

SinceSH+usespre-recordedaudio,whichcanbetiringtolistento,facilitatorsareessentialfor

ensuringthatthecourseisinterestingandengaging.Practiceandfamiliaritywiththecoursehelptoensurethatfacilitatorsdeliveritinanengagingway.

Facilitators’competenciesshouldbeassessed,includingthroughstructuredrole-playsanddirectobservation,aspartoftrainingandsupervision(see

Section7

formoredetails).

PartA-InformationontrainingSH+facilitators19

4.2TrainingtobecomeanSH+facilitator

ThereisnoformalWHOprocessorcertificationforSH+facilitators.Ultimately,theimplementingorganizationandsupervisorareresponsibleforensuringthatSH+isdeliveredcompetentlyandsaf