facilitator training workshop
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Facilitator Training Workshop. Group introductions. Name Organization & location Clinical background Stroke experience Previous Living with Stroke experience Expectations of workshop. Thoughts. I cannot teach anybody anything. I can only make them think. - PowerPoint PPT PresentationTRANSCRIPT
Facilitator Training Workshop
Group introductions
Name Organization & location Clinical background Stroke experience Previous Living with Stroke experience Expectations of workshop
Thoughts I cannot teach anybody anything. I can only make them
think.• Socrates (Greek philosopher, 470-399 BCE)
Change your thoughts and you change your world. • Norman Vincent Peale (American clergyman, 1898-1993)
The greatest discovery of my generation is that a human being can alter his life by altering his attitudes of mind.
• William James (American philosopher and psychologist, 1842-1910)
The only kind of learning which significantly influences behaviour is self-discovered or self-appropriated learning – truth that has been assimilated in experience.
• Carl Rogers (American humanist psychologist, 1902-1987)
Objectives To understand Living with Stroke (LWS) and its
objectives To understand particular challenges involved in
working with stroke survivors To focus on facilitation rather than clinical teaching To practice facilitation To develop familiarity with LWS materials To develop confidence in facilitating LWS
Housekeeping
Workshop structure: 1 day Phone Washrooms In your package: Expense sheets Presentation handout Detailed information on facilitation and group dynamics
• HSFO LWS Facilitator Notes• Facilitation: A Brief Overview• Group Dynamics Overview• LWS Kit• Evaluation Form
Agenda Morning
• LWS introduction• Facilitation basics: LWS-
offered separately if needed• Module 1• Module 2
Break• Module 3• Module 4
Lunch• Module 5• Module 6
Break• Module 7• Module 8• Wrap Up• Adjournment and
Evaluation
Living with Stroke introduction
Need for program
Greater reduction in quality of life than expected Problems five years after rehabilitation Family caregivers have increased health risks Opportunity to intervene to improve health-
related quality of life Networking opportunity for stroke survivors and
caregivers Increase awareness of community resources
Program description
6-8 week interactive workshop program • 1-2 module/week: develop group dynamics and skills• 2-hour workshop: maximum duration to prevent
fatigue
Focus: education and support, not clinical care Held in a community setting Survivor of stroke plus caregiver Optimal size: 8-12 participants
Program goals
To improve stroke outcomes by:• Providing stroke survivors and caregivers with
tools • Assisting stroke survivors and caregivers to cope
• Facilitating engagement in adjustment and
recovery
Program modules Module 1: Understanding Stroke Module 2: Physical Changes and Challenges Module 3: Swallowing and Nutrition **Module 4: Cognition, Perception & Communication **Module 5: Emotions: Focus on Depression Module 6: Activities and Relationships **Module 7: Reducing the Risk of Stroke **Module 8: Moving Forward
Flow of modules 5-10 minutes: Introduction and follow up Group ground rules 10-15 minutes: DVD 30-40 minutes: Individual stories from survivors and caregivers 15 minutes: Break 15 minutes: Teachable moment (based on stories) 10 minutes: Questions and stories 15 minutes: Teachable moment (based on previous questions)
and weekly commitment to change (goals): building self efficacy 5 minutes: Conclusion and suggested handouts
Room set-up
Room for adaptive equipment Chairs in semi-circle or circle with table Data projector, laptop and speakers
• Visibility and sound quality
Flip chart, black board or white board• Appropriate markers or chalk
Table at side • Refreshments, handouts, other resources• Signage if required
Facilitator tools Provided
• Marketing and recruitment materials • Manuals• National and regional resources• DVDs• Forms
Facilitator responsibility• Program marketing• Participant recruitment • Local resources: list and identify before program start • Visual aids, handouts and learning tools• Refreshments
Facilitation basics: Living with Stroke
How does a facilitator differ from
a clinical educator?
