developing std

1: Developing STD/HIV Training Capacity Among Spanish Speaking Community Prevention Providers Presenter: Alberto Pérez Co-Authors: Jasmin Delgado, MPH; Amy V. Smith, MPH; Alice Gandelman, MPH National STD Conference Philadelphia, PA March 8th, 2004 www.stdhivtraining.org Good afternoon. My name is AP & I am trainer for the CA STD/HIV PTC. We are 1 of 10 national training centers funded by the CDC & Prevention and provide courses that are designed to meet the needs of a wide array of health care professionals. Please visit the NNPTC booth to learn moreabout the CAPTC & other national training centers. Today I’ll be discussing how we adapted an existing curriculum for a training in English, to design a comparable course for bilingual staff primarily working as health educators, counselors, or outreach workers for Spanish speaking communities. I’ll also be describe how the resultant course “Resumen de ETS” was designed & implemented and some key aspects to making this a successful training.Good afternoon. My name is AP & I am trainer for the CA STD/HIV PTC. We are 1 of 10 national training centers funded by the CDC & Prevention and provide courses that are designed to meet the needs of a wide array of health care professionals. Please visit the NNPTC booth to learn moreabout the CAPTC & other national training centers. Today I’ll be discussing how we adapted an existing curriculum for a training in English, to design a comparable course for bilingual staff primarily working as health educators, counselors, or outreach workers for Spanish speaking communities. I’ll also be describe how the resultant course “Resumen de ETS” was designed & implemented and some key aspects to making this a successful training.

2: Background Requests for California STD/HIV Prevention Training Center (STD Overview for Non-clinicians in Spanish) Bilingual staff experienced in working with monolingual Spanish speaking clients gave insight into community needs. January 2001, work plan was prepared. To give you a little background on how the course was developed, we began to receive requests to conduct one of our most popular courses “STD Overview for Non-clinicians in Spanish. Our bi-lingual staff working with monolingual Spanish speaking clients really gave us insight to the need in the community to have trainings in Spanish. The development of the scope of work greatly helped us meet our training goals. In Jan. of 2001 an internal work plan was prepared that identified staff roles & responsibilities, and included a timeline for the development of a training manual and other course content materials. This document was crucial to us meeting our goal of piloting the training in November of that same year, in particular because we had other responsibilities to meet in our day to day work. Basically, it really kept us on track and focused on what had to be accomplished.To give you a little background on how the course was developed, we began to receive requests to conduct one of our most popular courses “STD Overview for Non-clinicians in Spanish. Our bi-lingual staff working with monolingual Spanish speaking clients really gave us insight to the need in the community to have trainings in Spanish. The development of the scope of work greatly helped us meet our training goals. In Jan. of 2001 an internal work plan was prepared that identified staff roles & responsibilities, and included a timeline for the development of a training manual and other course content materials. This document was crucial to us meeting our goal of piloting the training in November of that same year, in particular because we had other responsibilities to meet in our day to day work. Basically, it really kept us on track and focused on what had to be accomplished.

3: Learning Objectives for STD Overview Goal: Participants will be able to successfully integrate STD risk-reduction into teaching or counseling about sexual and reproductive health. Objectives: By the end of the training participants will be able to: Describe common STDs and their symptoms; Summarize STD trends locally and nationally; Describe the relationships between HIV and other STDs; To give you an idea of what are some of the key aspects that we focus on in the training, let’s go over the goal & learning objectives for the course. The overall goal of the course is to have participants integrate STD risk-reduction into their work! The learning objectives include: Describing common STDs & their symptoms, including the asymptomatic nature of certain STDs To be able to summarize STD trends on a local & national level. Not to memorize every single piece of data, but what the trends are. Another objective is to describe the relationship between HIV & STD’s, & how one can affect the other. To give you an idea of what are some of the key aspects that we focus on in the training, let’s go over the goal & learning objectives for the course. The overall goal of the course is to have participants integrate STD risk-reduction into their work! The learning objectives include: Describing common STDs & their symptoms, including the asymptomatic nature of certain STDs To be able to summarize STD trends on a local & national level. Not to memorize every single piece of data, but what the trends are. Another objective is to describe the relationship between HIV & STD’s, & how one can affect the other.

