Training of Trainers and Supervisors (ToTS)

EPILEPSY

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WELCOME

Icebreaker: Small Groups of 2 Find out the following and introduce your partner to the whole group

• Name• Profession• Current posting• Interest in and experience of epilepsy

AgendaBackground and ToTS ObjectivesPre-test

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Agenda: Day 1

Name of the facilitator/s8.00 – 8.30am Registration8.30 – 9.15am Welcome Session

•Icebreaker•Background & Learning objectives•Pre-test (demonstration)

9.15 – 10.00am Introduction to ToTS on Epilepsy• Mental Health Gap Action Programme (mhGAP)• Principles of ToTS• Course Materials

10.00 – 10.30am BREAK10.30 – 11.30am Introduction to Teaching Methodology

• Use of mhGAP training material

11:30 – 12:30pm Introduction to Support and Supervision12:30 – 1:30pm LUNCH1.30 – 3.30pm Demonstration of Session “Epilepsy”

3.30 – 4.00pm Preparation for Facilitator Exercise for Day 2

4.00 – 4.30pm Recap and Closing

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Agenda: Day 2

Name of the facilitator/s

8.00 – 10.00am Facilitation of Epilepsy SessionsFeedback by Observers

10.00 – 10.30am BREAK

10.30 – 12:30 Facilitation of Epilepsy SessionsFeedback by Observers

12.30 – 1.30pm LUNCH

1.30 – 3.00pm Practicing Supervision and Support

3.00 – 3.30pm BREAK (optional)

3.30 – 4.00pm Discussions

4.00 – 4.30pm Post-test

4.30 – 5.00pm Conclusion, evaluation, closing remarks

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Background of the Training

WHO Programme on Reducing the Epilepsy Treatment Gap

Four year multi-country project

ToTS as first step towards capacity-building

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Overall Objective for the Fight Against Epilepsy Programme

To improve access and care to services for people with epilepsy

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Specific Objectives for the Programme

• To develop and engage in the strategy for delivering epilepsy care

• To promote training of all professional health care providers, making them competent in diagnosing and treating epilepsy

• To improve awareness of community groups to decrease stigma and increase demand for epilepsy care

• To integrate provision of care and services for epilepsy within the primary health care system

• To monitor and evaluate the project and disseminate new ideas and knowledge

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Epilepsy Training of Trainers and Supervisors (ToTS)

Master Facilitator

Future Facilitators

Health Care Providers

Epilepsy Training

ToTS

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Epilepsy Training of Trainers and Supervisors (ToTS)

What is a ToTS?• A workshop to share knowledge on course content, to teach the

training and supervisory skills necessary to share that knowledge to others, and to understand how to conduct monitoring of the project’s progress.

What is my role as Master Facilitator? • To teach mhGAP epilepsy care, teaching methodology, and

supervision skills to Future Facilitators (YOU!) • To train you to train and supervise others in epilepsy care and

project monitoring

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Epilepsy Training of Trainers and Supervisors (ToTS)

What is your role?• Future Facilitators (You!) will learn about mhGAP and epilepsy

care, and practice facilitator, supervision and monitoring skills.

REMEMBER: • You are learning how to conduct a training on Epilepsy• Keep this in mind as we move through the course!

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Epilepsy Training of Trainers and Supervisors (ToTS)

What are the skills for a good trainer?

Brainstorm and Group Discussion: 5 mins

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Objectives of Training of Trainers and Supervisors (ToTS) Workshop

• Become familiar with mhGAP Epilepsy Module (EPI) and course materials

• Develop and practice facilitator and teaching skills for the EPI module and monitoring forms

• Learn how to interact with health care providers and conduct a participatory training workshop

• Develop and practice relevant supervision and monitoring skills 

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PRETEST

This is a test of your knowledge and skills and also a demonstration of how to administer a pre-test

Has 2 parts• Test which health care providers takes at the actual training• Question for future facilitators (you)

Duration: 15 minutes

Introduction to mhGAP, Epilepsy ToTS and Course

MaterialsDay 1

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Mental Health Gap Action Programme (mhGAP)