Promoting engagement Engagement
• Psychological energy: attention, interest, recognition of relevance
• Importance: Supports participation in recovery Facilitator
• Encourages participation in learning or change• Draws out knowledge and ideas
Provides appropriate structure for productive interactions Focuses on effective group processes Empowers group to discuss, think and act together Releases responsibility for outcome to participants
See Facilitation: A Brief Overview
Avoiding pitfalls Pitfalls
• Prevent group from achieving its objective • Arise externally or from within group• Potential pitfalls common• Anticipate and develop strategies to address them
LWS addresses barriers to engagement • Misinformation• Maladaptive health-related beliefs and attitudes• Practical barriers
Important: Barriers prevent problem-solving, learning and use of health information
Program principles
Psychoeducation Group dynamics Building self-efficacy Group process Eliciting the story Using the story for teaching
Psychoeducation
Health teaching and outcomes Knowledge vs behaviour change
• Why do we persist with unhealthy behaviours when we know the dangers?
• How can you bridge the gap between knowledge and behaviour change?
Psychoeducation
Health teaching and outcomes Personal relevance and applicability of information
• Increases learning • Influenced by attitudes and beliefs
Facilitators need to: • Understand health-related attitudes and beliefs• Reduce barriers by addressing attitudes and beliefs• Promote attitudes that facilitate adaptation • Use cognitive-behavioural strategies• Promote practice, problem solving and learning
Group dynamics
Forming Storming Norming Performing Re-forming
Key for LWS: Balance group process and individual needs
Building self-efficacy
Self-efficacy• Belief in one’s capability to master a new skill• Perception of competence to make a desired
change• Conscious awareness of ability to be effective, in
control• Confidence in ability to be successful
An important facilitator responsibility • How do you build your own sense of self-efficacy in
facilitating LWS?
Building self-efficacy
Self-efficacy: Central concept for LWS • Gradual, small changes• Failures and successes• Persistence and encouragement
LWS promotes the development of self-efficacy so participants come to believe they can make behavioural changes that promote their own recovery and health
Group process
Facilitator focuses on effective processes to create structure for effective interactions
• Providing methods and tools • Ensuring equal voice for participants
Meeting participants’ focus on content• Topics of discussion
Content vs process exercise
John is very distressed. He hasn’t seen his grandchildren since the stroke because he can’t drive anymore.
In this example, How could the facilitator focus on process? What
would be the impact on John and the group? How could the facilitator focus on content? What
would be the impact on John and the group?
Content vs process exercise
Andrew’s story Andrew has high blood pressure (145/105
mmHg) but he doesn’t like taking medication, so he only takes it occasionally. At the same time he wants to reduce his risk of another stroke. He says he quit smoking, maintains a healthy weight and walks half an hour daily.
How could the facilitator use Andrew’s story for teaching?
Participant stories
Sharing stories critical to program success Eliciting story is an important facilitator skill
• Asking the right questions• Identifying issues of personal importance• Uncovering barriers to change• Never giving advice or communicating criticism
WEEK 1Module 1: Understanding stroke
Module 1 Purpose Introduces program to stroke survivors and caregivers Creates a positive environment Encourages participating (sharing stories) Creates a foundation of knowledge about stroke in
general Introduces risk factor reduction – medication compliance Introduces the concept of making a commitment to
change (weekly goals)
Module 1
Facilitator focus• Supporting group formation • Eliciting the stories
Module 1 review • Facilitator introduction• DVD: Survivor stories
Integrating
• Participant stories Facilitator control of process (time) Specific challenges
Module 1
Challenges in working with stroke survivors Group formation and impact of stroke General strategies to encourage discussion Encouraging reluctant participants Managing talkative participants
Module 1
Supporting group formation • Creating an effective group from diverse
participants• Compensating for stroke impact
Remember, even mild impairments can:• Affect participation in and benefits derived from
LWS • Have implications for group process• Compromise attention, organization, concentration
Module 1
General strategies to encourage discussion • Open-ended questions• Continuation techniques and nonverbal cues
(nods)• Series of specific questions to obtain more detail
See Facilitator notes for more details
Module 1
Encouraging reluctant participants• Determine reason • Open-ended questions • Non-verbal encouragement, wait • Summarize and prompt speaker• Questions to focus on story• Summarize to focus health teaching
Module 1
Managing talkative participants • Use additional questions to refocus response• Respectfully interrupt and move to more relevant
topic • Tactfully redirect discussion• Return to agenda• Request other contributions • Use closed ended multiple-choice questions
Module 1 Module review
• Teachable moment • Use and incorporate information from stories • Educate about stroke• Use questions to engage participants• Elicit the story• Medications (adherence, not clinical) and healthy living
recommendations • Record responses: barriers, issues • Teachable moment• Discuss recommendations• Risk factor reduction
Module 1 Module review (cont’d)
• Program objectives and commitment to change• Record program objectives: What would you like to
get out of this program and what can this group and program do to help you meet your goals?