4: (Objectives, continued …) Describe which behaviors are high-risk for STD transmission; Explain how some methods of STD risk reduction may differ from that of pregnancy and sexually transmitted HIV; Describe the negative effects of STD infections – especially for women and newborns; Provide clear and simple risk-reduction messages about STDs to clients/students at sexual risk for pregnancy and HIV. Also, to describe which behaviors are high-risk for the transmission of STD’s. Participants will be able to explain how some methods of STD risk-reduction may differ from pregnancy & sexually transmitted HIV. To also describe the negative effects of becoming infected with an STD, especially for women & newborns. & finally, participants will be able to provide clear risk reduction messages about STDs to the clients in whatever capacity they are in. Also, to describe which behaviors are high-risk for the transmission of STD’s. Participants will be able to explain how some methods of STD risk-reduction may differ from pregnancy & sexually transmitted HIV. To also describe the negative effects of becoming infected with an STD, especially for women & newborns. & finally, participants will be able to provide clear risk reduction messages about STDs to the clients in whatever capacity they are in.

5: Resumen de Enfermedades Transmitidas Sexualmente:Dándole Un Sabor Latino Interactive games Learning activities addressing cultural myths & values associated with them Setting a tone with music & icons We wanted Resumen de ETS to reflect the English course while meeting the same learning objectives. We just didn’t want a translated course, we also wanted to really give it a “Sabor Latino”, a Latino flavor….giving it some spice. From beginning to end, we wanted participants to really feel they were in a training that embraced the Latino culture. One area where we felt we could give really give it some flavor and change from the English version was with the interactive games. We tailored these games, Bingo de Bacterias & Loteria de Pasiones to relate to the Latino culture and personal experience. These instructional games were derived from popular U.S./Mexico culture and are used to reflect course content presented to that point. We also inserted learning activities that addressed cultural myths and values within the Latino culture that we felt was important to discuss. This gave participants a Latino perspective when it comes to working with Spanish speaking clients and possible ways to address cultural myths regarding STD/HIV prevention. Another important element was creating a welcoming and familiar environment. The training rooms were decorated with papel picante, tables were decorated with a Mexican-motif, and miscellaneous Latino art pieces were displayed throughout the room. We played Spanish language music while training participants arrived in the morning and during breaks. Overall, the course, delivered by bilingual & bicultural trainers, embraced Latino beliefs & attitudes about sexuality and STD/HIV while concurrently reinforcing cultural norms that support healthy attitudes and practices.We wanted Resumen de ETS to reflect the English course while meeting the same learning objectives. We just didn’t want a translated course, we also wanted to really give it a “Sabor Latino”, a Latino flavor….giving it some spice. From beginning to end, we wanted participants to really feel they were in a training that embraced the Latino culture. One area where we felt we could give really give it some flavor and change from the English version was with the interactive games. We tailored these games, Bingo de Bacterias & Loteria de Pasiones to relate to the Latino culture and personal experience. These instructional games were derived from popular U.S./Mexico culture and are used to reflect course content presented to that point. We also inserted learning activities that addressed cultural myths and values within the Latino culture that we felt was important to discuss. This gave participants a Latino perspective when it comes to working with Spanish speaking clients and possible ways to address cultural myths regarding STD/HIV prevention. Another important element was creating a welcoming and familiar environment. The training rooms were decorated with papel picante, tables were decorated with a Mexican-motif, and miscellaneous Latino art pieces were displayed throughout the room. We played Spanish language music while training participants arrived in the morning and during breaks. Overall, the course, delivered by bilingual & bicultural trainers, embraced Latino beliefs & attitudes about sexuality and STD/HIV while concurrently reinforcing cultural norms that support healthy attitudes and practices.

6: Training Sessions California 10 trainings since November 2001 175 participants Mexico 5 Trainings in Mexico since January 2002 141 participants So where did we conduct these trainings? We delivered 10 training in California, from San Diego to Oakland, and cities such as Fresno in between. There were a total of 175 participants. We also conducted 5 trainings in Mexico since January of 2002, with a total of 141 participants. These are cities along the US-Mexico border. 3 of those trainings have been in Tijuana, Mex, which borders San Diego and is the most crossed border in the world, with an estimated 60 million people crossing annually. We have conducted trainings at these locations because we know diseases, especially STDs do not recognize borders, and they cross both ways. We see it as prevention there is prevention here.So where did we conduct these trainings? We delivered 10 training in California, from San Diego to Oakland, and cities such as Fresno in between. There were a total of 175 participants. We also conducted 5 trainings in Mexico since January of 2002, with a total of 141 participants. These are cities along the US-Mexico border. 3 of those trainings have been in Tijuana, Mex, which borders San Diego and is the most crossed border in the world, with an estimated 60 million people crossing annually. We have conducted trainings at these locations because we know diseases, especially STDs do not recognize borders, and they cross both ways. We see it as prevention there is prevention here.