Play the video

• mhGAP is a WHO programme to scale up care for mental, neurological and substance use disorders

• Launched in 2008• The focus is on increasing non-specialist

care, including primary healthcare, to address the unmet needs of people with mental health disorders

• mhGAP Intervention Guide (mhGAP-IG) is a clinical tool developed by WHO which explains management of priority conditions using protocols for clinical decision-making

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An evidence-based, clinical guide for the assessment and management of mental neurological and substance use disorders in non-specialized health settings

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mhGAP-IG modules

1. Depression2. Psychosis3. Bipolar disorder4. Epilepsy5. Developmental disorders6. Behavioral disorders7. Dementia8. Alcohol use and alcohol use disorders9. Drug use and drug use disorders10.Self-harm/suicide11.Other significant emotional or medically

unexplained complaints

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Care for People With Epilepsy

• 75-90% of people with epilepsy are untreated in these settings

• Care is affordable, feasible and can be provided by non-specialists

• Up to 75% of people with epilepsy could lead normal lives if treated with oral antiepileptic drugs• Cost as little as 5 dollars per year

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General Principles of Care

• Communication

• Assessment

• Treatment and monitoring

• Provision of social support

• Attention to overall well-being

• Protection of human rights

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General Principles of Care: Communication

• Ensure that communication is clear, empathic, and sensitive to age, gender, culture and language differences

• Be friendly, respectful and non-judgmental at all times

• Use simple and clear language

• Respond to the disclosure of private and distressing information (e.g. regarding sexual assault or self-harm) with sensitivity

• Provide information to the person on their health status in terms they can understand

• Ask the person for their own understanding of the condition

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Who is the target audience for mhGAP-IG?

• Staff not specialized in mental health or neurology

• General physicians, health technicians, nurses

• First point of contact and outpatient care

• First level referral centers, such as health posts or health

centres

• Referral to a specialist at a rural or provincial hospital can also

be the appropriate management

REMEMBER: You are going to teach basic care providers how to use the epilepsy module of mhGAP!

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Assess, Decide and Manage

The assess column guides clinical assessment of the person

The decide column specifies different clinical scenarios

The manage column describes how to manage the problem

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mhGAP-IG (p.34)

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mhGAP-IG (p.35)

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mhGAP EPI: Familiarization Activity

CASE STUDY: Patient comes into a health centre and you are the health care provider. He states that he had a ‘fall’ last week that he does not remember. His 7 year old son witnessed that he was shaking on the floor afterwards and did not talk for more than 5 minutes. There was urine on the floor when the patient woke up and blood in his mouth. This is the second time this has happened in the past two years. The patient has not had a fever, does not use substances and there are no metabolic abnormalities.

In pairs, answer the following questions using mhGAP-IG Epilepsy Module:• What is the diagnosis according to mhGAP?• What is the treatment according to mhGAP?

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Course Materials

• Facilitators Guide• Participants Guide• Presentation Slides• Hand-outs

• Supervision and support• Supervision and Monitoring Forms• Checklist of training skills• Teaching methodology

Introduction to Training MethodologyDay 1

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EXERCISE

What are the teaching methods that you are familiar with?

[Write answers on a flip chart.]

What tools, aids and/or equipment can you use?

Which methods have been used in this ToTS so far?

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Teaching Methodologies of mhGAP Courses

• Presentations• Demonstrations• Small and Large Group Discussion• Brainstorming (used in introduction)• Case Study• Role Playing

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Teaching Tools

• PowerPoint• Flipcharts• Video• Video equipment• Projectors• What else?

DISTRIBUTE HANDOUTS

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Presentations

• Lecture-style format• Can be in printed or oral form. • Lecture is telling someone about something

Demonstrate a lecture

Discuss: How effective is a lecture alone?