• Record weekly commitments to change: What change can you try over the next week to improve your health?
• Conclude session with review of learning and commitments
• Evaluation
Module 1
Module review (cont’d)• Local resources and handouts• Connecting to resources a program objective• Facilitator responsibility to prepare list
Support for recovery needed for self-care and reintegration
• Stroke survivors apply learning from rehabilitation• Family and caregiver provide supports for recovery• Link to community resources: important role
Module 1 small group exercise
When asked to tell his stroke story, one participant says, ”I thought this workshop was about moving forward—I don’t want to talk about the stroke. I feel I’ve put it all behind me.”
Module 1 small group exercise
Questions1. What are the pitfalls here?2. How could you engage him in the group
process? 3. What strategies can you develop to address
potential concerns?
Module 1 small group exercise
The workshop has reached the stage of committing to make a change that will reduce the risk of another stroke. You ask, “What change can you try over the next week to improve your health?”
One stroke survivor, who has participated throughout the workshop says “I don’t think I can do that.”
Module 1 small group exercise
Questions• How do you respond to this comment? • What questions can you use to identify barriers to
change?• What role could the other group members play in
helping this participant engage in committing to change?
• How can you turn this negative comment into a learning exercise for the group?
WEEK 2Module 2: Physical Changes and
Challenges
Module 2
Purpose• Address the most visible changes as a result of
stroke – the physical limitations• Discuss the importance of physical activity for
both recovery and risk reduction• Teach goal-setting skills: key for all modules
Module 2 Review ground rules Review previous weeks presentation Share goals, accomplishments, challenges Distribute resources pertinent to this week DVD: Recovery and physiotherapy – 13 minutes Participants share stories Facilitator educates about stroke and physical
limitations Participant stories about impact of physical limitations
Module 2
Facilitator educates about taking control and importance of physical activity
Goal setting skills Participants commit to one way of increasing
physical activity over the next week Facilitator concludes session Evaluation
Module 2
Unrealistic expectations common Managing unrealistic expectations
• Convert to problem-solving exercise• Recognize the difference between hopefulness
and denial• Safety implications
Module 2
Module 2 review • Goal-setting
Introduce SMART-c goals• Specific• Measurable• Attainable• Realistic• Timely• confidence
Module 2
S = Specific Defines action and emphasizes desired outcome Make a goal specific by answering:
• What do I want to accomplish?• What am I going to do?• How am I going to do it?
“I will exercise daily by walking” is more specific than “I will develop healthy habits”.
Module 2M = Measurable Measure progress toward goal by achieving small steps Make a goal measurable by including criteria for
success:• How will I measure progress toward my goal?• How will I know when I reach my goal?
“I will increase my daily walking duration by 10 min every week” is a measurable goal.
Achieving measurable progress toward a goal is a strong motivator
Module 2
A = Attainable Attaining goals should be a challenge but not impossible Feelings of success help to maintain motivation Make goals attainable by answering the following
questions:• Is it possible for me to achieve this goal?• What help, if any, do I need to achieve this goal?
“I will increase my daily walking duration by 10 min every week until I reach 30 min a day” is an attainable goal for many people.
Module 2
R = Realistic Based on existing knowledge, skills, or lifestyle Achievement may require change Make a goal realistic by designing it to be
difficult but not impossible:
“I will increase my daily walking duration by 10 min every week until I reach 30 min a day and I will continue this for 4 weeks.”
Module 2
T = Timely Timeframes ensure progress is made toward achieving
goals Make a goal a real task by attaching an achievable end
date:• When will I accomplish specific steps in this goal?• When will I accomplish the entire goal?
“I will increase my daily walking duration by 10 min every week until I reach 30 min a day and I will continue this for 4 weeks. I will reassess my exercise program after 4 weeks.”
