Facilitator Training Workshop
Group introductions NameOrganization & locationClinical backgroundStroke experiencePrevious Living with Stroke experienceExpectations of workshop
ThoughtsI 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)
ObjectivesTo understand Living with Stroke (LWS) and its objectivesTo 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 materialsTo develop confidence in facilitating LWS
Workshop structure: 1 dayPhoneWashrooms In your package:Expense sheetsPresentation handoutDetailed information on facilitation and group dynamics HSFO LWS Facilitator NotesFacilitation: A Brief OverviewGroup Dynamics OverviewLWS KitEvaluation Form
AgendaMorning LWS introductionFacilitation basics: LWS-offered separately if neededModule 1Module 2BreakModule 3Module 4LunchModule 5Module 6BreakModule 7Module 8Wrap UpAdjournment and Evaluation
Living with Stroke introduction
Need for program Greater reduction in quality of life than expected Problems five years after rehabilitationFamily caregivers have increased health risks Opportunity to intervene to improve health-related quality of life Networking opportunity for stroke survivors and caregiversIncrease awareness of community resources
Program description 6-8 week interactive workshop program 1-2 module/week: develop group dynamics and skills2-hour workshop: maximum duration to prevent fatigue Focus: education and support, not clinical careHeld in a community settingSurvivor of stroke plus caregiverOptimal size: 8-12 participants
Program goalsTo 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 modulesModule 1: Understanding StrokeModule 2: Physical Changes and ChallengesModule 3: Swallowing and Nutrition**Module 4: Cognition, Perception & Communication**Module 5: Emotions: Focus on DepressionModule 6: Activities and Relationships**Module 7: Reducing the Risk of Stroke**Module 8: Moving Forward
Flow of modules5-10 minutes: Introduction and follow up Group ground rules 10-15 minutes: DVD30-40 minutes: Individual stories from survivors and caregivers 15 minutes: Break15 minutes: Teachable moment (based on stories)10 minutes: Questions and stories15 minutes: Teachable moment (based on previous questions) and weekly commitment to change (goals): building self efficacy5 minutes: Conclusion and suggested handouts
Room set-upRoom for adaptive equipmentChairs in semi-circle or circle with tableData projector, laptop and speakersVisibility and sound quality Flip chart, black board or white boardAppropriate markers or chalkTable at side Refreshments, handouts, other resourcesSignage if required
Facilitator toolsProvided Marketing and recruitment materials ManualsNational and regional resourcesDVDsFormsFacilitator responsibilityProgram marketingParticipant recruitment Local resources: list and identify before program start Visual aids, handouts and learning toolsRefreshments
Facilitation basics: Living with Stroke
How does a facilitator differ from a clinical educator?
Promoting engagement Engagement Psychological energy: attention, interest, recognition of relevanceImportance: Supports participation in recovery Facilitator Encourages participation in learning or changeDraws out knowledge and ideas Provides appropriate structure for productive interactionsFocuses on effective group processesEmpowers group to discuss, think and act together Releases responsibility for outcome to participants
See Facilitation: A Brief Overview
Avoiding pitfalls PitfallsPrevent group from achieving its objective Arise externally or from within groupPotential pitfalls commonAnticipate and develop strategies to address themLWS addresses barriers to engagement MisinformationMaladaptive health-related beliefs and attitudesPractical barriers Important: Barriers prevent problem-solving, learning and use of health information
Program principles Psychoeducation Group dynamicsBuilding self-efficacy Group process Eliciting the story Using the story for teaching
PsychoeducationHealth teaching and outcomesKnowledge vs behaviour changeWhy do we persist with unhealthy behaviours when we know the dangers? How can you bridge the gap between knowledge and behaviour change?
PsychoeducationHealth teaching and outcomesPersonal relevance and applicability of information Increases learning Influenced by attitudes and beliefs Facilitators need to: Understand health-related attitudes and beliefsReduce barriers by addressing attitudes and beliefsPromote attitudes that facilitate adaptation Use cognitive-behavioural strategiesPromote practice, problem solving and learning
Group dynamics FormingStorming NormingPerforming Re-forming
Key for LWS: Balance group process and individual needs
Building self-efficacySelf-efficacyBelief in ones capability to master a new skillPerception of competence to make a desired changeConscious awareness of ability to be effective, in controlConfidence in ability to be successfulAn important facilitator responsibility How do you build your own sense of self-efficacy in facilitating LWS?
Building self-efficacySelf-efficacy: Central concept for LWS Gradual, small changesFailures and successesPersistence and encouragementLWS promotes the development of self-efficacy so participants come to believe they can make behavioural changes that promote their own recovery and health
Group processFacilitator focuses on effective processes to create structure for effective interactionsProviding methods and tools Ensuring equal voice for participantsMeeting participants focus on contentTopics of discussion
Content vs process exerciseJohn is very distressed. He hasnt seen his grandchildren since the stroke because he cant 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 exerciseAndrews storyAndrew has high blood pressure (145/105 mmHg) but he doesnt 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 Andrews story for teaching?
Participant storiesSharing stories critical to program successEliciting story is an important facilitator skillAsking the right questionsIdentifying issues of personal importanceUncovering barriers to changeNever giving advice or communicating criticism
WEEK 1Module 1: Understanding stroke
Module 1PurposeIntroduces program to stroke survivors and caregiversCreates a positive environment Encourages participating (sharing stories)Creates a foundation of knowledge about stroke in generalIntroduces risk factor reduction medication complianceIntroduces the concept of making a commitment to change (weekly goals)
Module 1Facilitator focusSupporting group formation Eliciting the storiesModule 1 review Facilitator introductionDVD: Survivor stories IntegratingParticipant storiesFacilitator control of process (time)Specific challenges
Module 1Challenges in working with stroke survivorsGroup formation and impact of strokeGeneral strategies to encourage discussionEncouraging reluctant participantsManaging talkative participants
Module 1Supporting group formation Creating an effective group from diverse participantsCompensating for stroke impact Remember, even mild impairments can:Affect participation in and benefits derived from LWS Have implications for group processCompromise attention, organization, concentration
Module 1General strategies to encourage discussion Open-ended questionsContinuation techniques and nonverbal cues (nods)Series of specific questions to obtain more detail
See Facilitator notes for more details
Module 1Encouraging reluctant participantsDetermine reason Open-ended questions Non-verbal encouragement, wait Summarize and prompt speakerQuestions to focus on storySummarize to focus health teaching
Module 1Managing talkative participants Use additional questions to refocus responseRespectfully interrupt and move to more relevant topic Tactfully redirect discussionReturn to agendaRequest other contributions Use closed ended multiple-choice questions
Module 1Module review Teachable moment Use and incorporate information from stories Educate about strokeUse questions to engage participantsElicit the storyMedications (adherence, not clinical) and healthy living recommendations Record responses: barriers, issues Teachable momentDiscuss recommendationsRisk factor reduction