Facilitator Training Workshop

1. Facilitator Training Workshop

2. Group introductions • Name • Organization & location • Clinical background • Stroke experience • Previous Living with Stroke experience • Expectations of workshop

3. 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)

4. 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

5. 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

6. 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 Agenda

7. Living with Stroke introduction

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. Facilitation basics: Living with Stroke

16. How does a facilitator differ from a clinical educator?

17. 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

18. 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

19. Program principles • Psychoeducation • Group dynamics • Building self-efficacy • Group process • Eliciting the story • Using the story for teaching

20. 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?

21. 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

22. Group dynamics • Forming • Storming • Norming • Performing • Re-forming • Key for LWS: Balance group process and individual needs

23. 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?

24. 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

25. 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

26. 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?

27. 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?

28. 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

29. WEEK 1 Module 1: Understanding stroke

30. 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)

31. 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

32. 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

33. 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

34. 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

35. 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

36. 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

37. 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

38. 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

39. 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

40. 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 aboutthe stroke. I feel I’ve put it all behind me.”

41. Module 1 small group exercise Questions • What are the pitfalls here? • How could you engage him in the group process? • What strategies can you develop to address potential concerns?

42. 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.”

43. 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?

44. WEEK 2 Module 2: Physical Changes and Challenges

45. 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

46. 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

47. 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

48. Module 2 • Unrealistic expectations common • Managing unrealistic expectations • Convert to problem-solving exercise • Recognize the difference between hopefulness and denial • Safety implications

49. Module 2 • Module 2 review • Goal-setting • Introduce SMART-c goals • Specific • Measurable • Attainable • Realistic • Timely • confidence

50. 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”.