Module 2
c = Confidence Final component in validating goal Confidence in achieving goal on a scale of 1-10 If confidence low, look at ways of raising it to 8-10
• What could prevent me from achieving my goal? • Why do I feel I may not achieve my goal? • What ideas or strategies can I try to increase my
confidence in achieving my goal? • What help do I need?
Break
WEEK 3Module 3: Swallowing and Nutrition
Module 3
Purpose• Reviews swallowing problems as a result of stroke• Presents the importance of healthy eating to
overall health, stroke recovery and risk reduction• Discusses coping with eating and dietary changes
Module 3 Review group ground rules Review last week’s module Share goals, accomplishments, challenges DVD – Professional Video, Dietician Participants share stories Facilitator educates on risks, incidence of dysphasia page
39 Participant Manual Participant stories about feelings and coping with changes
in eating
Module 3 cont.
Teachable moment: Facilitator discusses importance of positive strategies and solicits suggestions for dealing with restriction, maintaining social contacts and eating a healthy diet
Participants agree to try one way of improving diet over the next week
Facilitator summarizes session Evaluation
Dietary Sodium and Blood Pressure
PPP Dietary Sodium and Blood Pressure Go to : www.hypertension.ca -Click on view tools -Then click on 2009 Sodium Public
Education Sodium Slide Kit 45 slides developed for public education Easy to understand, menu makeovers, quiz
Module 3 exercise
During the workshop on Module 3, participants share their feelings about changes in their eating, and what this means to them. One participant says “I’m eating nothing but mush.”
Module 3 exercise
Questions1. How would you respond to this person?2. How could you use the group to support the
person?3. What questions could you ask to better
understand this person’s feelings?
Week 4 and 5
Module 4Cognition, Perception and Communication
Module 5Emotions: Focus on Depression
Module 4
Purpose• Introduce cognitive and perceptual problems• Review issues related to communication• Understand impact of changes • Develop ways of compensating for these changes
Module 4 Review group ground rules (only if necessary) Review goals, accomplishments, challenges DVD: Living with aphasia - 15 minutes Neuropsychologist video available Individual participants share stories about changes in their life Overview of cognitive, perceptual and communication problems Facilitator fills in information gaps about the importance of
these problems and coping strategies Participants set goals for the week Facilitator summarizes session
Module 4 Facilitation exercise: Suggest strategies for each of
the following: • Maximizing attention and comprehension• Compensating for age-related cognitive changes• Aiding comprehension and depth of understanding• Facilitating learning and memory• Teaching and discussion• Asking effective questions• Encouraging participant with cognitive impairments• Improving recall• Changing topics
Module 4 exercise
A participant is telling her story when she repeats herself several times. Her spouse says “For pity’s sake, you’ve said that three times!” There is laughter in the group.
Module 4 exercise
Questions1. As a facilitator, how do you defuse the
situation?2. How can you address the topic of memory
loss without causing further embarrassment?
3. What strategies do you use to get back on track with story telling?
Module 4 exercise
Cognition, perception and communication are sensitive topics. Participants are asked at the beginning of the session to tell their stories. One participant has some aphasia and finds it difficult to participate fully.
Module 4 exercise
Questions How do you ensure that this person has an
opportunity to share his story? What could you do to facilitate communication
between this person and the rest of the group? What assumptions do you think other group
members may make about this person? How do you address these assumptions?