7: Who Participated? (Total = 316) # % Health Educators 67 (21) Counselors, Soc Workers & Case Mgrs 63 (20) No Response 50 (16) Other 37 (12) Nursing Personnel 25 (08) Physicians & Physician Assistants 24 (08) Drug & Alcohol Counselors 12 (04) Administrators 12 (04) Community Health Outreach Workers 9 ( 03) Who participated in our trainings? We had a wide variety of participants, with our biggest group being health educators and HIV test counselors, followed by CHOWs and Promotoras. Although this course is designed for non-clinicians, we did have some Dr’s attend. These Dr’s were from Mexico, & were interested in the client centered messages discussed throughout the training. Who participated in our trainings? We had a wide variety of participants, with our biggest group being health educators and HIV test counselors, followed by CHOWs and Promotoras. Although this course is designed for non-clinicians, we did have some Dr’s attend. These Dr’s were from Mexico, & were interested in the client centered messages discussed throughout the training.

10: Retrospective Pre/Post Evaluation Results (n=171) At the conclusion of the trainings, retrospective evaluations were used to ask participants how they felt “before” & “after” the training. One thing to point out here is that the n=153 here does not equal the number of participants you saw on a previous slide of 316. That is due to the fact that we did not use the retrospective evaluation tool until mid 2002, which is why it does not match the 316 total. (Although we did use an evaluation after each training session, the first 7 training evaluatoins asked questions to see if the training modules were useful or not). The retrospective evaluations used a scale from 1-5. where 1=disagree & 5=agree. We saw an overall increase in levels of confidence after the training. To give an example, participants read the question, “I feel prepared to…….Integrate STD/HIV prevention into my work.” Participants mean “before” the training was 3.0. “After” going through the training, the mean rose to 4.63, which indicated a mean individual improvement change of 1.7. This reflects change on an individual level, not as an average. When participants were asked how they felt describing STD symptoms, “before” the training, the mean was 2.9. “After” the training, the mean increased to 4.6, or a mean individual improvement change of 1.8. When participants were asked about how they felt about describing STD trends, before the training, the mean was 2.4. “After” the training, the mean rose to 4.4. We see similar increases “after” the training, when it came to describing the relationship between STDs & HIV and being able to offer risk-reduction message to clients. Overall, the retrospective evaluations show significant change for participants, while meeting our learning objectives. And although these evaluations do not measure actual knowledge or long term retention, it does indicate that participants feel more confident about integrating STD/HIV prevention into their work and offer clear risk reduction messages, while being able to describe STDs & their symptoms. This confidence can be powerful for participants when they go back into their communities and disseminate this information back to clients. At the conclusion of the trainings, retrospective evaluations were used to ask participants how they felt “before” & “after” the training. One thing to point out here is that the n=153 here does not equal the number of participants you saw on a previous slide of 316. That is due to the fact that we did not use the retrospective evaluation tool until mid 2002, which is why it does not match the 316 total. (Although we did use an evaluation after each training session, the first 7 training evaluatoins asked questions to see if the training modules were useful or not). The retrospective evaluations used a scale from 1-5. where 1=disagree & 5=agree. We saw an overall increase in levels of confidence after the training. To give an example, participants read the question, “I feel prepared to…….Integrate STD/HIV prevention into my work.” Participants mean “before” the training was 3.0. “After” going through the training, the mean rose to 4.63, which indicated a mean individual improvement change of 1.7. This reflects change on an individual level, not as an average. When participants were asked how they felt describing STD symptoms, “before” the training, the mean was 2.9. “After” the training, the mean increased to 4.6, or a mean individual improvement change of 1.8. When participants were asked about how they felt about describing STD trends, before the training, the mean was 2.4. “After” the training, the mean rose to 4.4. We see similar increases “after” the training, when it came to describing the relationship between STDs & HIV and being able to offer risk-reduction message to clients. Overall, the retrospective evaluations show significant change for participants, while meeting our learning objectives. And although these evaluations do not measure actual knowledge or long term retention, it does indicate that participants feel more confident about integrating STD/HIV prevention into their work and offer clear risk reduction messages, while being able to describe STDs & their symptoms. This confidence can be powerful for participants when they go back into their communities and disseminate this information back to clients.