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Demonstration

Demonstrate a demonstration:

• Co-facilitators role play a doctor and patient interacting in a correct way and an incorrect way with respect to listening and communication skills

Participant Discussion (10 minutes)

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Small and Large Group Discussions

• Some discussions during the mhGAP Course will be conducted in small groups under the supervision of facilitators

• Some discussions will be conducted with the entire group under the supervision of facilitators

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Small and Large Groups Discussions: Examples

5 minute large group discussion on the following question:• How is epilepsy perceived and understood in the

communities in which you work?• Plenary and discussion for 5 minutes

2 minute small group discussion in pairs• Discuss cases of epilepsy where stigma was an issue• Plenary and discussion for 5 minutes

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Brainstorming

• Generate an extensive list of ideas, thoughts or alternative solutions on a specific topic or problem

• Stimulates thought and creativity and is often used to start group discussion

• Remember, there are no wrong answers with brainstorming!

Hint: Use a flip chart

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Case Study

• Choose a patient case as a teaching tool• Ask questions about the case to the audience• Ideal for practicing assessment and management of

mhGAP priority conditions, especially uncommon presentations or complex cases

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Case Study: Example

You are a primary care provider. A patient who has had two convulsive seizures on two different days in the last month has come to visit you. After your assessment and completion of a new patient form, there is no clear cause of the seizures and the person is otherwise well

Q1) According to mhGAP EPI module, what is the diagnosis and treatment plan?

Q2) What medication would you use and how would you explain the risks and benefits?

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Role-Plays

• Effective for practicing assessment, management, and communication skills

• Small groups of 3 people in which 2 participants play active roles and one participant observes and provides feedback

• Large role-plays facilitated as a demonstration for the entire group by the facilitator and a volunteer

• Emphasis of role-plays should not be placed on acting skills, but rather on the content and the lessons of the activity.

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Role-Play Exercise

• Need 2 volunteers, a primary care provider and a patient with epilepsy

• Primary Care Provider is seeing this patient for the first time and should interview the patient using mhGAP-IG module in order to come to a diagnosis. Take notes to fill out a new patient form.

• The patient has had 2 convulsive seizures in the past 2 months with no clear etiology

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Exercise (Optional)

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Checklist of Training Skills

A list of skills and actions that an effective facilitator should strive to utilize during training

• The list is aspirational – you are not expected to have immediate proficiency with all of these skills! Instead, use the checklist as a guide.

• Practice these skills throughout the ToTS training, and refer to the checklist when giving feedback to yourself and to other participants

DISTRIBUTE HANDOUTS

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Checklist of Training Skills: Categories

• Preparation• Presentation• Interaction• Time Management• Feedback

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Take-Home Points

1) Instruction should be performance based• ToTS training teaches tasks that you will be expected to

do on the job as a future facilitator of health workers

2) Active participation increases learning• ToTS training involves all participants in active

discussion, exercises such as role play, and practical work related to supervision and project monitoring.

3) Immediate feedback increases learning• All participants will be given immediate feedback from

master facilitator and other participants for each exercise

Introduction to Support and SupervisionDay 1

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Overview: Support and Supervision

• Introduction• Why part of ToTS?• Two types of supervision:

• Clinical• Programmatic

• Supervision Methods• Supervision Skills• How to organize supervision and monitoring visits• How to use the supervision forms• How to supervise the use of monitoring forms

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Introduction to Support and Supervision: Brainstorm

Questions for Participants:

What do you think support and supervision refers to?

(5 minute brainstorm)

What kind of support do you feel would be appropriate for integrating epilepsy care into primary care?

(5 minute large group discussion)

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Introduction to Support and Supervision

What is Support and Supervision? • A source of guidance for discussing challenging cases

and for clinical, administrative and programmatic issues

What are the objectives of Support and Supervision?• To improve knowledge and skills so that mhGAP trainees

can independently assess and manage people with epilepsy

• Encourage and support mhGAP trainees in their daily clinical work

• Not to evaluate their performance!