WEEK 5Module 5: Emotions: Focus on depression
Module 5
Purpose• Focuses on the emotional changes experienced by
caregiver and stroke survivor after a stroke: anger, grief, loss, depression and anxiety
• Explains why emotional reactions may occur and discusses ways of addressing them
• Discusses the importance of participants who may be clinically depressed seeing their physician for evaluation and appropriate treatment
Module 5 Review last weeks module Share goals, accomplishments, challenges DVD: Emotional issues 15 minutes Participant stories about emotional reactions, depressions, its
impact and coping Facilitator fills in information gaps about the connection
between stroke and mood changes, validates experiences Facilitator fills in information gaps, discusses importance of
differentiating normal emotions from depression Participants agree to try one way of coping with mood changes
over the next week Facilitator summarizes session Evaluation
Module 5
Manage participant emotions like any other effects of stroke
Strategies • Naming or labelling • Understanding and empathy• Normalizing emotion• Using opportunity for teaching• Providing support • Using respect to support progress
Module 5
Facilitator exercise and challenges• Review last week’s commitment to change • Incorporate caregiver perspective• Deal with depression with sensitivity
Module 5 review • DVD: Emotional issues• Teachable moment: Educate about depression
Impact of depression on overall health Importance of seeking help if depression suspected Review Geriatric Depression Scale pg 71 PM Be sensitive to perceived stigma
Module 5 Distress and suicide risk Be alert to potentially dangerous situations requiring
immediate attention• Thoughts of suicide• Indicators of problems managing medications
Stories may include distressing and intimate issues unrelated to stroke
• Provide empathy • Refocus discussion on parts of story relevant to module
Lunch
WEEK 6Module 6: Activities and Relationships
Module 6
Purpose Adjustment to life after a stroke Prevention of social isolation and depression
by promoting engagement Importance of social and family relationships Participation in both familiar and new
activities Community reintegration
Module 6 Review of last weeks module Share goals, accomplishments, challenges DVD: Family support and caregivers -16 min Individual participants share stories about changes in activities
of daily living and instrumental activities of daily living Facilitator fills in information gaps about the need to do things
differently, the meaning and emotional impact Participant stories about changes in relationships and activities Facilitator fills in information gaps, discusses importance of
engaging in life, and in important relationships and activities Facilitator summarizes session Evaluation
Module 6 exercise
Millie becomes a grandmother
Module 6 exercise
Questions How would you use this clip to engage the group? What makes this video clip so emotional for you? What do you think Millie is struggling with the
most? Why? If you showed this video clip in your group and
you saw tears, as a facilitator, how would you react?
WEEK 7 and 8Module 7: Reducing the Risk of
StrokeModule 8: Moving Forward
Module 7
Purpose• Focus on practical ways of adopting a healthy
lifestyle Healthy diet Physical activity Stress reduction
• Focus on implementation and necessary knowledge
Module 7 Concludes the workshop series Review last weeks module Share goals, accomplishments, challenges Review of stroke risk factors and warning signs of stroke DVD: Reducing the risk of stroke 10 min Participant stories about barriers to following health care advice Teachable moment: Practical approaches (nutrition labels, Canada
Food Guide, physical activity) Participant stories: Stress and coping, unhealthy coping strategies Teachable moment: Facilitator fills in information gaps, teaches
healthy coping Participants agree to try one healthy stress reduction method Facilitator summarizes session
Module 7 Facilitator exercise and challenges
• Follow-up on previous week’s goal • Caregiver perspective • Practical tools for healthy living and risk reduction
Module review• DVD: Reducing the risk of stroke • Teachable moment
Educating about lifestyle change and stress reduction Identifying tools Developing strategies to overcome barriers
• Weekly commitment to change: try a healthy stress reduction technique
Module 7: Group Exercise
The group just finished listing recommendations they were given regarding lifestyle and medication. The facilitator recorded the list on a flipchart. The facilitator asks the participants to share any barriers they anticipate in making the recommended changes.
Module 7: Group Exercise cont.
Questions:1. What key barriers to change may emerge
and list strategies to address barriers?
WEEK 8Module 8: Moving Forward
Module 8
Purpose• Recognizes progress participants have made in:
Understanding stroke Developing strategies to adapt to their new circumstances Developing the skills and confidence to change behaviours
Focuses on making and accomplishing future commitments to change on their own
• To get support (form a support group?)• To continue recovery and reduce stroke risk• To reclaim pleasures in life
Module 8 Facilitator introduction DVD: Life after stroke – 6 min Participant stories and program benefit Stroke Busters PPP Teachable moment: Facilitator validates learning and
reviews importance of active role in recovery Teachable moment: Facilitator fills in information gaps,
consolidates ways of addressing future challenges Support group discussion Discussion of future changes (goal setting) and exercise Conclusion
Module 8
Facilitator exercise and challenges• Setting the stage for the future• Encouraging group to continue to meet or join
support group
Module review • Follow up last week’s commitment to change • DVD: Life after stroke 6 min
Module 8
Module review (cont’d) • Participant stories: meaning of program and changes in
Knowledge Thinking Attitudes Behaviour
• Teachable moment: Summarize learning and movement
Passive to active Not understanding stroke impact to addressing problems Experiencing stress to taking personal control
Module 8 Module review (cont’d)
• Revisit question: What would you like to get out of this program and what can this group and this program do to help you meet your goals?
