Participatory training techniques

WORKSHOP“OST in Developing Countries:

A Primer”Atul Ambekar, Alok Agrawal (India)

Training for OST staff

• A multi-disciplinary team of staff is involved in service delivery – Doctor – Counsellor – Nurse – Programme Managers – Outreach workers and peer educators – Programme monitors / evaluators

• Relative advantages and disadvantages of training them together or training them separately?

Induction Training on OST0A five day training programme 0Conducted soon after recruitment of staff 0Conducted for a mixed group of staff (nodal officers,

doctors, nurses, counselors, data managers, programme managers and outreach workers)

0Class-room type training 0 Highly interactive and participatory 0 Exposure visit – an essential component

0BASED UPON A MANUAL 0Outcome:

0 Trained staff who begin service delivery after receiving a certificate

Organization of the manual

Rajat Ray, Anju Dhawan, Atul Ambekar (2011), Implementing OST : A Training manual for service providers, NACO, Government of India, New Delhi

Highlights of the manual 0 Developed as a ‘guide’ for facilitators

0 Not a substitute for practice guidelines or operating procedures0 Flexibility for facilitators for local adaptation

0 Applicable to a variety of OST settings 0 Entire training programme has been designed to be

participatory in nature0 Strives to address all three components – knowledge,

attitudes and skills0 Manual encourages training programmes for mixed group

of participants

0Organization of the manual0Content 0Format

Organization of the manual

Content of the manual0 Initial pages:

0 Acknowledgements 0 Message from DG, NACO0 Foreword (from NACO)0 Table of contents

0 Background 0 “About the manual”0 TOR for facilitators 0 Preparations for the training programme0 Draft agenda

0 Sessions (arranged chronologically) 0 Annexure

0 Record formats 0 Evaluation and feedback sheets

Areas covered in the training0Drugs, Drug Dependence, Harm Reduction, Principles

of drug treatment, OST: Basic knowledge (and attitude)0Assessment and Diagnosis: Clinical skills 0OST (induction, maintenance, dispensing): Clinical

skills 0Psycho-social interventions: Clinical skills 0Exposure to a functioning OST centre 0Programme management: Dispensing, record

maintenance, stock keeping, reporting, referral and linkage: knowledge , attitude and skills

Content of the manual0 Initial pages:

0 Acknowledgements 0 Message from DG, NACO0 Foreword (from NACO)0 Table of contents

0 Background 0 “About the manual”0 TOR for facilitators 0 Preparations for the training programme0 Draft agenda

0 Sessions (arranged chronologically) 0 Annexure

0 Record formats 0 Evaluation and feedback sheets

Training sessions

Day Sessions

Day 1

Introduction exercise: meeting strangers and building a rapport

Basics of Drugs: Overview of drugs and drug use disorders

Drug-related problems and harms

Local drug abuse scenario

General principles of drug treatment and harm reduction

Day Sessions

Day 2

Opioid substitution therapy – overview

Assessment and diagnosis

Assessment and diagnosis: role-play and case demonstration / presentation

Buprenorphine- pharmacology

Training sessions

Day Sessions

Day 3

Implementing OST with buprenorphine: induction, stabilisation, discontinuation

Special clinical situations – adolescents; women; HIV; other medical conditions, dual diagnosis

Psychosocial interventions

Role-play / demonstration of psychosocial interventionsScheme for implementing OST in Government centres: an overview

Training sessions

Day Sessions

Day 4

Exposure to the OST clinic, including demonstrationDebriefing and experience sharing

Programme management–I Procurement and supplies

Programme management–II Record maintenance and reporting

Training sessions

Day Sessions

Day5

Programme management-III Referral and networking, engaging civil societyProgramme management-IV Minimum standards of care, reportingOpen session

Working together: meeting between stakeholders

Training sessions

Content of each session

0Objectives 0Materials and method 0Steps 0Highlights (as box items)0Contents of the presentation

0Organization of the manual0Content0Format

Organization of the manual

Format

0The manual has been designed to be available in two versions: 1. Hard copy:

0Description of all the sessions0Handouts of slides along with ‘notes’ for the

facilitator

Format

0The manual has been designed to be available in two versions: 1. Hard copy:

0Description of all the sessions0Handouts of slides along with ‘notes’ for the

facilitator 2. Digital version: (available as a CD or online)

0The manual proper as a pdf file0Power point presentations as hyper links

Training techniques used in the manual

0Participatory presentation and discussion

0Group Work 0Observations and de-briefing 0Role Plays

Group work

0Ideal size: 4 – 10 people 0Shared characteristic: Same place of work /

same profession 0Fosters team building and bonding 0Provides opportunity for those to be heard

who may be silent in front of larger audience 0Encourages learning from the peers \0Helps assessment of pre-existing knowledge

and understanding by the facilitator

Role play

0Best suited for skill-based sessions 0Ideally at least the first such role play should

be almost scripted 0 Based on a pre-decided case vignette 0 Played by two facilitators (one playing client and

another playing the staff)

0Should be followed by feedback and discussion

Observation and De-briefing

0Gives a more ‘real’ and ‘hands-on’ experience 0Requires logistic arrangements and

preparations 0Should be coupled with de-briefing 0The facilitator should be well conversant with

the 0 Setting observed 0 Setting in which participants are likely to work

Refresher Training 0Ideal time: About 6 months after the initiation

into programme and then annually 0May be smaller in duration than the Induction

training 0Requires more skilled and experienced

facilitators 0The agenda needs to be tailored and customized

as per the perceived needs of the participants 0May have to be coupled with a stock taking

exercise or a programme review

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