When do you begin?• Following your mhGAP Epilepsy training

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Introduction to Monitoring

What is Monitoring? • A source of information on whether the project is making a

difference and for whom; it can identify programme areas that are on target or aspects of a programme that need to be adjusted

• Done continuously; collects programme inputs and outputs; is used to make immediate programme decisions

What are the objectives of Monitoring?• To provide vital information for improving planning and

allocating resources, improving service delivery, and demonstrating results as part of accountability to key stakeholders

When do you begin?• Following your mhGAP Epilepsy training, as a component of

supervision

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Why are Support and Supervision a part of ToTS? (1)

• Support the process of translating mhGAP epilepsy knowledge into clinical practice

• Ensure adequate delivery of mhGAP-IG epilepsy interventions by addressing challenges

• Identify and help to address problems faced by mhGAP trainees in managing complicated cases

• Improve the motivation of non-specialized healthcare providers to treat persons with epilepsy

• Ensure that medicines, logistics and other support systems for mhGAP epilepsy implementation are operational

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Why is Monitoring a part of Supervision and ToTS?• Ensure that monitoring forms are understood and usable

• Provide knowledge to train non-specialists in monitoring and the use of monitoring forms

• Emphasize the importance of monitoring for improvement of care delivery and health system strengthening

• Ensure adequate quality of epilepsy care by enabling monitoring of patients, health facilities and districts, and adjustments when problems are identified

• Ensure that allocation of resources and future planning is fully informed by data from consistent monitoring

• Ensure progress is adequately measured for accountability to key stakeholders

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Types of Supervision

1) Clinical Supervision:

To support mhGAP-trained Health Care Providers in delivering clinical epilepsy care

2) Administrative and Programmatic Supervision:

To provide support in the work environment as epilepsy care is integrated into the health care system. This includes supervision to ensure trainees are conducting regular monitoring.

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Supervision Methods

Supervision can be done in several ways:• On-site supervision• Remote supervision• Individual supervision• Group supervision

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Supervision Methods: StagesBegins After Health Care Providers trained in EPI

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Supervision Methods: Required Structure

• You will be a supervisor for each of your epilepsy trainees• You will conduct at minimum:

• Monthly Supervision Visits at each facility starting 4-6 weeks after the initial training

• ½ day for each visit• Supervision must include a confirmation that trainees

can and are using the monitoring forms provided• mhGAP district focal person will monitor the supervision

activity and collect facility-level monitoring data • Letter of introduction sent to each facility

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Additional Supervision Methods (optional)

• Ongoing group supervision in the form of bi-weekly grand rounds/clinical case review in a group setting of non-specialist providers. • Held at Provincial or District Hospitals• Alternatively, can be in form of remote supervision• Exact structure depends on available resources and the local

context.

• Brief refreshers for how to use monitoring forms and reminders to complete them as indicated (e.g. monthly, 3-monthly, with each new patient…)

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Exercise: Small Group Discussion

In pairs, discuss:

What types of supervision would be feasible for the settings in which you work?

Duration: 3 minute discussion

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Supervision Skills

• Clinical skills and experience in managing mental, neurological and substance use disorders

• Facilitation and problem-solving skills

• Thorough understanding of how to complete the provided monitoring forms, and where to send any completed forms

• Available time to conduct Support and Supervision, including regular supervisory visits

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Supervision Skills: Exercise

In small groups of 3 people, discuss:

What additional skills should a supervisor have in order to provide guidance for health care providers and epilepsy care?

Duration: 5 minutes

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Additional Skills Required for Supervisors

• Building Trust• Communication• Listening

• Observance and Guidance• Constructive Feedback• Encouragement

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How to Organize Monthly Visits: Overview

Preparation

Conducting the Visit:

Introduce activity Review facility supports Observe clinical interviewUser/Family Visits (optional) Interview Facility DirectorObserve use of monitoring

forms Group Supervision (optional) Staff Feedback and Problem

Solving Summary & Reporting

(Practice required: Day 2)

This part may fit better on 2nd day

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How to Organize Visits: Preparation

• Read the Support and Supervision Guide in full• Review the supervision and monitoring forms• Create a supervision schedule for Year 1• Letter of Introduction to each Facility• Schedule monthly visits with each facility• Invite EPI trained HCPs to each visit• Ask each HCP to schedule 2-3 follow up EPI patients on

that day for supervision

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How to Organize Visits: Forms

Send appropriate forms to facilities beforehand

Ask each facility to complete the Programmatic Support Form (Annex 2) at least 1 week in advance of each visit

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How to Organize Visits: Conducting the Visit, 6 Required Steps

Introduce activity Review facility supports Observe clinical interview User/Family Visits (optional) Interview Facility Director Observe use of monitoring forms, provide refresher

training if needed Group Supervision (optional) Staff Feedback and Problem Solving Summary & Reporting

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How to Organize Visits: Practicing

This takes practice!!!