Ask if they achieved their goals
• Participant stories about current strategies and approaches to future challenges
• Teachable moment: Opportunities for change Partnership with healthcare providers Connecting with community resources and programs Control of health, healthy choices and relapse mgt Warning signs of stroke; risk reduction
Module 8
Module review (cont’d)• Support group benefits: Stroke Recovery Canada• Review of process for making and achieving
commitment to change (goal setting)• Conclusion
Thank everyone for participating Congratulate participants Reinforce achievements Collect evaluation forms
Module 8 exercise
The group is in its final session and the facilitator is wrapping up the eight module series. A participant states, “I want to come to the next Living with Stroke session. When is it?”
Module 8 exercise
Questions1. How would you respond to this request?2. Why do you think this person wants to
repeat the program?3. What behaviours would indicate how the
participant is feeling?4. What options are available to the
participant in feeling connected to the community?
5. What feelings do you think you would have at the end of program?
Break
Living with Stroke Implementation
Local resources
Heart & Stroke Foundation Community centres Municipal parks and recreation departments Church or senior groups Day hospital programs Local chapters of organizations Professional care organizations Local libraries Support groups
Planning your program
Organizational issues• Who needs to be involved in program planning?• What is the process for program planning and
approval?• How long does it take?• Who will take responsibility for different aspects of
the program?
Planning your program
Logistic issues • Where can the program be held (accessibility,
chairs with arms, room for tables, washrooms, etc)• What equipment is available (television, DVD,
blackboards, speakers, flip charts and markers)?• When should the program be held (time of day or
evening, time of year [winter not optimal], day of week)
• Transportation assistance
Planning your program
Questions to answer:• How should the program be marketed and advertised?• What other healthcare professionals should be informed
of the program (and possibly involved in recruitment)?• How much in advance of the program should
recruitment begin?• Will refreshments be provided?• What educational tools would be useful?• What handouts are available and when
should these be given to participants?
Planning your program
Develop project team for program Identify team leader Assign responsibilities Develop work-back schedule Schedule project team update meetings Implement
Conducting your program
General requirements• Wheelchair accessible building, washrooms and room • Adequate lighting• Comfortable chairs with arms• Comfortable room temperature• Clear signage• Room for coats, boots, personal belongings• Quiet area: Minimal distractions • Room to walk around• Room for adaptive equipment
Conducting your program Workshop room requirements
• Chairs and tables in semi-circle to support participation• DVD player, speakers and television
Sound and visual quality Learn to operate
• Flip chart, blackboard or white board availability (+ markers) Record participant responses Use for teaching
• Tables for refreshments and handouts • Room for other resources and teaching tools
Conducting your program
Organize yourself• Have contact information for participants available
(telephone reminders?)• Use a notebook to record participant commitments
to change for follow up • Have a system to follow up on participant requests
for information or healthcare contacts etc• Assemble visual aids• Assemble handouts and other teaching tools
A note on refreshments
Providing refreshments for the break encourages socializing
Consider possible swallowing difficulties when choosing snacks:
• Serving yogurt or applesauce is usually safe, even for individuals with swallowing problems
• Providing water is important: it assists those who must take medications at specific times
• Having coffee and tea available for caregivers and stroke survivors who can drink thin fluids
Pacing workshops
Suggested times for module sections are only guidelines
Expected to change depending on the group composition, knowledge, interests and level of participation
Need to monitor workshop pacing during each session
Conduct all workshops in planned order
Networking
Network with the training group as your plan your program
Get support and build your confidence Brainstorm ideas Address concerns and questions
Contact Information
Tammy Tebbutt (519) 749 4300 ex 2605 [email protected]
Sandra Goodyear (519) 749 4300 ex 2735 [email protected]
Thank you facilitators! Good luck with your workshops!