11: Una Técnica: Games/Juegos Lotería de Pasiones Bingo de Bacterias y Sus Compañeras, las ETS Now we are at the fun part, going over the games. These games were so well received, they have now been incorporated in the English version. It’s a fun way to recap content and reinforce what has been presented. These games “Loteria de Pasiones” & “Bingo de bacterias y sus companeras, las ETSs” were also included because they heighten interactivity in the training, but to also to have fun while learning. Written comments on the evalutions indicated an overwhelming appreciation for the games. Now we are at the fun part, going over the games. These games were so well received, they have now been incorporated in the English version. It’s a fun way to recap content and reinforce what has been presented. These games “Loteria de Pasiones” & “Bingo de bacterias y sus companeras, las ETSs” were also included because they heighten interactivity in the training, but to also to have fun while learning. Written comments on the evalutions indicated an overwhelming appreciation for the games.

12: Lotería De Pasiones The first game we’ll briefly discuss is “Loteria de Pasiones”. This game was modeled after the popular US game of “Jeopardy” & the Mexican lottery game “Lotería” that children & families play in many countries. Selecting a category & point value, where the higher the point value, the more difficult the question, participants were split into 2 teams asked questions on content presented up to that point in the course. Although highly interactive, without proper directions, this game can get somewhat competitive. The first game we’ll briefly discuss is “Loteria de Pasiones”. This game was modeled after the popular US game of “Jeopardy” & the Mexican lottery game “Lotería” that children & families play in many countries. Selecting a category & point value, where the higher the point value, the more difficult the question, participants were split into 2 teams asked questions on content presented up to that point in the course. Although highly interactive, without proper directions, this game can get somewhat competitive.

Slide 13:Moving on to Bingo de Bacterias y Sus Compañeras, Las ETS”. This game was used in the context as a means to reinforce basic knowledge about bacterial, viral and protozoan transmission. Giving every participant a bingo card as you see above, scrambled differently of course, and a handfull of beans (remember, you are in spanish language course). The facilitator reads a question & participants are to place their frijole(bean) on the correct space. Once a participant gets 4 in a row or diagonally, the facilitator checks to make sure they are correct. If so, that person is the winner! To make sure there everyone is clear on each answer, its important to review each question & answer with the group. If there any questions about the games, or to get any materials for the games, please see my contact information at the conclusion here or see me after the presentation.Moving on to Bingo de Bacterias y Sus Compañeras, Las ETS”. This game was used in the context as a means to reinforce basic knowledge about bacterial, viral and protozoan transmission. Giving every participant a bingo card as you see above, scrambled differently of course, and a handfull of beans (remember, you are in spanish language course). The facilitator reads a question & participants are to place their frijole(bean) on the correct space. Once a participant gets 4 in a row or diagonally, the facilitator checks to make sure they are correct. If so, that person is the winner! To make sure there everyone is clear on each answer, its important to review each question & answer with the group. If there any questions about the games, or to get any materials for the games, please see my contact information at the conclusion here or see me after the presentation.

14: Future Direction Continue local courses in California & Mexico Continue to update the course with current data and new information Training of Trainers to increase local capacity What do we have planned from here. Future directions include to continue trainings in both California and Mexico. We currently are in the process of updating the course manual to reflect new information and data. And finally, we hope to have a Training of Trainers to increase local capacity. What do we have planned from here. Future directions include to continue trainings in both California and Mexico. We currently are in the process of updating the course manual to reflect new information and data. And finally, we hope to have a Training of Trainers to increase local capacity.

15: How To Contact Us Alberto Pérez (562) 570-4380 Bilingual Behavioral Interventions Trainer California STD/HIV Prevention Training Center Long Beach, CA aperez1@dhs.ca.gov Further Information: California STD/HIV Training Center 1947 Center Street, Suite #201 Berkeley, CA 94708 (510) 883-6642 www.stdhivtraining.org To contact us, here is our information. If you’d like information on our trainings, or questions about the training center, please contact the Training Center in Berkeley. To contact us, here is our information. If you’d like information on our trainings, or questions about the training center, please contact the Training Center in Berkeley.