• On Day 2, we will teach more about how to conduct a visit and practice in small groups

• HOMEWORK: Review the support and supervision guide for exercises on Day 2.

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How to Use the Supervision Forms

• Standardized forms designed to help you• Five forms available for use before, during and after

supervision visits • All forms should be submitted at least every 3 months

to mhGAP EPI focal points• Found in Supervision and Support Handout• Each form is to be used at a certain point in the process

 

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How to Use Supervision Forms: Purpose of Each Form - TBD

Form Purpose

1. Programmatic Support Form Collects statistics on prevalence, patient care, facility supports and staff issues

2. Record of Supervision of Trained Healthcare Provider

Tracks supervision and support activities

3. Clinical Support and Supervision Form

Tracks progress of the HCP EPI skills and knowledge

4. Difficult Case Report Form Documents difficult clinical cases encountered by HCPs

5. Supervisory Report and Feedback Form

Summarizes progress and challenges of the given facility

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How to Use Supervision Forms: When to Use - TBD

Form When to use?

1. Programmatic Support Form Preparing Phase (sent to facility)

2. Record of Supervision of Trained Healthcare Provider

Before and After the Supervision Visit

3. Clinical Support and Supervision Form

Observing Clinical Interview

4. Difficult Case Report Form Preparing and Observing Clinical Interview

5. Supervisory Report and Feedback Form

Reporting Phase

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How to Supervise the Use of Monitoring Forms

Form Who should use? When to use?

1. New Patient Form Primary health care provider

Any time a new patient presents to the clinic with epilepsy for the first time

2. Patient Follow-Up Form

Primary health care provider

Any time an epilepsy patient returns to the clinic for a follow-up appointment

3. Facility Monthly Report Form

Facility Staff Member Once per month

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Instructions: How to complete patient and facility monitoring forms

1. New Patient Form

2. Patient Follow-Up Form

3. Facility Monthly Report Form

Make sure these forms are being completed during correct times and submitted to District Coordinator

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Summary: Supervision and Support

• Supervision and Support are critical to the integration of epilepsy care

• One training workshop alone is not enough• Future Facilitators (YOU!) are trainers and supervisors• You will conduct monthly supervision visits on-site initially,

then quarterly• Prepare and become familiar with the steps and forms

(both supervising and monitoring)

Demonstration of Session “Epilepsy”Day 1

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Demonstration

Master facilitator give demonstration on epilepsy training [Slide 20-51 of the epilepsy training]

Demonstration of Session “Epilepsy”

Preparation for Facilitator ExerciseDay 1

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Facilitator Exercise: Overview

Purpose: • To practice training methodologies and gain experience

in preparing, presenting and facilitating an mhGAP lecture on epilepsy

• To learn how to give feedback to other future facilitators

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Facilitator Exercise: Instructions

Step 1. Prepare presentation on Day 1• Divide into pairs• Prepare assigned topic using the facilitator guide and

mhGAP-IG• Follow ‘Checklist of Training Skills’ as a guide

Step 2. Conduct Session on Day 2Step 3. Receive Feedback

• Feedback form – this is shown 4 slides later, is it also in a Word Doc?

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Facilitator Exercise: Suggested Instructions

Prepare a lecture with the following: • Brief Introduction and Welcome• At least 1 teaching technique other than presentation• Interaction and Participation• Use of mhGAP EPI module in lecture

Length of presentation: 25 minutes

Feedback provided by others: 5 minutes

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Suggested Assignments

GROUP SLIDES METHODOLOGY

1 1-19 Introduction Group Discussion (skip pretest)

2 51-59 Medication Role-playQuiz

3 60-73 Emergency management of seizures

Group DiscussionCase Study

4 74-86 Emergency management of seizures (cont')

Case Study

5 87-97 Advice, education and follow-up

Role-play

6 98-106 Advice, education and follow-up (cont')

Role-Play

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General Suggestions

• Use mhGAP-IG and the Facilitator Guide side by side to prepare your sessions

• Strengthen your knowledge by reading mhGAP-IG on epilepsy

• Be clear with role plays, instructions and discussions after

• Don’t read from PowerPoint slides

• Do interact and participate with the audience

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Other General Suggestions

• Repetition, repetition, repetition

• Observe one, do one and teach one

• Be simple and clear

• Less slides, more exercises

• More interaction

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Feedback Form

Observers complete this form after each pair of co-facilitators on Day 2

1 2 3 4 5

Clarity of Introduction

Clarity of Main Points

Clarity of Main Goals

Use of Summary

Body Language

Voice Tone/Speed/Clarity

Level of Student Interest

Level of Student Learning

Level of Student Participation

EVALUATION OF PARTICIPATORY PRESENTATION: Tick the appropriate box and make comments. Please give your classmate the benefit of honest feedback. Scale: 1-excellent /2-very good /3-satisfactory /4-fair /5-poor

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Training Skills Tips

While participants are working• Look available, interested, and willing to help• Encourage questions• Watch participants as they work; offer individual help to

participants who appear confused• This may be a good time to engage participants who

have been shy or quiet during the group portions of the training

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Demonstration Tips

Demonstrations (videos)• If there is no video available for a module that should

have one (such as not available for the training language or a power outage), act out the entire correct script (no short cuts) with a co-facilitator

• Follow the instructions in the Facilitator's Guide• State clearly the objective of the demonstration• Ask participant’s questions to check their understanding

of the material

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Role-Play Tips

Role-Plays• Clearly introduce the role-play by explaining its purpose,

the situation, and the roles to be enacted• Keep the role-play brief and to the point• After the role-play, guide a discussion. Ask questions of

both the players and observers• Summarize what happened and what lessons should be

taken away from the exercise

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Tips for Group Work

Practical Sessions and Group Work• Before dividing into groups, explain clearly the purpose

of the activity, what participants will do and the time limits of the exercise

• If needed, demonstrate a skill before asking participants to do it on their own

• Try to get participants to identify their own strengths and weaknesses. Ask questions like - What did you do well? What difficulties did you have? What would you do differently in the future?

Facilitation Exercises by ParticipantsDay 2

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Structure

25 minute presentations by pairs5 minute feedback orally and written with the Feedback Form

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Feedback Form

Use this form after each pair of co-facilitators

1 2 3 4 5

Clarity of Introduction

Clarity of Main Points

Clarity of Main Goals

Use of Summary

Body Language

Voice Tone/Speed/Clarity

Level of Student Interest

Level of Student Learning

Level of Student Participation

EVALUATION OF PARTICIPATORY PRESENTATION: Tick the appropriate box and make comments. Please give your classmate the benefit of honest feedback. Scale: 1-excellent /2-very good /3-satisfactory /4-fair /5-poor

Practicing Support and SupervisionDay 2

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Overview

• Detailed Steps on How to Conduct the Supervision Visit• Role-Play Demonstration• Small Group Role-Plays

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Remember that…

• You have already conducted the epilepsy training for health care providers

• You have scheduled your first visit at Facility A• You have ensured that all EPI-trained HCPs will be present

and have scheduled follow-up cases

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Conducting the VisitStep 1. Introduce Supervisory Visit

• Meet briefly with the facility director upon arriving to the facility

• Explain the purpose and the schedule of the visit, including the interview with the director

• Introduce yourself to the facility staff and explain the purpose of the visit

• Clearly mention that you have not come here for auditing or rating; instead you have come to make the situation better and to help all of them, by making constructive suggestions.

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Conducting the VisitStep 1. (con’t) Introduce Supervisory Visit

Explain that you will:• Observe clinical session of the health care provider who

received mhGAP training in order to reinforce skills and knowledge learned during mhGAP training

• Review facility supports such as equipment, medicines and supplies in order to identify any problems that might interfere with implementation of mhGAP,

• Review the use and reporting of monitoring forms, and• Meet with facility staff to discuss progress and how to

solve problems

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Conducting the VisitStep 2. Review Facility Supports

• Review the Programmatic Support Form from the facility

• Orient yourself to the facility and look at conditions that affect the implementation of mhGAP• Are space, equipment, availability of medicines and

other supplies, and clinic hours are optimal? • How is the examination area and where the supplies and

equipment are kept, as well as the storage and organization of patient records and drug supplies?

• Ensure that the examination rooms promote confidentiality for the patient.

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Conducting the VisitStep 3. Observe Clinical Interview and Use of Monitoring Forms

• Select an epilepsy follow-up patient • Observe the healthcare provider during case interview and

assessment. • Observe the use of monitoring forms (new patient form or

follow-up patient form)• Complete the Clinical Support and Supervision Form

and make additional comments on performance• Give feedback on health provider’s performance

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Conducting the VisitStep 4. Interview Facility Director

• Discuss and evaluate how epilepsy care is being integrated in terms of:• Logistics, monitoring supplies, medicines and

equipment, and facilitating the administrative and/or clinical aspect of patient care.

• Discuss the result of the Facility Form and the observation of the clinical setting

• Discuss the use of patient and facility-level monitoring forms, and their reporting to district level

• Discuss steps towards improvement of mhGAP implementation of epilepsy care

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Conducting the VisitStep 5. Give Feedback and Problem Solve with Staff

• Facilitate a meeting with all health facility staff and the director (co-chair)

• Explain that purpose of meeting is to solve problems by discussion including challenges and conflicts with staff

• Provide positive feedback such as acknowledging progress in treating epilepsy

• Discuss points of improvement

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Conducting the VisitStep 6. Reporting

Write a brief summary of the visitUse the Supervisory Report and Feedback Form as a

guide (Replace with “Use the Supportive Supervision Checklist as a guide”?)

Include:• Strengths and problems identified• Actions taken to address challenges and conflicts• Future actions needed during the next supervisory visit and at the

district/national level

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Conducting the VisitStep 6. Reporting & Using the Forms

• The Supervision forms and reports must be submitted to the focal point at least every 3 months

• Forms have been adapted to the country context, and can be adapted to the local context

• Familiarize yourself with supervision and monitoring forms prior to your mhGAP Epilepsy training

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Practicing Supervision and Support: Exercise for Step 1

Exercise for Step 1: Introducing the Visit• Role-Play Demonstration (5-10 mins)• 1 supervisor, 1 facility director and 1 facility staff• Supervisor to speak with director and staff member

using Step 1 instructions

Plenary Discussion: 10 minutes

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Practicing Supervision and Support: Exercise for Step 3Exercise for Step 3: Observe Clinical Interview

• Small Group Role-Play (10 mins)• 3 roles: 1 epilepsy-trained Health Care Provider, 1

Supervisor, 1 Follow-up Patient with Epilepsy• Supervisor should be completing the Clinical Support

and Supervision Form during the interview• Health care provider should be completing the Patient

Follow-Up form

Plenary Discussion: 10 minutes

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Practicing Supervision and Support: Exercise for Step 4

Exercise for Step 4: Interviewing the Facility Director• Role-Play Demonstration (5-10 mins)• Ask for 2 volunteers: 1 Facility Director and 1 Supervisor• Supervisor should be reviewing the Facility Form while

speaking with the Facility Director

Plenary Discussion: 10 minutes

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Additional Role-Plays and Exercises

(Optional)

Role Plays in Groups of 3 • 20 minutes

Plenary and Group Discussion

Discussions:Lessons learnt and next steps

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POST-TEST

• Post-test • End of Training Evaluation

• Must complete to get your training certificate!

• Duration: 15 minutes

CONCLUSIONS, EVALUATION AND CLOSING REMARKS

Day 2

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EVALUATION AND CLOSING REMARKS

Closing Remarks

THANK YOU FOR YOUR PARTICIPATION!